New Findings on Autism

Rates of autism have been soaring in the United States, and parents of children with the disorder are desperate for more information about the still-mysterious causes of autism and about effective interventions for affected children. Some valuable information on this topic has recently been published and is reported in the August 19 issue of Psychiatric News. For example, the American Academy of Pediatrics is urging that pediatricians screen all children for autism at well-child visits at 18 months and 24 months so interventions can begin early if needed. And a new pilot project indicates that pediatricians can assess children for autism as early as age 12 months through a simple screening test. Read more about this pilot screening project at http://pn.psychiatryonline.org/content/46/16/16.1.full.

Researchers are also devoting considerable effort to the search for the roots of autism, with the goal of learning enough about the etiology to prevent some cases of autism. A new study reported in the Archives of General Psychiatry suggests that environment plays a more crucial role than previously thought and may contribute more to autism's etiology than genes do. Read about the role of environmental risk factors in Psychiatric News at http://pn.psychiatryonline.org/content/46/16/16.2.full.

For an in-depth review of the etiology, diagnosis, and treatment of autism, see the Textbook of Autism Spectrum Disorders, from American Psychiatric Publishing. Information on this book is posted at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62341.

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Doctors, Nurses Embrace Alternative, Complementary Medicine

So many clinicians have rethought their traditional opposition to alternative and complementary medicine that more health care personnel now acknowledge using these interventions than do people in the general U.S. population. A recently reported survey of about 14,300 physicians, nurses, medical assistants, and health care administrators nationwide found that approximately three-fourths of them use alternative or complementary options to treat their own medical conditions or as prevention strategies. Among these interventions were yoga, massage, and herbal preparations. A report of this study appears in the August issue of Health Services Research.

To read how even the tradition-bound military is beginning to incorporate alternative medicine into its treatment arsenal, see Psychiatric News at http://pn.psychiatryonline.org/content/46/13/9.full.

And to learn more about the status of research on alternative and complementary medicine in depression treatment, see Psychiatric News at http://pn.psychiatryonline.org/content/45/15/17.1.full.

Also, for an in-depth look at this topic see the book Complementary and Alternative Treatments in Mental Health Care, published by American Psychiatric Publishing at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62202.

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Psychiatrists Recall Events of September 11

With the anniversary of the September 11, 2001, terrorist attacks approaching, several psychiatrists who worked in the New York area recently recalled that day and its aftermath.

At St. Vincent's Hospital, the closest trauma center to the World Trade Center, the staff heard that planes had struck the buildings and prepared for a medical disaster. “We didn't know the cause of the crash immediately, but any fire in a high-rise building is bad news,” said psychiatrist Spencer Eth, M.D.

The collapse of the buildings left many dead but few injured. The anticipated medical emergency turned into a mental health disaster. “People came to the hospital in distress,” said Eth. “They were grief-stricken, anxious, panicked, seeking assurance.”

“Most people I know in lower Manhattan were emotionally affected—including me,” he said. “Most recovered, but many did not. They really needed help for a long time....The soldiers we see in the VA now are legacies of September 11.”

To read interviews with Eth and three other psychiatrists who were in New York on that day, see Psychiatric News at http://pn.psychiatryonline.org/content/46/16/1.1.full.

For in-depth discussions of disaster-related mental health issues, see the American Psychiatric Publishing book Disaster Psychiatry: Readiness, Evaluation, and Treatment at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=7217.

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Mental Health Screening Connects High Schoolers With Help

Three out of four ninth-grade students identified as being at risk for mental health problems were connected with school- or community-based services in a study published in the September  Journal of the American Academy of Child and Adolescent Psychiatry.

A total of 4,500 students were offered the TeenScreen Mental Health Checkup between 2005 and 2009 and about 2,500 accepted, wrote Mathilde Husky, Ph.D., an assistant professor of clinical psychology in psychiatry at Columbia University, and colleagues. They found that about 20 percent were “at risk” for mental health problems and 74 percent of those students were not receiving treatment. After the at-risk students were referred to school- or community-based services, 76 percent completed at least one visit with a clinician within 90 days, but students were more likely to connect with school-based services than those in the community.

The study shows the value of routine mental health screening and connecting those teens with follow-up care, although getting students into community care may require more coordination, said the authors.

For more about the TeenScreen program, see Psychiatric News at 
http://pn.psychiatryonline.org/content/45/7/10.1.full.

To read more about child and adolescent mental health, see the upcoming revision of American Psychiatric Publishing's Concise Guide to Child and Adolescent Psychiatry, by Mina Dulcan, M.D., and MaryBeth Lake, M.D. at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62416#.

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Blue Shield Ordered to Pay For Anorexia Nervosa

A federal appeals court has ruled that BlueShield of California has to pay for a woman's 10-month residential treatment for anorexia nervosa, the Los Angeles Times reported August 29. The insurer had denied such coverage for the woman. Yet under California's Mental Health Parity Act, insurance plans must provide coverage of all medically necessary treatment for nine severe mental illnesses, including eating disorders, the court said.

BlueShield of California's denial also illustrates a persistent problem--that in spite of the national parity law, some insurers continue to deny equitable coverage for treatment of psychiatric conditions. As a result, APA and other groups are trying to get federal officials to release final regulations regarding the parity law. They believe that final regulations will help solve the problem.

