Clara Bohm, MD, is a nephrologist and associate professor in the Department of Internal Medicine at the University of Manitoba. 

Intradialytic Cycling Does Not Significantly Reduce Myocardial Stunning in Hemodialysis Patients

A multisite randomized trial found intradialytic exercise led to a modest, nonsignificant reduction in myocardial stunning among patients receiving hemodialysis, highlighting both the promise and limitations of exercise as a cardiovascular intervention in this population.

Clara Bohm, MD, a nephrologist and associate professor in the Department of Internal Medicine at the University of Manitoba, presented results from a multicenter, randomized 12-week trial of intradialytic cycling targeting hemodialysis-induced myocardial stunning at the World Congress of Nephrology (WCN).

Myocardial stunning is defined by transient, repeated episodes of ischemia-induced left ventricular dysfunction and is common during hemodialysis. It has been associated with increased cardiovascular morbidity and mortality. Given the substantial symptom burden and elevated cardiovascular risk faced by patients on dialysis, investigators have increasingly explored exercise as a potential therapeutic strategy.

Intradialytic exercise refers to physical activity performed during hemodialysis sessions, typically involving low- to moderate-intensity movements such as stationary cycling or resistance training, designed to improve physical function and potentially mitigate treatment-related complications.

The rationale for targeting myocardial stunning with exercise is grounded in both clinical need and biological plausibility. Exercise may address several contributing mechanisms, including underlying cardiac disease and vascular dysfunction. Additionally, aerobic exercise has been shown in the general population to induce ischemic preconditioning, in which repeated, low-level cardiac stress improves resilience to more severe ischemic events.

Despite this rationale, prior research has been limited. Many studies have been small, observational, and conducted in highly selected populations, raising concerns about generalizability. These studies have also often been cross-sectional or nonrandomized, introducing potential bias and limiting insight into long-term effects.

To address these limitations, investigators designed a multicenter randomized trial with minimal exclusion criteria to better reflect real-world patients receiving hemodialysis. Participants in the intervention arm completed 60 minutes of intradialytic exercise three times per week over a 12-week period.

At study completion, the control group demonstrated no change in the number of stunned myocardial segments from baseline. In the exercise group, investigators observed a reduction of approximately 1.3 stunned segments after 12 weeks; however, the difference did not reach statistical significance.

“We did not detect a significant effect of exercise on myocardial stunning,” Bohm said. “It’s possible the effect is still there, but smaller than what’s been seen in more selective populations.”

Importantly, the study cohort differed meaningfully from those in prior trials. The population included a higher proportion of women, approximately 20% Indigenous participants in the US, and about 35% of patients in each arm with significant heart failure—groups often underrepresented in earlier studies.

Adherence to the exercise intervention was consistent with other behavioral trials, with participants completing approximately 65% of prescribed sessions and achieving target intensity overall. However, subgroup analysis suggested disparities in engagement, particularly among women, who participated in fewer sessions, exercised for shorter durations, and at lower intensity.

“There’s a lot of enthusiasm around exercise as a therapy,” Bohm said. “But it’s critical that we test these interventions in larger, representative populations so we know what truly works.”

The study was conducted through a collaborative network of researchers focused on advancing exercise science in kidney disease, including the Global Renal Exercise Network.

Bennett PN, Penny JD, McIntyre CW, et al. Randomized Controlled Trial of Intradialytic Cycling as Kidney Exercise Rehabilitation for Cardiac Stunning in Hemodialysis (TICKERS_HD): A Clinical Research Protocol. 

Canadian journal of kidney health and disease

https://doi.org/10.1177/20543581251391112

Safoora Shahzeidi, Firouzeh Moeinzadeh, Shahidi S. Evaluating the effect of intradialytic cycling exercise on quality of life and recovery time in hemodialysis patients: A randomized clinical trial. 2022;27(1):84-84. doi:

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A multicenter RCT of intradialytic cycling showed a modest, nonsignificant reduction in myocardial stunning in hemodialysis patients.

