Atypical Antipsychotics Beneficial In Few Off-Label Conditions

Benefits and adverse effects vary among atypical antipsychotics used for off-label conditions, with no evidence supporting their use for several conditions—eating disorders, substance abuse, and insominia—for which they are sometimes used. That was the finding from a meta-analysis of effectiveness of atypical antipsychotics used for off-label conditions published September 28 in the Journal of the American Medical Association.

Small but statistically significant effects were found for aripiprazole, olanzapine, and risperidone in treatment of dementia in the elderly. Quetiapine was found effective for generalized anxiety disorder, and risperidone for obsessive-compulsive disorder, but all the antipsychotics had side effects of varying severity in all disorders for which they were prescribed.

For more information about the risks and benefits of atypical antipsychotics see Psychiatric News at http://pn.psychiatryonline.org/content/46/11/2.2.full, http://pn.psychiatryonline.org/content/44/5/1.1.full, and http://pn.psychiatryonline.org/content/43/13/12.full.

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Obama Asks for Rapid High-Court Ruling on Health Law

The Obama administration asked the Supreme Court on Wednesday to hear a case concerning the 2010 health care overhaul law. In addition, Republican state attorneys general separately asked the Supreme Court for a verdict early next year.
This makes it all but certain that the court will soon agree to hear one or more cases involving challenges to the law, with arguments likely by next spring and a decision possible by June, in the middle of the 2012 presidential campaign. The most controversial of the law's provisions, and one on which appeals courts have been divided, is the mandate for individuals to buy health insurance if they are not covered through an employer's or other plan.

To read Psychiatric News' coverage of legal challenges to the health reform law, see http://pn.psychiatryonline.org/content/46/15/1.1.full and http://pn.psychiatryonline.org/content/46/17/5.full.

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Bullying Prevention Summit Celebrates Progress

Last week, federal partners gathered for the second annual Bullying Prevention Summit, a two-day event hosted by the U.S. Department of Education. Participants celebrated the extensive antibullying work, outreach, and public engagement that resulted from the first summit, evidenced in the growing attention of schools and the media to the dangers of bullying.

“Bullying affects not only the child or children it targets, but the entire community that surrounds them—their parents, their classmates, even the child engaging in the bullying,” said Education Secretary Arne Duncan. “Keeping our children safe is everyone’s responsibility, and I’m proud to come together with so many national leaders, parents, teachers, and students to reaffirm our collective commitment to prevent bullying in every way possible.”

President Obama and Michelle Obama hosted a White House conference on bullying earlier this year. Read about it in Psychiatric News at http://pn.psychiatryonline.org/content/46/8/5.1.full. Much more on this topic is included in the new volume from American Psychiatric Publishing, Preventing Bullying and School Violence, with a description and purchasing information posted at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62384.

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Economic Recession Triggers More Abusive Head Trauma in Children

The occurrence of abusive head trauma (AHT), a leading cause of death from child abuse, increased during the economic recession. Researchers collected data for AHT cases diagnosed in children younger than age 5 from January 2004 through June 2009, by hospital-based child-protection teams in three U.S. regions. They found that the rate of AHT increased significantly in the 19 months during which there was a recession, compared with the 47 months before the recession. The group also examined unemployment rates during the study period, but found no relationship between unemployment and AHT rates.

“Given the high morbidity and mortality rates for children with AHT, these results are concerning and suggest that prevention efforts might need to be increased significantly during times of economic hardship,” said the researchers in the October Pediatrics.  

To learn about the latest clinical and research data on head trauma, see the new edition of the Textbook of Traumatic Brain Injury, available from American Psychiatric Publishing at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62357.

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Stimulant Medication Use for ADHD Continues to Rise

Use of stimulant medications to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents rose steadily from 2.4 percent in 1996 to 3.5 percent in 2008, said Samuel Zuvekas, Ph.D., of the Agency for Healthcare Research and Quality, and Benedetto Vitiello, M.D., of the National Institute of Mental Health, September 28 in AJP in Advance, the online edition of the American Journal of Psychiatry. This increase contrasts with the even sharper rise in the use of such drugs from 1987 (0.6 percent) to 1997 (2.7 percent).

The growth in the more recent 12-year span was due mainly to increased prescribing for adolescents aged 13 to 18. Use of stimulant medications for ADHD decreased in preschoolers and changed little in youngsters aged 6 to 12. “The continuous, steep increase in stimulant utilization in adolescents likely reflects the recent realization that ADHD tends to persist in puberty, causing significant functional impairment,” concluded Zuvekas and Vitiello.

Read more about the use of stimulant medications for ADHD in Psychiatric News at http://pn.psychiatryonline.org/content/46/15/24.2.full. To read the new study in AJP in Advance, see http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2011.11030387v1.

