Monday, April 30, 2012

Being Bilingual Brings Mental Health Benefits

Individuals who are bilingual appear to have superior sound-processing skills, Northwestern University researchers reported today in the Proceedings of the National Academy of Sciences. This finding suggests that bilingual individuals might possess an enhanced ability to pay attention, the researchers believe.

Being able to speak two languages likewise seems to reduce, in children, negative internalizing states such as anxiety, loneliness, and poor self-esteem, and negative externalizing behaviors such as arguing, fighting, or acting impulsively, other researchers have found. The reason, they hypothesized, may be because bilingual youngsters understand two cultures, and this understanding in turn helps them appreciate diversity and get along with their peers and teachers.

More information about this study of bilingual children can be found in Psychiatric News.

(Image: StockCube/Shutterstock.com)


Binge Eating May Be Linked to Substance Abuse

A history of binge eating a large amount of fatty food may be linked to the development of substance abuse, Penn State College of Medicine researchers reported April 24 online in Behavioral Neuroscience. The researchers found an association between bingeing on fat and the development of cocaine-seeking and of cocaine-taking behaviors in rats. Binge-eating disorder may also be added to DSM-5. "In the 20 years since publication of DSM-IV, there have  been more than 1,000 papers published on binge-eating disorder," Timothy Walsh, M.D., chair of the Feeding and Eating Disorders Work Group for DSM-5, told Psychiatric News. For more information on this subject, see Psychiatric News.

(Image: Wallenrock/Shutterstock.com)

Friday, April 27, 2012

Mental Illness Among Most Common Pre-Existing Conditions for Americans

Mental health disorders are among the leading pre-existing conditions that can lead to health insurance denials, according to a recent report by the U.S. Government Accountiability Office (GAO). Mental health disorders were second only to hypertension as the most commonly reported medical conditions among adults that could result in a health insurer denying coverage, requiring higher-than-average premiums, or restrictions on coverage. The GAO report is entitled, “Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million.”

Beginning January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) prohibits health insurers in the individual market from denying coverage, increasing premiums, or restricting benefits because of any pre-existing condition.

The GAO report can be found
here. For more information about the health care reform law see Psychiatric News here. And APPI has published “Healthcare Reform: A Primer for Psychiatrists,” which is online here.


(Image: Gelpi/shutterstock.com)



Antipsychotics Do Not Improve Cognition in Early-Onset Schizophrenia

Young people with early-onset schizophrenia showed minimal neurocognitive improvements associated with treatment with atypical antipsychotic medications, and the small improvements that were demonstrated were consistent with practice effects as described in adults with chronic schizophrenia treated with antipsychotics.

That was the finding from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study, whose results were published online March 15 in the Journal of the American Academy of Child and Adolescent Psychiatry. The results extend to early-onset patients the same disappointing results found for adults in the CATIE trials and other studies, refuting industry claims that atypical antipsychotics produce enduring improvements in cognition for patients with schizophrenia.

For more information about these findings, see Psychiatric News here.

(Image: Tramper/shutterstock.com)

Thursday, April 26, 2012

New Opportunity to Dispose of Old Prescription Meds

The Drug Enforcement Administration (DEA) has scheduled another National Prescription Drug Take-Back Day this Saturday, April 28, from 10:00 a.m. to 2:00 p.m. Participants in the DEA’s third National Prescription Drug Take-Back Day on October 29, 2011, turned in more than 377,086 pounds of unwanted or expired medications for safe disposal at the 5,327 take-back sites.

“These events have dramatically reduced the risk of prescription-drug diversion and abuse and increased awareness of this critical public-health issue,” said DEA Administrator Michele Leonhart. "The amount of prescription drugs turned in by the American public speaks volumes about the need to develop a convenient way to rid homes of unwanted or expired prescription drugs. DEA remains hard at work to establish a drug-disposal process and will continue to offer take-back opportunities until the proper regulations are in place." 

For more information about the event, including a collection-site locator, see the DEA's "Got Drugs?" site.

The Centers for Disease Control and Prevention (CDC) says that states need to take more responsibility for reining in prescription drug abuse. Read more about the CDC's stance in Psychiatric News, here

(Image: mashe/Shutterstock.com)

APA Urges Senate Committee on Veterans Affairs to Take Further Steps

APA Medical Director James H. Scully Jr., M.D., addressed the Senate Committee on Veterans’ Affairs (VA) earlier this week, citing concerns that veterans and their families continue to experience delays in accessing quality mental health and substance abuse care in the VA system. Scully, himself a Navy veteran and former head of the Denver VA, said that APA applauds the recent announcement by the VA to hire an additional 1,900 psychiatrists, psychologists, and social workers to better serve veterans.

In his letter, Scully emphasized that addressing workload issues and VA payscale inequities affecting psychiatrists would help alleviate the department's psychiatrist shortage. Scully also urged the VA to focus its human resources efforts on hiring psychiatrists, as well as engaging community-based psychiatrists, and said that strategies such as engaging rural psychiatrists and using telepsychiatry are crucial to meeting the mental health needs of rural veterans.

The VA is already working on a number of important initiatives to engage community psychiatrists, including training them on military culture. Scully said that APA would welcome a more robust training partnership with the VA.

