PTSD Linked to Higher Risk for Heart Disease

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Individuals with posttraumatic stress disorder (PTSD) may face an increased risk of developing heart disease, according to a study published online in the American Journal of Cardiology. Six hundred thirty-seven veterans without known coronary artery disease underwent coronary artery calcium scanning for clinical indications, and presence of PTSD was evaluated. In subjects with PTSD, coronary artery calcium was more prevalent than in the non-PTSD cohort and their scores were significantly higher in each Framingham risk score category compared to the non-PTSD group.

Two and a half years ago, Psychiatric News reported on a similar study in which PTSD was linked to an increased risk of dying relatively young of heart disease among U.S. Army Vietnam War-era veterans. That study was based on data collected in 1985 and 1986 from a sample of 4,328 men who served in the U.S. Army from 1965 to 1971. Included in the sample were 2,409 individuals who were sent to Vietnam.

Veterans in the subsample were given electrocardiograms, and blood-pressure readings and cardiovascular-medication use were used to screen out borderline heart disease cases. All veterans were assessed for PTSD diagnostic and symptom status.

By the completion of follow-up in 2000, 52 of the veterans in the total sample had died of a heart attack, chronic ischemic heart disease, atherosclerotic disease, hypertensive heart disease, or heart failure. Having a diagnosis of PTSD at baseline, such as having a positive D-PTSD case definition, doubled the risk of death from early onset heart disease at follow-up, according to the 2008 study published in Psychosomatic Medicine (July 2008). For more information, see Psychiatric News, see http://pn.psychiatryonline.org/content/43/22/18.1.full.

AMA Proposes Plan to Fix SGR Problem

Congressman and physician Bill

Cassidy stresses to APA members

the importance of doctors' being

involved in the political process.

Credit: Karen Layser

The AMA and APA are among the medical societies that have been calling for a major overhaul of the formula by which Medicare computes physician reimbursement fees. The current sustainable growth rate (SGR) formula has physicians in line for a 29.5% cut in 2012; such increases have been common in recent years, leading to last-minute, nail-biting dramas on Capitol Hill to pressure Congress to reverse the threatened cuts.

The AMA has now unveiled SGR replacement plans using a three-pronged approach, according to American Medical News: "(1) repeal the SGR, (2) implement a five-year period of positive Medicare payment updates based on practice costs, and (3) test and transition to multiple payment models designed to enhance the coordination, quality and appropriateness of care while addressing cost concerns."

The SGR was a major topic of discussion at APA's recent Advocacy Day 2011 event. (See http://pn.psychiatryonline.org/content/46/10/14.full). Advocacy Day brought 70 psychiatrists from 42 states to Washington, D.C., to learn advocacy skills and the fine points of policies and legislation about key health and mental health issues. As part of the event, participants conducted almost 250 Capitol Hill visits in one day, covering nearly half of Congress's 535 members.

APA will continue to lobby Congress to fix the Medicare physician reimubursement system. Watch Psychiatric News for updates.

New Outpatient Psychiatric Clinic To Treat Former Inmates

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Treating current and former prison inmates for psychiatric disorders, including substance abuse, can be a daunting challenge even for the most experienced psychiatrists and mental health professionals, in large part because of the chasm between prison culture and that of the society outside the prison walls. Many inmates had serious and untreated mental disorders before they were incarcerated, and other develop such illnesses while behind bars.

   A philanthropic organization, the Jacob and Valerie Langeloth Foundation, is trying to break down some of the barriers that keep inmates and ex-cons from receiving psychiatric care. It has given a $200,000 grant to the Fortune Society in New York City to develop an outpatient clinic that will provide a range of mental health services, including psychotherapy, medication management and treatment-adherence monitoring, to formerly incarcerated individuals. The Fortune Society has been assisting ex-inamtes readjust for more than 40 years.

   For more about the unique challenges and issues involved in providing mental health care to ex-inmates, see Psychiatric News, http://pn.psychiatryonline.org/content/46/10/9.1.full.

Vermont Governor Signs Single-Payer Bill

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Vermont still has "a few challenges" ahead to meet its goal of a universal health care system this decade, Gov. Peter Shumlin said Thursday as he signed into law the bill designed to make the state the nation's first with fully publicly funded health care. More than 150 people, including legislators, administration officials, advocates who pushed for the bill and a handful of opponents gathered on the Statehouse steps to witness the signing. The Vermont Psychiatric Association has supported the legislation. For more information, see Psychiatric News, http://pn.psychiatryonline.org/content/46/9/4.2.full.

