Thursday, June 30, 2011

Supportive Text Messages Help Smokers Kick the Habit

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In a study posted online today in The Lancet, researchers from the London School of Hygiene and Tropical Medicine report that smokers who received mobile phone text messages encouraging them to quit were more successful than those who did not. In a single-blind, randomized trial in the United Kingdom, 5,800 smokers willing to make a quit attempt were randomly allocated, using an independent telephone randomization system, to a mobile phone text messaging smoking cessation program (txt2stop), comprised of motivational messages and behavioral-change support, or to a control group that received text messages unrelated to quitting. The primary outcome was self-reported continuous smoking abstinence, biochemically verified at six months. Abstinence at six months was significantly increased in the txt2stop group.

Depression can make it significantly harder for smokers to quit. Read more about smoking and depression in Psychiatric News at http://pn.psychiatryonline.org/content/45/11/6.1.full.

Appeals Court Says Individual Insurance Mandate Is Constitutional

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A federal appeals court in Cincinnati upheld the constitutionality of a key part of the health care reform law yesterday, ruling that the “individual mandate” requirement that all Americans purchase health insurance is legal. This was the fourth federal court to find the law constitutional; two other courts have ruled that Congress exceeded its powers in passing the law.

In the case decided yesterday, which was brought by Ohio officials, a panel of three judges voted 2-1 in favor of the mandate, with one of the supporting votes being cast by Judge Jeffrey Sutton, an appointee of former President George W. Bush, who stated that “Not every intrusive law is an unconstitutionally intrusive law.”

Both proponents and opponents of the health care reform law expect the Supreme Court to be the final arbiter of the law's constitutionality.

To read more coverage of the health care reform law, see Psychiatric News at http://pn.psychiatryonline.org/content/46/1/11.1.full and http://pn.psychiatryonline.org/content/46/10/17.1.full.

Wednesday, June 29, 2011

Suicide Prevention Study Finds Surprising Results

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The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) used a care-management approach to treat depression. In the trial, doctors adhered to special treatment protocols, and trained care managers followed up with patients. Overall results have been good, but investigators hoped the trial might also reduce disparities between white and minority populations.

Now Yuhua Bao, Ph.D., of the Department of Public Health at Weill Cornell Medical College, and colleagues, report in the June Archives of General Psychiatry that racial and ethnic minorities had worse outcomes than their non-Hispanic white peers. However, they also noted that, regardless of race or ethnicity, less-educated patients benefited more from the PROSPECT intervention than did patients with a college education. “Adding culturally tailored strategies to collaborative depression care management models may be needed to extend their benefits to minority patients,” the researchers emphasized.

Read more about the PROSPECT project in Psychiatric News at
http://pn.psychiatryonline.org/content/46/10/9.2.full.

Bipolar Patients Have Equal Educational Attainment

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Norwegian researchers compared groups of patients with bipolar disorder with a sample from the general population to see if having the illness affected educational achievement.

The researchers from the psychiatric division of Stavanger University Hospital recruited 252 individuals diagnosed with bipolar disorder from acute care hospital wards and 230 from outpatient clinics. They compared these patients with 100,869 people in the general population.

Patients from the acute ward had more severe illness, but both they and the outpatients had similar levels of educational achievement as the general population, wrote Helle Schoeyen, and colleagues in the July Journal of Affective Disorders. This held true for people aged less than 45. But patients with bipolar disorder aged 45 to 80 actually had higher levels of education than the general population. However, the bipolar patients were more likely to be unmarried and to receive disability benefits than the control group.

“These findings emphasize the importance of early identification and adequate follow-up treatment of [bipolar disorder] throughout the life span in order to prevent a decline in social and occupational function,” wrote the researchers.

For more about how individuals with bipolar disorder can succeed in life, see Psychiatric News:
http://pn.psychiatryonline.org/content/46/10/16.1.full.

Tuesday, June 28, 2011

Largest Physician Organization Backs Same-Sex Marriage

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At its annual meeting last week in Chicago, the AMA added its voice to the chorus of medical organizations, including APA, that have adopted policies supporting the right of same-sex couples to marry and highlighting the health-related consequences of denying them this right. The AMA emphasized that denying the right of civil marriage "imposes harmful stigma on gay and lesbian individuals and couples and their families" and "contributes to health care disparities affecting same-sex households." The AMA also went on record vowing to support measures "providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits as afforded opposite-sex households." The AMA has in recent years adopted several policies that address the needs and rights of gay and lesbian physicians, medical students, and patients.

To read more about how bias against gay, lesbian, bisexual, and transgendered individuals affects mental health, see Psychiatric News at http://pn.psychiatryonline.org/content/46/9/9.2.full, http:/pn.psychiatryonline.org/content/46/11/17.2.full, and
http://pn.psychiatryonline.org/content/45/7/14.2.full.

States Barred From Restricting Violent Video Games

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The U.S. Supreme Court on Monday issued a key ruling that disappointed parents and others who thought it was a good idea for states to pass laws restricting minors' access to extremely violent video games. A 7-2 majority of the justices overturned as a violation of the First Amendment's free-speech rights a California law that prohibited the sale or rental of video games to youth aged 17 and younger if those games gave players options that included "killing, maiming, dismembering, or sexually assaulting an image of a human being."

