Friday, November 21, 2014

Senators Hear Testimony on MH Care and Suicide Prevention for Veterans


A bipartisan group of U.S. senators expressed concern at a hearing Wednesday about what they see as the slow pace of change in the Veterans Health Administration’s (VHA) mental health care system—a concern intensified after listening to two women whose sons, veterans of Iraq or Afghanistan, had died by suicide.

“When people are hurting, they don’t want to wait to get help,” stressed committee chair Sen. Bernie Sanders (I-Vt.), who then asked how the $5 billion authorized for hiring additional clinicians was being spent. Those funds were not specifically allocated for mental health care providers, replied psychiatrist Harold Kudler, M.D. (above, right), chief mental health services consultant for the VHA. However, the agency was nevertheless allocated a share of those funds to recruit more providers, increase points of access, and test new modes of outreach in rural areas.

Still other avenues could be explored in the effort to reduce the number of veterans who die by suicide, said psychiatrist Elspeth Cameron Ritchie, M.D., M.P.H., (above, left), a retired Army colonel who is now chief clinical officer of the Washington, D.C., Department of Behavioral Health and a member of an Institute of Medicine panel that studied the effectiveness of treatments for posttraumatic stress disorder.

The VHA should, for example, conduct more research to understand which of its patients are at increased risk for suicide, Ritchie said. Service members also should be screened with closer attention to specific tasks they performed while deployed, as well as for any toxic exposures—like Agent Orange or the antimalarial drug mefloquine—which might produce symptoms of psychiatric illness or increased suicide risk.

The testimony was presented as the Senate considered the Clay Hunt SAV [Suicide Prevention for American Veterans] Act, which includes measures for suicide prevention and medical school loan forgiveness for psychiatrists and certain other practitioners who join the VHA.

For more about mental health issues that affect veterans and the findings of the Institute of Medicine report, see the Psychiatric News article “Pentagon, VA Lack Data to Assess PTSD Care Systems.”

(Image: Aaron Levin/Psychiatric News)

Thursday, November 20, 2014

Great American Smokeout Is a Day to Focus on Quitting the Habit


Today marks this year's Great American Smokeout, a day when the American Cancer Society (ACS) encourages smokers to make a plan to quit, or to plan in advance and quit smoking that day. "By quitting—even for one day—smokers will be taking an important step towards a healthier life—one that can lead to reducing cancer risk," the ACS emphasizes. "Tobacco use remains the single largest preventable cause of disease and premature death in the U.S.," the organization points out, yet despite all the warnings and data documenting severe health risks, about 20% of Americans still smoke.

And the benefits of quitting smoking are by no means limited to improvements in physical health. "Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. The effect size seems as large for those with psychiatric disorders as those without. The effect sizes are equal to or larger than those of antidepressant treatment for mood and anxiety disorders," researchers have found in a study published in BMJ based on a systematic review of research and a meta-analysis. "Smokers can be reassured that stopping smoking is associated with mental health benefits," the researchers emphasized.

For more on smoking and mental health, see the Psychiatric News article "Smoking Cessation for Patients Called an Urgent Priority."

APA is holding a #YourMH @twitter chat today on smoking cessation in observance of the Great American Smokeout. Join your APA colleagues in responding to questions and comments from the public from noon to 1 p.m. EST. To join, use #YourMH (stands for "Your Mental Health") or @apapsychiatric. If you haven't created a Twitter account yet, click here to do so now. Here's your chance to share your knowledge and insights.

Wednesday, November 19, 2014

Study Finds Brain Region Is Reduced in Teens With History of Early Childhood Depression


A recent study published in JAMA Psychiatry shows that a key region of the brain involved in emotion may be smaller in size in youth who had been diagnosed with depression as preschoolers, compared with their peers who were not diagnosed with depression.

Joan Luby, M.D. (photo), director of the Early Development Program at Washington University School of Medicine in St. Louis, and colleagues conducted a study in which approximately 130 youth with and without a previous diagnosis for major depressive disorder (MDD) were followed from preschool-aged years to adolescence to assess the psychopathological and long-term neuroanatomical consequences of the onset of MDD in early childhood.