Read about community-level programs that provide support for returning veterans in Psychiatric News, here.

Wednesday, April 25, 2012

What's the Relationship Between Autism and Socioeconomic Status?

In the United States, epidemiological studies indicate that cases of autism spectrum disorders are found more frequently in families with high socioeconomic status (SES). That contrasts with most health conditions, which appear more often in low SES individuals. So Dheeraj Rai, M.B.B.S., of the U.K.'s University of Bristol, and colleagues studied health records of about 590,000 children (including 4,709 with autism spectrum disorder) in Stockholm County, Sweden to see if the same pattern held.

They found, however, that children from lower-income families and those whose parents worked manual jobs had a 40 percent higher risk of autism spectrum disorders, they reported in the May Journal of the American Academy of Child and Adolescent Psychiatry. “Studies finding the opposite may be underestimating the burden of ASD in lower SES groups . . . and may result from SES inequalities in access to services,” concluded Rai and colleagues.

To read more about autism spectrum disorders, see Psychiatric News here and here and the Textbook of Autism Spectrum Disorders from American Psychiatric Publishing here.

(Image: Jaimie Duplass/Shutterstock.com)

Daily Physical Activity Cuts Alzheimer's Risk


Daily physical activity is associated with a reduced risk of Alzheimer's disease, reports Aron Buchman, M.D., of the Rush Alzheimer’s Disease Center at Rush University in Chicago. Buchman and colleagues attached devices that measure activity on the wrists of 716 older people 24 hours a day for up to 10 days and then followed them for an average of 3.5 years.

Participants with low total daily physical activity had more than twice the risk of developing Alzheimer's than those with high total daily physical activity, the researchers reported online April 18 in Neurology. The association remained even after adjusting for baseline physical, social, and psychological conditions. Because the device was attached to the wrist it measured physical activity that is not strictly exercise, like cooking or gardening, suggesting that such activities may benefit the elderly as well, noted an accompanying editorial. “[T]his study supports encouragement of physical activity at any age, including very old age.”

To read more about Alzheimer's disease research, see Psychiatric News here and here.

(Image: Alan Lucas/Shutterstock.com)

Tuesday, April 24, 2012

Teen Drug Users Suffer High Depression Rates

Clinicians treating adolescents who acknowledge recreational use of methamphetamines or ecstasy (MDMA) have new reason to be concerned about sequelae of this drug use. Researchers at the University of Montreal reported April 18 in the Journal of Epidemiology and Community Health that teenagers who used one or both of these drugs had significantly increased risk for depression one year later. After studying 3,900 10th graders, the researchers found that "compared to non-users, adolescents who acknowledged taking either speed or ecstasy had a 60 percent to 70 percent greater risk of experiencing telltale signs of depression a year after their last recorded use."

The researchers added that further study is needed to assess whether the independent associations between meth and ecstasy use and depression in teens "reflect drug-induced neurotoxicity and whether adolescence is a period of increased vulnerablity to the hazards of synthetic drug exposure."

Another synthetic drug, referred to as "bath salts," is rapidly gaining in popularity among adolescents and others, with unknown consequences. Read about that problem in Psychiatric News. For comprehensive information about interventions for teen drug abuse, see Clinical Manual of Adolescent Substance Abuse Treatment from American Psychiatric Publishing.

(image: Victor Correia/Shutterstock.com)

Mental Health Care Waits Much Longer Than VA Acknowledged

With the need for mental health care growing dramatically after years of war in Iraq and Afghanistan, veterans often have to wait to get an appointment with a mental health clinician, but the delays veterans face in obtaining this care turn out to be much longer than indicated by data from the Department of Veterans Affairs. The Washington Post reported on April 24 that the VA Office of Inspector General has found that in 2011 only about half of veterans seeking mental health care for the first time were seen within 14 days, not the 95% that the VA had claimed were seen within 14 days. And a majority waited an average of 50 days for a comprehensive evaluation, the report stated. Responding to the inspector general's finding, Senate Veterans Affairs Committee Chair Patty Murray (D-Wash.), called the situation "deeply disturbing" and demanded action from the VA. "Getting our veterans timely mental health care can...be the difference between life and death," she said.

Last week the VA announced that it plans to hire 1,900 additional psychiatrists and other clinicians to meet the demand for mental health care.

To read about critical mental health issues in combat veterans, see Psychiatric News here and here.

(image: Straight 8 photography/Shutterstock.com)

Monday, April 23, 2012

Violence Can Shorten Children's Telomeres

Various life adversities have been found to shorten our telomeres—the DNA-protein complexes that cap the ends of chromosomes and that, if they become too short, cause cell death. While telomere shortening has been linked with characteristics of aging, it now appears that this phenomenon can occur even in children. As researchers reported April 24 in Molecular Psychiatry, children who had experienced violence had shorter telomeres than children who had not been victims of violence.

Moreover, it looks as if the negative personality trait of hostility can chip away at telomere length as well, at least in men. Hostility has long been associated with an increased risk of age-related disease and all-cause mortality. So hostility may adversely affect health by curtailing telomeres and hastening cell death.

For more information about this study, see Psychiatric News .

