Friday, September 4, 2015

Vietnam War Veterans Still Face PTSD, Depression 40 Years Later

Forty years later, an estimated 271,000 veterans of the Vietnam War have current posttraumatic stress disorder (PTSD) or subthreshold PTSD—one-third of whom also have current major depressive disorder, according to the National Vietnam Veterans Longitudinal Study (NVVLS), published in the September issue of JAMA Psychiatry.

The NVVLS reassessed a sample of 2,348 veterans who were first studied 25 years ago as part of the National Vietnam Veterans Readjustment Study (NVVRS). For the study, researchers used a variety of instruments to evaluate PTSD and depression, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-IV supplemented with PTSD Checklist for DSM-5 items (PCL-5+).

Among male theater veterans, the researchers estimate a current prevalence of war-zone PTSD based on CAPS-5 criteria of 4.5% or 10.8% for current full plus subthreshold PTSD, and 11.8% prevalence based on the PCL-5. For female veterans, the equivalent rates were 6.1%, 8.7%, and 6.6%. PTSD rates were lower for veterans who were posted elsewhere than Vietnam.

The course of the disorder was different between veterans who did and did not serve in Vietnam, said lead author Charles Marmar, M.D., a professor and chairman in the Department of Psychiatry at the New York University School of Medicine. “For era veterans, self-reports of PTSD symptoms during 25 years are low and stable, whereas, for theater veterans, mean levels are higher and increasing.”

The study shows the need for increased access to care and for “anticipating challenges that lie ahead for Iraq and Afghanistan veterans,” Marmar and his colleagues concluded.

“No other study has achieved this quality of longitudinal information, and the sobering findings tell us as much about the Vietnam generation as about the lifelong impact of combat service in general, relevant to all generations,” commented Charles Hoge, M.D., of the Center for Psychiatry and Neuroscience at the Walter Reed Army Institute of Research in Silver Spring, Md., in an accompanying editorial.

For more about the psychiatric effects of military service, see the Psychiatric News article “Troops Face Complex, but Not Inevitable, Mental Health Issues.”

(Image: Orhan Cam/Shutterstock)

Thursday, September 3, 2015

Kenneth Cole Billboard Fuels Harmful Stigma

Last week, fashion designer Kenneth Cole posted a billboard linking gun violence with mental illness.

“Mr. Cole’s statement on gun reform creates a misleading impression that people who suffer from mental illness are violent,” APA President RenĂ©e Binder, M.D., wrote in her blog today about the billboard. “This is a disappointing misrepresentation of the facts and only serves to further stigmatize those suffering from mental illness.”

In reality, the vast majority of mentally ill people are not violent, and most violent acts are committed by people who are not mentally ill, pointed out Binder. People with serious mental illness are 11 times more likely to be victims of a violent crime in the past year than the general population.

“The numbers simply do not bear out what Mr. Cole implies on his billboard,” Binder continued. “But he does get one thing right: many Americans with mental health issues don’t get the help they need.”

Barely two out of five adults with mental illness receive needed treatment.

“The right answer here is to get people with mental illness treatment, not marginalize them, especially when stigma is one of the biggest barriers preventing people from receiving care,” wrote Binder.

The Affordable Care Act and the Mental Health Parity and Addiction Equity Act together are helping address many of these barriers, she said. Lowering barriers to care will help get people in treatment earlier and help prevent many of the disabling aspects of mental illness.

Sharing APA’s outrage over the billboard was the New York State Psychiatric Association, which represents APA members in the state of New York.

Under the Twitter hashtag of #givestigmatheboot, APA responded to Cole’s statement with a series of messages to set the record straight. “1 in 4 people with serious mental illness has been the victim of a violent crime in the past year” and “Disappointed with @mr_kennethcole for linking gun violence, mental illness. Follow us to get the facts. #givestigmatheboot” were two of APA’s tweets.

APA members who would like to participate in the social media campaign are urged to join the conversation at #givestigmatheboot.

“We are advocates for reform on this issue, but suggesting that a vulnerable, stigmatized segment of the population is the cause is ignorant, dangerous, and patently false,” concluded Binder.

Nearly 90 Percent of Americans Say They View Mental, Physical Health Equally

About 90% of U.S. adults report that mental health and physical health are equally important, yet more than 30% believe that mental health care is inaccessible and 40% believe it’s something that most people cannot afford, according to a recent national online survey.

