Postpartum Period High-Risk Time for Women With Mood Disorders

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Pregnant women with a history of mood disorders—either depression or bipolar disorder—are much more likely to experience an acute episode of their mood disorder during the postpartum period than during the pregnancy itself, according to a report that appeared online in AJP in Advance on July 28. The finding provides research confirmation of what clinicians have observed for many years—that the postpartum period poses considerable health risks for women with either unipolar or bipolar disorder.

The AJP study is posted at http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2011.11010148v1. In addition, a chapter is devoted to the subject of depression care and pregnancy in the book, Treatment Resistant Depression: A Roadmap for Effective Care, published by American Psychiatric Publishing this year. For purchasing information, see www.appi.org.

IQ a Factor in Neurodevelopment Process Leading to Psychosis

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 A meta-analysis of data on 4,396 subjects with schizophrenia and 745,000 controls from 12 independent studies found significant decrements in premorbid IQ among individuals who later developed schizophrenia. The risk of schizophrenia increased by 3.7 percent for every point decrease in IQ, and greater premorbid IQ decrements were associated with earlier onset of illness.

The results were published online July 11 in Schizophrenia Research. IQ alone is not a measure for schizophrenia risk, but as one component among many neurodevelopmental factors, it appears to increase risk across the range of intellectual ability, researchers said.

The study contributes to a growing body of research focused on factors in psychosis risk and early identification of individuals at high risk for developing psychosis. You can read much more about these issues in Psychiatric News at http://pn.psychiatryonline.org/content/43/3/2.full and http://pn.psychiatryonline.org/content/46/10/18.1.full.

Blast-Related Traumatic Brain Injury May Persist

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Military personnel who suffer blast-related traumatic brain injury (TBI) may have residual damage, say researchers at the Washington University School of Medicine in St. Louis in the June New England Journal of Medicine, disputing the argument that impairments due to mild TBI in combat veterans do not typically persist.

They performed diffusion tensor imaging (DTI)—a type of magnetic resonance imaging—on 63 U.S. male military personnel who were evacuated from the field to the Landstuhl Regional Medical Center in Germany within 90 days after a blast-related TBI diagnosis and on 21 control subjects. Abnormalities revealed on DTI were consistent with traumatic axonal injury in many of the subjects with TBI. None had detectable intracranial injury on computed tomography.

For more on how civilians will benefit from the military's experience in treating brain trauma, see Psychiatric News at http://pn.psychiatryonline.org/content/46/6/6.1.full.

Serious CNS Reactions Possible in Patients Taking MAOI Drugs, Says FDA

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On Tuesday, the Food and Drug Administration (FDA) released two drug-safety communications regarding serious CNS reactions that are possible when a patient is taking serotonin psychiatric medications. Both the antibacterial drug Zyvox (linezolid) and the drug methylene blue inhibit the action of monoamine oxidase A, an enzyme responsible for breaking down serotonin in the brain. Either drug may lead to serotonin build-up in the brain, causing the toxicity known as serotonin syndrome. Symptoms include mental changes (confusion, hyperactivity, memory problems), muscle twitching, excessive sweating, shivering, diarrhea, trouble with coordination, and/or fever.

Linezolid is used to treat pneumonia, infections of the skin, and infections caused by a resistant bacterium (Enterococcus faecium). Methylene blue is used to treat methemoglobinemia, vasoplegic syndrome, ifosfamide-induced encephalopathy, and cyanide poisoning. It is also used as a dye in diagnostic applications. The FDA recommends these two drugs not be given to patients taking serotonergic drugs, but recognizes there are some conditions that may be life-threatening or require urgent treatment with those drugs. 

Timely news about psychiatric drugs can be found regularly in the "Med Check" column of Psychiatric News. See the latest at http://pn.psychiatryonline.org/content/46/12/18.2.full.

Methamphetamine Abuse Linked to Parkinson's Disease

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Abusing methamphetamine or other stimulants leads to increased chances of developing Parkinson’s disease, say researchers at Toronto’s Centre for Addiction and Mental Health. An association between methamphetamine abuse and Parkinson’s has been suspected for 30 years but the new research provides the first documented evidence, said principal researcher Russell Callaghan, Ph.D.

The researchers looked at medical records from 1990 through 2005 of nearly 300,000 patients. Of those, 40,472 were hospitalized for methamphetamine use. That group had a 76 percent greater chance of having Parkinson’s than either of two comparison groups: nonaddicts hospitalized for appendicitis and cocaine abusers.

Statistically, the rate of Parkinson’s among the methamphetamine abusers was 21 per 10,000 and 12 per 10,000 in the general population.

