Friday, April 18, 2014

Drug Education Prompts Elderly to Reduce Benzodiazepine Use, Study Finds

According to a study published in this week’s JAMA Internal Medicine, discontinued use of benzodiazepines by the elderly is made easier when patients are educated about the medication’s potential harm.

Researchers from the departments of pharmacy and geriatrics at the University of Montreal conducted a study to determine whether educating older patients on the health risks of benzodiazepines would serve as an effective method to discourage the use of such drugs. The study included 303 long-term users of benzodiazepines, aged 65 to 95. The participants were randomly selected to receive a booklet describing adverse health risks of benzodiazepines, along with instructions on how to safely reduce use of the medication and information on alternative strategies for treating insomnia and anxiety.

At the six month follow-up, the results showed that 62 percent of the patients who received booklets initiated a conversation with their physician or pharmacist about benzodiazepine therapy cessation, while 27 percent completely discontinued use. Patients who were not educated on the potential harms of benzodiazepines had a discontinuation rate of 5 percent.

The authors wrote, "In an era of multimorbidity, polypharmacy, and costly therapeutic competition, direct-to-consumer education is emerging as a promising strategy to stem potential overtreatment and reduce the risk of drug harms." The authors concluded that "the value of the patient as a catalyst for driving decisions to optimize health care utilization should not be underestimated."

To read about treatments and diagnosis of sleep disorders and anxiety, see Essentials of Geriatric Psychiatry, Second Edition from American Psychiatric Publishing.

(Kristo-Gothard Hunor/

Effects of Childhood Bullying Extend Well Into Middle Age, Study Finds

A study published in today’s AJP in Advance—"Adult Health Outcomes of Childhood Bullying Victimization: Evidence From a Five-Decade Longitudinal British Birth Cohort"—suggests that impact of being bullied in childhood may persist at least until midlife.

Researchers from the Institute of Psychiatry at King’s College, London, gathered data from the British National Child Development Study—which follows the lives of all children born in England, Scotland, and Wales during one week in 1958—to assess the ramifications of childhood bullying victimization into adulthood. The researchers analyzed data of nearly 8,000 participants with information concerning bullying exposures between ages of 7 and 11 and who participated in follow-up well-being assessments between ages 23 and 50.

The results showed that participants who were victims of childhood bullying had higher rates of depression, anxiety, and suicidal ideation at age 45, compared with those who were not bullied. In addition, victims of childhood bullying were less likely to be living with a partner and have social relationships and were more likely to endure economic hardships and have a poor perceived quality of life at age 50.

David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont, and a child and adolescent psychiatrist, stated during an interview with Psychiatric News, “Despite increased awareness and the widespread implementation of school-based prevention programs, bullying remains a common experience for many young people. The current results underscore the importance of early recognition and access to appropriate and ongoing treatment for both bullies and their victims, as well as the need for additional research on the efficacy of programs designed to reduce the incidence of childhood bullying."

To read more about the impact of childhood bullying on mental health, see the Psychiatric News article, “Effects of Bullying Don’t End When School Does.” Also see the book Preventing Bullying and School Violence from American Psychiatric Publishing.

(Image: Twin Design/

Thursday, April 17, 2014

Problem-Solving Therapy May Help Prevent Onset of Major Depression In Elderly, Study Finds

According to a study published in Psychiatric Services, problem-solving therapy for primary care (PST-PC)—an intervention delivered by nonmental health professionals to help patients improve coping skills and confidence—may serve as a beneficial therapy for older adults who are at risk for major depression.

Charles Reynolds III, M.D., a professor of geriatric psychiatry at the University of Pittsburgh Medical Center, and colleagues evaluated the efficacy of PST-PC in preventing episodes of major depression and reducing depressive symptoms in elderly adults. The study, "Early Intervention to Preempt Major Depression Among Older Black and White Adults," included approximately 250 individuals with subsyndromal depressive symptoms who received 15 months of PST-PC, a technique that has been shown to reduce stress, or dietary coaching, which had been shown to reduce depression risk in an elderly population in a previous study by Reynolds. The two cohorts were compared with each other, in addition to being compared with age-matched cohorts from previously published studies of those who received neither therapy for subsyndromal depressive symptoms.

