FDA Committee Approves New Insomnia Drug

A Food and Drug Administration (FDA) advisory committee has decided that Merck's experimental drug suvorexant is effective against insomnia, but that starting doses should be low—15 mg. for the elderly and 20 mg. for the nonelderly. The FDA will consider the advisory committee's recommendations as it completes its review of Merck's New Drug Application for suvorexant.

If approved, suvorexant would be the first in a new class of medicines called orexin receptor antagonists. Orexins are neurotransmitters in the brain that help keep a person awake. By temporarily blocking the actions of orexins, suvorexant helps facilitate sleep. "We are excited about the potential of suvorexant as a new and different approach to treating insomnia, a serious condition that affects up to one-third of the adult population," Darryle Schoepp, Ph.D., said in a press statement. He is senior vice-president and head of the Neuroscience and Ophthalmology Division of Merck Research Laboratories.

More information about suvorexant can be found in Psychiatric News here. More information about treating insomnia can be found in Psychiatric News here and also in American Psychiatric Publishing's Clinical Manual for Evaluation and Treatment of Sleep Disorders.

(Image: wavebreakmedia/Shutterstock.com)

Exposure to Suicide Predicts Increased Suicidality in Adolescents, Study Finds

Exposure to suicide can lead to suicidal ideation and suicide attempts in adolescents, researchers at the Harvard School of Public Health reported in the May 21 Canadian Medical Association Journal. Their finding was based on responses from 8,766 Canadian adolescents aged 12 to 17 who were part of the National Longitudinal Survey of Children and Youth, carried out from 1998 to 2007. Study participants were asked whether anyone in their school had died by suicide and whether they personally knew anyone who had died by suicide. Social support for the youths and stressful life events were also assessed in the study. The prevalence of exposure to a schoolmate's suicide and personally knowing someone who died by suicide increased with age, and such exposure was consistently associated with suicide attempts and, to a lesser degree, with suicidal ideation.

"Our results support schoolwide interventions over current targeted interventions, particularly over strategies that target interventions toward children closest to the decedent," the researchers concluded.

Experts say that patient involvement is key to any suicide-prevention strategy's success. Read more on that topic in Psychiatric News here. And find more information about such strategies in The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition, available here.

(Image: Piotr Marcinski/Shutterstock.com)

APA Responds to Oklahoma Tornado

APA President Dilip Jeste, M.D., sent a message of support to the Oklahoma Psychiatric Physicians Association (OPPA) in the wake of the tornado that ripped through the Oklahoma City suburb of Moore on Monday. The tornado flattened much of the city of 55,000 and left at least 24 dead, according to local officials.

“APA offers its sympathies and support to all those affected by this unfortunate tragedy,” said Jeste. “We know our colleagues may be called upon to deal with the mental health consequences that may arise from this event, and we are confident that they will meet this challenge.”

In addition, APA’s Committee on Psychiatric Dimensions of Disasters sent the district branch information and links to resources about coping with the aftermath of disasters. The OPPA noted that recovery from a disaster as massive as this one will take a long time.

“In the days and months ahead, we encourage everyone affected to consider their emotional wounds and well-being and to speak with a doctor, a counselor, a clergyman, or your family to help the emotional healing begin,” said OPPA President Chariny Herring, D.O., and Brent Bell, D.O, chair of  the OPPA’s Disaster Committee.

Two books from American Psychiatric Publishing provide extensive information on responding to the mental health sequelae of disasters—Disaster Psychiatry: Readiness, Evaluation, and Treatment, and Care of Children Exposed to the Traumatic Effects of Disaster.

