Friday, May 29, 2015

Global Study Finds Some Members of General Population Report Psychotic Experiences

Psychotic experiences, such as hallucinations and delusions, are not restricted to individuals with certain mental illnesses—the general population sometimes experiences these symptoms too, according to a study published this week in JAMA Psychiatry.

Researchers from the University of Queensland in Australia and Harvard Medical School analyzed data from the World Health Organization World Mental Health Surveys that included more than 31,000 adults to assess the lifetime prevalence of psychotic experiences among the general population. 

The analysis revealed that 5.8 percent of those surveyed reported having at least one psychotic experience in their lifetime, with hallucinatory experience being the most prevalent at 5.2 percent compared with delusional experience at 1.3 percent. The results also showed lifetime prevalence of psychotic experiences was higher among women (6.6 percent) than men (5 percent), and higher among individuals who lived in middle-income (7.2 percent) and high-income (6.8 percent) countries than those in low-income countries (3.2 percent). However, the psychotic experiences were infrequent, with 32.2 percent of respondents with lifetime psychotic experiences reporting only one episode and 31.8 percent reporting having experienced two to five episodes. 

“We are interested in learning why some people recover, while others may progress to more serious disorders such as schizophrenia,” John McGrath, M.D., Ph.D., a research professor in the Queensland Brain Institute and lead author of the study, said in a press release. “We can use these findings to start identifying whether the mechanisms causing these hallucinations are the same or different in both situations.” 

For more on psychosis in the general population, see the Psychiatric Services article “Treatment Seeking and Unmet Need for Care Among Persons Reporting Psychosis-Like Experiences.”

(Image: Naeblys/

Thursday, May 28, 2015

For Some Women, Discontinuing Hormone Therapy May Increase Risk of Depression

During perimenopause, women face an increased risk of new and recurrent depression. Now, a new report finds that women with a history of perimenopausal depression (PMD) who discontinue hormone therapy may experience the return of depression symptoms.

For the study, published Wednesday in JAMA Psychiatry, Peter J. Schmidt, M.D., chief of the Section on Behavioral Endocrinology at the National Institute of Mental Health, and colleagues recruited asymptomatic postmenopausal women with a history of PMD whose symptoms remitted following hormone therapy (n=26) and asymptomatic postmenopausal women who were receiving or had previously received hormone therapy and had no history of depression (n=30).

For three weeks, all participants received open-label transdermal estradiol therapy (100 µg/d) before being randomized to a parallel design in which they received either estradiol (at the same dose given during the open-label period) or matched placebo skin patches for three additional weeks. During weekly clinic visits, depressive symptoms were monitored, and women rated the presence and severity of vasomotor symptoms daily.

The researchers found that while none of the women reported depressive symptoms during open-label use of estradiol, women with a history of PMD that were given the placebo skin patch experienced a significant increase in depression symptom severity. In contrast, women with a history of PMD who continued estradiol therapy and those with no history of PMD (who received estradiol or placebo) remained asymptomatic. There were no differences between the groups in reported hot flashes or plasma estradiol levels.

“These observations, in the context of similar plasma reproductive hormone levels, suggest that normal changes in ovarian estradiol secretion can trigger an abnormal behavioral state in susceptible women,” the authors wrote. “Women with a history of PMD should be alert to the risk of recurrent depression when discontinuing hormone therapy.”

For related information, see the Psychiatric News article “Antidepressant May Have Role in Treating Menopause Symptoms.”

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Wednesday, May 27, 2015

Children's Suicide Rates Reflect Racial Differences

Between 1993 and 2012, 657 children in the United States died by suicide, the 11th leading cause of death among children aged 5 to 11 years. While the overall suicide rate did not change significantly over that time (from 1.18 to 1.09 per million), there were notable differences between white and black children.

“Among white children, the suicide rate decreased significantly during the study period (incident rate ratio = 0.86), whereas for black children there was a significant increase in the suicide rate (incident rate ratio = 1.27),” wrote epidemiologist Jeffrey Bridge, Ph.D., a principal investigator at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues in JAMA Pediatrics.