After two years, the analysis showed PST-SC to be just as effective as dietary coaching in preventing episodes of major depression in this at-risk cohort. Incident rates for major depression in both cohorts were approximately 9%, compared with published rates of 20% to 25% in those who received neither treatment. The researchers also observed a significant reduction in depressive symptoms in both PST-SC and dietary-coaching groups.

“Avoiding episodes of major depression can help people stay happy and engaged in their communities...," commented Reynolds. “This project tells us that interventions in which people actively engage in managing their own life problems...tend to have a positive effect on well-being and a protective effect against the onset of depression.”

To read more about the role of problem-solving therapy in treating mental illness, see the Psychiatric News article, "Future Looks Promising for Mental Illness Prevention."

(Photo Courtesy of PUMC)

Psychiatrists' Role in the Brave New World of Health Care

APA President Jeffrey Lieberman, M.D., is using the Psychiatric News Alert as a forum to reach APA members and other readers. This column was written by Dr. Lieberman and Grant Mitchell, M.D. Please send your comments to

Health care reform has been a long time coming. Although many date the start of the health care reform process with the passage in 2010 of the Affordable Care Act (aka Obamacare), the economic and social forces that are driving it have been building for decades. (Think Medicare, Medicaid, HMOs, managed care, Hillary Clinton, and Harry and Louise [see here]). However, even now, many health care providers, and physicians in particular, would prefer to deny the inevitable: the transformative changes that will occur in the U.S. health care system.

It is true that we don’t know whether this change will be a gentle set of waves or a tsunami, and we don’t know into what form the health care system and the roles of its providers will ultimately be reconfigured. We just know that a comprehensive transition is looming.

In a previous column (“Change, Challenge, and Opportunity: Psychiatry in the Age of Health Care Reform,” Psychiatric News, October 4, 2013), Howard Goldman and I discussed the health care reform process from the macro health policy and economic perspectives. In this article, Grant Mitchell and I discuss how this will impact individual psychiatrists.

The goal of a transformed health care system is to expand care, improve quality, and lower costs. These goals may seem antithetical. Indeed, this is especially concerning to patients with mental illness and limited resources who have historically had limited access to care. Psychiatrists know firsthand this frustration, and that of their patients and their families, with the current models of care and financing: limited payments and visits, with silos between physicians that contribute to fragmented care. And although it’s gratifying that timely and ongoing treatment of psychiatric disorders is finally being recognized as critical to controlling health care costs, we are waiting for stronger policies that will remove the barriers to access to care and payment for such care.

Read more here.

You can follow Dr. Lieberman on Twitter at @DrJlieberman.

Wednesday, April 16, 2014

Evaluation of Integrated Care at CMHCs Reveals Successes, Challenges

Integrated care can take many forms. One is to offer primary and other general medical care services to patients already receiving psychiatric services at a community mental health center (CMHC), notes a new report by Deborah Scharf, Ph.D., of the RAND Corp. To test that care paradigm, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) began awarding Primary and Behavioral Healthcare Integration (PBHCI) service grants to expand primary care access at CMHCs.

The evaluation of the programs found that patients enrolled in PBHCI clinics show improvement in measures of dyslipidemia, hypertension, and diabetes but not on others, like smoking or excess weight, compared with those receiving services at non-PBHCI clinics. “SAMHSA and its partner agencies may benefit from replicating successful initiatives, refining delivery of services, and working with state policymakers to further coordinate policies affecting delivery of integrated care,” the researchers concluded.

"As project director for one of the PBHCI grant projects studied by RAND, I am pleased to see that access to care for our medically at-risk populations can be improved by integrated on-site availability in the mental health setting,” said psychiatrist John Kern, M.D., chief medical officer at Regional Mental Health Center in Merrillville, Ind., in an interview with Psychiatric News.

To read more about the move to integrated care, see the Psychiatric News articles, "NIMH Fosters ‘Practice-Ready’ Solutions to Integrating Primary, MH Care" and "Get Started in Integrated Care by Picking Up the Phone," which is written by Kern. Read previous findings from the same research group in the Psychiatric Services
article, "Integrating Primary Care Into Community Behavioral Health Settings...."

