Monday, August 2, 2021

Early Psychosis Intervention Can Be as Effective in Real World as in Clinical Trial Environment

An intervention for patients with first-episode psychosis known as OPUS is as effective—and in some cases superior—in real-world clinical practice as was found when the intervention was tested in clinical trials, according to a report in AJP in Advance.

“Early intervention services for psychosis are, by definition, a complex psychosocial intervention, and, once implemented, they may not be delivered with the same rigorous attention to program fidelity, low caseload, motivation, and so on as they had in the controlled environment of a randomized trial,” wrote Christine Merrild Posselt, M.Sc., of Copenhagen University Hospital and colleagues. “The study results provide further evidence in support of implementation and funding of early intervention services worldwide.”

OPUS is a modified form of assertive community treatment for psychosis that includes family involvement and social-skills training provided by a multidisciplinary team of psychiatrists, psychologists, nurses, social workers, physiotherapists, and vocational therapists. A clinical trial of 547 adults showed OPUS was superior to standard care, which led to broad implementation of this program in Denmark in 2003.

For the current study, Posselt and colleagues compared the five-year outcomes of 3,328 patients who received OPUS after this implementation—identified using Danish health registers—with the five-year outcomes of 545 of the original clinical trial participants. This period included two years of OPUS intervention and three years of follow-up.

The researchers found that patients receiving OPUS had lower odds of a psychiatric hospital admission than the clinical trial participants across the five-year time span, as well as lower rates of psychotropic medication use. Rates of suicide or death by any cause were similar for patients receiving OPUS as well as the clinical trial participants. OPUS patients were less likely to work or attend school than their clinical trial counterparts during the first three years after initiating OPUS, but by year five, had higher odds of being in work or school.

“Positive effects beyond those observed in the randomized trial may be due to more flexible setups, improved experience with delivering the intervention, or other factors,” Posselt and colleagues wrote. “We accounted for potential differences in patient characteristics in the analyses, which suggests that this is not likely to have been a confounder in our results.”

To read more on this topic, see the Psychiatric Services article “Implementing Evidence-Based Interventions to Improve Vocational Recovery in Early Psychosis: A Quality-Improvement Report.”


Friday, July 30, 2021

House Passes Bills to Boost Funding for Mental Health, Substance Use Programs

Yesterday the U.S. House of Representatives approved significant funding increases for key mental health and substance use disorder (SUD) programs included in the FY 2022 Labor, Health and Human Services, Education, and Related Agencies and the Military Construction, Veterans Affairs, and Related Agencies appropriations bills.

The legislation increases funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) by $3.16 billion, an increase of nearly 50% over FY 2021, to $9.16 billion. The SAMHSA increase includes the following:

  • An $825 million increase to the Mental Health Services Block Grant, including a 10% set-aside for crisis services and an additional $100 million for mobile crisis response and an $89.6 million increase for the Suicide Lifeline and implementation of the 988 phone number.
  • Additional substance use treatment resources of $1.6 billion, including a 33% increase in State Opioid Response Grants.
  • $20.3 million for the Minority Fellowship Program, a 20% increase.

The bill also includes the following funding:

  • An increase of $341 million for the Health Resources Services Administration (HRSA) to support health workforce development, including $28 million for HRSA’s loan repayment program for the substance use disorder treatment workforce.
  • $37.5 million for the Employee Benefits Security Administration, including a specific focus on improving compliance with the Mental Health Parity and Addiction Equity Act.
  • $330 million for the National Institutes of Health research on health disparities, including $250,000 through the National Institute on Minority Health and Health Disparities, as well as a 25% overall increase for the National Institute on Drug Abuse and a roughly 5% increase for the National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism.
  • $2.9 billion in additional funding for veterans mental health care, including a $286 million boost for suicide prevention outreach.

APA issued a statement thanking House Appropriations Committee Chair Rosa DeLauro (D-Conn.) and the committee for leading the effort to provide the funding in the legislation.

“This week’s action by the House is step one in an appropriations process that needs to go through the legislative process,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “But the best way to position funding for psychiatry and mental health, including substance use, for success is for the APA administration and our members to be aggressive advocates at every step in the process. So spread the word. Our advocacy matters and is making a difference.”