Long-term implications could be significant, said Callaghan: “Given that methamphetamine and other amphetamine stimulants are the second most widely used illicit drugs in the world, the current study will help us anticipate the full long-term medical consequences of such problematic drug use.”

Read about the possible use of a common medication to lower Parkinson's risk in Psychiatric News at http://pn.psychiatryonline.org/content/46/10/32.2.full.

Women With PTSD Have Lower Birthweight Babies

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Babies born to women who have posttraumatic stress disorder (PTSD) weigh less than babies born to other women and are more likely to arrive prematurely, says a new University of Michigan study. The study looked at 839 women divided into three groups: 255 with PTSD during pregnancy, 307 exposed to trauma but not diagnosed with PTSD, and 277 not exposed to trauma.

Babies born to women with PTSD weighed 10 ounces less than those of the trauma-exposed women and about 8 ounces less than infants of the non-exposed women. Race was also a factor in the results. African-American women are more likely to have PTSD during pregnancy because they have greater lifetime exposure to trauma and tend to get less treatment. “It is essential that outcomes are improved in this high risk group of women,” said researcher Julia Seng of the University of Michigan Institute for Research on Women and Gender. “Maternity care needs to take traumatic stress into account…”

To read much more about PTSD in women, see Psychiatric News at http://pn.psychiatryonline.org/content/45/23/32.1.full.

Strategy May Not Succeed in Reducing Teen Drinking

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With beach and vacation season in full swing, and teens as apt to give in to peer pressure as ever, parents of adolescents may be anxious to try strategies to minimize the odds that their children will drink too much alcohol and suffer the often devastating consequences. One tactic for limiting teens' desire to imbibe that has gained popularity of late is for parents to provide opportunities for their teens to drink in supervised contexts as a way to foster responsible drinking. But a recent study discovered that adult-supervised drinking is in fact associated with higher levels of harmful alcohol use by teens than is the case for teens who lived in an area with a "zero-tolerance" approach to alcohol use by minors. Alcohol consumption in general was equivalent for teens under the contrasting approaches.

Read more about this surprising finding in Psychiatric News at http://pn.psychiatryonline.org/content/46/12/16.1.full.

Scientists Move One Step Closer to Heroin Vaccine

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Could a vaccine that protects heroin users from the effects of that dangerous drug someday be in the treatment arsenals of psychiatrists and other addiction specialists? While such a weapon is a long way from being ready for prime time, researchers at the Scripps Institute in La Jolla, Calif., report in the Journal of Medicinal Chemistry that in rat experiments a vaccine has proven effective in obstructing heroin's ability to dampen pain and in preventing the development of an addiction to heroin. The next task the Scripps group plans to undertake is to see if the vaccine prevents relapse in rats that had previously developed a heroin addiction, said lead researcher Kim Janda.

Progress is also being made in devising a vaccine that combats cocaine addiction, with promising findings coming out of experiments on mice. To read much more about development of a cocaine vaccine, see Psychiatric News at http://pn.psychiatryonline.org/content/46/5/20.2.full and http://pn.psychiatryonline.org/content/46/5/20.3.full

To learn about the latest advances in treating addictions, watch for the new book from American Psychiatric Publishing titled Cocaine and Methamphetamine Dependence: Advances in Treatment, scheduled to be published in September and available at www.appi.org.

Vietnam Vets May Have Survived the War, But Still Be At Risk

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Brain injuries experienced by Vietnam War veterans during that conflict may be opening them to greater risk of dementia as they age, researchers reported at the Alzheimer's International Conference in Paris on July 18.

War-related brain injuries are problematic, of course, for many other reasons in addition to dementia. For example, they can trigger seizures, depression, aggression, severe headaches, dizziness, and other symptoms. For more information on traumatic brain injuries, see Psychiatric News at http://pn.psychiatryonline.org/content/44/1/2.full.

Comprehensive information about brain injuries in general can be found in the Textbook of Traumatic Injury, published by American Psychiatric Publishing in 2011. The lead author was Jonathan Silver, M.D. More information about the book and how to purchase it is available at http://appi.org/Pages/default.aspx.

Can People Be Made to Lie Under Hypnosis?

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Can you lie under hypnosis? Can you be convinced to do terrible or embarrassing things under hypnosis? If a wart is removed by hypnosis, will it come back?

The answer to the first question is yes, and to the latter two it is no, according to a psychiatrist who is a hypnosis expert. Thus, while the psychological state of hypnosis has its limitations, it can also produce some dramatic—and surprising—changes in the world of the mind, body, and human behavior.