(Image: WaveBreakMedia/

Study Finds Varying Rates of PTSD In and Out of VA Health System

Only about half of U.S. veterans who served in Iraq or Afghanistan seek care from the Veterans Health Administration (VHA), and the VHA says that 22% of that cohort were diagnosed with posttraumatic stress disorder (PTSD). Other surveys of veterans, however, record much lower rates, noted Christine Vaughan, Ph.D., and colleagues from the RAND Corporation in the Psychiatric Services in Advance study, "Prevalence of Mental Health Problems Among Iraq and Afghanistan Veterans Who Have Received and Not Received VA Services.” The authors said that their data point to the need for connecting more veterans with mental health care services.

The study of a sample of 913 veterans living in New York state found that rates of probable PTSD (23%), probable depression (21%), or either diagnosis (30%) for those using the VHA system were about three times higher than for those not receiving VHA care. The comparable rates for those not using VHA services were 6%, 8%, and 11%, respectively. Those differential results suggest that rates for these psychiatric disorders among VHA patients don’t reveal the wider dimensions of veterans’ health problems. Still, the lower rates for nonusers should be cause for concern, the researchers noted.

“Given the size of the previously deployed force and the low rate of VHA enrollment, this proportion represents a significant number of veterans whose treatment needs are not being met by the VHA,” concluded Vaughan and colleagues. “Considerable improvement in the health status of veterans may be achievable if they can be connected with high-quality services.”

To read more about mental health care for veterans, see the Psychiatric News articles, "Military Mental Health Issues Will Be in Meeting Spotlight" and "Knowledge of Military Life Facilitates Vets' Mental Health Care."

(Image: Susan Montgomery/

Tuesday, April 15, 2014

Bipolar Disorder Patients in Integrated Primary Care May Need More-Intensive Services, Study Shows

Primary care patients with bipolar disorder enrolled in an integrated care system in Washington state may require more intensive services than currently provided in a collaborative care model, according to a study, “Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder,” which is published online today in Psychiatric Services.

Researchers from the University of Washington identified 740 primary care patients with bipolar disorder in the statewide mental health integration program (MHIP) between January 2008 and December 2011 using the Composite International Diagnostic Interview and clinician diagnosis. The MHIP uses collaborative care based on the IMPACT model (Improving Mood–Promoting Access to Collaborative Treatment) to improve recognition and systematic treatment of patients with psychiatric disorders in primary care settings.

Primary care patients with bipolar disorder had high symptom severity on both depression and anxiety measures using the Patient Health Questionnaire and the Generalized Anxiety Disorder scale. Psychosocial problems were common, with approximately 53% reporting concerns about housing, 15% reporting homelessness, and 22% reporting lack of a support person. Yet only 26% of patients were referred to specialty mental health treatment.

Study co-author Wayne Katon, M.D. (photo above), vice chair of the Department of Psychiatry at the University of Washington, said that the study indicates that these patients may need more-intensive care than is currently provided in a collaborative care model, in which a care manager, supervised by a psychiatrist, provides the direct patient care. “The importance of this article is that the U.S. federally qualified primary care clinics, as well as many primary care clinics that treat both uninsured and Medicaid patients, are likely to have a significant percentage of patients with bipolar illness, especially bipolar 2 illness,” Katon told Psychiatric News. “This article emphasizes that despite the fact that only about one-third improve with treatment in these clinics, few are being referred to community mental health clinics or actually attend when referred. These clinics already had integrated collaborative care—that is, the use of a care manager supervised by a psychiatrist—so the inference is that these patients may need more-intensive psychiatric treatment, which could occur if psychiatrists are integrated into the clinics either in person or via telemedicine. Alternatively, the clinics need to establish better links with community mental health.”

To read more about integrated and collaborative care, see the Psychiatric News article by Katon, "Three Decades of Working in Integrated Care."

APOE-4 Allele May Confer Greater Alzheimer's Risk for Women, Study Suggests

Presence of the APOE-4 gene, the strongest genetic risk factor for Alzheimer disease identified to date, appears to confer greater risk for women, according to a study published online in Annals of Neurology. Researchers at Stanford University examined the APOE-4-by-sex interaction in the risk for conversion from healthy aging to mild cognitive impairment (MCI) in 5,496 controls and from MCI to Alzheimer’s disease in 2,588 patients with MCI. The interaction was also tested in cerebrospinal fluid biomarker levels of 980 subjects from the Alzheimer's Disease Neuroimaging Initiative.