Read details of the parity efforts of APA and its allies in the August 19 Psychiatric News at http://pn.psychiatryonline.org/content/46/16/5.1.full. 

As to whether medical treatment for anorexia nervosa is cost-effective in the first place, ample evidence shows that this is in fact the case. For example, a large 2007 study found that over two-thirds of women with anorexia nervosa made a clinical recovery and usually progressed to full recovery during the next five years. For more information about this study, see the American Journal of Psychiatry at http://ajp.psychiatryonline.org/cgi/content/abstract/164/8/1259?maxtoshow.

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Unemployment Takes Psychological Toll on Americans

The dismal economy of the past three years, and particularly long-term unemployment, are playing havoc with Americans' mental health, according to the August 17 Miami Herald. For example, about one-third of the 62,000 monthly calls to the Substance Abuse and Mental Health Services Administration's suicide-prevention hotlines are now related to economic distress.

Psychiatrists are also finding that the dire economy is eroding Americans' mental well-being. For instance, a Pittsburgh psychiatrist reported that the most stressed individuals are small-business owners who worry about their employees as well as their own welfare. A Michigan psychiatrist reported that he has several patients devastated by the recent dire straits of the automobile industry. And as a New York psychiatrist said, "If the economy continues to get worse before it gets better, and if more and more people are out of work, I suspect that we are going to see much more family discord and depression in addition to anxiety and maybe even an increase in the suicide rate."

To read more about the toll the recession is taking on Americans' mental health and how it is affecting psychiatric care, see Psychiatric News at http://pn.psychiatryonline.org/content/44/10/4.1.full and http://pn.psychiatryonline.org/content/45/23/36.full. 

Information about stress and mental health in general can be found in the American Psychiatric Publishing book, Does Stress Cause Psychiatric Illness? See http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=8482.

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Brain Differences Seen in Children Who Experience Severe Irritability

Children who experience extreme irritability in the face of frustration may have a distinct psychiatric illness that is not bipolar disorder. New research using magnetoencephalography and a computerized game rigged to induce frustration shows distinct neural correlates underlie the phenomena of irritability and distinguish a subgroup of children who may have a diagnostic entity distinct from bipolar disorder (BD).

That’s important because many children who have symptoms of what has been called "severe mood dysregulation" (SMD)—characterized by chronic irritability and a tendency to respond to frustration in developmentally inappropriate ways—receive a diagnosis of bipolar disorder even though they lack the episodes of mania associated with that condition. 

The term "severe mood dysregulation” was developed by Ellen Leibenluft, M.D., a co-author of the new study, and colleagues at NIMH. Criteria for the syndrome are being tested in field trials for DSM-5.

Read more about this syndrome and its possible inclusion in DSM-5 in Psychiatric News at http://pn.psychiatryonline.org/content/46/2/4.1.full.  

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Major Study Finds No Link Between Vaccines and Autism

There is no link between childhood vaccination and autism, according to a major report by the prestigious Institute of Medicine (IOM).

A 600-page report, “Adverse Effects of Vaccines: Evidence and Causality,” released Thursday by the IOM, analyzed more than 1,000 research articles and concluded that few health problems are caused by or clearly associated with vaccines. The review did find evidence of 14 health outcomes, including seizures, brain inflammation, and fainting, that can be caused by certain vaccines but occur rarely. However, the evidence shows no link between immunization and autism.

Despite clear statements from APA and the AMA that there is no evidence linking vaccination and autism, some parents have boycotted vaccinations for their children, sometimes resulting in outbreaks of infectious disease. Read much more about the issue in Psychiatric News at http://pn.psychiatryonline.org/content/44/14/4.1.full, http://pn.psychiatryonline.org/content/45/5/2.1.full, and http://pn.psychiatryonline.org/content/45/19/18.2.full.

Also, the “Concise Guide to Child and Adolescent Psychiatry, Fourth Edition,” published this year by American Psychiatric Publishing, includes the latest clinical information about autism. For purchasing information see http://www.appi.org/.  

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Believing in Depression: Religion and Mental Health

Individuals placing a high level of importance on religion or spirituality may be less susceptible to recurring depression, according to a new study in the August 24 AJP in Advance. The10-year prospective study focused on the adult offspring of participants in an earlier study that found a link between religiosity/spirituality and a reduced risk of major depression.

Lisa Miller, Ph.D., an associate professor of psychology and education at Columbia University Teachers College, led a team of researchers in assessing the mental health of 114 adult children of parents both with and without depression. Individuals reporting a strong connection to religion or spirituality at the beginning of the study were found to have approximately one-fourth the risk of experiencing major depression as other participants by the end of the study.

Read the full study results in AJP in Advance at http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2011.10121823v1.
Additional information about the relationship between religion and spirituality and the diagnosis, course, and outcome of mental illness can be found in Religious and Spiritual Issues in Psychiatric Diagnosis at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2658.

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Drug Ads for Doctors Fail FDA's Guidelines

Nearly half of advertisements directed at physicians fail to adhere to at least one FDA guideline governing content. That’s the finding of researchers at Mount Sinai School of Medicine, who recently performed a cross-sectional analysis of November 2008 pharmaceutical advertisements in top U.S.-based biomedical journals.