To read more on this provocative subject, especially on the psychiatric conditions that can be helped by hypnosis, see Psychiatric News at http://pn.psychiatryonline.org/content/46/13/10.2.full.

A book about hypnosis is also for sale through American Psychiatric Publishing titled Trance and Treatment: Clinical Uses of Hypnosis, second edition, by Herbert Spiegel, M.D., and David Spiegel, M.D. See http://appi.org/SearchCenter/Pages/default.aspx?k=hypnosis.

People With Serious Mental Illness Have Shorter Life Expectancy

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Certain mental illnesses can cut patients' lives tragically shorter. A Danish analysis of life expectancy among people with serious mental illness found that life expectancy was 18.7 years shorter for men with schizophrenia than men in the general population. The corresponding number for women with schizophrenia was 16.3 years; for men with bipolar disorder, 13.6 years; and for women with bipolar disorder, 12.1 years. Researchers also found that excess mortality from physical diseases and medical conditions was much more likely to influence life expectancy than was death from external causes.

“Life Expectancy Among Persons With Schizophrenia or Bipolar Disorder” was published online in Schizophrenia Research (July 7, 2011). In recent years, there have been increasing calls for psychiatrists to more actively monitor the general medical health of their patients with serious mental illness. See Psychiatric News, http://pn.psychiatryonline.org/content/43/21/2.full.

President to Announce Formal End to "Don't Ask, Don't Tell"

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The Washington Post reported that President Obama will announce today that the Pentagon is ready to permit gay and lesbian individuals to serve openly in the military, formally ending the policy known as “Don’t Ask, Don’t Tell.” The White House confirmed to Psychiatric News this morning that "the President will meet with the Secretary of Defense and the Chairman of the Joint Chiefs to review the certification of the repeal of 'Don’t Ask, Don’t Tell.' "

APA has long had a position statement opposing the exclusion or dismissal from the Armed Forces of any individual on the basis of sexual orientation. It has also condemned all forms of bias directed at gay and lesbian individuals and adopted a position statement calling for laws to allow same-sex civil marriage. You can read more about issues surrounding "Don't Ask, Don't Tell"

in Psychiatric News at http://pn.psychiatryonline.org/content/46/1/12.1.full.

FDA Orders New Warning on Seroquel Label

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The FDA has required a new warning on the label of the atypical antipsychotic Seroquel (quetiapine) cautioning doctors about potential prolongation of the QT interval that may occur when above-recommended amounts of Seroquel are combined with specific drugs. The warning advised against the use of Seroquel in combination with certain antiarrhythmics, antipsychotics, antibiotics, and other drugs, prompted by notice of 17 post-marketing cases of induced QT prolongation. Seroquel's prior labeling had warned of the heart arrhythmia risk but hadn't mentioned other drugs that could interact with the antipsychotic. The revised label also raises caution about use by the elderly and people with heart disease.

Even without the new warning, Seroquel's label is many pages long. Read about recent concerns regarding "overwarning" about adverse events on drug labels in Psychiatric News at http://pn.psychiatryonline.org/content/46/14/2.2.full.

Traumatic Brain Injury a Hot Topic at Alzheimer's Association International Conference in Paris

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One of the most-discussed topics of the Alzheimer's Association International Conference (AAIC) that ends today is the role of traumatic brain injury (TBI) in development of dementia, particularly in veterans and athletes. Research presented at the conference showed that older veterans who experienced a TBI showed a more than twofold risk for developing dementia. What researchers learn from these patients can be used to help those who experience any form of TBI. 

"About 1.7 million people experience a TBI each year in the United States, primarily due to falls and car crashes," explained speaker Kristine Yaffe, M.D., a professor of psychiatry, neurology and epidemiology at the University of California, San Francisco (UCSF) and director of the Memory Disorders Program at San Francisco VA Medical center. "TBI is also referred to as the 'signature wound' of the conflicts in Iraq and Afghanistan, where TBI accounts for 22 percent of casualties overall and 59 percent of blast-related injuries. Data suggest that TBI in older veterans may predispose them to development of dementia. And they raise concern about the potential long-term consequences of TBI in younger veterans." 

To read more about how civilians will benefit from the military's experience with brain trauma, see Psychiatric News at http://pn.psychiatryonline.org/content/46/6/6.1.full.

ACLU Challenges Michigan's Sentencing for Juveniles

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A federal judge is allowing an American Civil Liberties Union lawsuit to proceed that challenges Michigan’s life-without-parole sentence for individuals who committed crimes while juveniles. The ACLU and the ACLU of Michigan believe that Michigan’s sentencing practice constitutes cruel and unusual punishment and violates constitutional rights. Under Michigan law, children as young as 14 who are charged with certain felonies can be tried as adults and, if convicted of a homicide offense, sentenced to life without parole.

