Michel, Ian

Fundamental to medical education, gross anatomy first introduces medical students to human mortality, often provoking stress. Sense of purpose, a key aspect of well-being, may serve as a protective factor. We studied students’ sense of purpose during an anatomy course, examining its links to performance, spirituality, and belief in an afterlife. Fifty medical students who took a 7-week gross anatomy course in 2022 or 2023 completed the Life Engagement Test at the beginning, middle, and end of the course. We collected other data including demographics, religious/spiritual beliefs, and previous exposure to body donors. Practical and final examinations assessed course performance. Strong sense of purpose at the three measurement points was positively correlated with practical exam performance (r = 0.40, P = .004; r = 0.44, P = .003; r = 0.30, P = .047, respectively) but not National Board of Medical Examiners’ anatomy subject exam performance. Staunch believers and non-believers in an afterlife maintained a stable sense of purpose, while students uncertain about the afterlife experienced a decline from the beginning to the middle of the course and even more to the end ( P = .046; P = .008, respectively). These students also had significantly lower practical examination performance as compared to other students (95% CI [−10.84, −0.52]). In conclusion, a strong sense of purpose predicts better performance in a 7-week anatomy course. Both believers and non-believers in an afterlife do well, but students wavering in their beliefs experience a declining sense of purpose and lower grades. Supporting these students when they confront human mortality, including in other contexts such as palliative care/hospice settings, may be beneficial.

ABSTRACT Background Despite the classic Kraepelinian dichotomy between bipolar disorder (BD) and schizophrenia (SZ), contemporary evidence suggests shared antecedent risk factors and similarities in the early course. This study aimed to identify distinct trajectories leading to first‐episode mania (FEM) and first‐episode psychosis (FEP) by examining antecedent psychopathology, including psychiatric diagnoses, symptoms, substance use, and psychotropic medication exposure. Methods Individuals born after 1985 who resided in Olmsted County, Minnesota, USA, and had FEM/FEP were identified through the Rochester Epidemiology Project. Latent class analysis (LCA) was used to identify subgroups based on antecedent psychopathology incorporating 57 dichotomous antecedent measures before FEM/FEP. Results A total of 202 individuals ( BD n = 73, SZ n = 129; 26.7% female, mean age 20.8 ± 3.7 years) were included. A 3‐class LCA model optimally fits the data. Class 1 (Neurodevelopmental, 29.7%) had a high prevalence of neurodevelopmental disorders, behavioral symptoms, and ADHD medication use. Class 2 (Depressive‐Anxious, 31.2%) included depressive and anxiety disorders, mood‐related symptoms, and SSRI / SNRI use. Class 3 (Minimal Psychiatric Morbidity, 39.1%) had a low prevalence of antecedent diagnoses and symptoms, with comparable substance use to other classes. There were significant diagnostic differences, with SZ being more common in the Neurodevelopmental (71.7%) and Minimal Psychiatric Morbidity (70.9%) classes, while BD was more common in the Depressive‐Anxious class ( p = 0.007). Neurodevelopmental and Minimal Psychiatric Morbidity classes had higher proportions of males (85.0% and 82.3%, respectively) compared to the Depressive‐Anxious class (50.8%, p < 0.001). The Neurodevelopmental class showed an earlier age at first mental health visit (9.5 ± 5.5 years) and a longer antecedent illness duration (10.8 ± 6.1 years) than the other classes ( p < 0.001). Conclusion This study identified three distinct pathways to FEM and FEP, offering a transdiagnostic perspective on the antecedent illness trajectories of BD and SZ. Future research should validate these categories that are more inclusive than the classic BD versus SZ dichotomy and explore their potential for predicting illness course and guiding personalized early interventions.

AbstractBackground and ObjectivesWhen administered as prescribed, the naloxone component of buprenorphine‐naloxone combination medications is putatively considered inert due to reduced naloxone bioavailability via transmucosal. However, there is a growing body of evidence to the contrary. The aim of our study is to determine the extent of naloxone absorption in a large cohort of patients receiving sublingual buprenorphine‐naloxone.MethodsUsing the Mayo Clinic Unified Data Platform, 425 patients prescribed sublingual buprenorphine/naloxone who received a controlled substance monitoring panel (CSMP) between January 1, 2022, and January 1, 2023 were identified and included. The CSMP is an immunoassay panel that confirms positive results quantitatively with gas chromatography mass spectrometry or liquid chromatography tandem mass spectrometry. This panel provides urinary detection for buprenorphine (cutoff: 5 ng/mL), naloxone (25 ng/mL), as well as their respective metabolites norbuprenorphine (5 ng/mL), norbuprenorphine‐glucuronide (20 ng/mL), and naloxone‐glucuronide (100 ng/mL).ResultsOf our 425 patients, 76% had norbuprenorphine (n = 323), and 77% had norbuprenorphine‐glucuronide (n = 327) in their toxicology tests, respectively. Naloxone‐glucuronide was detected in 91% (n = 294) of the specimens with norbuprenorphine and 88.7% (n = 290) of the specimens with norbuprenorphine‐glucuronide.Conclusion and Scientific SignificanceTo our knowledge, this is the largest study to date demonstrating the presence of naloxone metabolites in patients taking combined buprenorphine‐naloxone medications. The results of this study refute the notion that naloxone absorption is negligible when administered in sublingual preparations. Further research on how this absorption impacts medication usage, dosing, adherence, and side effects is necessary.