The results showed that more than 55% of those with early childhood MDD displayed pathological guilt during their preschool years, compared with 20% in the nondepressed group. Using magnetic resonance imaging (MRI), the researchers found that the right anterior insula—involved in emotion and self-perception—was smaller in adolescents with a history of MDD and guilt during early childhood, compared with that of their counterparts without such medical history. The data also showed that adolescents with smaller insula were more prone to experiencing recurrent episodes of clinical depression as they aged.

The researchers noted that “excessive guilt and depression may put preschoolers on a developmental trajectory that contributes to problems with depression later in childhood and even throughout life.” They concluded that the current findings concerning the brain’s right anterior insula "are consistent with mounting research in adult MDD suggesting that insula function and structure may be a target biomarker for major depression."

To read more about how the size of brain regions may serve as biomarkers for psychiatric disorders, see the Psychiatric News article "Brain-Region Size May Be Long-Sought Biomarker."

(Image Courtesy of Washington University School of Medicine)

Tuesday, November 18, 2014

Recovery Model Helps Reduce Use of Seclusion, Restraint in Large Hospital System


From 2001 to 2010, the use of mechanical restraint and seclusion in the Pennsylvania state hospital system declined significantly after incorporation of targeted strategies and a recovery-oriented model of care, according to a report in Psychiatric Services in Advance titled “Correlation Between Reduction of Seclusion and Restraint and Assaults by Patients in Pennsylvania’s State Hospitals.” Additionally, patient-to-patient assaults declined slightly, although patient-to-staff assaults were unaffected.

Researchers affiliated with the Pennsylvania state hospital system conducted a prospective study to assess the use of seclusion and restraint from 2001 through 2010. They examined 12,900 anonymized records involving the 1,801 civilly committed individuals who were physically or mechanically restrained and secluded in the nine civil state hospitals during the study period. They found that the use of mechanical restraint declined significantly from .37 to .08 episodes per 1,000 days, and the use of seclusion declined significantly from .21 to .01 episodes per 1,000 days.

The researchers attribute the change to the incorporation of “The Six Core Strategies for Reducing Seclusion and Restraint Use” issued by the National Association of State Mental Health Program Directors. These strategies include better leadership, data transparency, use of clinical alerts, workforce development, policy changes, enhanced use of response teams, implementation of dialectical behavior therapy, and discontinuation of the use of PRN (or "as needed") orders) to prevent or limit agitation, anxiety, and physical aggression. They also attribute the change in part to a systemwide recovery-oriented model of care. “Pennsylvania’s commitment to a recovery approach has transformed its service-delivery system to emphasize community services and supports,” they said. “This commitment is the overall reason for the significant reduction in use of seclusion and restraint.”

For more on how hospitals are dealing with seclusion and restraint concerns, see the Psychiatric News article "Psychiatric Hospital Aesthetics Affect Seclusion, Restraint Use."

(Image: Stokkete/shutterstock.com)

Monday, November 17, 2014

New Study Finds Sleep Learning Effective in Curbing Smoking


A new study suggests that smoking can be curbed, at least in the short term, through subliminal learning during early stage sleep. These findings from researchers at the Weizmann Institute in Israel were presented yesterday at the Society for Neuroscience annual meeting in Washington, D.C.

The study enrolled 76 smokers to receive one session of aversive conditioning by pairing the smell of cigarette smoke with the noxious smell of rotten eggs or rotten fish. The participants were divided into three groups—one received the conditioning while awake, the second received the conditioning during stage 2 sleep, and the third during deep REM sleep.

All the participants kept a smoking diary that tracked their behaviors one week before and one week after their aversive-conditioning session. The smokers who received their stimuli during stage 2 sleep reported a 34% reduction in smoking over the next week, while those who received the smells during REM sleep reported a more modest 12% reduction; the smokers who were awake reported no changes.

