Thursday, December 18, 2014

Preliminary Study Shows Primary Care Provider Training Can Improve Prescribing for Children


A New York state initiative to provide psychiatric consultation to pediatric primary care providers about prescribing psychotropic medication shows promise for enhancing providers' comfort with prescribing, according to the report “Detection and Treatment of Mental Health Issues by Pediatric PCPs in New York State: An Evaluation of Project TEACH” published online in Psychiatric Services in Advance.

Researchers in the Department of Child and Adolescent Psychiatry at New York University School of Medicine and colleagues at other institutions evaluated Project TEACH (PT), a statewide training and consultation program for pediatric primary care providers (PCPs) on identification and treatment of mental health conditions. The project is part of a collaboration between the REACH Institute (Resource for Advancing Children’s Health) and five academic departments of psychiatry. The curriculum consists of 15 hours of in-person training, a tool kit, and Web-based learning tools, along with a six-month distance learning program that includes 12 one-hour consultation calls with child psychiatrists.

Researchers compared an intervention group of 176 PCPs who volunteered for PT training with a stratified random sample of 200 PCPs who did not receive PT training. Data on prescription practices, diagnoses, and follow-up care were from New York State Medicaid files for youths seen by the trained and untrained PCPs. They found that the percentage of children prescribed psychotropic medication increased after PT training (from 9% to 12%), a larger increase than in the untrained group (from 4% to 5%).

“Our findings suggest potential benefits of training PCPs to identify and treat children’s mental health conditions," the researchers said. "Provider training and consultation may be a meaningful way to help reduce the number of children who do not receive treatment for mental health conditions, but further research is necessary to determine whether this type of model will be useful as the responsibility for mental health care and outcomes shifts under health care reform.”

For more about this program, see the Psychiatric News article, "New York Child Psychiatry Divisions Fill Gap in Collaborative Care Model."

(Image: Lisa F. Young/shutterstock.com)

Wednesday, December 17, 2014

Health Coaching Intervention Effective for Obesity in Those With Serious Mental Illness, Study Finds


A health coaching intervention for obesity appears to be effective in achieving and sustaining clinically significant reductions in cardiovascular risk for overweight and obese individuals with serious mental illness.

That’s the finding of a replication trial of the In SHAPE program in the report “Pragmatic Replication Trial of Health Promotion Coaching for Obesity in Serious Mental Illness and Maintenance of Outcomes,” published in AJP in Advance.

In SHAPE is a 12-month program consisting of individual weekly meetings in the community with a health-promotion coach, a fitness club (YMCA) membership, and nutrition education adapted for people with serious mental illness that was found in a previous study to contribute to clinically significant reduction in cardiovascular risk in overweight or obese adults with serious mental illness.

In the new study, Stephen Bartels, M.D., of the Department of Psychiatry and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth and colleagues randomly assigned 210 individuals with serious mental illness and a body mass index greater than 25 receiving services in three community mental health organizations either to the 12-month In SHAPE program or to fitness club membership alone. The primary outcome measures were weight and cardiorespiratory fitness (as measured with the 6-minute walk test) assessed at baseline and at 3, 6, 9, 12, and 18 months.

At 12 months, the In SHAPE group had greater reduction in weight and improved fitness compared with the fitness club membership group. Primary outcomes were maintained at 18 months. Approximately half of the In SHAPE group achieved clinically significant cardiovascular risk reduction, defined by a weight loss greater than 5 percent or an increase of greater than 50 meters on the 6-minute walk test.

“By comparing In SHAPE to an active comparison condition (a fitness club membership), we were able to test the specific contribution of having a health-promotion coach,” the researchers stated. “Having a health-promotion coach was associated with more than two-and-a-half times the mean amount of fitness club attendance, which in turn was associated with greater weight loss and improved fitness.”

For more on this subject, see the Psychiatric News article, "Health Mentors Prove Valuable For Those With Serious Mental Illness."


(Image: Shutterstock)

Tuesday, December 16, 2014

Senator Blocks Passage of Veterans' Suicide Prevention Bill


The legislative battle went down to the wire, but a lone recalcitrant senator ultimately blocked passage of a bill to help reduce suicides among veterans by enabling the Veterans Health Administration (VHA) to hire more psychiatrists. APA, veterans’ service organizations, and the Department of Veterans Affairs had strongly backed the Clay Hunt Suicide Prevention for American Veterans Act, which the House of Representatives approved unanimously last week.

The Senate vote was blocked by a “hold” placed on the bill by retiring Sen. Tom Coburn (R-Okla.), who objected to the allegedly dysfunctional management of the VHA. A hold permits a single senator to block a vote on the Senate floor.

In reply, Sen. Richard Blumenthal (D-Conn.) noted that the act included provisions for annual evaluations of the VHA’s mental health care and suicide prevention programs, in addition to encouraging recruitment of “not less than 10” psychiatrists per year into the VHA in part through use of a medical school loan repayment program. Psychiatrists entering the program would agree to a minimum of two years of service with the VHA in return for a $30,000 per year loan repayment.

There is hope for passage early next year, however. “Veterans groups have assurances from Senators John McCain (R-Ariz.) and Richard Burr (R-N.C.) for a quick reintroduction in January,” said Lizbet Boroughs, deputy director of APA’s Department of Government Relations. “A bipartisan group of 20 senators currently supports the bill, and Representatives Jeff Miller (R-Fla.) and Tim Walz (D-Minn.) will act quickly on the House side, as well.”

For more in Psychiatric News about psychiatrists and mental health care in the VHA, see the article “Psychiatrists’ Pay to Rise at Veterans Health Administration.”