They found that these advertisements contained bias on a wide range of issues across content areas addressed by the FDA; there was no single problem that was consistently identified for guideline nonadherence. They also found that the ads do a poor job of conveying basic information necessary for safe prescribing, with the majority failing to quantify serious risks, more than one quarter failing to quantify benefits, and nearly half providing no verifiable references.

“Our study is the first in nearly 20 years to provide a systematic assessment of the adherence of U.S. advertisements to FDA guidance and provides context to inform the FDA's new 'bad ad' program,” said Deborah Korenstein, M.D., an associate professor of medicine at Mount Sinai, and her colleagues, in online PloS One August 17. “Physicians should ensure that their prescribing is informed by the clinical literature and not by marketing materials."

Read more about the FDA's "bad ad" program in Psychiatric News at http://pn.psychiatryonline.org/content/45/12/1.2.full.

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FDA Cuts Dosage Level for Citalopram

The U.S. Food and Drug Administration (FDA) said that the antidepressant drug citalopram should no longer be prescribed at dosages above 40 mg per day because it can cause problems in the heart’s electrical system in some people with pre-existing heart disease.
People with prolongation of the QT interval may be prone to developing dangerously abnormal heart rhythms if they take higher doses. Dosages up to 60 mg per day were previously indicated by the FDA, although the higher dosage showed no added benefit in clinical trials involving depression treatment, said the FDA. Patients with underlying heart conditions and those with low blood levels of potassium and magnesium are at particular risk for developing prolongation of the QT interval.

The FDA notified clinicians and patients about the decision on August 24.

Read more about this issue in Psychiatric News at http://pn.psychiatryonline.org/content/46/10/32.1.full.

The FDA alert is posted at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm269481.htm

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Child Psychiatrists Back Up Pediatricians

Programs in several states now allow child psychiatrists based at medical schools to support pediatricians and other primary care providers as they care for young patients with psychiatric problems, says a report in the August Psychiatric Services by Stewart Gabel, M.D., of the New York State Office of Mental Health and Barry Sarvet, M.D., of the Baystate Medical Center in Springfield, Mass.

Primary care clinicians provide much of the mental health care for children and adolescents, but they usually don’t have the training to manage severe or complicated cases. The states of Massachusetts, Washington, New York, and Ohio now use systems by which university child psychiatrists can offer telephone or videoconferencing consultation, backed up by in-person evaluations when needed. The child psychiatrists also offer educational seminars for the primary care doctors and nurses in their states.

Both the consultation and educational services were developed to help ease the nationwide shortage of child and adolescent psychiatrists.

Read more about these vital academic partnerships in Psychiatric Services at http://ps.psychiatryonline.org/cgi/content/abstract/62/8/827 and in Psychiatric News at http://pn.psychiatryonline.org/content/46/3/10.2.full.

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Toxoplasma Infection Linked to Development of Schizophrenia

In a major prospective study, researchers have identified an elevated risk of schizophrenia in women who have high levels of antibodies to Toxoplasma gondii, a microscopic protozoa that causes the infection known as toxoplasmosis. The study sample consisted of more than 45,000 women in Denmark who had given birth from 1992 to 1995. The women were followed up until 2008. Previous studies have shown such an association in adults who already have schizophrenia, but this study was the first to replicate that finding in a prospective cohort study. A report of the study appears in the August issue of the American Journal of Psychiatry, and is posted online at  http://ajp.psychiatryonline.org/cgi/reprint/168/8/814.

In an extensive commentary in the same issue of the journal, Alan Brown, M.D., M.P.H., of the Department of Psychiatry at Columbia University notes that this new study adds to previous research "suggesting that environmental exposures may play a more important role in the etiopathogenesis of schizophrenia than has been previously assumed." Read Brown's commentary at http://ajp.psychiatryonline.org/cgi/content/full/168/8/764.

Read more about the links between schizophrenia and infection in Psychiatric News at http://pn.psychiatryonline.org/content/45/6/1.2.full and http://pn.psychiatryonline.org/content/45/6/19.1.full.

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Gender Can Influence Alcoholism Susceptibility

Though genes influence alcohol susceptibility, so does gender, according to a study reported August 16 in the journal Alcoholism: Clinicial and Experimental Research.

Of the alcoholism-related genes, those most consistently linked with it are the ALDH genes, which are involved in alcohol metabolism. In this study, some 400 male alcoholics and 200 female alcoholics were genotyped for the ALDH2 gene. Some of the subjects had an inactive form of the ALDH2 gene; others had an active form. The researchers then compared the men with the inactive form to the men with the active form, and the women with the inactive form to the women with the active form.

They found gender-related differences. For example, the onset age of alcoholism in the women with the inactive form was significantly lower than in the women with the active form. This was not the case for the men. Moreover, prevalence of comorbid psychiatric disorders was significantly higher in women with the inactive form. This was not the case for the men.

While genes and gender influence alcoholism susceptibility, so does environment. Scientists recently found that when people who possess a particular variant of an alcohol-susceptibility gene—KCNJ6—also experience early-life adversity, they are even more at risk of alcohol problems than if they just had the gene variant. Read more about this study in Psychiatric News at http://pn.psychiatryonline.org/content/46/7/16.1.full.

