PREHEALTH
SUCCESS EMPOWERING THE NEXT GENERATION OF HEALTHCARE PROFESSIONALS
January 2024
Getting Involved in Research as an Undergraduate Student
Tip Guide
VOLUME #1
MEDICAL BREAKTHROUGH Cognitive Behavioral Therapy As a Treatment for Anxiety Disorders
Dr.James Vickers
Director of the Wicking Dementia Research and Education Centre, Distinguished Professor
ALZHEIMER’S DISEASE RESEARCH
DR. DANI CABRAL Dual board certified neurologist, psychiatrist & memory specialist
02 Letter from the Editor 03 Spotlight #1 07 Spotlight #2 Hear from our Editor-in-Chief
Dr. James Vickers
Dr. Dani Cabral
12 Medical Breakthrough #1
Cognitive Behavioral Therapy As a Treatment for Anxiety Disorders
14 Medical Breakthrough #2
The Positive Impacts of Chatbots in Crisis Intervention: A Technological Revolution
17 Health and Wellness Health Crisis 20 22 Opinion Ideas #1 24 Opinion Ideas #2 27 Career Development 28 Resource Corner Mental Health Tips
Burnout in Medical Students
Lecanemab Drug for Alzheimer’s Disease
OCD Unmasked
Finding a Research Position
Books Regarding Mental Health
Prehealth2success
Dear Reader,
It's amazing to think that just a few months ago, our team gathered to set goals for publishing our first digital magazine, and now we've finally achieved that goal. I'm honored to have worked with such a talented group of people who made this publication possible. I'm thrilled to introduce our audience to our first digital magazine.
Champion
Editor-in-Chief
As an international community organization, Prehealth2Success aims to promote healthcare awareness and support pre-health students on their journey to careers in the healthcare industry. Our mission goes beyond promoting understanding of healthcare topics; we're committed to providing opportunities for aspiring healthcare professionals to thrive and positively impact global healthcare outcomes. We invite you to join us as we explore the theme of 'Mental Health' in this publication. Mental health, as described by the World Health Organization, is not simply the absence of mental disorders. It is a crucial part of our overall health that encompasses our emotional, psychological, and social well-being. It has a profound impact on how we think, feel, and act, and as a result, it is important to explore this crucial aspect of our lives that affects our day-today activities. Join us now as we delve into the theme of mental health through our articles, designed for prehealth and non-pre-health students, professionals, and non-professionals alike. We have articles that cater to everyone, and we hope that these pieces will be as informative and insightful for you as they were for us to research and compile.
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Wick g D men and Ein tia ese ducaetio n CenR tre arch
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Dr. Dani Cabral
07 Photograph taken at the 2023 NEI Synapse.
Her Journey Dr. Cabral's path to medical school was nontraditional and involved several challenging experiences that eventually led her to pursue a career in medicine. Despite facing discouragements and negative thoughts, such as feeling slow to get started, she persevered and overcame these obstacles to achieve her goal. Her mother, a single mother, passed away from ovarian cancer when she was 17 years old, just before she received her high school diploma. She had to grow up quickly as she entered college and became financially independent, supporting herself with work and loans. When applying for college, she chose Vassar College, a small liberal arts college, and pursued an international studies degree rather than pre-med which was her prior intention. Dr. Cabral felt compelled to explore that world at the time, and her studies allowed her to study abroad in Argentina, Spain, and Germany. She acquired new abilities including how to connect and communicate with people from all origins and cultures as a result of her travels, which was beneficial. After graduating from college, however, she realized her calling to medicine and enrolled in a postgraduate premed program at Harvard University. She completed her pre-med studies at night while working as a research assistant in pharmaceutical epidemiology at Brigham Women's Hospital. 08
After her initial medical school application was not successful, she returned to travel and participated in a medical volunteer program in Nicaragua and moved to Tempe, AZ where her best friend was living. While she prepared to retake the MCAT and reapply to medical school, she fortuitously found a job helping develop a pioneering hospice dementia program, which was her first exposure to individuals and families with dementia. This role gave her a fresh perspective on ideas like loss, death, and dying as well as what people go through during grief, despite the fact that she had no family members who had dementia. Her significant experience grieving her mother’s death and loss of childhood helped her to connect in some ways to the grief and grieving that happens in dementia. She was accepted into medical school with her reapplication, and it was an exciting occasion when she was a member of the inaugural class of the University of Arizona College of Medicine–Phoenix campus.
She kept in touch with the contacts she had made in the area while working at the Dementia Hospice program. She made the decision to pursue both neurology and psychiatry because she observed and worked with the clinical side and felt that a strong foundation in both were essential to care of those with Alzheimer’s and related dementias. She completed the six-year dual residency program and a fellowship in neurodegenerative disease research.
She became interested in the realm of Alzheimer's because it presented intellectual, emotional, psychological, spiritual, and existential challenges. She connected with people who were suffering, and the most fulfilling part was seeing people feel more hopeful even after only one visit. Prior to attending medical school, she realized that she preferred working with outpatients over inpatients because she enjoys establishing relationships gradually in a supportive environment. 09
Side Note
Words of Wisdom
Dr. Dani is extremely passionate about her work. She strongly believes that her patients deserve the best possible care and that good clinicians and researchers are the key to achieving that. Her motivation stems from this belief. She is grateful for what may have seemed like setbacks in the past, as they ultimately led her to where she is today. She feels life obstacles and challenges are what make us each unique and help us connect with others. Without those obstacles, such as not going to med school right away, she wouldn't be where she is today.
