mental health
What happens when a manic episode go viral
Anthony Tieuli for STAT
During his junior year of college, Tyler Adolfo (above) experienced a manic episode that caused him to lose connection with reality. In a matter of weeks, he made 1,155 posts on what was then called Twitter, many of them gibberish. Grandiose delusions also led him to post a TikTok video with allegations about his fraternity brothers. He began to have confrontations with other people, including his mother. He attacked a friend with a pocketknife.
He was kicked out of his fraternity — not for physical violence, but for posting about its leadership online, Adolfo told STAT contributor Eric Berger. His story is representative of a modern problem that people with bipolar disorder face these days: the fallout from the delusional, sometimes hurtful things they said online. "If you have manic behaviors on social media, there is a lot of cleaning up to do," one psychiatrist said. But the accompanying shame can also lead someone right into a depressive episode. Read more from Eric about how the era of social media has changed the calculations for people with bipolar disorder.
cancer
New evidence on personalizing mammograms by risk
Mammography recommendations tend to come as a "one size fits all" guideline, though that's hardly how cancer risk works. Things like family history, genetics, geography, and age all impact a person's breast cancer risk. UCSF cancer researcher and breast oncologist Laura Esserman's big dream with her WISDOM study was to see if personalized risk-based screening, where patients get more or less frequent screens based on a risk calculator, could be done at scale, and if it had certain benefits over annual screening.
Now she has an answer. The study's key findings, published Friday in JAMA, are that the patients who received personalized screenings received the same rate of breast cancer diagnoses at stage 2B or later compared to the annual screening group. The risk-based screening group had a 37% reduction in stage 2B cancers versus the annual screening group as well. This means that personalized screening was just as safe in terms of catching cancer as annual mammography. It also suggests that some breast cancers may have been caught earlier, explaining the overall reduction in stage 2B cancers.
The highest risk group, which received a mammography and MRI screening every six months, also had more frequent biopsies compared to the lower risk groups. Patients with the lowest risk could get no screening until age 50, then screening every two years. Overall, the study did not see a reduction in biopsies in the personalized risk group versus the annual group.
Ultimately, this suggests that personalized risk-based screening can be done safely and at scale — WISDOM had nearly 30,000 participants. Esserman and her colleagues are now working on a follow-up trial, WISDOM 2.0, which is enrolling participants as young as 30 to help identify high risk patients who may benefit from earlier intervention. — Angus Chen
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