Friday, May 25, 2018

Women Who Receive Abortion No More Likely to Have Suicidal Thoughts Than Those Denied Abortions

A study published Thursday in AJP in Advance found that having an abortion does not place women at higher risk of experiencing suicidal thoughts than being denied an abortion. In fact, the rates of suicidal ideation were low across groups, when compared with other studies of pregnant and postpartum women.

“The study adds to the growing body of evidence that having an abortion does not lead to negative mental health outcomes,” study co-author M. Antonia Biggs, Ph.D., of the University of California, San Francisco, told Psychiatric News. “Therefore, policies requiring that women be warned that they are at increased risk of becoming suicidal if they choose abortion are not evidence based.”

Biggs and colleagues assessed the effects of having an abortion or being denied an abortion on women’s experiences of suicidal ideation over five years, using data from the University of California, San Francisco’s Turnaway Study. This longitudinal study was designed to look at the effects of receiving an abortion compared with being denied an abortion on women’s socioeconomic, mental health, and emotional well-being.

The researchers examined data from nearly 1,000 women recruited from 30 U.S. abortion facilities. Women were interviewed by telephone one week after their abortion visit, then every six months for five years. Women completed the suicidal ideation items on the Brief Symptom Interview (BSI) and the Patient Health Questionnaire (PHQ-9). Women who received abortions within two weeks of a facility’s gestational age limit (average 20 weeks pregnant) were compared with women who were denied an abortion because the length of their pregnancy exceeded the facility’s gestational age limit (average 23 weeks pregnant) and carried their pregnancies to term. For further comparison, the study also included a group who obtained a first-trimester abortion (average eight weeks pregnant).

One week after seeking an abortion, 1.9% of the near-limit group and 1.3% of those turnaway-birth group reported suicidal ideation symptoms on the BSI. Over the five-year study, the proportion of women with suicidal ideation symptoms on the BSI declined significantly to 0.25% for women in the near-limit group and nonsignificantly to 0.21% for those who were denied an abortion and later gave birth, wrote the authors.

“By following women for five years, we are able to assess whether abortion is followed by an increase in suicidal ideation and whether the suicidal ideation trajectories of women who obtained an abortion differ from those of women denied an abortion. For women having an abortion, we found that the proportion with any symptoms did not increase but rather decreased over the five-year period,” Biggs and colleagues wrote. “We also found no effect of receiving compared with being denied an abortion on either of our two suicidal ideation measures at any time point, dispelling the notion that abortion increases women’s risk for suicidal ideation over time.”

For related information, see the Psychiatric News article “Five-Year Study Suggests Abortion Does Not Lead to MH Problems.”

(Image: iStock/stock-eye)

Thursday, May 24, 2018

APA President Goes to Hill to Urge Provision of MH Services to Incarcerated Individuals

More than 2 million times every year, individuals with serious mental illness are arrested. Moreover, more than half a million people with serious mental illness are incarcerated at any given time. In fact, 44% of jail inmates and 37% of state and federal prisoners have a history of a mental illness.

“Those numbers are staggering no matter how you look at them,” said APA President Altha Stewart, M.D., at congressional briefing titled “Innovations and Challenges in Providing Mental Health Services to People in Prison and Those Reentering the Community.” APA was one of the sponsors of the briefing.

Driving the crisis are the higher rates of arrest of people with mental illness for petty crimes directly related to their disorder, such as public nuisance, public urination, drunkenness, or behavior perceived by others as dangerous, said Stewart, who is also a professor of psychiatry and director of the Center for Health in Justice-Involved Youth at the University of Tennessee Health Science Center. Longer stays for people with mental illness, coupled with low utilization of evidence-based treatments during incarceration, confounds the problem.

Psychiatrists are the most highly trained, highly skilled physicians to manage the treatment of incarcerated individuals with serious mental disorders, yet are underrepresented in correctional settings, with typically just one provider for every 150 inmates, Stewart said. The costs, too, are staggering: total expenditures on prisons is nearly $43 billion and states are spending $33,000 per inmate per year.