“As a pre-med student, I wish someone had told me that a little bit of extra effort can go a long way. If you find yourself in a position where you're not receiving any interview offers for medical school, it's important to take a critical look at your application and try to understand why. The truth might be uncomfortable to admit, but it's necessary. For example, if you received a bad score in a course, and you know you need to retake it, it's important to do so. Even if it's painful to see your friends moving forward while you feel stuck, putting in that little extra effort in the short term demonstrates your stamina, passion, and drive.”
“If you truly want to achieve your goals, especially if you want to pursue a career in medicine, you have to be willing to work extremely hard and make sacrifices. ”
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Q:
Do you have any regrets or things you wish you could change?
Tips for students during shadowing • Show up on time or early when shadowing someone; call if you will be late. It shows respect.
"I wish I had been more open about my identity, background, and struggles, and felt empowered by it earlier on. When you share your true self with others, you find the people who truly connect with you and will support you. This opens up opportunities that are meant to be part of your life, especially in a challenging career. It's a process, but being true to yourself is crucial for happiness and moves you toward your dreams."
Take Home Tips • Cultivate a support system that will help you through the dark times. • Don’t suffer in silence, no matter how difficult it is to speak up; find people to talk to.
• Cultivate curiosity in all fields, or at least pretend to. Ask questions and show interest in honoring your seniors. • Limit looking at your phone during patient visits.
“Let yourself be silently drawn by the strange pull of what you really love” - Rumi
• Let your unique light shine
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ABSTRACT
Cognitive Behavioral Therapy (CBT) is a structured and goal-oriented form of talk therapy. It has been extensively studied and proven to be effective in treating various mental conditions, including anxiety disorders. CBT equips individuals with the necessary tools to modify their thoughts and behaviors that worsen anxiety. This review aims to evaluate the effectiveness of CTB according to current literature.
INTRODUCTION
MEDICAL BREAKTHROUGH
Anxiety disorders are the most prevalent psychiatric disorders and can have a significant impact on people's lives [1]. Many need extensive medical attention, leading to high service use and substantial economic costs [2,3]. This can result in a considerable burden on patients and their loved ones, affecting the quality of life for all involved [3]. Anxiety disorders often go untreated in primary care. Treatment is necessary when patients exhibit distress or experience complications [4]. Anxiety disorders such as Panic disorder (PD), Generalized Anxiety Disorder (GAD), and Social Anxiety Disorder (SAD) are
typically treated using medication and/or psychotherapy [5]. On the other hand, Specific Phobias (SP) are usually addressed through behavioral therapy alone. Although some forms of psychotherapy have shown effectiveness in treating anxiety disorders, there is still some concern regarding their lower efficacy compared to medications [6].
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This is accomplished through the use of cognitive techniques such as restructuring thoughts and behavioral methods such as exposure therapy [4]. Studies have shown that CBT is highly effective in the treatment of generalized anxiety disorder.
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Most studies indicate that cognitive therapy reduces symptoms of depression and anxiety as effectively as medication, with lower rates of relapse. According to a recent study, CBT showed significant positive effects compared to control conditions such as usual care or being placed on a waitlist [10].
CONCLUSION
COGNITIVE BEHAVIORAL THERAPY
Patients suffering from anxiety disorders require supportive discussions and attention to the emotional difficulties associated with the condition. Some patients may require formal psychological treatment, which is typically done on an outpatient basis, a common example being Cognitive Behavioural Therapy (CBT) [5]. CBT refers to a class of scientifically-informed interventions that seek to directly manipulate dysfunctional ways of thinking and patterns of behavior to reduce psychological suffering [7]. According to cognitive models, exaggerated appraisal of danger is a fundamental aspect that contributes to the development of anxiety disorders [8]. Although anxiety disorders may vary in their content and triggers, research has shown that they share common underlying features. This suggests that they are more alike than different [9]. CBT interventions for anxiety have a common focus of modifying negative beliefs about the likelihood and consequences of potential harm.
Cognitive Behavioral Therapy (CBT) is a proven and effective treatment for anxiety and stressrelated disorders. CBT uses specific techniques that target unhelpful thoughts, feelings, and behaviors that are shown to generate and maintain anxiety. CBT can be used as a standalone treatment, but it may also be combined with standard medications to treat patients with anxiety disorders. Moreover, this treatment is flexible and can benefit anyone experiencing emotional psychopathology, such as anxiety or depression disorders, or distressing emotions that cause interference in daily activities. Therefore, referral to a CBT provider is strongly recommended for patients who exhibit such symptoms and problems, as it can actively address and alleviate their symptoms.
1. Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in Psychiatry, 11(595584). https://doi.org/10.3389/fpsyt.2020.595584 2. Smit, F., Cuijpers, P., Oostenbrink, J., Batelaan, N., de Graaf, R., & Beekman, A. (2006). Costs of nine common mental disorders: implications for curative and preventive psychiatry. The journal of mental health policy and economics, 9(4), 193–200. 3. Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., & Beekman, A. T. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta-analysis of direct comparisons. World Psychiatry, 12(2), 137-148. https://doi.org/10.1002/wps.20038 4. Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., J. Smits, J. A., & Hofmann, S. G. (2018). Cognitive Behavioral Therapy for Anxiety and Related Disorders: A Meta-Analysis of Randomized Placebo-Controlled Trials. Depression and Anxiety, 35(6), 502. https://doi.org/10.1002/da.22728 5. Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93-107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow 6. Chen, T. R., Huang, H. C., Hsu, J. H., Ouyang, W. C., & Lin, K. C. (2019). Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. Journal of psychiatric research, 118, 73–83. https://doi.org/10.1016/j.jpsychires.2019.08.014 7. Hofmann, S. G., Asmundson, G. J., & Beck, A. T. (2013). The science of cognitive therapy. Behavior therapy, 44(2), 199–212. https://doi.org/10.1016/j.beth.2009.01.007 8. Beck, A. T., & Haigh, E. A. (2014). Advances in cognitive theory and therapy: the generic cognitive model. Annual review of clinical psychology, 10, 1–24. https://doi.org/10.1146/annurev-clinpsy-032813-153734 9. Rosellini, A. J., Boettcher, H., Brown, T. A., & Barlow, D. H. (2015). A Transdiagnostic Temperament-Phenotype Profile Approach to Emotional Disorder Classification: An Update. Psychopathology Review. https://doi.org/10.5127/pr.036014 10. New Insights Into the Power of CBT Therapy | Psychology Today. (n.d.). Www.psychologytoday.com. Retrieved August 28, 2023, from https://www.psychologytoday.com/us/blog/the-addiction-connection/202307/new-insights-into-the-power-of-cbt-therapy
Technological development has altered how humans interact, communicate, and seek assistance when things are bad. The use of chatbots in crisis intervention is a notable innovation that has arisen. These AI-powered virtual assistants are made to offer rapid help, direction, and comfort to people going through various crises, from natural catastrophes to mental health difficulties.
