Friday, May 26, 2017

Psychotic Experiences Found to Be Higher Among Adolescent City Dwellers

Adolescents raised in urban neighborhoods may be significantly more likely to have psychotic experiences than their rural counterparts, according to a study published this week in Schizophrenia Bulletin. The association remained significant after adjusting for other factors, including family socioeconomic status, family psychiatric history, and adolescent cannabis use.

“These findings highlight the importance of early, preventative strategies for reducing psychosis risk and suggest that adolescents living in threatening neighborhoods within cities should be made a priority,” said senior author Helen Fisher, Ph.D., of King’s College London in a press release

Fisher, together with colleagues at King’s College London and Duke University, found that neighborhood social conditions and personal victimization by violent crime were strong contributing factors to adolescent psychotic expressions. Adolescents who had grown up in the most adverse neighborhoods and had been victim to a violent crime had nearly five times the chances of experiencing psychotic phenomena compared with those without such history, according to the study.

As part of the Environmental Risk (E-Risk) Longitudinal Twin Study, the researchers asked 2,063 18-year-olds in England and Wales about whether they had had any psychotic experiences since the age of 12. Participants were deemed to have these experiences if they reported during an interview at least one out of 13 potential psychotic experiences, such as believing they were being followed, hearing voices others could not hear, or thinking their food was poisoned. Just over 30% of the study’s total participants said they had at least one psychotic experience.

Researchers measured neighborhood social factors, such as trust and support between neighbors, and signs of threats such as assaults and vandalism through postal code surveys of neighbors living alongside participants. Personal victimization by violent crime was assessed through interviews with the participants themselves.

Of adolescents who had lived in the most socially adverse neighborhoods (neighborhoods that were simultaneously characterized by lower levels of social cohesion and higher levels of neighborhood disorder), 24% reported to have been personally victimized, compared with 15% who lived in better neighborhoods. Adolescents who had been victimized by violent crime had over three times greater odds of having psychotic experiences, the study found. 

Early intervention offers the best hope for improving outcomes in psychosis, the authors concluded. “It is crucial to understand how the wider structural and social environment may influence psychotic experiences among young people in order to design and effectively target preventive interventions,” they wrote. 

For related information, see the Psychiatric News article “Hallucinations Can Be Marker For Variety of Psychiatric Disorders in Youth.”

(Image: iStock/LeoPatrizi)

Thursday, May 25, 2017

APA to U.S. Senate: Reject the American Health Care Act in Favor of Bipartisan Solutions

If the Affordable Care Act (ACA) replacement bill that narrowly passed the U.S. House of Representatives earlier this month becomes law, it will leave some 14 million more people uninsured next year than under the current law and 23 million more in 2026, the Congressional Budget Office (CBO) announced Wednesday. APA responded promptly to the news, renewing its call for the U.S. Senate to reject the ACA replacement bill, the American Health Care Act (AHCA), in favor of a bipartisan solution. 

“We are deeply troubled that 23 million Americans could lose access to health care,” past APA President Maria A. Oquendo, M.D., Ph.D., said in a press release. “Taking away their coverage is unconscionable.” (Oquendo recently took this message to Capitol Hill, where she and leaders from several other medical associations met with Republican senators to discuss their opposition to the AHCA.)

Among other things, APA is concerned about what changes proposed in the AHCA would mean for people with mental illness and substance use disorders; an estimated 1.3 million Americans with serious mental illness and 2.8 million Americans with substance use disorders gained coverage for the first time under the expansion of Medicaid in the ACA.

The AHCA, which passed the House on May 4 by a margin of 217-213, is currently under consideration in the Senate, where it is expected to undergo significant changes before it comes up for a vote.

“Congress made much progress over the past three years, culminating in the passage last year of the bipartisan, bicameral 21st Century Cures Act,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “This current bill reverses those gains. We stand ready to work with both parties to ensure adequate health care for all Americans.”

