More Depression Screening Urged for Pregnant Women, New Mothers

Increased screening of pregnant women and new mothers for major depression and conflicts with intimate partners may help identify women at risk for suicide, a University of Michigan Health System-led analysis of federal data concluded. Findings were published online November 7 in General Hospital Psychiatry.

The study analyzed five years of suicide data from the National Violent Death Reporting System. Only a small percentage of women who take their own lives are pregnant or have recently given birth, but their frequent interactions with the health care system provide important opportunities for clinicians to intervene if risk factors are better understood, the researchers said. Among their findings: pregnant and postpartum women had a much higher incidence of conflicts with intimate partners than their counterparts, and Hispanic women were more likely than other ethnic groups to take their own lives when pregnant or soon after giving birth.

For more information on pregnancy and mental health, see Psychological Aspects of Women's Health Care: The Interface Between Psychiatry and Obstetrics and Gynecology, Second Edition, from American Psychiatric Publishing.

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Medication Take-Back Day Nets Over 188 Tons

Americans participating in the Drug Enforcement Administration’s (DEA’s) third National Prescription Drug Take-Back Day on October 29 turned in more than 188.5 tons of unwanted or expired medications for safe disposal at the 5,327 take-back sites available in all the states and U.S. territories. When the results of the three Take-Back Days are combined, the DEA and its state, local, and tribal law-enforcement and community partners have removed nearly 1 million pounds (498.5 tons) of medication from circulation.

“The amount of prescription drugs turned in by the American public during the past three Take-Back Day events speaks volumes about the need to develop a convenient way to rid homes of unwanted or expired prescription drugs,” said DEA Administrator Michele Leonhart, who noted that these three events have dramatically reduced the risk of prescription-drug diversion and abuse.

For more about the history of federal efforts to create safe methods for disposing of prescription drugs, particularly those susceptible to diversion and abuse, see Psychiatric News.

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APA Urging Members to Contact Congress On Medicare Fees

Psychiatrists and other physicians who treat Medicare beneficiaries are facing a reimbursement cut of about 27 percent on January 1, thanks to the Sustainable Growth Rate—or SGR—part of the complex formula the federal government uses to determine how much physicians will be paid by the Medicare program. With the failure of Congress to overhaul or replace the formula, APA has sent an Action Alert to its members urging them to contact their senators and representative and explain why the SGR formula should be repealed. APA points out that the cost of fixing the SGR has soared to $300 billion, and future delays in addressing the problem will only make it much more expensive, and thus much harder, to repair. And allowing the drastic fee cuts to be implemented next year is likely to impede Medicare beneficiaries' access to treatment as fewer physicians will agree to treat that population.

The APA Action Alert, including suggested wording when contacting lawmakers, can be accessed at http://capwiz.com/psychorg/issues/alert/?alertid=57396516. Read more about the SGR problem and its impact on physicians in Psychiatric News.

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Psychiatrists Declare Norwegian Mass Murderer Psychotic

On July 22 Anders Breivik set off bombs in buildings in downtown Oslo, Norway, and then went to a youth camp outside the city where he went on a shooting rampage. In all, 77 people died that day, most of them young campers. Earlier today, psychiatrists evaluating Breivik's mental state at the request of an Oslo court concluded that he was psychotic at the time of the massacre and should be sent to a psychiatric hospital rather than to prison. The report by the two evaluating psychiatrists will now be reviewed by a panel of forensic psychiatrists before the court rules on whether Breivik, who has admitted the killings, will be put on trial, the Associated Press reported.

Immediately after the massacre, Norwegian psychiatrists and other mental health professionals responded as part of emergency teams and in emergency departments. To read an interview with the president of the Norwegian Psychiatric Association and more about the mental health response to the tragedy, see Psychiatric News.

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Creative Individuals May Be Cyclothymic

Students pursuing artistic careers scored higher on the cyclothymic dimension of bipolar disorder than did students pursuing other types of careers, a study published in the December Journal of Affective Disorders has found. In addition to findings from this study, other evidence suggests a link between mental illness and creativity. For more information, see Psychiatric News.

Other studies of a potential link between mental illness and creativity have suggested a connection among creativity, mental illness, and left-handedness or ambidexterity. To learn more about this topic, also see Psychiatric News.