To help prevent recidivism and encourage successful reentry into the community, Stewart urged support for HR 4005, a bipartisan bill introduced by Rep. Paul Tonko (D-N.Y.) to permit the use of federal Medicaid funds for health care services for incarcerated individuals during the 30-day period preceding their release. Currently, under Title XIX of the Social Security Act, federal Medicaid funds are prohibited to be spent on people who are incarcerated. Securing an individual’s Medicaid coverage prior to their release would give individuals “a leg up and reduce their risk of relapse of mental health conditions or overdose while also lowering their risk of recidivism back into the criminal justice system,” Stewart said.

Robert Morgan, Ph.D., chair of the Department of Psychological Sciences at Texas State University, said that by treating inmates for mental illness only, prison systems are missing half the equation for helping these individuals. Instead, research has zeroed in on several central “criminogenic risk factors” that increase people’s risk for becoming enmeshed in the criminal justice system, regardless of whether they are mentally ill. These factors include antisocial behavior and personality traits, antisocial associations, criminal thinking and associates, family problems, marital problems, and poor work or school performance. 

“We need to target the issues that are putting these people at risk for future contact with the criminal justice system,” Morgan said. Services aimed at reducing the criminogenic factors are no more expensive than traditional programs, yet result in a 30% to 50% reduction of recidivism, depending on the type of service provided. For instance, one such program in a probation office in Texas was associated with a reduction in participants’ re-arrests by 50% at the two-year mark, he said.

For information on a program to help people readjust to community life after incarceration, see the Psychiatric News article “APA Foundation Gives ‘Helping Hand’ to Former Inmates.”

(Image: David Hathcox)

Wednesday, May 23, 2018

Extending Weekend Sleep May Reduce Risk of Death in Some Adults Under 65

Adults under the age of 65 who regularly sleep five or less hours on weeknights but more hours on weekend nights appear to have a lower risk of death than those who sleep five or less hours a night on weekends, according to a study in the Journal of Sleep Research.

“The results imply that short (weekday) sleep is not a risk factor for mortality if it is combined with a medium or long weekend sleep,” Torbjörn Åkerstedt, Ph.D., of the Karolinska Institutet in Stockholm and colleagues wrote. “This suggests that short weekday sleep may be compensated for during the weekend, and that this has implications for mortality.”

To examine the association of both weekday and weekend sleep duration on overall mortality, Åkerstedt and colleagues tracked mortality in a cohort of 38,015 Swedish adults aged 18 and over from October 1997 through the end of 2010. At the start of the study, each participant was asked to assess both the number of hours he or she regularly slept on a workday night and a weekend night. The researchers relied on the Swedish National Register of Death to obtain information on date of death and the underlying causes of death in participants from the cohort study.

Of the 38,015 people included in the analysis, 3,234 deaths occurred during study. Statistical analysis revealed that among individuals under age 65, short weekend sleep was associated with a significant 52% higher mortality rate compared with those who slept seven hours on the weekend, while no association was found for long (nine or more hours) weekend sleep. Additional analysis revealed that consistently sleeping five or less hours on both weekdays and weekends was associated with a 65% higher mortality rate compared with consistently sleeping six or seven hours a night, and consistently sleeping eight or more hours was associated with a 25% higher mortality rate. The associations between weekend sleep or weekday/weekend sleep durations and mortality were not observed among individuals aged 65 and older.

“In conclusion, our findings indicate that mortality is increased when both weekday and weekend sleep is short or when both are long in subjects below the age of 65 years. However, when weekend sleep is extended after short weekday sleep, no association with mortality is seen,” the authors wrote. “We suggest that this may reflect positive effects of compensatory sleep. However, this issue needs to be addressed in longitudinal studies of changes in sleep duration and their link to mortality.”

For related information on this topic, see the APA Publishing book Sleep Disorders and Psychiatry, edited by Daniel J. Buysse, M.D.

(Image: iStock/andresr)

Tuesday, May 22, 2018

Social Communication Impairments in Childhood Sometimes Linked to Later Suicidal Behavior

Children who have difficulty communicating in social situations—a trait common in children with autism spectrum disorder (ASD)—may be at higher risk for suicidal ideation and behavior in late adolescence compared with those without these problems, according to a report in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Suicidal behavior in individuals with autism is often underreported, particularly in those with impaired communicative abilities and comorbid self-injurious behavior,” Iryna Culpin, Ph.D., of the University of Bristol and colleagues wrote. “Our findings emphasize the potential importance of assessing whether self-injurious behavior occurs in the context of suicidal ideation.”