(Image: Susan Montgomery/Shutterstock.com)

Monday, December 15, 2014

Patients Should Know Their Rights Under the Parity Law


December 15 is Bill of Rights Day, a time to recognize and reflect on the freedoms and protections that people in this country have, for it is critical to know your rights to protect those rights.

Among the mental health community, an important right was established in 2008 with the passing of the Mental Health Parity and Addiction Equity Act (MHPAEA). This law made it clear that insurers cannot discriminate against patients with a mental illness, including a substance use disorder.

However, the MHPAEA can be truly effective only if it is properly enforced, and to that end, APA created a poster to help educate patients about mental health parity and their rights under the MHPAEA.

Titled “Fair Insurance Coverage: It’s the Law,” this poster clearly and simply explains the 10 key elements of the law and the steps to take when a violation is suspected.

APA hopes its members and partners join in the effort to protect mental health patients and ensure that all insurers play by the rules. Physicians and therapists should print a copy and post it their office or waiting room, and any other interested parties are likewise encouraged to display the poster in their workplace and/or share the link. Patients and members of the public are invited to download and review the poster as well. Subscribers of Psychiatric News will find a color copy of the poster in the December 5 print edition of the paper.

Learn more about the MHPAEA and find resources related to the law here.

To read APA President Paul Summergrad’s column on this subject, see the Psychiatric News article “Parity Enforcement: A Top Priority.”

(Image: Michelle Holland)

Friday, December 12, 2014

FDA Warns That Ziprasidone May Lead to Potentially Fatal Skin Reaction


Yesterday the Food and Drug Administration (FDA) released a warning stating that the use of ziprasidone (marketed as Geodon), intended to treat schizophrenia and bipolar disorder, may increase risk for a rare but serious skin reaction that can result in death.

The skin reaction, known as drug reaction with eosinophilia and systemic syndromes (DRESS), may start as a rash that can eventually spread to all parts of body. The condition causes a higher-than-normal number of eosinophils, which can lead to fever, swollen lymph nodes, and inflammation of organs such as the heart, kidney, liver, lungs, and pancreas.

The FDA released the warning statement after the agency reviewed information from six patients in whom the symptoms of DRESS appeared between 11 and 30 days after initiating treatment with ziprasidone. Based on this information, the FDA is requiring Pfizer, the drug's manufacturer, to add a new warning for DRESS to the Warning and Precautions section of the drug labels for the capsule, oral suspension, and injection formulations.

The FDA is urging health care professionals to stop patient treatment with ziprasidone if DRESS is suspected. They are also asking physicians, as well as patients, to report any side effects involving ziprasidone in the “Contact Information For Voluntary Adverse Event Reporting” section of the FDA MedWatch website.


Thursday, December 11, 2014

APA Urges Senate to Pass Veterans Mental Health Care Bill


APA today joins veterans’ service organizations like the Iraq/Afghanistan Veterans of America, Vietnam Veterans of America, the Wounded Warrior Project, and the Disabled American Veterans in urging the U.S. Senate to pass its version of the Clay Hunt Suicide Prevention for American Veterans (SAV) Act (S. 2930) before adjourning for the year.

The House of Representatives on Tuesday passed a related bill that, among other provisions, encourages increased recruitment of psychiatrists into the Veterans Health Administration through use of a medical school loan repayment program.

APA members can contact their senators by clicking here.

Should the Senate adjourn in the next few days without acting on the measure, the bill will have to be reintroduced in January.

“Many of the nation’s veterans face significant mental health conditions, which are the invisible wounds of war,” said APA President Paul Summergrad, M.D. “Far too often they are not receiving expert, timely care. This legislation is a critical step in helping veterans get the care they need, which is our sacred obligation to provide.”

For more in Psychiatric News about incentives for psychiatrists in the Veterans Health Administration, see: "Psychiatrists’ Pay to Rise at Veterans Health Administration."

(Image: Shutterstock.com)

Wednesday, December 10, 2014

Mortality Associated With Antipsychotic Dosage Reveals U-Shaped Curve, Study Shows


Among patients with schizophrenia, the cumulative antipsychotic exposure displays a U-shaped curve for overall mortality, revealing the highest risk of death among those patients with no antipsychotic use and those with the highest antipsychotic use. That's the finding of a report on mortality associated with antipsychotic use appearing online in Schizophrenia Bulletin.

It has been generally believed that long-term use of antipsychotics increases mortality and, especially, the risk of cardiovascular death, but no solid data existed to substantiate this. So Swedish researchers identified all individuals in Sweden with schizophrenia diagnoses before year 2006 (N=21,492), aged 17–65 years, and individuals with first-episode schizophrenia during the follow-up, 2006–2010 (N=1,230). Patient information was prospectively collected through nationwide registers. Total and cause-specific mortalities were calculated as a function of cumulative antipsychotic exposure from January 2006 to December 2010.

They found that the highest excess overall mortality was observed among first-episode patients with no antipsychotic use compared with age- and gender-matched controls from the general population. This was followed by patients with high exposure to antipsychotic medication (greater than 1.5 DDD/day). Patients with low exposure (<0.5 DDD/day) and moderate exposure (0.5–1.5 DDD/day) had lower overall mortality. The high exposure and no exposure patients were associated with higher cardiovascular mortality than either low exposure or moderate exposure.

“These results indicate that both excess overall and cardiovascular mortality in schizophrenia is attributable to factors other than antipsychotic treatment when used in adequate dosages,” the researchers state.

For more information, see the Psychiatric News article, "Antipsychotics for Elderly Vary in Mortality Risk."

(Image: Shutterstock)

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