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Mercedes Martinez, MD, is a professor of pediatrics and medicine, medical director of the intestinal transplant program at the Center for Liver Disease and Abdominal Organ Transplantation, and medical director of the pediatric abdominal organ transplantation program at NewYork-Presbyterian.

The Rise of IBAT Inhibitors in Cholestatic Disease Management

As the treatment landscape for rare cholestatic liver diseases evolves, focus is shifting beyond biochemical control to the broader burden of disease. With the emergence of ileal bile acid transporter (IBAT) inhibitors, clinicians are beginning to rethink traditional treatment approaches and their potential to improve both symptoms and long-term outcomes.

In 2025, maralixibat (Livmarli) was granted US Food and Drug Administration (FDA) approval for the treatment of cholestatic pruritus in patients with 

Alagille syndrome (ALGS) and progressive familial intrahepatic cholestasis (PFIC)

. Most recently, the FDA approved linerixibat (Lynavoy), another IBAT inhibitor, for the treatment of cholestatic pruritus in adult patients with primary biliary cholangitis (PBC). Now, the class of agents is being explored in other rare cholestatic liver diseases in the phase 3 EXPAND trial.

Clinical trials of IBAT inhibitors have primarily focused on pruritus reduction as a primary endpoint, but Mercedes Martinez, MD, a professor of pediatrics and medicine at CUMC, pointed to growing evidence suggesting broader clinical impact. Drawing from registry data and observational cohorts, she noted that patients treated with these agents appear to experience improved native liver survival, reduced need for transplantation, and better nutritional status.

Although the precise mechanisms remain under investigation, she explained that reducing bile acid recirculation likely mitigates hepatotoxicity, while relief from severe pruritus may improve sleep, appetite, and growth.

For Martinez, however, the most striking impact is seen in quality of life. She described dramatic transformations in pediatric patients whose lives had previously been dominated by relentless itching. The downstream effects, including better sleep, improved school performance, and reduced caregiver burden, underscore how profoundly pruritus can shape daily life for both patients and families.

“These kids come to the office, and the skin is like leather [because of how] much they scratch. And now, seeing these kids coming to the office, the skin is very smooth. They are happier, they are doing better in school, because they can focus,” Martinez explained. “It just goes beyond the itch.”

This evolving understanding is also influencing her treatment approach. Traditionally, management of cholestatic pruritus has followed a stepwise paradigm, beginning with antihistamines or bile acid sequestrants and escalating to agents like rifampin. However, Martinez said she now questions that framework. Given the limited efficacy and frequent side effects of older therapies, she believes IBAT inhibitors may warrant earlier use. In her own practice, she has already begun shifting toward these agents as frontline therapy in conditions like PFIC and Alagille syndrome, tailoring dosing based on symptom severity and response.

Despite the promise, Martinez acknowledged ongoing challenges, particularly around access and cost. She stressed that studies like Mirum Pharmaceuticals’ EXPAND study of maralixibat, though limited in size, provide important proof of concept for broader application across cholestatic liver diseases.

Looking ahead, she expressed hope that regulators and payers will recognize the value of these therapies, not only in reducing symptoms, but in meaningfully improving long-term outcomes and quality of life for patients with rare liver diseases.

Editors’ Note: Martinez reports no relevant disclosures.

