Friday, February 16, 2018

APA Joins Other Physician Groups to Demand Action on Gun Violence

In the aftermath of Wednesday’s shooting that killed 17 students and staff members at Marjory Stoneman Douglas High School in Parkland, Fla., APA and four organizations representing 450,000 physicians and medical students called on President Donald Trump and Congress to take meaningful action against gun violence.

Joining with APA were the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Physicians.

“Gun violence is a public health epidemic that is growing in frequency and lethality, and it is taking a toll on our patients,” the groups said in a statement released today. “We urge our national leaders to recognize in this moment what the medical community has long understood: we must treat this epidemic no differently than we would any other pervasive threat to public health. We must identify the causes and take evidence-based approaches to prevent future suffering.”

The groups have asked the president and Congress to take the following actions:
  • Label violence caused by the use of guns a national public health epidemic.
  • Fund appropriate research at the Centers for Disease Control and Prevention as part of the FY 2018 omnibus spending package.
  • Establish constitutionally appropriate restrictions on the manufacture and sale, for civilian use, of large-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity.
While mass shootings attract much attention from the public and the media, the groups noted that current policies regarding access to guns in this country expose Americans daily to the risks of violent acts including suicide, homicide, and unintentional injury.

“The families of the victims in Parkland and all those whose lives have been impacted by daily acts of gun violence deserve more than our thoughts and prayers. They need action from the highest levels of our government to stop this epidemic of gun violence now,” the statement concluded.

(Image: iStock/izzzy71)

Thursday, February 15, 2018

FDA Approves First Blood Test to Detect Concussions

The Food and Drug Administration (FDA) on Wednesday approved the first blood test to evaluate mild TBI (mTBI) or concussion.

The test, called the Brain Trauma Indicator, works by measuring levels of two proteinsUCH-L1 (ubiquitin C-terminal hydrolase L1) and GFAP (glial fibrillary acidic protein). These proteins are released from the brain following a head injury and appear in the blood within hours of the injury.

“A blood-testing option for the evaluation of mTBI/concussion not only provides health care professionals with a new tool, but also sets the stage for a more modernized standard of care for testing of suspected cases,” FDA Commissioner Scott Gottlieb, M.D., said in a press release.

Health care professionals currently evaluate patients suspected of head injuries with the 15-point Glascow Coma Scale followed by a computed tomography (CT) scan of the head to detect intracranial lesions that may need follow-up care. More than 90% of patients presenting to the emergency department with mild TBI or concussion have a negative CT scan, according to Banyan Biomarkers, Inc., the developer of the Brain Trauma Indicator.

The FDA evaluated data from a multicenter, prospective clinical study of 1,947 individual blood samples from adults with suspected mTBI/concussion and reviewed the product’s performance by comparing mTBI/concussion blood tests results with CT scan results. According to the FDA, the Brain Trauma Indicator was able to predict the presence of intracranial lesions on a CT scan 97.5% of the time and those who did not have intracranial lesions on a CT scan 99.6% of the time.

“These findings indicate that the test can reliably predict the absence of intracranial lesions and that health care professionals can incorporate this tool into the standard of care for patients to rule out the need for a CT scan in at least one-third of patients who are suspected of having mTBI,” the agency noted in the press release. The results of the test are available within three to four hours.

For related information, see the Psychiatric News article “Blood Test May Detect Concussions Days Later.”

Wednesday, February 14, 2018

Antidepressants May Reduce Opioid Use in Patients With Comorbid Depression, Chronic Pain

Patients experiencing chronic pain and depression may be more likely to stop taking opioids if they adhere to their antidepressants, reports a study published in the British Journal of Psychiatry. Further analysis also suggests that halting opioid use contributes to improvements in depression.

“Depression can worsen pain and is common in patients who remain long-term prescription opioid users,” Jeffrey Scherrer, Ph.D., of the Saint Louis University School of Medicine said in a press release. “Effective depression treatment may break the mutually reinforcing opioid-depression relationship and increase the likelihood of successful opioid cessation.”

