Tuesday, March 31, 2015

Three-Month Form of Paliperidone Reduces Relapse in Schizophrenia, Study Shows

A three-month formulation of paliperidone palmitate administered four times yearly as a long-acting injectable significantly delayed time to relapse in patients with schizophrenia compared with placebo, according to a report in JAMA Psychiatry.

Researchers with Janssen Research & Development LLC conducted a randomized, multicenter trial from April 2012 through April 2014 in eight countries. Of the 506 patients enrolled (aged 18 to 70 years; DSM-IV-TR diagnosis of schizophrenia), 305 were randomized to three-month paliperidone palmitate (n=160) or placebo (n=145).

A total of 42 patients (29 percent) in the placebo group and 14 patients (9 percent) in the group receiving three-month paliperidone palmitate experienced a relapse event. Consequently, the independent data-monitoring committee recommended early study termination for efficacy.

Paliperidone palmitate was originally formulated as a once-monthly atypical antipsychotic long-acting-injectable (LAI) and is approved for treatment of schizophrenia in adults in numerous countries. The recently developed three-month formulation offers the prospect of reducing relapse risk related to sub-therapeutic plasma concentrations and its associated negative consequences in patients with schizophrenia, the researchers noted.

“Patients randomly assigned to placebo were nearly four times more likely to relapse … than those who continued to receive three-month paliperidone palmitate,” they stated. “Patients at risk for sudden discontinuation from treatment could therefore benefit from three-month paliperidone palmitate, providing protection from relapse for up to one year after the last dose.”

For more on this topic, see the Psychiatric News article “Some Experts Urge More Use of Long-Acting, Injectable Antipsychotics.”

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Monday, March 30, 2015

Gene Variant Predicts Antidepressant Response and Side Effect Severity

A variant in a gene called ABCB1 can predict how a person will respond to certain antidepressants, reports a new study in AJP in Advance titled “ABCB1 Genetic Effects on Antidepressant Outcomes: A Report From the iSPOT-D Trial.”

The study involved 683 patients who received escitalopram, sertraline, or extended-release venlafaxine; the participants also had their ABCB1 gene sequenced. All three of these medications interact with P-glycoprotein, the protein encoded by the ABCB1 gene that functions in transporting antidepressants across the blood-brain barrier.

The authors found a variant called rs10245483 had a significant effect on remission rate and side effects, though it varied depending on the medication. People who had two copies of the common variant (G/G) responded better and had fewer side effects with escitalopram and sertraline. In contrast, people with the minor variant (T/T) responded better and had fewer side effects with venlafaxine.

The degree of remission correlated with the relative cognition of the patient. G/G participants had a greater rate of remission with escitalopram if their cognition was intact, whereas people with T/T displayed a greater rate of remission with venlafaxine if their cognition was impaired.

To read about a potential pharmacogenetic biomarker that may help inform sobriety treatment, see the Psychiatric News article “Genetic Analysis Identifies Possible Acamprosate Biomarker.”


Thursday, March 26, 2015

Coordinated Specialty Care for First-Episode Psychosis Improves Functioning, Recovery, Study Finds

Measures of occupational and social functioning improved significantly over time, symptoms declined, and rates of remission improved in patients who received services in a specially designed, team-based intervention for first-episode psychosis.

Those results were reported in "Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program," published online in Psychiatric Services in Advance.

The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program Implementationand Evaluation Study developed tools to implement and disseminate an innovative, team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. RAISE is a project of the National Institute of Mental Health; the study was conducted by researchers at multiple institutions involved in RAISE.

A total of 65 individuals in RAISE Connection Program treatment across two sites (Baltimore and New York City) were enrolled and received services for up to two years. Primary outcomes such as social and occupational functioning and illness symptoms were evaluated. Trajectories for individuals’ outcomes over time were analyzed.

In the follow-up period, the occupational functioning score on the Mental Illness Research, Education, and Clinical Center (MIRECC) version of the Global Assessment of Functioning increased on average by .96 points per month, and the MIRECC GAF social functioning scale increased by .38 points per month. In the follow-up period, the Positive and Negative Syndrome Scale (PANSS) total score decreased on average by .54 points per month. For every month of follow-up, the PANSS positive score decreased on average by .20 points.

“The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced,” the researchers said. “The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model... Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.”

For related information on this topic, see the Psychiatric News article, "Benefits Persist Decade After Early Psychosis Intervention."

(Image: xpixel/shutterstock.com)

Wednesday, March 25, 2015

White House Launches Network for Alternative Payment Models

APA President Paul Summergrad, M.D. (left), was among those in attendance when President Barack Obama and Secretary of Health and Human Services Sylvia Burwell today helped launch the Health Care Payment Learning and Action Network to help shift health care payment from a model based on quantity to one that rewards providers for quality of care.

The Network is one way to make health care more effective and more efficient, said Obama in remarks noting the fifth anniversary of the Affordable Care Act (ACA).

“It is in our common interest to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people,” said Burwell.