Brooks A. FDA Approves Maralixibat (Livmarli) Tablet for Alagille Syndrome, PFIC. HCPLive. April 14, 2025. Accessed April 10, 2026. 

https://www.hcplive.com/view/fda-approves-maralixibat-livmarli-tablet-alagille-syndrome-pfic

Brooks A. FDA Approves Linerixibat (Lynavoy) As First Treatment for Cholestatic Pruritus in PBC. HCPLive. March 19, 2026. Accessed April 10, 2026. 

https://www.hcplive.com/view/fda-approves-linerixibat-lynavoy-as-first-treatment-for-cholestatic-pruritus-in-pbc

Mirum Pharmaceuticals. Mirum Pharmaceuticals Completes Enrollment in Phase 3 EXPAND Study of LIVMARLI® (maralixibat) in Additional Rare Cholestatic Liver Diseases. March 16, 2026. Accessed April 10, 2026. 

https://ir.mirumpharma.com/news/news-details/2026/Mirum-Pharmaceuticals-Completes-Enrollment-in-Phase-3-EXPAND-Study-of-LIVMARLI-maralixibat-in-Additional-Rare-Cholestatic-Liver-Diseases/default.aspx

Martinez describes how IBAT inhibitors are reshaping cholestatic pruritus care, with impacts on symptoms, growth, and long-term liver outcomes.

Hepatology

Cholangitis

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Optimizing Cholestatic Disease Care With IBAT Inhibitors, With Mercedes Martinez, MD

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

The American Academy of Dermatology (AAD) has issued its first-ever guidelines focused on both prevention and management of 

 in pediatric patients, underscoring various distinctions in dosing, care considerations, and safety compared to those of adults.

Released in the Journal of the American Academy of Dermatology, these new recommendations were developed through the work of a multidisciplinary expert panel. They were designed to help guide clinicians in dermatology who treat atopic dermatitis, a condition known to impact up to 25% of children worldwide.

“These updated AAD pediatric [atopic dermatitis] guidelines feel genuinely practice-changing because they reflect a real evolution in how we think about disease burden, treatment goals, and when to escalate care,” Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University School of Medicine, told 

Related to prevention, the AAD’s new guidelines point to limited supporting evidence for most strategies, with dietary, supplemental, and environmental interventions not having demonstrated consistent benefit. Moisturizer implementation was the only approach to be given a conditional recommendation by the AAD for diminishing disease risk in infants and young children.

For treatment, the AAD’s panel provided a set of 26 evidence-based recommendations across the available systemic, topical, phototherapy treatments for this disease. The guidelines helped to reinforce the role of standard treatments for atopic dermatitis such as emollients while incorporating newer targeted agents.

“What feels truly revolutionary is the normalization of systemic therapy as part of standard care for pediatric [atopic dermatitis], not a last resort—paired with a strong emphasis on quality of life, itch, and patient-reported outcomes as core treatment targets, not secondary considerations,” Shahriari said. “That shift matters, because in atopic dermatitis, the skin does not tell the whole story.”

Moisturizers to diminish dryness and pruritus.

Topical calcineurin inhibitors (pimecrolimus, tacrolimus) for addressing flare management and intermittent maintenance.

Topical corticosteroids as first-line therapy for maintenance and flares.

Phosphodiesterase (PDE)-4 inhibitors (crisaborole, roflumilast) to diminish itch and the frequency of flares.

Topical JAK inhibitors (ruxolitinib) for treating those with mild-to-moderate disease.

Topical aryl hydrocarbon receptor agonists (tapinarof) to improve inflammation and patients’ skin barrier function.

Biologics (dupilumab, tralokinumab, lebrikizumab) for treating moderate-to-severe disease.

Oral JAK inhibitors (upadacitinib, abrocitinib, baricitinib) for treating moderate-to-severe disease.

Among the conditional recommendations, the following were included by the AAD in their new guidelines:

Bathing followed by moisturizer utilization as part of routine care.

Wet wrap therapy at the time of patients’ flares under clinician guidance.

Phototherapy for more extensive or severe disease.

Recommendations against routine use of systemic corticosteroids were also stressed in the guidelines. The release emphasized reserving them for short-term management of severe flares. Additionally, the panel discouraged topical antimicrobials and PUVA phototherapy in pediatric patients.

“These guidelines move us away from a reactive, topical-only mindset in pediatric [atopic dermatitis] and toward a more modern, proactive, patient-centered approach that recognizes the full burden of disease and supports earlier, more thoughtful intervention when topicals are no longer enough,” Shahriari opined.