Waking Up To Prescription Drug Abuse

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Prescription drug abuse is attracting the attention of advocacy organizations and policymakers everywhere. Today, the Partnership for a Drug-Free Canada announced the launch of a nation-wide public awareness campaign on the non-medical use of prescription drugs by teens. The organization hopes to get the message out to parents to keep their medication in a secure location and have a talk with their kids about drug abuse. The campaign will launch in June 2011.
   And here in the U.S. the Obama administration recently brought together the heads of several government agencies to mark the release of a coordinated federal plan to deal with the nation's growing prescription drug abuse epidemic.
   Under the plan the FDA would require drug manufacturers to develop education programs for prescribers to help them identify, treat, and end dependence on prescription drugs. The plan notes that while there are a number of classes of prescription drugs that are abused, it “primarily focuses on the growing and often deadly problem of prescription opioid abuse.” At the heart of the plan is the requirement that drug manufacturers provide educational programs to those licensed to prescribe long-acting and extended-release opioids. In addition, manufacturers would be required to provide materials to assist physicians in counseling patients in the proper use and risks of these drugs.
   APA, the American Academy of Addiction Psychiatry (AAAP), and the American Osteopathic Academy of Addiction Medicine (AOAAM) released a joint statement applauding the plan. For more information see Psychiatric News http://pn.psychiatryonline.org/content/46/10/1.1.full

"Competency" Continues to Engage Courts, Forensic Psychiatry Experts

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Jared L. Loughner, accused in the Jan. 8 shooting spree that seriously injured Congresswoman Gabrielle Giffords and left six others dead, was ruled incompetent to stand trial by Federal Judge Larry A. Burns on Wednesday. Before the ruling, Loughner was dragged screaming from the courtroom in Tucson after disrupting the hearing; he watched the rest of the proceedings on a monitor in a holding cell. The court heard testimony from two expert witnesses that Mr. Loughner suffered from schizophrenia.
   Legal standards around “competency” continue to engage the courts and experts in psychiatry and the law. For instance, a 2008 U.S. Supreme Court ruling held that competence of criminal defendants to represent themselves in a trial, rather than have an attorney represent them, is separate from competence to stand trial and could require a psychiatric evaluation separate from the evaluation of competence to stand trial. For more information see Psychiatric News, http://pn.psychiatryonline.org/content/45/13/10.2.full

Predicting Psychosis: Who Will "Convert" and Who Will Not?

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The ability to identify young people at very high risk for psychosis and to monitor and treat them before they have a psychotic break is an exciting possibility with enormous public health potential. Yet challenges persist in accurately predicting who will and will not go on to develop psychosis. At a recent meeting of the International Congress of Schizophrenia Researchers, experts in prevention presented data on what happens to those young people identified as being at “high risk” but who do not go on to develop psychosis. Understanding the clinical course of these “non-converters” can help improve predictive criteria. For more information see Psychiatric News, http://pn.psychiatryonline.org/content/46/10/18.1.full

Should Physicians Ask Patients If They Own a Gun?

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Gunshot injuries are a significant public health problem with enormous medical costs associated with them—a 1999 study in the Journal of the American Medical Association found that the per gunshot injury cost of treatment and follow-up was in excess of $17,000, most of which is born by taxpayers. So should physicians be allowed to ask patients about whether they own a gun? It’s a question that has stirred debate in Florida. For more information see Psychiatric News, http://pn.psychiatryonline.org/content/46/10/15.1.full

Supreme Court Rules Prison Overcrowding Dangerous to Health

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The Supreme Court on Monday ruled that the extreme overcrowding in California prisons is a violation of the U.S. Constitution's ban on cruel and unusual punishment and ordered the state to reduce its prison population by 30,000 in the next two years. Among prisoners who originally brought the suit was a group of mentally ill inmates who charged that the overcrowding prevented them from receiving needed mental health treatment. APA had filed an amicus brief in the case maintaining that the extreme overcrowding negatively affected the quantity and quality of mental health care available to inmates and that the harsh conditions themselves contributed to a deterioration of inmates' mental health.

For more information about this case see Psychiatric News at http://pn.psychiatryonline.org/content/45/24/20.full.

New Mothers Should Be Asked About Smoking Habit

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New mothers should be asked whether they smoke cigarettes and, if so, how many a day. A study reported by Medscape's Alice Goodman from the American Congress of Obstetricians and Gynecologists 59th Annual Clinical Meeting indicates that smoking may be a sign that the mothers are suffering from postpartum depression. The finding came from a survey from the Pregnancy Risk Assessment Monitoring System, a project of the Centers for Disease Control and Prevention. Also, depression was strongly associated with the number of cigarettes smoked; it was found in 13% of nonsmokers, 22% of light smokers (10 or fewer cigarettes per day), and 29% of those who smoked more than 10 cigarettes per day.

The study was based on a survey of a random sample of 8,074 new mothers in Maryland who delivered babies between 2004 and 2008. Participants completed the survey between 2 and 9 months after delivery.