Case law is moving in the direction of recognizing that permanently incarcerating individuals who committed crimes as juveniles is indeed cruel and unusual punishment. The Supreme Court took that position last year in the case Graham v. Florida, in which APA and other organizations had filed an amicus brief. The majority decision echoed the brief, which argued that due to minors' lack of understanding, they should not have to sacrifice their freedom for the rest of their lives for behavior that can be influenced by their incomplete brain development. For more information, see Psychiatric News at http://pn.psychiatryonline.org/content/45/12/13.1.full. Additional information on brain development in youth can be found in the book Developmental Psychopathology and Wellness: Genetic and Environmental Influences, published by American Psychiatric Publishing and edited by James J. Hudziak, M.D. Ordering information is posted at http://appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62279.

Better Pain Management May Prevent Use of Antipsychotics

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A study in the current BMJ found that a systemic approach to the management of pain significantly reduced agitation in nursing home residents with moderate to severe dementia. Better pain management, say the authors, could reduce the wide use of antipsychotic medications in a population in which agitation is common and thus the risk of experiencing dangerous side effects, such as stroke or even death. The researchers had speculated that pain may be the cause of many of these patients’ agitation. More information on the negative impact of antipsychotics on elderly people appears in Psychiatric News at http://pn.psychiatryonline.org/content/46/13/20.1.full.

Psychiatrists Urged to Fight Threat to Graduate Medical Education

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 APA is urging its members to contact their U.S. senators and representatives to register their oppostion to a plan that would save money in the Medicare program by slashing the funds Medicare pays to support graduate medical education throughout the country. Raised as one strategy in Congress's contentious debt-reduction negotiations, the cuts to teaching hospitals that train residents in primary care and specialties such as psychiatry could total between $14 billion and $60 billion over 10 years. APA emphasizes that such cuts would seriously jeopardize "the country's ability to care for an aging population and close a projected physician shortfall." 

APA members can call their senators and representatives using APA's toll-free hotline at (866) 727-4894 and leave a message urging them to oppose deficit reduction that guts funds for graduate medical education. 

Read more about Medicare issues affecting graduate medical education and patient care in Psychiatric News at      http://pn.psychiatryonline.org/content/46/5/15.1.full and http://pn.psychiatryonline.org/content/45/10/15.full.

Brain Changes Point to Individuals at "Ultra High Risk" for Psychosis

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Better identification of patients at “ultra high risk”  of psychosis, using biomarkers or brain imaging, can aid in the prediction of who will or will not convert to acute psychosis. A new study in the July Schizophrenia Bulletin titled “Cortical Thickness Reduction in Individuals at Ultra-High Risk for Psychosis,” uses magnetic resonance imaging to show that ultra high risk individuals have significant cortical thinning in the prefrontal cortex, anterior cingulate cortex, inferior parietal cortex, parahippocampal cortex, and superior temporal gyrus compared with healthy controls.

More accurate prediction of who among individuals at risk will convert to psychosis was a major focus at this year’s International Congress of Schizophrenia Research. For more information on this important topic, see Psychiatric News http://pn.psychiatryonline.org/content/46/10/18.1.full.

Stressors, Genes, and Mental Illnesses All Contribute to Suicidal Behavior

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Suicides increased in nine European countries after the start of the global economic crisis, a study reported in the July 9 The Lancet indicated. This researchers suggested that the crisis was a major causative factor in the suicides.

But it often takes not just a stressor, such as an economic crisis, but also mental illness to trigger suicidal behavior, scientists have found. Indeed, it looks as if a large percentage of suicide attempts--60 percent--can be attributed to four mental disorders--major depression, borderline personality disorder, nicotine dependence, and postraumatic stress disorder, researchers recently reported. For more information on this study, see Psychiatric News at http://pn.psychiatryonline.org/content/46/3/16.2.full. And researchers are finding more and more evidence that genes contribute to suicidal behavior as well. For more information on this topic, see Psychiatric News at http://pn.psychiatryonline.org/content/46/10/20.2.full

The Risk of Alzheimer's May Lurk Just Around Your Corner

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When small health problems--say, hearing problems, eyesight issues, or even denture fit--add up, the combined effect can increase a person's risk for Alzheimer's disease. This unexpected finding was reported July 13 in Neurology. But other  findings about Alzehimer's risk have also lately emerged.