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Hormones Can Contribute to Psychiatric Problems in Women

Women are far more likely than men to develop thyroid problems, especially past age 50, and abnormal levels of thyroid hormones can cause depression, anxiety, or other psychiatric symptoms, according to a report in the November 21 New York Times. The menopausal transition can also put middle-aged women at risk of major depression, a 10-year prospective study has found, and the cause may well be changes in reproductive hormones. You can read more about this study in Psychiatric News.

More information about the menopause and women's mental health can be found in the book Menopause: A Mental Health Practitioner's Guide from American Psychiatric Publishing.

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Substance Use Treament Rates Lower for Minorities

Significant racial and ethnic differences exist in rates of treatment for substance use disorders (SUDs), according to data from 144,000 adolescents in the National Survey on Drug Use and Health covering 2001 to 2008. Of those, 11.4 percent had been treated for a substance use disorder in the prior year.

“The findings indicate exceptionally low rates of treatment for SUDs among all adolescents, with black and Hispanic adolescents experiencing the lowest rates of SUD treatment,” wrote researchers led by Janet Cummings, Ph.D., of the Rollins School of Public Health at Emory University, in the December Journal of the American Academy of Child and Adolescent Psychiatry. After adjustment, about 6.9 percent of blacks and 8.5 percent of Hispanics had been treated in the previous years, compared with 10.7 percent of whites. Adolescents who received mental health treatment were more likely to get substance abuse treatment, too.

Future research should investigate barriers to treatment and whether lower rates of substance abuse treatment lead to worse outcomes later in life, such as more encounters with the criminal justice system, concluded the authors.

For more about teen drug use, see Psychiatric News.

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Bullying Hard to Define, but Still Must Be Tackled

A recent blog in the Washington Post looked at how society has a hard times defining bullying among young people, especially in schools. “Though we can all agree that bullying is wrong, we can’t agree on exactly what it is,” wrote Janice D’Arcy. But stopping bullying doesn’t involve identifying and punishing mean kids, wrote psychiatrist Stuart Twemlow, M.D., in Psychiatric News.

 Bullying is a social process, not a personal one, said Twemlow, a professor of psychiatry at Baylor College of Medicine and co-author with Frank Sacco, Ph.D., of Preventing Bullying and School Violence (American Psychiatric Publishing). “Shaping the child's behavior with social-skills training won’t effect change in the system until group dynamics, often unconscious, are discussed and resolved,” he said. “All schools need to take steps to mold a set of ideas or an approach to prevent bullying, adapt it to their cultural context, and get very high buy-in from staff and parents. Then a school can truly become a creative social, emotional, and intellectual learning environment.”

For purchasing and additional information see Preventing Bullying and School Violence.

Stuart Twemlow’s comments on bullying are published in Psychiatric News.

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Psychiatrist Makes Surprising—and Dangerous—Career Change

Age barriers have fallen in several areas in recent years, but some realms remain stubbornly the province of the young—or do they? One psychiatrist has taken a dramatic step to defuse the myth that the military is one of those areas where only the young are welcome to join. Rebecca Tomsyck, M.D., was in private practice in Charlotte, N.C., when at age 53 she decided to join the U.S. Army. She said she felt a call to serve her country, plus her husband expressed a desire to live overseas. She worked out an agreement with the Army to enter at the rank of lieutenant colonel and be assigned to a post in Germany. In 2007 she was sent to Iraq where she worked with a combat stress unit. In 2010, she was assigned to an Air Force base in Afghanistan where she treated mental health problems in service members from all branches. Then, last summer, now a full colonel, Tomsyck was awarded the Bronze Star for meritorious service in Afghanistan.

To read much more about Tomsyck's mid-life career shift and her experiences in both Iraq and Afghanistan, see Psychiatric News.

(Photo: Rebecca Tomsyck, M.D.) 

Young Children Not Immune From Eating Disorders

Eating disorders don't always wait until adolescence to appear. Young children who intentionally restrict their eating may have eating disorders as well, according to a study published in the October Archives of Pediatrics and Adolescent Medicine. But what actually prompts youngsters to develop eating disorders? Body dissatisfaction and especially body dissatisfaction coupled with depression are among the leading causes, according to a new study. To read more recent research on this topic, see the November 4th issue of Psychiatric News.

In-depth coverage of the etiology and treatments available for eating disorders can be found in the American Psychiatric Publishing book Clinical Manual of Eating Disorders.