American Academy of Dermatology Issues First-Ever Pediatric Atopic Dermatitis Guidelines, Highlighting Prevention Strategies and Effective Treatments. American Academy of Dermatology. April 7, 2026. Accessed April 10, 2026. 

https://www.aad.org/news/aad-issues-first-pediatric-atopic-dermatitis-guidelines

Hadi HA, Tarmizi AI, Jamshed S, et al. The Epidemiology and Global Burden of Atopic Dermatitis: A Narrative Review. Life (Basel). 2021 Sep 9;11(9):936. doi: 10.3390/life11090936. PMID: 34575085; PMCID: PMC8470589.

Articles

New pediatric atopic dermatitis guidance from the AAD delineates prevention and treatment approaches distinct from adults, reflecting evolving goals around symptom control and quality of life. Preventive strategies show limited evidence; routine moisturizer use in infants and young children receives a conditional recommendation. Treatment recommendations span topical, systemic, and phototherapy options, reinforcing emollients and topical anti-inflammatories while integrating targeted agents. Notably, systemic therapy is positioned as standard care for appropriate moderate-to-severe disease, while routine systemic corticosteroids are discouraged.

These new dermatology guidelines represent the first-ever atopic dermatitis-centered guidelines for pediatric patients issued by the AAD.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

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The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

First-Ever Pediatric Eczema Guidelines Issued by American Academy of Dermatology

In the first quarter of 2026, a variety of late-phase data, regulatory milestones, and emerging therapeutic strategies helped the dermatology landscape to leap ahead in its evolution. An array of 

 decisions expanded options for treatment across inflammatory and rare diseases, including the approvals of icotrokinra and secukinumab for psoriasis and pediatric hidradenitis suppurativa (HS), respectively.

At the same time, new findings presented at the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 in Denver highlighted the continued innovations seen in therapeutic development this year, with head-to-head and long-term trial research reinforcing advances in psoriasis and atopic dermatitis care. Beyond clinical and regulatory progress, Q1 also reflected a growing emphasis on advocacy, equity, and physician well-being through 

’s dermatology-focused podcast discussions.

In this review, the editorial team spotlights these key dermatology headlines from 

’s coverage in the first quarter of 2026:

Icotrokinra, an Oral Il-23 Inhibitor, Receives FDA Approval for Psoriasis

In a notable FDA decision from Q1 2026, the FDA approved icotrokinra (ICOTYDE) for those aged 12 years and older living with moderate to severe plaque psoriasis and who weigh at least 40 kg. Patients deemed eligible for the drug must also be candidates for systemic therapy or phototherapy. Johnson & Johnson’s announcement suggests the decision marks a first for this oral targeted peptide selectively blocking the interleukin (IL)-23 receptor. The decision introduced a new mechanistic class to the psoriasis armamentarium following the phase 3 ICONIC trial program.

FDA Approves Secukinumab for Pediatric Patients 12 Years and Older with HS

Another Q1 FDA approval was for secukinumab in moderate to severe hidradenitis suppurativa (HS). Secukinumab was FDA-approved for pediatric patients aged 12 and older, making the agent the only IL-17A inhibitor currently indicated for this type of patient. The drug itself is a fully human monoclonal antibody formulated to directly target IL-17A, a key cytokine driving the inflammatory pathways. This FDA approval of secukinumab provides a differentiated biologic option to an area where options for younger individuals with HS have been limited.

FDA Accepts NDA for Bezuclastinib in Non-Advanced Systemic Mastocytosis

Another Q1 FDA announcement was released by Cogent Biosciences, with the company noting the FDA’s acceptance of its new drug application (NDA) for bezuclastinib in adult patients with non-advanced systemic mastocytosis (NonAdvSM), supported by findings drawn from the pivotal SUMMIT trial program. A PDUFA target action date is now set for the drug on December 30, 2026. The FDA’s acceptance of this drug’s application could mark this as the first medication targeting the KIT D816V mutation in this patient population.