Writing for the majority, Justice Antonin Scalia said, "Like the protected books, plays, and movies that preceded them, video games communicate ideas--even social messages--through many familiar literary devices...and through features distinctive to the medium." He also maintained that none of the studies that have linked violent video games with aggressive behavior in youngsters were able to convincingly prove that link. In his dissent, Justice Steven Breyer had cited those studies as a reason to uphold the California law. Read more about the potential mental health consequences of violent video games in Psychiatric News at http://pn.psychiatryonline.org/content/45/16/22.1.full

Monday, June 27, 2011

U.S. Urged to Invest More in Alzheimer's Research

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According to a June 24 Reuters report, board members of Alzheimer's Disease International have urged Congress to invest more money in Alzheimer's disease research. The rationale, the board members claimed, is that as the world population ages, more and more people are going to be diagnosed with Alzheimer's, and effective treatments and preventatives will be needed more than ever.

Meanwhle, a lot of Alzheimer's research is already under way and might possibly bear fruit regarding Alzheimer's treatments or preventatives.

For example, scientists reported in the March Archives of Neurology that cognition has already declined sharply five to six years before Alzheimer's disease is usually diagnosed. So if an effective treatment for Alzheimer's is going to be found, it may be necessary to apply it at this very early stage. More information about that study can be found in Psychiatric News. See http://pn.psychiatryonline.org/content/46/9/18.2.full.

More Insights Into the Genetic Basis of Crime

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According to an article in the June 19, 2011, New York Times, it was less than two decades ago that the National Institutes of Health withdrew funds from a conference on the genetics of crime after some people complained that the idea smacked of eugenics. But since the human genome was sequenced a decade ago, scientists and criminologists are returning to the subject. For example, the most severe type of antisocial behavior has its onset in childhood and is usually accompanied by attention-deficit/hyperactivity disorder (ADHD). Furthermore, this antisocial behavior subtype has been linked with a particular variant of a so-called COMT gene. Thus it looks as if the variant may contribute to the antisocial behavior displayed by youth who have the subtype.

But how might the variant lead to antisocial behavior in such youngsters? By impairing social understanding, scientists from the United Kingdom recently found. And this finding may have important implications for treatment and prevention of antisocial behavior in children who both have ADHD and who engage in such behavior, the scientists believe.

More information on this study of antisocial behavior and its implications can be found in Psychiatric News at http://pn.psychiatryonline.org/content/46/2/25.2.full.

Friday, June 24, 2011

AMA Responds to Florida Gun Communication Law

Credit: Nikola Bilic
The AMA is a vigorous defender of the physician-patient-family relationship and opposes state or federal efforts to interfere in the content of communication in clinical care delivery between clinicians and patients. Thus, the AMA plans to support litigation that may be necessary to block the implementation of newly enacted state or federal laws that restrict the privacy of physician-patient-family relationships or that violate the First Amendment rights of physicians in their practice of the art and science of medicine. That’s what the AMA House of Delegates said at this year’s annual policymaking meeting in Chicago in June.

The resolution is in response to a controversial new Florida law that restricts what physicians are allowed to discuss with patients about gun ownership. Florida psychiatrists and other physicians have voiced strong concerns about how this would interfere with a potentially important element of the doctor-patient relationship, since this type of knowledge can be crucial in preventing accidental, or even deliberate, injuries or deaths. For coverage of the AMA meeting look to upcoming editions of Psychiatric News, and for more information about the Florida law see Psychiatric News at http://pn.psychiatryonline.org/content/46/5/16.3.full.

AMA Sticks by Policy Requiring Individuals to Purchase a Minimum Level of Health Insurance

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The AMA's House of Delegates reaffirmed its support for policy that would require individuals to purchase a minimum level of catastrophic and preventive health insurance as part of overall health insurance reform aimed at achieving universal access to health care. The vote took place at the AMA's annual policymaking meeting this past week in Chicago.

More than 60 percent of the House’s 480-plus delegates voted in favor of the report reaffirming the policy, but the minority—comprised primarily of delegates from southeastern states and from surgical specialties—brought to the debate an intensity that mirrors that surrounding the provisions within the Patient Protection and Affordable Care Act (the health care reform law)requiring individuals to purchase insurance. Look for extensive coverage of the AMA's June meeting in upcoming issues of Psychiatric News.

For more information about the AMA policy on health care reform, see Psychiatric News at http://pn.psychiatryonline.org/content/45/24/4.2.full.

Thursday, June 23, 2011

A Warm Mom Beats the Chill of Poverty


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 Genes and molecules now confirm that having a nice mother when you’re poor can be good for your health, say researchers from the University of British Columbia and the University of California at Los Angeles.

They evaluated biomarkers of inflammation and immune activation in 53 people, ages 25 to 40, who grew up in poor families. Those whose mothers expressed warmth toward them showed less production or activity of three pro-inflammatory factors, compared with those who grew up in similar settings but whose mothers treated them with less warmth, said the researchers, in July issue of Molecular Psychiatry.

The idea that family support may protect people under adversity from poor health outcomes is not new, but little is known about possible biological mechanisms linking the two. This study suggests the possibility that the detrimental immunologic effects of low socioeconomic environments early in life may be partly offset by life in a supportive family.

For more on parenting and how it can affect children's mental health, see Psychiatric News,
http://pn.psychiatryonline.org/content/46/8/26.1.full.