(Image: iStock/flySnow)

Register Now for Mental Health Services Conference

The program for APA’s Mental Health Services Conference is now available. This virtual event will take place Thursday, October 14, and Friday, October 15. Under the theme “Sociopolitical Determinants: Practice, Policy, and Implementation,” the meeting will feature educational programs and innovations in clinical services designed to ensure equal access to high-quality mental health care for all patients regardless of race/ethnicity, age, religion, nationality, sexual orientation, gender identity, socioeconomic status, or geographical background. Lowest registration rates are now in effect.


Thursday, July 29, 2021

Lyme Disease Heightens Risk of Mental Disorders, Suicidality, Study Finds

People in Denmark diagnosed with Lyme disease in a hospital went on to have 28% higher rates of mental disorders and were twice as likely to have attempted suicide, compared with those without the diagnosis, according to a study published Wednesday in AJP in Advance. Having more than one episode of Lyme disease was associated with a higher rate of mental disorders, affective disorders, and suicide attempts.

According to the CDC, nearly half a million people a year in the United States are treated for Lyme disease (also known as Lyme borreliosis), the most common vector-borne disease, and the areas where Lyme disease is common are expanding. Several studies have pointed to a connection between Lyme disease and psychiatric manifestations in people with untreated infection as well as months to years after antibiotic therapy, wrote Brian A. Fallon, M.D., M.P.H., of Columbia University and New York State Psychiatric Institute and colleagues. The current study is believed to be the first large population-based study examining the relationship between Lyme disease and psychiatric outcomes.

The researchers analyzed patient medical records for the nearly 7 million people living in Denmark and compared individuals diagnosed with Lyme disease in a hospital setting (n=12,616) with those without this diagnosis. Specifically, they examined cases of various mental disorders and suicidality among all individuals and adjusted the results based on known risk factors for mental illness such as sex, age, education level, socioeconomic status, and comorbidities. Patients who had a history of mental disorder or suicidality prior to the Lyme disease diagnosis were excluded from the analysis.

The analysis revealed that in addition to patients with Lyme disease being at greater risk of mental disorders and suicide attempts compared with those without this disease, they also had a 42% higher rate of affective disorders and a 75% higher rate of death by suicide. “Notably, the rate for affective disorders was highest during the first year after diagnosis and highest for completed suicide during the first 3 years after diagnosis,” Fallon and colleagues wrote.

“Our study focused on those whose Lyme disease was severe enough to require hospital contact,” Fallon told Psychiatric News. “Our results are therefore not surprising, given that individuals with hospital-based diagnoses of serious infections are known to have an increased risk of subsequent affective disorders and suicide.” The study results may not be generalizable to potentially less severe cases of Lyme disease that were handled outside the hospital.

Despite the findings, hospital-diagnosed cases of Lyme disease were not a major contributor to the overall rate of mental disorders or suicide in the general population, the authors noted. For example, the absolute rate for suicide of patients who were diagnosed with Lyme disease in the hospital was low, accounting for 25 fatalities over a 22-year period, representing 0.2% of all suicides during that time.

“Although the absolute population risk is low, clinicians should be aware of the potential psychiatric sequelae of this global disease,” Fallon and colleagues concluded.

For more on this topic, see the chapter on infectious diseases in The American Psychiatric Association Publishing Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry from APA Publishing.

(Image: iStock/Ladislav Kubeš)

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Wednesday, July 28, 2021

People With Mental Illness at Greater Risk of Death From COVID-19, Meta-Analysis Finds

People with mental illness had a higher risk of dying from COVID-19 than people without mental illness, according to an international meta-analysis of studies conducted between December 2019 and July 2020. Patients with schizophrenia and/or bipolar disorders had the highest risk of COVID-19 mortality, according to the report. The findings were published Tuesday in JAMA Psychiatry.

“Patients with mental health disorders can have multiple comorbidities that have been identified as risk factors for severe COVID-19: diabetes, hypertension, chronic obstructive respiratory disease, and end-stage kidney disease,” wrote Guillaume Fond, M.D., Ph.D., of Aix-Marseille University in France and colleagues. “Mental health disorders are also associated with socioeconomic deprivation and reduced access to care, two important factors of poor COVID-19 outcomes.”

Fond and colleagues analyzed data from 16 population-based studies across seven countries (Denmark, France, Israel, South Korea, Spain, the United Kingdom, and the United States). These studies included 19,086 patients with a wide range of mental disorders, including mood disorders, alcohol use disorder, schizophrenia spectrum disorders, and bipolar disorders, among others.

