There are approximately one million older lesbian, gay, bisexual, and transgender (LGBT) adults in the USA. Their mental health issues result from interactions between genetic factors and stress associated with membership in a sexual minority group. Although advancements in acceptance and equal treatment of LGBT individuals have been occurring, sexual minority status remains associated with risks to physical and mental well-being. Older LGBT adults are more likely to have experienced mistreatment and discrimination due to living a majority of their lives prior to recent advancements in acceptance and equal treatment. All LGBT adults experience one common developmental challenge: deciding if, when, and how to reveal to others their gender identity and/or sexual orientation. LGBT individuals have higher rates of anxiety, depression, and substance use disorders and also are at increased risk for certain medical conditions like obesity, breast cancer, and human immunodeficiency virus (HIV). Improved education and training of clinicians, coupled with clinical research efforts, holds the promise of improved overall health and life quality for older LGBT adults.

Depressive disorders are common, costly, and often chronic or recurrent. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study revealed that more than 1 in 3 outpatients with major depressive disorder will not achieve symptomatic remission despite several attempts at monotherapy, augmentation, and/or combination treatment (1-3). The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study of over 2,000 outpatients with bipolar disorder found that adding antidepressants to mood stabilizers did not improve outcomes in patients with bipolar depression (4).Most depressed patients initiate treatment in primary care settings. As primary care treatment improves, psychiatrists are likely to see more and more depressed patients with two, three, or more adequately delivered but failed treatment trials. Only a few treatments, such as atypical antipsychotic medications, olanzapine and fluoxetine combined, ECT, transcranial magnetic stimulation, lithium (5), and, most recently, pramipexole (6), have been studied in randomized controlled trials for treatment-resistant depression, which is usually defined as failure of one or two well-delivered antidepressant See related feature: Clinical Guidance (Table of Contents)

Grit and ambition are psychological factors that may protect neurocognitive function among persons living with HIV (PLWH). We examined associations between grit, ambition, premorbid verbal intellectual function, and current neurocognitive and everyday functioning among PLWH and persons without HIV (HIV-). 120 PLWH and 94 HIV- adults completed the Grit Scale (includes total score and consistency of interests and perseverance of effort subscales), ambition scale, and a comprehensive neurobehavioral battery. PLWH had lower grit scores than HIV- adults. The two groups did not differ on ambition. No relationship was observed between grit and cognition among HIV- adults. Among PLWH, however, higher perseverance of effort and more ambition was related to better global neurocognitive functioning, and higher grit, but not ambition, was related to independence in daily functioning. Longitudinal studies are needed to elucidate these relationships over time and examine whether grit or ambition have protective effects on cognitive outcomes among PLWH.

One effect of the COVID-19 pandemic is the disruption of in-person clinical experiences within geriatric psychiatry residency education. Online resources for trainees are needed to fill resultant gaps. Methods: The American Association of Geriatric Psychiatry (AAGP) Teaching and Training Committee leadership collaborated with geriatric psychiatry experts to develop a webbased geriatric psychiatry curriculum for psychiatry residents and other learners. In addition, we planned to obtain initial self-report outcomes of the curricular modules. Results: The COVID-19 AAGP Online Trainee Curriculum (aagponline.org/covidcurriculum) consists of approximately 30 video-recorded lectures provided by AAGP member experts. A demographic survey and pre-/ postsurvey attached to each module allow us to obtain learner characteristics and feedback on each module. Conclusions: The Curriculum has the potential to supplement psychiatry residency education during the pandemic and potentially raise the profile of AAGP, with the goal of inspiring interest within geriatric psychiatry. Results of the initial self-report evaluation should be available in 1 year (