Wednesday, September 17, 2014

Training Mental Health Clinicians Boosts Tobacco Treatment for Patients, Study Finds


Training a range of mental health clinicians to deliver tobacco treatment services can increase use of such services and boost the patients’ willingness to quit smoking, according to a new study published in Psychiatric Services in Advance.

“Smoking rates among individuals with a mental illness or substance use disorder are at least double those of the general population,” said Jill Williams, M.D., a professor and director of the Division of Addiction Psychiatry at the Robert Wood Johnson Medical School, and colleagues.

The researchers recruited 20 clinicians, including 13 psychiatrists, and gave then a two-day training session on assessment and treatment of smokers. The curriculum covered behavioral and pharmacological treatments, how to help less-motivated smokers, and how to manage complex cases. Patient charts from the clinicians’ caseload were reviewed before and after the training. After the training, more patients were advised to quit by the participating clinicians (9% before versus 36% after training), more developed treatment plans for quitting (20% versus 60%), and more patients were informed about nicotine replacement therapy (10% versus 31%).

Despite this improvement, more could be done for these patients, concluded Williams and colleagues. “Strategies beyond training may be needed to enhance [smoking-cessation] prescribing by these practitioners,” the suggested.

For more in Psychiatric News about the link between smoking and mental illness, see the article “Smoking Cessation for Patients Called an Urgent Priority.”

(Image: Stepan Popov/Shutterstock.com)

Tuesday, September 16, 2014

Early Intervention in At-Risk Children Can Reduce Psychiatric Problems in Adulthood.


Early and sustained intervention of children with conduct problems can lower the chances that those problems will extend into adulthood, reports a new study published in AJP in Advance titled “Impact of Early Intervention on Psychopathology, Crime, and Well-Being at Age 25.”

Known as Fast Track, this project enrolled kindergarteners who displayed aggressive or disruptive behaviors into a multi-component, 10-year, manualized program aimed at instilling social competencies that would extend throughout their lifetimes "through social skills training, parent behavior-management training with home visiting, peer coaching, reading tutoring, and classroom social-emotional curricula," the researchers noted. The program took place in four communities: Durham, N.C., Nashville, Seattle, and rural Pennsylvania. A similar set of at-risk children receiving only the standard interventions in their community were followed as a control group.

There has not been much evidence showing that behavioral improvements in children translate into adulthood, but so far, the Fast Track study seems to suggests that such an intervention can have an impact, finding that while 69% of the adults in the control group displaying at least one psychiatric problem at age 25, only 59% of Fast Track participants displayed a psychiatric problem at the same age. Fast Track participants also displayed decreased rates of substance abuse crimes, violent crimes, and risky sexual behavior compared with controls, as well as higher levels of happiness and well-being.

“This shows that we can go a full eight years after last seeing these children and still see reductions in the rates of problem outcomes for this group as young adults,” said study author Kenneth Dodge, Ph.D., director of the Center for Child and Family Policy at Duke University.

The improvements in behavior were consistent among each of the 13 subgroups assessed (including those defined by gender, ethnicity, study site, etc.), demonstrating that this approach has potential for a wide range of children and risk levels.

To read about a promising early-intervention effort with children in Australia, known as Headspace, see the Psychiatric News article “Australian Youth Get a ‘Soft Entry’ Into Mental Health System.”

(image: PathDoc/Shutterstock)

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.”

GRei/Shutterstock

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/
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(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.

Disclaimer

The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.