Modernization of Technology
Before delving into the benefits of chatbots in crisis response, it is essential to recognize the technological breakthroughs that have made this innovation feasible before exploring the benefits of chatbots in crisis response. Artificial intelligence (AI) has made considerable strides in recent decades with technologies like natural language processing (NLP), machine learning, and deep learning enabling the creation of chatbots capable of accurately comprehending and responding to human language [3]. These advancements have laid the groundwork for the efficient utilization of chatbots in emergency scenarios.
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Accessibility
POSITIVE IMPACTS OF CHAT BOTS IN
Crisis Intervention
Chatbots' accessibility is one of the most essential advantages of crisis intervention. No matter where they are or what time zone they are in, chatbots are always on hand to help anyone in need. By making assistance always accessible, this accessibility lowers the possibility of delayed intervention at crucial times [1].
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Anonymity Chatbots provide privacy, allowing people to ask for assistance without worrying about being judged or stigmatized. When people are experiencing a mental health crisis and may be reluctant to confide in others about their troubles, this anonymity can be beneficial [10].
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Scalability Unlike human crisis intervention services, chatbots are scalable to meet the demands of a crisis since they can handle a large volume of simultaneous chats. This scalability allows more individuals to get the assistance they require during major disasters [9].
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Chatbots are built to react immediately, which is essential in time-sensitive emergency circumstances like the prevention of suicide or the emergency reaction to natural catastrophes. Their capacity to offer quick assistance can prevent injury and save lives [2].
Based on user input, specific chatbots are equipped with machine learning algorithms to identify a catastrophe's first indications. A crisis may not escalate if it is detected early enough to allow for proactive action and assistance [5].
Because chatbots can interact in numerous languages, people from different linguistic backgrounds can use crisis intervention services. This function ensures that people can access assistance despite language challenges [8].
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Rapid response
Lessening the Workload of Human Specialists Chatbots are built to react immediately. Their capacity to offer quick assistance can prevent injury and save lives [2].
Early Detection
Continuous Learning Chatbots can continue learning and response improvement depending on user interactions and feedback. Because of their capacity for adaptation, they can change over time and improve efficiency [4].
Chatbots have favorable effects on crisis intervention; from enhanced accessibility and anonymity to quick response and early crisis sign identification. These benefits have become possible due to developments in AI and related fields, enabling chatbots to offer valuable assistance to those in need. While chatbots cannot replace human involvement in a crisis, they enhance current crisis intervention services and significantly improve the crisis response. The potential for chatbots to help in crisis intervention will only increase as technology develops, highlighting their significance in the modern world.
Language Accessibility
Bridging Gaps in Access to Care Chatbots can close gaps in access to care by providing quick support and resources in remote or disadvantaged locations where traditional crisis intervention services may not be readily available [4].
1. Abd-Alrazaq, Alaa Ali, et al. “Effectiveness and Safety of Using Chatbots to Improve Mental Health: Systematic Review and Meta-Analysis.” Journal of Medical Internet Research, vol. 22, no. 7, 13 July 2020, p. e16021, www.jmir.org/2020/7/e16021/, https://doi.org/10.2196/16021. 2. Chow, James, and Lu Xu. “Chatbot for Healthcare and Oncology Applications Using Artificial Intelligence and Machine Learning (Preprint).” JMIR Cancer, vol. 7, no. 4, 9 Feb. 2021, https://doi.org/10.2196/27850. 3. Guo, Yuqi, et al. “Artificial Intelligence in Health Care: Bibliometric Analysis.” Journal of Medical Internet Research, vol. 22, no. 7, 29 July 2020, p. e18228, https://doi.org/10.2196/18228. Accessed 9 Nov. 2020. 4. Haque, MD Romael, and Sabirat Rubya. “An Overview of Chatbot Based Mobile Mental Health Applica-Tions: Insights from App Description and User Reviews (Preprint).” JMIR MHealth and UHealth, 5 Dec. 2022, https://doi.org/10.2196/44838. 5. Lamsal, Rabindra, et al. “CrisisTransformers: Pre-Trained Language Models and Sentence Encoders for CrisisRelated Social Media Texts.” ArXiv.org, 11 Sept. 2023, arxiv.org/abs/2309.05494. Accessed 25 Sept. 2023. 6. Marr, Bernard. “AI in Mental Health: Opportunities and Challenges in Developing Intelligent Digital Therapies.” Forbes, www.forbes.com/sites/bernardmarr/2023/07/06/ai-in-mental-health-opportunities-and-challengesin-developing-intelligent-digital-therapies/?sh=2ef847995e10. Accessed 25 Sept. 2023. 7. Russell, McCann A. “APA PsycNet.” Psycnet.apa.org, psycnet.apa.org/record/2011-25015-001. 8. Shan, Yi, et al. “Language Use in Conversational Agent–Based Health Communication: Systematic Review.” Journal of Medical Internet Research, vol. 24, no. 7, 8 July 2022, p. e37403, https://doi.org/10.2196/37403. Accessed 24 Aug. 2022. 9. SJØLIE, H., et al. “Crisis Resolution and Home Treatment: Structure, Process, and Outcome - a Literature Review.” Journal of Psychiatric and Mental Health Nursing, vol. 17, no. 10, 26 Aug. 2010, pp. 881–892, https://doi.org/10.1111/j.1365-2850.2010.01621.x. Accessed 17 Nov. 2019. 10. Winegar, Norman. “How an Artificial Intelligence Chatbot Can Provide Convenient, Helpful Support.” The Trucking Network Inc., 4 Nov. 2021, thetruckingnetwork.ca/ how-an-artificial-intelligencechatbot-can-provide-convenient-helpful-support/.Accessed 25 Sept. 2023.