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Psychiatric Disabilities in U.S. Show Steep Rise

About 2.7 percent of Americans aged 18 to 64 reported some level of disability due to depression, anxiety, or emotional problems in the period 2007-2009, according to a new study in the American Journal of Public Health.

That represents an increase from 2.0 percent 10 years earlier even as the prevalence of disability attributed to other chronic conditions decreased, wrote Ramin Mojtabai, M.D., Ph.D., an associate professor at the Johns Hopkins Bloomberg School of Public Health. The increase in the prevalence of psychiatric disability occurred mainly among two groups: adults with disabilities caused by other chronic conditions and adults with a greater level of psychological distress who had not had any contacts with mental health professionals during the prior year.

To read more about issues concerning psychiatric disability, see Psychiatric News at http://pn.psychiatryonline.org/content/46/16/10.1.full.

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Physicians' Love Affair With Social Media Outpaces Public's

Survey data compiled early in 2010 showed that 41.6% of physicians said they were social-media users, but a trickle quickly became a torrent. Data from a survey in April and May of this year indicated that 84% of physicians have joined the social-media bandwagon, saying that they use Facebook, LinkedIn, and their relatives for personal purposes, and by last month that figure had soared to 90%. For the general public, in contrast, social media are being used by 65%, according to a report posted September 26 on amednews.com, the Web site of American Medical News.

Physicians' embrace of social media does not, however, mean that it has changed the way the vast majority practice medicine. The most recent survey, by QuantiaMD, found that only 67% used social media professionally, and physicians seem to be reluctant to use these sites as a way to communicate with patients. One-third said they had received requests to "friend" a patient on Facebook, but of those, 75% did not accept those invitations.

To read about psychiatrists' use of social media, including potential pitfalls, see Psychiatric News at http://pn.psychiatryonline.org/content/46/17/6.full and http://pn.psychiatryonline.org/content/46/11/12.full.

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Depression Risk Drops as Caffeine Consumption Grows

Caffeine has been associated with both positive and negative health effects, but a new study of the link between caffeine and depression adds an intriguing entry on the positive side of the ledger.

A decade-long prospective study shows that depression risk decreases as coffee consumption increases, report Harvard researchers in the September 26 Archives of Internal Medicine. They studied coffee drinking in 50,739 women in the U.S. who had a mean age of 63 and were depression-free at baseline in 1996. They noted that while caffeine is "the world's most frequently ingested psychoactive substance," few studies have shed light on its link to depression. To assess whether a substance in coffee other than caffeine may be at the root of the association, the researchers also questioned participants about drinking decaffeinated coffee, but no relationship with depression rates was found for decaf consumption. The more caffeinated coffee the participants drank, the lower their risk of eventually developing depression.

To read about a possible link between chocolate—another widely consumed caffeine-containing treat—and depression, see Psychiatric News at http://pn.psychiatryonline.org/content/45/11/14.1.full.

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Innocence Project's Efforts Fail For Death-Row Inmate

Georgia death-row inmate Troy Davis was executed on September 21 despite extensive efforts to save him after witnesses recanted their testimony about his responsibility for the shooting of a police officer. Some of those fighting to have his death sentence commuted were part of the Innocence Project, which has had a hand in the exoneration of death-row inmates through DNA testing, although there was no DNA evidence at issue in this case.

The Innocence Project was co-founded by Barry Scheck, J.D., a defense lawyer who became known through the 1995 murder trial of former professional football player O.J. Simpson. The project also paved the way for similar programs to be founded throughout the United States. Today there are 68 of them. And thanks to the efforts of these programs, 271 prisoners have been exonerated through DNA testing, 17 of whom were scheduled to be executed, and the actual perpetrators were identified in 120 of these cases.

More information about the Innocence Project can be found in Psychiatric News at http://pn.psychiatryonline.org/content/46/14/13.1.full.

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APA Examines Possible Health Care Targets in Deficit Reduction

Last week President Obama formally transmitted his jobs proposal to Congress. The president proposed to cover the $450 billion price tag by including it in a $3 trillion deficit reduction package. The proposal was pronounced “DOA” by Republicans and Democrats alike. That’s probably the case for the overall package, but some elements will undoubtedly be in play as the Joint Select Committee on Deficit Reduction, or the “supercommittee,” moves toward its November 23 deadline. In the latest "Medicare Update" on APA’s Web site, Nicholas Meyers, director of APA’s Department of Government Relations, discusses health-related cuts that the supercommittee is considering among its options and their impact.  If you have any questions, contact your DGR staff at advocacy@psych.org.

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More Monitoring Urged Regarding Antipsychotic Use in Children

Millions of prescriptions for antipsychotic drugs have been written for children and adolescents in the last two years, and an FDA advisory group has now urged regulators to continue studying safety monitoring for side effects of the drugs. The panel was concerned about weight gain and whether children taking the medications were at increased risk for diabetes. There is currently insufficient evidence to decide if that is the case, said panel member, Jonathan Mink, M.D., a child neurologist at the University of Rochester Medical Center.