The survey, conducted between August 10 and August 12, asked U.S. adults aged 18 and older about their perceptions of mental health, including whether they had ever been diagnosed with or thought they had a mental disorder and the barriers they viewed to treatment. The survey also asked participants about their experiences with and attitudes toward suicide. A total of 2,020 adults completed the survey, and the results were weighted for age within gender, region, race/ethnicity, income, and education where necessary to align them with their actual proportions in the population.

While one-third of adults reported having been diagnosed with a mental health condition by a health care provider, 47% said they may have had a mental health condition at some point, and more than 10% of those surveyed reported missing work days because they were too anxious (14%) or too depressed (16%) to go to work.

Participants’ perceived barriers to seeing a mental health professional included the following: 43% viewed it as “something most people can’t afford,” 31% viewed it as “not accessible for most people,” 30% viewed it as “something people do not know where to find.” However, the majority of the 38% of adults who reported having ever received treatment for a mental health condition said that the treatment was helpful, whether the treatment was in-person psychotherapy (82%), prescription medication (75%), or another form of treatment.

The survey also found that 55% of all Americans have been affected by suicide in some way. The majority of participants believe that better access to psychotherapy or medication (63%), better training for health care providers (62%), more research into how to help people and why people die by suicide (60%), and educating the public about suicide prevention (59%) would help reduce the number of people who die by suicide.

“Progress is being made in how Americans view mental health and the important role it plays in our everyday lives,” said psychiatrist Christine Moutier, M.D., chief medical officer of the American Foundation for Suicide Prevention. “People see the connection between mental health and overall well-being, our ability to function at work and at home, and how we view the world around us.”

For related information on Americans' attitudes toward mental health care, see the Psychiatric Services report "Attitudes About Required Coverage of Mental Health Care in a U.S. National Sample."


Wednesday, September 2, 2015

Meta-Analysis Finds Association Between Obesity and ADHD in Adults, Children

Adults and children with attention-deficit/hyperactivity disorder (ADHD) are significantly more likely than those without the condition to be obese, according to a meta-analysis of studies appearing in AJP in Advance.

Independent studies evaluating whether an association between obesity and ADHD exists have drawn conflicting conclusions. To examine the relationship between obesity and ADHD, an international team of researchers searched through a broad range of databases and unpublished material to identify population-based studies and clinical studies of individuals with ADHD compared with non-ADHD controls.

Of the forty-two studies (which included 728,136 people) selected for inclusion, the researchers found that obesity was significantly associated with an ADHD diagnosis in both adults and children. The estimated prevalence of obesity was increased by about 70% in adults with ADHD compared with adults without ADHD and by about 40% in children with ADHD compared with children without ADHD. The researchers also noted that individuals taking medication for ADHD were not at any higher risk for obesity than those with untreated ADHD.

“Although obesity has been found to be associated with other mental health conditions, such as depression and anxiety, its association with ADHD might be particularly significant for its potential treatment implications,” the study authors wrote. “Assessing the risk for obesity should be part of the assessment and management of ADHD.”

To read more about ADHD, see the Psychiatric News article "Study Suggests ADHD in Adults May Be Distinct Disorder."

(Paul Velgos/Shutterstock)

Tuesday, September 1, 2015

Extended-Release Guanfacine Reduces Hyperactivity in Children With ASD

Extended-release guanfacine appears to be safe and effective for reducing hyperactivity, impulsiveness, and distractibility in children with autism spectrum disorder (ASD), according to a study published in AJP in Advance.

While extended-release guanfacine is approved for children with attention deficit/hyperactivity disorder (ADHD), the medication is not well studied in children with ASD. Researchers from the Research Units on Pediatric Psychopharmacology Autism Network conducted a multisite, randomized clinical trial comparing extended-release guanfacine with placebo in children with ASD accompanied by hyperactivity, impulsiveness, and distractibility.

For the study, 53 boys and nine girls, who ranged in age from 5 to 14 years, were randomly assigned to extended-release guanfacine or placebo for eight weeks. The modal daily dose at week 8 was 3 mg/day (range: 1 mg/day to 4 mg/day) for the extended-release guanfacine group and 3 mg/day (range: 2 mg/day to 4 mg/day) for the placebo group.

The guanfacine group showed a 43.6% decline in scores on the Aberrant Behavior Checklist-hyperactivity subscale compared with a 13.2% decrease in the placebo group. The rate of positive response (much improved or very much improved on the Clinical Global Impression-Improvement scale) was 50% for the guanfacine group compared with 9.4% for the placebo group.