Upadacitinib Regulatory Applications Submitted for Adults, Adolescents with Vitiligo

In Q1, both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) received AbbVie’s regulatory applications seeking approval of upadacitinib (Rinvoq) 15 mg once daily for adults and adolescents with non-segmental vitiligo (NSV). These submissions resulted from previously disclosed findings resulting from the Viti-Up clinical trial program. Viti-Up investigators had looked at the safety and efficacy of upadacitinib in those with NSV.

Risankizumab Outperforms Deucravacitinib on Psoriasis Clearance Across Patient Subgroups in Phase 4 Head-to-Head Trial

In data highlighted at AAD 2026, risankizumab (Skyrizi) therapy demonstrated significantly greater clearance of skin versus deucravacitinib (Sotyktu) at the 16-week mark across an array of different patient subgroups, specifically among adults with biologic-naïve moderate plaque psoriasis. These data, resulting from a subgroup analysis of the phase 4 IMMpactful study, helped investigators to extend the primary efficacy findings of IMMpactful.

Sustained PASI Responses Observed Through Week 60 with Zasocitinib, With Melinda Gooderham, MD

Additional phase 3 findings highlighted during AAD pointed to zasocitinib as an oral treatment shifting the medication landscape for moderate-to-severe plaque psoriasis. Trial investigators found high levels of skin clearance known to usually be the domain of biologics in these poster data, and these results were described at AAD by investigator Melinda Gooderham, MD, medical director of the SKiN Centre for Dermatology in Ontario, Canada. Gooderham spoke in depth on the pivotal phase 3 LATITUDE trial program.

RADIANT-AD: Rademikibart Effective Over 52 Weeks in Atopic Dermatitis, With Cheng Zhou, MD

Rademikibart in adults and adolescents living with moderate-to-severe atopic dermatitis was also highlighted at AAD during a late-breaking data session, with the results highlighted pointing to rademikibnart’s use as leading to rapid and clinically significant improvements. Such results were noted to be sustained through 52 weeks. These data, drawn from the phase 3 RADIANT‑AD trial, demonstrated rapid, clinically meaningful improvements in adults and adolescents by Week 16 across all major efficacy endpoints. By 1 year of use, investigators noted a notable majority of those on the drug saw near‑maximal skin clearance and sustained itch control.

ICONIC-LEAD: 1 Year Icotrokinra Data Confirm Durable Psoriasis Clearance, PRO Improvements in Adults, Adolescents, With Jennifer Soung, MD

The phase 3 ICONIC-LEAD trial was discussed by Jennifer Soung, MD, founder and director of Clinical Research at Southern California Dermatology. The data confirmed icotrokinra (ICOTYDE) use as leading to durable clearance of skin. The findings also suggested meaningful patient-reported improvements were observed among adults and adolescents with moderate-to-severe psoriasis. A lack of new safety signals were also highlighted through Week 52.

The Medical Sisterhood: Building Influence in Medicine as Women Physicians, With Nastasha Mensikovzka, MD, PhD

Host Mona Shahriari, MD, known for her role as assistant clinical professor of dermatology at Yale University School of Medicine and practicing dermatologist in Connecticut, was joined in this episode of the podcast by Natasha Mesinkovska, MD, PhD, a dermatologist and researcher at the University of California, Irvine School of Medicine Department of Dermatology. The pair spoke about visibility, resilience, mentorship, and the art of commanding a room recorded in recognition of Women's History Month.

The Medical Sisterhood: Physician Mom Burnout & Mental Health Strategies, With Jennifer Hsiao, MD

In this episode of The Medical Sisterhood, Shahriari interviewed Jennifer Hsiao, MD, a dermatologist and clinical associate professor of clinical dermatology at Keck Medicine of the University of Southern California (USC), during which the 2 held a discussion about visibility, leadership, and building a meaningful academic career in dermatology. Additionally, they touched on the invisible labor faced by female physicians, particularly mothers.

