Tuesday, November 24, 2015

Participation in Mental Health Courts May Lessen Future Arrests

Criminal defendants who enter mental health court programs may perceive their treatment as significantly less voluntary than those not participating in such programs, but they appear to experience better outcomes, according to a study published in Psychiatric Services in Advance.

Woojae Han, M.S.W., of the University of Albany, and Allison Redlich, Ph.D., of George Mason University compared the treatment outcomes of 357 defendants in mental health courts with 384 people with mental health problems who had recently entered the legal system, examining the impact of community mental health and substance abuse treatment on recidivism at the time of court entry and six months later.

Analysis of interview data with the participants and national arrest data revealed significant increases in treatment motivation and use of community mental health and substance abuse services among participants in the mental health courts compared with the others; however, the perceived voluntariness of treatment decreased in the mental health court group. Increased medication compliance and mental health service use were associated with a significant decrease in arrests for the mental health court group, but not the control group, the authors reported.

“This finding suggests that treatment itself may not lead to meaningful criminal justice outcomes (for example, reduced arrests) but that treatment combined with court monitoring decreases arrests for offenders with mental illness,” the study authors wrote.

For more in Psychiatric News about mental health courts, see “Mental Health Courts: An Effective Alternative to Incarceration” and “MH Court Cuts Violence, Even in Felony Cases.”

(Image: bikeriderlondon/Shutterstock)

Monday, November 23, 2015

Meta-Analysis Finds Stimulants Reduce Quality, Quantity of Sleep in Youth With ADHD

Stimulant medications appear to reduce the quantity and quality of sleep for children with attention-deficit/hyperactivity disorder (ADHD), according to a meta-analysis published online today in Pediatrics. The findings suggest that clinicians should carefully monitor sleeping behaviors of children taking these medications and adjust treatment to promote optimal sleep.

Previous studies examining the effects of stimulants on sleep in youth with ADHD have produced contradictory findings, with some suggesting that stimulants impair sleep while others propose the medication leads to relief from ADHD symptoms and improvements in sleep.

For the current study, researchers from the University of Nebraska, Lincoln, conducted a meta-analysis of nine randomized, controlled studies involving 246 children and adolescents who were diagnosed with ADHD, had been randomly assigned to stimulants (methylphenidate and amphetamine), and had sleep assessed using objective measures.

The researchers found that youth with ADHD who took stimulants took a longer time to fall asleep, have worse sleep efficiency, and sleep for shorter periods of time. The analysis revealed that the more times a day a stimulant was taken, the longer it took for the youth to fall asleep. Additionally, while the findings revealed that stimulants had a negative effect on sleep efficiency regardless of how long the youth took the medication, sleep efficiency appeared to improve over time.

“The results of the present meta-analysis highlight the importance of carefully weighing the potential benefits and adverse effects of stimulant medications when prescribing to children,” the study authors wrote. “Pediatricians are also encouraged to provide referrals for behavioral treatment of ADHD and sleep, either in addition to or as an alternative to prescribed medications.”

For related information, see the Psychiatric News article “Children With ADHD Benefit From Sleep-Focused Treatment.”

(Image: Donskaya Olga/Shutterstock)

Friday, November 20, 2015

Judge Awarded for Work on Decriminalization of People With Mental Illness

In a ceremony yesterday evening at the United States Supreme Court, Florida Judge Steven Leifman, J.D., was honored with the 2015 William H. Rehnquist Award for Judicial Excellence from the National Center for State Courts for his work on behalf of people with mental illness in the Miami-Dade (Fla.) County criminal justice system.

Leifman, who also serves on the board of directors of the American Psychiatric Association Foundation, has both advocated for and implemented programs to divert from county jails into treatment and community support people with mental illness who do not pose a risk to public safety.

“It is important to recognize a larger American problem: the rising presence of people with mental illness in our jails and prisons even as the general prison populations declines,” said Leifman. The intersection of the criminal justice and mental health systems is “fragmented, underresourced, and outdated.”

Solving this problem cannot be accomplished by one person, one level of government, or one party, he said. “We are used to an adversarial criminal justice system, but we need to reach across boundaries.”