(Image: Ayelet KIeshet/Shutterstock.com)



Friday, April 20, 2012

Psychiatrist Yeates Conwell, M.D., Named "Innovation Advisor"

Geriatric psychiatrist Yeates Conwell, M.D., was chosen as one of 73 “Innovation Advisors”—and the only psychiatrist—in the federal government’s Innovation Advisors Program (IAP). The IAP encourages Conwell and other "Innovators" in the program to conduct a project that will yield results around each component of three goals: better health, better-quality care, and lower costs.

As director of a partnership between University of Rochester Medical Center and a community services provider network called the Senior Health and Research (SHARE) Alliance, Conwell will try to develop collaborative systems of care integrating primary care, mental health care and—most uniquely—community senior-service agencies in the care of depressed elderly in the community. His first project is a dementia care program that will link memory-disorder specialty services (geriatric psychiatry, psychology, neurology, general medicine, and nursing) with social work and other community-based care to optimize independent functioning and quality of life for people with dementia and their families, while reducing overall costs.

The IAP and Conwell’s vision as an Innovation Advisor dovetails with a growing movement toward “integrated care,” merging primary care and mental health treatment, often in co-located facilities. For more information about Conwell and the IAP see the April 20 issue of Psychiatric News here.

(Image: Courtesy Yeates Conwell, M.D.)


 




VA to Beef Up Mental Health Staffing at VA Medical Centers

The Department of Veterans Affairs announced yesterday that it plans to hire an additional 1,900 psychiatrists, psychologists, social workers, and other mental health care staff in order to reduce long wait times for services at many veterans medical centers. The New York Times reported today that the hiring would increase the department’s mental health staff by nearly 10 percent at a time when the veterans health system is being overwhelmed not just by veterans returning from Iraq and Afghanistan, but also by aging veterans from the Vietnam era.

Commenting on the need for the new positions, Senate Veterans Affairs Committee Chair Patty Murray (D-Wash.) said, "Too often we have seen staff vacancies, scheduling delays, and red tape leave those veterans who have been brave enough to seek help in the first place left with nowhere to turn."

For extensive reporting about veterans’ mental health issues see Psychiatric News here and here.
(Image: Straight 8 Photography/shutterstock.com)

Thursday, April 19, 2012

Medication Doesn't Enhance CBT Results in ADHD Patients


Cognitive-behavioral therapy (CBT) is an effective treatment for attention-deficit/hyperactivity disorder (ADHD) in adults, but adding medication doesn't enhance the results of CBT in patients with ADHD. That's the conclusion of University of British Columbia researchers published online April 5 in BMC Psychiatry. Their study was a secondary analysis comparing 23 participants randomized to CBT plus dextroamphetamine with 25 participants randomized to CBT plus placebo. Both groups showed robust improvement in symptoms and functioning, but the use of medication did not significantly improve the outcome over and above use of CBT and placebo. Their results, said the researchers, suggest that CBT can be effective in adults with ADHD, even in patients who are not able to use stimulants.

Recent research suggests that some adults with ADHD have an additional component of the disorder known as deficient emotional self-regulation (DESR), which is possibly a distinct familial subtype or variant of ADHD. For more information on this, see Psychiatric News, here.

(Image: Dimitry Atanasov / Shutterstock.com)

Neuromotor Behavior Affected by Intrauterine Antipsychotic Exposure

Intrauterine antipsychotic exposure may significantly affect neuromotor performance in 6-month-old infants. Researchers at Emory University reported online April 2 in the Archives of General Psychiatry the results of a 1999 through 2008 prospective controlled study of 309 mother-infant pairs. Examiners masked to maternal-infant exposure status administered a standardized neuromotor examination (the Infant Neurological International Battery) that tests posture, tone, reflexes, and motor skills. Infants prenatally exposed to antipsychotics scored signficantly lower than infants with antidepressant or no psychotropic exposure. Their results, said the researchers, highlight "the need for further scrutiny of the reproductive safety and neurodevelopmental sequelae of fetal antipsychotic exposure."

Last year, the Food and Drug Administration required the labels of all antipsychotics to be updated to reflect concerns about potential risk for extrapyramidal symptoms and withdrawal symptoms in newborns whose mothers were treated with antipsychotic medications during the third trimester of pregnancy. Read more about it in Psychiatric News, here.

(Image: Kruchankova Maya / Shutterstock.com)

Wednesday, April 18, 2012

Publication Bias Affects Views of Antipsychotic Drugs

“Publication bias in the reporting of trials of second-generation antipsychotic drugs enhances the apparent efficacy of these drugs,” wrote Peter G√łtzsche, M.D., of the Nordic Cochrane Centre in Denmark, in the online journal PLoS Medicine, on March 20. “These findings show how selective reporting of clinical trial data undermines the integrity of the evidence base and can deprive clinicians of accurate data on which to base their prescribing decisions.”

G√łtzsche was commenting on a paper in the same journal by Erick Turner, M.D., and assistant professor of psychiatry and pharmacology at Oregon Health Sciences University.

Turner and colleagues reviewed 20 published trials of eight second-generation antipsychotics and found only a nonsignificant difference in outcomes. However, the effect size for another four unpublished trials (0.23) was barely half that of the published trials (0.47) and achieved statistical significance. "Without increased access to regulatory-agency data, publication bias will continue to blur distinctions between effective and ineffective drugs,” wrote Turner and colleagues.