Those differences were largely driven by a significant decrease in suicide rates among white boys (from 1.96 per million to 1.31 per million) and a significant increase among black boys (from 1.78 to 3.47 per million). Hanging/suffocation accounted for 78 percent of all suicides.

The authors speculated on several possible explanations of this disparity in outcomes—black youth may be exposed to more violence or traumatic stress, for instance—but could not say for certain what caused the observed difference in suicide rates.

“[F]uture steps should include ongoing surveillance to monitor these emerging trends and research to identify risk, protective, and precipitating factors associated with suicide in elementary school–aged children to frame targets for early detection and culturally informed interventions,” they concluded.

For more in Psychiatric News about children and suicide, see: "CBT for Child Anxiety May Confer Long-Term Protection From Suicidality."

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Tuesday, May 26, 2015

Citicoline Appears to Reduce Cocaine Use in Patients With Bipolar Disorder, Study Finds

Citicoline reduced cocaine use and was well tolerated by patients with bipolar disorder, according to a report published May 22 in AJP in Advance. However, because the treatment effects diminished over time, the authors of the study suggest citicoline may work best as an acute treatment while other interventions are initiated.

For the study by E. Sherwood Brown, M.D., Ph.D., a professor of psychiatry at the University of Texas Southwestern Medical Center, and colleagues, 130 outpatients with bipolar I disorder and cocaine dependence received citicoline or placebo for 12 weeks. (Citicoline is sold as a prescription drug in Japan and Europe and over the counter as a dietary supplement in the United States. It has a mild side effect profile, is relatively inexpensive, and has no known drug-drug interactions, according to the researchers.) Assessments of mood, based on the Inventory of Depressive Symptomatology–Self Report, the Hamilton Depression Rating Scale, and the Young Mania Rating Scale, were performed weekly, and urine drug screens were conducted three times per week.

While no between-group differences in mood symptoms or side effects were observed, the researchers found that there was a significant treatment group and group-by-time effect (whether or not missing urine screens were imputed as cocaine positive).

“The effects of citicoline in reducing cocaine use appeared to occur quickly and tended to decline during the study,” the authors write. “These findings suggest that citicoline might be most effectively used in an acute treatment to reduce cocaine use in inpatient settings while other treatments are initiated rather than as a long-term monotherapy.”

For more on strategies to reduce cocaine use, see the Psychiatric News article "Cocaine Vaccination Isn't Science Fiction Anymore."

Friday, May 22, 2015

FDA Approves New Three-Month Long-Acting Antipsychotic Invega Trinza

The FDA has approved Invega Trinza (paliperidone palmitate), a long-acting atypical antipsychotic intended to treat schizophrenia, from Janssen Pharmaceuticals Inc.

The approval of the injectable antipsychotic, which remains active in the body for three months, was based on results from a two-year maintenance trial with 506 patients diagnosed with schizophrenia. The analysis, published March 29 in JAMA Psychiatry, showed that patients who were administered Invega Trinza were statistically less likely to relapse than those who were administered placebo. The most common adverse effects of the medication included injection-site reactions, weight gain, upper respiratory tract infections, and extrapyramidal symptoms.

The newly approved antipsychotic will come with a boxed warning stating that it is not approved for patients with dementia-related psychosis and that use of the drug may increase the risk for death in elderly patients with dementia.

Before patients can begin taking Invega Trinza, they must first show tolerability to Janssen's Invega Sustenna, a one-month form of paliperidone palmitate, for at least four months.

Invega Trinza was approved under the FDA's priority review process, a fast track for drugs thought to represent a significant advance in medical care. It is being marketed by Janssen.

For more information about psychotropic medications in the pipeline, see the Psychiatric News article "Candidates, Innovation Missing From Psychotropic Drug Pipeline."

Thursday, May 21, 2015

Experts Discuss Mental llness, Risk for Violence, and Gun Ownership

An evidence-based assessment of dangerousness—not mental illness, per se—should guide public policies regarding restrictions on gun ownership, Jeffrey Swanson, Ph.D. (left), of Duke University School of Medicine said during the "Do Firearm Restrictions Prevent Suicide and Violence in People With Serious Mental Illness?" workshop at the APA annual meeting in Toronto. He was joined by Joshua Horwitz, executive director of the Educational Fund to Stop Gun Violence.

