Friday, May 1, 2015

APA Event Addresses Mental Health Needs of American Indians

American Indians have long experienced lower health status when compared with other Americans. During an APA-sponsored event in Sioux Falls, S.D., on Thursday, community leaders and mental health professionals called for more to be done to address the mental health needs of this population.

“We know what the health inequities are among the Native American population,” APA CEO and Medical Director Saul Levin, M.D., M.P.A, told conference attendees. “It’s time for us to do something. APA is here to help and can use its lobbyists to help address these issues to legislatures.”

Debanjana Bhattacharya, M.D., M.P.H. (left), a fourth-year psychiatry resident at the Sanford School of Medicine at the University of South Dakota and APA minority fellow, described the toll mental illness was having on the people of South Dakota alone. “Suicide rates for American Indians in South Dakota are 2.5 times than the rates in the surrounding states of Iowa, Nebraska, and North Dakota,” said Bhattacharya, who helped organize the event. Alcohol use disorder is also one of the leading causes of death among American Indians residing in South Dakota.

To help address these needs, individuals from the public and private sectors recently formed the Alliance for American Indian Behavioral Health, which aims to advance health equity for Native Americans within the Sioux Falls area through the promotion of available resources and training in cultural competence for non-Native American health care professionals.

Yesterday's event was sponsored by APA’s Division of Diversity and Health Equity in conjunction with the South Dakota Psychiatric Association.

To read more about efforts in addressing mental health issues among American Indians, see the Psychiatric News article "White House Hosts Briefing on Federal Suicide Prevention Efforts."

(Image: Vabren Watts/Psychiatric News)

Thursday, April 30, 2015

Study Finds Victims of Childhood Bullying Are More Likely to Have Mental Health Problems Than Those Maltreated

Being bullied during childhood has a greater negative impact on the mental health of young adults than experiencing maltreatment early in life, according to a study published in The Lancet Psychiatry. Specifically, children who were bullied were found to be around five times more likely to experience anxiety and nearly twice as likely to report depression and self-harm at age 18 than children who were maltreated.

For the study, Dieter Wolke, Ph.D., a professor of psychology at the University of Warwick, UK, and colleagues analyzed data on maltreatment, bullying, and overall mental health from two longitudinal studies—the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom (ALSPAC) and Great Smoky Mountains Study (GSMS) in the United States.

The study included 4,026 children from ALSPAC—whose parents provided information about their exposure to maltreatment (defined as physical, emotional, or sexual abuse, or severe maladaptive parenting, or both) between the ages 8 weeks and 8.6 years; exposure to bullying was assessed during conversations with the children at ages 8, 10, and 13—and 1,420 children from GSMS, who reported information on maltreatment and bullying between the ages of 9 and 16. Symptoms of anxiety, depression, self-harm, and suicidality were measured at age 18.

Of the 4,026 children in the ALSPAC cohort, 341 (8 percent) were exposed to only maltreatment, 1,197 (30 percent) were exposed to only bullying, and 283 (7 percent) were exposed to both maltreatment and bullying. As adults, 402 (10 percent) were classified as having anxiety, 316 (8 percent) as having depression, and 361 (9 percent) as having reported self-harm in the past year. A total of 207 (15 percent) in the GSMS cohort were exposed to only maltreatment, 225 (16 percent) to only bullying, and 159 (10 percent) to both maltreatment and bullying. As adults, 135 (12 percent) were classified as having anxiety, 87 (6 percent) as having depression, and 64 (7 percent) as having reported self-harm in the past year.

After adjusting for potential confounders, the authors reported that being bullied only was a higher risk for overall mental health problems than was being maltreated only in both cohorts (OR 1.6 [95% CI 1.1–2.2] for ALSPAC; 3.8 [1.8–7.9] for GSMS). Children who were bullied were more likely to have anxiety (4.9 [2.0–12.0] for GSMS), depression (1.7 [1.1–2.7] for ALSPAC) and self-harm (1.7 [1.1–2.6] for ALSPAC) as adults than children who were maltreated by adults.

While governmental efforts have focused almost exclusively on public policy to address family maltreatment, less attention and resources have been directed at addressing bullying, the study authors note. “Since bullying is frequent and found in all social groups, and current evidence supports that bullied children have similar or worse long-term mental health outcomes than maltreatment, this imbalance requires attention,” they write.

For more on the long-term effects of bullying, see the Psychiatric News article, “Effects of Bullying Don’t End When School Does.”

(Image: Monkey Business Images/Shutterstock)

Wednesday, April 29, 2015

Most Children With ADHD Stay on Stimulant Medication, Study Shows

Stimulant medication continued to be used by most children three to six years after the conclusion of research known as the Preschool ADHD Treatment Study (PATS) in which they had participated. About 1 in 4 children was no longer taking medication, and about 1 in 10 was on an antipsychotic. Antipsychotic treatment was associated with more comorbidity.