For an in-depth view of the latest clinical knowledge in treating alcoholism, see American Psychiatric Publishing's new book, Clinical Manual for Treatment of Alcoholism and Addictions. Purchasing information is available at http://www.appi.org/.

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Tanning May Be an Overlooked Addiction

Tanning may be addictive, a new study in press with Addiction Biology has found.

Bryon Adinoff, M.D., a professor of psychiatry and substance abuse research at the University of Texas Southwestern Medical Center, and colleagues used a brain imaging technique called SPECT to measure blood flow in the brains of seven frequent tanning bed customers while they were exposed to ultraviolet light and to sham ultraviolet light. They found an increase in blood flow in certain areas of the subjects' brains that are associated with reward while the subjects were exposed to ultraviolet light, but not while they were exposed to sham light. "These findings suggest that ultraviolet light may have centrally rewarding properties that encourage excessive tanning," the scientists said.

A few months ago, another study also suggested that tanning may be addictive. Of some 400 students at a large university, more than 200 had used indoor tanning facilities, and more than a third met addiction-to-tanning criteria adapted from DSM-IV-TR criteria for substance-related disorders. Read more about this study in Psychiatric News at http://pn.psychiatryonline.org/content/45/13/24.1.full.

The tanning addiction topic also underscores the importance of the mind-body connection, and American Psychiatric Publishing has just published a book on that subject, titled Clinical Manual of Psychosomatic Medicine: A Guide to Consultation-Liaison Psychiatry. Purchasing information is available at www.appi.org.

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ADHD Affects Rising Number of Youth

Nine percent of U.S. children aged 5–17 were diagnosed with attention-deficit/hyperactivity disorder (ADHD) between 2007 and 2009, an increase of more than 2 percent from the number of diagnoses made between 1998 and 2000. These are the findings of a new study released by the National Center for Health Statistics (NCHS).

For the study, Lara Akinbami, M.D. and her colleagues at NCHS’s Office of Analysis and Epidemiology compared more than a decade’s worth of data from the National Health Interview Survey. The researchers noted that ADHD increases were recorded for both boys and girls, with variations among race and ethnicity narrowing over the years.

Read more about ADHD diagnosis and treatment around the world in Psychiatric News at http://pn.psychiatryonline.org/content/46/11/20.1.full. More detailed information about ADHD can be found in the new fourth edition of Concise Guide to Child and Adolescent Psychiatry, available at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62416#. 

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New Laws Improve Treatment Options for Mentally Ill in Illinois

Illinois residents suffering from mental illness and substance abuse disorders will now have greater access to mental health care services under a set of new laws enacted August 18 by Governor Pat Quinn. Among the new measures is a law requiring insurance companies to provide equal coverage for mental health and substance abuse treatment—a law that exceeds the requirements of the recently enacted federal mental health parity legislation.

Another new law signed by Quinn creates a task force charged with developing a strategic plan for state mental health and developmental disabilities services. Additional measures establish regional mental health networks and new local community health advisory committees.

For the latest on efforts to finalize federal parity law regulations, read more in today's issue of Psychiatric News at http://pn.psychiatryonline.org/content/46/16/5.1.full.

Additional information about the parity rule-making process can be found at http://pn.psychiatryonline.org/content/45/15/9.2.full.

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More Research Needed About Refugee Children

Exposure to violence is a major risk factor in determining whether refugee children develop PTSD or other mental health problems. Researchers at Oxford, Harvard, and Yale universities, and the Oxford Health NHS Foundation Trust recently conducted a systematic review of the mental health risk factors and outcomes of displaced and refugee children and adolescents, focusing on the income levels of the countries in which they eventually settled.

“The mental health of children who have been forcibly displaced is of particular concern because of their experiences of insecurity at a formative state of child development,” the authors emphasize. They call for further research on specific groups of children, including ex-combatants, children who have been the victims of traffiking, children with uncertain immigration status, and refugees returning (voluntarily or involuntarily) to their home country. The early-life adversity that refugee children experience may affect them even at the level of their DNA.

For more information about the consequences of childhood maltreatment and exposure to violence, read Psychiatric News at http://pn.psychiatryonline.org/content/46/13/1.1.full. In addition see the book PTSD in Children and Adolsescents, which is available from American Psychiatric Publishing at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62026.

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Addiction Gets Redefined

Addiction is a chronic brain disease, not just the result of bad behaviors or bad choices. That’s according to a new and extensive definition of addiction by the American Society of Addiction Medicine (ASAM), the nation’s largest professional society of physicians who treat addictions. The statement marks the first time ASAM has taken an official position that addiction is not solely related to problematic substance abuse; the definition encompasses addiction to alcohol, drugs, gambling, or sex.

The new definition resulted from a four-year process and the involvement of more than 80 experts, including top addiction authorities, addiction medicine clinicians, and neuroscience researchers. The development process also involved extensive dialogue with the National Institute on Drug Abuse.

Read ASAM's complete definition of addiction at www.asam.org/DefinitionofAddiction-LongVersion.html.