Swanson, a professor of psychiatry and behavioral science, presented evidence showing that while there are instances when those with a serious mental illness are at increased risk of violence, serious mental illness, on its own, contributes very little to overall violence towards others. (Mental illness alone carries a far greater risk for suicide.)

For instance, he showed data from a survey of public behavioral health system psychiatric outpatients with serious mental illness in five U.S. sites demonstrating that the risk of violence rose significantly when in combination with substance abuse, early victimization, and/or exposure to violence in one's current social environment.

Swanson offered these following principles to guide public policy regarding restricting access to firearms:

  • Prioritize contemporaneous risk assessment based on evidence of behaviors that correlate with violence and self-harm at specific times, not mental illness or treatment history per se as a category of exclusion;

  • Preempt existing gun access, rather than simply thwarting a new gun purchase by a dangerous person;

  • Provide legal due process for deprivation of gun rights;

  • Preserve confidential therapeutic relationships;

  • Prevent the unpredictable through universal background checks, but also by reducing the social determinants of violence and investing in improved access to mental health and substance abuse services.

For more information on gun policy and mental illness, see the Psychiatric News article "Capitol Hill Gets Straight Story On Gun Violence, Mental Illness" and the Psychiatric Services article "Gun Policy and Serious Mental Illness: Priorities for Future Research and Policy."

(Image: Mark Moran)

Wednesday, May 20, 2015

Understanding the Motivations of Cheating Athletes Can Guide Treatment

“Deflategate” may be the word of the day in the sports world, but it is neither the first nor the last example of athletes cheating to gain an edge on competitors. Winning is everything to many athletes, no matter the cost to their integrity and health.

Cheating in sports likely falls into one of the four B’s: Betting, Bribery, Battery, and Banned substances, said Thomas Newmark, M.D., a professor of psychiatry at the Rowan School of Medicine, at APA’s 2015 annual meeting in Toronto today. He gave an overview of infamous sports scandals in cheating, ranging from cyclist Lance Armstrong’s use of performance enhancement drugs to the ice skater Tanya Harding’s planned assault on fellow competitor Nancy Kerrigan at the Olympic trials in 1991. Newmark discussed that underlying motives behind some cheating scenarios are the gaining of fame, extreme financial incentives, success, and acceptance, or, in the case of collegiate athletes, grades and maintaining eligibility.

Psychiatrists can step in and help athletes caught cheating by educating them about the error of their ways or helping them cope with the stress of dealing with a suspension or the end of a career, said Eric Morse, M.D., a sports psychiatrist who works with professional, college, and youth athletes and teams. Ironically, sometimes it is the psychiatrist who is pressured to cheat—to provide a medical diagnosis that helps a college athlete drop a course he is failing or “legalize” a banned medication with a back-dated prescription.

Dan Begel, M.D., a cofounder of the International Society for Sport Psychiatry, discussed that athletes with personality disorders such as narcissistic, borderline, or antisocial personalities are at higher risk of cheating behaviors. “Understanding the deeper motivations of such athletes can drive treatment,” said Begel. “It is important to explore childhood and family and cultural dynamics to develop a treatment plan.”

Therapy tools highlighted during the session to treat athletes included cognitive-behavioral therapy, family therapy, dynamic therapy, and supporting therapy. The experts emphasized that the key role of psychiatrists in sports medicine is to educate athletes about cheating, help them not to cheat again, and help with the consequential stress of being caught—which could result in a loss of identity for the player.

Ira Glick, M.D., professor emeritus of psychiatry and behavioral sciences at the Stanford University School of Medicine, said that a personal, family, and cultural history of the athlete are good starting points for therapy.

“Cognitive-behavioral therapy, family therapy, dynamic therapy, or supportive therapy can help,” said Glick. “Often the elite athlete may feel a sense of entitlement that needs to be addressed.”

For more on how sports can inform therapy, see Psychiatric News article “Why Sports Evoke Passion, for Better or Worse.”

(Image: Peter Weber/


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