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Health & Wellness Mental health is described by the World Health Organization (WHO) as a state of mind that encompasses emotional, psychological, and social well-being. The mental health status of an individual influences the individual’s cognition, perception, and behavior [1]. Humans do not exist in isolation, but rather in a society with various stressors and other individuals. Therefore, it is logical to assume that mental well-being can be influenced by how one copes with stress and interpersonal interactions. Mental health can therefore be defined as an individual’s capacity to behave in ways to achieve a better-quality life while respecting the personal, social, and cultural boundaries of others in society [1]. Mental health encompasses three dimensions: emotional, psychological, and social well-being. Any impairment in these areas can increase the risk of mental disorders or disturb an individual's mental health status. The issues society faces regarding mental health stem from impairments in these three dimensions. Tips to maintain your mental health and overall well-being.
Exercise Physical exercises like running, walking, dancing, cycling, or even gardening can improve your mental health and well-being. Physical activity achieves this in various ways, including: a) Improving mood: Studies have shown that engaging in physical activity triggers the release of certain brain chemicals that can boost your mood, induce relaxation, and reduce anxiety [2].
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Essential tips to maintain your mental health and overall well-being.
b) Controlling weight and boosting self-confidence: Engaging in physical activity through exercise can aid in preventing excess weight gain or maintaining weight loss. This is because when you exercise, you burn calories. The more intense your exercise routine, the more calories you burn. Maintaining a healthy lifestyle not only prevents health problems such as high blood pressure and stroke but also enhances your confidence in feeling and looking healthy [2].
c) Promoting better sleep: Not getting enough sleep or poor sleep quality increases the risk of mental disorders, while insomnia can be a symptom of psychiatric disorders, like anxiety and depression, it is now recognized that sleep problems can also contribute to the onset and worsening of different mental health problems, including depression, anxiety, and even suicidal ideation. Engaging in regular physical activity can aid in falling asleep faster, improving sleep quality, and enhancing the depth of sleep. However, it is important to avoid exercising too close to bedtime to prevent feeling too energized to fall asleep [3].
d) Being a social activity: Engaging in exercise and physical activity can be a pleasant experience. It provides an opportunity to relax, appreciate nature, or participate in activities that bring you joy. Physical activity can also facilitate bonding with loved ones in an enjoyable social environment. Therefore, consider enrolling in a dance class, embarking on a hiking adventure, or becoming part of a soccer team. Discover a physical activity that brings you pleasure and pursue it [4].
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Eating Healthy Research has shown that following a Mediterranean diet that includes plenty of fruits, vegetables, nuts, and legumes, moderate amounts of poultry, eggs, and dairy, and only occasional red meat can lower inflammation levels in humans [4]. However, consuming meals that are high in calories and contain saturated fat can lead to immune activation [4]. This may cause inflammation, which can negatively impact brain health by causing cognitive decline, hippocampal dysfunction, and damage to the bloodbrain barrier. Additionally, research has linked mental health conditions such as mood disorders to heightened inflammation. Therefore, it is possible that poor diet choices may increase the risk of depression and other mental disorders through this mechanism [4].
Social Connections In today's society, there has been a shift towards individualism and self-reliance, which has led to an increase in feelings of loneliness and isolation. Despite technological progress, online relationships often lack the depth of true closeness [5]. Therefore, it is crucial to prioritize social connections as they have a profound impact on our physical, emotional, and psychological well-being, even affecting our life expectancy. Studies show that having strong social bonds has been linked to lower levels of stress, anxiety, and depression, as well as improved sleep and resilience during life's challenges [6]. Additionally, happiness, self-esteem, empathy, healthy eating, and physical activity all tend to improve when we have satisfying social relationships. Surprisingly, people with strong social networks have a 50% greater chance of survival [5]. 1. World Health Organization. (2022, June 17). Mental Health. World Health Organization; World Health Organization. https://www.who.int/news-room/factsheets/detail/mental-health-strengthening-our-response 2. Chaput, P., Klingenberg, L., Rosenkilde, M., Gilbert, A., Tremblay, A., & Sjödin, A. (2011). Physical Activity Plays an Important Role in Body Weight Regulation. Journal of Obesity, 2011. https://doi.org/10.1155/2011/360257 3. Columbia University Department of Psychiatry. (2022, March 14). How Sleep Deprivation Impacts Mental Health. Columbia University Department of Psychiatry; Columbia University. https://www.columbiapsychiatry.org/news/howsleep-deprivation-affects-your-mental-health 4. Firth, J., Gangwisch, J. E., Borsini, A., Wootton, R. E., & Mayer, E. A. (2020). Food for Thought 2020: Food and mood: how do diet and nutrition affect mental wellbeing? The BMJ, 369. https://doi.org/10.1136/bmj.m2382 5. Facja, I. (2023, August 22). The Transformative Influence of Social Connections on Mental Health. Centric Mental Health. https://mentalhealth.ie/blog/thetransformative-influence-of-social-connections-on-mentalhealth#:~:text=On%20the%20mental%20front%2C%20strong%20social%20bon ds%20correlate 6. Selvaraj, R., Selvamani, T. Y., Zahra, A., Malla, J., Dhanoa, R. K., Venugopal, S., Shoukrie, S. I., Hamouda, R. K., & Hamid, P. (2022). Association Between Dietary Habits and Depression: A Systematic Review. Cureus, 14(12). https://doi.org/10.7759/cureus.32359
“To live a fulfilling life, it is essential to prioritize our mental health. This can be achieved by incorporating regular exercise, maintaining a healthy diet, and nurturing our social connections.”