These drugs are prescribed for bipolar disorder in teens and preschoolers, and for affective psychoses in children aged 7 to 12. Little clinical research with children on the effectiveness and safety of the drugs in these groups has been carried out, however. The panel asked for label revisions regarding pediatric use and adverse events when these drugs are approved for new pediatric indications.

To read more on the use of antipsychotics in children and adolescents, see Psychiatric News at http://pn.psychiatryonline.org/content/46/12/18.2.

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PTSD, Lung Illnesses Are Health Effects of 9/11

A “consistent body of knowledge has emerged” showing that the most common health effects of the September 11, 2001, terrorist attack on the World Trade Center involve the lungs and the mind, according to an online commentary in the Journal of the American Medical Association. Rates of PTSD have been high among those who were injured, heavily exposed to dust, worked for extended periods in rescue or recovery work, or lost a loved one or colleague, wrote Lorna Thorpe, Ph.D., of the City University of New York School of Public Health, and Stephen Friedman, M.D., M.P.H., of the New York City Department of Health and Mental Hygiene.

“Delineation of responsibility for worker-safety oversight, improved protective equipment for workers, structured shift rotations of responders, rapid screening of high-risk populations,...and early access to mental health treatment are just some of the most important lessons learned,” the researchers concluded.

For much more on what researchers have learned about the mental health effects of the 9/11 attacks, see Psychiatric News at http://pn.psychiatryonline.org/content/46/18/1.1.full and http://pn.psychiatryonline.org/content/46/18/14.1.full.

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Is Hoarding Disorder a New Diagnosis?

Previously considered a subtype of obsessive-compulsive disorder (OCD), hoarding disorder (HD) may become a diagnosis in its own right. A review commissioned by the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group, published in the June 2010 Depression and Anxiety, found sufficient evidence to recommend classifying HD as a new disorder.

Further work, led by one of the authors of the review, has now characterized comorbidity patterns in people who hoard. Randy Frost, Ph.D., and colleagues compared psychiatric comorbidity in a large HD sample with a control group meeting criteria for OCD without HD. High comorbidity rates were observed for major depressive disorder, as well as acquisition-related impulse control disorders such as compulsive buying, kleptomania, and acquiring free things. Fewer than 20 percent of HD participants met criteria for OCD. Inattentive ADHD was diagnosed in 28 percent of HD participants and was significantly more frequent than among OCD participants. Results were published online July 18 in Depression and Anxiety.  

To view preliminary drafts of revisions to the diagnostic criteria proposed for DSM-5, go to www.dsm5.org.

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ECG Abnormality Not Reliable Indicator Of Anorexia Nervosa Severity

A prolonged QT interval is not reliably correlated with sudden death in patients with anorexia nervosa (AN). Although AN carries the highest mortality of any psychiatric disorder, largely attributable to sudden cardiac death or suicide, the actual mechanism of death has been controversial. Researchers at the University of Colorado and Denver Health Medical Center published online in General Hospital Psychiatry this week the results of their study of ECG abnormalities in a cohort of 19 medically compromised, very-low-body-mass index AN patients.

They corrected for previous studies' deficiencies of previous, including lack of standardized ECG and reliance on formulas that did not take into account the extremes of heart rate often observed in AN. "Although delayed cardiac repolarization was observed among a medically compromised cohort of patients with anorexia nervosa, the corrected QT interval was not a reliable correlate of disease severity despite digital ECG adjudication and optimal rate correction," they concluded.

Read more about  suicide as a cause of mortality in AN patients in Psychiatric News at http://pn.psychiatryonline.org/content/46/17/25.2.full. Also see the Clinical Manual of Eating Disorders, available from American Psychiatric Publishing at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62270.

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House Says Autism Research Funding Will Continue

On Tuesday the House of Representatives approved legislation to reauthorize federal funding for autism research when it passed the Combating Autism Reauthorization Act. The bill amends the Public Health Service Act to extend and reauthorize through Fiscal 2014 the surveillance and research program for autism spectrum disorders and other developmental disabilities, as well as the education, early detection, and intervention of these conditions. The bill still needs Senate approval. 

One initiative to pinpoint autism cases earlier than is now the case is to train pediatricians to conduct screenings. Read a description of this effort in Psychiatric News at http://pn.psychiatryonline.org/content/46/16/16.1.full. And for an in-depth review of the etiology, diagnosis, and treatment of autism, see the Textbook of Autism Spectrum Disorders, from American Psychiatric Publishing. Information on this book is posted at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62341.

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CBT as Adjunct to Medication Improves OCD Treatment Response in Children

Adding cognitive-behavior therapy (CBT) to medication can significantly improve treatment response in children with obsessive-compulsive disorder (OCD) who are only partially responsive to medication treatment. That’s the finding of a study in the September 21 Journal of the American Medical Association. 