For the study, the authors analyzed data on a subset of children who were participants in the Avon Longitudinal Study of Parents and Children, a large birth cohort study in the United Kingdom. The starting sample included children who had received a diagnosis of ASD or showed signs of difficulties in at least one of four ASD traits—social communication, pragmatic language, repetitive behavior, and sociability—measured by parent report on validated instruments. Culpin and colleagues also examined how these youth responded to questions about self-harm and suicidal thoughts or plans at age 16. Complete outcome data on suicidal behavior and ideation at age 16 years were available for 5,031 adolescents.

Culpin and colleagues found a statistically significant association between impaired social communication and self-harm with suicidal intent, suicidal thoughts, and suicidal plans. There was no association between an ASD diagnosis, per se, and suicidal behavior.

Additional statistical analysis revealed that “children with impaired social communication skills were at increased risk for depressive symptoms in early adolescence, which, in turn, was a strong risk factor for suicidal behavior later in adolescence,” they wrote. While “depression explained about a third of the variance of the association between childhood autistic traits and suicidal behavior, substantial variance remained unexplained,” they added.

“These results are important in identifying difficulty with social communication as a potential risk factor for suicidality in the context of depressive symptoms,” wrote Jeremy Veenstra-VanderWeele, M.D. (pictured above), director of the division of child and adolescent psychiatry at Columbia University, in an accompanying editorial. “As a clinician who works with the ASD population, I am dismayed but not surprised to see data support our experience with youth who are suffering and considering suicide at elevated rates compared to their peers. …This is an urgent and obvious area for further research to try to prevent what we now recognize.”

For related information, see the Psychiatric News article “Basis of Inability to Regulate Emotions in Autism Identified.”

Monday, May 21, 2018

Depression in Men May Impact Pregnancy Chances in Couples Seeking Treatment for Infertility

Among couples being treated for infertility, depression in the male partner was linked to lower pregnancy chances, according to a study in Fertility and Sterility. In contrast, depression in the female partner was not found to influence the rate of pregnancy or live birth.

Depression rates are known to be high among couples seeking fertility treatments, with previous research finding 41% of women and nearly 50% of men in such couples show signs of depression, wrote Emily A. Evans-Hoeker, M.D., of Virginia Tech Carilion, and colleagues.

To investigate the role of depression on pregnancy outcomes in couples seeking non-IVF treatments, the researchers combined data from two multi-site, randomized, controlled clinical trials, including 1,650 women and 1,608 men. Only couples not undergoing in-vitro fertilization (IVF) were included, and only the women in the studies were asked about antidepressant use. In both studies, the men and women took the Patient Health Questionnaire (PHQ-9) to screen for depression. A PHQ-9 score ≥10 was used to define currently active major depression.

Among those studied, 5.96% of the women and 2.28% of the men were rated as having currently active major depression. Couples in which the male partner had major depression were 60% less likely to conceive and have a live birth than those in which the male partner did not have major depression.

Additional analysis revealed that antidepressant use in women undergoing non-IVF fertility treatments did not increase pregnancy rates. However, women using non-SSRI antidepressants (n=6) were about 3.5 times more likely to have a first trimester pregnancy loss, compared with those not using antidepressants—a difference not seen in women who took SSRIs only.

“Our study provides infertility patients and their physicians with new information to consider when making treatment decisions,” study co-author Esther Eisenberg, M.D., of the Fertility and Infertility Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development said in a press release.

(Image: iStock/PeopleImages)

Friday, May 18, 2018

Coordinated Specialty Care Program in NY Shows Promise in Early Treatment of Psychosis

Patients with recent-onset psychosis who participated in a coordinated specialty care program in New York state experienced significant improvements in health, function, and education/employment within months, according to a report published this week in Psychiatric Services in Advance. The findings add to the growing body of evidence that early intervention programs can reduce symptoms and improve quality of life for patients recently diagnosed with psychosis.