Those are the findings of a prospective, naturalistic follow-up study of PATS by Benedetto Vittielo, M.D., of the National Institute of Mental Health, and colleagues at several other institutions, published in the Journal of Child and Adolescent Psychiatry. 

They reassessed 206 of the 303 children who had participated in PATS at three years and 179 children at six years after completion of the controlled study. Pharmacotherapy and clinical data were obtained from the parents. Pharmacotherapy was defined as use of a specific class of medication for at least 50 percent of the days in the previous six months.

At year three, overall, 34 percent were on no pharmacotherapy, 41.3 percent were on stimulant monotherapy; 9.2 percent on atomoxetine (alone or with a stimulant); 8.3 percent on an antipsychotic, usually together with a stimulant; and the remaining 7.2 percent were on other pharmacotherapy. Overall, 65.0% were on an indicated ADHD medication.

At year six, just under 27 percent were on no pharmacotherapy, 40.2 percent were on stimulant monotherapy, 4.5 percent on atomoxetine, alone or with a stimulant, 13.4 percent on 
an antipsychotic, and 15.1 percent on other pharmacotherapy. Overall, 70.9% were on an indicated ADHD medication.

Antipsychotic treatment was associated with more comorbidity, in particular disruptive behavior disorders and pervasive development disorders, and a lower level of functioning.

For related information, see the Psychiatric News article “Study Assesses Association Between Weight Gain, ADHD Medication.”

(Image: tomertu/


Tuesday, April 28, 2015

New Book From APA Describes Mental Illnesses for General Audiences

Patients, families, and others now have access to the latest information on mental disorders and available treatments through a comprehensive, easy-to-understand book that APA released today, Understanding Mental Disorders: Your Guide to DSM-5.

“We need to have a conversation in this country, and everyone has to have a greater literacy and understanding of these illnesses,” said former Rhode Island Congressman Patrick Kennedy (left) at a launch event at the National Press Club in Washington, D.C. Kennedy, who is one of the country's leading advocates on mental health issues, wrote the foreword to the 370-page book. "It empowers patients and their loved ones by giving them knowledge and understanding."

Understanding Mental Disorders is based on the latest, fifth edition of APA's Diagnostic and Statistical Manual of Mental Disorders. The organization of the book follows that of DSM-5 and lists risk factors, warning signs, symptoms, and treatments for each disorder. The book also includes brief case studies to illustrate real-life examples of people with these conditions.

“This book can lead to helpful communication between patients, their families, and their psychiatrists,” noted APA President Paul Summergrad, M.D. (right), chair of psychiatry at Tufts University School of Medicine.

Besides patients and their families, Understanding Mental Disorders will be helpful for other health professionals, law enforcement personnel, educators, coaches, members of the clergy, as well as others who want to educate themselves about mental illness.

"Psychiatrists now have an authoritative source of information on mental disorders to recommend to their patients and loved ones," said APA President-Elect RenĂ©e Binder, M.D. “The book will overcome stigma about mental illness because it emphasizes that these are brain disorders and they are treatable.”

In addition to Kennedy, Summergrad, and Binder, participating in the launch of the book at the National Press Club were Jeffrey Borenstein, M.D., a member of the book’s advisory panel; Paul Gionfriddo, president and CEO of Mental Health America; and Barbara Van Dahlen, Ph.D., the founder and president of Give an Hour.

For more in Psychiatric News about Understanding Mental Disorders, see "New Manual to Offer One-of-Kind Layperson’s Guide to DSM-5."

--aml   (Image: David Hathcox)

Monday, April 27, 2015

Anxious Parents Can Transmit Anxiety to Children, Twin Study Shows

The association between parental and offspring anxiety and neuroticism appears to be environmental rather than genetic—that is, children and adolescents learn anxious behaviors from their parents rather than inheriting anxiety genetically.

That’s the conclusion of a remarkable study titled "The Intergenerational Transmission of Anxiety: A Children-of-Twins Study" by Thalia C. Eley, Ph.D., of Kings College London and colleagues at institutions in the United States and Sweden. The study was published in AJP in Advance.

Researchers used data from the Twin and Offspring Study of Sweden comprising information on 387 monozygotic twin families and 489 dizygotic twin families. Parental anxious personality was self-reported by twins using 20 items from the Karolinska Scales of Personality. Offspring anxiety symptoms were measured using items from the Child Behavior Checklist (30). Twins, their spouses, and offspring all reported on offspring behavior over the previous six months. A method of statistical analysis called Structural Equation Modeling allowed the researchers to quantify the effects of additive genetic, common environmental—that is, nongenetic effects that make members of a nuclear family similar to one another—and nonshared environmental effects (which make members of a family different from one another) of parental anxiety.

For both anxiety and neuroticism, the models provide support for significant direct environmental transmission from parents to their adolescent offspring. In contrast, there was no evidence of significant genetic transmission, according to the report.