Protein Analysis Narrows Diagnosis of Alzheimer's Disease

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Ordinarily, Alzheimer’s disease can only be diagnosed after death. Scientists have been searching for biomarkers to diagnose or even predict the illness, with only modest success. Now, German researchers writing in the journal Neurology have measured the concentration of several proteins in cerebrospinal fluid that further characterize Alzheimer’s and differentiate it from other forms of dementia.

Robert Perneczky, M.D., and colleagues from the Technical University Munich collected samples from 58 patients with mild cognitive impairment and followed them for  three years. Patients with mild cognitive impairment who later progressed to having Alzheimer’s disease had significantly higher concentrations of soluble amyloid precursor protein-β (sAPPβ) than similar patients who did not get Alzheimer’s disease or patients with frontotemporal dementia. A combination of sAPPβ, tau (another protein), and age differentiated the mild cognitive impairment patients with Alzheimer’s from those who never got Alzheimer’s, with a sensitivity of 80 percent and a specificity of 81 percent. In addition, a model using the sAPPβ and tau proteins differentiated Alzheimer’s and the frontotemporal dementia groups with a sensitivity of 95 percent and a specificity of 81 percent.

Read more on the role of proteins in Alzheimer’s disease in Psychiatric News at
http://pn.psychiatryonline.org/content/46/9/18.1.full.

Wednesday, June 22, 2011

Antidepressants Reduce Suicide Attempts

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The Journal of Clinical Psychiatry recently published a 27-year longitudinal observational study of antidepressants and risk of suicide attempts. The study sample included 757 participants at 5 U.S. academic medical centers who enrolled from 1979 to 1981 during an episode of mania, depression, or schizoaffective disorder. The risk of suicide attempts or suicides was reduced by 20 percent among participants taking antidepressants, thus antidepressants were associated with a significant reduction in the risk of suicidal behavior.

In England, a multipronged National Suicide Prevention Strategy has resulted in a reduced number of suicide attempts. Read more about it in Psychiatric News at http://pn.psychiatryonline.org/content/46/1/8.2.full.

Mental Health Benefits of Coming Out Depend on Context

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A recently published study has examined the mental health effects of disclosing one’s identity as lesbian, gay, or bisexual (LGB) in different social contexts. In the online June 20 issue of Social Psychological and Personality Science, researchers at the Department of Clinical and Social Sciences in Psychology, University of Rochester in Rochester, New York and the Department of Psychology at the University of Essex in Essex, United Kingdom, performed an online survey of 161 anonymous participants who identified themselves as lesbian, gay, or bisexual. They asked participants to complete measures of the same predictor and outcome variables across five possible social contexts in their lives: friends, family, coworkers, school, and religious community. Their findings supported the potential value of coming out, but somewhat conditionally, as individuals who disclosed more tended to experience greater wellness only in a supportive atmosphere. Disclosing in controlling social contexts was not associated with these positive emotional outcomes.

“This research has implications for practitioners providing treatment to LGB individuals because it suggests that people experience greater wellness when they come out in certain contexts, but certainly not all contexts,” said the researchers. See Psychiatric News for another recent study of the mental health of LGB youth: http://pn.psychiatryonline.org/content/46/2/6.1.full.

Tuesday, June 21, 2011

Psychiatrists Elected to Influential AMA Posts

Patrice Harris, M.D.
 Jolene Butts Freeman
Two psychiatrists and APA members won election to key positions at the AMA on Tuesday. Patrice Harris, M.D., was elected to the AMA Board of Trustees in her first run for a Board seat, an unusual achievement at the AMA. She has served as a member of the AMA Women Physicians Congress and chaired the AMA Council on Legislation. She has also been president of the Georgia Psychiatric Physicians Association and was the founding president of that district branch's political action committee. She commented after learning of her election victory that her vision for the AMA "is physicians working together for a healthier future, a healthier practice environment, a healthier population, and a healthier collaboration with the federation of medicine."

Former APA President and Assembly Speaker John McIntyre, M.D., won election to a second term on the AMA's influential Council on Medical Service. That council develops and forwards to AMA's policymaking House of Delegates socioeconomic-related policies, such as those involving health care reform and access-to-care issues, that impact the practice of medicine. Harris and McIntyre add significantly to psychiatry's influence at the AMA, following closely on the heels of the election of psychiatrist Jeremy Lazarus, M.D., as AMA president-elect.

Read more about Harris and McIntyre in Psychiatric News at http://pn.psychiatryonline.org/content/46/10/8.2.full and http://pn.psychiatryonline.org/content/46/10/8.3.full.

Cutting-Edge Technology Could Change Mental Health Field

Nikolaos Papanikolopoulos, Ph.D., et al.
On June 14, The Wall Street Journal profiled an 87-year-old man named Milton Greidinger, a homebound retiree. He was participating in a pilot virtual reality program for seniors that aims to help elderly New Yorkers living alone combat isolation and depression through modern technology.

Modern technology is being explored to benefit people's mental health in other ways as well. For example, University of Minnesota scientists are using some of the latest computer software technology to see whether there are differences in movements between children who remain healthy and those who will later develop a psychiatric disorder. Once a set of movement patterns that are associated with common childhood psychiatric disorders is established, the next step will be to conduct longitudinal studies to confirm whether such abnormalities represent risk markers for later development of psychiatric illness.