To read more about possible bias in publication of clinical trials of antipsychotics, see Psychiatric News here.
(Image: Andrew S./Shutterstock.com)

American Psychiatric Foundation Grantee Honored by Time Magazine

Dr_Romberg.jpegTime magazine today honored psychologist Barbara Van Dahlen, Ph.D., as one of its 100 most influential people in the world for 2012. Van Dahlen founded Give an Hour, a nonprofit organization that connects volunteer psychiatrists and other mental health professionals with current and former military personnel and their families for an hour of free therapy each week. Since 2005, Give an Hour has brought together over 6,100 providers with service members and their families.

“The American Psychiatric Foundation is very proud to have been partners with Give an Hour for the past four years,” said Paul Burke, executive director of the foundation. “Barbara Van Dahlen richly deserves this recognition and honor.”

“Barbara has tenaciously attacked the epidemic of posttraumatic stress disorder, helping break through the stigma that prevents many from seeking help,” wrote former Chairman of the Joint Chiefs of Staff Adm. (ret) Mike Mullen, in Time. “She has served thousands nobly and has been an extraordinary example for all of us in her life and her giving.”

For more information about Van Dahlen and Give an Hour, see Psychiatric News here and here.
(Image: Give an Hour)

Tuesday, April 17, 2012

Treating Depressed Moms to Remission Helps Kids

Children of mothers whose depression remitted after treatment or other intervention had significantly fewer behavior problems than children whose mothers remained depressed, report researchers at Loyola University Maryland in Baltimore. They studied 60 low-income women with major depression and their children ages 4 to 11. The women were randomly assigned to receive either medication or cognitive-behavioral therapy or were referred to community services as a control.

Active treatment alone of mothers did not result in improvement in their children's behavior problems or adaptive skills, they said in the April Psychiatric Services. However, about 28% to 32% of the mothers achieved remission. Children of those mothers had significantly fewer behavior problems than children whose mothers remained depressed. “[More] research is needed on the long-term effects on families of treating mothers' depressive episodes to determine whether the benefits of remission persist,” concluded the authors.

For more about the diagnosis, and treatment of psychiatric illness during pregnancy and after giving birth, click here for Psychiatric News, and click here to see the American Psychiatric Publishing book Mood and Anxiety Disorders During Pregnancy and Postpartum.
(Image: Marina Dyakonova/Shutterstock.com)

Parity Law Author Condemns Implementation Delay

Regulatory action needed to implement the federal mental health care parity law has stalled, which has led to "uncertainty and confusion for employers over what they must cover and when parity applies," stated the law's frustrated coauthor in an op-ed column in the Washington Post on April 13.

Two former U.S. senators—Pete Domenici who coauthored the law along with the late Sen. Paul Wellstone, and Gordon Smith, also a former senator and a strong supporter of the law—wrote that "President Obama voted for the bill as a U.S. senator, and all indications are that he remains supportive. Yet...the final rule that would provide clarity to the millions who have a mental illness or substance-use disorder, and to their employers, has not been issued." Without regulations stating what is covered by the parity mandate, health insurance plans are maintaining "discriminatory barriers to care, such as imposing stricter prior-authorization requirements for mental health and addiction treatment" than they do for other medical illnesses.

Read more about concerns regarding implementation of the parity law in Psychiatric News here and here.

(image: zimmytws/Shutterstock.com)




Monday, April 16, 2012

Fragile X Syndrome Findings in Mice May Someday Help Humans

A new compound reversed many of the major symptoms of fragile X syndrome in mice, scientists from Hoffmann-LaRoche and Massachusetts Institute of Technology reported in the April 12 Neuron. Although the drug, called CTEP, is not being developed for humans, the findings still have significance for humans with fragile X syndrome, which has several behavioral and cognitive symptoms that overlap with those seen in autism. "The most important implications of our study are that many aspects of fragile X syndrome are not caused by an irreversible disruption of brain development and that correction of the altered glutamate signaling can provide widespread therapeutic benefit," the lead scientist wrote in an accompanying press release.

Even though fragile X syndrome and autism share symptoms, these symptoms do not arise from the same brain abnormalities, other researchers reported a few months ago. The results of these studies may also have clinical implications, the researchers suggested. More information about this study can be found in Psychiatric News.

 (Image: ZouZou/Shutterstock.com)

Cancer Can Lead to Death in Sometimes Unexpected Ways

People who have been diagnosed with cancer have a markedly increased risk of suicide and cardiovascular death during the period immediatley after being given the diagnosis, reported Swedish and Icelandic researchers April 5 in the New England Journal of Medicine. They had followed more than 6 million Swedes for a five-year period.

Only a small proportion of subjects died by suicide immediately after being diagnosed with cancer. However, the suicide risk during the first week following the diagnosis was 12 times higher than in people without cancer. Similarly, the risk of cardiovascular death was six times higher during the first week, and three times higher during the first month, after a cancer diagnosis.

More information about the mental health sequelae of cancer, as well as a psychiatrists account of his cancer battle, can be found in Psychiatric News .