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A Simple "Thanks" May Make People More Resilient

Research has shown that experiencing gratitude increases people's ability to deal with adversity, Michael Miller, M.D., editor-in-chief of the Harvard Mental Health Letter, reported in his publication's November issue. But while gratitude appears to be one key element in building resilience, a particularly relevant one at Thanksgiving time, there are many other ways to become resilient as well, research has demonstrated—for example, not working less, but doing work that you love, believing that you can cope with negative emotions, having a reason for living, religious faith, meditation, exercise, altruism, the ability to form and maintain relationships, and the confidence to steer your own life.

More information about these studies can be found in Psychiatric News here and here.

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Americans With Mental Illness Often Lack Health Insurance

Uninsurance rates among adults with frequent mental distress are extremely high, a study published in the October Psychiatric Services has found. Thus many of the people who have the greatest need for treatment, and the health insurance to pay for it, are probably the least likely to have access to it. And regardless of whether the Supreme Court decides if the new health care reform law is constitutional, this study bolsters the argument that the law is likely to benefit a very substantial number of Americans.

More information about the findings and implications of this study can be found in Psychiatric Services at http://ps.psychiatryonline.org/article.aspx?articleid=178311 and in Psychiatric News at http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=180750.

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Weight Loss Drug One Step Closer To FDA Approval

Yet another experimental weight loss drug is making its way toward approval from the U.S. Food and Drug Administration (FDA). Researchers at the Univerity of Alabama's Nutrition Obesity Research Center published online in Obesity last week the results of a 56-week randomized, controlled trial to evaluate the safety and efficacy of a controlled-release combination of phentermine and topiramate, known as Qnexa. In addition to average weight loss of 14.4 percent of initial body weight among those who completed the study at the top dose of the combination, severely obese patients had improvements in blood pressure, glucose, triglycerides, and cholesterol. The results with Qnexa suggest the potential to effectively treat severely obese patients without surgery.

Vivus, Inc., the developer of Qnexa, also announced last week that the FDA has accepted for filing and review the New Drug Application for Qnexa for the treatment of obesity. The FDA is expected to make a decision on the application next April. 

Approval of Qnexa would make it the only prescription appetite suppressant available in the United States. Previous drugs in this class have been approved, but later withdrawn after reports of serious side effects. Read more in Psychiatric News.

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Women Who Drink Before Age 21 More Suicidal, Homicidal

Women born after 1960 and allowed to drink before age 21 are at higher risk for both suicide and homicide, said researchers at Washington University School of Medicine in St. Louis in an online article this week in Alcoholism: Clinical and Experimental Research. In an analysis of data from the U.S. Multiple Cause of Death files, 1990 to 2004, combined with data on the living population from the U.S. Census and American Community Survey, women legally permitted to drink prior to age 21, before the establishment of a uniform drinking age, showed an association between minimum drinking age and committing homicide or suicide. The data contained records on over 200,000 suicides and 130,000 homicides for individuals born from 1949 to 1972, years during which the drinking age was in flux.

"Lower drinking ages may result in persistent elevated risk for suicide and homicide among women born after 1960," concluded the researchers, who estimated that the national drinking age of 21 may be preventing about 600 suicides and 600 homicides annually.

Another recent study showed that giving teens opportunities to drink alcohol in supervised contexts does not inhibit their consumption. Read more about it in Psychiatric News.

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Video Gamers Have More Left Ventral Striatum

Teens who frequently play video games have more left striatal grey matter volume than peers who play less. In a study published online this week in Translational Psychiatry, researchers based at Ghent University in Belgium looked at 154 healthy 14-year-old adolescents (72 males and 82 females) recruited from secondary schools in Berlin. Researchers classified participants as frequent or infrequent players based on whether they played above or below the median of nine hours a week. Using structural magnetic resonance imaging, the researchers found significantly higher left ventral striatum grey matter for frequent vs. infrequent video gamers. "Our results have implications for the understanding of the structural and functional basis of excessive but nonpathological video-game playing and the role of the ventral striatum in ‘behavioral’ addiction," wrote the researchers.

To read about another recent study that found possible connections between television viewing and video-game exposure and the development of attention problems in children, see Psychiatric News.

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Combined Use of Two Psychiatric Drugs Ups Cardiac Death Rate

Combined use of antipsychotic and antidepressant drugs was associated with a greater risk of sudden cardiac death (SCD) during a coronary event than was found in people not using such drugs, said a study in the European Heart Journal. Data from 2,732 people who died of SCD showed that 9.7 percent of patients in the sudden-death group had used antipsychotics, compared with 2.4 percent in the control group, while 8.6 percent of patients in the sudden-death group had used antidepressants, compared with 5.5 percent of controls. The effect was significant among patients using tricyclic antidepressants, but not selective serotonin reuptake inhibitors.