In OCD patients aged 7 to 17 who continued to have a Children's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate medication trial, the addition of CBT to medication management, compared with medication management alone, resulted in a significantly greater response rate.

To read coverage in Psychiatric News about research related to CBT for children with OCD, see http://pn.psychiatryonline.org/content/39/23/32.1.full. And more information about obsessive-compulsive disorder is covered in the APA publication "Let's Talk Facts About Obsessive-Compulsive Disorder," which can be ordered at http://appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2387. In addition, this year American Psychiatric Publishing released the book “Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-5.” For purchasing information see www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2659.

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APA Urges Members to Contact Congress About Medicare Fees

President Obama and a "supercommittee" in Congress, both looking for massive savings to reduce the national debt, have indicated that health programs like Medicare and Medicaid cannot be considered immune from cutbacks. One potential target that has been cited is physician payment under the Medicare program, with such payment rates scheduled to be slashed by almost 30 percent on January 1. APA and its partners in a coalition of national medical organizations are calling on physicians to take action to convince Congress that such a massive reimbursement cut will have devastating consequences for care of Medicare beneficiaries. APA sent out an alert on September 20, urging its members to contact their senators and representatives to call for the repeal of the sustainable growth rate formula (SGR), the tool the government uses to determine Medicare fees, and which has led to the huge looming cuts.

Members can send a message to their members of Congress at http://ama.capwiz.com/ama/issues/alert/?alertid=53132696 or connect through APA's toll-free hotline at (866) 727-4894.

Psychiatric News has provided extensive coverage of the problems with the SGR formula and attempts to convince Congress to repeal it. See http://pn.psychiatryonline.org/content/46/6/4.1.full and http://pn.psychiatryonline.org/content/46/16/1.2.full.

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NIDA Hopeful That Vaccines Can Fight Addiction

The National Institute on Drug Abuse (NIDA) has announced that it is funding the innovative work of two researchers who are developing vaccines they hope can combat two troubling and stubborn addictions—those to methamphetamine and nicotine. The recipients of NIDA's second Avant-Garde Awards for Innovative Medication Development Research are Thomas Kosten, M.D., of Baylor College of Medicine, who heads a research team that hopes to have a methamphetamine vaccine ready for clinical trials within five years, and Peter Burhkard, Ph.D., of the University of Connecticut, who is developing a peptide nonoparticle nicotine vaccine that will be administered intranasally.

NIDA Director Nora Volkow, M.D., said the two researchers represent the program's goal "to support investigators of exceptional creativity who propose bold and highly innovative new research approaches that have the potential to produce a major impact on the treatment of drug abuse.”

Cocaine addiction is also the target of vaccine research. Read about developments in this effort in Psychiatric News at http://pn.psychiatryonline.org/content/46/5/20.2.full. Also, learn more about the latest in treating addictions in the upcoming American Psychiatric Publishing book, Cocaine and Methamphetamine Dependence: Advances in Treatment. Information on this book is posted at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62407.

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Kentucky Physicians Tackle Benzodiazepine Abuse

Because so many of their patients had been clamoring for the benzodiazepine Xanax (alprazolam), in some cases to abuse it, a Louisville mental health clinic has taken an unusual step—its physicians are no longer prescribing it, the New York Times reported on September 14.

In May, the White House also moved to curtail abuse of prescription drugs. It announced that the Food and Drug Administration would require manufacturers of opioid pain medications to train physicians in the use of these medications and to develop materials for patients on their appropriate use and disposal. Read more information about this federal initiative in Psychiatric News at http://pn.psychiatryonline.org/content/46/10/1.1.full.

And abuse of prescription drugs seems to be a serious problem among adolescents, a National Institute on Drug Abuse survey has found. Last year, for example, use of the prescription opioid oxycodone was 5 percent among 12th graders. For more on this issue see the APA journal Psychiatric Services at http://ps.psychiatryonline.org/cgi/reprint/62/1/107. 

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Insulin Nose Spray Improves Memory in Alzheimer's Patients

Squirting insulin deep into the nose can improve memory in some Alzheimer's patients, The New York Times reported on September 12. The study, published online in Archives of Neurology, included 104 subjects. Those receiving 20 miligrams of insulin spray twice a day for four months experienced memory improvement, whereas those getting a saline solution spray did not.

A number of Alzheimer scientists, however, believe that if Alzheimer's is going to be effectively treated, it will be necessary to treat it long before symptoms become blatant. The reason is that research has shown that by the time individuals meet clinical criteria for Alzheimer's, they have already experienced years of accelerated cognitive decline.

Learn more about the earliest signs of Alzheimer's in Psychiatric News at http://pn.psychiatryonline.org/content/46/9/18.2.full.

And for more information about Alzheimer's in general, see The American Psychiatric Publishing Textbook of Alzheimer Disease and Other Dementias. Purchasing information is posted at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemID=62278.