The Medical Sisterhood: Advocacy and Systemic Change, With Kristi Hawley, DO

The January episode of The Medical Sisterhood spotlighted topics such as advocacy, autonomy, and the quiet breaking points many women physicians experience in the world of modern medicine. Kristi B. Hawley, DO, founder and owner of The Derm Institute of West Michigan, spoke with Shahriari in this podcast. Hawley’s journey as a dermatologist, practice owner, and advocate for physicians provided a lens into the systemic challenges faced by clinicians in the modern world.

Skin of Color Savvy: Tackling Colorism in Dermatology, With Seemal Desai, MD, and Pearl Grimes, MD

Skin of Color Savvy: The Art and Science of Treating Patients of Color

, hosted by Skin of Color Society (SOCS) leaders, the show had Seemal Desai, MD, past president of SOCS, as guest host. Desai was joined by Pearl Grimes, MD, a globally recognized expert in vitiligo and pigmentary disorders and founder of the Vitiligo and Pigmentation Institute of Southern California. A nuanced discussion was conducted by the pair on colorism, its historical roots, and its intersection with the clinical management of pigmentary disorders.

Skin of Color Savvy: Why 2026 Is the Year of Skin Equity, With Susan Taylor, MD, Nada Elbuluk, MD, MSc, and Mona Shahriari, MD

 podcast from Q1, guest host Mona Shahriari, MD, led a forward-looking conversation on advancing skin health equity alongside Nada Elbuluk, MD, MSc, board-certified dermatologist and Professor at the USC Keck School of Medicine, Department of Dermatology and Susan Taylor, MD, the Bernett Johnson Endowed Professor of Dermatology at the University of Pennsylvania Perelman School of Medicine.

Skin of Color Savvy: Challenges and Successes in a Dermatologist’s Career, With Nicole Negbenebor, MD

Nicole Negbenebor, MD, clinical assistant professor of dermatology and director of the Skin of Color Clinic at the University of Iowa, spoke about the twists and turns she faced in her professional journey in dermatology. Negbenebor also touched on her clinical interests, her research advocacy, and her commitment to improving care for diverse patient populations.

Skin of Color Savvy: Serving the Underserved in Dermatology, With Abrahem Kazemi, MD

Board-certified dermatologist and director of cosmetics and laser dermatology for Pinnacle Dermatology, Abrahem Kazemi, MD, spoke in this episode of the podcast about his own reflections on the personal and professional experiences forming his approach to dermatologic care, especially for patient populations considered to be underserved. Kazemi was asked about his journey into dermatology and shared about the background that led to his commitment to closing gaps in dermatologic care access.

Q1 2026 brought meaningful late-phase readouts and regulatory momentum that broadened dermatology’s therapeutic toolkit while amplifying equity and clinician well-being initiatives. FDA activity included approval of icotrokinra, a first-in-class oral IL‑23 receptor–targeted peptide for moderate-to-severe plaque psoriasis in patients ≥12 years and ≥40 kg, and secukinumab for moderate-to-severe pediatric HS (≥12 years). Additional milestones included NDA acceptance for bezuclastinib in non-advanced systemic mastocytosis and regulatory submissions for upadacitinib in non-segmental vitiligo.

This review of dermatology news from the first quarter of 2026 highlights key headlines, FDA news, and more.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Q1 2026 Recap: Dermatology News and Updates

Dominic Sisti, PhD, is an associate professor in the Department of Medical Ethics & Health Policy and the director of the Scattergood Program for the Applied Ethics of Behavioral Health Care. Sisti is also the host of 

, our monthly multimedia series on medical ethics in modern healthcare. 

As consumer-facing artificial intelligence tools become more accessible, some patients are increasingly turning to platforms such as ChatGPT for 

 support. This trend raises ethical, clinical, and safety considerations for psychiatrists navigating conversations with patients who may be using AI in place of, or alongside, traditional psychotherapy.