Among controls, male and female carriers of the gene were more likely to convert to MCI or Alzheimer's, but the effect was stronger in women. The APOE-4-by-sex interaction on biomarker levels was significant for MCI patients and showed that women carriers were more likely to have defects in the "tau" protein in the brain, which has been linked with the characteristic neurofibrillary tangles associated with dementia.

“These findings have important clinical implications and suggest novel research approaches into AD pathogenesis,” the researchers said.

To read more about research on this subject, see the Psychiatric News article, "Plasma APOE-4 Levels Linked to Dementia Risk." Also see the American Journal of Psychiatry study, "Effect of Knowledge of APOE Genotype on Subjective and Objective Memory Performance in Healthy Older Adults."

(Image: Alexander Raths/

Monday, April 14, 2014

New Study Investigates Association Between Obesity and ADHD

Various studies have linked attention-deficit/hyperactivity disorder (ADHD) with obesity. But questions have been raised about whether ADHD contributes to development of obesity or obesity contributes to development of ADHD. A prospective, longitudinal, population-based study suggests that both answers may be correct. Childhood ADHD symptoms significantly predicted adolescent obesity, rather than the opposite. Yet one contributor to obesity—a lack of physical activity in childhood—predicted inattention in adolescence.

The study included some 8,000 children and was headed by Alina Rodriquez, Ph.D., a visiting professor in epidemiology and biostatistics at the Imperial College London School of Public Health. Results appear in the April Journal of the American Academy of Child and Adolescent Psychiatry.

The study findings have clinical implications, Rodriquez and her team said in their report, in that children with ADHD should be monitored for being overweight or obese at an early age, thus potentially averting a developmental trajectory of obesity. Also, since physical inactivity was found to mediate the association between ADHD and obesity, physical activity should be encouraged in youngsters with ADHD. And since a lack of physical activity in childhood predicted inattention in adolescence, "physical activity may also alleviate ADHD symptoms in the long term," they said.

More information about ADHD can be found in the American Psychiatric Publishing book, Essentials of Child and Adolescent Psychiatry. For a comprehensive text about the field of overweight and obesity, see The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance, also from American Psychiatric Publishing.

(Image: Christophe Rolland/

In Spite of Mixed Clinical Trial Results, NMDA Receptor Enhancers May Still Prove Useful

Although a phase-2 clinical trial reported recently in JAMA Psychiatry suggested that an NMDA receptor enhancer called bitopertin might be effective against the negative symptoms of schizophrenia, two phase-3 trials concerning bitopertin to treat negative symptoms gave disappointing results, according to the drug's manufacturer, R. Hoffmann-LaRoche Ltd. in Switzerland.

Whether bitopertin eventually turns out to be an effective drug for negative symptoms, two experts on the subject remain hopeful that NMDA receptor enhancers might prove beneficial in countering schizophrenia's negative symptoms, at least for certain patients. One is Donald Goff, M.D., a professor of psychiatry at New York University and an expert in translational schizophrenia research. The other is Serdar Dursun, M.D., Ph.D., a professor of psychiatry and neuroscience at the University of Alberta in Canada.

"It's possible that a subgroup of patients might benefit from these agents, but Roche wasn't able to identify a biomarker that would predict response," Goff said in an interview. And as Dursun told Psychiatric News, "There must be improved clinical-trial methods that include identification of biomarkers so as to reduce the patient heterogeneity problem in schizophrenia."

For more about research into the use NMDA receptor enhancers to treat negative symptoms, see the Psychiatric News article "Surprising Drug Improves Schizophrenia Symptoms."


Friday, April 11, 2014

Study Links Major Depression in Childhood With Cardiac Risk Factors in Adolescence

Depression in adults has been identified as a risk factor both for incident coronary heart disease and for cardiac events among patients with established heart disease, but how early in life does this association start? Perhaps as early as childhood, a study headed by Jonathan Rottenberg, Ph.D., of the University of South Florida and published in Psychosomatic Medicine suggests.