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ADHD Drugs Raise Heart Rate, Not Blood Pressure

Long-term use of stimulant medications to treat attention-deficit/hyperactivity disorder (ADHD) raises questions about the drugs' effects on the heart. Researchers in the Multimodal Treatment Study of Children with ADHD (MTA) who followed patients in a clinical trial a dozen years ago now report that children treated with methylphenidate and other stimulant drugs did not have increased rates of hypertension; however, their hearts did beat slightly faster on average while in treatment.

The study, by Benedetto Vitiello, M.D., of the National Institute of Mental Health, and colleagues, appeared in AJP in Advance on September 2. Once the 14-month study was over, patients were free to use any treatment or none at all. The increase in heart rate observed several years later was likely attributable to patients who continued to take the drugs.

There were no cardiac-related illnesses or death, said the researchers, but they recommended that children with any underlying heart abnormalities should be monitored closely for cardiovascular problems. For more information, see Psychiatric News at http://pn.psychiatryonline.org/content/46/15/24.2.full.

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Bullying a Bigger Problem Than One Bad Kid

Most people see bullying as a one-on-one affair: bully torments victim. But there’s more to it than that, say two experts in a new book. Bullying is a symptom of a malfunctioning social system, not just the behavior of a single troubled individual, write Stuart Twemlow, M.D., and Frank Sacco, Ph.D., authors of Preventing Bullying and School Violence, published by American Psychiatric Publishing, a division of the American Psychiatric Association.

Twemlow and Sacco suggest ways mental health professionals can identify and help children at risk of bullying, work with education systems, and promote positive attitudes and coping skills that are the hallmarks of mental health.

For more about Preventing Bullying and School Violence, see http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62384.

Information on bullying from the CDC appears in Psychiatric News at http://pn.psychiatryonline.org/content/46/11/20.2.full.

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Sleep Problems Raise Psychiatric Hospitalization Risk

Sleep problems are highly prevalent among Medicaid patients with serious mental illness and are associated with greater inpatient and emergency mental health service use. Those are findings of researchers at Johns Hopkins Bloomberg School of Public Health and the American Psychiatric Institute for Research and Education published in the September Psychiatric Services.

They studied a sample of 1,560 Medicaid patients whose psychiatrists were asked to provide information on their diagnoses, medications, sleep problems, treatments, psychiatric hospitalizations, and use of emergency services. Overall, 78 percent of the patients were rated by their psychiatrists as having some sleep problems. Patients with sleep problems had greater odds of psychiatric hospitalization and of emergency service use compared with those with no sleep problems.

The researchers characterized their results are "a first glimpse at a significant clinical problem with far-reaching implications for service use and cost of care in this patient population."

Sleep problems can also lead to metabolic syndrome. Read more about this dangerous condition in Psychiatric News at http://pn.psychiatryonline.org/content/46/2/27.full.

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Judge Blocks Florida Law Restricting Gun Questions From Doctors

A federal judge has blocked enforcement of the Florida law that restricts what physicians can say or ask about guns to their patients. The law was passed earlier this year by the Republican-controlled legislature and signed into law June 2 by GOP Gov. Rick Scott. The governor, the National Rifle Association, and other supporters contended it was a violation of privacy and possibly the Second Amendment for physicians to question patients about the presence of guns in their home.

District Judge Marcia Cooke ruled that the law violates the U.S. Constitution’s free-speech guarantees and does not trample gun rights. In her ruling, Cooke said she found very little evidence of widespread harassment or discrimination of gun owners by physicians. Republican Sen. Greg Evers, who was the chief Senate sponsor said he was disappointed in the ruling and expected an appeal would be filed.  

In a resolution passed at its June meeting, the AMA has expressed opposition to the law. Read more about this controversial law in Psychiatric News at http://pn.psychiatryonline.org/content/46/14/10.3.full.

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What's Behind Dramatic Rise in Hospitalizations for Eating Disorders?

Hospitalizations for either a primary or secondary eating-disorder diagnosis showed a dramatic increase of 24 percent from 1999 to 2009, according to a report from the Agency for Healthcare Research and Quality.

This increase was attributable to a 40 percent rise in secondary diagnoses in conjunction with eating disorders—from 17,118 to 23,946 during the period—since principal diagnoses of eating disorders fell by 1.8 percent, according to a “statistical brief" titled, “An Update on Hospitalizations for Eating Disorders, 1999 to 2009.” Among hospitalizations in which eating-disorders were the secondary diagnosis, the primary diagnoses were mood disorders, fluid and electrolyte disorders, schizophrenia and other psychotic disorders, alcohol-related disorders, and poisoning by medications or drugs.

Psychiatric News recently reported on studies finding a genetic link to suicide risk in persons with eating disorders. To read about that link, see http://pn.psychiatryonline.org/content/46/17/24.1.full.

