Current Psychopharmacology - Volume 10, Issue 1, 2021

Background: Over the past decade, the use of electronic nicotine delivery system (ENDS) devices such as e-cigarettes has increased dramatically, particularly among students and other transitional- age youth. Societal norms and the variety of ENDS devices available have also evolved dramatically in recent years. Objective: This article provides a comprehensive review and synthesis of contemporary literature, as it relates to ENDS use among transitional-age youth. Methods: Over 125 peer-reviewed studies, literature syntheses, legal reports and contemporary media works focused on ENDS use and vaping were reviewed. Results: Marketing strategies for ENDS devices have primarily targeted teens and young adults. Though ENDS devices are advertised as a safer alternative to cigarettes, accumulating data demonstrate significant health risks and consequences associated with use. The long-term health effects remain largely unknown; however, detrimental acute effects are apparent. Furthermore, rather than aiding in tobacco cessation efforts, the use of ENDS by transitional-age youth is correlated with the increased use of conventional tobacco products and other substances of abuse. Students appear to be ill-informed regarding the dangers of using ENDS products. Conclusion: Given the rapid increase in ENDS users each year, and accumulating concerns about health risks associated with use, university student health services must be prepared to address this growing problem. As clinical practice guidelines do not yet exist to encourage ENDS-product cessation, the use of the evidence-based strategies developed for tobacco cessation is advised. More research is needed to determine the most effective methods to prevent the initiation of ENDS use within this population.

Background: Sexual misconduct on university campuses is rampant and underreported, particularly among graduate and professional students. To combat this, the entire university community, especially campus clinicians, must be trauma-informed, allowing for reduction of stigma, an increase in reporting rates, and an acceptance that trauma will be treated within the academic theater. Yet, this environment is rare. Despite the laws passed, procedures enacted, and resources allocated, many victims are still met with a university response that creates further trauma, ultimately discouraging disclosures. The probability that a student will report is dependent on diverse factors at the institutional level. Compounding this further is the complexity of graduate and professional students themselves. These individuals regularly navigate numerous, sometimes simultaneous roles within the university structure (e.g., student, staff, faculty, and employee), engaging in relationships with clear power imbalances. Moreover, factors like age, cultural and ethnic background, need for recommendations, desire for future employment, developmental experiences, and personal distal/proximal relationships also contribute to their inherent vulnerability. Objective: The authors of this paper have gathered and reviewed published information on graduate and professional students who are victims of sexual misconduct while in the academic environment and discuss systemic and individual strategies to ameliorate the impact. Conclusion: Gaps in the literature include current, large-scale studies on the prevalence of sexual misconduct among graduate and professional students, universal protocols for preventive and treatment strategies, the framing of education as a climate-shifting opportunity for empowerment, and a holistic model that addresses the needs of the entire academic universe.

Background: Binge drinking is a dangerous practice. Among college students, continuously high rates of binge drinking in campus result in deaths, accidents, poor academic performance, risky behavior, the development of substance use disorder, and a number of other serious problems and conditions. Collegiate Recovery Programs have shown promise as an intervention for curbing binge drinking at colleges and universities. Objective: This paper reviews the literature on the prevalence and risks of campus binge drinking, and the relative success of interventions designed to limit it. While certain initiatives have succeeded more than others, the most appropriate strategy combines efforts on the environmental and individual level to incorporate policies tailored to the unique needs of a given collegiate community, consistent with findings on the best options for treatment and recovery in general. Results: Evidence suggests that Collegiate Recovery Programs are an effective strategy at some schools because they provide holistic and targeted care for students in recovery. They serve a vulnerable student population whose interests are often overlooked in the wider consideration of campus binge drinking and issues of safety and bureaucratic incentives. Conclusion: Collegiate Recovery Programs ought to be considered as at least one helpful avenue for schools considering ways to cut down elevated binge drinking rates. Tailored strategies incorporating other effective approaches should consider these programs as part of their overall focus.

ADHD affects 5-6% of all college students. It is a disorder with profound comorbidities and consequences, including increased mortality. Difficulties and damage accrue synergistically during the college years, directly affecting academic achievement and graduation rate. It can be reasonably extrapolated that these students may be at higher risk for sentinel events involving impulsive behavior, intoxication and self-harm, and that current campus policies aimed at reducing access to stimulant medication contribute to social injustice by disproportionately affecting already disadvantaged students. After exploring the large body of observational data, specific recommendations regarding diagnosis and treatment are made. The gold-standard for diagnosis is a comprehensive clinical interview informed by reports from others who know the patient. While universities often demand neuropsychological testing before offering medication, there is a broad agreement among researchers and clinicians that this is not scientifically justified. The most effective treatments combine pharmacotherapy with individual and group psychotherapy. Stimulants are very effective. So much so that starting all patients on non-stimulants solely to prevent diversion is clinically inappropriate. Rather, effective methods to limit diversion that do not limit access to care for those with the disorder must be developed. Various psychotherapies have been assessed and have shown benefits. A CBTbased, comprehensive, multi-modal and manualized intervention has been specifically created and examined for use with college students. The outcome data are encouraging. By combining appropriate diagnostics, effective pharmacotherapy, and comprehensive, multi-modal psychotherapy, administrators and clinicians may join forces to meaningfully improve retention, academic achievement, graduation rates, and emotional growth for this large and high-risk cohort. Colleges may need to invest in hiring expert clinicians to deploy this care, as most do not have enough of them currently.