Also, much more on the latest research and clinical knowledge in addiction treatment is available in American Psychiatric Publishing's Clinical Manual for Treatment of Alcoholism and Addictions at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62373.

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Brain Receptor Gives Clues to ADHD Cause And Possible Treatment

A type of receptor in the brain associated with attention-deficit/hyperactivity disorder (ADHD) appears to cause its effects by failing to interact with a dopamine receptor, said National Institute on Drug Abuse (NIDA) researchers.

Working with mice, Sergi Ferre, M.D., Ph.D., found that the D4.7 dopamine receptor variant, unlike the D4.2 and D4.4 subtypes, could not interact with the short version of the dopamine type 2 receptor to reduce glutamate release in the striatum, the brain region associated with impulsivity and symptoms of ADHD in humans.

Stimulant medications used to treat ADHD are known to be less effective in patients who carry the D4.7 variant, and the new research may explain why. "Although previous studies have shown that dysfunctional dopamine D4 receptors are implicated in ADHD, this is the first study to show how this genetic difference might translate into functional deficits seen with this disorder,” said NIDA Director Nora Volkow, M.D. “Further research is needed to explore how this deficient interaction between receptors might be remedied, which could then lead to new medications for the treatment of ADHD."

Read more about the link between genes and ADHD in Psychiatric News at http://pn.psychiatryonline.org/content/46/12/1.2.full. Information about ADHD and its treatment is also available in the pamphlet "Let's Talk Facts About Attention-Deficit/Hyperactivity Disorder (ADHD)," available from American Psychiatric Publishing at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2433.

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Childhood Maltreatment Worsens Adult Depression

Adults maltreated as children have a much harder time overcoming depression, said researchers at King’s College London. Their analysis of 26 studies showed that a history of physical abuse or sexual abuse, neglect, or family conflict or violence was associated with a poorer course of depression and worse treatment outcomes, wrote Andrea Danese, M.D., Ph.D., and colleagues in the American Journal of Psychiatry online August 14.

Review of 16 epidemiological studies covering more than 23,000 patients indicated that adults with depression who were maltreated as children grew up to have double the likelihood of recurrent and persistent depressive episodes than those who were not maltreated.

Also, their analysis of 10 clinical trials covering 3,100 patients found that a history of maltreatment was associated with poor outcomes for antidepressant drug treatment and even worse results when treatment combined medication and psychotherapy.

Thus, early preventive and therapeutic interventions may be more effective than later efforts in preventing a poor long-term course of depression, they concluded.

Read an abstract of the study at http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2011.11020335v1. To learn more about the psychiatric outcomes of child maltreatment, see Psychiatric News at http://pn.psychiatryonline.org/content/44/21/27.full.

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Program Succeeds in Preventing Teen Suicides

Teenagers who completed a suicide-prevention and depression-awareness program given in their high school were less likely to attempt or contemplate suicide and more likely to recognize a friend who seemed to be suicidal.

Developed at Cincinnati Children's Hospital, the program is believed to be one of the few suicide-prevention inititatives with study data backing its effectiveness. A study evaluating the program appears in the new issue of the Journal of School Health and was led by Keith King, Ph.D., of the University of Cincinnati. Among the key findings were that three months after completing the program, significantly fewer students said they were considering suicide than before the program, reported planning a suicide attempt, actually attempted suicide, and acknowledged feeling said and hopeless. In addition, substantial percentages of the students said they planned to talk more with ther parents or friends about their problems and now recognized warning signs of depression and suicidality.

Suicide is the third-leading cause of death in adolescents and young adults. Read more about suicide prevention efforts in Psychiatric News at http://pn.psychiatryonline.org/content/46/1/8.2.full; http://pn.psychiatryonline.org/content/45/14/12.1.full; and http://pn.psychiatryonline.org/content/45/20/4.2.full. Important information about suicide and teenagers is also available in the American Psychiatric Association pamphlet "Let's Talk Facts About Teen Suicide," which can be ordered at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2371.

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Drug Firms Unhappy With Facebook Rule Change

Facebook has declared that drug companies must play by the same rules as the other millions of its subscribers, and this has led the firms to take a very unusual action where the popular social networking site is concerned--hitting the "escape" key. What has the drug companies troubled is Facebook's declaration that they will no longer have the privilege of closing their Facebook "walls" to comments from the public, reported the Washington Post on August 14. The firms are worried that people will post information about the side effects they experienced on a particular medication or write other comments critical of a product. If a company learns of a side-effect posting, it may be required to report that to the Food and Drug Administration, which will use it monitor the drug's safety. As of last Sunday, Seroquel manufacturer AstraZeneca had shut down a Facebook page on depression, and Johnson & Johnson planned to shut down four of its pages. A Pfizer spokesperson said the world's largest drug firm will keep its pages open for the time being, but closely monitor the activity on them.

Drug companies' use of Facebook is just one example of how social media have reshaped the medical and health landscape in the last few years. Physicians have also joined the social-media revolution, and not always with the desired results. To read much more about psychiatrists' use of social media, see Psychiatric News at http://pn.psychiatryonline.org/content/46/11/12.full and http://pn.psychiatryonline.org/content/45/11/5.1.full.