The Network has signed up more than 2,800 entities involved in all aspects of the health care system: clinicians, patients, payers, employers, state and local governments, advocates, and professional medical societies, including APA. Its goal is to link 30 percent of payments made under the ACA to quality measures by 2016 and 50 percent by 2018, goals that were set previously for Medicare.

The Network will be funded by the Centers for Medicare and Medicaid Services and administered by the MITRE Corporation. Through teleconferencing, best practices in alternative payment models.

“Our goal is to improve how providers are paid, how care is delivered, and how information is distributed,” said Burwell.

For more in Psychiatric News on accountable care organizations, see “Moving to an Integrated Medical and Psychiatric Payment Platform.”

--aml  (Image: APA)

Tuesday, March 24, 2015

Your Help Needed Now to Stabilize Medicare!

We need your voice and just a few minutes of your time.

Over the past week, Congressional leaders have negotiated bipartisan legislation that would permanently repeal the flawed sustainable growth rate (SGR) formula, replacing it with positive physician payment reforms. APA is asking for your help to get this legislation over the finish line.

If Congress does not act by March 31, physician Medicare payments will be cut by 21%. This is a direct threat to Medicare providers and our patients, who are disproportionately hurt by declining Medicare reimbursements. Stability in Medicare is long overdue. Please visit APA’s Legislative Action Center and make sure that Congress hears your voice today.

Thank you for your advocacy.

(Image: shutterstock.com/Mikhail Kolesnikov)

Suicide Rates Disproportionately Higher in Rural Areas

An analysis of mortality data in young people (ages 10-24) has found that rural suicide rates are nearly double those of urban areas for both males and females.

Overall suicide rates in the most rural U.S. counties defined by population size and proximity to a metropolitan area were 19.93 per 100,000 for males and 4.40 per 100,000 for females, compared with 10.31 and 2.39 per 100,000 for males and females, respectively, in the most urban areas, according to a report in JAMA Pediatrics. In general, the rates trended higher as counties became more rural. The period under study was January 1, 1996, through December 31, 2010.

Firearms and hanging/suffocation were the two most common methods of suicide among youth (51 percent and 34 percent, respectively), though for both males and females the rates of suicide by firearm declined while rates of suicide by hanging/suffocation increased over time between 1996 and 2010.

Firearm suicide deaths showed some of the most striking rural-urban contrast; in the most recent period analyzed (2008-2010), the rates of suicide by firearm were about 3 times higher in rural areas compared with urban areas.

The study authors proposed that several factors may account for these trends, including geographic and social isolation, less availability of mental health services in rural areas, and more common ownership and use of firearms in such regions.

To read about suicide prevention among youth, see the book Helping Kids in Crisis: Managing Psychiatric Emergencies in Children and Adolescents from American Psychiatric Publishing.

(shutterstock/Sascha Burkard)

Monday, March 23, 2015

APA Fights for Mental Health Parity as ACA Marks Fifth Anniversary

On the fifth anniversary of the signing of the Affordable Care Act (ACA), APA continues working to ensure that the promise of the reform law—which mandates mental health and substance use service as an essential health benefit and compliance with the federal parity law in newly formed health exchanges—is realized.

In a statement released today, five years after he signed the watershed legislation into law, President Obama said the ACA is working.

“After five years of the Affordable Care Act, more than 16 million uninsured Americans have gained the security of health insurance—an achievement that has cut the ranks of the uninsured by nearly one third,” Obama said. “These aren’t just numbers. Because of this law, there are parents who can finally afford to take their kids to the doctor. There are families who no longer risk losing their home or savings just because someone gets sick. ... There are Americans who, without this law, would not be alive today.”

But the ACA faces a potentially fateful Supreme Court challenge to certain provisions of the law. And a recent study in Psychiatric Services found inconsistencies with the federal parity law in the benefits summaries for mental health and substance abuse services of health plans in two state-run health exchanges. Those inconsistencies—in quantifiable treatment limits (cost-sharing, deductibles, treatment limits) and nonquantifiable treatment limits (prior authorization and other strategies for restricting treatment use)—may either reflect actual no-compliance with the law or an effort by plans to dissuade potential consumers who expect to use mental health services from enrolling in a plan.

APA is pursuing a multifaceted strategy of education and advocacy, as well as legal action against companies that fail to comply with the law. As part of that strategy, APA created the Mental Health Parity Poster and is encouraging psychiatrists and other mental health clinicians to post it in waiting rooms or clinics to educate patients about their legal right to equal treatment. More than 100,000 posters have been distributed, with district branches (DBs) and other associations and hospitals cobranding them. A Spanish-language version is being developed.

For more information, see the Psychiatric Services study "A Tale of Two States: Do Consumers See Mental Health Insurance Parity When Shopping on State Exchanges?“ See also the "Employer Guide for Compliance With the Mental Health Parity and Addiction Equity Act," developed by the American Psychiatric Foundation and its Partnership for Workplace Mental Health.


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.