More information on postpartum depression is posted at http://pn.psychiatryonline.org/content/45/18/18.1.full and http://pn.psychiatryonline.org/content/42/13/1.1.full

Autism More Common Than Assumed

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The prevalence of autism and autism spectrum disorders, based on research relying on evaluation of medical records, has long been assumed to be about 1 in 110. But a new study in the American Journal of Psychiatry evaluating children for autism where they live, instead of just through their medical records, reveals a surprisingly higher prevalence. For more information, see  http://pn.psychiatryonline.org/content/46/10/7..

Boston University Takes Top Honors

Credit: David Hathcox

Residents from Boston University School of Medicine won the Fifth MindGames competition at APA's 2010 annual meeting in Honolulu. The members of the winning team (from left to right) are B.U. residents Ana Ivkovic, M.D., Mark Oldham, M.D., and Brie Beaudoin, M.D.

Over 100 programs from across the U.S. and Canada competed in a qualifying phase that began in February. The three finalists who advanced to the competition in Honolulu were Boston University, New York Presbyterian/Cornell Campus, and the University of Pittsburgh Medical Center. Residents were tested on their knowledge of a wide range of topics related to psychiatry and medicine in a "Jeopardy"-style format that attracted a packed crowd of supporters and cheerleaders for all three programs.

As in the past, renowned psychiatrist Glen Gabbard, M.D., served as MindGames moderator. Judges were Naleen Andrade, M.D., Charles Nemeroff, M.D., and Michelle Riba, M.D.

To learn more about MindGames, see http://pn.psychiatryonline.org/content/46/8/16.2.full.

Assembly Takes Action on Maintenance of Certification

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The APA Assembly took several actions at its meeting in Honolulu to respond to extensive member dissatisfaction with changes and new mandates that are coming to the maintenance of certification process after being approved by the American Board of Psychiatry and Neurology and the American Board of Medical Specialties. Assembly members want the Board of Trustees to inform the ABPN's board of directors about psychiatrists' unhappiness about the requirements, particularly the one mandating that all physicians obtain feedback from patients on the treatment they are receiving. They are also urging the APA Trustees to invite ABPN representatives to form a joint APA-ABPN commission to explore a range of maintenance of certification issues. In addition, Assembly members want APA to intervene with ABPN to address what many are calling "exorbitant' fees for the initial certification exam.

For more information on maintenance of certification and how it impacts psychiatrists, see http://pn.psychiatryonline.org/content/45/22/3.1.full.

'Sopranos' Actress Says Mental Illness Informed Her Acting

Credit: David Hathcox

“For me the biggest problem is the stigma of mental illness,” said actress Lorraine Bracco in an interview at the 10th annual Conversations event sponsored by the American Psychiatric Foundation in Honolulu. “I have always felt that if you had a broken leg or cancer or a toothache, you would seek immediate medical attention.”

The event took place at APA’s 2011 annual meeting. Conversations features well-known individuals who have firsthand experience with mental illness. Past speakers have included Maureen McCormick, George Stephanopolous, Brooke Shields, and Tipper Gore, among others.

Bracco played the role of psychiatrist Jennifer Melfi on the HBO series "The Sopranos." During the interview , which took place in front of an annual meeting audience of hundreds, Bracco said her own experience in psychotherapy and wrestling with depression helped her in the role.

“From my own experience, I realized how easily medication works, talk therapy helps, and you don’t have to suffer alone,” Bracco said.

Read more about Bracco's experience with mental illness in Psychiatric News at http://pn.psychiatryonline.org/content/40/12/2.full.

Hawaii Governor Designates May as APA Month

Credit: David Hathcox

Hawaii's governor, Neil Abercrombie, addressed a plenary session of the APA Assembly during APA's 2011 annual meeting in Honolulu and told the delegates that he proclaimed May as APA month in Hawaii. He presented a proclamation to former Assembly speaker Jeffrey Akaka, M.D., of Honolulu. Akaka was largely responsible for bringing APA to Hawaii for its annual meeting.

All of the governor's message was not celebratory, however, as he explained how even a longtime advocate of expanding access to health care can be stymied when recession thwarts the best-laid plans. The reality he is facing is one in which his state revenues are down so much in the last two years that he is having to weigh cuts to Medicaid to deal with a surge in eligible applicants. Coverage of the Assembly's meeting will appear in a future issue.

Former Scientologist Gives Account of Group's Anti-Psychiatry Activities

Nancy Meany, author of My Billion
Year Contract Credit: David Hathcox

Protests by members of the Church of Scientology outside APA annual meetings are the latest manifestations of a veritable war that the organization declared against psychiatry over a half century ago. Inside the Honolulu Convention Center during this week's annual meeting in Honolulu, a panel discussed the war’s origins and tactics.