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Psychotherapy and Antidepressants Benefit Women in Midlife

Psychotherapy and antidepressants can benefit midlife women in several crucial ways. They can be vital interventions for a range of difficulties such as sexual problems, substance abuse, chronic illness, or depression, the August Harvard Women's Health Watch points out.

For example, psychotherapy has proved to be a key adjunct to treatments for diabetes and arthritis, the authors say, and benefits midlife women who have eating disorders. Though eating disorders are mostly associated with adolescent girls, there is increasing awareness that midlife women can also face anorexia, bulimia, or other problems with food or body image in response to their changing bodies and life circumstances.

Antidepressants can help midlife women who are experiencing a major depression during the menopausal transition, Deborah Cowley, M.D., a professor of psychiatry at the University of Washington, commented in the March 21 Journal Watch Psychiatry. The menopausal transition and early post-menopause are a high-risk time for major depressive episodes. To read about the findings of a study on this topic, see Psychiatric News at   http://pn.psychiatryonline.org/content/46/10/31.2.full.

American Psychiatric Publishing has several books on issues concerning the mental health of women in midlife. Among them are Menopause--A Mental Health Practitioner's Guide; A Woman's Guide to Menopause and Hormone Replacement Therapy; and the Clinical Manual of Women's Mental Health. Purchasing information is available at www.appi.org.

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Guide Dogs for the Mind Gain Popularity

Not long ago, Rosie, a golden retriever therapy dog that specializes in comforting people when they are stressed, was allowed in a New York courtroom to provide psychological support to a teenage girl who was testifying that her father had raped her. Although Rosie is the first judicially approved courtroom dog in New York, she may be part of a growing trend, the New York Times reported on August 8. In Arizona, Hawaii, Idaho, and Indiana, courts have allowed such trained dogs to give psychological support to vulnerable witnesses, especially children.

There also seems to be a growing trend toward canines helping people with psychiatric illnesses, Joan Esnayra, Ph.D., founder and head of the Psychiatric Service Dog Society recently told Psychiatric News. Although there are no hard numbers, as many as 10,000 Americans and Canadians may be using one, she said. For more information on this trend and on Esnayra's Psychiatric Service Dog Society, see Psychiatric News at http://pn.psychiatryonline.org/content/45/19/14.1.full.

Furthermore, some psychiatrists not only believe in the value of psychiatric service dogs, but also use dogs in their practices as therapy dogs. For more information on this subject, see Psychiatric News at http://pn.psychiatryonline.org/content/45/19/14.2.full.

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Rise in Antidepressant Prescriptions for Undiagnosed Patients

Nonpsychiatric providers are prescribing antidepressant medications in increasing numbers for patients who have not been diagnosed with a mental illness, finds news research published in the August Health Affairs. This, according to the study’s authors, has contributed to antidepressants becoming the third most commonly prescribed class of medications in the U.S. today.

Researchers Ramin Mojtabai, M.D. Ph.D. of Johns Hopkins Bloomberg School of Public Health, and Mark Olfson, M.D., M.P.H. of Columbia University employed data from the 1996–2007 National Ambulatory Medical Care Surveys to review a sample of office-based physician visits made during a one-week period by patients over 18 years of age. They reported an increase from 59.5 percent to 72.7 percent in the number of visits during which individuals were prescribed antidepressants without receiving a concurrent psychiatric diagnosis.

Read more about questionable prescribing practices in Psychiatric News at http://pn.psychiatryonline.org/content/45/1/10.2.full.  

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Women With Depression at Greater Risk of Stroke

Suffering from depression or having so in the past may increase the likelihood of stroke for older women, according a new study in the American Heart Association’s journal Stroke. Specifically, the researchers, led by An Pan, Ph.D. of Harvard School of Public Health’s Department of Nutrition, found that women aged 54–79 who currently suffer from depression are 41 percent more likely to have a stroke than those without the illness, while women with a history of depression are 29 percent more likely than those without to experience a stroke sometime in the future.

The researchers also reported that women taking SSRIs for the treatment of  depression faced a 40 percent increase in the likelihood of suffering a stroke. For the study, Pan and his colleagues looked at data contained in health questionnaires completed by women in 2000 as part of the long-term, epidemiological Nurses’ Health Study funded by the National Institutes of Health.

Read more about the connection between depression and stroke risk in Psychiatric News at http://pn.psychiatryonline.org/content/46/2/25.1.full. Much more information about stroke can be found in The American Psychiatric Publishing Textbook of Geriatric Neuropsychiatry, Third Edition. Ordering information is posted at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62371.

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Poor Sleep Quality May Predict Dementia Five Years Later

Older women have an increased risk of developing cognitive impairment and dementia five years after reporting sleep-disordered breathing, such as recurrent arousals from sleep and intermittent hypoxemia, according to researchers at the University of California, San Francisco. Such breathing problems are common in older adults, especially women, as people who have spent time with their grandmothers can attest. A number of other adverse health outcomes including hypertension, cardiovascular disease, and diabetes have also been associated with sleep-disordered breathing. But this is the first time a prospective link has been made between sleep-disordered breathing and dementia.