For instance, scientists have found that both having the APOE e4 gene variant and living in a hazardous neighborhood can impair cognition. And since the e4 variant is a strong predictor of increased risk for Alzheimer's, and even small decrements in cognitive function predict dementia risk, it could be that people who have the e4 variant and  live in a "hazardous" neighborhood are in even greater danger of developing Alzhemer's than those who have the e4 variant and  do not live in a hazardous neighborhood.

Find more information about this study and other recents findings from Alzheimer's research in Psychiatric News at http://pn.psychiatryonline.org/content/46/8/27.full and in the Textbook of Alzheimer's Disease and Other Dementias, published by APPI, which can be ordered at http://www.appi.org/.

New Data on Effect of "Black Box" Warning for Children Using Antidepressants

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How did the 2003 FDA advisory warning on suicidality among children using SSRI antidepressants affect the recognition and treatment of depression in children? A new analysis appearing in Psychiatric Services (July 2011) indicates that the so-called “black box” warning may have diminished the likelihood of making an outpatient visit for depression but not the prescription of an antidepressant in the case of a diagnosis of depression. “National Trends in Prescribing an Antidepressant Before and After an FDA Advisory on Suicidality Risk in Youths” is posted at  http://psychservices.psychiatryonline.org/cgi/content/full/62/7/727. For further coverage of the findings, see the next issue of Psychiatric News, and for information on the “black box” warning, see http://pn.psychiatryonline.org/content/42/19/1.1.full.

Physicians Argue Case Against Florida Law On Communication About Gun Ownership

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Lawyers representing doctors in Florida told a U.S. District Court judge this week that physicians have had to impose “self-censorship” on health-screening questionnaires and verbal exchanges with patients, because of a state law barring physicians from asking patients about gun ownership without compelling reasons.

Physicians say they face high fines or could lose their licenses if they warn families about the risks of keeping guns in homes or other places. The law says doctors and other healthcare practitioners “shall respect a patient’s right to privacy and should refrain” from asking about gun ownership or whether people have guns in their homes. Observers say litigation around the law may go to the U.S. Supreme Court.

At the annual policy making meeting of the AMA, AMA delegates approved a resolution opposing state or federal efforts to interfere in the content of communication in clinical care delivery between clinicians and patients. For coverage of this and other issues at the AMA, see upcoming editions of Psychiatric News. For coverage of the Florida state law, see Psychiatric News, http://pn.psychiatryonline.org/content/46/5/16.3.full, http://pn.psychiatryonline.org/content/46/10/15.1.full.

Alzheimer’s Association Research Roundtable Workgroup Releases Report

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The Alzheimer’s Association Research Roundtable Workgroup has published its findings and conclusions in the current issue of Alzheimer’s & Dementia, including recommendations for conducting clinical trials of amyloid-lowering agents. The  group was convened in July 2010 to review publicly available trial data in response to advice from the Food and Drug Administration (FDA) to sponsors conducting clinical trials with amyloid-lowering agents for  treating Alzheimer’s. The FDA raised concerns about potential adverse events, specifically cerebral microhemorrhage and vasogenic edema, and recommended discontinuation in patients with any microhemorrhages during the study, advice that appeared stringent and limiting to many researchers.

Prior to publication, the workgroup report was sent to the FDA for review, and the FDA subsequently revised and updated its original advice to sponsors in a manner consistent with the report.

Amyloid-lowering agents are one approach to amyloid in the brain currently being investigated. To read about another approach, see Psychiatric News at http://pn.psychiatryonline.org/content/46/9/18.1.full.

High Stress Plus Caffeine: A Recipe for Psychosis Risk?

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Add stress to high daily caffeine intake, and what do you get? Hallucinatory symptoms possibly, according to Australian researchers. They grouped 92 community-recruited individuals free of psychiatric or neurological history, psychotropic medication use, and auditory impairment by self-reported stress levels and caffeine intake. Participants were asked to listen to white noise and to report each time they heard the song “White Christmas” during the white noise. Since the song was never played, each time a participant indicated they heard the song was recorded as a “false alarm.” All of the participants thought they heard the song being played, but those in the high stress-high caffeine group had the most false alarms.

The researchers concluded that increased caffeine consumption, in the presence of high levels of stress, has the potential to increase the experience of psychotic symptoms, specifically auditory hallucinations. The report was published in Personality and Individual Differences.

For more information about predictions of who may or may not be at a high risk for psychosis, see Psychiatric News at http://pn.psychiatryonline.org/content/46/10/18.1.full.

Child Abuse Ups Odds of Psychosis as Adult

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Young people who were forced to have sex before age 16 were 10 times more likely than others to develop psychosis as adults, a new study finds.