(Image: Lisa S./Shutterstock.com) 

Friday, April 13, 2012

"Bully"--A New Documentary Opens Nationwide Today

The documentary “Bully,” about teenage bullying, is in theaters now, after weeks of controversy over the “R” rating the film initially received because of some its language, thereby making it difficult or impossible to see for the age group that could benefit most from its message.

Now rated PG-13, the movie, which chronicles the experience of several adolescents who were bullied and the often-clueless adults in their lives, should be seen by teens and adults alike, says a reviewer in the Washington Post today. “This intimate, straightforward, often wrenching portrait of five families dealing with bullying and its aftermath doesn't hold many surprises at a time when such campaigns as 'It Gets Better' and special programming on kids' cable networks are bringing the issue to the fore. Then again, these heartbreaking stories of victimization, perseverance, and adult cluelessness bring a necessary human face to an experience all too often banished to the realm of statistics or hazy 'kids will be kids' denial.”

For coverage of mental health issues related to bulllying, see Psychiatric News here and here.

(Image: oliveromg/shutterstock.com)

BPD Patients Frequently Remit but Fare Worse Than Patients With Other Personality Disorders

Remission of symptoms of borderline personality disorder (BPD) is quite common but full recovery—including good vocational functioning—is less so, and patients with BPD over time fare worse in terms of remission, recovery, and recurrence of illness than do patients with other personality disorders. Those were major findings of a longitudinal comparison of BPD and other personality disorders that appeared online on March 28 in AJP in Advance.

 Cumulative rates of remission for BPD patients ranged from 78 percent for those with an eight-year remission to 99 percent for those with a two-year remission. The corresponding rates for those with other personality disorders were 97 percent and 99 percent, respectively. Rates of recovery for borderline patients ranged from 40 percent for recoveries lasting eight years to 60 percent for recoveries lasting two years. For Axis II comparison subjects, cumulative rates of recovery ranged from 75 percent for recoveries lasting eight years to 85 percent for recoveries lasting two years.

For additional information about outcomes and treatment for patients with BPD see Psychiatric News, here and here.  To read more about BPD, see Borderline Personality Disorder: A Clinical Guide, Second Edition, from American Psychiatric Publishing.

(Image: Dick Ercken/shutterstock.com)

Thursday, April 12, 2012

Arkansas Jury Finds Johnson & Johnson Guilty in Latest Risperdal Case

Johnson & Johnson (J&J) "lied to patients and doctors" in its claims about its antipsychotic Risperdal, said Arkansas Attorney General Dustin McDaniel this week, after a jury found the company guilty following 10 days of testimony. This is the latest case regarding fraudulent claims about the company's second-generation antipsychotic, Risperdal (risperidone). The jury determined that J&J downplayed and hid risks associated with the drug, which has been linked to increased risk of stroke and death in elderly dementia patients and to seizures, weight gain, and diabetes.

After the jury's decision, Arkansas Circuit Court Judge Tim Fox, issued a penalty of $1.19 billion for the nearly 240,000 violations of the state's Medicaid fraud law. The New York Times reported that he also fined the company $11 million for violations of the state's deceptive practices act.

A South Carolina judge previously upheld a $327 million civil penalty against J&J, which in March 2011, was found guilty by a jury of overstating the safety and effectiveness of Risperdal. Read more about that case in Psychiatric News here.

(Image: Iraidka/Shutterstock.com)

Substance Use Disorder Patients Need Better Screening for ADHD

Better screening procedures for attention-deficit/hyperactivity disorder (ADHD) are needed for patients with substance use disorders. "Considering the high rate of ADHD comorbidity among substance use disorder patients, it is crucial to promote a systematic diagnostic approach to this disorder in specialized addiction-treatment settings," wrote French researchers online April 9 in Current Opinion in Psychiatry.

They found that diagnosing ADHD in substance use disorder patients is challenged by phenomenological aspects of addiction and frequently by other psychiatric disorders that overlap with symptoms of ADHD. A comprehensive search for child and adult symptoms including the temporal relationship of ADHD, substance use, and other psychiatric disorders should maximize the validity and reliability of adult ADHD diagnosis in this population. Further, the researchers said, a follow-up evaluation of ADHD symptoms during treatment of a substance use disorder may reduce the likelihood of misdiagnosis.

Comorbid psychiatric conditions are common in adults with ADHD, but clinicians may diagnose those other conditions, yet overlook the ADHD. Read more about it in Psychiatric News, here. For an in-depth review of how ADHD is complicated by other psychiatric conditions, see American Psychiatric Publishing's ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults.

(Image: kentoh/Shutterstock.com)

Wednesday, April 11, 2012

Unique Issues Affect Depression in Elderly People

With the U.S. population aging, it's likely that more and more individuals are worrying about whether the vicissitudes of growing older, such as declining health, death of loved ones, and loss of self-sufficiency, will propel them down a path to depression. Writer Carolyn Butler of the Washington Post explored this issue in depth in the paper's April 10 Health and Science section, coming to the conclusion that "aging does seem to make us more vulnerable to depression, but it's not a foregone conclusion."