The meta-analysis revealed that patients with any mental disorders had a 1.38 times greater risk of dying from COVID-19 than did people without mental disorders. Those with schizophrenia and/or bipolar disorders had a 1.67 times greater risk of COVID mortality; this may be related to genetic variations in patients with schizophrenia or bipolar disorder that compromise their immune function, Fond and colleagues wrote.

The findings point to the importance of “requiring enhanced preventive and disease management strategies for people with mental illness,” the authors concluded. “Future studies should evaluate the risk [of COVID-19] for each mental health disorder and confirm that patients with schizophrenia and bipolar disorders are at the highest risk of mortality.”

For related information, see the Psychiatric News article “COVID-19 Greatly Increases Mortality Risk for Schizophrenia Patients, Research Shows.”

(Image: iStock/BlackJack3D)

Tuesday, July 27, 2021

Children With ADHD May Benefit From Taking Micronutrients

Children with attention-deficit/hyperactivity disorder (ADHD) and irritable mood who are not taking psychotropic medications may benefit from supplemental micronutrients, suggests a study in the Journal of the American Academy of Child & Adolescent Psychiatry.

Evaluations by clinicians revealed that a greater percentage of children who took micronutrient capsules for eight weeks experienced symptom improvements compared with children who took placebo pills, the study found. The children in the micronutrients group also grew taller on average over the eight-week trial.

“Although [the] findings did not demonstrate between-group differences on core symptoms of ADHD in this study, micronutrient supplementation was associated with global improvements that factored in a range of life domains including anxiety, anger, and sleep,” wrote Jeanette M. Johnstone, Ph.D., of Oregon Health & Science University and colleagues.

For the multisite trial, Johnstone and colleagues recruited children aged 6 to 12 who met DSM-5 criteria for ADHD and displayed at least one symptom of irritability or anger, according to parent reports. To be included in the trial, the participants had to be psychotropic medication free for at least two weeks and be willing to swallow 9 to 12 capsules a day with food.

The researchers randomly assigned 135 children to either the micronutrient or placebo groups. Children in the micronutrient group took capsules containing a blend of vitamins and essential minerals (including vitamins A and B12, folate, copper, potassium, and more), amino acids, and antioxidants. Children in the placebo group took the same number of placebo capsules from bottles with a mild vitamin/mineral scent. Parents completed the Child and Adolescent Symptom Inventory-5 (CASI-5), which assesses ADHD, oppositional defiant behavior, disruptive mood dysregulation, and peer conflict symptoms, at the start of the study as well as weeks 4 and 8. Clinicians completed the Clinical Global Impression-Improvement (CGI-I) subscale at week 8.

Of the 135 children randomized, 126 completed the trial. For the CGI-I, 54% of the micronutrient group and 18% of the placebo group were categorized as responders (defined by a CGI-I score of 1 or 2, “very much” or “much” improved). The parent-reported CASI-5 revealed significant improvements in both groups; however, there was no significant difference between these groups. Children in the micronutrient group on average grew six millimeters (about 0.24 inches) more than children in the placebo group. There were no differences in adverse events reported by children in either group.

“This fully-blinded RCT of micronutrients addresses several concerns related to existing ADHD treatment, including the possibility of counteracting height suppression and treating associated irritable mood, emotional dysregulation, and aggression,” the authors concluded. “Based on blood and urine tests and systematic adverse event reporting, micronutrients given at doses between the Recommended Dietary Allowance and Upper Tolerable Intake Level appear safe and may be developed into an alternative or complementary treatment for ADHD.”

For related information, see the Psychiatric News article “Irritable Symptoms in Youth With ADHD Don’t Necessarily Require Extra Medications.”

(Image: iStock/SeventyFour)

Monday, July 26, 2021

Future Care Planning Can Help Patients With SMI, Aging Caregivers With Major Life Transitions

Future care planning can be difficult for aging parents and caregivers of people with serious mental illness (SMI). An article in Psychiatric Services in Advance describes the important role that mental health professionals can play in helping families to prepare for the future.

“Just as mental health professionals guide parent caregivers to facilitate medication adherence and prevent relapses for a child with serious mental illness, they should also routinely take the lead in discussing and cocreating a future care plan [when caregivers and patients are older],” wrote Thanapal Sivakumar, M.D., of the National Institute of Mental Health and Neuroscience in Bengaluru, India, and colleagues.