The news, said the researchers “has the potential for a large public-health impact.” Their results suggested that hypoxia is the mechanism for the association: “Our findings suggest a potential role for supplemental oxygen therapy for sleep-disordered breathing in elderly individuals,” they said.

To learn more about the role sleep disorders can play in the development of metabolic syndrome, see Psychiatric News at http://pn.psychiatryonline.org/content/46/2/27.full.

A comprehensive look at sleep disorders can be found in the American Psychiatric Publishing book, Clinical Manual for Evaluation and Treatment of Sleep Disorders. For more information see www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62271.

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Report Disputes Medicaid’s Buprenorphine Restrictions

Many state Medicaid programs restrict access to the use of buprenorphine to relieve withdrawal symptoms in those addicted to heroin or other opiates, fearing that the drug is costlier or less safe than therapies such as methadone. But University of Massachusetts researchers say there is no evidence to support rationing buprenorphine to save money or ensure safety, pointing out that buprenorphine has expanded access to treatment because the drug can be prescribed by a physician and taken at home compared with methadone, which by law must be administered at an approved clinic. Although buprenorphine is somewhat less effective than methadone in eliminating opioid abuse, it is more effective than drug-free treatment alone and carries less of the stigma than methadone treatment.

For more information on this topic, see the Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence from American Psychiatric Publishing at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62369.

APA offers an eight-hour online course of specialized training needed to prescribe buprenorphine, as required by the Drug Addiction Treatment Act of 2000. For more information, go to www.apaeducation.org/.

You can also read about current concerns regarding opioid abuse and diversion in Psychiatric News at http://pn.psychiatryonline.org/content/46/10/34.1.full.

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Virginia Tech Shooting Affected Students All Over Campus

Much posttraumatic stress disorder among Virginia Tech students after the April 2007 shooting incident that left 32 dead was due to several factors other than being directly attacked or injured. About 15 percent of the 4,369 students surveyed three or four months after the shooting reported PTSD symptoms, said Michael Hughes, Ph.D., a professor of sociology at Virginia Tech, and colleagues in the journal Psychological Trauma.

The largest single factor explaining PTSD symptoms was the inability to confirm the safety of friends (30 percent), followed by the death of a (not close) friend (20 percent), and the death of a close friend (10 percent). As a result, students with PTSD symptoms were not a small, obvious group with direct exposure to death and injury, but were widely scattered around the campus. These “high-prevalence, low-impact stressors” call for a “broad-based outreach to find students needing mental health treatment interventions,” said the researchers.

For more on violence and mental illness and the Virginia Tech shooting, see Psychiatric News at http://pn.psychiatryonline.org/content/42/10/1.1.full and http://pn.psychiatryonline.org/content/46/14/3.full.

Read more about this topic in American Psychiatric Publishing's Disaster Psychiatry: Readiness, Evaluation, and Treatment by Frederick Stoddard, M.D., et al. at
www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=7217. 

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Mother's Depression Linked to Children's Growth

A mother’s depression is significantly associated with poor growth in her children, said researchers from the University of Maryland School of Medicine and the Johns Hopkins Bloomberg School of Public Health. In a meta-analysis of 17 studies conducted in developing countries in Asia, Africa, Latin America, and the Caribbean, Pamela Surkan, Ph.D, Sc.D., and colleagues, found that the odds ratio for an association between maternal depression and underweight or stunted-growth children was about 1.5. The relationship was even stronger when the analysis was limited to long-term studies, said the researchers in the July Bulletin of the World Health Organization.

Several mechanisms might influence how the mother’s depression affects children’s growth, but other studies have shown that the disorder is treatable, even in developing countries. “[A] reduction in the incidence of maternal depressive symptoms in developing countries would not only have a beneficial effect on mothers, but would also improve child growth substantially, and this in turn could influence the children’s future health, development, and economic status,” concluded the researchers.

Read more about maternal depression and its effects on children in Psychiatric News at http://pn.psychiatryonline.org/content/46/7/13.1.full.

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New APA Primer Unravels Mysteries Of Health Care Reform

To many psychiatrists and other physicians, the intricacies of the health care reform law resemble pieces of a puzzle they have had assemble on their own, but APA has come up with a straightforward guide to solving the puzzle in the new publication "Health Care Reform: A Primer for Psychiatrists."

The manual is a collaborative effort by APA's Publishing Division and the Department of Government Relations (DGR) to help psychiatrists understand how the Patient Protection and Affordable Care Act affects them and the patients they treat. The primer includes articles on health care reform from Psychiatric News, the American Journal of Psychiatry, and Psychiatric Services and information prepared by DGR. Among the topics discussed are coverage of mental health care services under the reform law, the integration of mental health and general health care, and how the insurance market will be structured under the reform law.

The primer is posted at www.appi.org/SiteCollectionDocuments/Journals/PSY/HealthCareReform.pdf.

Read more about how the reform law is changing psychiatric practice in Psychiatric News at http://pn.psychiatryonline.org/content/46/6/9.2.full.

