Tuesday, August 4, 2015

Comprehensive Mental Health Reform Legislation Introduced in Senate

A bipartisan pair of U.S. senators today introduced the Mental Health Reform Act of 2015, intended to expand access to care, enforce parity, and increase the mental health workforce.

“This bill gives hope to patients, to families, and to our society and redirects [patients] down a path that ends in wholeness,” said Sen. Bill Cassidy (R-La., at right in photo), a gastroenterologist, at a press conference at the U.S. Capitol Visitor Center.

The bill seeks to build inpatient and outpatient capacity, increase the number of providers, invest in research and dissemination of best practices, and better coordinate physical and mental health care, added his cosponsor, Sen. Chris Murphy (D-Conn., left).

“The nation’s mental health system needs reform and investment, and we applaud Senators Murphy and Cassidy for this comprehensive reform initiative,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. (center), at the press conference. “We will work with legislators on both sides of the aisle to accomplish mental health reform.”

Levin noted that APA is pleased to see that many of the important provisions in the bill previously introduced in the House by Reps. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas), the Helping Families in Mental Health Crisis Act, are included in this proposed Senate legislation.

“We are proud to be working with our colleagues in the House,” said Sen. Murphy. “These two bills represent the best chance of getting behavioral health legislation passed.”

 “We are encouraged by the fact that lawmakers in the House and the Senate have filed comprehensive mental health reform legislation,” said APA President Renée Binder, M.D.

For more in Psychiatric News on mental health legislation, see "House Health Subcommittee Opens Discussion on Mental Health Bill."

(Image: Aaron Levin)

Monday, August 3, 2015

Cholinesterase Inhibitors Found to Increase Risk of Significant Weight Loss in Dementia Patients

Cholinesterase inhibitors, which are commonly used to treat dementia, may increase the risk of adverse weight loss in people 65 and older, reports a new study by researchers at the University of California, San Francisco (UCSF).

Because severe weight loss can ultimately result in death, the findings suggest that clinicians should consider this risk when prescribing cholinesterase inhibitors such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon).

While previous studies have suggested an association between cholinesterase inhibitors like donepezil or galantamine and weight loss, the new analysis provides the first evidence of clinically significant weight loss in a large, real-world population.

The researchers, led by Meera Sheffrin, M.D., a geriatrics fellow at UCSF School of Medicine and San Francisco Veterans Administration (VA) Medical Center, used national VA data from 2007 to 2010 to evaluate patients 65 or older who had been diagnosed with dementia and recently received a new prescription for a cholinesterase inhibitor or a different chronic medication; they identified 1,188 patients on cholinesterase inhibitors and 2,189 matched controls on other medications.

After 12 months on the medications, 29.3% of patients on cholinesterase inhibitors experienced significant weight loss (defined as the loss of 10 or more pounds) compared with 22.8% of the patients on the other medications, which corresponded to a 1.23 fold increased risk of weight loss in patients prescribed cholinesterase inhibitors.

The study authors noted that further research is needed to validate these findings and identify patient subgroups that may be at the greatest risk of weight loss from cholinesterase inhibitors. Because the population included in the study was primarily male veterans, additional research is needed to assess the applicability of the findings to women.

The study was published online today in the Journal of the American Geriatrics Society.

To learn more about the risks and benefits of cholinesterase inhibitors, see the APA’s Guideline Watch on Alzheimer's Disease and Other Dementias.

(Image: 3dfoto/Shutterstock.com)

Friday, July 31, 2015

Cardiovascular Risk Factors May Predict Brain Changes, Cognitive Decline

A study published this week in the journal Radiology suggests that subtle differences in regional brain volumes that appear to be related to cardiovascular risk factors may potentially serve as an early indicator of cognitive decline before the onset of dementia.