The study included 566 adolescents—210 who had a major depressive episode in childhood, 195 never-depressed siblings of those children, and 161 healthy control youth with no history of a major psychiatric disorder. All subjects were evaluated for cardiovascular risk factors such as smoking, obesity, and sedentary behavior. The group that had been depressed was found to smoke significantly more, to be significantly less active physically, and to have a significantly higher rate of obesity than their siblings and the controls.

"This is an interesting study and importantly provides additional evidence to support early treatment of depression," Kayla Pope, M.D., J.D., director of Neurobehavioral Research at Boys Town Nebraska/Iowa, told Psychiatric News. "We know that a diagnosis of depression is associated with an increase in morbidity and mortality, and this study provides further insight into the disease pathway. This study also speaks to the need for treatment strategies to address lifestyle issues as well as depressive symptoms and to target exercise, diet, and smoking cessation as key components of a treatment plan."

More information about the depression-cardiovascular association can be found in the Psychiatric News articles "Depression-Cardiovascular Link Found in Young Adults" and "Collaborative Care for Depression Can Reduce Risk for Heart Attacks, Strokes."


Thursday, April 10, 2014

Antipsychotic Use in Children on Medicaid Needs Close Monitoring, Researchers Suggest

Very young children and those in foster care who are enrolled in Maryland’s Medicaid program are more likely to be taking atypical antipsychotic medications for attention-deficit/hyperactivity disorder (ADHD) that is not comorbid with other illnesses than other young people receiving Medicaid benefits. Noting the "profound" increase in off-label use of antipsychotics, including for ADHD, researchers from the University of Maryland, Johns Hopkins University, and Morgan State University, all in Maryland, examined administrative data on 266,590 youth. About 2.5% of the 2- to 12-year-olds and 5.2% of the 13- to 17-year-olds were prescribed atypical antipsychotics for ADHD in 2006, reported Julie Zito, Ph.D., a professor of pharmacy and psychiatry at the University of Maryland School of Pharmacy, online Tuesday in the Journal of Child and Adolescent Psychopharmacology.

Zito and colleagues found differences in atypical antipsychotic medication use that varied by age, Medicaid eligibility, and diagnostic status. For example, youth in foster care diagnosed with ADHD and no other comorbid illness were three times more likely to be taking atypical antipsychotics and for an additional 100 days per year than their peers enrolled in Medicaid because of low family income. Since side effects such as weight gain, high cholesterol, elevated blood glucose, or insulin resistance can occur with use of antipsychotic drugs, the researchers urged careful review of each case before prescribing and continued monitoring and research to assure that the benefits of these medications outweigh the risks in children and adolescents. They concluded, "Exposure to atypical antipsychotics in Medicaid-insured youth, in particular for children in foster care and those diagnosed with ADHD, was substantial, warranting outcomes research for long-term effectiveness, safety, and oversight for appropriate cardiometabolic monitoring."

To read more in Psychiatric News about the use of antipsychotic medications in young people, see the article, “Increase in Off-Label Antipsychotic Use Seen in Canadian Youth.” Also see Clinical Manual of Child and Adolescent Psychopharmacology, Second Edition, from American Psychiatric Publishing.

(Image: Image Point Fr/

Wednesday, April 9, 2014

Experimental Nasal Spray May Treat Social Anxiety Disorder, Study Indicates

An experimental intranasal spray known as PH94B may be a novel, effective, and well-tolerated acute treatment for performance and social anxiety in women with social anxiety disorder. The finding appears in the study, "Effect of an Acute Intranasal Aerosol Dose of PH94B on Social and Performance Anxiety in Women With Social Anxiety Disorder," published in AJP in Advance.

Researchers at several institutions conducted a phase 2, multicenter, randomized, double-blind, placebo-controlled, single-dose study of PH94B. Ninety-one women aged 19 to 60 with generalized social anxiety disorder received placebo intranasal spray (single-blind) 15 minutes before laboratory-simulated public-speaking and social-interaction challenges. Patients who experienced significant distress during at least one challenge returned a week later to receive either intranasal PH94B or placebo aerosol spray (double-blind) before repeat challenges.