More information on the use of computer software technology to evaluate differences in movement between children who are healthy and those who may develop a psychiatric disorder can be found in Psychiatric News at http://pn.psychiatryonline.org/content/46/9/22.1.full.

Monday, June 20, 2011

Psychiatrist to Become Next President of the AMA

Jeremy Lazarus, M.D.
Psychiatrist Jeremy Lazarus, M.D., was elected Saturday as president-elect of the AMA. Lazarus, speaker of the AMA House of Delegates and a past speaker of the APA Assembly, is only the second psychiatrist to be president of the AMA. The first was Rock Slyester, M.D., who was installed as the 93rd president of the AMA on May 16, 1939.

Lazarus, who ran unopposed for president-elect, is a private-practice psychiatrist in Denver and was reelected speaker of the AMA House of Delegates in June 2010, after having served as vice speaker from 2003 to 2007. He is a past president of the Colorado Medical Society, Colorado Psychiatric Society, and the Arapahoe County Medical Society. He serves as chair of the AMA Board of Trustees (BOT) Compensation Committee and as a member of the AMA-BOT Executive and Finance committees. Representing the AMA on the Health Coverage Coalition for the Uninsured and the Ride for World Health, he has been one of the AMA's chief spokespersons on issues involving the uninsured. Read more about Lazarus and psychiatrists' involvement in policymaking at the AMA in Psychiatric News at http://pn.psychiatryonline.org/content/46/11/3.1.full and http://pn.psychiatryonline.org/content/46/10/8.1.full.

Could Stifling Summer Heat Be Increasing Suicide Risk?

Dawn Johnston/istockphoto
As American weather seems to be becoming more extreme, with dramatic snowstorms, countless tornadoes, and stifling heat, there is little doubt that it is affecting Americans' mental health. For example, the recent numerous tornadoes have left many homeless and psychologically traumatized.

But if air pollution is added to the weather mix, the mental health impact may be particularly toxic, an intriguing new study suggests. The scientists linked suicides not just with extreme temperatures and barometric pressure, but with air pollutants such as particulate matter, sulfur dioxide, and ozone. This study is both "fascinating" and troubling, Lise Van Susteren, M.D., a Washington, D.C. psychiatrist and environmental activist, told Psychiatric News. For more information, see Psychiatric News at http://pn.psychiatryonline.org/content/46/12/32.1.full.

Friday, June 17, 2011

AMA House of Delegates Meets This Weekend

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The 2011 Annual Meeting of the American Medical Association House of Delegates begins tomorrow in Chicago. The House of Delegates is the policy-making body of the AMA, bringing together an inclusive group of physicians and medical students representing every state and specialty. More than 200 policy proposals will be considered on emerging issues in science, ethics, government, public health and business. In addition, a number of APA member psychiatrists are running for elective office at the meeting, including Jeremy Lazarus, M.D., currently the Speaker of the House, who is running unopposed for President of the AMA. Also running for office are Patrice Harris, M.D., a candidate for the Board of Trustees, John McIntyre, M.D., who is running for re-election to the AMA’s Council on Medical Services, and Stuart Gitlow, M.D., who is a candidate for re-election to the Council on Science and Public Health. For more information, see Psychiatric News, http://pn.psychiatryonline.org/content/46/11/3.1.full.

MedPAC Urges SGR Reform

Agnieszka Guzowska/Shuttestock
A report issued Wednesday by the Medicare Payment Advisory Commission (MedPac), “Medicare and the Health Care Delivery System,”   is urging significant reforms to the way physicians are paid under the Medicare program, including a variety of options for replacing the Sustainable Growth Rate component of the current formula. That component, which requires that increases in Medicare volume be compensated for by decreases in physician payment, would mandate an across-the-board cut in physician payment of 21 percent on January 1, 2012. An earlier report by MedPAC in April urged Congress to rescind the scheduled payment cut and replace it with an increase in payment of one percent. For more information see Psychiatric News, http://pn.psychiatryonline.org/content/46/8/6.2.full.

Thursday, June 16, 2011

Migraine and PTSD Affect Men and Women Differently

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Although both migraine headaches and posttraumatic stress disorder (PTSD) are more prevalent in women than men, men may have greater odds of suffering from migraine and PTSD together, according to a study recently posted online in Headache: The Journal of Head and Face Pain. The mechanism for this association is not known, but the age of a patient at the time of a traumatic life event resulting in PTSD may be an important factor for the sex differences. The two most common traumatic events reported by migraineurs with PTSD—transportation accidents and combat—are likely to occur after the age of 12.

As thousands of U.S. troops return home with PTSD, understanding the association between PTSD and migraine may be a key to helping them recover their health and mental well-being.

Read more about “What Works” in PTSD care, in Psychiatric News: http://pn.psychiatryonline.org/content/46/7/4.1.full.

Smoking Linked to Depression, Risk for Suicide

Grandpa/Shutterstock
Researchers at the Washington University School of Medicine’s Department of Psychiatry recently carried out genetic linkage analyses of DSM-IV-diagnosed major depressive disorder in two samples that are part of the Nicotine Addiction Genetics project, an international consortium focused on tobacco dependence. “We used an affected sibling-pair design, in which at least two adult offspring per family reported a history of DSM-IV major depressive disorder, and tested for linkage,” said the group in its report. “Results appear to confirm a genome-wide significant linkage signal at chromosome 3p25-3p26.” The authors note that their finding, in light of previous studies, raises the possibility of common genetic influences across major depressive disorder and smoking-related behavior, or of gene-by-environment (i.e., smoking) interaction effects on major depressive disorder.