Researchers from the Keck School of Medicine at the University of Southern California, Los Angeles, analyzed data from 1,629 participants in the Dallas Heart Study, aged 25 to 73, to investigate modifiable cardiovascular risk factors (alcohol consumption, smoking, diabetes, and obesity) associated with regional brain volume changes and their association with preclinical deficits in cognitive performance. Participants’ cardiovascular risk factors were evaluated in an initial baseline visit; brain volumes and cognitive function were assessed seven years later by, respectively, magnetic resonance imaging and the Montreal Cognitive Assessment (MoCA).

The results showed that alcohol consumption and diabetes were associated with smaller total brain volume, while smoking and obesity were associated with reduced volumes in the posterior cingulate cortex. Lower hippocampal volume was associated with previous alcohol consumption and smoking, and lower precuneus volume correlated with alcohol consumption, obesity, and high fasting blood glucose numbers.

Low total scores for MoCA were associated with reduced posterior cingulate volume in participants under 50 and with reduced hippocampal and precuneus volumes in those 50 and over.

“Our findings reveal that lower total brain, hippocampal, precuneus, and posterior cingulate volumes are associated with cardiovascular risk factors and with impaired cognitive performance before the onset of clinical dementia. … even in participants younger than 50 years,” the researchers noted. They concluded that subtle differences in regional brain volumes in midlife may serve as a biomarker for brain insult before the onset of dementia.

To read more about associations between brain volume and cognitive function, see the Psychiatric News article, “Study Provides New Details on How Brain Ages.”

(Image: PathDoc/shutterstock.com)

Thursday, July 30, 2015

FDA Issues Warning Over Brintellix, Brilinta Confusion

The Food and Drug Administration today issued a warning to health care professionals and patients concerning reports of confusion between the antidepressant Brintellix (vortioxetine) and the anti-blood clotting medication Brilinta (ticagrelor), which has resulted in the wrong medication being prescribed or dispensed.

The FDA has determined that the main reason for the confusion between the two medications—with extremely different indications—is the similarity in the marketed names of the drugs. While Brintellix is used to treat major depressive disorder, Brilinta is used to lower the risk of recurrent heart attacks or death from a heart problem after a heart attack or severe chest pain.

To reduce the risk of name confusion, the FDA recommends that health care professionals include the generic name of the medication (e.g., vortioxetine) in addition to the brand name and the indication for use when prescribing the medication. The FDA also recommends that patients check their prescriptions to ensure that the correct medication was dispensed.

Thus far, no reports made to the FDA regarding the name confusion have indicated that a patient has ingested the wrong medication; however, the agency announced that reports of prescribing and dispensing errors continue.

Researchers Identify, Validate Potential Serum Biomarker Panel for First-Onset Schizophrenia

The ability to firmly diagnose schizophrenia before symptoms of the disease arise can help improve patient outcomes by reducing periods of untreated psychosis. In a paper recently published in Translational Psychiatry, Sabine Bahn, M.D., Ph.D., of the University of Cambridge and colleagues describe the development of a biomarker test for the identification of individuals at risk of developing schizophrenia based on multiplex immunoassay profiling analysis of 957 serum samples.

The researchers first conducted a meta-analysis of five independent cohorts comprising 331 first-onset drug-naive schizophrenia patients and controls to establish a diagnostic serum biomarker panel, which led to the identification of 26 biomarkers that best discriminated patients and controls. Next, they evaluated the diagnostic performance of the 26-analyte panel using samples from two independent cohorts comprising 93 patients diagnosed with first- or recent-onset schizophrenia and 88 controls, which yielded an area under the curve (AUC) of 0.97 (sensitivity=87%, specificity=97%, accuracy=93%) for schizophrenia detection. Lastly, the researchers tested the predictive performance of the panel before onset of psychosis using two cohorts of 445 pre-onset or at-risk individuals.