“We found a strong association of psychosis with childhood sexual abuse, particularly when it involved sexual intercourse,” wrote Paul Bebbington, Ph.D., of the Department of Psychiatry at the Royal Free and University College Medical School in London, and colleagues in the July British Journal of Psychiatry.

The researchers drew on a sample of 7,353 people from the adult population of England in 2007. They asked respondents if anyone had ever talked to them in an unpleasant sexual way, touched them sexually without their consent, or had sexual intercourse with them without consent. Non-consensual sexual intercourse was strongly associated with later psychosis, although Bebbington noted that the study design could not determine causation. They found no link between cannabis use and psychosis in this group, unlike some previous researchers.

Read more about the relationship between child abuse and mental illness in Psychiatric News at http://pn.psychiatryonline.org/content/45/20/4.1.full.

Experts Issue "Grand Challenges" to World Mental Health Community

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A panel convened by the National Institute of Mental Health (NIMH) of 422 experts from more than 60 countries has described the most important challenges to improving the lives of people with psychiatric, neurological, and substance abuse disorders.

Disorders such as schizophrenia, depression, epilepsy, Alzheimer’s disease, and drug or alcohol dependence together result in more years of productive life lost to death, disability, or poor health than either cancer or heart disease, according to panel. Addressing the “Grand Challenges in Global Mental Health” would improve access to diagnosis and treatment for millions around the world, said the panelists in the July 7 issue of Nature.

The top five challenges the experts identified are:

• Integrating screening and basic services into routine primary health care,

• Reducing the cost and improving the supply of effective medications,

• Improving children’s access to evidence-based care by trained health care providers in low- and middle-income countries,
• Providing effective and affordable community-based care and rehabilitation,

• Strengthening mental health training for all health care personnel.

“Participating in global mental health research is an enormous opportunity, a means to accelerate advances in mental health care for the diverse U.S. population, as well as an extension of our vision of a world where mental illnesses are prevented and cured," said NIMH Director Thomas Insel, M.D., in a statement.

For more coverage of key mental health issues around the world, see Psychiatric News at
http://pn.psychiatryonline.org/content/46/2/29.1.full.

What's Best for Depression: Single Drug Or a Combination?

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In many fields of medicine physicians often find that a combination of medications produces better outcomes than does a single medication. Researchers at the University of Texas Southwestern Medical Center in Dallas wanted to see if that holds true for depression treatment as well on the factors of patient retention in treatment, side-effect burden, and quality of life. They enrolled in their study 660 outpatients with major nonpsychotic depression from primary care and psychiatry practices. Patients were assigned to one of three groups: escitalopram plus placebo (monotherapy), bupropion plus escitalopram, or venlafaxine plus mirtazapine.

The researchers found that remission and response rates were not significantly different at either 12 weeks or seven months after the start of the study, and the same held true for quality-of-life and social-adjustment measures. Both of the combination treatments led to more side effects than did monotherapy. The researchers concluded that combinations of SSRI antidepressants offered no advantages as first-line treatments.

Read more about this study in Psychiatric News, at http://pn.psychiatryonline.org/content/46/13/23.2.full.

Army Finds It's Part of Opioid-Abuse Epidemic

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Government and private surveys over the last few years have documented a burgeoning crisis involving abuse of prescription medications, particularly opioid pain relievers. In fact, opioid overdose is now the second-leading cause of unintentional death in the U.S., second only to motor-vehicle crashes, prompting the Centers for Disease Control and Prevention to label pharmaceutical opioid overdose a national epidemic.

And now the U.S. Army has acknowledged that it has no immunity from the opioid-abuse epidemic. The Associated Press reported on July 11 that the Army has a new policy of limiting the number of prescription pain medications a soldier can receive at one time and may discipline those who violate the policy. Last November the Army limited soldiers to a 30-day supply, down from the 60- to 90-day supply that was more common. Then last month the Army announced that soldiers who are found to be using prescription pain medications for more than six months after they were prescribed were at risk of being disciplined. The goals are to have soldiers who are in pain see their physicians more frequently as well as to improve medication safety.

To read more about the epidemic of opioid abuse sweeping the country and strategies for limiting it, see Psychiatric News at http://pn.psychiatryonline.org/content/46/10/34.1.full and http://pn.psychiatryonline.org/content/46/11/18.2.full

APA Members Invited to Join LinkedIn

APA members are invited to join a LinkedIn group exclusively for them and connect with their APA colleagues worldwide. LinkedIn is a free online professional networking service.

With almost 1,000 members, the group has become the “go-to” place for psychiatry networking, mentoring, and discussing breaking news in the field. There are more than 30 discussions taking place now. Group members will receive updates on APA member benefits and information on upcoming APA meetings and other events.

