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)

Thursday, August 27, 2015

Virginia TV Shooting Leaves a Wide Circle of Loss


The shooting of two television journalists outside of Roanoke, Va., yesterday went out over the air during a live broadcast, exposing viewers to real-life violence and trauma as it happened.

WDBJ reporter Alison Parker, 24, and cameraman Adam Ward, 27, were interviewing economic development official Vicki Gardner, 62, when a gunman identified as Vester Flanagan attacked them. Parker and Ward were killed and Gardner was injured.

"Our hearts go out to the victims’ families, who are right here in our home state of Virginia," said APA CEO and Medical Director Saul Levin, M.D., M.P.A.

Family members, friends, and coworkers of the victims as well as the surrounding community are grieving over the deaths of two admired and beloved people, a reminder of the widening circle around such tragedies.

“At such moments, employers might want to remind workers about the availability of mental health supports through employee assistance programs,” said Levin during an interview on Thursday with a television station in the Washington, D.C., region. Those who appear to have strong reactions to a tragedy should be approached and offered support or other help, he added.

Viewers, especially children, may also have been traumatized by what they saw on live television, but need to be approached individually, said APA President Renée Binder, M.D., in an interview with Psychiatric News.

“It is normal to have a reaction, such as anxiety or intrusive thoughts,” said Binder. “People don’t have to talk about it but there should be no stigma in doing so if they wish.”

Should they choose to do so, discussing their reactions with anyone—a doctor, mental health professional, teacher, religious leader, or friends and colleagues—may help, she said.

For information on fostering a workplace culture that supports emotional health and well-being, see the American Psychiatric Association Foundation’s Partnership for Workplace Mental Health.

For more in Psychiatric News about how communities cope with acts of violence, see “Mental Health Community in Charleston Offers Services, Support in Wake of Violence.”

(Image: Rawpixel/Shutterstock)

Wednesday, August 26, 2015

Military Women Are at No Greater Risk of Developing PTSD Than Men


While past research on gender differences in the onset of posttraumatic stress disorder (PTSD) among U.S. veterans has been mixed, a recent study by the departments of Defense and Veterans Affairs suggests that women in the military are at no greater risk of developing PTSD than their male counterparts who experience similar traumatic events.

The study included more than 2,300 pairs of men and women in the military who were matched based on an array of variables—including combat exposure, alcohol misuse, depression, and sexual assault—and surveyed on PTSD symptoms over an average time span of seven years (from 2001 to 2008). All participants had been deployed at least once to Iraq or Afghanistan and did not show signs of PTSD at the study’s initiation. Outcome measures included a positive screen for PTSD and symptom severity scores measured by the PTSD Patient Checklist-Civilian Version.

The results, published in the Journal of Psychiatric Research, showed that 6.7 percent of women and 6.1 percent of men developed PTSD — a difference that was not statistically significant. There was also no difference in the severity of PTSD symptoms among men and women who developed the disorder.

“This study supports the positive direction being taken by the expansion of women's occupations into combat arms roles, and suggests continued support from the [Department of Defense] for women seeking occupational equality in the military setting,” the researchers noted. They concluded that the current findings support the notion that gender alone is not an indicator of PTSD risk.

To read more about the efforts to treat PTSD in military personnel, see the Psychiatric News article “Military Turns to Collaborative Care to Treat PTSD, Depression.”

(Image: bikeriderlondon/shutterstock.com)

Tuesday, August 25, 2015

Outreach Care Management, Self-Management Improves Outcomes for Patients With Depression


A program that combined outreach care management and self-management skills for people with chronic or recurrent depressive symptoms was more effective than treatment as usual in reducing depressive symptoms and major depressive episodes, according to a study published last week in Psychiatric Services in Advance.

Researchers from the Group Health Research Institute in Seattle recruited 302 participants ages 18 and older with chronic depression or recurrent episodes of depression from five primary care clinics in the Seattle area. Participants were randomly assigned to treatment as usual or a self-management support service consisting of depression self-management training, recovery coaching, and care coordination.

The 18-month intervention included regular telephone or in-person contacts with a care manager and a structured group program. As part of the group program, participants met weekly for ten weeks, twice a month for two months, and then once a month for maintenance of progress. The meetings were co-led by a care manager and a trained peer specialist.

Repeated-measures estimates of the long-term effect of the intervention versus usual care (average of the six-, 12-, and 18-month outcomes adjusted for age, gender, and site) indicated that intervention participants had less severe symptoms, higher recovery scores, and were less likely to be depressed.

“A systematic program of care management and group self-management support is a worthy addition to outpatient care for patients with chronic depressive symptoms,” the study authors wrote. “By combining elements of the chronic care model and the recovery model in a single program, the program successfully integrated the management strengths of the chronic care model with the sense of optimism and well-being provided by a care management approach.”

For related information, see the Psychiatric News article “Integrated Care Book Offers ‘How-To’ Advice for Psychiatrists.

(Image: Monkey Business Images/Shutterstock)

Monday, August 24, 2015

Suicidal Thoughts, Attempts Are Higher in Patients With Migraine, Comorbid Fibromyalgia


People who have migraines and fibromyalgia have a higher rate of suicidal thoughts or attempts than those with migraines alone, according to a study published online Friday in Neurology.

For the study, researchers surveyed over 1,300 adult migraine patients who had attended a specialty headache clinic. Around 10% of these patients reported also having fibromyalgia, and among this subset 58.3% of patients reported suicidal ideation and 17.6% reported suicide attempts. In migraine patients who did not report fibromyalgia, the rates for ideation and attempt were 24.1% and 5.7%, respectively.

Patients with migraines and fibromyalgia also reported a higher frequency of headaches, more headache-related disability, poorer sleep quality, and more depression and anxiety symptoms than those with migraines only.

The authors noted that since all the participants in the study went to a headache clinic, their symptoms and discomfort may be higher than the average population, so the findings may not be applicable to everyone. However, they recommended that future studies explore the relationship between suicide risk and other pain conditions to see if there is some unique effect of combined migraine and fibromyalgia or if the risks are due to increased pain in general.

To read more about the effective management of people with chronic pain conditions, see the FOCUS article "A Review of Chronic Noncancer Pain: Epidemiology, Assessment, Treatment, and Future Needs."

(Image: Monkey Business Images/Shutterstock)

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