According to the authors, “The predictive performance achieved by the panel was excellent for identifying U.S. military personnel (AUC: 0.90 [0.86–0.95]) and help-seeking prodromal individuals (AUC: 0.82 [0.71–0.93]) who developed schizophrenia up to two years after baseline sampling. The performance increased further using the latter cohort following the incorporation of CAARMS (Comprehensive Assessment of At-Risk Mental State) positive subscale symptom scores into the model (AUC: 0.90 [0.82–0.98]).”

While the authors acknowledged that further validation studies using larger independent pre-onset sample sets are needed, they wrote, “[t]he biomarker panel presented here represents a validated set of biomarkers from which a definitive signature for diagnosis and prediction of schizophrenia in the clinical setting could be developed. Ultimately, further developments of the biomarker panel could form the basis of a low-cost blood test, which can complement DSM-5- or ICD-10-based diagnostic approaches.”

To read more about potential biomarkers for psychiatric illness, see the Psychiatric News article “Potential Biomarker for Suicide Vulnerability Identified.”

(Image: kao/Shutterstock.com)

Wednesday, July 29, 2015

Social Integration Lowers Risk of Suicide in Women, Researchers Say

Being socially well integrated appears to lower the risk of suicide in women, according to a study published online today in JAMA Psychiatry.

To examine the association between social integration and suicide, Alexander Tsai, M.D., Ph.D., of Massachusetts General Hospital and colleagues analyzed data from 72,607 women participating in the Nurses’ Health Study who were surveyed about their social relationships from 1992 to 2010. Social integration was based on a seven-item scale covering “marital status, social network size, frequency of contact with social ties, and participation in religious or other social groups.”

Overall, there were 43 suicides during 1,209,366 person-years of follow-up—a rate the authors noted is lower than suicide rates nationally. After adjustment for age and other variables, the authors determined that women with the highest level of social integration had a hazard ratio for suicide of 0.23 versus 1.0 for women recording the lowest level of social integration.

“Our study strongly suggests that social integration has a protective association against suicide risk for women, even after adjustment for multiple indicators of poor mental health,” the authors wrote. “Interventions aimed at strengthening existing social network structures, or creating new ones, may be valuable programmatic tools in the primary prevention of suicide.”

“[T]he results of their study invite further research to explore whether factors or behaviors that reflect longstanding measures of individual social integration predict a person’s mindset when he or she is suicidal,” wrote Eric Caine, M.D., a professor of psychiatry at the University of Rochester, in an accompanying editorial.

For more in Psychiatric News about suicide, see “Stigma: ‘I Need to Tell You Something I’ve Never Spoken to You About’.”

(Image: Andresr/Shutterstock.com)

Tuesday, July 28, 2015

Physical Activity May Be Protective Against Suicidality in Bullied Adolescents

Physical activity appears to be inversely related to sadness and suicidality in adolescents and may be protective against suicidality in adolescents who are bullied, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

Using the 2013 National Youth Risk Behavior Survey (N=13,583), researchers from the University of Vermont analyzed the effect of physical activity on odds ratios for sadness, suicidal ideation, and suicide attempts according to whether students were bullied.

Overall, 30.0% of students reported sadness for at least two weeks, 22.2% reported suicidal ideation, and 8.2% reported suicide attempts in the previous 12 months. Bullied students were twice as likely to report feeling sad and three times as likely to report suicidal ideation or attempts.

But students who reported exercising four to five days per week had lower adjusted odds of sadness, suicidal ideation, or suicide attempts than students who exercised one day or less each week. After stratifying by bullying, similar but slightly weaker associations were observed. Overall, exercise for four or more days per week was associated with an approximately 23% reduction in suicidal ideation and attempts in bullied students.

“The consequences of bullying are well described, yet little is known about protective factors that may diminish the negative sequelae,” the researchers stated. “One possible factor, physical activity, improves mental health in general and clinical populations....We hypothesized that physically active students would be less likely to feel sad or report suicidal ideation or attempts, including bullied students."

For related information, see the Psychiatric News article "Effects of Bullying Don't End When School Does."

(Image: Jacek Chabraszewski/Shutterstock.com)


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