Scherrer and colleagues analyzed electronic medical records from the Veterans Health Administration for this study. They identified 2,821 patients who received antidepressants for a new diagnosis of depression following at least 90 days of opioid use for chronic pain (excluding cancer pain or HIV pain). Of this group, 1,077 of the patients were adherent to antidepressants (took at least 80% of their prescribed amount) and 1,744 were not.

The authors calculated that antidepressant adherence was associated with a 24% greater likelihood of opioid cessation; this association was not related to duration of opioid use, degree of pain, or number of other medical comorbidities.

An exploratory analysis of all four patient subgroups (adherent/nonadherent and opioid cessation/noncessation) revealed that patients who stopped using opioids—regardless of their adherence—showed greater improvements in their depressive symptoms. However, antidepressant adherent patients who stopped using opioids showed the greatest improvements.

While the authors cautioned more studies are needed to confirm these preliminary findings, they wrote “together, these results provide preliminary evidence that a reduction in depression may lead to OAU [opioid analgesic use] cessation … opioid taper paired with antidepressant medications could result in a faster reduction of depression symptoms and increase the likelihood of successful OAU cessation.”

To read more on this topic, see the Psychiatric News article “Many Prescription Opioids Go to Adults With Depression, Anxiety.”

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Tuesday, February 13, 2018

APA Commends Bipartisan Budget Deal for Health, MH Provisions

The bipartisan budget agreement passed last week by Congress won praise from APA for its inclusion of funding for many mental health, substance use, and criminal justice programs that will benefit millions of Americans living with serious mental and substance use disorders. APA had lobbied hard on many of these issues for months leading up to the vote.

Among the major provisions of the legislation is an extension of the Children’s Health Insurance Program through 2028, marking the longest reauthorization in the program’s history. CHIP is a federal-state partnership that provides comprehensive health insurance coverage for children whose families earn too much to qualify for Medicaid but not enough to afford private insurance. CHIP insures 9 million children, including 850,000 with serious behavioral or emotional disorders.

The budget agreement also provides the following:
  • $6 billion to help fight the nation’s opioid epidemic, primarily through state grants that expand substance abuse and mental health treatment. In addition, $2 billion has been earmarked over the next two years to support research at the National Institutes of Health, including its study of nonopioid pain therapies.
  • Two-year reauthorizations of funding for the community health centers; the National Health Service Corps, which provides student loan forgiveness to health professionals who work in rural or underserved areas; and the Teaching Health Center Graduate Medical Education Program. These all provide critical health-related resources to vulnerable communities.
  • Technical corrections related to the Medicare Access and CHIP Reauthorization Act (MACRA), which will help ease regulatory burdens faced by physicians.
  • Additional funding for Department of Veterans Affairs hospitals and clinics.
  • Funding that will improve access to telehealth services by Medicare Advantage enrollees.

“Through enhanced federal commitment to programs—stimulating the mental health workforce, furthering evidence-based practices, and advancing medical research—we can ensure the next generation of mental health professionals are well prepared to combat current and future health-related challenges,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., wrote in a letter to congressional leaders following the bill’s passage. “APA looks forward to continued collaboration to build and support robust systems of care, innovative programs, and a high-performing workforce to ensure the stability of our healthcare system now and for the future.”

Detailed information on the budget agreement will appear in the March 2 issue of Psychiatric News.

(Image: David Hathcox)

Monday, February 12, 2018

ABMS Online Survey Seeks Feedback From Physicians on MOC

Physicians are invited to provide feedback about Maintenance of Certification (MOC) requirements through an online survey being conducted by the American Board of Medical Specialties (ABMS).

The survey is part of an ABMS initiative titled “Continuing Board Certification: Vision for the Future.” The feedback from the survey, which members of the public and other stakeholders are also invited to take, will help identify key concerns regarding MOC and inform the work of ABMS’s new Vision for the Future Commission. The commission will use the survey results as part of a comprehensive assessment of continuous board certification to make it "meaningful to physicians and the patients they serve well into the next decade." The commission will submit a draft report for public comment in November; a final report will be submitted to the ABMS Board of Directors in February 2019.

According to an ABMS spokesperson, the survey will be live for another three to four weeks.