Patients who received PH94B during the second set of challenges had a significantly greater decrease in mean Subjective Units of Distress scores during the public-speaking and social-interaction challenges, compared with the first set of challenges, than did patients who received placebo for both sets of challenges. A significantly greater proportion of the PH94B group were much or very much improved from the first to the second sets of challenges, compared with the placebo group (75% and 37%, respectively).

“Continued positive findings for PH94B would suggest a novel mechanism of drug action via human nasal chemosensory receptors,” the researchers said. “If so, this could lead to the ability to treat psychopathological states with nanomolar doses of drugs that do not even enter the systemic circulation and may represent a distinct advance in psychotherapeutics.”

To read more about research into treatments for social anxiety, see the Psychiatric News article, “CBT Proves its Mettle in Social Anxiety Treatment.”

(Image: Tashatuvango/

Tuesday, April 8, 2014

APA Annual Meeting Mobile App Now Available

APA has just launched its mobile app for the 167th Annual Meeting to be held May 3 to 7 in New York, giving you 24-hour access to the meeting. Downloading is easy. The app can be used with all Web-enabled smartphones and tablets. You can use the app to plan your schedule and better navigate the meeting. There are several easy-to-use interactive capabilities designed to enhance your meeting experience.

These include:

· Use "My Schedule" to create your schedule with one click, adding sessions and exhibitors in which you are interested. You can create your schedule via your computer and save and access the schedule onsite via your mobile device.

· Search the scientific program sessions by day, format, and topic or by speaker.

· Use maps to view each floor of the meeting hotels and the Exhibit Hall in the Javits Convention Center. When searching on the scientific program, you can view the room location on the map.

· Receive important real-time alerts from APA regarding meeting reminders and program updates.

· Browse the exhibitors and locate who you want to visit on the Floor Plan Map.

· Connect with attendees and new colleagues using the “Friends” feature.

Ten Times More People With Serious Mental Illness in Jails Than Hospitals

Ten times more individuals with serious mental illness are residing in state prisons and county jails today than in the nation’s state psychiatric hospitals, according to a new study released today by the Treatment Advocacy Center (TAC). “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey” found that in 44 states the largest institution housing people with severe psychiatric disease is a prison or jail. Nationwide, the study reports that there are an estimated 356,000 mentally ill inmates compared with 35,000 public-hospital patients.

The survey provides state-by-state illustrations of how protocols for treating mentally ill inmates who are deteriorating or acutely ill create obstacles that leave inmates without treatment for extended periods or indefinitely, especially in county jails. The report also contains several recommendations, including use of court-ordered outpatient treatment—deemed by the Department of Justice to be an evidence-based practice for reducing crime and violence—to help at-risk individuals live more safely and successfully in the community.

“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” said psychiatrist E. Fuller Torrey, M.D., founder of TAC and lead author of the study. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.”

In comments to Psychiatric News, Torrey said, “it is remarkable that we have let this situation deteriorate to this point.” He added, “Jails and prisons are not built to be mental hospitals, and corrections personnel are neither hired nor trained to be mental health workers. We have returned to the situation that existed in the 1830s when Dorothea Dix began the reform movement to get mentally ill persons removed from jails and prisons and put into hospitals. The fact that we are where we were almost 200 years ago should give us all pause.”

To read more on this subject, including strategies to reverse the trend, see the Psychiatric News article, "Judges, Psychiatrists Confer on Handling Mental Illness in Justice System." Also see "Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review" in Psychiatric Services in Advance.
(Image: angelo gilardelli/


Monday, April 7, 2014

CDC Reports Continuing Rise in Autism Prevalence Rates

The Centers for Disease Control (CDC) reports that 1 in 68 8-year-old children in the United States (14.7 per 1,000) had autism spectrum disorder (ASD) in 2010, the most recent year for which these data are available. This number is about 30% higher than the prevalence of ASD that the CDC reported in its previous survey released two years ago, which was 1 in 88 children (11.3 per 1,000). The CDC said a child meets its criteria for ASD "if a comprehensive evaluation of that child completed by a qualified professional describes behaviors consistent with the...DSM-IV-TR diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder–not otherwise specified (including atypical autism), or Asperger disorder."