She cited psychiatrists who explained that major depression affects only about 2% of those aged 65 or older, though minor depressions are more common, afflicting about 25% of older people. Other experts described factors that impact risk for late-life depression, including the role that medical conditions can play, and warning signs in elderly friends or relatives that might signal the presence of depression and the need for medical intervention. "The good news," Butler emphasized, "is that there is a range of highly effective pharmaceutical and psychotherapy options for dealing with depression at any age."

To read about depression and other mental health issues in the elderly, see Psychiatric News here and here. For much more on mental illness in the elderly see the new book Essentials of Geriatric Psychiatry, Second Edition, from American Psychiatric Publishing.

(image: Yuri Arcurs/shutterstock.com)

Autism Diagnosis Made Quicker With New Online Tool

Researchers at Harvard Medical School have developed a new Web-based process for detecting autism in young children—one that they say can reduce the three hours required for the standard autism-evaluation procedure to mere minutes. The researchers determined that just seven of the 93 questions currently administered by trained clinicians as part of the Autism Diagnostic Interview, Revised, are sufficient to diagnose autism with nearly 100 percent accuracy. The simplified process would also incorporate the assessment of short home-video clips of children suspected of having autism.

Read more about new autism research in Psychiatric News and in the Textbook of Autism Spectrum Disorders, from American Psychiatric Publishing.
(Image: alpturk33/Shutterstock.com)

Tuesday, April 10, 2012

Long-Term Stimulant Use Doesn't Cause Blood-Pressure Spike

With stimulant medications an increasingly popular treatment for children with attention-deficit/hyperactivity disorder (ADHD), concerns have been raised about whether their use over the long term will raise a child's risk of developing hypertension. Benedetto Vitiello, M.D., chief of the Child and Adolescent Treatment and Preventive Intervention Research Branch of the National Institute of Mental Health, led a 10-year study to assess whether such a risk exists. In a report in the American Journal of Psychiatry, he and his colleagues reported that they did not find a link between long-term stimulant use for ADHD and elevated blood pressure in the hypertensive or prehypertensive range. They did, however, find that greater cumulative stimulant use was linked to a higher heart rate at years 3 and 8 of the 10-year study.

Read more about this study in the current issue of Psychiatric News here, and read the results of a study that assessed cardiovascular safety of methylphenidate use in adults here

(image: Kamira/Shutterstock.com)

Antipsychotic May Improve Anorexia Nervosa

With no medications approved for treatment of anorexia nervosa, a potentially fatal eating disorder, the finding that the antipsychotic olanzapine improved survival in a mouse model of anorexia offers some encouraging news in the search for treatments for the disorder. Researchers at the University of Chicago reported in Neuropsychopharmacology that mice treated with small doses of olanzapine were more likely to maintain their weight when given an exercise wheel and restricted food access, conditions that produce activity-based anorexia (ABA) in animals. Stephanie Klenotich, a graduate student in neurobiology and the paper's first author, said, "We found over and over again that olanzpine was effective in harsher conditions, less-harsh conditions, adolescents, adults—it consistently worked."

Daniel Le Grange, Ph.D.,a coauthor of the paper and director of the University of Chicago's Eating Disorders Clinic, pointed out that one challenge in this area is finding a medication that anorexia patients will agree to take regularly, since they often reject drugs that cause weight gain or have strong sedative effects.

To read an in-depth review of assessment and treatment of eating disorders, see American Psychiatric Publishing's Clinical Manual of Eating Disorders. And read more about eating disorder treatment in Psychiatric News.

Monday, April 9, 2012

Several Gene Mutations Linked to Autism

Three teams of scientists working independently have zeroed in on several gene mutations that they agree sharply increase a child's chances of developing autism, the New York Times reported on April 4.

Yet the gene mutations are rare and account for only a tiny fraction of autism cases. Also, a child's genetics account for only about half of autism's etiology, another study suggests. The rest of the disorder's etiology appears to have roots in environmental factors such as older paternal age, low birth weight, and viral infections during pregnancy. For more information about this study and the influences of genes and environment of development of autism, see Psychiatric News .

(Image: Jaimie Duplass/Shutterstock.com)

Hard-Hitting Journalist Didn't Shy Away From Discussing His Depression

Mike Wallace, the CBS reporter who became one of America's best-known broadcast journalists for his relentless interrogations on the long-running news magazine "60 Minutes," died April 8 at age 93. "A reporter with the presence of a performer, Wallace went head to head with chiefs of state, celebrities, and con artists for more than 50 years....," said the New York Times.

Wallace was one of the first celebrities to come out publicly about having a mental illness. Wallace talked about his years-long struggle with depression, his suicide attempt, his treatment, and his ultimate recovery during an episode of the PBS series "HealthyMinds," in which he was interviewed by psychiatrist and "HealthyMinds" host Jeffrey Borenstein, M.D. (Borenstein was recently appointed editor-in-chief of Psychiatric News.)

See the "HealthyMinds" interview with Wallace here.

Friday, April 6, 2012

New Analysis Shows Psychiatric Drugs as Efficacious As General Medical Drugs

A newly published “panoramic overview” of meta-analyses looking at how psychiatric and general medical drugs compare with placebo shows that the psychiatric drugs, including antidepressants, are as efficacious as drugs used to treat general medical conditions.

