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.”

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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.

Deadline is Tomorrow for Reviewing, Disputing Sunshine Act Data


Tomorrow (September 10) is the deadline to review and dispute the accuracy of data reported by the pharmaceutical and medical-device industries in accordance with the "Sunshine Act" regarding payments physicians may have received from them. The “Open Payments” database, administered by the Centers for Medicare and Medicaid (CMS), has been the subject of much controversy in recent weeks after errors in physician data were reported to the agency. Access to the database was suspended at least three times as CMS worked with industry on fixing the problems.

While the public website will still be launched as planned on September 30, it will not include the entire first round of submitted data or data on some research payments to physicians. CMS continues to have concerns about the integrity of the data and has said it was returning about one-third of the records to manufacturers and group purchasing organizations for correction; these records will be included in the next reporting cycle in June 2015.

Early this month, the AMA sent a detailed letter to CMS Administrator Marilyn Tavenner, co-signed by APA and dozens of other medical organizations, urging the agency to implement a delay in allowing public access to the system until March 31, 2015, citing several concerns including technical problems, the cumbersome registration process, and the appeals process. The reporting system was established through the Physician Payments Sunshine Act as required by the Affordable Care Act to give the public information about possible relationships between their physicians and industry.

Physicians who have not done so already are advised to register on the Open Payments site and review their data. Information on the three-step verification and registration process is posted on APA's website.


APA is observing National Suicide Prevention Week from September 8 to 14 and World Suicide Prevention Day on Wednesday, September 10. From noon to 1 p.m. EDT on World Suicide Prevention Day, APA will be holding a Twitter chat on suicide and suicide prevention, hosted by Gabriela Cora, M.D. To follow or participate in the chat, follow @APAPsychiatric or use the hashtag #yourMH. Members who have not yet joined Twitter, set up your account today at https://twitter.com/
.

(Image: rangizzz/shutterstock.com)

Monday, September 8, 2014

Plan to Join the Conversation on Suicide Prevention on Wednesday


APA is observing National Suicide Prevention Week from September 8 to 14 and World Suicide Prevention Day on Wednesday, September 10. From noon to 1 p.m. EDT on World Suicide Prevention Day, APA will be holding a Twitter chat on suicide and suicide prevention, hosted by Gabriela Cora, M.D. The Twitter chat is one of a weekly series that APA sponsors to provide an opportunity for psychiatrists to lead conversations on current mental health issues and be involved with patients, the public at large, key influencers, and members of allied groups.

To follow or participate in the chat, follow @APAPsychiatric or use the hashtag #yourMH. If you have not yet joined Twitter, set up your account today at https://twitter.com/.

Please note: APA’s Twitter chats are usually scheduled on Fridays at noon. This week’s chat was moved to Wednesday in observance of World Suicide Prevention Day.

Collaborative Care Improves Depression in Cancer Patients, Studies Find


A trio of related studies from the United Kingdom appearing in Lancet, Lancet Oncology, and Lancet Psychiatry reveals that nearly three-quarters of cancer patients who have major depression are not currently receiving any depression treatment. However, the studies also demonstrate that a program of integrated collaborative care is highly effective at reducing this co-occurring depression, even in cancer patients with a poor prognosis.

Known as Depression Care for People with Cancer (DCPC), this program provides both antidepressants and psychotherapy in a systematic fashion, with cancer nurses and psychiatrists working together with primary care physicians. The DCPC was compared with usual care in a pair of multicenter clinical trials called SmaRT Oncology-2 and SMaRT Oncology-3.

The Oncology-2 trial involved 500 adults with major depression and cancer who had a good prognosis. After 24 weeks, 62% of patients receiving the DCPC intervention responded to treatment, compared with only 17% receiving usual care. The DCPC recipients also reported less anxiety and fatigue, and a better quality of life.

The Oncology-3 trial adapted the integrated care program for testing in 142 lung-cancer patients, who typically have a poor prognosis, and correspondingly, a higher prevalence of depression. However, DCPC was still effective in this group, as patients reported greater improvements in their depression, anxiety, and quality of life compared with subjects in usual care.

And a key side benefit was that DCPC was cost-effective; for the Oncology-2 trial, for example, the integrated care only added around $1,000 per patient, which included all treatment sessions, treatment supervision, and telephone discussions about depression care.

To read more about how integrated care can help reduce health care costs, see the Psychiatric News article, “Shifting to Integrated Care Will Save Health System Huge Sums, Report Finds.”

NOTE: This week is National Suicide Prevention Week, and World Suicide Prevention Day is September 10. On that day from noon to 1 p.m., EDT, APA will be holding a Twitter chat on suicide and suicide prevention, hosted by Gabriela Cora, M.D. The Twitter chat is one of a series that provides an opportunity for psychiatrists to lead conversations on current mental health issues and be involved with key influencers, allied groups, patients, and the public at large.

Andrey_Popov/Shutterstock

Friday, September 5, 2014

SAMHSA Celebrates 25 Years of National Recovery Month and Releases Data on Substance Abuse


Yesterday, mental health experts and those recovering from mental illness, including substance use disorders, gathered at the National Press Club in Washington, D.C., to celebrate the 25th anniversary of National Recovery Month, which is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).“[For] a quarter of a century, we have been illuminating, defining, validating, and shaping a concept into a fact that people do recover from addiction and mental illness,” said SAMHSA Administrator, Pamela Hyde, J.D., in addressing the audience (photo above). “[Today] we acknowledge and celebrate that reality.”

As part of the celebration, SAMHSA released some of the data from its 2013 National Survey on Drug Use and Health (NSDUH). “An estimated 24.6 million Americans 12 years and older were current drug users,” Hyde reported, emphasizing that means more than 9% of the U.S. population acknowledged drug use at the time of the survey. Marijuana was the most commonly used illicit drug, with 19.8 million individuals saying they used it in the month prior to the survey. The next most common example of illicit drug use was nonmedical use of prescription pain relievers, used by 4.5 million individuals. Alcohol use was estimated to be prevalent in about half (52.2%) of the U.S. population aged 12 and older, with 60.1 million individuals acknowledging binge drinking. SAMHSA reported that of the people who needed treatment for a substance use disorder or alcohol use disorder, only 11% received help.

The latest NSDUH survey also found that drug use is up slightly from last year. Hyde stated that the alarming rates of drug use, especially marijuana use, may be a result of a growing perception that the use of one drug is less harmful than another. "'Social norms' have to change," said Hyde, "or else we are going to keep meeting here every fall and sharing the same problem. We will be watching [these trends] closely over the next few years."

To view available data from the 2013 National Survey on Drug Use and Health, click here. For information on the risk perception of certain illicit drugs, see the Psychiatric News article, "News Is Mixed on Teenagers and Substance Use."

(Image: Vabren Watts/Psychiatric News)

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