Previous studies have tested various forms of aversive conditioning such as bad smells, bad tastes, or mild electric shocks as a smoking cessation tool, though such trials have not been remarkably successful, possibly because the participants were awake and anticipating the stimuli. These new positive findings reinforce the idea that indirect behavioral therapy through sleep or hypnosis, for example, may offer more benefit.

To read more about why quitting smoking is important for mental well-being, see the Psychiatric News article, "Smoking Cessation Bestows Multiple Mental Health Benefits." Read more about smoking cessation treatment in the November American Journal of Psychiatry study, “Combination Treatment With Varenicline andBupropion in an Adaptive Smoking Cessation Paradigm.”

(shutterstock/Paul Cowan)

Friday, November 14, 2014

FDA Flags Generic Versions of ADHD Medication


Yesterday, the Food and Drug Administration (FDA) released a statement concerning the therapeutic benefits of two generic versions of Concerta tablets (methylphenidate hydrochloride extended-release tablets), intended to treat attention-deficit/hyperactivity disorder (ADHD) in adults and children. The agency is asking whether the generic products are bioequivalent to the brand-name drug.

The FDA’s inquiry was prompted by an internal reexamination of previously submitted data for the three approved generic versions of Concerta, which included non-brand-name methylphenidate hydrochloride extended-release tablets manufactured by Mallinckrodt Pharmaceuticals, Kudco Ireland Ltd, and Concerta manufacturer Janssen Pharmaceuticals. The results showed that while Janssen’s generic version was therapeutically equivalent to brand-name Concerta—releasing medicine in the body over a period of 10 to 12 hours—the generic versions manufactured by Mallinckrodt and Kudco were more likely to deliver the medicines at a slower rate during the designated time range, which may lessen the drug’s desired effect in some patients.

As a result, the FDA changed the therapeutic equivalence (TE) rating for the Mallinckrodt and Kudco products from AB to BX—meaning that the products are still approved and can be prescribed, but are no longer recommended as automatic substitutes for Concerta at pharmacies. The FDA has asked Mallinckrodt and Kudco to confirm the bioequivalence of their products within six months or to voluntarily withdraw them from the market.

In a statement, the FDA said, “If you or your health care professional are concerned the drug product is not providing the desired effect and you do not know the manufacturer, contact the pharmacy where the prescription was filled to verify the product’s manufacturer.... [Also] contact the prescribing health care provider to discuss whether or not a different drug product would be more appropriate.” The FDA has not identified any serious safety concerns with the two generic products.

Read the FDA press release on generic versions of Concerta here.

Thursday, November 13, 2014

Potential Biomarker for Alcohol-Dependence Drug Identified


Researchers at the Mayo Clinic have identified a potential biomarker to identify which people would most benefit from acamprosate treatment for alcoholism. In a genetic study that evaluated 225 individuals who were participating in either a residential or outpatient sobriety program, the research team found that a variant of the GRIN2B gene was associated with longer alcohol abstinence over the three-month study period.

The GRIN2B gene encodes a portion of the NMDA receptor, which is involved in learning and memory but has also been tied to several alcohol-related issues including dependence, withdrawal, craving, and relapse.

A second analysis of 110 alcohol-dependent subjects in Germany identified a similar connection between GRIN2B and sobriety in people taking acamprosate, which provides a key step forward for future applications in pharmacogenetic screening.

"Previous studies have suggested other genes as possible biomarkers for sobriety," said lead author Victor Karpyak, M.D., Ph.D., an assistant professor of psychiatry at Mayo, "but this is the first time we have verified a biomarker in an independent population."

Karpyak did note that since all the participants were taking acamprosate, other biological mechanisms cannot yet be ruled out. His group is preparing a blinded, placebo-controlled study to confirm whether the abstinence effects are connected with acamprosate usage.

To read about another potential medication that can improve alcohol abstinence, see the Psychiatric News article "Anticonvulsant Drug Shows Efficacy in Treating Alcoholism."

(Image: shutterstock/foxterrier2005)

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