Psychologist Prescribing Bill Dies in Illinois Legislature

The push by Illinois psychologists and their legislative allies to permit the state's doctoral-level psychologists to prescribe medication came to an end for now, as the lead sponsor of the bill in the Illinois House of Representatives, Rep. John Bradley (D), withdrew it from consideration in committee. A companion bill on the issue had passed the state Senate. The Illinois Psychiatric Society (IPS) and APA were active in leading the opposition to the bill, which would have permitted psychologists to prescribe, with oversight coming from the state's psychological licensing board rather than from the medical licensing board. APA provided a grant to the IPS to fight the legislation. In its campaign to defeat the prescribing bill, the IPS rallied its members with a legislative alert urging them to register their opposition with their state representatives. It said, in part, "Please remind your state legislator that there can be NO shortcuts when it comes to patient safety." IPS President-elect Linda Gruenberg, M.D., told Psychiatric News today that the district branch fought very hard to defeat this proposal out of a serious concern for its impact on patient safety and will remain vigilant should the bill reappear in the legislature. She noted that it can still be resurrected this year during a veto session in late November.

Read more about the bill in Psychiatric News.

(image: Tang Yan Song/Shutterstock.com)

Antipsychotics Being Recalled in Canada

Three companies have agreed to recall all lots of the antipsychotic quetiapine in Canada due to potential contamination with the antibiotic clindamycin, according to an announcement from Health Canada, that country's federal health agency. The recall applies to 25 mg, 100 mg, 200 mg, and 300 mg doses manufactured by Cobalt Pharmaceuticals Company, Laboratories Riva Inc., and Sanis Health Inc. All three companies are advising physicians and other health care professionals to contact their patients who have been supplied with any quetiapine from these manufacturers "to help ensure a safe transition over to alternative authorized and not affected quetiapine products on the Canadian market," the agency said. The announcement also advises patients to immediately contact their health care provider with questions about their use of the medication, not to discontinue treatment without advice from their clinician, and to report any adverse reactions potentially related to quetiapine products to Health Canada. No adverse reports have been received by Health Canada to date.

To read the complete announcement, click here.

(image: Ivsanmas/Shutterstock.com)

President Bill Clinton Discusses MH Care at APA Annual Meeting

"On balance I think you should be hopeful,” Bill Clinton, the 42nd president of the United States, told APA members yesterday in a keynote speech at APA’s 2013 annual meeting in San Francisco. “We have come a long way on this issue of mental health coverage since my grandmother was hospitalized briefly in a state hospital in the 1950s. I have seen the dark side of this, and I have seen the bright, wonderful work that you do.”

Clinton’s comments were part of a remarkable address in which he talked to a packed hall of meeting attendees by satellite about a range of public-policy issues—foreign and domestic—which, because of global interdependence, now require new ways of problem-solving that allow all parties win. He cited as an example the work of the William J. Clinton Foundation in negotiating with the soft-drink industry to revamp its business plans so that the companies could still profit while dramatically decreasing the amount of sugar in drinks consumed by schoolchildren.

Similarly, though some people still need to be persuaded of the value and importance of mental health coverage, the issue is now one of getting all parties to work together to make it happen, he emphasized.

“This issue [of mental health access] still needs to be destigmatized among some,” said Clinton. “But it is now largely a question of problem-solving….There has got to be a way out of this [political gridlock] so that we join every other wealthy, decent society on earth and provide universal, affordable health care to all that doesn’t exclude mental health care.”

To read more about sessions at this year's APA annual meeting, click here.

Award-Winning Author Discusses Living With Schizophrenia

“My therapist used to say I was three people—Professor Saks, the lady with the thick medical history, and Elyn,” recounted Elyn Saks, Ph.D., J.D., in a conversation today with APA President Dilip Jeste, M.D., at the Opening Session of APA's 2013 annual meeting about her struggle with and continuing recovery from schizophrenia. “And he thought Elyn was the most neglected. Eventually, through psychotherapeutic work, coming to terms with the narcissistic injury of having a serious mental illness, it began to define me less. It became accident rather than essence. Today Elyn and Professor Saks are at the forefront, and the lady with the thick chart is trailing in third.”
Saks' remarks were part of a wide-ranging conversation with Jeste about living with a serious mental illness while also pursuing a successful career as a writer, ethicist, and lawyer. Saks is the Orrin B. Evans Professor of Law, Psychology, and Psychiatry and Behavioral Sciences at the University of Southern California and a MacArthur Foundation Fellowship winner. She is also the author of an award-winning best-seller, The Center Cannot Hold: My Journey Through Madness, an autobiographical account of her long struggle with schizophrenia.