APA has previously offered the following recommendations to lawmakers:
  • Maintain the current level of coverage for mental health and substance use disorders in health insurance plans. 
  • Maintain safeguards in private insurance by specifically prohibiting the following: 
    • Denying coverage based upon a pre-existing condition; 
    • Establishing lifetime and annual dollar limits on essential health benefits; and
    • Discrimination based upon health status, including a history of mental illness or substance abuse. 
  • Any efforts to restructure Medicaid must ensure sufficient funding for mental health and substance use issues and not shift the cost to states in a way that forces them to tighten eligibility requirements, provider reimbursement, or benefits.  
  • Ensure full implementation and enforcement of the bipartisan Mental Health Parity and Addiction Equity Act, which calls on insurers to offer coverage for mental health care on par with coverage for any other ailment.
“As the Senate debates reforms to the health system, services for people with mental health and substance use disorders—and their families—must be maintained. The APA urges the Senate to reject the American Health Care Act in favor of bipartisan legislation,” the release noted.

Write Your Senators and Urge Them to Start Over on AHCA

APA members are urged to contact their senators to express opposition to the AHCA and instruct the Senate to set aside the House bill and start over on new legislation that does not put at risk health care for people with mental health/substance use disorders. To make such communication quick and easy, visit the APA Advocacy Center.

(Image: Mikhail Kolesnikov/Shutterstock)

Wednesday, May 24, 2017

Involuntary Psychiatric Care, Malingering, and More From APA’s 2017 Annual Meeting

Highlights of day five coverage from APA’s Annual Meeting include a tribute to the late psychiatrist Chester Pierce, M.D., discussion of involuntary psychiatric care, and tips on how to work with patients who distort or withhold key information.

Look for future coverage of APA’s 2017 Annual Meeting in upcoming issues of Psychiatric News.

Pernicious Effects of Racism Discussed in Session Honoring Chester Pierce, M.D.

The late Harvard psychiatrist Chester Pierce, M.D., left a legacy that continues to inspire his successors in the study of the connection between race and mental health in America. Read More >

Columbia Residents Win 2017 MindGames Competition for Second Straight Year

The team from Columbia emerged victorious during the 11th annual MindGames competition at APA’s Annual Meeting. The competition that pits residents from psychiatry programs across the country against each other to test their knowledge of psychiatry. Read More >

The Battle Over Involuntary Psychiatric Care

Involuntary psychiatric treatment is regarded by many as essential in some settings, and there is evidence from some states that when appropriately administered, it is effective. But it is not without controversy and some ardent critics. Read More >

Determining Whether Service Members Are Malingering Poses Dilemma for Military M.D.s

American military personnel who are discharged because of a service-related disability may be eligible for a lifetime of monthly payments of between 30 percent and 100 percent of their salary and health benefits. That may be a temptation to a few who might choose to stretch the truth about an injury or psychiatric disorder. Read More >

Expert Shares Guidance on Prescribing Medicinal Marijuana to Avoid Legal Snags

Twenty-nine states and the District of Columbia have legalized medical cannabis, so psychiatrists throughout the country are or could be involved in prescribing marijuana to patients. Read More >

Confronting Non-Disclosure Can Engage Patients in New Ways

Physicians rely on patients to tell them what is wrong, but patients who distort or withhold critical facts can be challenging, especially for trainees, requiring advanced interviewing skills. Read More >

Toronto Psychiatrist Brings ECHO Model to Mental Health

The telehealth-based mental health initiative is helping to connect local physicians with specialists at an academic medical center for a short didactic lecture on rotating medical topics followed by intensive case discussions. Read More >

Pediatric Integrated Care Is Key to Meeting Needs of Young Patient

Since becoming president of the American Academy of Child and Adolescent Psychiatry in 2015, Gregory K. Fritz, M.D., has made it his mission to educate child and adolescent psychiatrists about how best to collaborate with others in primary or specialty medical care. Read More >