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HEALTH CRISIS The practice of medicine is a highly stressful profession, and it's no surprise that medical training and education can also create pressure. Good mental health and avoiding burnout are essential for medical professionalism among students. This review aims to explore our current understanding of burnout among medical students and suggest strategies to overcome this challenge.
Burnout syndrome is a response to chronic work stress, which can become chronic and cause health issues [1]. This psychological condition can result in cognitive, emotional, and attitudinal damage, leading to negative behavior towards work, colleagues, patients, and the professional role. However, it is not a personal problem, but a consequence of certain characteristics of the work activity [2]. Since the term "burnout" was introduced in the scientific literature, various approaches have been proposed to understand its causes and development. Several theories have emerged to explain the onset of the syndrome, including social cognitive theory, social exchange theory, organizational theory, structural theory, job demands-resources theory, and emotional contagion theory [3]. The term "burnout syndrome" was originally developed for medical professionals but has since been extended to all workers. Although it has been commonly used over the past decade, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders does not classify burnout as a disease. However, several countries, such as Sweden, recognize burnout as a legitimate cause of sick leave [4]. The World Health Organization's 10th edition of the International Classification of Diseases (ICD-10) has identified burnout as a factor that affects health status and can influence help-seeking behavior [5]. Burnout is coded as Z73.0 in the ICD-10 and defined as a state of vital exhaustion. The concept of burnout has led to new studies among physicians, residents, and medical students [6]. Research has shown that medical students are more prone to burnout and depression than people of
similar age pursuing other careers [7]. Almost 50% of medical students suffer from burnout, which is higher than their non-medical peers [8]. The causes of burnout in medical students include competing time demands, financial difficulties, and the misconception that healthcare professionals don't face mental health issues such as anxiety and depression [8]. Medical student burnout can lead to a range of symptoms, including depression, anxiety, sleeplessness, headaches, gastrointestinal issues, and poor concentration [9]. When experiencing distress in their personal lives, medical students may resort to consuming more alcohol, developing a cynical outlook on life, and withdrawing socially. In some cases, they may even act disruptively, affecting both their classmates and personal relationships. If the impact of burnout is severe, medical students may decide to change their career path entirely [8]. It is essential to consider burnout symptoms in academic institutions. It is necessary to distinguish between clinical and non-clinical presentations of burnout and provide services accordingly [10]. Various approaches have been suggested to reduce burnout, such as improving student well-being through personal or institutional methods, as well as working with the proposed model. Additionally, to help students better cope with the stress of studying, a combination of workload reduction, psychological support, clear exam rules, and opportunities to build a supportive community can be beneficial [11]. For clinical cases, brief, individually focused, and mindfulness-based interventions have been found effective.
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HEALTH CRISIS
Other suggestions include implementing educationalparticipatory programs, coaching programs, or improving the relationship between students and academic staff, as well as creating inspiring and authentic teaching [12]. Research findings indicate that burnout is a common experience among medical students. To address the psychological impact of the stressors, interventions should be developed to improve the well-being of such students. It is also important to conduct further studies exploring how multidisciplinary interventions provided early in medical school can enhance the well-being of students both during and after medical school. By prioritizing the well-being of medical students, we can strive to create a healthier physician workforce.