“War” is no mere metaphor, said Nancy Many, a former Scientology member who addressed a packed meeting room. Many belonged to the “paramilitary wing” of the organization and ran an espionage operation that placed agents in every psychiatric hospital in the Boston area, for instance. Other agents broke into psychiatrists’ offices to steal and photocopy patient records, and infiltrated local professional psychiatric societies, she said.

Until 1954, L. Ron Hubbard, Scientology’s founder, spoke condescendingly about psychiatry, but afterward he associated the profession with communists, the FBI, and the pharmaceutical industry. Hubbard likely saw psychiatrists as competition for his ideas, which promised a better life for adherents through a rigorous (and expensive) training regimen. The advent of psychotropic drugs in the mid-1950s captivated the American public and threatened to sideline Hubbard, said panelist Stephen Wiseman, M.D., a psychiatrist at St. Paul’s Hospital in Vancouver, B.C., Canada. In 1969, Scientology set out not merely to oppose but to destroy psychiatry, calling it is a pseudoscience because there were allegedly no biological tests for mental disorders and no cures.

At stake is more than a conflict between organizations, said Wiseman. Scientology and front groups consistently work to limit access to psychiatric care. They lobbied against parity legislation, supported black-box warnings on psychotropic medications, and testified against FDA’s reclassification of electroconvulsive therapy. That wider threat against not only psychiatrists but their patients should stir members of the profession to understand the organization and develop clear and comprehensive ways to deal with it.

More coverage of APA's annual meeting will appear in the June 17 issue.

Forgivness and Recognition of Humanness Key to Peace, Says Tutu

Credit: David Hathcox

“There is no future without forgiveness, within nations and between nations,” said Archbishop Desmond Tutu at the Convocation of Distinguished Fellows at APA’s 9011 annual meeting in Honolulu.

Forgiveness, helped by truth telling, moved Tutu’s native South Africa through the transition from apartheid to freedom and democracy. That transition might have been a “ghastly bloodbath that would have overwhelm[ed] our beautiful land,” he said. But instead of revenge and retribution, South Africa created truth and reconciliation commissions to hear the grim stories of both the victims and perpetrators of apartheid-era atrocities.

“The people who did that didn’t have horns and tails,” said Tutu. “They were human beings like you and me.”

Recognition of that humanity was essential, he said. He recounted the story of a white woman injured so badly in an anti-apartheid bombing that she could no longer bathe or feed or clothe herself. She told her story, saying that she only wanted to meet the perpetrator, to forgive him and to ask him to forgive her. Victims couldn’t sit in judgment over lesser mortals; they could only be wounded healers, he said.

“Our world is waiting for such as you,” said Tutu, addressing the healers in the audience that filled the hall to overflowing. “We are all made for goodness, for gentleness, for compassion, for laughter, for caring. That is what God created us for.”

Psychiatry on Verge of New World, Says NIMH Director

Credit: Mark Moran

It’s time to fundamentally re-think mental illness, said NIMH Director Thomas Insel, M.D., in a lecture at APA’s 2011 annual meeting in Honolulu. Insel delivered this year’s Frontiers of Science Lecture. Insel told psychiatrists at the meeting that psychiatric diagnosis today is made by observation of symptoms, detection of illness is late, prediction of illness is poor, etiology is unknown, and treatment is trial and error. There are no cures and no vaccines. But that will change. Psychiatric research today promises to produce a true science of the brain based on three core principles: 

• Mental disorders are brain disorders
• Mental disorders are developmental disorders
• Mental disorders result from complex genetic risk plus experiential factors.

“Rethinking mental illness means changing the emphasis so that you make sure the worst outcomes don’t happen,” he said. “We need to ask the question, How does variation in the genome lead to changes in particular neuronal circuits, which in turn bias the way an individual deals with emotional regulation?” With a true science of mental illness—from genes, to cells, to brain circuits, to behavior—psychiatrists will be able to better predict who is likely to develop a mental disorder and to intervene earlier. “Once that happens,” he said, “we will be in a different world.”

Lecture Raises Questions about Ethical Use Of Psychological Techniques

Andrea Tone, Ph.D. receives APA's Rush
Award from former APA President Nada
Stotland, M.D.

Credit: Mark Moran

How does society form judgments about what “ethical” medical practice looks like? That’s the question that Andrea Tone, Ph.D., winner of this year’s Benjamin Rush Award at APA’s 2011 annual meeting, explored in a lecture titled “Spies and Lies: Cold War Psychiatry and the CIA.” She is Canada Research Chair in the Social History of Medicine at McGill University. Tone described her current research examining the Central Intelligence Agency’s efforts during the Cold War—code named MKULTRA—to develop strategies for manipulating mental states and altering brain function. The effort involved experiments with surreptitious administration of drugs and other chemicals (including LSD), hypnosis, sensory deprivation, isolation, and various forms of verbal or other abuse.

