CRISPR and Beyond: What’s known, what’s changed, and what stays the same in sickle cell care in the United States.

Abstract: Psychiatric comorbidities are common but understudied in adults with Sickle Cell Disease (SCD). The available literature shows elevated rates of clinical depression (25-30%), anxiety, neurocognitive impairment due to stroke and microvascular changes, and that there are barriers to adherence. There is limited evidence suggesting increased risk for suicide and suicidal ideation. There are complex interrelationships among SCD, pain, psychology, and opioid therapy. Depressive symptoms in SCD are associated with greater likelihood of developing chronic pain, more pain burden, higher acute care utilization, greater use of opioid pain medication, and less relief from medication. As standards for multidisciplinary sickle cell centers develop, mental health providers are increasingly considered an optimal element. Despite the high needs, exposure and knowledge of SCD is limited amongst psychiatrists, psychologists, and other mental health clinicians. Consultation-Liaison Psychiatrists should be at the forefront of improving the mental health care for this patient population.

In this workshop, we will review the psychiatric diagnoses, presentations, prevalences, and treatment modalities for adults with SCD and will review the strength of the current evidence base for specific psychiatric treatment recommendations.

Dr. Beth Leimbach will review the most updated knowledge about the common psychiatric comorbidities in adults with SCD, the data on the use of cognitive behavioral therapy, and emerging data on ketamine, with potential applications to both pain and mood symptoms. Finally, she will discuss the potential benefits of using buprenorphine in this population.

Dr. Liz Prince will present new findings about approaches to psychotherapeutic engagement of adults with SCD in medical settings, and will discuss unique aspects of caring for pediatric and transition-age patients. She will make recommendations for CL psychiatrists working in integrated settings or looking to collaborate with hematology clinics.

Dr. Adrienne Mishkin will discuss the biological mechanisms, state of the evidence, and emerging standard of care in the area of allogeneic stem cell transplantation and genetically modified autologous stem cell transplantation including CRISPR, Editas, and Bluebird trials, as well as other less known modalities. She will review the limited data about psychiatric health after these treatments, and relate her own experiences with patients’ psychological concerns after curative therapy.

Dr. Pat Carroll will reflect on the overall state of SCD medical and psychiatric care in the United States, and help the audience appreciate where we are in the evolution of the care of this unique illness. He will discuss specific implications for psychiatrists caring for these patients, and make recommendations about how to approach this work.