APA President Renée Binder, M.D., who attended the ceremony, noted that the award to Dr. Leifman highlights the national recognition by the judicial system of the inappropriate criminalization of persons with mental illness. 

"Chief Justice John Roberts listened carefully while Dr. Leifman gave an elegant and passionate speech of his experience as a sitting judge and seeing defendants with obvious mental illness and confusion who had committed minor offenses and were being sent to jail inappropriately," she said. "APA is working collaboratively with Judge Leifman and with other stakeholders to highlight this problem and address solutions."

For more in Psychiatric News about Judge Leifman’s work in Miami, see “Program Prepares Defendants for Return to the Community” and “Defendants With Mental Illness Diverted to Social Security System.”

(Image: Rick Reinhard)

FDA Extends Deadlines for Clozapine REMS Program

The Food and Drug Administration (FDA) is extending deadlines for provider and pharmacy certification for participation in the Clozapine Risk Evaluation and Mitigation Strategy (REMS).

In an announcement issued this week, the FDA said it is indefinitely extending the deadlines due to technical and other problems associated with the Clozapine REMS. New deadlines will be issued after further evaluation by the administration. “We are also carefully evaluating next steps regarding the December 14, 2015, pre-dispense authorization (PDA) launch,” the FDA said in a statement. “We will communicate the revised certification deadlines and additional information about the PDA launch as soon as possible.”

The Clozapine REMS Program replaces the individual clozapine patient registries that had been required previously for monitoring neutrophil counts in patients receiving the antipsychotic, which has been associated with a risk for agranulocytosis. The new REMS program was initiated this year in an effort to ease burdens on clinicians and pharmacies and to make clozapine—one of the most effective antipsychotics and the only drug approved for treatment-resistant schizophrenia—accessible to more patients.

The administration said the deadlines are being extended to help ensure that health care professionals have sufficient time to complete this process and that patient access to clozapine is maintained. “Health care providers should prioritize the medical needs of their patients and, as appropriate, continue prescribing and dispensing clozapine to patients with an absolute neutrophil count (ANC) within the acceptable ranges while the issues are being resolved by the Clozapine REMS program administrators,” the administration said. “Prescribers and pharmacies should continue to work with the Clozapine REMS Program administrators to resolve any issues and continue their efforts to complete certification and update patient information to meet the requirements of the program.”

APA is continuing to discuss concerns related to implementation of the Clozapine REMS program with the FDA. For information on the Clozapine REMS, click here. For further information in Psychiatric News, see “Why Won’t Clinicians Use Clozapine Despite Proven Superiority?”

Thursday, November 19, 2015

Are Your 1500 Forms Being Rejected? Here’s Help!

APA has received reports that Medicare providers who file 1500 Health Insurance Claim Forms are having a large number of their claims returned due to a change in the reporting requirements that went into effect on October 1.

Medicare contractors are returning claims for correction or resubmission to mental health professionals who fail to indicate in line item 21 of the 1500 claim form whether ICD-9 or ICD-10 codes are used.

For services that were provided prior to October 1, ICD-9 codes should be used even if the claim is filed after that date; for services on or after October 1, 2015, ICD-10 codes should be used. ICD-9 codes are indicated by using a 9 in item #21; ICD-10 codes are noted with a 0.

Also, though there is some inconsistency among what payers are accepting, the general feedback that APA is receiving is that codes submitted in Item 21 should not contain a decimal point (for example, the code F43.10 should be submitted as F4310).

DSM-5 lists both the ICD-9 and the ICD-10 codes for each diagnosis. The ICD-9 codes are in black ink and the ICD-10 codes are to the right of them in gray ink.

For information about how to implement ICD-10 codes using DSM-5, see Using DSM-5 in the Transition to ICD-10.

We encourage you to provide us with feedback regarding any problems you have with the claims you file by sending an email to dsm5@psych.org. The more feedback we receive from you, our practitioners, the better we can communicate tips like the above to help ensure that your claims are accepted.