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1. Maslach, C., & Leiter, M. P. (2006). Stress and quality of working life: Current perspectives in occupational health. Greenwich: Information Age Publishing. 2. Bouza, E., Gil-Monte, P. R., Palomo, E., en representación del Grupo de trabajo para deliberar sobre el síndrome de quemarse por el trabajo burnout en los médicos de España, & Componentes del Grupo de trabajo para deliberar sobre el síndrome de quemarse por el trabajo burnout en los médicos de España (2020). Work-related burnout syndrome in physicians in Spain. Síndrome de quemarse por el trabajo (burnout) en los médicos de España. Revista clinica espanola, 220(6), 359–363. https://doi.org/10.1016/j.rce.2020.02.002 3. Edú-Valsania, S., Laguía, A., & Moriano, J. A. (2022). Burnout: A Review of Theory and Measurement. International Journal of Environmental Research and Public Health, 19(3). https://doi.org/10.3390/ijerph19031780 4. Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., de Girolamo, G., Graaf, R., Demyttenaere, K., Gasquet, I., Haro, J. M., Katz, S. J., Kessler, R. C., Kovess, V., Lépine, J. P., Ormel, J., Polidori, G., Russo, L. J., Vilagut, G., Almansa, J., … ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project (2004). Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta psychiatrica Scandinavica. Supplementum, (420), 21–27. https://doi.org/10.1111/j.16000047.2004.00327.x 5. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., Wang, P. S., & National Comorbidity Survey Replication (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289(23), 3095–3105. https://doi.org/10.1001/jama.289.23.3095 6. Frajerman, A., Morvan, Y., Krebs, M., Gorwood, P., & Chaumette, B. (2018). Burnout in medical students before residency: A systematic review and meta-analysis. European Psychiatry, 55, 36-42. https://doi.org/10.1016/j.eurpsy.2018.08.006 7. Ishak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout in medical students: a systematic review. The clinical teacher, 10(4), 242–245. https://doi.org/10.1111/tct.12014 8. Index, W.-B. (n.d.). Medical Student Burnout | The Well-Being Index. Www.mywellbeingindex.org. https://www.mywellbeingindex.org/medical-student-burnout 9. Curtis, K. (2021, July 12). What Is College Student Burnout? Signs, Symptoms, and How to Get Help. EduMed. https://www.edumed.org/resources/college-student-burnout-survival/ 10. Armstrong R. A. (2014). When to use the Bonferroni correction. Ophthalmic & physiological optics: the journal of the British College of Ophthalmic Opticians (Optometrists), 34(5), 502–508. https://doi.org/10.1111/opo.12131 11. Thun-Hohenstein, L., Höbinger-Ablasser, C., Geyerhofer, S., Lampert, K., Schreuer, M., & Fritz, C. (2021). Burnout in medical students. Neuropsychiatrie, 35(1), 17-27. https://doi.org/10.1007/s40211-020-00359-5 12. Phillips, S. P., & Clarke, M. (2012). More than an education: the hidden curriculum, professional attitudes and career choice. Medical education, 46(9), 887–893. https://doi.org/10.1111/j.1365-2923.2012.04316.x
A false hope or a delusive contentment? For the past two decades, people with Alzheimer's disease have experienced hope, disappointment, and unnecessary controversies [1]. With an estimated 55 million individuals worldwide affected by the disease, and it being a leading cause of death, the need for an effective treatment is crucial [3]. However, efforts to develop a drug that can prolong the course of Alzheimer's Disease, by using antibodies to clear amyloid beta (Aβ) molecules from the brain, have faced numerous complications over the last 20 years. The first antibodies tested in phase 3 clinical trials, bapineuzumab, and solanezumab, did not improve clinical outcomes in mild to moderate Alzheimer's disease. Hopes were again dashed in mid-2019 when two phase 3 trials of aducanumab, a next-generation drug that specifically targeted tau biomarkers, were terminated early for vanity [4, 5].
Against this setting, another potential “breakthrough” drug, Lecanemab was dropped on November 29th, 2022, awaiting FDA approval.
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A false hope or a delusive contentment? Lecanemab is the first “potential” disease-altering drug for Alzheimer’s Disease to make it past phase-2 clinical trials. It met its primary endpoint by reducing patients’ cognitive decline by 27% when compared to people injected with a placebo [6]. A detailed study of Lecanemab was presented at the Clinical Trials conference in San Francisco, USA, with papers waiting to be published. In the trial, 1795 people with mild cognitive impairment or early Alzheimer's disease, plus evidence of amyloid on a PET (Positron Emission Tomography) scan or by CSF (Cerebrospinal Fluid) testing, were randomly assigned to receive 10 mg lecanemab via intravenous infusion every 2 weeks, or alternate placebo. After 18 months of treatment, lecanemab reduced cognitive decline by 27% when measured by the Clinical Dementia Rating-Sum of Boxes (CDR-SB). In addition to the categories mentioned above, all key secondary endpoints were met [3]. However, a 0.45-point difference on the CDR-SB, an 18-point scale, might not be clinically meaningful [2,4]. In addition, it is proven that 1 in every 5 people tested with Lecanemab developed ARIA (amyloid-related imaging abnormalities), resulting in unmasked bias between the patients who took the drug, and those who didn’t [5].
1. The first successful clinical trial for a new alzheimer’s drug is making Big News. BUCK. (n.d.). https://www.buckinstitute.org/blog/thefirst-successful-clinical-trial-for-a-new-alzheimers-drug-is-making-big-news-buck-professor-julie-andersen-weighs-in-onlecanemab/psafe_param=1&utm_source=google&utm_campaign=9875367091&utm_content=100538235295&utm_term=&utm_mediu m=431382611728&gad=1&gclid=CjwKCAjwseSoBhBXEiwA9iZtxlnI2lnyJMYlfedRq_ULt-6BTEuDXSn7Ahg8ur5Kgd3urX0Z28aZhoCTg4QAvD_BwE 2. Jaffe-Hoffman, M., & Jaffe-Hoffman, M. (2020, September 10). Israeli revolutionary alzheimer’s treatment to launch phase 1 trial: Weizmann USA. American Committee for the Weizmann Institute of Science. https://www.weizmann-usa.org/news-media/in-thenews/israeli-revolutionary-alzheimer-s-treatment-to-launch-phase-1-trial/?gad=1&gclid=CjwKCAjwseSoBhBXEiwA9iZtxlGfrQUL5mjO821Zb7h4lfHEbQig4sHc_D8CKHlas24WefVbXj6wRoCvfMQAvD_BwE 3. Balch, B., By, Balch, B., Writer, S., & 24, Jan. (2023, January 24). Recent breakthroughs in alzheimer’s research provide hope for patients. AAMC. https://www.aamc.org/news/recent-breakthroughs-alzheimer-s-research-provide-hope-patients 4. Qiao, Y., Chi, Y., Zhang, Q., & Ma, Y. (2023, May 5). Safety and efficacy of lecanemab for alzheimer’s disease: A systematic review and meta-analysis of randomized clinical trials. Frontiers in aging neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196238/ 5. Lecanemab for alzheimer’s disease: Tempering hype and hope - the lancet. (n.d.). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02480-1/fulltext 6. Neuroscience. Neuroscience Clinical Research CRO | Syneos Health. (n.d.). https://www.syneoshealth.com/therapeuticdepth/neurosciencecreative=621756988988&keyword=alzheimer+clinical+trial&matchtype=p&network=g&device=c&gad=1&gclid=Cjw KCAjwseSoBhBXEiwA9iZtxm0tIbxht7_ekS8VMfCpGILimJGQnD6H_4NSE-Utk5thjo8Akknx2RoCcjgQAvD_BwE
Given these concerns, it is yet to be determined whether Lecanemab can truly be a game changer in treating Alzheimer’s Disease. Nevertheless, the results of Lecanemab can be used to pave the way for future Alzheimer's Disease Clinical trials, treatment options, and diagnostic testing mechanisms [1].