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APA Files Amicus Brief in Tucson Shooting Case

To ensure that courts have input from psychiatrists on mental-illness issues, APA and the American Academy of Psychiatry and the Law (AAPL) have filed an amicus brief in the case of Jared Lee Loughner, accused of killing six people and wounding 13 including Rep. Gabrielle Giffords at a Tucson shopping center in January. The brief argues that based on previous court rulings, the government has the right to order the administration of involuntary medication to a pre-trial detainee who poses a danger to himself or others without requiring a judicial hearing. Former APA and AAPL president Paul Appelbaum, M.D., chair of APA's Committee on Judicial Action, said "psychiatrists working in correctional facilities need the flexibility to deal with dangerous persons without the delay involved in lengthy court proceedings." The brief addresses issues in managing violent patients and the use of antipsychotic medications. Loughner's defense team has insisted that a judicial hearing is required before he can be involuntarily medicated.

Read more about the issues in this case in Psychiatric News at http://pn.psychiatryonline.org/content/46/3/1.1.full. For an in-depth review of issues regarding psychiatry and the law, see American Psychiatric Publishing's Textbook of Forensic Psychiatry at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62378.

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More Insights Into Dyslexia Emerge

How people with dyslexia hear language may be more important than previously realized, the New York Times reported on August 1. Researchers at the Massachusetts Institute of Technology found that individuals with dyxlexia have more trouble understanding speech than those without dyslexia. The researchers also learned that spoken language deficiencies persist even when people with dyslexia learn to read well.

And thanks to a large population study, evidence has become more compelling that two particular genes contribute to dyslexia. The link between dyslexia and one of these genes was even stronger when subjects had attention-deficit/hyperactivity disorder or a developmental language disorder as well as dyslexia.

More information about this study can be found in Psychiatric News at http://pn.psychiatryonline.org/content/46/12/19.full.

And more information about dyslexia in general can be found in a book published by American Psychiatric Publishing called Learning Disabilities - Implications for Psychiatric Treatment. See http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=8383.

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Opioids Not Only Intervention for Chronic Pain Patients

Prescription opioid medication addiction may be common among patients with chronic pain, according to a new study published in the July Journal of Addictive Diseases. Thirty-five percent of those receiving long-term treatment with opioids now meet the criteria for addiction.

The good news for chronic pain patients, however, is that there are other types of medications that can counter chronic pain besides opioids. And a number of these are medications that psychiatrists often prescribe. Also, there are certain other techniques and interventions, such as psychotherapy, that can provide substantial relief to chronic pain patients. For more information on these subjects, see Psychiatric News at http://pn.psychiatryonline.org/content/46/11/18.1.full; http://pn.psychiatryonline.org/content/46/11/18.2.full; and http://pn.psychiatryonline.org/content/46/11/19.full.

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Risperidone Shows No Benefit as Adjunctive Treatment for PTSD

Six-month treatment with risperidone showed no benefit over placebo in treating patients with military-related PTSD who were resistant to treatment with selective serotonin-reuptake inhibitor (SSRI) antidepressants, according to a report in August issue of the Journal of the American Medical Association. The study was a six-month, randomized, double-blind, placebo-controlled trial conducted from February 2007 to February 2010 at 23 Veterans Administration outpatient medical centers. Despite limited evidence supporting the practice, second-generation antipsychotics—of which risperidone is one—are commonly used for SSRI-resistant symptoms of PTSD, the authors say.

Psychiatric News has provided extensive coverage about the mental health needs of soldiers returning from Iraq and Afghanistan; for recent coverage see http://pn.psychiatryonline.org/content/46/11/15.1.full.

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Loss of Insurance Common in Early Psychosis

Loss of insurance is a frequent occurrence for individuals experiencing early psychosis, according to a report in the August issue of Psychiatric Services. Among 31 patients enrolled in a special community program for early psychosis who had public or private insurance at baseline, just 14 maintained continuous coverage for a full year.

This finding is troubling because recent research indicates that reducing the duration of untreated acute psychosis is critical to long-term outcome, so loss of insurance—which can mean delay or discontinuation of treatment—can be devastating.

Read a full report of the study at http://ps.psychiatryonline.org/cgi/content/full/62/8/878, and further coverage of the study will appear in an upcoming issue of Psychiatric News.

For information about rapid treatment of early psychosis see Psychiatric News, http://pn.psychiatryonline.org/content/43/13/13.1.full. And for comprehensive clinical information about treatment of schizophrenia see Essentials of Schizophrenia, published this year by American Psychiatric Press. Purchasing information is available at www.appi.org/.  

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CBT Effective for Psychogenic Pain

Cognitive-behavioral therapy (CBT) can be an effective treatment for psychogenic neurologic symptoms, but there are major obstacles to its provision in practice, said researchers at the University of Edinburgh, U.K., online August 3 in Neurology.

Outpatients of two neurology services who had functional symptoms rated by a neurologist as "not at all" or only "somewhat" explained by organic disease were randomly allocated to two groups. One group received “usual care,” the other also received guided self-help in the form of a self-help manual and four 30-minute guidance sessions. The primary outcome was self-rated health on a 5-point Clinical Global Improvement scale (CGI) at three months. The researchers found that CBT-based, guided self-help therapy improved self-reported general health, as measured by the CGI, in patients with functional neurologic symptoms.

For information about other types of disorders for which CBT has proven to be an effective treatment, see Psychiatric News at http://pn.psychiatryonline.org/content/46/10/19.1.full.

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