The most common adverse events reported by the guanfacine group included drowsiness, fatigue, and decreased appetite.

“Although symptoms of ADHD and ASD often co-occur and may reflect shared underlying genetic risk, the ADHD syndrome in ASD may differ from ADHD in children without ASD,” the researchers stated. “Children with ASD may be internally focused on topics of special interest, find little reward in matters outside of their circumscribed interest, and, consequently, pay little attention to other environmental stimuli. Hyperactivity and impulsiveness in children with ASD appear similar to the hyperactivity and impulsiveness in ADHD and are more amenable to measurement.”

For related information, see the Psychiatric News article "AACAP Updates Guidelines on Autism Spectrum Disorder."

(Image: nito/Shutterstock)

Monday, August 31, 2015

Brain Connectivity Map May Reveal Response to Antipsychotic Drug Treatment

Measuring the pattern of activity in the brain region known as the striatum may be able predict how well a patient with acute psychosis responds to antipsychotics, according to a study published Friday in AJP in Advance. While this method needs some further development, it does show the potential to be a clinical tool that could help reduce the uncertainty associated with treatment response to antipsychotic medications.

The study authors used functional MRI (fMRI) to develop brain connectivity maps in a cohort of 41 first-episode schizophrenia patients; the fMRI images were taken prior to the patients’ participation in a clinical study of risperidone or aripiprazole. A comparison of the connection profiles of the patients who responded to the medications with those that did not revealed 91 nodes throughout the brain that were functionally connected to the striatum and associated with treatment response.

The researchers applied this “connectivity index” to an independent set of 40 newly hospitalized patients with acute psychosis and found that the index could predict a positive drug response with around 78% accuracy.

In general, the fMRI scans showed that drug responders had less striatal connectivity—a deficit the authors suggest may be remedied by drug action. In contrast, non-responders tended to have greater connectivity, suggesting the biological mechanisms for their psychosis is resistant to primary functional effects of standard antipsychotic medications, according to the authors.

For related information, see the Psychiatric News article “CSF Biomarkers Studied as Factors to Predict Schizophrenia Onset.”

(Image: D.K. Sarpal et al., AJP in Advance, August 28, 2015)

Friday, August 28, 2015

How Katrina Changed Psychiatrists and Lessons They Learned

On Saturday, the nation will mark the 10th anniversary of the day Hurricane Katrina barreled into the Gulf Coast, leaving more than 1,800 dead, tens of thousands stranded, and property damage of about $108 billion.

“We all have a sense of expectations and beliefs about stability in the world,” Anthony Speier, Ph.D., an associate professor of clinical psychiatry at Louisiana State University (LSU) in New Orleans, told Psychiatric News. “In Katrina, the flooding and displacement meant that the normal anchors of life were in disarray and that stability was no longer available and had to be re-established.”

Speier managed Louisiana Spirit, the federally funded crisis counseling program created after the hurricane. He was one of more than a dozen mental health professionals interviewed for a two-part series in Psychiatric News that examines the indelible imprint the hurricane left on the minds of the mental health professionals who lived and traveled to the region shortly after the storm.

Hurricane Katrina Is No Distant Memory to Gulf Coast Clinicians” describes the impact that the hurricane had on psychiatrists who were working in New Orleans when the storm hit and their involvement in efforts to rebuild the region's mental health infastructure.

Psychiatrists Who Volunteered After Katrina Look Back on Lessons” details the efforts that were made to recruit, vet, connect, and organize volunteer psychiatrists, and the lessons psychiatrists gained from the challenges they experienced.

“Katrina was a hard experience but also a reminder of the privilege we have of helping people at a very difficult time,” said Howard Osofsky, M.D., a professor and chair of the Department of Psychiatry at the LSU Health Science Center School of Medicine in New Orleans. “I was very impressed at how people can endure difficulty and grow as human beings in the process.”

For more on the best practices for helping those affected by disaster, see Disaster Psychiatry: Readiness, Evaluation, and Treatment from American Psychiatric Publishing. APA members can purchase the book at a discount. Also, see the American Journal of Psychiatry article "Disruption of Existing Mental Health Treatments and Failure to Initiate New Treatment After Hurricane Katrina."

(Image: Gregory Pelt/Shutterstock)


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