Background: The typical age of onset for psychotic disorders is concurrent with the typical age of enrollment in higher education. College and graduate students often experience new academic and social demands that may leave them vulnerable to substance use and mental health problems, including the initial onset of a psychotic episode. Objective: To provide a current overview of the guidelines and literature for the diagnosis and treatment of early psychosis with special consideration for the college and graduate student population in the United States. To highlight areas of need and provide recommendations for clinicians who work at educational institutions and their health services, along with general psychiatrists and psychologists who work with post-secondary education populations, to help close the treatment gap. Methods: A review of interventions and best practice for the treatment of early psychosis in college students was conducted, informed by the authors’ current experience as clinicians working with this population at a university in the United States. Results: Thorough psychiatric interviews and screening tools can help in the early identification of individuals at clinical high risk for, and at the first onset of, psychosis. Coordinated specialty care services are the gold standard for early psychosis and include psychotherapy interventions (such as cognitive behavioral therapy and individual resiliency training), as well as support for a student to return to school or work. Individuals experiencing a first episode of psychosis, in general, respond better to lower doses of antipsychotics and may also experience more adverse effects. Conclusion: Return to a high level of functioning is possible in many cases of early psychosis, with early identification and treatment essential.

The transition from pediatric to adult psychiatric care is not well coordinated. Transitional age youths who are going to college for the first time experience a number of concomitant stressors, which make the transition of psychiatric care even more difficult. Given the burden of psychiatric illness in college students and the limited resources available, more investigation into feasible means of coordinating care needs to occur. Particularly as individuals with mental illness are most likely to experience lapses in care during this transition and have worse outcomes, being more likely to drop out of college.

Background: The need for mental health care among college students has grown exponentially over the last decades; not only is the number of students needing care greater, but there is a higher acuity as well. 19.9 million students are estimated to attend college in fall 2019. Relatively few consensus guidelines exist on college mental health treatment and services. Objective: The aim of this study is to review the current understanding of depression and suicidality in the college population, current treatment methods, and campus-wide systems considerations for addressing these issues. Methods: Review of current literature. Results: The increasing rates of depression and suicidality in the college student population have resulted in increased morbidity and mortality, affecting college students and campuses across the country. A comprehensive approach to address these issues includes treatment at an individual levelincluding psychopharmacological treatment and various therapies, knowledge of campus and local community resources, engaging students’ support systems including parents when appropriate, and campus-wide systems approaches and interventions for reducing depression and increasing ease of access to mental health services. Conclusion: A comprehensive and systems approach is necessary for addressing the increased rates of depression and suicidality among college students.

Background: Pregnancy and lactation are governed by hormones and neurophysiological processes, including differential expression of trophic factors, functional and structural synaptic plasticity, and neurogenesis in different brain areas. Objectives: The aim of the study was to evaluate the number of neurotrophic factors, synaptic plasticity, and neurogenesis in the hippocampus of rats during pregnancy, lactation, as well as in dams that were deprived of their pups one week after birth or treated with Finasteride or Clomiphene. Methods: Adult female Sprague Dawley CD rats were treated with finasteride (25 mg/kg, subcutaneously) or clomiphene (5 mg/kg, intragastrically) from day 12 to 18 of pregnancy. Dams during pregnancy, lactation, and those deprived of their pups, which were sacrificed 7 days after delivery, were used to study Brain-Derived Neurotrophic Factor (BDNF) and Activity-regulated Cytoskeletal (Arc) protein expression, dendritic spine density (DSD), and cell proliferation in the hippocampus. Results: BDNF, Arc, and DSD markedly increased after 21 days of pregnancy (the time of delivery), an effect that lasted for 21 days during lactation and was abolished by physiological weaning (21 days after delivery). The modifications in the mentioned parameters were associated with a dramatic reduction of neurosteroid content when compared to estrus females. In contrast, after 21 days of pregnancy, an increase in cell proliferation and a decrease during the first three weeks of postpartum were observed. Finasteride and clomifene failed to modify the changes in BDNF and Arc content elicited by pregnancy and delivery. Pups deprivation induced a rapid reduction in the amount of BDNF, Arc, and DSD while increasing cell proliferation. Conclusion: In rats, the changes in plastic properties of hippocampal neurons during pregnancy, lactation, and pups deprivation may play a crucial role in the modulation of maternal care.