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Uninsured Numbers Rise Along With Poverty

The number of people without health insurance  rose from 49.0 million in 2009 to 49.9 million in 2010, according to a report released yesterday by the U.S. Census Bureau.

Meanwhile, the percentage without coverage—16.3 percent—was not statistically different from the rate in 2009, according to the report, “Income, Poverty, and Health Insurance Coverage in the United States: 2010.” The Census Bureau also reported that in 2010, median household income declined and the poverty rate increased.

Last year President Obama signed the Patient Protection and Affordable Care Act, designed to extend health insurance to the uninsured. APA's Publishing Division and the Department of Government Relations (DGR) has developed a primer to help psychiatrists understand how the health reform law affects them and their patients. The primer includes articles on health care reform from Psychiatric News, the American Journal of Psychiatry, and Psychiatric Services and information prepared by DGR. The primer is posted at www.appi.org/SiteCollectionDocuments/Journals/PSY/HealthCareReform.pdf.

Read more about the provisions of the reform law in Psychiatric News at http://pn.psychiatryonline.org/content/45/7/1.2.full and http://pn.psychiatryonline.org/content/46/16/10.1.full.

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Omega-3 Fatty Acid Brings Modest Improvement in ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) may benefit from the addition of omega-3 fatty acid to their pharmacology regimen. It may also bring some improvement for children whose parents decline to have them take a pharmacological agent to treat ADHD. These findings come from a meta-analysis of omega-3 fatty acid supplementation reported in the August Journal of the American Academy of Child & Adolescent Psychiatry. Researchers Michael Bloch, M.D., and Ahmad Qawasmi, M.D., of the Yale Child Study Center evaluated 10 trials involving 699 children and found a "small but significant effect [for omega-3 fatty acid] in improving ADHD symptoms," but that beneficial effect fell short of that found for stimulants and other pharmacotherapies used to treat ADHD.

Read much more about the latest ADHD-related research and clinical findings in Psychiatric News at http://pn.psychiatryonline.org/content/46/15/24.2.full and http://pn.psychiatryonline.org/content/46/12/19.full. In-depth information about ADHD is also available in the American Psychiatric Publishing volume, ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults. Information about this book is posted at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62158.

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Psychiatrists Should Be Alert to Social Media Pitfalls

While social media like Facebook, YouTube, and their kin become a routine part of life, psychiatrists and other physicians often forget that a little extra analysis is in order before they hit that "send" button sending a potentially unprofessional comment or image into cyberspace. They should expect that patients may search the Internet for information and other material about them and must exercise caution to ensure that their professional role is not compromised, even if material they post is not work related.

Residents and young physicians in particular, for whom using social media is often second nature, may not have thought through the implications of sending every thought and photo into cyberspace. "The idea of privacy as we know it is changing," says John Luo, M.D., past president of the American Association for Technology in Psychiatry. And for psychiatrists, that makes caution the watchword when using social media. "Anything posted can go viral," he warned.

Read more about the pitfalls physicians face in using social media and how they can be avoided in the new issue of Psychiatric News at http://pn.psychiatryonline.org/content/46/17/6.full.

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Private Practitioners Want to Control Costs

Given fixed Medicare and managed care payments, one way physicians can keep their private practices in the black is by identifying costs they can control. These include human-resource expenses, spreading fixed costs out as much as possible, and exploiting the latest information technology.

But how might a psychiatrist harness information technology to control costs? One way is to run nearly the entire practice on a laptop. Psychiatrist Amy Berlin, M.D., who has a solo practice in San Francisco, explained how she does it at this year's APA annual meeting. Read about her nearly paper-free practice in Psychiatric News at http://pn.psychiatryonline.org/content/46/15/11.full.

Some psychiatrists are also getting serious about using electronic health records to save time and space and keep staff costs down. For more information about psychiatrists' experiences in the cyberspace realm, see Psychiatric News at http://pn.psychiatryonline.org/content/45/8/6.1.full.

And more information about how to use technology and the Web to minimize administrative overhead and enhance clinical services is found in American Psychiatric Publishing's Entering Private Practice: A Handbook for Psychiatrists. Purchasing information is available at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemID=62141.

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Sizable Minority of Seniors Have Mild Cognitive Impairment

Between 10 percent and 20 percent of Americans older than age 65 have mild cognitive impairment, the New York Times reported in a September 6 article. It may include lapses in name recall or word finding, trouble remembering appointments, difficulty paying bills, or losing one's train of thought. And it is often, although not always, a precursor to Alzheimer's disease.

But how many people with mild cognitive impairment will actually develop Alzheimer's within five years? More than half, Sylvia Belleville, Ph.D., director of the University of Montreal's Institute of Geriatrics, and colleagues found in a recently released study. And is there any way that those with mild cognitive impairment might be able to substantially lower their Alzheimer's risk? Although the jury is still out as far as memory training is concerned, Belleville and colleagues have found that memory training can in fact lead to brain activation in individuals with mild cognitive impairment, and especially in the hippocampus, the brain's memory center.