"The CDC report was based on a review of records rather than actual clinical assessments," David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont, a child and adolescent psychiatrist, and APA treasurer, told Psychiatric News. "As a result, it tells us more about how often autism is being diagnosed as opposed to changes in the underlying incidence. The data were also derived from relatively few states—just 11 were surveyed. However, even in this limited sample, the geographic variations are quite striking and clearly warrant further investigation. From a clinical perspective, increased awareness is leading to earlier recognition and more accurate diagnoses. The real challenge is to make sure that all these kids have access to the comprehensive services they need and deserve."

More information about autism and research into potential treatment options can be found in the Psychiatric News articles, "Pieces of Autism Puzzle Slowly Coming Together" and "Oxytocin Treatment May Improve Social Communication in Autism."

(Image: ivelin radkov/

Anxiolytic and Hypnotic Medications Associated With Increased Mortality Risk, Study Finds

In a study published in the British Medical Journal, researchers at Warwick Medical School in the United Kingdom led a study assessing rates of mortality associated with antianxiety and sleeping medications. The study compared 37,727 patients who had a prescription for anxiolytic or hypnotic drugs with 69,418 patients with no prescription for such medications. Patients were tracked for an average of 7.6 years. The results showed that "there was an overall statistically significant doubling of the hazard of death (hazard ratio 2.08) after adjusting for a wide range of potential confounders, including physical and psychiatric comorbidities, sleep disorders, and other drugs."

Daniel Buysse, M.D., a sleeping disorder expert and professor of psychiatry at the University of Pittsburgh School of Medicine, told Psychiatric News that though hypnotic drugs are “are efficacious for the treatment of insomnia...they can have short-term and possible long-term side effects. These drugs are statistically associated with increased mortality risk, but retrospective cohort studies cannot completely control for potential confounds, such as severity of illness and multiple comorbidities." Buysee emphasized that psychiatrists, along with their patients, should carefully consider the pros and cons before prescribing such medications and should monitor side effects regularly once the patient begins taking the medication.

To read about diagnosis and treatment of anxiety and sleep disorders, see the Psychiatric News articles, "DSM-5 Sleep-Wake Disorders Section Targets Comorbidity" and "DSM-5 Updates Depressive, Anxiety, and OCD Criteria."

(Image: PhotoSGH/

Friday, April 4, 2014

APA Unveils Report on Cost-Effectiveness of Integrated Care

“The key to the sauce of health care reform is mental health, and the key ingredient in that sauce is integrated care,” said APA President Jeffrey Lieberman, M.D. (at right in photo), opening a press briefing and roundtable discussion sponsored by APA this morning in Washington, D.C., on “Integrated Primary and Mental Health Care: Reconnecting the Brain and the Body.”

The event marked the release of a new report, “The Economic Impact of Integration: Implications for Psychiatry,” by the international actuarial firm Milliman Inc. That report found that general medical costs for patients who have behavioral health disorders are 2-3 times higher than for those without behavioral illness. In fact, the additional health care costs incurred by people with behavioral comorbidities were estimated to be $293 billion in 2012. Effective integration of medical and behavioral care could save $26 billion to $48 billion annually in general health care costs, according to the report. The report considers commercial, Medicare, and Medicaid patient populations and includes utilization and cost data from millions of patients. Moreover, it compares data from those with both chronic medical conditions and behavioral conditions with data from those with only chronic medical conditions.

“Mental illness is important not only because of the pain and suffering it causes, but because it is too large to ignore,” said APA President-elect Paul Summergrad, M.D. (at left in photo) at the press conference.

The event brought together leaders in the movement toward integrated and collaborative care who emphasized that a key to addressing rising costs in American health care is integrated care that addresses the mental health needs of patients in primary care, as well as the primary care needs of those in specialty mental health settings. Speakers included Michael Hogan, Ph.D., former commissioner of the New York State Office of Mental Health; John O’Brien, senior policy advisor at the Centers for Medicare and Medicaid Services; Michael Shoenbaum, Ph.D., senior advisor for mental health services, epidemiology, and economics at NIMH; Elinore McCance-Katz, M.D., chief medical officer at SAMHSA; Henry Chung, M.D., medical director for the Montefiore Accountable Care Organization; Frank deGruy, M.D., professor and chair of the Department of Family Medicine at the University of Colorado School of Medicine; and Keris Myrick, Ph.D., M.B.A., president of the National Alliance on Mental Illness.