The study, which appears in the February British Journal of Psychiatry, refutes a 2008 study that appeared in the Journal of the Public Library of Science (PloS), which purported to show that antidepressants demonstrated superiority to placebo only in cases of severe depression. The PloS study had garnered much publicity, including coverage on "60 Minutes."

In the new study, researchers looked at meta-analyses of 48 drugs in 20 medical diseases, and 16 drugs in 8 psychiatric disorders to compare efficaciousness. They found that there were some general medical drugs with clearly higher effect sizes than the psychotropic agents, but the psychiatric drugs were not generally less efficacious than other drugs.

The British Journal of Psychiatry report joins a study that appears in the Archives of General Psychiatry that also refutes the earlier PLoS report by using patient-level data to track response and remission rates over time. That report showed that fluoxetine and venlafaxine are efficacious for major depressive disorder in all age groups, and that baseline severity was not significantly related to degree of treatment advantage over placebo.

For coverage of both studies, look for upcoming editions of Psychiatric News. And for more coverage about comparisons of antidepressants and placebo, see Psychiatric News here.

(Image:ajt/shutterstock.com)

Whitney Houston's Death Sends Message to Clinicians

An official autopsy report released Wednesday reveals that popular singer Whitney Houston had cocaine in her body at the time of her death in a Beverly Hills hotel room on February 11. Houston, who recorded such hit songs as “I Will Always Love You,” “I Wanna Dance With Somebody,” and “Greatest Love of All,” was a superstar in the 1980s and 1990s but led a tumultous personal life that included bouts with addiction and admissions to drug rehab. The tragedy is a reminder that clinicians should screen all patients for substance use disorders and help those who screen positive to get appropriate treatment; also, maintenance treatment for such patients may be needed. For extensive coverage of substance abuse, see Psychiatric News and Cocaine and Metamphetamine Addiction: Advances in Treatment, from American Psychiatric Publishing.

(Image: SkillUp/shutterstock.com)

Thursday, April 5, 2012

NIDA to Showcase “PEERx” for Teens at First Rx Drug Abuse Summit

The first National Rx Drug Abuse Summit will be held next week in Orlando, Fla, and the National Institute on Drug Abuse (NIDA) will be showcasing “PEERx,” an initiative that uses interactive videos and other tools to educate teens about the dangers of prescription drug abuse and help them to spread the word. Teen leaders from SADD (Students Against Destructive Decisions) will assist NIDA in exhibiting PEERx and hosting a train-the-trainer workshop for state and national leaders, law enforcement officials, medical professionals, community advocates, treatment experts, educators, private industry leaders, and others attending the event.

NIDA’s involvement in the summit also includes an exhibit for NIDAMED, NIDA's outreach to physicians, which will include a collection of resources to assist health care providers in detecting drug abuse early, preventing escalation to addiction, and referring patients to treatment when necessary.

Visit the PEERx portion of the "NIDA for Teens" Web site, here, and learn more about the first National Rx Drug Abuse Summit at http://nationalrxdrugabusesummit.org/.

Recent studies have investigated the link between lack of sleep in teens and health-risk behaviors, including drug abuse. Read more in Psychiatric News, here.

(Image: NIDA)

Annual Meeting Daily Bulletin Preview and Mobile Event App Now Available!

The Daily Bulletin preview issue and the Mobile Event APP can jump-start your meeting experience by drawing attention to sessions and meeting attractions waiting for you. (At left is the QR code to download the app; if it doesn't work, click here for more information.)

The annual meeting app will provide attendees with all of the information and real-time updates they need to navigate the event via their mobile devices. Content areas of the app include information on sessions and exhibitors, maps, daily news, and feeds. The app is available for iPhone, iPad, Android, and some Blackberry devices as well as a WAP application for all other web-enabled mobile devices.

Five issues of The Daily Bulletin will be produced, including the preview edition posted online today that highlights scientific sessions, special events, and local attractions. The Daily Bulletin will be available in digital and print versions. Digital viewers will be able to add notes, bookmark pages, and share content via e-mail and social media. Print copies of the bulletin will be available at the convention center, and there will be door-to-door distribution at selected meeting hotels. The bulletin is also "going mobile." The mobile edition will showcase selected articles from each print issue along with daily schedule information. Viewers of the mobile edition will be able to comment on and share articles.

Wednesday, April 4, 2012

Inadequate Evidence Backs School MH Efforts

Only limited evidence supports the role of school environment in impacting adolescent mental health, according to a review by researchers at England's University of Bristol. They evaluated reports from five controlled trials and 23 cohort studies. “Two nonrandomized trials found some evidence that a supportive school environment improved student emotional health, but three randomized controlled trials did not,” they said in the journal Pediatrics, published online April 2. “Six cohort papers examined school-level factors but found no effect. Methodological shortcomings were common.”

Perceptions of school connectedness and teacher support predicted future emotional health, but school effects were smaller than individual-level effects, they said. More studies, especially randomized controlled trials, are needed to  understand which school-based interventions can benefit students' mental health.

To read more in about mental health interventions in schools, see Psychiatric News here and here.