For more information on these findings by Belleville and her group, see Psychiatric News at http://pn.psychiatryonline.org/content/46/16/14.1.full.

And for more information about Alzheimer's in general, see Let's Talk Facts About Alzheimer's Disease, from American Psychiatric Publishing. Purchasing information is posted at http://appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemID=2420.

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NYC Firefighters at WTC Have High PTSD Rates

Years after the September 11 attacks on the World Trade Center, researchers found that 7 percent of  New York City firefighters surveyed in 2009-2010 reported probable posttraumatic stress disorder (PTSD), according to a study published online September 7 in Disaster Medicine and Public Health Preparedness.

That figure was less than the 10 percent prevalence found in the first year after 9/11, but is significantly higher than the 1.8 percent reported among the general U.S. male population. Firefighters hired after September 11 recorded only a 1 percent PTSD prevalence.
Early arrival at the World Trade Center site, less exercise, greater alcohol intake, and concurrent symptoms of respiratory or gastroesophageal illness were among the conditions associated with PTSD symptoms, wrote Mayris Webber, Dr.Ph.H., of the New York City Fire Department’s Bureau of Health Services and colleagues. “[PTSD] may thus persist or may arise not solely because of the intensity of the event experienced, but also because of physical injuries or illnesses sustained during the event and changes in health behaviors after the event,” said Webber.

To learn more about the mental health consequences of the September 11 attacks, see Psychiatric News at http://pn.psychiatryonline.org/content/46/17/1.1.full. In addition, comprehensive information about best practices in treating the psychiatric sequelae of disasters is provided in the new book Disaster Psychiatry: Readiness, Evaluation, and Treatment available from American Psychiatric Publishing at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=7217.

Appeals Court Rejects Challenge to Health Care Reform Law

The U.S. 4th Circuit Court of Appeals yesterday rejected a lawsuit by Virginia’s attorney general challenging the 2010 health care reform law. The three-judge panel did not rule on the case's merits, but instead said that the state lacked standing to bring suit since it hadn't been harmed by the law.

Virginia Attorney General Ken Cuccinelli (R) had argued that the Affordable Care Act violated a state law enacted specifically to block the federal health reform law and signed the day after the health reform law was signed.

“If we were to adopt Virginia’s standing theory, each state could become a roving constitutional watchdog of sorts; no issue, no matter how generalized or quintessentially political, would fall beyond a state’s power to litigate in federal court,” said Judge Diana Gribbon Motz. The court also rejected a  separate suit against the reform law by Liberty University in Lynchburg, Va. In that case, the court ruled that the penalty the law requires of individuals who don’t buy health insurance was equivalent to a tax. It said a tax cannot be challenged in court before it is collected.

To read about the outcome of other legal challenges to the health care law, see Psychiatric News at http://pn.psychiatryonline.org/content/46/10/17.1.full.

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Campus Shooting Sheds Light on Genetic Heritability of PTSD

Why do some people develop posttraumatic stress disorder (PTSD) when others—exposed to the same trauma—do not? Studies show that genetic factors interact with trauma to determine who will develop PTSD, but the mechanism for this heritability has been unknown.

Researchers at Emory University and Northern Illinois University had a unique opportunity to evaluate female college students who had been interviewed prior to, and shortly after, a mass shooting on the Northern Illinois University campus in February 2008. They used prospective psychological data, combined with salivary samples of students' DNA, to examine the link between polymorphisms within the serotonin transporter gene promoter region and PTSD/acute stress disorder symptoms that developed in the aftermath of exposure to the shooting.

Their data suggest that the serotonin transporter may mediate responses to severe trauma. “When examined in a relatively homogenous sample with shared trauma and known prior levels of child and adult trauma, the 5-HTTLPR multimarker genotype may serve as  useful predictor of risk for PTSD-related symptoms in the weeks and months following the trauma,” they wrote September 5 in the online Archives of General Psychiatry.

For more about the Northern Illinois University campus shooting and the emergency response of the Illinois Division of Mental Health, see Psychiatric News at http://pn.psychiatryonline.org/content/43/6/2.full. Valuable information this topic is also presented in Clinical Manual for Management of PTSD, new this year from American Psychiatric Publishing, at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62359.

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Is Caffeine Consumption Linked to Pediatric Depression?

Do depressed children self-medicate with soda? A group of researchers in Brazil have reported data that suggest that depressed children consume more caffeine than nondepressed children, primarily in the form of sugary soft drinks. They looked at 51 children aged 9 to 12 who were assessed for depressive symptoms with the Children's Depression Inventory and whose eating habits were assessed with the Nutrition-Behavior Inventory. The children were compared with control children who did not have psychopathology in a Brazilian city.