In this Q&A, Dominic Sisti, PhD, from Penn Medicine, discusses access gaps driving adoption, potential benefits, safety concerns, and the guardrails needed for responsible integration of AI into mental health care.

Watch the full feature on the benefits and dangers of AI in psychiatry, featuring Sisti and practicing psychiatrists 

From an ethics standpoint, how should clinicians interpret the growing trend of patients using tools like ChatGPT as a form of informal psychotherapy?

 It's important that clinicians recognize that the prolific use of general-purpose AI for psychotherapy is a sign that there just really isn't enough access to mental health care. People are turning to these tools because they can't get appointments with psychotherapists, or if their insurance policies don't cover the costs. AI is a very easy, convenient solution when someone feels like they need to talk to someone.

Unfortunately, these…AI platforms aren't really trained to treat people in a way like a psychiatrist might, and so there's very important questions around whether they are safe. First off, how would these AI platforms [respond] to a patient who is indicating they have suicidal ideation or behavior?

There's a lot that needs to be worked out still, but I am actually optimistic that AI can provide a level of support to people who otherwise don't have access to mental health care. It's just that these…AI platforms aren't designed for that. There are platforms now that have been trained and are being designed with this in mind, and they seem to be safer; we'll see.

What point does AI-generated mental health guidance cross the threshold from information into something that resembles clinical care?

 If the AI is pushing back suggestions about medications, about psychotherapy, modalities, etc, it might cross that line. I could see an environment that is HIPAA compliant, where the AI has been trained to provide an elevated level of screening, or even some therapeutic modality, could work well.

Right now, the general AIs don't really have guardrails in place, as far as I know, but there are ones that are… being developed by researchers and psychiatrists…who are trying to train up these platforms to respond appropriately and with evidence-based suggestions. I do believe, however, there really should be a human in the loop on all these types of suggestions so that we can be sure that the individual who's using the platform is getting good information.

What are some examples of these guardrails that are in research?

 For example, figuring out ways to redirect a person who may have suicidal ideation or behavior to appropriate resources. How can we design AIs to recognize that elevated risk and prompt the user to reach out to a loved one, or to call a Crisis Text Line?

There's no real regulatory framework around how these guardrails should be put in place. We need to have [an] age restriction….so that kids aren't in there talking about their own mental health challenges and maybe suicidal behaviors without someone being notified of that.

How should clinicians respond when patients disclose they are following advice generated by AI systems?

 I think in a non-judgmental way. I do think that these platforms offer patients another outlet for processing emotions, and depending on the severity level, it might be perfectly appropriate that they're using the platform, or it might be helpful. It really depends on the case.

If a patient shows up and says, “I've been using ChatGPT exclusively, and it's told me everything I do is right,”…there's probably some counseling that needs to happen there. I do think that when patients have experience with… human psychotherapy…an AI agent could actually add a little bit of another perspective because the patient really understands that it's a machine.

What are the most pressing ethical risks associated with patients using AI as a therapist, particularly for individuals with serious mental illness?

 We're just learning now about all the different potential risks to patients who have mental disorders such as schizophrenia, bipolar disorder, or depression. There's been an uptick in what's been called AI-induced psychosis. I think that there is the risk of a patient… having dangerous thoughts and behaviors, and the AI doesn't actually respond correctly, then the AI might actually offer suggestions for killing oneself. We've seen that already.

How should clinicians counsel patients about privacy risk when using consumer-facing AI tools for mental health discussions?

People using them [must be] aware that their data is not really secure. If they're uploading medical information or saying things that are super personal, all those chats can be discovered. If it's a HIPAA-compliant agent, things are a little bit better in terms of privacy.

And what are the most significant gaps in current regulation when it comes to AI and psychiatry?

