APA Praises Sens. Grassley, Brown for Bill to Protect Part D Coverage of Needed Mental Health Medications

APA has endorsed new Senate legislation requiring Medicare Part D plans to provide robust coverage for six classes of medications, including medications needed to treat depression and schizophrenia. The bill was introduced yesterday by U.S. Sens. Chuck Grassley (R-Iowa; left) and Sherrod Brown (D-Ohio; right).

If passed, the legislation would prevent the Centers for Medicare and Medicaid Services (CMS) from implementing rules putting restrictions on those classes of medications outside of the formal regulatory process—medications that are needed by the most vulnerable psychiatric patients. In January 2014, CMS had proposed a rule that could have limited “protected class” status, but dropped the proposal in the face of public opposition led by APA, medical societies, patient advocates, and other allied stakeholders.

The Grassley-Brown bill would require protected-class status for antipsychotics, antidepressants, anticonvulsants, antineoplastics, antiretrovirals, and immunosuppressants, meaning that all or substantially all of the medications in these categories would continue to be available to patients.

“We applaud this bipartisan legislation, which will ensure that Medicare patients will continue to have coverage for these needed medications,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We thank Sen. Grassley and Sen. Brown for their leadership on this important issue. The legislation would protect our nation’s most vulnerable citizens who depend on these life-saving treatments for depression, schizophrenia, and other serious and chronic illnesses.”

For more information on CMS’s withdrawal of the proposal to eliminate certain psychiatric medications from protected status last year, see Psychiatric News.

First Lady, APF, Broad Coalition Pledge to 'Change Direction' of U.S. MH Dialogue

“It is time to tell everyone who is dealing with a mental health issue in this country that they are not alone and that getting support and treatment isn’t a sign of weakness--it’s a sign of strength,” First Lady Michelle Obama told 500 mental health leaders and advocates at the launch in Washington, D.C., of the “Change Direction” campaign.

The campaign builds on the work of Give an Hour, which arranges for pro bono mental health services for veterans and their families. “Change Direction” unites an array of businesses, government entities, and organizations to educate at least 30 million Americans about mental illness. The American Psychiatric Foundation, APA, and American Psychiatric Publishing are founding members of the campaign.

“We need to change the conversation about mental illness and recognize that it is not different from any other illness,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., emphasizing a core theme of all the event’s speakers.

The campaign seeks to raise awareness and train people to recognize five signs of emotional suffering in themselves or the people around them: withdrawal, agitation, hopelessness, decline in personal care, and change in personality. Target audiences include military personnel, veterans, and family members; corporate and government employees; first responders; students, teachers, school officials, and coaches; and health care professionals.

“Our mental health is just as vital as our physical health and treating it that way will take courage from everybody,” concluded Obama. “If we can summon that strength, then I guarantee that we will save lives and soon enough, caring for our mental health won’t be considered such a courageous act. It will be just another part of our lives.”

For more in Psychiatric News about Give an Hour, see the Psychiatric News article “Give an Hour to Expand Free Care for Veterans.”

--AML (Image: Aaron Levin)

Study Finds High Prevalence of Prenatal Alcohol Exposure Disorders Among Patients of Chicago Clinic

Over 38 percent of the patients who attended a family medicine clinic in Chicago’s Southside had a neurodevelopmental disorder associated with prenatal alcohol exposure (ND-PAE).

While national surveys has estimated that disorders due to fetal alcohol exposure may affect 2% to 5% of individuals, this new report, published yesterday in Psychiatric Services in Advance, shows how pervasive this problem can get in certain communities.

The article assessed the records of 590 adult and 21 youth psychiatric patients--almost entirely African-American--who attended the Family Medicine Clinic at Jackson Park Hospital.

Of the 611 patients, 237 (226 adults and 11 children) had clinical profiles consistent with ND-PAE, now recognized as an emerging condition in DSM-V; in contrast, only 53 patients presented with a “classical” DSM-V neurodevelopmental disorder such as ADHD or autism. The higher ND-PAE prevalence among the child patients (57 percent) may suggest that this problem is becoming more pronounced, though the sample size was small.

“Fetal alcohol exposure is at the root of much of the violence, abuse, incarceration, special education, and poor adaptability that plague these underserved African-American communities,” said lead author Carl Bell, M.D., a clinical professor of psychiatry and public health at the University of Illinois School of Medicine. “Hopefully these results will bring more attention to the problem of ND-PAE, which is the most common preventable form of intellectual disability.”

To read more about the addition of ND-PAE to DSM-V, see the Psychiatric News viewpoint article, "New DSM Code Should Benefit Clinicians, Researchers."

(shutterstock/ChameleonsEye)

Study Finds That Anticholingeric Medications Increase Risk of Pneumonia

A study of 3,000 seniors has shown that medications with anticholinergic effects (those that block the neurotransmitter acetycholine) are associated with a higher risk of developing pneumonia.

Drugs that have anticholinergic properties treat a wide swath of conditions, many of which are common in older adults; these include asthma, COPD, gastrointestinal disorders, and bladder problems. Anticholinergic drugs are also important therapies for mental disorders; benzodiazepines and tricyclic antidepressants fall into this category.