“That clearly shows us that the mental disorder itself was not the reason for the association, but rather that it was the drugs used to treat these patients that made sudden cardiac death more probable,” said Heikki Huikuri, M.D., the study’s principal investigator. The results show the need for cardiologists and psychiatrists to coordinate care of patients with symptoms usually treated by either specialty.

To read more about the association between sudden cardiac death and psychiatric medications, see Psychiatric News.

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Psychiatric Institutions Must Help Patients Quit Smoking

Smoking rates are higher for people with serious mental illness than for the general population, contributing to a 25-year reduction in life expectancy in that population, according to a report from Legacy, a national antismoking organization.

“Individuals who have psychiatric disorders smoke at rates almost twice as high as the general population,” said the report. However, not enough is being done to help people with mental illness to quit smoking, said Legacy CEO Cheryl Healton, Dr.P.H. Many mental health care providers believe that tobacco is just a form of self-medication. Some still use cigarettes as a means of reward and control in psychiatric institutions. “People with mental illnesses are just as motivated to quit as the general population and they should be given that chance to do so,” said Healton. Psychiatric hospitals and clinics should have smoke-free policies, and providers should be trained in tobacco-cessation strategies, which should be integrated into mental health treatment plans, the report concluded.

Read more about the difficulties involved in reducing smoking in psychiatric facilities in Psychiatric News.

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AMA to Work With Stakeholders on Problem of Prescription Drug Shortages

The AMA will work with oncologists, anesthesiologists, the Institute for Safe Medication Practices, and other stakeholders to implement recommendations of the 2010 Drug Shortage Summit. AMA yesterday approved a report by its Council on Science and Public Affairs addressing the problem of prescription drug shortages at the Interim Meeting of the House of Delegates. Child psychiatrist Louis Kraus, M.D. (left), a member of the council, is pictured here with fellow Section Council on Psychiatry member John McIntyre, M.D., at a reception Saturday honoring McIntyre for his work as past chair of the section council.

In an interview with Psychiatric News, Kraus said the council will bring a report to the House next June on the use of antipsychotic medication for children. For information on that topic see Psychiatric News at http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=112103 and  http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=113156.

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Low Birth Weight Is Risk Factor for Autism

Low birth weight may increase a person's chances of developing autism, according to a study in the November Pediatrics. More than 600 children who were born in the mid-1980s weighing 4.4 pounds or less were followed until age 21. The researchers found that 5 percent of them had autism spectrum disorder diagnoses, a rate five times that found in the general American population. Also, the lower the birth weight, the higher the likelihood of an autism diagnosis.

The latest knowledge about the causes of and treatments for autism can be found in a new book, Textbook of Autism Spectrum Disorders, published by American Psychiatric Publishing. See www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62341.

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AMA Report Supports Designation of Intellectually Disabled as Medically Underserved

A report by the AMA’s Council on Medical Services debated yesterday at the AMA’s Interim Meeting of the House of Delegates in New Orleans will put the AMA’s support behind an effort to classify individuals with intellectual disabilities as a medically underserved group. Psychiatrist Vijaya Appareddy, M.D., a former vice chair of the President’s Committee on Intellectual Disabilities, brought a resolution to the AMA house last year that resulted in the CMS report. The report will likely be approved when the full House of Delegates meets this afternoon. Appareddy, pictured here, says designation as a medically underserved group will help to improve access and quality of care for a vulnerable population. For further coverage of the meeting, see upcoming editions of Psychiatric News; for information about intellectual disabilities, see http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=104486 and http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=104001.

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Americans Impatient With Alzheimer's Research Progress

Tens of thousands of Americans are calling on the government to correct "dramatically underfunded research" for Alzheimer's disease and to improve diagnostic tools and treatments for it, according to a report released by the Alzheimer's Association on November 7. But what many of these people probably do not realize is that extensive research into Alzheimer's disease is already taking place and is bearing fruit. For example, scientists recently reported the finding that amyloid plaques can build up in the brain long before Alzheimer's-associated memory loss appears.

Read much more about this study in Psychiatric News. Researchers also recently reported that a dramatic cognitive decline is seen years before a diagnosis of Alzheimer's is made. 