Nicotine dependence has been identified as a risk factor for suicide attempts. Read more about it at http://pn.psychiatryonline.org/content/46/3/16.2.full.

Wednesday, June 15, 2011

African-American Teens More Apt to Use School-Based Services

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School-based mental health services are valuable because they place the point of care where the children are. Now a new study of 796 middle school students in a small city in Louisiana finds that African-American students are more likely than their white classmates to make use of those school-based systems.

Researchers from the TeenScreen program at Columbia University in New York and York University in Toronto said that 45 percent of African-American students were identified by screening tests as being at risk, compared to 33 percent of white students. The study was published online in the Community Mental Health Journal.

When referred to services, both racial groups used community serves at equal rates. However, the African-American students were more likely (93 percent) to use school-based services than whites (76 percent).

Many mental disorders make their first appearance by age 14, and early screening and access to treatment may help minimize their severity. For more about the availability of mental health care for children and adolescents, see Psychiatric News at http://pn.psychiatryonline.org/content/46/8/25.full

New Support Group for Spouses of Injured Military Troops

Diane Garcia/Shutterstock
A psychiatrist at Walter Reed Army Medical Center in Washington has organized a support group for the spouses of U.S. military personal coping with traumatic brain injury or posttraumatic stress disorder.
U.S. Army Col. Charles Engel, M.C., director of the Deployment Health Clinical Center, set up the program. The armed services are only now coming to grips with the effects that brain injuries and PTSD can have on families.

“We've been at war for a decade at this point and on some level even for those of us who are in it, it’s sort of shocking that we continue to learn as we go,” Engel told CBS News.

For the moment, the support group is a pilot program and open to only 12 persons at a time.

Read more about programs to help military families in Psychiatric News at:
http://pn.psychiatryonline.org/content/46/10/1.2.full

Tuesday, June 14, 2011

Florida M.D.s Go to Court Over Gun-Control Law

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A group of Florida physicians opposed to a controversial new state law that muzzles what they are allowed to discuss with patients about gun ownership is hoping that a court will overturn the law and rule that it interferes with their free-speech rights.

The law at issue is actually a toned-down version of an earlier proposal that would have permitted both criminal penalties and multimillion-dollar fines to be imposed on physicians who ask patients or patients' family members about gun possession or the presence of guns in the home. Florida psychiatrists and other physicians voiced strong concerns about how this would interfere with a potentially important element of the doctor-patient relationship, since this type of knowledge can be crucial in preventing accidental, or even deliberate, injuries or deaths. While the state's leading newspapers joined physicians in opposition, both houses of the Florida legislature passed the bill by wide margins, though with language that was not as restrictive as the orignial version. The compromise allows physicians to ask about gun ownership only if this information "is relevant to the patient's medical care or safety or the safety of others." The most severe penalties were also removed, though physicians can be reported to the state medical board if they are accused of violating the law.

Read more about the Florida gun law and psychiatrists' reaction to it in Psychiatric News at http://pn.psychiatryonline.org/content/46/5/16.3.full and http://pn.psychiatryonline.org/content/46/10/15.1.full.

Disaster Psychiatry Book Provides Valuable Roadmap for Clinicians

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A new book from American Psychiatric Publishing Inc. (APPI) provides clinicians with a comprehensive exploration of what to expect regarding mental health sequelae after a manmade or natural disaster strikes. With psychiatrists playing an ever-increasing role in the aftermath of disasters, Disaster Psychiatry: Readiness, Evaluation, and Treatment is a practical guide to help them and other mental health professionals respond rapidly and effectively.

Edited by Frederick Stoddard Jr., M.D., Anand Pandya, M.D., and Craig Katz, M.D., the book reviews postdisaster evaluations for a range of psychiatric disorders that responders will confront; psychotherapies and pharmacotherapies that have proven effective; interventions with groups, families, and children; legal and ethical issues; and the importance of self-care for disaster responders, along with other crucial topics. The book can be ordered at http://www.appi.org/. Read more about psychiatric intervention after disasters in Psychiatric News at http://pn.psychiatryonline.org/content/46/11/1.1.full and http://pn.psychiatryonline.org/content/45/15/26.full.

Monday, June 13, 2011

Longevity Is Mixed Blessing for People With HIV

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Thanks to effective treatment, HIV-infected patients are living much longer than they used to. Their life expectancy at age 20 increased from nine years in the period 1993-1995 to 24 years in 2002-2004. Today people who are newly infected with HIV may even be capable of achieving a normal lifespan if they rigorously adhere to HIV treatment.

But this longevity is a mixed blessing. For as the Associated Press reported on June 12, three decades after the first diagnosis of HIV, doctors are seeing signs of premature or accelerated aging such as memory loss, arthritis, kidney failure,and high blood pressure in HIV survivors in their 40's and 50's.

The good news, however, is that researchers are trying to get at the causes of such premature or accelerated aging—for instance, is it due to HIV, to the drugs used to treat it, or to both—and to find effective ways of dealing with it.