To join the APA group on LinkedIn, go to http://www.linkedin.com/ and conduct a “Group” search for the “American Psychiatric Association.” If you have any questions about the group or sign up, contact Neila Ariasaif in the APA Membership Department at nariasaif@psych.org or (703) 907-7362. For additional information on APA member benefits, go to www.psych.org/MainMenu/MembersCorner.aspx.

Novel Approach Urged for Dealing With Bullies

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Bullying is a problem in many schools. A novel suggestion on how to prevent it comes from a Texas psychiatrist who grew up in a rough part of his New Zealand town and who has since become a bullying expert. His name is Stuart Twemlow, M.D.

When one student bullies another in the presence of still other students, Twemlow proposes, the solution is to recruit those bystanders who obviously disapprove of the bullying behavior to help in dispute mediation between the bully and the bullying victim. More often than not these bystanders are happy to assist, he says.

More information on Twemlow's views on bullying and how best to respond to it can be read in Psychiatric News at http://pn.psychiatryonline.org/content/46/6/20.2.full and in an APPI book authored by Twemlow titled Preventing Bullying and School Violence. For information about ordering the book see http://appi.org/Pages/default.aspx.

Is Polypharmacy Good? It Depends on the Patient, the Condition, and the Combination of Medications

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If one drug is useful in treating a mental illness, is more than one drug better? That’s a question three studies in this month’s American Journal of Psychiatry seek to answer. The studies suggest that the answer is specific to the combination chosen and to the diagnosis. Polypharmacy is common in psychiatry, especially for patients with severe mental illness.

The studies looked at patients with alcohol dependence, depression, and schizophrenia, and each came to a slightly different conclusion, depending on the condition being studied. So there does not seem to be an easy or universal answer to the question of whether one drug or a combination is the best treatment option.

To read the studies, see the American Journal of Psychiatry at http://ajp.psychiatryonline.org/. For coverage of this issue in Psychiatric News, see http://pn.psychiatryonline.org/content/46/11/15.2.full. Additionally, Treatment Resistant Depression: A Roadmap for Effective Care, published by the American Psychiatric Publishing, addresses this issue. For purchase information, see http://www.appi.org/.

White House to Start Sending Condolences to Families of Troops Who Commit Suicide

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The White House has announced that it will begin sending condolence letters to families of troops who commit suicide in combat zones. The new policy is a reversal of one that extends back through several presidential administrations to decline to send condolence letters to families of service members who committed suicide, even if the suicides occurred in combat zones. The policy was based on concerns in military circles that recognizing such deaths would encourage more suicides. Presidential condolence letters will still not go to families of service members who commit suicide in areas other than official combat zones.

In recent years, the military suicide rate has risen above the rate for the general population, a reflection, experts say, of the stress of rapid-tempo combat operations and multiple deployments. Additionally, the high rate of traumatic brain injury associated with roadside bombs in Afghanistan and Iraq is believed to have contributed to depression and PTSD among soldiers. 

Psychiatric News has provided extensive coverage of the crisis involving suicides and the soaring rate of PTSD in the military, including at http://pn.psychiatryonline.org/content/44/5/4.1.full. Additionally, see The Textbook of Traumatic Brain Injury, 2nd edition, published by American Psychiatric Publishing Inc. Purchase information is posted at http://www.appi.org.

Major Report Describes Strategies for Preventing and Relieving Pain

Institute of Medicine

The Institute of Medicine (IOM) released its report "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" last week. The report was requested by the Department of Health and Human Services as required by the 2010 Patient Protection and Affordable Care Act, which characterized pain as a major public-health problem.

According to the IOM, chronic pain affects an estimated 116 million U.S. adults, more than the total affected by heart disease, cancer, and diabetes combined, and costs the nation up to $635 billion annually in medical treatment and lost productivity. The 329-page report may be downloaded free at http://www.iom.edu/. 

Read extensive coverage about the diversion and abuse of opioid pain-control medications in Psychiatric News at http://pn.psychiatryonline.org/content/46/10/34.1.full
and http://pn.psychiatryonline.org/content/46/10/1.1.full.

DEA Hopes Arrests Put Dent in “Bath Salts” Spread

U.S. Drug Enforcement Administration

The U.S. Drug Enforcement Administration (DEA) has announced the arrest of a major distributor of “bath salts,” recreational designer drugs with significant and dangerous adverse effects. Nine employees of retail shops in Manhattan and Brooklyn that sold the drugs were also arrested. New York State Health Commissioner Nirav Shah issued an immediately effective ban on the sale and distribution of bath salts on May 23.

