Friday, September 19, 2014

FDA Approves Psychiatric Drug Combo for Weight Loss

The Food and Drug Administration (FDA) has approved Contrave—a combination drug consisting of naltrexone (an opioid receptor antagonist) and bupropion extended-release (an antidepressant and pharmacological smoking-cessation aid) —as a new treatment option for weight loss in people who have a body mass index (BMI) of 30 or greater (obesity) or a BMI of 27 or greater (overweight) with one weight-related condition such as hypertension or type II diabetes.

The effectiveness of Contrave was measured in multiple clinical trials with approximately 4,500 obese and overweight individuals, with and without significant weight-related conditions, who were on a reduced-calorie diet and a physical activity regimen. Results in a trial with nondiabetic patients, showed that 42% of participants taking Contrave were able to shed at least 5% of their body weight in a year, while only 17% of patients treated with placebo were able to do so. In a clinical trial with diabetes patients, those taking the combination drug where twice as likely to lose 5% of their body weight within a year than were control subjects. Most common adverse reactions reported included nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.

Because the medication contains bupropion, it has a boxed warning for increased risk of suicidal behaviors and serious neuropsychiatric events. The exact neurochemical effects of the drug leading to weight loss are not yet fully understood, according to the drug's manufacturer, Takeda Pharmaceutical.

In an interview with Psychiatric News, Petros Levounis, M.D., M.A., chair of psychiatry at Rutgers New Jersey Medical School, said that an approval of a novel pharmacological approach to treat obesity is one that should be applauded, since obesity is a major health concern that is critical for both physical and mental health. “While the exact mechanism of action of the naltrexone/bupropion combination has not been elucidated, each drug has a proven success record in addiction treatment: bupropion for tobacco and naltrexone for alcohol and opioid use disorders. As we are starting to conceptualize food—and specifically sugar—as a bona fide addiction, Contrave has the potential of being a game-changer in our battle against obesity."

For more information about the FDA's approval of Contrave, as well as the agency's recommended prescribing practices surrounding the drug, see the FDA News Release.

(Image: Seanika/

Thursday, September 18, 2014

Let Congress Know Medical Research Funding Matters to You!

APA is urging psychiatrists to contact their members of Congress, urging them to give increased priority to funding for medical research at the National Institutes of Health (NIH). APA is part of a coalition of more than 300 medical, academic, and advocacy organizations that are participating today in the Rally for Medical Research Hill Day, the goal of which is to educate members of Congress about the consequences of shrinking federal funding for medical research at the agency that has been the driving force behind decades of advances in understanding and treating a wide range of illnesses.

"In spite of the unprecedented opportunities in neuroscience and genetics that exist today, our nation’s support for medical research is in serious decline," said APA President Paul Summergrad. "APA strongly supports reinvigorated and growing federal investment for the NIH so that we do not lose a generation of talented researchers and the cures they could discover. We are at a transformative moment in the history of psychiatric research, and Congress should ensure that we seize upon this moment to achieve fundamental understanding of these disorders and the ways we can best care for patients in an integrated health care system"

Members of many of the participating organizations are attending a Capitol Hill rally today and have arranged to meet with their House and Senate representatives to emphasize the message that increased investment in the NIH is a critical national priority "to improve health, spur more progress, inspire more hope, and save more lives." Before the visits, they attended an advocacy training session to help them hone their messages (see photo). Others are encouraged to send emails or regular letters or make phone calls to their House and Senate members. Posting messages on the lawmaker's Facebook page is another way to convey the importance of this issue, the organizers note. Last year, more than $1.6 billion was cut from the NIH budget.

In addition, for the next three months, until Election Day, APA’s Department of Government Relations will be conducting Engage 2014—a grassroots campaign designed to encourage our members to advocate on behalf of the mental health community as well as increase participation in grassroots efforts among the APA membership as a whole. Information about Engage 2014 is posted on the APA website here.

NOTE: In observance of National Hispanic Heritage Month, this Friday's #YourMH @TWITTER chat will be on Hispanic mental health. #YourMH chat takes place every other Friday from noon to 1 p.m. ET. To join, use the #hashtag #YourMH (stands for "Your Mental Health") or @APAPSYCHIATRIC. And during the chats, don't just sit on the sidelines—tweet your comments!