AMA Calls for Ban on Direct-to-Consumer Ads, Citing Impact on Drug Costs

The American Medical Association this week called on the Food and Drug Administration (FDA), which oversees prescription drug advertising, to ban direct-to-consumer advertising (DTCA), citing its effect on rising pharmaceutical prices. 
At the Interim Meeting of the AMA’s House of Delegates in Atlanta, earlier this week, delegates who voted for the resolution said that although DTCA may increase awareness about diseases and drugs to treat them and thereby prompt some patients to visit a physician, the ultimate goal of DTCA is to drive demand for a product, which may affect the overall cost of drugs. A number of other resolutions and reports at the meeting were devoted to the issue of escalating drug prices.

Psychiatrist and AMA Board Chair-elect Patrice Harris, M.D., M.A. (pictured left), said the vote in support of a ban on DTCA reflects concerns among physicians about the negative impact of commercially driven promotions. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate,” she said. “Patient care can be compromised and delayed when prescription drugs are unaffordable and subject to coverage limitations by the patient’s health plan. In a worst-case scenario, patients forego necessary treatments when drugs are too expensive.”

The United States and New Zealand are the only two countries that allow DCTA of prescription drugs.

The AMA, in a statement about the vote, cited market research by the firm Kantar Media showing that advertising dollars spent by drug makers have increased by 30 percent in the last two years to $4.5 billion.

For more information about the resolution, see an upcoming edition of Psychiatric News. For related information on DTCA, see the Psychiatric News article “Some Worry Drug Companies Will Exploit New Media.”

(Image: Ted Grudzinski/AMA)

Wednesday, November 18, 2015

Bright Light Therapy Found To Be Effective in Treating Adults With MDD

Bright light therapy has been shown to be effective in people with seasonal affective disorder (SAD), but a new study published today in JAMA Psychiatry shows that this therapy may also serve as an effective treatment for nonseasonal major depressive disorder (MDD).

To examine the efficacy of light treatment alone or in combination with antidepressants for the treatment of MDD, Raymond Lam, M.D., a professor of psychiatry at the University of British Columbia, and colleagues conducted an eight-week randomized, placebo-controlled trial of adults aged 19 to 60.

A total of 122 patients with MDD were randomly assigned to one of four groups: light therapy (active white light box for 30 minutes in early morning plus placebo pill each day); antidepressant therapy (inactive negative ion generator plus fluoxetine hydrochloride (20 mg) each day; combination light and antidepressant treatment; or placebo (inactive negative ion generator plus placebo pill). The primary outcome measure was a reduction in score on the Montgomery Åsberg Depression Rating Scale (MADRS), from baseline to endpoint. Secondary outcome measures included response (greater than 50% reduction in MADRS score) and remission (MADRS score less than 10 at end point).

The results showed that light monotherapy and combined therapy was statistically superior to placebo as it relates to reduction in MADRS scores; there was no statistical difference between fluoxetine monotherapy and placebo. For the respective placebo, fluoxetine, light, and combination groups at the end point, response was achieved by 33.3%, 29.0%, 50.0%, and 75.9% and remission was achieved by 30.0%, 19.4%, 43.8%, and 58.6%.

“Bright light treatment, both as monotherapy and in combination with fluoxetine, was efficacious and well tolerated in the treatment of adults with nonseasonal MDD. The combination treatment had the most consistent effects,” noted the researchers. “Further studies exploring mediators and moderators of response will be important.”

To read more about therapies for seasonal affective disorder, see the AJP in Advance article “Outcomes One and Two Winters Following Cognitive-BehavioralTherapy or Light Therapy for Seasonal Affective Disorder.”

(Image Point Fr/Shutterstock)

SAMHSA Seeks Chief Medical Officer to Address MH Issues at Federal Level

Here’s a rare opportunity to maximize the reach of your medical knowledge and skills by becoming a part of a federal agency that seeks to improve the mental health of all Americans. The Substance Abuse and Mental Health Services Administration (SAMHSA) is recruiting for the position of chief medical officer in its Office of Policy, Planning, and Innovation in Rockville, Md. Among the positon’s major responsibilities are advising SAMHSA’s Advisory Committee on a range of medical and scientific policy questions, providing expert advice on medical considerations and related matters that impact on program plans and/or goals, and participating in national meetings and symposia involving experts and leaders in behavioral health. Click here for more details and application information.


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