Tone focused especially on the work of American psychiatrist Ewen Cameron, M.D. As director of the Allan Memorial Institute (“the Allan”) in Montreal, Cameron received funding from front organizations of the CIA (one of which was named the “Society for Human Ecology”) to conduct experiments on unsuspecting Canadian citizens. Today, such experiments are widely condemned. But at the time, Cameron (whom Tone says was unaware of the fact that Society for Human Ecology was a front for the CIA) was one of the most highly regarded psychiatrists in North America.

So why he is condemned today when he was celebrated then? Tone argues that Cameron’s experiments fit well with social and cultural trends at the time, in a way that carries lessons for our own time. Those trends included the emerging belief that mental illness was entirely biological in nature and that psychopharmacology was the key to eradicating it, as well as the belief that treatment for mental illness needed to be made more efficient, rapid, and cost-efficient. For coverage of the annual meeting, see future editions of Psychiatric News.

APA President Looks Toward Transformation of Mental Health Care

Credit: David Hathcox

Outgoing APA President Carol Bernstein, M.D., opened APA's 2011 annual meeting in Honolulu saying that APA is committed—in the words of her presidential theme—to “transforming mental health through leadership, discovery, and collaboration.”

“As we continue to make advances in our exploration of brain chemistry, physiology, and structure, as we discover more about how our environment and life experiences interact with our biology and physiology, we will come closer to developing treatments that will help our patients lead fuller, richer lives, while continuing to live productively with chronic illness,” Bernstein said. “Our treatment armamentarium will become more nuanced and individualized as we incorporate genetics and genomics, culture and development into psychiatric nosology, epidemiology and treatment.”

A full report of Bernstein's speech will appear in a future issue of Psychiatric News. For continuing information about the meeting, go to http://www.apaannualmeeting.blogspot.com/, and follow the meeting on Twitter at #APA2011.

Giffords Shows Effectiveness of TBI Treatment



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Arizona Rep. Gabrielle Giffords, who was critically wounded during a shooting at a Tucson shopping center in January, travelled to Florida to watch the launch of the space shuttle Explorer this morning. Giffords’ husband is NASA astronaut Mark Kelly, a crewmember on the flight. Giffords recovery from her wounds is said to be remarkable, and treatment of traumatic brain injury has advanced rapidly—in part because of the experience of treating soldiers injured in Iraq and Afghanistan. For more information, see Psychiatric News at http://pn.psychiatryonline.org/content/46/6/6.1.full.

Computer Center Helps Brain-Injured Soldiers Retrain Their Minds

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A computer lab at Walter Reed Army Medical Center is helping military personnel with traumatic brain injuries to regain their memories and focus. At the Brain Fitness Center, soldiers participate in “brain workouts” with computer games. The games vary in difficulty from standard over-the-counter memory-sharpening programs to those specifically designed for brain  injuries. The sessions last 15 minutes, several times a day. Scientific studies to verify the effectiveness of the treatment are just under way, but soldiers believe the computer sessions are helping. The center is one of several established by the Department of Defense around the country. For more information on how civilians will benefit from the military’s experience in treating brain trauma, see http://pn.psychiatryonline.org/content/46/6/6.1.full. For information on a study that will assess the effectiveness of PTSD treatments, see http://pn.psychiatryonline.org/content/46/7/4.1.full.

Learn the Latest in Psychiatry While Catching Up WIth Colleagues

It’s finally here! APA’s 2011 annual meeting begins tomorrow in Honolulu. The meeting features hundreds of cutting-edge scientific sessions led by the field’s top experts and master educators. APA President Carol Bernstein, M.D., will officially open the meeting on Sunday, May 15, at 3:30 p.m., and deliver her presidential address, followed by remarks by incoming APA President John Oldham, M.D. On Monday, May 16, at 3:30 p.m., Bishop Desmond Tutu will present the William C. Menninger Convocation Lecture. Lorraine Bracco from “The Sopranos” is this year’s special guest at the “Conversations” event; it will be held Tuesday, May 17, at 3 p.m. Look for coverage of the meeting in future issues of Psychiatric News. In the meantime, follow the meeting on Twitter at #APA2011.

Congressional Caucus Holds Briefing On Psychiatric Problems in Military



Col. Gregory Gadson is director of the

U.S. Army Wounded Warrior program,

which helps injured Army soldiers

move back to active duty or civilian life.