Ilana Nossel, M.D., of Columbia University Medical Center and NYS Psychiatric Institute and colleagues tracked the progress of 325 patients aged 16 to 30 who had experienced nonaffective psychosis for less than two years and participated in OnTrackNY, a statewide program that connects patients with a multidisciplinary care team. OnTrackNY provides coordinated specialty care, including evidence-based psychosocial interventions and medication. At the beginning of the program and follow-up every three months, clinicians evaluated the patients using Global Assessment of Functioning (GAF) symptom, occupational, and social functioning scales; education and employment status; and psychiatric hospitalization rate.

Nossel and colleagues compared data from admission and months 3, 6, 9, and 12 following enrollment, although the length of the follow-up periods varied by participant, depending on the date of enrollment. After three months in the program, the patients’ hospitalization rates decreased from 70% to 10%. After six months in the program, the patients’ education and employment rates increased from 40% to 80%; GAF scores continued to improve for the duration of the study.

“[This study] helps to further solidify CSC [coordinated specialty care] as a standard of care for young people with the recent onset of a psychotic illness,” Nossel told Psychiatric News. “Often young people with psychosis or schizophrenia may be hesitant to engage in treatment or may not believe they have an illness. The CSC approach is to meet people where they are, use a shared decision-making approach, and help people achieve the goals that are important to them.”

For related information, see the Psychiatric News article “Participation in Early Psychosis Program May Reduce Risk of Death.”

(Image: Alexander Raths/Shutterstock)

Thursday, May 17, 2018

First Non-Opioid Medication Approved to Reduce Opioid Withdrawal Symptoms in Adults

The Food and Drug Administration (FDA) on Wednesday announced the approval of Lucemyra (lofexidine hydrochloride) for the treatment of symptoms associated with opioid withdrawal in adults 18 and older. These can include anxiety, agitation, drug craving, muscle aches, sleep problems, stomach cramps, and more. Lucemyra—an oral, selective alpha 2-adrenergic receptor agonist—is approved for treatment up to 14 days.

This medication “provides a new option that allows providers to work with patients to select the treatment best suited to an individual’s needs,” said Sharon Hertz, M.D., director of the Division of Anesthesia, Analgesia, and Addiction Products in the FDA’s Center for Drug Evaluation and Research, in a statement.

The decision to approve Lucemyra was based in part on the results of two randomized, double-blind, placebo-controlled clinical trials of 866 adults who met DSM-IV criteria for opioid dependence and were physically dependent on opioids and undergoing abrupt opioid discontinuation. Participants assigned to Lucemyra and placebo were asked to rate the severity of opioid withdrawal symptoms using the Short Opiate Withdrawal Scale of Gossop (SOWS-Gossop) using one of four response options (none, mild, moderate, and severe), with the SOWS-Gossop total score ranging from 0 to 30 (higher score indicates a greater severity of withdrawal symptoms).

According to the FDA, SOWS-Gossop scores were lower for patients treated with Lucemyra compared with placebo, and more patients completed the studies’ treatment period in the Lucemyra group compared with the placebo group. The most common side effects reported by study participants on Lucemyra included low blood pressure, slow heart rate, sleepiness, sedation, and dizziness. Lucemyra was also associated with a few cases of fainting. When Lucemyra is stopped, patients may experience a marked increase in blood pressure, the agency cautioned.

The long-term effects of Lucemyra will be among several factors evaluated in ongoing postmarketing studies. “Clinical studies will be required to evaluate the safety of Lucemyra in clinical situations where use could be expected to exceed the maximum 14-day treatment period for which the product is currently approved, such as gradual opioid taper; to gather additional safety data on the effects of lofexidine on the liver; and to further characterize the effects on blood pressure after lofexidine is stopped,” the agency stated.

According to a press release by US WorldMeds, the manufacturer of Lucemyra, the medication is usually administered in three 0.18 mg tablets taken orally four times daily at five- to six-hour intervals during the period of peak withdrawal symptoms (generally five to seven days following last use of opioids). Lucemyra should be discontinued with gradual dose reduction over two to four days.

Lucemyra is expected to be commercially available in the United States in August 2018, according to US WorldMeds.


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