Winners of the Resident/Medical Student Poster Competition Announced

The Resident/Medical Student Poster Competition is an APA Annual Meeting tradition that allows residents and medical students to attend the meeting, present their research, and be recognized for quality work. Read More >

Tuesday, May 23, 2017

Overcoming Addiction, Googling Patients, and More From APA’s 2017 Annual Meeting

Highlights of day four coverage from APA’s Annual Meeting include two tales of patient recovery, the ethical and clinical questions you should consider before Googling your patients, and debates over the value of genetic tests in psychiatric practice.

Through tomorrow, Psychiatric News is delivering an evening digest of some of the day’s highlights—from the lecture halls to the exhibit floor. Whether you are here in San Diego or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

From Depths of Addiction to Triumph of Recovery: ABC Journalist Shares Story of Strength and Inspiration

During the 2017 William C. Menninger Memorial Award Lecture Monday, Elizabeth Vargas delivered a candid address, describing the evolution of her alcoholism and its roots in a gripping anxiety she experienced since childhood. Read More >

Author Cahalan Tells a Tale of the Art and Science of Clinical Care

“I know what it is like to lose your grip,” author Susannah Cahalan said during the Opening Session on Sunday. “I have come back intact, and I hope I can share with you the perspective of a patient. I want to offer you a view from the inside of psychosis, hallucinations, and delusions.” Read More >

Rep. Tim Murphy Wins Javits Award

Rep. Tim Murphy (R-Pa.), who spearheaded the effort for mental health reform in Congress, received APA’s 2017 Jacob K. Javits Award for Public Service. Read More >

To Google or Not to Google: How Much Do You Want to Know About Your Patient?

The practice of Googling a patient’s name may be too easy to resist and may seem innocuous. But a panel of experts said that Googling and other forms of collecting collateral information about a patient online raise a host of questions, ethical and clinical, about how that information may affect the physician-patient relationship and clinical care. Read More >

Pediatric Psychosomatic Physician Talks About Special Considerations for Young, Medically Ill

While most people think of psychosomatic medicine as a field that treats adult patients with cancer, HIV/AIDS, or other serious illnesses, there is a vibrant and emerging community of pediatric psychosomatic doctors. Read More >

Expert Panel Debates Benefits, Harms of Pharmacogenetic Testing

Over the course of a Learning Lab session, experts fielded a range of questions on genetic testing—including scientific, ethical, judicial, and financial considerations. Read More >

Lessons Learned From Studying Mental Health Outcomes of U.S., U.K. Soldiers

The president of the Royal College of Psychiatrists describes the similarities and differences between the mental health outcomes of U.S. and U.K. military members. Read More >

APA Raises $16,000 for Free Clinic Project

The proceeds from the annual APA Gives Back program went to the UCSD Student-Run Free Clinic Project. The project operates four clinics in the San Diego area, providing free medical and preventive care, health education, and access to social services. Read More >

Future of NIMH, Goldwater Rule, and More From APA's 2017 Annual Meeting

Highlights of day three coverage from APA’s Annual Meeting include an address by the NIMH director on the future of the institute, the naming of the winners of APA’s Psychiatry Innovation Lab, the importance of partnerships when caring for the military, and how mental illness played a major role in the musical genius of Robert Schumann.