Sivakumar and colleagues offer recommendations for mental health professionals on when to begin planning for future care, who should participate in this planning, and what should be included in a future care plan for the plan to be successful. The recommendations include the following:

  • Begin working on a future care plan while parents are in good health. The authors noted that developing a future care plan will likely require multiple meetings between mental health professionals and families, and needs may change over time.
  • Facilitate conversations between parents, patients, and prospective caregivers so that everyone feels heard. The authors wrote that these conversations may help to identify life skills that patients may need to develop and help mental health professionals triage patients to appropriate services to support this development.
  • Consider patients’ needs related to food and housing, health services, social support, transportation, insurance, and finances, and work with families to identify how they might share the responsibilities related to these needs in the future.

The authors noted that mental health professionals should take the lead in collaborating with parents, patients, and others to facilitate future care planning. “This initiative will provide a sense of relief to parents that their son or daughter will be cared for after their lifetime while ensuring that the [patient] has the best chance to manage the transition successfully,” they wrote.

For related information, see the Psychiatric News article “Mobile App Helps People With SMI Create Crisis Plan.”

(Image: iStock/PeopleImages)

Friday, July 23, 2021

Nonpartner Physical Violence Affects More Than Half of Men With Disabilities

More than half of men who have disabilities have experienced nonpartner physical violence, mostly by strangers, a study in the American Journal of Preventive Medicine has found. The findings highlight the need for violence prevention and intervention programs that are inclusive of and responsive to the needs of men and women with disabilities.

Zarintaj A. Malihi, Ph.D., of the University of Auckland in New Zealand and colleagues analyzed data from the 2019 New Zealand Family Violence Survey/He Koiora Matapopore, in which face-to-face interviews were conducted with 2,887 New Zealanders aged 16 years or older between 2017 and 2019. The study was designed to determine the prevalence rates of nonpartner physical and sexual violence reported by people with physical, intellectual, psychological, and multiple disabilities compared with the prevalence reported by people without disabilities. Questions about violence were drawn from the WHO Multi-Country Study on Violence Against Women questionnaire and adapted to include men.

Overall, more people with disabilities reported nonpartner physical and sexual violence experience than those without disabilities. Among men with disabilities, 56.2% experienced lifetime nonpartner physical violence and 5.6% experienced lifetime nonpartner sexual violence. In 59.3% of cases, this violence was perpetrated by strangers. Among women with disabilities, 15.4% experienced lifetime nonpartner physical violence and 11.1% experienced lifetime nonpartner sexual violence. In 59.7% of cases, this violence was perpetrated by parents and relatives.

People with psychological disabilities reported the highest prevalence rates of nonpartner physical and sexual violence. Women with psychological disabilities had 1.97 times the odds of experiencing nonpartner physical violence and 2.65 the odds of experiencing nonpartner sexual violence compared with women who had no psychological disabilities. Men with psychological disabilities had 2.5 the odds of experiencing nonpartner physical violence and 43.74 times the odds of experiencing nonpartner sexual violence compared with men who had no psychological disabilities.

“Policy and practice implications [of the findings] include the need for the development of prevention and intervention programs that meet the needs of people with different types of disabilities,” Malihi and colleagues wrote. “Programs need to be implemented in ways that are accessible and appropriate, considering physical needs and the needs of those with intellectual and psychological disabilities because these individuals may have difficulty in understanding danger or in communicating their experiences in ways that others believe.”

The vast majority of perpetrators of nonpartner physical and sexual violence upon people with disabilities were men. Men were the main perpetrators in 84.7% of nonpartner physical violence experienced by men with disabilities and 55.3% of nonpartner violence experienced by women with disabilities. Men were the perpetrators in 80% of cases of nonpartner sexual violence against men with disabilities and all cases of nonpartner sexual violence against women with disabilities.

“The findings also speak to the importance of addressing social norms about masculinity and power,” the researchers wrote. “The social norms that support men’s use of violence need to be addressed as part of national prevention campaigns.”

For related information, see the Psychiatric Services article “Victimization and Perpetration of Violence Involving Persons With Mood and Other Psychiatric Disorders and Their Relatives.”

(Image: iStock/makotomo)

US Remains Under Public Health Emergency Due to COVID-19

The U.S. Secretary of Health and Human Services on Tuesday signed a renewal of determination that the public health emergency due to the COVID-19 pandemic remains in effect.



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