More information on this subject can be found in the March 4,2011 Psychiatric News : http://pn.psychiatryonline.org/content/46/5/18.1.full.

There Are More Older Male Binge Drinkers Than You Might Think

Rob Bouwman/Shutterstock
Although people tend to think of binge drinking as being a young male problem, actually quite a few middle-aged and older men are binge drinkers as well – 16 percent, in fact, according to a study reported in the May Journal of Clinical Psychiatry.

Moreover, the middle-aged and older male binge drinkers were found to have significantly more alcohol abuse disorder or alcohol dependence disorder than middle-aged men who drank alcohol, but did not binge.

Furthermore, some of these men may need professional help for their alcohol problem, but not realize that, in addition to programs such as Alcohol Anonymous, several medications are on the market that can counter alcohol craving or use. More information on this  subject can be found in Psychiatric News  at http://pn.psychiatryonline.org/content/45/23/34.1.full and http://pn.psychiatryonline.org/content/45/23/34.2.full

Friday, June 10, 2011

Alzheimer's Advances Reported

Kheng Guan Toh/Shutterstock
A report in Nature Communications published yesterday shows that two antibodies known to play a role in Creutzfeldt-Jakob disease (the human form of “mad cow disease”) could help block the onset of Alzheimer's disease in the brain. The study, entitled “Interaction between prion protein and toxic amyloid beta assemblies can be therapeutically targeted at multiple sites” showed that these antibodies, known as ICSM-18 and ICSM-35, can block damaging effects on brain tissue caused by amyloid beta, the accumulation of which disrupts neuronal communication and causes memory loss. Meanwhile, the current issue of Psychiatric News reports on new guidance from National Institute on Aging and the Alzheimer's Association urging a three-staged approach to Alzheimers consisting of the preclinical stage, a “mild cognitive impairment phase,” and an “Alzheimer's dementia phase.” For more information see http://pn.psychiatryonline.org/content/46/11/1.2.full.

Japanese Orphaned by Quake, Tsunami Appeal for Mental Health Care Center

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The New York Times reports that four Japanese students recently orphaned by the March 11 quake and tsunami gathered yesterday at Times Square to solicit tourists and New Yorkers for money to build a mental health care center in the disaster-hit area.In addition to the four, two Americans and another Japanese orphaned by the 1995 Kobe earthquake joined forces, passing out Japanese packets of tissues and shouting "Help Japan!" to passersby who dropped coins and bills into donation boxes, according to the Times.

The fundraising activity was organized by the Tokyo-based nonprofit organization Ashinaga, which has been providing educational and psychological support to orphans worldwide. The funds raised would be earmarked for a facility, "Tohoku Rainbow House" in Sendai for children, like themselves, who lost loved ones in the disaster. Psychiatric News reports on efforts by Japanese psychiatrists and other mental health professionals to provide relief in the wake of the March disaster. For more information see http://pn.psychiatryonline.org/content/46/11/1.1.full.

Thursday, June 9, 2011

Another Diet Drug Raises Concerns

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Orexigen Therepeutics met with the FDA last week regarding Contrave, an investigational combination therapy of naltrexone and bupropion for the treatment of obesity and maintenance of weight loss. Although Orexigen has already evaluated Contrave in more than 4,500 patients, the FDA asked for a trial of between 60,000 and 100,000 patients showing that the drug doesn’t raise heart attack or stroke risk. Orexigen says it won’t pursue approval.

The risk vs. benefit ratio for most diet drugs leans toward risk, and the FDA’s reluctance to approve a new drug in this class may be due to experiences with previous diet drugs. Sibutramine (Meridia) was pulled from the market in October 2010 due to serious concerns about cardiovascular risks. Sibutramine continues to pose a threat to public health, however, by repeatedly surfacing in counterfeit and contraband formulations of over-the-counter weight loss and erectile dysfunction supplements.

To read more about sibutramine, see Psychiatric News at http://pn.psychiatryonline.org/content/46/9/23.full.

Serial Killer Behaviors Ritualistic, But Not Necessarily Consistent

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National attention has focused on Long Island this week, where new searches have taken place for possible victims of a serial killer. Remains of 10 bodies have been found there since December of 2010, four of them known prostitutes who advertised for clients on Craigslist. Investigators are faced with the question of whether all 10 are victims of the same killer; they believe two may be unrelated to the others. Forensic experts are analyzing remaining victims to find clues to link their cases. A 2010 study based on the records of 38 serial sexual killers and their 162 victims debunked the common belief that such killers engage in “signature” behaviors—identical ritualistic behaviors—at each crime scene.

For more on serial killer behavior, see Psychiatric News at http://pn.psychiatryonline.org/content/45/16/16.2.full.

Wednesday, June 8, 2011

Mental Illness Leading Cause of Youth Disability

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Young people are usually considered healthier than older people, but around the world, they lose years of their lives to disability, according to a recent study in The Lancet. Researchers used data from the World Health Organization’s 2004 Global Burden of Disease study.

The three main causes of years lost to disability in 10- to 24-year-olds were neuropsychiatric disorders—including mental illnesses and alcohol abuse. That proportion was far ahead of accidents (15 percent) and infectious and parasitic diseases (10 percent), the next leading causes of disability.

“The health of young people has been largely neglected in global public health,” concluded Fiona Gore, of the Department of Health Statistics and Informatics at the World Health Organization in Geneva, Switzerland, and colleagues. “The findings of this study suggest that adolescent health would benefit from increased public health attention.”