Wednesday, September 17, 2014

Training Mental Health Clinicians Boosts Tobacco Treatment for Patients, Study Finds

Training a range of mental health clinicians to deliver tobacco treatment services can increase use of such services and boost the patients’ willingness to quit smoking, according to a new study published in Psychiatric Services in Advance.

“Smoking rates among individuals with a mental illness or substance use disorder are at least double those of the general population,” said Jill Williams, M.D., a professor and director of the Division of Addiction Psychiatry at the Robert Wood Johnson Medical School, and colleagues.

The researchers recruited 20 clinicians, including 13 psychiatrists, and gave then a two-day training session on assessment and treatment of smokers. The curriculum covered behavioral and pharmacological treatments, how to help less-motivated smokers, and how to manage complex cases. Patient charts from the clinicians’ caseload were reviewed before and after the training. After the training, more patients were advised to quit by the participating clinicians (9% before versus 36% after training), more developed treatment plans for quitting (20% versus 60%), and more patients were informed about nicotine replacement therapy (10% versus 31%).

Despite this improvement, more could be done for these patients, concluded Williams and colleagues. “Strategies beyond training may be needed to enhance [smoking-cessation] prescribing by these practitioners,” they suggested.

For more in Psychiatric News about the link between smoking and mental illness, see the article “Smoking Cessation for Patients Called an Urgent Priority.”

(Image: Stepan Popov/

Tuesday, September 16, 2014

Early Intervention in At-Risk Children Can Reduce Psychiatric Problems in Adulthood.

Early and sustained intervention of children with conduct problems can lower the chances that those problems will extend into adulthood, reports a new study published in AJP in Advance titled “Impact of Early Intervention on Psychopathology, Crime, and Well-Being at Age 25.”

Known as Fast Track, this project enrolled kindergarteners who displayed aggressive or disruptive behaviors into a multi-component, 10-year, manualized program aimed at instilling social competencies that would extend throughout their lifetimes "through social skills training, parent behavior-management training with home visiting, peer coaching, reading tutoring, and classroom social-emotional curricula," the researchers noted. The program took place in four communities: Durham, N.C., Nashville, Seattle, and rural Pennsylvania. A similar set of at-risk children receiving only the standard interventions in their community were followed as a control group.

There has not been much evidence showing that behavioral improvements in children translate into adulthood, but so far, the Fast Track study seems to suggests that such an intervention can have an impact, finding that while 69% of the adults in the control group displaying at least one psychiatric problem at age 25, only 59% of Fast Track participants displayed a psychiatric problem at the same age. Fast Track participants also displayed decreased rates of substance abuse crimes, violent crimes, and risky sexual behavior compared with controls, as well as higher levels of happiness and well-being.

“This shows that we can go a full eight years after last seeing these children and still see reductions in the rates of problem outcomes for this group as young adults,” said study author Kenneth Dodge, Ph.D., director of the Center for Child and Family Policy at Duke University.

The improvements in behavior were consistent among each of the 13 subgroups assessed (including those defined by gender, ethnicity, study site, etc.), demonstrating that this approach has potential for a wide range of children and risk levels.

To read about a promising early-intervention effort with children in Australia, known as Headspace, see the Psychiatric News article “Australian Youth Get a ‘Soft Entry’ Into Mental Health System.”

(image: PathDoc/Shutterstock)

Monday, September 15, 2014

Lifestyle Intervention Improves Weight Loss, Glucose Levels in People Taking Antipsychotics

People with serious mental illnesses such as schizophrenia or bipolar disorder are at greater risk for obesity and diabetes, both from the illness itself and contributing factors such as antipsychotic medications that affect glucose metabolism.

A study published online today in AJP in Advance shows that a comprehensive lifestyle intervention could be an effective approach to reducing the metabolic problems of people taking antipsychotics for their mental illness. As published in the report “The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial,” Carla Green, Ph.D., M.P.H., and colleagues at the Kaiser Permanente Center for Health Research in Portland, Ore., tested the effectiveness of a multifaceted program of diet, physical activity, health education, and behavioral modification. They enrolled 200 adults taking antipsychotic medication and with a body mass index of at least 27; half of the participants were randomly chosen to participate in the STRIDE program for 12 months—a six-month initiation phase followed by a six-month maintenance phase.