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Physicians Oppose Grassley Proposal on Off-Label Prescribing

Physicians at the AMA House of Delegates meeting in New Orleans today said they oppose a requirement proposed by Iowa Sen. Charles Grassley that physicians who prescribe medications with “black-box” warnings on an off-label basis certify in writing that the drug meets minimum criteria for coverage and reimbursement by virtue of being listed in one authorized drug compendia used by Medicare. A resolution opposing the Grassley amendment is part of a larger item brought to the house by the American Medical Directors Association on prescribing atypical antipsychotic medications for people with dementia. That motion calls for the AMA to help create educational tools and programs to promote appropriate pharmacological techniques for managing behavioral symptoms of dementia. Pictured is psychiatry section council member Paul Wick, M.D., who spoke at reference committee hearings this morning in support of the resolution. The fate of the resolution will be decided this week when the full House of Delegates meets. See upcoming editions of Psychiatric News for coverage of the AMA meeting, and for more information on the issue of antipsychotics and dementia, see http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=112827.

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Psychiatry Flexes Its Muscle at the AMA

Psychiatrist John McIntyre, M.D., was honored at a reception last night during the American Medical Association’s Interim Meeting of the House of Delegates in New Orleans. A past president of APA and former chair of the Section Council on Psychiatry, McIntyre is serving his second term on the AMA’s Council on Medical Services and continues to be active in the section council. He is pictured here with the current section council chair, Carolyn Robinowitz, M.D.  

In recent years APA’s delegation to the AMA has become among the most influential in the House of Medicine. At the annual meeting of the House of Delegates in June, psychiatrist Jeremy Lazarus, M.D., who is speaker of the house, was elected president-elect of the AMA and will assume the presidency in June 2012. Additionally, Patrice Harris, M.D., was elected to the Board of Trustees, and Stuart Gitlow, M.D., won re-election to the Council on Science and Public Health. For more information, see Psychiatric News.

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AMA House to Consider Resolution on Use of Antipsychotics for Dementia

Use of antipsychotic medications for patients with dementia in long-term care facilities will be among the issues discussed over the next three days by physicians gathering today for the interim policymaking meeting of the American Medical Association’s House of Delegates in New Orleans. (Pictured is psychiatrist Jeremy Lazarus, M.D., who was elected president-elect of the AMA in June; Lazarus will begin his tenure as president in June 2012.) See upcoming editions of Psychiatric News for coverage of the meeting; for reports on the use of antipsychotics to treat dementia, see http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=108443,  
and http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=115824.

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Most Smokers Don't Make Use of Available Help to Quit

More than two-thirds of people who smoke wish they didn't. The Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report  found that that in 2010, 69 percent of adult smokers wished to quit; of those, only 6.2 percent succeeded, and most smokers did not utilize advice, counseling, or other assistance to help them quit. For Psychiatric News coverage of issues around smoking cessation, see http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=113083, http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=112771, and
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=112592.

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Steep Cuts in State Funding Will Hurt Mentally Ill People

Between 2009 and 2011, more than $1.6 billion was cut from state funds for mental health services, says the National Alliance on Mental Illness in a report released today. These cuts led to significant reductions in both hospital and community services for vulnerable individuals with serious mental illness. The data in the report are limited to general fund appropriations for state mental health agencies and does not include mental health funds under the control of other state agencies such as state Medicaid agencies, housing authorities, or child and family authorities. The NAMI report follows and expands upon a similar one it issued by in March. For more information, see Psychiatric News.

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Stroke Risk Factors Predict Cognitive Decline

Vascular risk factors may lead to cognitive impairment, even if they don’t lead to stroke. Researchers at Indiana University School of Medicine evaluating participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study found that subjects with significant risk factors for stroke—even if they didn't experience stroke—were more likely than their peers to develop cognitive decline. "Subclinical cerebrovascular disease including white-matter abnormalities, silent cerebral infarction, and brain atrophy may underlie the association we saw between stroke risk factors and cognition,” wrote Frederick Unverzagt, Ph.D., an associate professor of psychiatry, and his colleagues in the November 8 Neurology.

Their results suggest that the Framingham Stroke Risk Profile (FSRP), which provides an estimate of the 10-year risk for future stroke based on age and presence and severity of several cardiovascular risk factors, might also be a useful tool for predicting changes in cognitive function.