According to the DEA, companies in India and China are principally responsible for manufacturing and exporting  the synthetic stimulants. Shippers typically mislabel the products to evade detection by law enforcement and sell them via the internet to distributors around the world. Small retailers then sell the drugs online, through traditional distribution methods, or by retail distribution at convenience stores, gas stations, and "head shops."

Read more about the serious problems associated with "bath salts" in Psychiatric News at http://pn.psychiatryonline.org/content/46/8/8.1.full.

Psychological Distress in Pregnancy May Raise Asthma Risk in Kids

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Depression in pregnant women and new mothers has long been associated with poor health outcomes in their children. Now a new study suggests that being burdened emotionally during pregnancy may also lead to increased risk for asthma among offspring up to five years after birth.

Researchers from Columbia University studied 279 inner-city African-American and Hispanic women during pregnancy. They recorded measures of psychological distress, including perceived physical health, sadness, poor self-esteem, anxiety, confused thinking, hopelessness/helplessness, and psychophysiological symptoms. Over the next five years, they asked the mothers if their children ever wheezed, a key symptom of asthma. About 70 percent of the mothers who reported high levels of anxiety or depression while pregnant said their child had wheezed before age 5. Adjusting for other potential influences on asthma like race, education, second-hand smoke, or the mother’s history of asthma did not change the outcome.

“Understanding how maternal depression affects a child’s respiratory health is important in developing effective interventions,” wrote the researchers in the July Annals of Allergy, Asthma and Immunology.

Read more on the connection between mental and physical health in Psychiatric News at http://pn.psychiatryonline.org/content/46/2/10.2.full.

Environment May Play Bigger Role in Origins of Autism

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For decades, researchers have assumed that autism spectrum disorders were largely due to genetic factors, based on a 1977 study of twin pairs.

A new study in the Archives of General Psychiatry (published online July 4) looked at 192 pairs of twins born from 1987 to 2004 in which at least one child had an autism spectrum disorder to assess the relative roles of genetics and environment in risk for those disorders.

“Environmental factors common to twins explain about 55 percent of the liability to autism,” wrote Joachim Hallmayer, M.D., of the Department of Psychiatry at Stanford University School of Medicine, and colleagues. “Although genetic factors also play an important role, they are of substantially lower magnitude than estimates from prior twin studies of autism.” Environmental risk factors during pregnancy or in the first year of life might  include parental age, low birth weight, multiple births, and maternal infections during pregnancy, they wrote.

Read more about autism prevalence in Psychiatric News at
http://pn.psychiatryonline.org/content/46/10/7.full.

Insurance Industry Expansion Gets Little Notice

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Considerable attention by the medical community and patients is being focused on how accountable care organizations (ACOs) are poised to restructure large segments of the U.S. health care system. But until the Washington Post delved into a related issue, the media and political spotlight has largely avoided another trend that also could reshape that system

The paper published in its July 3 issue a report on how the nation's largest health insurance companies are increasing the extent to which they already manage medical care by buying up group practices and launching their own physician management companies. In a trend that has the potential to set off the same types of alarms that these companies' push into managed care did in the 1990s, the insurers are convinced that their bottom line will improve if the wall often separating decisions about providing care and paying for it is demolished. While the movement is in its infancy, it could lay the groundwork for a turf battle or even bidding wars if the companies and ACOs pursue the same groups or competing groups in a geographic area.

For extensive coverage of ACOs and the changes in store for the health care system, see Psychiatric News at
http://pn.psychiatryonline.org/content/46/6/9.2.full and http://pn.psychiatryonline.org/content/46/13/8.1.full.

DSM-5 Public Comment Period Extended

The DSM-5 Task Force has extended the period in which the public can comment on proposed criteria to be included in the upcoming fifth revision of APA's Diagnostic and Statistical Manual of Mental Disorders. Interested parties now have until July 15 to submit their suggestions and comments to the task force at the Web site www.dsm5.org.  

The task force indicated that the comment period was extended in particular to allow for additional suggestions on proposed criteria and assessment approaches concerning the personality disorders, which are being uploaded to the DSM Web site. Criteria  appearing on the Web site are undergoing "real-world" testing in large academic centers and in solo and group practices representing a broad range of clincial practice settings.

Psychiatric News continues to provide updates on the development of DSM-5 and will continue to do so until its scheduled publication in May 2013. Read recent Psychiatric News articles about DSM-5 at http://pn.psychiatryonline.org/content/46/5/7.full, http://pn.psychiatryonline.org/content/46/10/18.2.full, and http://pn.psychiatryonline.org/content/46/10/21.2.full