From now through May 24, Psychiatric News will deliver an evening digest of some of the day’s highlights—from the lecture halls to the exhibit floor. Whether you are here in San Diego or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

NIMH Director Discusses His Vision for Institute

As part of his Year 1 listening tour, Joshua Gordon, M.D., Ph.D., the new director of the National Institute of Mental Health (NIMH), presented a special lecture in which he discussed the institute’s future funding outlook as well as his vision for its future—and what that might mean for psychiatry. Read More >

Session on Goldwater Rule Elicits Diverse Reactions From Participants

Ethics experts and session participants share their views on the Goldwater Rule. Read More >

Partnerships Are Key to Caring for Members of the Military, Says Vice Admiral

Military and civilian health care providers share a common overarching mission and have much to offer each other. Read More >

APA’s New Mental Health Registry Will Help You Improve Care, Meet Reporting Requirements

PsychPRO, the mental health registry being developed by APA to help members more easily meet quality reporting and maintenance of certification (MOC) requirements, has gotten off to a fast start since the launch of its preliminary phases last October. Read More >

Experts Describe Ongoing Efforts to Shift Conversation on Psychiatric Medications

At a Presidential Symposium, members of the neuroscience-based nomenclature (NbN) task force discussed the history and future of their nearly decade-long effort to change psychotropic medicine descriptions to reflect their molecular targets or mode of action instead of an arbitrary indication. Read More >

Your Patients May Want You to Incorporate Spirituality Into Treatment

While most hospitals rely on chaplain services to address the spiritual needs of patients, a hospital-wide initiative at McLean Hospital aims to “empower, encourage, and train clinicians around the hospital to attend to patient’s spirituality and religion rather than ignoring or outsourcing this area of life.” Read More >

APA Congratulates Winners of the Psychiatry Innovation Lab

APA held its third Psychiatry Innovation Lab competition at this year’s Annual Meeting on Sunday. The goal of the competition is to accelerate innovative ideas and ventures that aim to improve the delivery of mental health care. Read More >

Richard Kogan, M.D., Explores Genius of Composer Robert Schumann

Psychiatrist and concert pianist Richard Kogan, M.D., describes the mind of 19th century German composer Robert Schumann and how Schumann’s mental illness played a major role in his musical genius. Watch >

Partnering With Community Groups May Improve Outcomes in Older Adults Who Hoard

A thorough psychiatric evaluation that identifies psychiatric, medical, and cognitive comorbidities is essential to the effective management of hoarding in the elderly, but most individuals will require additional hands-on assistance. Read More >

Workshop Attendees Debate Best Options for Treating Perinatal Depression

The cases discussed included guidance on how to monitor medications and adjust dose as needed during pregnancy, as well as some of the different treatment options available. Read More >

In tomorrow’s Psychiatric News Alert: A report on ABC News journalist Elizabeth Vargas’s lecture and discussion with NIDA Director Nora Volkow, M.D., at the Convocation of Distinguished Fellows.

Monday, May 22, 2017

Innovative Solutions for Expanding MH Care and More From APA’s 2017 Annual Meeting Day Two

Day two of APA’s Annual Meeting included an announcement of the results of a national poll on Americans’ views on access to mental health care, an address by the director of NIAAA, and discussion about ways to strengthen the therapeutic alliance with a patient after a suicide attempt.

From now through May 24, Psychiatric News will deliver an evening digest of some of the day’s highlights—from the lecture halls to the exhibit floor. Whether you are here in San Diego or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

Oquendo Recounts Victory of 21st Cures Act, APA’s Ongoing Efforts on AHCA

“We are at the threshold of a wonderful era for psychiatry,” said APA President Maria A. Oquendo, M.D., Ph.D., recapping an eventful presidential year highlighted by her presence at the White House for the signing of the 21st Century Cures Act.
Read More >

Everett to Center Presidency on Innovative Solutions to Expanding Care, Increasing Support to Members

During the Opening Session, APA President-elect Anita Everett, M.D., said the development of innovative systems for improving access to care, team-based care for first-episode psychosis, and initiatives regarding physician wellness and burnout would be key goals for her presidency. Read More >

Large Majority of Americans Say MH Care Should Be Covered by Insurance

Mental health is important to Americans, and they think it should be important to their elected representatives as well, according to the results of a national poll released today by APA. Read More >