Robert Freedman, M.D., editor of the American Journal of Psychiatry, told Psychiatric News, “This study is a landmark, because it is the first to clearly establish the early transmission of anxiety symptoms from parents to children, not through their shared genetic background, but rather from the way in which anxious parents raise their children. Parents who are anxious can now be counseled and educated on ways to minimize the impact of their anxiety on the child's development.”

For related information, see the Psychiatric News article “CBT for Child Anxiety May Confer Long-Term Protection From Suicidality.”

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Friday, April 24, 2015

Experts Consider Best Options for Treatment, Prevention of Opioid Abuse

Opioid addiction experts from across the country were on Capitol Hill yesterday to provide expert testimony on the growing opioid epidemic in the United States and common misperceptions about factors driving this trend.

“Let me state clearly so as to leave no room for doubt,” said Rep. Tim Murphy (R-Pa., left), the chair of the U.S. House Energy and Commerce Subcommittee on Oversight and Investigations. “Our current strategies are failing, and I am not going to stop until we start moving in the direction of success defined not just as getting individuals off of street drugs and onto a government-approved opioid, but getting them to the point of drug-free living.”

The hearing included perspectives from leading experts in opioid addiction, who discussed the best options for treatment and prevention, including medication-assisted treatment and prescription drug–monitoring programs.

“I fully recognize the importance of medication-assisted treatment as a transition from street drugs and to prevent overdose from heroin,” Murphy remarked, “but relying on this as the one and only solution shouldn’t be the strategy.”

“Unlike many other disorders with high mortality rates, opioid use disorder is treatable, and a joint effort of health professionals, community advocates, and policymakers is urgently needed to reverse this tragic trend,” testified Adam Bisaga, M.D., a professor of psychiatry at Columbia University School of Medicine.

The scientific evidence base for medication-assisted treatment as part of an overall strategy to fight opioid addiction was highlighted by several members of the expert witness panel. "Opioid-addicted people need access to a broad range of treatments for opioid addiction,” said Laurence Westreich, M.D., president of the American Academy of Addiction Psychiatry. "This must include access to medication-assisted therapy and treatment for co-occurring psychiatric disorders.”

“We don’t have just an opioid misuse epidemic or an opioid overdose epidemic, we also have an opioid overprescribing epidemic,” explained Anna Lembke, M.D., an assistant professor of psychiatry and behavioral sciences at Stanford University Medical Center. “Contrary to what is commonly believed, doctors who treat addiction are not the source of the problem. The methadone that accounts for 40 percent of deaths by a single-drug opioid pain reliever is almost entirely in the form of pills prescribed for the treatment of pain, rather than coming from methadone maintenance clinics that treat individuals who are heroin dependent. Thus, it’s very important that we not only scrutinize physicians who prescribe opiates for the treatment of addiction, but also for those physicians who treat other common chronic illnesses such as pain.”

After the testimonies, Murphy told Psychiatric News that the hearing was an eye opener. “A lot of Americans who need treatment for opioid addiction are not getting the needed treatment. We need more providers to treat addiction and more regulation of the prescription practices that involve opiates," he said. "The subcommittee is definitely going to take the recommendations that were made today into consideration in hopes of bringing about change.”

To watch a recording of the hearing, click here. To read about more treatments for opioid addiction, see Psychiatric News articles "Psychiatrists Describe Trends in Medications to Treat Addiction" and "SAMHSA Releases Guidance for Initiating Medication Treatment for Opioid Overdose."

(Image: Vabren Watts/Psychiatric News)

Thursday, April 23, 2015

Scientists Identify Molecular Marker of Major Depression

Increased amounts of mitochondrial DNA (mtDNA) may serve as a molecular marker of major depression, according to a study published today in Current Biology.

Researchers at the University of Oxford obtained genome sequences from 5,864 women with recurrent major depression and 5,783 women without a history of major depression who were participants in the China, Oxford, and VCU Experimental Research on Genetic Epidemiology (CONVERGE) Project. The researchers also interviewed the study participants to assess lifetime adversities, including a history of childhood sexual abuse and other stressful life events.

Sequencing of the amount of mtDNA and mean telomere length—two components of the genome suspected to be associated with adverse life experiences—revealed a significant association between major depression and the amount of mtDNA. While additional analysis found that mtDNA amount and telomere length were associated with adverse life events, conditional regression analyses showed that the molecular changes were contingent on the presence of major depression.

“We could find no evidence that stressful life events act via changes in mtDNA or telomere length to increase the risk of major depression,” the study authors noted. Nonetheless, “these findings identify increased amounts of mtDNA as a molecular marker of major depression and have important implications for understanding how stress causes the disease,” the authors concluded.

"We have only a snapshot of the relationship between the molecular markers and depression," Jonathan Flint, a professor of molecular psychiatry at the University of Oxford and senior author on the paper, stated in a press release. "We want to know how they change over time—before, during, and after a depressive illness. That information will tell us much about their clinical utility."

To read more on biomarkers for depression, see the Psychiatric News article “Scientists Closer to Finding Tests for DepressionBiomarkers.”

(The Biochemist Artist/Shutterstock)


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