The 27-member commission is co-chaired by psychiatrist Christopher Colenda, M.D., M.P.H., president emeritus of the West Virginia University Health System (WVUHS). According to the ABMS website, the commission will “engage and gather the perspectives of those involved and affected by physician certification, including practicing physicians; advocates for patients and the public; state medical societies; specialty associations and societies; accreditors; credentialing organizations; health care delivery systems; experts in assessment, learning, and quality improvement; certifying boards; and other professional organizations.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., said the survey is an opportunity for APA members to register their concerns about MOC and its relevance to physicians and patient care. “APA leadership continues to be aware of the serious concerns many members have about the current structure of MOC and continuing board certification,” Levin said. “We wholeheartedly support the value of lifelong learning but believe that the process for professional self-regulation needs to be clinically relevant and not add to the administrative burdens with which many physicians are already wrestling.

“I encourage APA members to use the ABMS survey to share their experience and expertise and help mold the future direction of MOC and continuing board certification,” he said.

For more information, see the Psychiatric News article “Board Opposes Use of MOC Status to Penalize Physicians.”

Friday, February 9, 2018

APA Announces Winners of 2018 Election

APA’s Committee of Tellers has approved the following results of APA’s 2018 national election. Please note that these results are considered public but not official until approved by the Board of Trustees at its meeting March 17-18.

Bruce J. Schwartz, M.D.

Gregory W. Dalack, M.D.

Richard F. Summers, M.D.

Early Career Psychiatrists Trustee-at-Large
Ayana Jordan, M.D., Ph.D.

Area 1 Trustee
Eric M. Plakun, M.D.

Area 4 Trustee
Cheryl D. Wills, M.D.

Area 7 Trustee
Annette M. Matthews, M.D.

Resident-Fellow Member Trustee-Elect
Rana Elmaghraby, M.D.

Complete results of the election will be reported in the March 2 issue of Psychiatric News.

Thursday, February 8, 2018

For Better or Worse: Risk of Alcohol Use Disorder Rises When Spouse is Diagnosed

A study of married couples in Sweden found that spouses strongly resemble one another in their risk for alcohol use disorder (AUD), with the way spouses interact with each other playing a strong causal role, according to a report published yesterday in JAMA Psychiatry.

Women in a first marriage with no history of AUD were nearly 14 times more likely to be diagnosed with AUD immediately after their husbands were diagnosed with AUD and about four times as likely after two years, compared with women who had no spousal exposure to AUD, according to Kenneth S. Kendler, M.D., at the Virginia Institute for Psychiatric and Behavioral Genetics and colleagues. Similarly, husbands with no history of AUD were more than nine times as likely to be diagnosed with AUD immediately after their wives were diagnosed, and about three times as likely after three years.

Researchers examined population, medical, pharmacy, and crime registries in Sweden to determine marital and AUD status, excluding married partners who did not reside together. First, they identified 8,562 married couples where neither had a history of AUD prior to marriage and one spouse developed AUD during the marriage. These couples were compared with individuals who did not reside with a spouse with an AUD. The researchers then studied 4,891 individuals with multiple marriages whose first spouse had no AUD diagnosis and second spouse did, or vice versa.

Researchers noted that individuals who remarried were more likely to move from having a spouse without AUD to a spouse with AUD than vice versa. When individuals moved from a marriage to a spouse with AUD to a spouse without the disorder, they cut their risk for AUD by half. By contrast, individuals who moved from a marriage to a spouse without the disorder to one with AUD greatly increased their risk of AUD (seven times the risk in women, and nine times the risk in men).

The report follows a 2016 study published in the American Journal of Psychiatry that men and women married to a spouse with no history of AUD are much less likely to experience AUD themselves. It concluded that while marriage generally was protective against the risk of alcohol use disorder, marriage to a spouse with AUD greatly increased the risk of the disorder for both men and women.

“Although genetic and biological factors contribute strongly to the predisposition to alcohol dependence, these findings complement our prior work on marriage and divorce in showing how close social bonds such as marriage can also powerfully influence, for better or worse, the risk for AUD,” the researchers concluded.

For related information, see the Psychiatric News article “Marriage May Decrease Future Risk of Alcohol Use Disorder.”

(Image: iStock/Rawpixel)


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