For more about mental health epidemiology among young people, see Psychiatric News at
http://pn.psychiatryonline.org/content/46/8/25.full.

Women as Resilient in Combat as Men

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Over the last decade, women in the U.S. armed forces have been increasingly exposed to combat in the wars in Iraq and Afghanistan. Women have historically higher rates of trauma-related consequences but little is known about how that applies to combat settings.

Based on a representative sample of returning women veterans, Dawn Vogt, M.D., an associate professor of psychiatry at Boston University School of Medicine, and colleagues now report that female service members deployed to the two war zones showed almost no negative associations with postdeployment mental health compared to men, and thus “may be as resilient to combat-related stress as men.”

For more about combat-related stress and its treatment, see Psychiatric News at http://pn.psychiatryonline.org/content/46/11/4.1.full.

Tuesday, June 7, 2011

Alcohol Dependence Linked to Mental Illness Severity

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 Adults with mental illness are four times more likely to develop alcohol dependency than adults without mental illness, according to a new study. It also showed that the rate of alcohol dependency increases as the severity of the mental illness increases. The report, by the federal government's Substance Abuse and Mental Health Services Administration (SAMHSA), found that while 7.9 percent of those with mild mental illness were alcohol dependent, 10 percent of those with moderate mental illness  were alchol dependent, as were 13.2 percent of those with serious mental illness.

"Co-occurring mental illness and substance use disorders are to be expected, not considered the exception," said SAMHSA Director Pamela Hyde, J.D., commenting on the study's findings. "Unfortunately, signs and symptoms of these behavioral health conditions are often missed by individuals, their friends, and family members and unnoticed by health professionals. The results can be devastating and costly to our society." For more on alcohol dependency and its treatment, see Psychiatric News at http://pn.psychiatryonline.org/content/46/7/16.1.full and http://pn.psychiatryonline.org/content/45/6/10.2.full.

Gay, Bisexual Youth More Apt to Engage in Risky Behavior


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 A huge survey of more than 150,000 adolescents by the Centers for Disease Control and Prevention (CDC) finds more reasons to be concerned about the mental--and physical--health of teens who identify as gay, lesbian, or bisexual. The survey found that these youth are more likely than their heterosexual peers to take part in risky behaviors such as drinking, smoking, refusing to wear a helmet while bicycling, purging to lose weight, and attempting suicide.

 Howell Wechsler, head of the CDC's Division of Adolescent and School Health, was quoted as saying in response to the findings that the report "should be a wake-up call for families, schools, and communities that we need to do a much better job of supporting these young people.... Any effort to promote adolescent health and safety must take into account the additional stressors that these youth experience because of their sexual orientation, such as stigma, discrimination, and victimization." Read more about mental health issues in gay youth at Psychiatric News at http://pn.psychiatryonline.org/content/46/9/9.2.full and http://pn.psychiatryonline.org/content/46/11/17.2.full.

Monday, June 6, 2011

Keeping a Straight Face Isn't the Answer

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There's a song that goes, "You can tell by the lines in my smile that I have been around for awhile." Apparently laugh lines can now tell us far more than how long someone has been hanging around the planet. A study presented today at the Endocrine Society meeting in Boston found an association between the depth of wrinkles on the face and neck of postmenopausal women and bone density: women with worse wrinkles had lower bone density than women with smoother faces. 

But don't worry--researchers are not recommending keeping a straight face to avoid low bone density. The healing and mood-elevating power of laughter is well known, as shown in a study reported last year by Psychiatric News. Patients with treatment-resistant obsessive-compulsive disorder were being implanted with a deep brain stimulation device when it was noticed that they began to smile or laugh. Researchers found that the more patients had laughed upon stimulation, the fewer symptoms they had two years later. For more information, see http://pn.psychiatryonline.org/content/45/11/16.2.

Melvin Sabshin, M.D., Former APA Medical Director, Dies

Melvin Sabshin, M.D., APA medical director from 1974 to 1997, died Saturday, June 4 in London, England, where he had been living since his retirement. During his tenure as medical director, Sabshin led the APA and American psychiatry through enormous changes. Among his most important achievements, detailed in his 2008 book Changing American Psychiatry (published by APPI), was to help move psychiatric diagnosis and treatment toward a more empirical, evidence-based nosology. Sabshin was also a pivotal figure in the confrontation with the Soviet Union over abuse of psychiatry during the Cold War. Psychiatric News published a three-part series about that historic confrontation. For more information see http://pn.psychiatryonline.org/content/45/21/6.1.full, http://pn.psychiatryonline.org/content/45/22/11.1.full, and http://pn.psychiatryonline.org/content/45/23/9.1.full.

Friday, June 3, 2011

Medication May Help PTSD Patients Recall
Fewer Negative Memories

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A study posted online May 18 in the Journal of Clinical Endocrinology and Metabolism suggests that blocking cortisol could be an effective treatment for posttraumatic stress disorder. The cortisol was blocked by metyrapone, a drug used in the diagnosis of adrenal insufficiency and occassionaly Cushing's syndrome. Researchers found that four days after administration of metyrapone, subjects had far less recall of negative emotional components of a story shown in a video.