NIAAA Director Describes ‘Dark Side of Addiction,’ Hope for Future Treatments

The negative emotional states experienced by people with substance use disorders are an integral part of the addictive process, according to George F. Koob, Ph.D. Read More >

Winners of Assembly Election Announced

At their meeting held yesterday in conjunction with the Annual Meeting, members of the APA Assembly chose James R. Batterson, M.D., of Kansas City, Mo. (right), as the group’s next speaker-elect. He is the Area 4 representative and is concluding his term as recorder. Steven Daviss, M.D., a representative from the Maryland Psychiatric Society, was elected recorder. The new officers begin their terms at the close of the Annual Meeting, at which time Theresa Miskimen, M.D., of Piscataway, N.J., will become the speaker of the Assembly.

Asking Patients About Suicide Narrative May Improve Long-Term Outcomes

Placing greater emphasis on a patient’s narrative of the feelings leading up to a suicide attempt may not only strengthen the therapeutic alliance, but create a foundation from which safety planning and long-term outreach can be maintained. Read More >

What Can Children’s Books Teach You About Your Patients?

All literature is born from the human need to tell stories that help us understand ourselves and others. Children’s books—which allow young readers to experience love, loss, and betrayal through the lives of characters—can lead to cognitive and emotional growth in young people. Read More >

Psychiatrists Have Tools Needed to Help Patients in Pain

Physicians today appreciate that chronic pain involves vicious cycles of both physical and psychological feedback. Read More >

Historical Survival Traits May Be to Blame for Some Mental Health Disorders

Depression and anxiety are, paradoxically, directly linked to the same genetic traits that evolved to help our ancestors survive, said Lee Goldman, M.D., author of Too Much of a Good Thing: How Four Key Survival Traits Are Now Killing Us. Read More >

Sunday, May 21, 2017

Clinical/Research News From APA’s 2017 Annual Meeting Day One

Welcome to San Diego!

APA’s 2017 Annual Meeting began in San Diego today. From now through May 24, Psychiatric News will deliver an evening digest of some of the day’s highlights—from the lecture halls to the exhibit floor. Whether you are here in San Diego or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

Strengthening Sense of Identity Can Promote Mental Health of Students of Color

Identity can be a source of both emotional adversity and strength for ethnic minority college students, said speakers at a panel today at APA’s Annual Meeting.
Read More >

When Should Psychiatrists Disclose Mental Health Problems?

Psychiatrists have been at the forefront of encouraging patients to adopt ideas like recovery, resilience, and engagement, yet when confronting their own mental health issues, psychiatrists lean toward privacy. Read More >

Experts Describe Recent Advances in Psychodynamic Psychotherapy

Interpretation of transference, treatment of narcissistic personality disorder, and the evolution of psychodynamic treatments for borderline personality disorder and posttraumatic stress disorder were among topics discussed. Read More >

Volkow Honored for Addiction Research

Nora Volkow, M.D., director of the National Institute on Drug Abuse, was presented the Presidential Award for 2017 today by the American Association of Chairs of Departments of Psychiatry. The organization presents the award each year to a psychiatrist for distinguished scientific achievement and leadership in the field of psychiatry. Volkow was honored for her groundbreaking psychiatric research demonstrating drug addiction is a brain disease. She is flanked by Ondria Gleason, M.D., chair of the Department of Psychiatry at the University of Oklahoma School of Community Medicine, and Britta Ostermeyer, M.D., chair of the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Health Sciences Center.

Panel Discusses the Role of Mobile Technology in Mental Health Care

As interest in digital technologies like smartphones and telemedicine continues to expand in psychiatry, psychiatrists should be aware of the promise and the pitfalls of this digital evolution. Read More >

Scopolamine May Offer Clues About Fast-Acting Antidepressants

Ketamine’s ability to relieve symptoms of treatment-resistant depression in a matter of hours has captured the attention of clinicians and patients alike. However, it’s not the only medication on the market capable of exerting rapid antidepressant effects. Read More >


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