(Image: Elena Eliseeva/Shutterstock.com)

Six Paths Found for Autistic Kids' Development

Children with autism appear to fall into six patterns of development between ages 2 and 14, report Christine Fountain, Ph.D., and colleagues at Columbia University. Their study of 6,975 children with autism born in California from 1992 to 2001 found six typical patterns of social, communication, and repetitive-behavior functioning. “Children whose symptoms were least severe at first diagnosis tended to improve more rapidly than those severely affected,” wrote the authors in the journal Pediatrics online April 2.

One group, which the researchers labeled “bloomers,” included about 10 percent of the children. They had low functioning at first, but then “experienced rapid gains, moving from severely affected to high functioning.” According to the researchers, “[T]hose most likely to ‘bloom’ are those without intellectual disability and those with more educated, nonminority mothers.”

That last point has important treatment implications. “If this heterogeneity in outcomes is associated with parental and community resources, then equal access to early intervention and treatment resources for less-advantaged children is vital,” said the authors.

To read more about diagnosing autism, see Psychiatric News hereAlso, see the latest information about autism and related disorders in American Psychiatric Publishing's Textbook of Autism Spectrum Disorders.

(Image: SergiyN/Shutterstock.com)

Tuesday, April 3, 2012

Resident Match Results Disappointing for Psychiatry

Despite an often-cited need for more psychiatrists in the United States, especially child psychiatrists, the latest numbers from the National Resident Matching Program show that fewer U.S. medical school seniors have chosen a career in psychiatry, continuing a generally downward trend over the last six years. Reacting to the match results, APA President John Oldham, M.D., said, "We need to reach out to medical students in more effective ways than simply exposing them to a four-week clerkship on an inpatient unit, with no follow-up of the patients they have cared for. Establishing and maintaining ongoing relationships with patients is one of the key factors that makes psychiatry such a fulfilling career." As for possible reasons behind the decline, APA Medical Director James H. Scully Jr., M.D., noted that psychiatry is in a very exciting time "when we have more scientific developments in the field than ever before, but this means that the field is evolving in ways in which the outcome is unknown." Another potential deterrent is the massive student debt facing many medical school graduates, driving them to choose more lucrative specialties such as surgery.

Look for much more detail about this year's match results in an upcoming issue of Psychiatric News. Read about the results of last year's resident match here.

(image: auremar/Shutterstock.com)


APA Urges Changes to Physician Payments Sunshine Act

Reflecting its strong support of transparency regarding transactions between psychiatrists and the pharmaceutical industry, APA has expressed support of most of the proposed rule implementing the Physician Payments Sunshine Act. In comments to the Centers for Medicare and Medicaid Services (CMS), however, APA cites several problems with the rule that it urges CMS to correct.

For example, APA wants a delay in manufacturer reporting until January 1, 2013, because CMS may not have the final rule in place until early summer, and the proposed rule requires manufacturer reporting to begin 90 days after the final rule is published. APA also maintains that CMS has underestimated the time it will take some physicians—especially those in solo private practice who do not have support staff—to check records and verify the accuracy of reports about their interactions with drug manufacturers. In addition, APA believes that clearer guidelines are needed than the ones CMS has issued on correcting reports of interactions with drug manufacturers that physicians believe are erroneous.

To read more about the Physician Payments Sunshine Act and APA's response to it, see the latest issue of Psychiatric News.

(image:barbaliss/Shutterstock.com)



Monday, April 2, 2012

Being Bilingual May Help Ward Off Dementia

Individuals who are bilingual tend to experience the onset of dementia years later than those who speak only one language, studies have found. Now researchers offer a possible explanation for this phenomenon in the March 29 Trends in Cognitive Sciences. They propose that the lifelong need to monitor two languages in order to select the appropriate one leads to a constant recruitment of brain regions critical for attention and cognitive control. Such constant recruitment may, in turn, strengthen certain brain regions and help ward off the encroachment of dementia.

Exercise is another intervention that some scientists believe may be able to prevent dementia. In a recent study, for example, exercise was found to not only reduce amyloid plaques, the hallmark of Alzheimer's, in the brains of cognitively normal individuals, but to reduce them in individuals who carry the APOE-e4 gene variant. The e4 variant is a well-established risk factor for Alzheimer's. For more information about this study see Psychiatric News.

(Image: Lightspring/Shutterstock.com)



Depression a Common Disorder in Stroke Victims

A substantial number of individuals who experience stroke or transient ischemic attacks (TIAs) are depressed, Duke University researchers report in the American Heart Association's journal Stroke. They analyzed some 1,500 adults with stroke and found that 18 percent were depressed three months later and 13 percent a year later. For the 400 subjects with TIAs, 14 percent were depressed three months later and 13 percent a year later. Nearly 70 percent of stroke and TIA patients with persistent depression still weren't treated with antidepressants during the following year. The researchers determined depression using the Patient Health Questionnaire-8, which covers a range of depressive symptoms. Although the cause of the depression was not explored in the study, the depression may have contributed to the strokes or the strokes to the depression.

Still other research suggests that depression can contribute to stroke or heart attacks. For example, in a large prospective study of young adults, subjects who had been depressed were twice as likely to experience a fatal cardiovascular event as those who had not been depressed. For more information about this study, see Psychiatric News .

(Image: Kuzma/Shutterstock.com)



Disclaimer

The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising on this site. Clinical information is not peer reviewed and thus should be independently verified.