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OPINION IDEAS
OCD UNMASKED SHEDDING LIGHT ON THE HIDDEN STRUGGLES OF OBSESSIVE-COMPULSIVE DISORDER
Obsessive Compulsive Disorder (OCD) is a common anxiety disorder that affects millions around the world. It causes disturbing thoughts, fears, and troubles to flood into an individual’s mind. Not only does this cause them immense anxiety, but they also have to control these obsessions through rituals which are actions that aid in reducing the bombardment of distress caused by these obsessive thoughts [1]. We will delve deeper into what OCD is, what its origins are, and how it is being treated in the modern day. 24
To begin with, OCD had been described as early as in the seventeenth century by Robert Burton, an Oxford Don, who documented a case in his compendium, The Anatomy of Melancholy (1621) [5]. Further, the study also mentions that the concepts of OCD had again been observed in France and Germany in the nineteenth century. However, it wasn’t until the late twentieth century, with the emergence of brain imaging techniques and neurochemical assays, that the biology behind this disorder became well-understood. OCD usually begins before the age of 25, often during adolescence. Interestingly, among individuals seeking treatment, the mean age of diagnosis is more apparent in males than females. In a series reported by Rasmussen and Eisen in 1992, the mean age of OCD was 21 years and 22 years in men and women, respectively. Moreover, major symptoms became apparent before age 15 in ⅓, ⅔ before age 25, and less than 15% after age 35 [5]. These staggering numbers display how common OCD is in young children and how it was usually termed as being “crazy” or “utterly mad” by people who were not educated about mental health. Furthermore, several symptoms can showcase OCD in an individual. Some of them are fear of germs, fear of forgetting, losing, or misplacing something, fear of losing control over one’s behavior, and having things in perfect order.
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To ensure their obsessions are satisfied, individuals with OCD partake in activities such as excessive cleaning, repeating words silently, repeatedly checking things, and compulsive counting. These compulsions allow them to have temporary solace from their anxieties. Still, it does not end their rituals, as they were prone to be conducted several times during a day, usually taking up an hour of their time [4]. A structured psychiatric interview was conducted for 100 OCD patients where their conditions were evaluated. 31% of them suffered from major depression, 11 % from social phobia, 8% from eating disorders, 7% from social phobia, 6% from panic disorder, and 5% from Tourette’s syndrome. Major depression affected most OCD patients while panic and anxiety disorders were common too, however, schizophrenia was rare [5]. OCD can be diagnosed by a psychological evaluation using diagnostic criteria for OCD such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Lastly, a physical exam can be conducted to rule out other problems that could be causing some symptoms that affect the body physically [2]. Ultimately, this repetitive behaviour can affect an individual’s social, personal, and work life greatly, due to the immense disruptions caused by it. Unfortunately, children who suffer from OCD may not realize that their behavior is out of the ordinary and live in constant fear that something terrible might happen if they do not fulfill their rituals.
Prehealth2success
On the other hand, adults would turn towards drugs or might avoid situations that trigger their symptoms [4]. These stressful events may trigger OCD episodes or make them worse [1]. With every problem in this world, there always is a solution. Ultimately, for OCD, two main treatments are conducted today, which include psychotherapy and medications. To attain the best result, a combination of both treatments is used. Psychotherapy encompasses effective approaches such as Cognitive Behavioral Therapy (CBT), which is effective for individuals struggling with OCD. Additionally, Exposure and Response Prevention (ERP) involves gradually exposing an individual to the object that they fear or have an obsession with and helping them learn to resist the urge to carry out their compulsive rituals. Secondly, medications such as antidepressants are most commonly used to treat OCD and there are different medicines for various age groups. Those approved by the U.S. Food and Drug Administration (FDA) to treat OCD include Clomipramine (Anafranil) for adults and children 10 years and older, Fluoxetine (Prozac) for adults and children 7 years and older, Fluvoxamine for adults and children 8 years and older, Paroxetine (Paxil, Pexeva) for adults only, and Sertraline (Zoloft) for adults and children 6 years and older [2]. Following these treatments, people tend to find support groups highly beneficial as they offer opportunities for socialization, provide advice, and reduce feelings of isolation [3].