 If you prompt the AI the right way, you can actually get it to tell you methods of suicide, which should be impossible. In this context, if you're a scholar and you're trying to study suicide, or you're [a] suicidologist, that's different. We need AIs to be able to distinguish between requests for scholarly information versus requests for someone who's really desperate and is looking for that information to use.

What recommendations do you think should be in place?

There’s ways that you can infer age without even asking for age. Being able to figure out if it's a child or a minor and adjusting the chat to an appropriate level, then quickly bringing a human [in] the loop, is critical.

If you could establish one guiding principle for clinicians navigating AI in psychiatry today, what would it be?

If a psychiatrist is working with a patient who is using AI, the guiding principle…is the principle of beneficence. This is one of the four principles of Biomedical Ethics, which is essentially a crystallization of the Hippocratic oath to do no harm, to try to do good.

If the clinician thinks that the AI is adding value to the treatment, then maybe supplementary therapy using an AI seems okay. Those are the questions that will be answered as we learn more about the safety and efficacy, and hopefully, these platforms can be designed in a way that they do add value and are safe and effective.

Sisti discusses ethics, safety, and guardrails as patients use ChatGPT for mental health support and clinicians navigate AI’s role in psychiatry.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

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Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

AI in Psychiatry Raises Ethics Questions With Dominic Sisti, PhD

Aaron Troy, MD, MPH, is a clinical research fellow in cardiovascular medicine at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.

Troy discusses the recent changes to the ABCs of CVD, highlighting an increased focus on lifestyle interventions and the management of risk factors.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

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Arrhythmia

Strategic Alliance Partnership

Reviewing the Updated ABCs of Cardiovascular Disease Prevention, With Aaron Troy, MD, MPH

Simon Davies, MD, is  a consultant nephrologist at the University Hospital of North Midlands and Professor of Nephrology and Dialysis Medicine, as well as director of the Institute for Applied Clinical Sciences at Keele University.

Davies explains the future of at-home dialysis access, including policy changes and technological innovation. 

Chronic Kidney Disease

Expanding Dialysis Access: Policy, Variation, and the Role of Peritoneal Dialysis

Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

Experts discuss interpreting genetic testing in liver disease, the role of biopsy, and how to integrate variants into clinical decision-making.

Putting the Pieces Together: Genetic Testing, Biopsy, and Clinical Judgment

Nicole Chase, MD, is a board-certified allergist/immunologist at St. Paul Allergy Asthma, Minneapolis VA Health Care System (part-time), and an associate professor of medicine at the University of Minnesota Medical School.

Chase discusses how the FDA’s labeling change aligns epinephrine nasal spray (neffy) with other weight-based epinephrine formulations.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Anaphylaxis

The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

Weight-Based Dosing Informs Age Removal for Epinephrine Nasal Spray, With Nicole Chase, MD

Alberico Catapano, PhD, is the research director and head of the laboratory of lipoproteins and atherosclerosis and of the lipid clinic at MultiMedica IRCCS.

Catapano discusses the superior reduction in LDL-C, ApoB, and non-HDL-C demonstrated by enlicitide, suggesting its role as an add-on for LDL-C lowering.

Dyslipidemia

Enlicitide Superior to Oral Non-Statin Therapies for LDL-C Lowering, With Alberico Catapano, PhD

Robert Gish, MD, is the Medical Director of the Hepatitis B Foundation in Doylestown, Pennsylvania. He is an Adjunct Professor of Medicine at the University of Nevada School of Medicine in Las Vegas. He serves as an Adjunct Professor of Pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences at UCSD, a Clinical Professor of Medicine at Loma Linda University. In addition, he is the Medical Director of the American Pacific Health Foundation.

In this segment of Liver Lineup, experts discuss genetic testing in cholestatic disease, highlighting real-world cases demonstrating the value of these tests.

Genetic Panels in Hepatology: Identifying the Right Patients

Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

Experts unpack new T2-targeted biologics for severe asthma and eosinophilic COPD, sharing biomarker tips, sequencing debates and payer hurdles,

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

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