“We cannot determine whether the high consumption of caffeine in our study population was actually ‘causing’ depression or if high consumption was used to relieve some symptoms of depression,” the researchers wrote in their report, published online August 25 in BMC Pediatrics. “It is possible that children meeting diagnostic criteria for major depression use caffeine to ‘self-medicate’ to ease the symptoms associated with depression.”

Depression in children can also be closely related to symptoms of depression in their mothers. Learn more about this complex interaction in Psychiatric News at http://pn.psychiatryonline.org/content/46/7/13.1.full. Also read much more about childhood depression in American Psychiatric Publishing's Concise Guide to Child and Adolescent Psychiatry, Fourth Edition. Ordering information is available at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62416.

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Oregon Parity Law Does Not Increase Costs Significantly

Parity does not “break the bank.”
  
That was the finding from a study of the effect of Oregon’s law requiring parity coverage of mental illness and substance abuse treatment. The study, appearing online in AJP in Advance, found that increases in spending on mental health and substance abuse services after implementation of Oregon’s parity law were almost entirely the result of a general trend observed among individuals with and without parity. Expenditures per enrollee for mental health and substance abuse services attributable to parity did not differ significantly from zero in any of the four health plans that were studied.

That finding is significant because Oregon’s parity law is unique among state parity laws in that it requires that “non-quantifiable treatment limits”—that is, various restrictions on utilization of services—cannot be more restrictive for mental illness and substance abuse than for general medical and surgical care.

The study of Oregon's parity law follow-up is online at http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2011.11020320v1. And for additional coverage of parity and legal battles around treatment limits in the federal parity law see Psychiatric News at http://pn.psychiatryonline.org/content/45/9/1.1.

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Seniors in the "Doughnut Hole" Buy Fewer Medications

About 12 percent of people receiving the Medicare prescription drug benefit in 2009 fell into the so-called “doughnut hole”—the gap in coverage that is part of the originally designed benefit—according to a study by the Kaiser Family Foundation released today.

While in the doughnut hole, where they receive no Medicare coverage for their prescription drugs, beneficiaries bought fewer drugs, including about 11 percent fewer monthly prescriptions in 2009, compared with the period in which they were getting prescription costs subsidized. The report, “Understanding the Effects of the Medicare Part D Coverage Gap in 2008 and 2009,” analyzes pharmacy claims data compiled by IMS Health and was conducted by researchers at Georgetown University, NORC at the University of Chicago, and the Kaiser Family Foundation.

APA, in collaboration with other mental health groups, established a Web site www.MentalHealthPartD.org dedicated to delivering the latest information on Part D issues. And to read much more about the Medicare prescription drug benefit and the doughnut hole see Psychiatric News at http://pn.psychiatryonline.org/content/44/15/6.1.full.

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National Take-Back Day Is Fast Approaching

Much has been written about the soaring rates of prescription abuse and misuse in the United States, and now a federal agency is trying to enlist the public in a program to change that troubling trend. The U.S. Drug Enforcement Administration (DEA) hopes that its National Prescription Drug Take-Back Day on October 29 will be a way for people with unwanted or out-of-date medications to dispose of them in a safe and controlled manner and thus remove the possibility that they will be misused.

The Substance Abuse and Mental Health Services Administration estimated in 2009 that more than 7 million Americans were abusing prescription drugs, and the Partnership for a Drug-Free America says that that approximately 2,500 teens use prescription drugs rather than illegal ones to get high for the first time each year. Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet, and that people don't know how to properly dispose of unused medications. For its October 29 collection inititative, the DEA has set up prescription-drug disposal centers throughout the United States. A list of the centers is posted at http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html.

To read much more about the crisis involving abuse of prescription medications and strategies to reduce the problem, see Psychiatric News at http://pn.psychiatryonline.org/content/45/17/9.3.full and http://pn.psychiatryonline.org/content/45/20/6.1.full.

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Is Medicine's 'July Effect' Myth or Reality?

Many medical insiders have suggested that every time the calendar turns to July, the massive turnover of medical staff throughout the U.S., usually numbering more than 100,000 personnel, contributes to a temporary drop in the quality of medical care and an increase in mortality as experienced teams are broken up and replaced with staff who are unfamiliar with their new hospital's procedures and culture. This has been called the "July effect."

Researchers at the University of California, San Francisco School of Medicine tested this hypothesis by analyzing 39 studies that had explored this topic and met strict inclusion criteria. Their conclusion--the July effect is, in fact, no myth.

As for the specific causes of the decline in care quality they identified, John Young, M.D., and colleagues said, "Unfortunately, our review discovered little evidence to discern to what extent worsened mortality and efficiency stem from clinical inexperience, inadequate supervision of trainees in new roles, and loss of 'system knowledge' due to cohort turnover." Among remedies suggested in an accompanying editorial in the July Annals of Internal Medicine are staggered starting schedules for trainees.

To read more about this study and the July effect, see the new issue of Psychiatric News at http://pn.psychiatryonline.org/content/46/17/12.full.

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