As we make advancements throughout the medical field, we need to understand the importance of helping people who suffer from mental health problems, OCD being one of the most common ones, and do our best to aid them in reintegrating into society so that they can carry out their daily activities and have a healthy social, personal, and work life, just like the rest of us. In our opinion, fostering an inclusive society where everyone can reap the benefits of doing their share, people with mental health issues should not be left behind. Specifically, individuals who face common issues such as OCD should be rehabilitated by our medical society. Furthermore, individuals who suffer from OCD and unintentionally break the law due to their compulsions should have the opportunity to rehabilitate and heal instead of being prosecuted. Ultimately, as we become more inclusive to people by helping them, we will achieve more benefits as a whole. 1. John Hopkins Medicine. (n.d.). Obsessive-Compulsive Disorder (OCD). Www.hopkinsmedicine.org. Retrieved September 23, 2023, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/obsessivecompulsivedisorder ocd#:~:text= Experts%20aren%27t%20sure%20of 2. Mayo Clinic. (n.d.). Obsessive-compulsive disorder (OCD) - Diagnosis and treatment - Mayo Clinic. Www.mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosistreatment/drc-20354438#:~:text=The%20two%20main%20treatments%20for 3. NHS. (2021, February 16). Treatment - Obsessive compulsive disorder (OCD). Nhs.uk.https://www.nhs.uk/mentalhealth/conditions/obsessive-compulsive-disorder-ocd/treatment/ 4. NIMH. (2019, October). Obsessive-Compulsive Disorder. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorderocd#:~:text=Obsessive%2DCompulsive%20Disorder%20(OCD) 5. Stanford Medicine. (n.d.). About OCD. Obsessive-Compulsive and Related Disorders. Retrieved September 23,2023, from https://med.stanford.edu/ocd/about.html#:~:text=Obsessive%2Dcompulsive%20disorder%20(OCD)
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TIP GUIDE
GETTING INVOLVED IN RESEARCH AS AN UNDERGRADUATE STUDENT By following these three steps, students can easily find research positions, and pursue various research opportunities. 2) TARGETING POTENTIAL Working as an intern in a lab, performing independent studies, or MENTORS participating in a summer program are some of the best ways to start a research career. Doing research as an undergraduate student is not only great for the resume, but can also hone critical thinking, rational processing, and problem-solving skills. Unfortunately, the increasing class size of public universities has made it difficult for undergraduates to find the right research opportunities and the proper research mentor. However, this statement should not deter prehealth students from participating in one of the most creative, exciting, and exhilarating college experiences.
1) IDENTIFYING INTERESTS Identifying exciting research topics in a specific subfield is the initial step in mapping out a research pathway. One of the best ways to find passion is by reading scientific articles published in professional magazines such as Psychology Today or Scientific Health. Reading various papers will ultimately help students in gaining a basic understanding of various research pathways.
Professors are mostly looking for individuals who are committed and willing to train for at least two years. Arguably, the summer before the coming academic year is the best time to start looking out for a lab. This timetable is when mentors are not lecturing and are more relaxed. Aside from conferences and other personal commitments, professors are willing to help students during this time frame. Summer opportunities are extremely beneficial and can usually lead to a full-year research position.
3) FINDING THE RIGHT SITE The easiest approach to finding an appropriate site involves finding a research department of interest and visiting the departmental web page. The faculty contact information and recent list of publications are usually available for personal use. Most universities and independent facilities have an approved list of research faculty in the form of a student research program. The most selective internships/summer programs usually require a written application of interest.
When applying, it is always helpful to list all extracurriculars, achievements, accolades, and past research experiences. Above all, showing obvious passion for the mentor’s work will increase the chances of landing a research opportunity in their lab. Regarding this, Prehealth2success offers a few specific webinars as part of the summer research bootcamps, comprising three separate sections including “the Undergraduate Research Journey Series”, “the Email Outreach workshop”, and “Exploring the foundations of research”. These workshops can be a great way to understand how to approach research mentors, craft effective email templates for research inquiries, and actually land an effective research opportunity. All workshops are available on several social media platforms, with the webinars being updated on YouTube regularly. There are numerous ways to reach out and get involved in research as an undergraduate student. Making the best use of all resources available, demonstrating a genuine passion for innovation, and following all of the tips given in this article will surely result in a student landing an extraordinary research 27 internship/program.
Resource Corner Reading Suggestions
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Neurologist Oliver Sacks, respectfully recounts stories of patients with amnesia, dementia, rare syndromes, mental health disorders, and brilliant talents.
YA authors, including Kami Garcia, Ellen Hopkins, Maureen Johnson, etc., recount their experiences with mental illness in this collection of essays and memoirs.
BY: JENNIFER HEISZ, PHD
BY: OLIVER SACKS
BY: 31 AUTHORS
tional ic F MENTAL
HEALTH READINGS
A notable neuroscientist explains groundbreaking research on how fitness and exercise can combat mental health conditions and offers detailed advice for improving focus, creativity, and sleep.
The author provides the skills needed to navigate common life challenges and take care of emotional and mental health.
A gripping and darkly funny memoir that is a testament to the undeniable, indestructible love between a mother and a daughter, both dealing with mental health issues.
BY: DR JULIE SMITH
BY: LIZ SCHEIER
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Neuroscience: Exploring the Brain takes a fresh approach to the study of neuroscience, emphasizing the biological basis of behavior and mental health.
BY: SOCIETY FOR NEUROSCIENCE
BY: BARRY W. CONNORS, MARK F. BEAR, & MICHAEL PARADISO
HEALTH READINGS
euroscience N & MENTAL
Brain Facts is a valuable resource for professors, students, and undergraduates who want an overall view of the field of neuroscience and mental health.
Used by clinicians and researchers to diagnose and classify mental disorders, this book can help undergraduate and graduate students gain a thorough understanding of mental health disorders and related treatment options.
BY: AMERICAN PSYCHIATRIC ASSOCIATION
This book integrates must-have neuroscience information with clinical and physiological considerations to help readers master the fundamentals of neuroscience. It can give undergraduates a complete understanding of neuroscience and mental health concepts.
BY: ALLAN SIEGEL & HRDAY N. SAPRU
Combines the latest findings from the field of neuroscience with expert text and state-ofthe-art illustrations and imaging techniques to provide an incomparable insight into every facet of the brain.
BY: RITA CARTER
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VOL 1
MENTAL HEALTH
JAN 2024
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