“Together we believe we can reunite the brain and the body,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “Now is the time to do it.”

(Image: David Hathcox)

FDA Approves Hand-Held Device to Rapidly Reverse Opioid Overdose

Yesterday, the Food and Drug Administration approved Evzio, a naloxone hydrochloride auto-injector, for emergency treatment of opioid overdose outside of hospital settings.

"Over the past 10 to 15 years we have been experiencing a staggering epidemic of opioid overdose deaths," Petros Levounis, M.D., M.A., chair of psychiatry at Rutgers New Jersey Medical School and a member of the APA Council on Addiction Psychiatry, said in an interview with Psychiatric News. "The approval of a naloxone auto-injector....will make a big difference in saving lives. It essentially gives patients, their friends, and their families the power to instantaneously reverse a near-fatal event."

Evzio, which is injected into the muscle or under the skin, rapidly delivers a single dose of naloxone equivalent to a single dose of naloxone injection from a standard syringe. Evzio injections can be easily administered by family members or caregivers of those with opioid addiction. Once the auto-injector is turned on, it provides verbal instructions to the user describing how to deliver the medication, similar to automated defibrillators. The FDA recommends that caregivers of people known to abuse opioids become familiar with the instructions or practice with a device trainer before use of the auto-injector is needed.

The FDA, which placed the device in its fast-track approval process, emphasizes that Evzio is not a substitute for immediate medical care and that the person administering Evzio should seek immediate medical attention on the patient’s behalf. Repeated Evzio injections may be needed, since naloxone may not work as long as opioids.

For more detailed information about the FDA's approval of Evzio, click here. To read more about attempts to address the epidemic of opioid abuse, see the Psychiatric News article, "Medication Shows Promise in Treating Opioid Painkiller Addiction."

Thursday, April 3, 2014

Vice President Joe Biden to Speak at APA Annual Meeting

Vice President Joe Biden will address APA's 167th Annual Meeting in New York City on Monday, May 5. He will deliver the William C. Menninger Memorial Convocation Lecture at 2 p.m. at the Javits Convention Center in Hall 3E, Level 3.

“We are delighted that Vice President Biden will join us at the APA Annual Meeting to address the psychiatric community on the important issues of how our country can best care for persons with mental illness and addictions,” said APA President Jeffrey Lieberman, M.D.

APA’s annual meeting runs from Saturday, May 3, to Wednesday, May 7.

“Vice President Joe Biden has been a long-time supporter of the importance of psychiatric research and access to care, and has been a leading voice on reducing the stigma of mental illness and bringing an end to the suffering it has caused," said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We are honored that the Vice President has agreed to present the keynote lecture at this year’s annual meeting.”

Biden graduated from the University of Delaware and Syracuse Law School and served on the New Castle County Council. Then, at age 29, he became one of the youngest people ever elected to the United States Senate. As a Senator from Delaware for 36 years, Senator Biden established himself as a leader on some of our nation's most important domestic and international challenges. As Chairman or Ranking Member of the Senate Judiciary Committee for 17 years, then-Senator Biden was widely recognized for his work on criminal justice issues including the landmark 1994 Crime Bill and the Violence Against Women Act. He has been at the forefront of issues and legislation related to terrorism, weapons of mass destruction, post-Cold War Europe, the Middle East, and Southwest Asia.

Now, as the 47th Vice President of the United States, Joe Biden has continued his leadership on important issues facing the nation. The Vice President was tasked with implementing the American Recovery and Reinvestment Act, helping to rebuild our economy and lay the foundation for a sustainable economic future. As part of his continued efforts to raise the living standards of middle-class Americans across the country, Vice President Biden has also focused on the issues of college affordability and American manufacturing growth, key priorities of the Administration.

Friday, April 4, is the last day to register for APA's annual meeting at advance registration rates. To register, click here.

For the latest news about APA's annual meeting, follow @APAPsychiatric and #APAAM14.


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