Psychiatric News attended a briefing today where Rep. Grace F. Napolitano (D-Calif.), Rep. Tim Murphy (R-Pa.), and the Congressional Mental Health Caucus hosted top military mental health officials and military spouses to update congressional members and staff on posttraumatic stress, traumatic brain injury, and suicide prevention in military members, veterans, and their families. Speakers included Navy Capt. Paul Hammer, MC, director of the Defense Center of Excellence; Gen. Peter Chiarelli, vice chief of staff for the Army; and Army Col. Gregory Gadson, director of the U.S. Army Wounded Warrior program. Army Sgt. Maj. Robert Gallagher detailed his ongoing recovery from his “wounds above the shoulders.”


Gadson’s legs had to be amputated after a roadside bomb blast in Iraq, but that was not the end of his career. “The Army recognized that even with my injury I still had worth and allowed me to continue to serve,” said Gadson, who played football at West Point.

Recently, the Institute of Medicine announced that it is undertaking a huge study to identify the most effective ways to assess and treat military members for posttraumatic stress. More information is posted in Psychiatric News at http://pn.psychiatryonline.org/content/46/7/4.1.full. And NIMH is studying Army data on suicide to understand its causes and prevent it. See http://pn.psychiatryonline.org/content/44/16/1.1.full.

Atypical Antipsychotics Misused in Nursing Homes

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Fourteen percent of elderly nursing home residents had Medicare claims for atypical antipsychotic medications in a six-month period in 2007, and more than half were prescribed erroneously, according to the Office of Inspector General of the Department of Health and Human Services. The drugs were either not used for medically accepted indications or not documented as having been administered to the elderly nursing home residents, among whom dementia is common. The widespread use of antipsychotics occurred despite their carrying a black-box warning about increased risk of death in elderly patients with dementia. Information about the FDA warning appears in Psychiatric News at http://pn.psychiatryonline.org/content/43/14/1.1.full. An article on the OIG report will appear in the June 3 issue.  

Media Reports of Suicide Risk Among Gay Youth Confirmed by Study

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Teenage bullying, especially of young gay people, and the heightened risk of suicide among victimized adolescents has made a lot of news recently. Is it real or is it media hype? In fact, a recent meta-analysis of 19 studies looking at depression and suicide among children and adolescents suggests it's all too real. Gay adolescents are three times as likely to report a history of suicidal ideation, suicidal intent, or suicidal attempts that require medical attention than are their straight peers, according to the study. Moreover, the disparity in suicide risk between gay and nongay youth appears to increase with each level of severity—ideation, intent with a plan, actual suicide attempts, and attempts requiring medical attention. For more information see Psychiatric News, http://pn.psychiatryonline.org/content/46/9/9.2.full.

Oregon Seeks Delivery System Reform Using Model of ACOs

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The Patient Protection and Affordable Care Act includes a provision that allows states that are granted a federal Medicaid waiver to devise their own solutions for achieving increased access to health care and reducing costs. The state of Oregon is one state that is doing just that.Oregon is moving toward a sweeping transformation of general health and mental health services, including the creation of regional “coordinating care organizations (CCOs)” responsible for organizing the delivery of all health services for citizens in each region of the state. CCOs are the state's designated term for what have elsewhere been called “accountable care organizations” (ACOs)—the coalitions of hospitals, health systems, physicians, and other health care providers envisioned as a new model for providing coordinated, cost-effective care across populations. For more information, see http://pn.psychiatryonline.org/content/46/9/6.1.full.

Appeals Court Hears Health Care Reform Cases

Natalia Bratslavsky: Shutterstock 

The first two cases on the constitutionality of the Patient Protection and Affordable Care Act to reach a federal appeals court were heard today. A three-judge panel of the U.S. Court of Appeals for the Fourth Circuit in Richmond expressed strong support for the law and suggested the law is valid, despite objections from the state and others. The full court of appeals bench is evenly divided between Republican and Democratic appointees; however, the randomly selected panel for this case are all Democratic appointees. Both cases center on the provision of the law referred to as the individual or insurance mandate, requiring people to buy insurance or face a monetary penalty. In Cuccinelli v. Sebelius, a Republican-appointed judge struck down the mandate, while in Liberty University v. Geithner, a Democratic-appointed judge upheld it. Two other appeals court cases are pending. None of these decisions are likely to be the last stop for the litigation, as further appeals to the Supreme Court are expected. For more information on the insurance mandate and Cuccinelli v. Sebelius, see Psychiatric News at http://pn.psychiatryonline.org/content/46/1/11.1.full.

New Service Delivery Model to Be Tested Under Health Care Reform

Credit: Gunnar Pippel /Shutterstock

"Accountable Care Organizations" (ACOs) continue to be the focus of policymakers as a model for a reformed health care delivery system. ACOs were designated for a demonstration project, known as the Medicare Shared Savings Program, in the Patient Protection and Affordable Care Act signed by President Obama last year. Generally, ACOs are coalitions of physicians and hospitals responsible for coordinating medical care for populations of patients across the continuum of care; they agree to be accountable for improving the health and experience of care for individuals, as well as the health of populations, while reducing the growth rate in health care spending. Psychiatrists could play an important role in ACOs.