Psychiatric News previously reported on another drug that may be useful for the treatment of PTSD--morphine. Researchers found that administering morphine immediately following injury or during resuscitation or early trauma care led to significantly less risk of PTSD. For more information, see http://pn.psychiatryonline.org/content/45/5/14.2.full.

AMA Submits Comments on Accountable Care Organizations

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The American Medical Association (AMA) today submitted comments to the Centers for Medicare and Medicaid Services (CMS) on their proposed rule on Medicare Accountable Care Organizations (ACOs). The AMA supports developing and testing ACOs as one of an array of payment and delivery innovations, but it has urged CMS to make significant changes to the proposed rule to allow all interested physicians to lead and participate.
  “A well-developed ACO model has the potential to improve care coordination and quality while promoting cost savings, and to help ensure success the AMA has asked CMS to make numerous revisions and to issue an interim final rule that allows the flexibility to adapt as needed,” said AMA President Cecil B. Wilson, M.D., in a statement.
  The AMA offered constructive changes to the proposed payment and risk structure of ACOs to encourage participation by physicians in all practice sizes, including providing a payment option that does not require shared loss and allowing groups to receive a percentage of all savings achieved. “Forming an ACO requires significant resources for a physician practice, and CMS must allow those who take this risk to fully share in the benefits from day one,” Wilson said.
  The AMA House of Delegates last year approved its own principles for ACOs, and the subject will be a major focus at this month’s policymaking meeting in Chicago. For more information, see Psychiatric News, http://pn.psychiatryonline.org/content/46/9/4.3.full

Thursday, June 2, 2011

Serious Mental Illness and Early Mortality

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Individuals with serious mental illness (SMI) were found to have lost between 8 and 17.5 years of life, according to a study of life expectancy in a cohort of over 31,000 people with SMI in England. The results show that the impact of serious mental illness on life expectancy is marked and generally higher than similarly calculated impacts of well-recognized adverse exposures such as smoking, diabetes and obesity. The study, “Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London,” was published online on May 18 on PlosOne.

The study confirms what has been widely reported elsewhere—that people with serious mental illness die earlier than their healthy counterparts. And this is largely due not to suicide or other factors directly related to mental illness, but to poorer general health and poorer access to quality medical care. For more information see Psychiatric News, http://pn.psychiatryonline.org/content/43/16/7.full.

Horses Ride to Rescue of Some Psychiatric Patients


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 Equine-assisted therapy--using horses as a therapeutic intervention--reduced violent behavior in a group of hospitalized psychiatric patients, according to research reported at the American Psychiatric Association's annual meeting in May in Honolulu. The patients participated in weekly group therapy sessions for three months that involved them in horse-related tasks such as grooming or placing a saddle on the horse. The 104 study participants were at risk for violent behavior or were highly regressed and had a mean age of 44.8, reported researchers from Greystone Park Psychiatric Hospital in New Jersey and the University of Medicine and Dentistry of New Jersey. The subjects assigned to equine-assisted therapy were compared with subjects who receive canine-assisted therapy and those who received psychosocial therapy. Only the patients in the equine-assisted therapy group showed a decline in violence-related incidents at the three-month follow-up. Patients with affective disorders showed greater reduction in violent incidents than did those with schizophrenia.

Read more about the use of horses as a potential therapeutic intervention in Psychiatric News at http://pn.psychiatryonline.org/content/44/22/4.full.


Wednesday, June 1, 2011

Senators Continue Call for Policy Reversal
On Condolence Letters

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Once again President Obama has been urged to end a policy that bars him from sending a letter of condolence to family members of troops who die by suicide. This latest call came from Sen. Barbara Boxer (D-Calif.), co-chair of the Senate Military Family Caucus, and a bipartisan group of senators.

Late last year, APA told the Obama administration that the policy discriminated toward people with mental illness and urged that the longstanding policy be reversed. The Obama administration has been reviewing whether to maintain the policy since November 2009, according to the Suicide Prevention Action Network USA.

“The contributions of these men and women to their country are not less for having suffered a mental illness. A reversal of this policy to allow condolence letters to family members will not only help to honor the contributions and lives of the service men and women, but will also send a message that discriminating against those with mental illness is not acceptable,” said then APA President Carol A. Bernstein, M.D.

For more information on APA's position, see http://pn.psychiatryonline.org/content/45/22/2.4.full.

Cell Phones and the Brain: Reason for Concern?

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The World Health Organization's International Agency for Research on Cancer released findings on Tuesday of an intensive review of research on the effects of cell-phone use and concluded that while the evidence is not strong enough to convict the ubiquitous devices of causing harm to humans, there is reason to exercise caution. The review panel's chair, preventive-medicine expert Jonathan Samet, M.D., of the University of Southern California, said that the data point to cell phones being "possibly carcinogenic," a category that puts it in the company of low-frequency magentic fields emitted by powerlines, for example.

The key factors in the WHO panel's decision to issue a caution were studies linking cell-phone use to two types of brain tumors--malignant gliomas and benign acoustic neuromas. The panel didn't issue  recommendations about amount of cell-phone exposure it believes may be safe or the need for regulations of the devices. Experts commenting on the findings, however, said it may be prudent to increase the use of the phones for texting and to use headsets that put distance between the user's head and the phone.

For more about research on cell phones and the brain, see Psychiatric News at http://pn.psychiatryonline.org/content/46/7/1.2.full.

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