After 12 months, the STRIDE participants had lost an average of 6 pounds more than the control group, while also reducing their fasting blood glucose levels from about 106 to 100 mg/dL (at the top of the normal range). During this time, the STRIDE group also reported significantly fewer medical hospitalizations than controls (6.7% were hospitalized versus 18.8% of controls).

Other interventions have demonstrated moderate weight loss in people with mental illness, but STRIDE is the first also to show improvements in glucose levels and number of hospitalizations. “This shows that if people with serious mental illness participate in intensive programs and are given the right tools and support they can lose the same amount of weight as people without serious mental illness,” the researchers said.

To learn about another approach to reduce weight and improve the health of people with serious mental illness, see the Psychiatric News article “Health Mentors Prove Valuable for Those With Serious Mental Illness.”


Friday, September 12, 2014

Long-term Use of Anxiolytics Linked to Alzheimer's Disease, Study Suggests

While previous research has shown a link between benzodiazepines and acute cognitive function, a link between the anxiolytic medicines and an increased risk for certain neurocognitive disorders remains unclear. A team of researchers from France and Canada conducted a study to investigate the relationship between the risk of Alzheimer's disease (AD) and long-term exposure to benzodiazepines, as well as a potential dose-response relationship in 1,796 people—aged 66 and older—with a first diagnosis for AD and 7,184 age-matched healthy controls. The study analyzed participant’s prescription and medical records dating back six years prior to diagnosis.

The results, published in BMJ, showed that past use of benzodiazepines for three months or more was associated with an increased risk—up to 51%—for AD. The association increased even more with longer exposure to the anxiolytic. In addition, the use of long-acting forms of benzodiazepines increased risk for AD by 19 percent more than that of the short-acting. Results were sustained after adjusting for anxiety, depression, and sleep disorders.

“Benzodiazepines are known to be associated with an increased risk of worsening cognition…even in cognitively normal elderly subjects,” said Davangere Devanand, M.D., director of the geriatric psychiatry program at Columbia University, in an interview with Psychiatric News. “This cognitive worsening may lead to diagnosis of Alzheimer’s disease as described in this study. In such situation, tapering and stopping the benzodiazepine and then re-evaluating the patient’s cognition can be helpful in clarifying the diagnosis. If the cognitive decline is due to benzodiazepines and the patient does not have an underlying dementia such as Alzheimer’s disease, the cognitive decline should reverse after stopping the treatment. Prescribers should use benzodiazepines sparingly…because of their known adverse effects.”

To read more about adverse effects associated with the use of benzodiazepines and other psychoactive drugs, see the Psychiatric News articles “Benzodiazepines May Raise Dementia Risk” and “Risk-Benefit Analyses in Medication Decision Making.” 

(Image: Kristo-Gothard Hunor/Shutterstock)

Tuesday, September 9, 2014

Collaborative Care for Depression in Ob-Gyn Patients Appears to Especially Help Disadvantaged, Study Suggests

Collaborative depression care adapted to obstetrics-gynecology settings appears to have a greater impact on depression outcomes for socially disadvantaged women with no insurance or with public coverage compared with women with commercial insurance, according to “A Randomized Trial of Collaborative Depression Care in Obstetrics and Gynecology Clinics: Socioeconomic Disadvantage and Treatment Response,” in AJP in Advance.

In the study, 205 women who screened positive for depression with a score of at least 10 on the Patient Health Questionnaire–9 and met criteria for major depression or dysthymia were randomized to a 12-month intervention program or to usual care, with blinded assessments at 6, 12, and 18 months. A total of 120 patients had no insurance or relied on public coverage ,and 85 had commercial insurance.

The collaborative care model included an initial engagement session with the care manager, choice of psychotherapy or medication, help for uninsured patients with charity care for medications and use of social workers as care managers to help alleviate barriers to care.

Compared with patients with commercial insurance, those with no insurance or with public coverage had greater recovery from depression symptoms with collaborative care than with usual care over the 18-month follow-up period.

Senior author Wayne Katon, M.D., (pictured above) told Psychiatric News the study is one of the first to show the benefits of collaborative care for disadvantaged patients. “Contrary to some studies which suggest that depression in socially disadvantaged women is difficult to treat due to the many social stressors these women experience, the current study in two university affiliated Ob-Gyn clinics actually showed that collaborative care was associated with a greater degree of recovery from depression compared to usual care in women with either no insurance or publically funded insurance compared to women with commercial insurance,” he said.


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