Struggle and Solidarity: Seven Stories of How Americans Fought for Their Mental Health Through Federal Legislation, edited by Michael T. Compton, M.D., M.P.H. and Marc W. Manseau, M.D., M.P.H., is a remarkable journey of societal challenges, the individuals and legislation that rose to meet them, and the flood of downstream effects on the mental health and lives of all those who live in the United States. This publication is highly recommended for those who aim to learn about the historic forces that have shaped health in this country and their continued effects today, as the editors focus on seven stories with themes that ring true for all of us—food, employment, economic security, clean air and climate change, racial and gender equity, education, and housing. In doing so, readers, whether clinician or policymaker, are provided an exceptional display of the relationship between health outcomes, the social determinants of health, and the political and policy decisions that undergird them.

The 988 Suicide and Crisis Lifeline launched nationwide on July 16, 2022, marking a shift in the accessibility and provision of crisis services in the United States. The 988 line ideally serves as both an intervention and an entry point to a continuum of care. Community-based mobile crisis teams, capable of quickly responding to individuals in need, serve as the next step in a continuum approach, their development paralleling that of emergency medical services established 50 years ago with emergency medical technicians, paramedics, and ambulances. Mobile crisis response has great promise for providing targeted and clinically appropriate assessment and care, decreasing utilization of more restrictive and expensive levels of care, and reducing reliance on police for psychiatric intervention.

Background

Takotsubo cardiomyopathy (TC), also known as stress-induced cardiomyopathy, has been increasingly described in relation to psychiatric illness.

Methods

We performed a literature review to identify the key findings related to psychiatric illness in TC that may be relevant to the practice of mental health and other health care providers.

Results

The association of psychiatric illness with TC in addition to the spectrum of psychiatric illness found in TC, the role of exacerbation or treatment of psychiatric illness in triggering TC, different modes of presentation, prognostic implications, and long-term management of psychiatric illness in TC are discussed. Additionally, we review the limitations of the pre-existing literature and suggest areas of future research.

Conclusions

There is a strong association between pre-existing psychiatric illness, particularly anxiety and mood spectrum disorders, and TC. Acute exacerbation of psychiatric illness, rapid uptitration or overdose of certain psychotropic agents, and electroconvulsive therapy may trigger TC. Further studies are needed to better evaluate the prognostic significance and long-term management of psychiatric illness in TC.

Background

The increased prevalence of psychiatric illness among patients with takotsubo cardiomyopathy (TC) has been previously described.

Objectives

We sought to assess the effect of pre-existing psychiatric illness on clinical outcomes following the diagnosis of TC.

Methods

Adults diagnosed with TC at Vanderbilt University Medical Center between 1999 and 2015 were included in the study. Medical records were retrospectively reviewed to identify any pre-existing mood, anxiety, or schizophrenia-spectrum illness before TC presentation. Multivariable logistic regression was used to test for independent association of pre-existing psychiatric illness with 30-day mortality and recurrent TC; Cox proportional hazard analysis was used to evaluate for association with long-term mortality.

Results

Among 306 patients diagnosed with TC during the study period, 114 (37%) had a pre-existing psychiatric illness. In all, 43 (14%) and 88 (29%) patients died within 30 days of index diagnosis and as of last medical record review, respectively. Of the 269 who survived their index hospitalization, 19 (7%) had a confirmed recurrent episode of TC. In multivariable analyses, pre-existing psychiatric illness was not associated with increased 30-day (P = 0.320) or long-term (P = 0.621) mortality. Pre-existing psychiatric illness was associated with higher risk of recurrent TC (odds ratio = 7.44, 95% CI: 2.30-24.01, P < 0.001).

Conclusions

Pre-existing psychiatric illness was associated with an increased risk of recurrent TC. No significant association was noted between pre-existing psychiatric illness and survival.

Identifying transition states-saddle points on the potential energy surface connecting reactant and product minima-is central to predicting kinetic barriers and understanding chemical reaction mechanisms. In this work, we train a fully differentiable equivariant neural network potential, NewtonNet, on thousands of organic reactions and derive the analytical Hessians. By reducing the computational cost by several orders of magnitude relative to the density functional theory (DFT) ab initio source, we can afford to use the learned Hessians at every step for the saddle point optimizations. We show that the full machine learned (ML) Hessian robustly finds the transition states of 240 unseen organic reactions, even when the quality of the initial guess structures are degraded, while reducing the number of optimization steps to convergence by 2-3× compared to the quasi-Newton DFT and ML methods. All data generation, NewtonNet model, and ML transition state finding methods are available in an automated workflow.