In related news, a recent study bolsters evidence that depression may be a robust predictor of stroke, even independently of memory impairments that might precede a stroke. Read more about it in Psychiatric News.

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Children Are Affected by Depressed Dads

Children who live with their depressed fathers are more likely than their peers to have emotional and behavioral problems. That’s the finding of Michael Weitzman, M.D., a professor of pediatrics and psychiatry at New York University School of Medicine, and colleagues published in the November 7 Pediatrics. The researchers said the negative effects of maternal mental health problems on child health are well documented, but this is the first study to show that living with depressed fathers is independently associated with increased rates of children's emotional and behavior problems. Their study population was a representative sample of 22,000 children and their parents.

 “[T]his finding raises questions of great importance about how to educate the health care workforce, how to develop and implement strategies to facilitate identifying fathers with mental health problems, and how to develop referral systems and ways to reimburse for this vital work,” wrote Weitzman and colleagues.

To read more about the association between maternal mental health and child behavior, see Psychiatric News.

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Too Many Brain Cells Are Sign of Autism

Having a big brain may seem like an advantage at first thought, but new research indicates that it may be one symptom of autism. Boys with autism displayed an abnormally large number of neurons in the prefrontal cortex, the area of the brain involved in social, communication, and cognitive development, according to lead researcher Eric Courchesne, Ph.D., of the University of California, San Diego. Courchesne and colleagues reported in the November 9 JAMA that the brains of seven boys with autism contained 67 percent more cortical cells than brains of boys without autism. Those cells develop in great numbers early in fetal development but are normally removed during the last trimester.

“[I]f future research can pinpoint why an excessive number of brain cells are there in the first place, it will have a large impact on understanding autism, and perhaps on developing new treatments,” said Courchesne. For more about autism, see Psychiatric News.

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Child Psychiatrists, Pediatricians Team Up to Help Kids

The shortage of mental health providers for children and adolescents has led to creative consultative relationships between child psychiatrists in academic centers and the primary care clinicians who see young patients in their offices. Programs already exist in places like Washington state and Massachusetts. There, child psychiatrists are easily available during working hours to consult by phone with pediatricians. The psychiatrists also can do face-to-face evaluations of children referred by the pediatricians when needed and offer periodic in-service training in psychiatry to pediatricians and their staffs. Now, psychiatrists and pediatricians have formed the National Network of Child Psychiatry Access Programs to support the development and sustainability of state and local programs in 25 states and help new ones to develop. For more information on integrated pediatric care, see Psychiatric News.

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High Court to Hear Case on Teens' Prison Sentences

One year after it ruled that youth under age 18 cannot be sentenced to life in prison without the possibility of parole in non-homicide cases, the Supreme Court said on Monday it will hear two cases to decide whether it is also unconstitutional to sentence juvenile murderers to life-without-parole sentences. In their 2010 ruling, the court's majority considered testimony from psychiatric and other mental health experts that adolescents' still-developing brains may not provide them with the same decision-making capabilities as those of adults, and thus should not be subject to the same penalties as the most severe for which adults are eligible. The justices ruled that sentencing minors who haven't commited murder to life without parole violates the Eighth Amendment's ban on cruel and unusual punishment. In an amicus curiae brief APA and other organizations submitted in the 2010 case, they stressed that "juveniles...are less able to restrain their impulses and exercise self-control [and] less capable than adults of considering alternative courses of action and maturely weighing risks and rewards...."

To read more about APA's amicus brief and the Court's reasoning in the 2010 case, see Psychiatric News.

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Seriously Ill Psychiatric Patients Need New Home

The future of the former residents of the now-shuttered Vermont State Hospital remains uncertain, as state officials desperately seek housing alternatives for those displaced by severe flooding that devastated the hospital in August. Vermont Gov. Peter Shumlin (D) recently announced his intention to keep the hospital closed while a newer, smaller facility is built. The hospital has had a troubled history, including the 2003 loss of its certification, but the sudden evacuation of its 51 patients has created an unprecedented challenge for state officials, reported a recent article in the New York Times. According to the paper, local hospitals Fletcher Allen and Rutland Regional Medical Center have provided temporary beds for some of the displaced patients, but they are not staffed and equipped to handle severely ill psychiatric patients, and a permanent fix has yet to be determined. Read more about the recent closure of the only state hospital in Vermont in Psychiatric News.