The Centers for Medicare and Medicaid recently released new rules governing the nature and function of ACOs. For more information, see Psychiatric News at http://pn.psychiatryonline.org/content/46/9/4.1.full.

Debate on Paying for Medicare Heats Up



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 While politicians on both sides of the aisle agree that projections of Medicare's soaring costs mean some intervention will have to be implemented, the battle to find a remedy looks to be guided as much by emotion as rational planning. Last week Health and Human Services Secretary Kathleen Sebelius warned that the Republican plan to replace fee-for-service Medicare with a system of vouchers allowing beneficiaries to buy their insurance in the private market raises the risk that America's seniors will run out of their own money and be forced to go without medical care. She even suggested that cancer patients under the Republican plan could "die sooner." She based this on a CBO estimate that that by 2030, seniors will be paying for 68% of their care out of pocket, compared with 25% now. Not surprisingly Republicans reacted with outrage. Also on the Medicare reform agenda is how to pay physicians for their services in the future. For more on that controversy, see http://pn.psychiatryonline.org/content/46/6/4.1.full.

Employment and Mental Health: What's Best?

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The nation’s economy is still in turmoil. In the first three months of 2011, the economy grew at a 1.8 percent annual rate, but that rate was down from that of the previous quarter. The outlook for employment is still pessimistic. At the opening of trading on the stock market today, stocks were mixed, and worries about Greece’s debt problems rose as its debt rating descended further into junk status. How does this bad news impact the mental health of Americans? Is it better to have any job rather than a bad job? These and other questions are examined in a Psychiatric News article posted at http://pn.psychiatryonline.org/content/46/9/9.1.full.

Check Out the New Issue!



Patrick Kennedy is interviewed by
Jeffrey Borenstein, M.D., on the
public TV program "Healthy Lives."

Credit: WLIW-21

The May 6 issue of Psychiatric News is now live on the Internet. In this issue you'll find a report on Rep. Patrick Kennedy's new brain-research initiative, called "The Next Frontier: One Mind for the Brain"; an update on state efforts to grant psychologists prescriptive authority; a dramatic tale about a psychiatrist who returned to his home country of Libya to provide medical assistance; preliminary results of a major study on risk factors associated with suicide in the Army; and a report on a study indicating that cognitive decline is evidenced years before a diagnosis of Alzheimer's is made. To access these and other articles in the issue, go to http://pn.psychiatryonline.org/content/46/9.toc.

Why Blacks May Suffer Disproportionately From Stroke

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As researchers and clinicians try to understand and remedy race-related disparities in general and mental health care, one clue appears in a study published in the latest issue of the journal Stroke. The researchers found that when blacks experience symptoms of stroke, they are likely to first call a friend or relative instead of calling 911. With the speed of medical intervention critical to stroke outcome, this delay may explain in part why blacks in the U.S. appear to suffer disproportionately from strokes. The study was conducted in an underserved urban population that is predominately black and found that among hospitalized stroke patients in a large hospital in Washington, D.C., only 12 percent called 911 to request medical help. Other studies have found that blacks are also less likely than whites to receive treatments that break up brain blood clots that cause stroke, in part because of delays in getting to the hospital. For information about how racial disparities affect mental health and its treatment, see http://pn.psychiatryonline.org/content/45/21/4.5.full and http://pn.psychiatryonline.org/content/45/20/22.1.full.

No Jail Time in Bullying Suicide Case

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A plea was struck in a highly watched school bullying court case, giving five of six defendants a year of probation and no jail time. Kayla Narey, Sharon Chanon Velázquez, Ashley Longe, Sean Mulveyhill, and Flannery Mullins  plead guilty in Hampshire Superior Court in Massachusetts to charges of criminal harassment of Phoebe Price. More serious charges were dropped as part of the plea arrangement. The agreement is subject to approval of a judge. Additional charges are still pending against the sixth defendant, Austin Renaud. Price committed suicide following what prosecutors described as weeks of systematic bullying and harassment. Several high-profile cases of bullying and cyber bullying have brought the topic into the national spotlight, culminating in the Obamas' hosting policymakers and advocates at a White House conference on bullying prevention. For more information on the White House bullying summit, see http://pn.psychiatryonline.org/content/46/8/5.1.full.