Jeste interviewed Saks about issues related to recovery, stigma, resilience, the relative value of psychosocial and pharmacological interventions, and bioethics relevant to people with serious mental illness. She recounted painful—as well as joyful and humorous—aspects of her journey and concluded with a note of gratitude to the field of psychiatry. “In many ways psychiatry has been the star of my show. I'm incredibly grateful for what you do. And on behalf of my fellow patients, thank you very much," she said.

APA Leaders Pay Tribute To Jay Scully, M.D., as He Nears Retirement

It was a little more than 10 years ago when James H. Scully Jr., M.D., became medical director of APA. Today, as he prepares to step down from that position in the fall, former APA President and Assembly Speaker Richard Harding, M.D., led a light-hearted but poignant tribute to Scully at the Assembly’s morning plenary.
 

 “As president at the time, I had the honor of appointing a search committee headed by former APA President Herb Pardes, M.D. While the committee came up with a host of good candidates, one stood out: Jay Scully.”

Harding recounted Scully’s years as a naval medical officer and his leadership in psychiatric education, commenting that those experiences prepared him well for the demanding position he has held as head of the APA staff. “He had a hard job set ahead of him,” said Harding. “A decade ago, things were not real rosy at APA—I can assure you of that. The planning for DSM-5 was just beginning, a war was going on, the antipsychiatry movement was strong, and we were broke—APA had nothing in reserves. Jay set a course for APA and turned all that around—we’re in a far different place today.”

Former speaker of the Assembly and current Area 7 Trustee, Jeffrey Akaka, M.D., of Hawaii, draped a Kukuki nut lei around Scully’s neck and slipped him some of his signature chocolate-covered macadamia nuts, and another former speaker of the Assembly, Albert Gaw, M.D., presented him with an oversized, engraved gavel. Gaw was speaker when Scully became medical director.

“We saw Jay in many moods through the years,” said Harding, “and if we saw him frustrated, we always knew it was because of his principles or because something critical needed to be done for the APA membership or our patients. Few people have earned the respect in psychiatry that Jay has throughout a career dedicated to others.”

Change in Annual Meeting Session With President Bill Clinton

Because President Bill Clinton is not feeling well after considerable travel recently, his doctors advised him to avoid a long cross-country plane trip. As a result, he will address the APA annual meeting as originally scheduled Sunday at 5:30 p.m. in Hall D of the Moscone Convention Center, but will do so via satellite. He regrets the inconvenience but is glad that he will be a part of the annual meeting. APA Medical Director James H. Scully Jr., M.D., will still engage in a question-and-answer period with President Clinton, asking questions submitted by APA members. Doors will open at 4:30 p.m. Annual meeting badges are required for entry.

APA Releases DSM-5 Today

After 14 years of development, APA today released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), incorporating nearly 20 years of scientific advances and clinical experiences since the manual's last revision in 1994. DSM-5 is available in a print edition first, and an electronic version will be available later this year.

"The changes to the manual will help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care," commented DSM-5 Task Force Chair David Kupfer, M.D. "We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research." Among those changes are a new chapter organization that shows how mental disorders may relate to one another based on underlying vulnerabilities or symptom characteristics. In addition, in DSM-5 disorders are organized in the context of age—that is, along a developmental lifespan within each chapter—as well as gender and cultural expectations. While the number of disorders are about the same as in the last edition of DSM, several new disorders have been added, including binge eating disorder, disruptive mood dysregulation disorder, and hoarding disorder. A new section for the manual, Section III, describes several conditions that warrant more research before they can be considered as formal disorders in the main part of the manual.

APA says that it will make the process of revising the manual in the future more responsive to research breakthroughs via incremental updates until a new edition is required. Thus, diagnosis guidelines won't be tied to a static publication but to scientific advances.

DSM-5 and its supplementary publications can be ordered at www.psychiatry.org/dsm5. More information about the manual is also available on the site.