A team from the Group Health Research Institute in Seattle examined health and pharmacy data from 1,039 cases of pneumonia that occurred among their older, immune, competent patients (65-94) as well as 2,000 healthy controls of the same age and gender composition.

They found that 59% of the pneumonia cases had one or more prescription fills of an anticholinergic 90 days or less before the diagnosis, compared with 35% of the healthy group. The pneumonia group also showed higher chronic anticholinergic use, with 53% of the patients having filled three or more prescriptions over the past year, compared with 36% of the controls.

Members of this research team had recently published another study demonstrating that extended use of anticholinergic medications might increase the risk for dementia in older adults. To learn more, see the Psychiatric News Alert “High Dose and Extended Use of Anticholinergic Drugs May Increase Risk for Dementia, Study Suggests.”

(shutterstock/decade3d)

Risk for Dying Young Increased With ADHD Diagnosis, Study Finds

Though previous research has shown an association between attention-deficit/hyperactivity disorder (ADHD) and mental illnesses that are likely to increase mortality such as oppositional defiant disorder and substance use disorder, it is unknown whether an ADHD diagnosis alone is capable of increasing risk for premature death.

Researchers from Aarhus University in Denmark conducted a study with approximately 2 million individuals born between 1981 and 2011 to investigate whether any association exists between an ADHD diagnosis and premature mortality. Health records of the subjects were analyzed from first birthday until 2013.

The results, published in Lancet, showed that of the 32,061 individuals with a diagnosis for ADHD, 107 died before the age of 33—a rate that is twice that for persons without the disorder, even after adjusting for factors that increase risk for premature death such as history of psychiatric disorders and employment status. In addition, the researchers found that individuals diagnosed at age 18 years or older were more than four times as likely to die early compared with those without ADHD at the same age. More than half of all deaths among those with ADHD were caused by automobile crashes and other accidents.

Timothy Wilens, M.D., chief of child and adolescent psychiatry at Massachusetts General Hospital for Children, told Psychiatric News that the study adds to the literature emphasizing the importance of properly diagnosing and treating ADHD. “While the risk of premature death in this age group remains low, the overall findings are a reminder for individuals with ADHD, their families, and practitioners that early identification and treatment of ADHD may help to improve overall long-term outcome including issues of safety. Moreover, individuals with ADHD must continue to be vigilant about the increased risk for addictions as well as mishaps related to driving."

More information about adult ADHD and its treatment can be found in the American Psychiatric Publishing book Understanding and Treating Adults With Attention-Deficit/Hyperactivity Disorder.

(Image: Lightspring/shutterstock.com)

Congressman and Senator Come Together to Discuss Forthcoming MH Legislation

A congressman and a senator working on parallel tracks for comprehensive mental health care reform made their bipartisan case in a Washington discussion today.

Rep. Tim Murphy (R-Pa.) said he plans to reintroduce his bipartisan Helping Families in Mental Health Crisis Act in March.

“We are going line by line, tweaking the bill now,” said Murphy, a psychologist, in a presentation organized by The Hill, a newspaper that covers national politics. “The legislation could move this year.”

Sen. Chris Murphy (D-Conn.) praised his House counterpart for the expertise and attention he has brought to a complicated issue and said he is working on a “substantially similar” bill in the Senate. (The two men are not related, they pointed out.)

Expanding the mental health workforce, reducing barriers to accessing care, increasing the number of inpatient psychiatric beds, integrating primary and mental health care, and solving reimbursement problems were all critical components of a comprehensive bill, both legislators agreed.

“We can pass comprehensive mental health reform,” said Sen. Murphy, whose home state was the site of the Sandy Hook school shooting in 2012. “I hope we don’t have another tragedy before we make common-sense changes in the mental health system.”

They expressed a willingness to work with both Democratic and Republican colleagues.

“There is no party loyalty on this issue,” said Rep. Murphy. “This is all about helping people and bringing the system into the 21^st century.”

For more in Psychiatric News about the progress of mental health legislation, see "Author of House Mental Health Bill Addresses APA Assembly."

Medical Groups Urge Steps to Cut Gun Violence

APA and seven other medical societies yesterday joined with the American Bar Association in a statement published in Annals of Internal Medicine that calls for a reduction in “the health and public health consequences of firearms.”

“Across the United States, physicians have firsthand experience with the effects of firearm-related injuries and deaths and the impact of such events on the lives of their patients,” said the statement. None of the recommendations contravened the Second Amendment, according to the American Bar Association.

In addition to APA, the other signatories were the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Emergency Physicians, the American Congress of Obstetricians and Gynecologists, the American College of Physicians, the American College of Surgeons, and the American Public Health Association.

The organizations specifically cautioned against the indiscriminate inclusion of “all persons with any mental or substance use disorder in a category of persons prohibited from purchasing firearms,” while supporting greater access to mental health treatment.

The statement also calls for more research into firearm violence and unintentional injury and elimination of laws that prohibit physicians from discussing gun ownership with patients.

"We believe that multidisciplinary, interprofessional collaboration is critical to bringing about meaningful changes to reduce the burden of firearm-related injuries and death on persons, families, communities, and society in general," the authors concluded.

For information in Psychiatric News about the APA Board of Trustees's recent statement on firearms, see "APA Board Urges Public-Health Approach to Gun Violence."

(Shutterstock/Monkey Business Images)