May Is Borderline Personality Disorder Awareness Month

On May 8, 2007, the National Education Alliance for Borderline Personality Disorder organized congressional hearings to educate legislators about borderline personality disorder (BPD). Congressional co-sponsors for the event were Tom Davis (R-Va.) and Nita Lowey (D-N.Y.). On April 1, 2008, the U.S. House of Representatives passed, by a vote of 414-0, House Resolution 1005 in support of the month of May as Borderline Personality Disorder Awareness Month. Psychiatric News featured a four-part series profiling prominent clinician-researchers who have specialized in research on, and treatment of, BPD. See http://pn.psychiatryonline.org/content/46/6/16.1.full,  http://pn.psychiatryonline.org/content/46/7/11.1.full,
http://pn.psychiatryonline.org/content/46/8/4.1.full.  The fourth and final installment in the series will appear online tomorrow.

APA Announces Reorganization of DSM-5 Chapters

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APA today announced a new organizing framework for DSM-5, in which chapters will be arranged by general categories such as neurodevelopmental, emotional and somatic to reflect potential commonalities in etiology within larger disorder groups. The manual’s new organization combines certain disorders under more comprehensive chapter headings while breaking others out from their previous categories. The reorganization of chapters is the latest step in the evolution of the new diagnostic manual, a 14-year project that has involved hundreds of experts from the United States and abroad. The first round of field trials is now testing the new diagnostic criteria in real-world settings, including at nearly a dozen larger academic and clinical centers; almost 3,900 mental health professionals in individual practice and smaller settings also will participate before the trials conclude. Publication is scheduled for 2013. For more information see Psychiatric News, http://pn.psychiatryonline.org/content/46/5/7.full.

House Guts Health Reform Law Funding

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The House of Representatives voted on Tuesday, May 3, to deny funding for a major component of the health reform bill, the state-based insurance exchanges. Proponents of the exchanges maintained that this structure would be a successful method for expanding access to health insurance to those who did not receive insurance through their employers and could not afford to buy it on their own via the private insurance market. The nearly straight-line party vote was 238-183, with all Republicans voting for the funding cut; they were joined by just three Democrats. Previous House bills aimed at killing the Patient Protection and Affordable Care Act failed after the Senate refused to go along. Republicans have vowed to continue their efforts to repeal most or all of the reform act's provisions. For more information see http://pn.psychiatryonline.org/content/45/9/4.2.full.

Government Health Leaders Vow to Continue Asthma Fight

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In recognition of World Asthma Day on May 3, the directors of three key government health agencies have reaffirmed their commitment to research and clinical studies that will improve prevention, diagnosis, and management of the chronic illness estimated to affect 17 million aduts and 7 million youth under age 18 in the U.S. Asthma is also a concern of psychiatrists and others in the mental health care field, since studies have shown that depression is associated with physiological changes that can increase the risk of asthma and other disorders. For more information see http://pn.psychiatryonline.org/content/45/16/16.1.full. In addition, a recent study has shown a link between asthma and suicide by teenagers. Read more at http://pn.psychiatryonline.org/content/45/21/20.2.full.

Libyan-American Psychiatrist Untertakes Mission to Homeland

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Although the death of Osama Bin Laden closes a chapter in the fight against terrorism, citizens in several nations continue to fight against terrorism and tyranny in their homelands. For example, an Oregon psychiatrist, Omar Reda, M.D., has returned to Libya, where he was born and raised, to lend his medical and mental health expertise to the efforts of the Libyan people to free themselves from the dictatorship of Muammar Gaddafi. In the May 6 issue of Psychiatric News, Reda talks about his mission to Libya, his reunion with his family, and plans for return visits. On that date the article can be accessed at

 http://pn.psychiatryonline.org/content/current.

Actress Honored for Work With Traumatized Children



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Award-winning actress and children’s author Jamie Lee Curtis will receive an award tomorrow in Washington, D.C., at the sixth annual National Children's Mental Health Awareness Day sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). Curtis is being honored for her work on behalf of children. The theme of the event, of which APA is a cosponsor, is "Building Resilience in Young Children Dealing With Trauma." A study reported in the April 15 issue of Psychiatric News emphasized the importance of early identification of children who suffer traumatic injury because they are at higher of risk of developing anxiety, depression, or substance used and thus may need referral to psychiatric care. For more information, see http://pn.psychiatryonline.org/content/46/8/26.2.full. Sign up for the Webcast of the SAMHSA event at http://www.samhsa.gov/children.

Psychiatrists Offer Free Mental Health Services To Vets, Military

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The news that a special force of Navy Seals cornered Osama bin Laden, mastermind behind the 9/11 attacks, and killed him during a firefight has heartened Americans everywhere, while reminding them of the sacrifices made by our veterans, active-duty military, and their families in the decade-long war on terror. The American Psychiatric Association has partnered with Give an Hour, a national network of psychiatirsts and mental health professionals who volunteer their services to members of the military, veterans, and their families. For more information, see Psychiatric News at http://pn.psychiatryonline.org/content/43/5/1.2.full. Information on Give an Hour and how to volunteer is posted at http://www.giveanhour.org/.