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Memory Blips in Your Earlier Years Rarely Serious

"Memory lapses  can be aggravating, frustrating, and even embarrassing," Susan Lehmann of the Johns Hopkins Hospital Geriatric Psychiatry Clinic was quoted as saying in the October 11 Washington Post. "[But] the truth is that occasional memory blips in your 30s—and even in your 40s and 50s—rarely signal a serious problem." But what happens when you reach your 60s and 70s —when do memory blips indicate a concern about development of Alzheimer's disease?

Not long ago, leading Alzheimer's experts, under the aegis of the National Institute on Aging and the Alzheimer's Association, came together to answer this question. Alzheimer's should now be viewed as consisting of three stages, they decided: a stage where there are no obvious symptoms, but where noxious changes are already brewing in the brain, or what is called the "preclinical phase"; a stage in which mild cognitive problems emerge, but daily functions can still be performed, or what is called the "mild cognitive impairment phase"; and a stage in which a person meets clinical criteria for a probable diagnosis of Alzheimer's, or what is called the "Alzheimer's dementia phase."

More information about these guidelines can be found in Psychiatric News at http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=108666. 

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Varenicline Side Effects Continue to Be Serious Concern

The smoking-cessation medication varenicline (Chantix) is linked with a significantly greater risk of suicidal behavior than other smoking-cessation products, Curt Furberg, M.D., Ph.D., a professor of public health sciences at Wake Forest University, and colleagues reported online November 2 in the journal PloS One. Furberg and his colleagues have also published research coupling varenicline use with violence toward others. For more information about this research, see Psychiatric News at http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=114040.

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Dimensional Measures Show Significant Comorbidity Among Seriously Mentally Ill

Dimensional diagnostic measures, such as those being proposed for use in DSM-5, reveal a more complex symptom profile for public-sector patients with serious mental illness than do categorical diagnoses, said William Narrow, M.D., M.P.H, associate director of APA’s Division of Research, at a symposium at APA's Institute on Psychiatric Services last week in San Francisco. Narrow presented a study by the American Psychiatric Institute for Research and Education in which rates of categorical diagnoses and dimensional symptom ratings were examined for patients with schizophrenia, major depressive disorder, PTSD, and substance use disorders.

For each of these diagnostic groups, the dimensional ratings revealed significant comorbidity that was not captured by the DSM-IV categorical diagnoses. For instance, among patients with schizophrenia, 10 percent had anxiety symptoms that were rated as “severe,” and 73 percent had symptoms of anxiety that were either “mild” or “moderate.” Yet only 6 percent had received a diagnosis of anxiety. 

Psychiatric News is running a series of articles titled “DSM-5: Advancing Diagnostics” about proposed changes to the manual, including the dimensional measures that are being proposed. See Psychiatric News here and here. 

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Schizophrenia-Related Genes Active Before Birth

Some genes suspected of causing schizophrenia are activated in the developing brain before birth, a study published October 27 in the journal Nature suggests. Insights into other prenatal factors that contribute to schizophrenia are also emerging—for example, that when fetal distress is followed by developmental delay, it increases a child's risk of developing schizophrenia fivefold. For information about this study, see Psychiatric News.

Information about still other prenatal factors that increase the risk of schizophrenia can be found in the new American Psychiatric Publishing book Essentials of Schizophrenia, which provides the latest knowledge of the causes, nature, and treatment of schizophrenia.

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CDC Declares Painkiller Deaths Epidemic

Deaths from prescription painkillers--opioids or narcotics--have become a public-health epidemic, said the Centers for Disease Control and Prevention (CDC) in the November Vitalsigns. The number of overdose deaths is now greater than those of deaths from heroin and cocaine combined, and a big part of the problem is nonmedical use of prescription painkillers. In 2010, about 12 million Americans reported nonmedical use of prescription painkillers in the past year. Enough prescription painkillers were prescribed in 2010 to medicate every American adult around the clock for a month. Although most of these pills were prescribed for a medical purpose, many ended up in the hands of people who misused or abused them.

Improving the way prescription painkillers are prescribed can reduce the number of people who misuse, abuse, or overdose from these drugs, while making sure patients have access to safe, effective treatment, said the CDC.

A stunning increase in the diversion and abuse of opioid medications may be an unintended measure of the success of efforts to provide patients with better control of their pain. Read more about it in Psychiatric News.

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Irritable Bowel Syndrome a Common Mental Health Issue

Irritable bowel syndrome (IBS) may be the result of psychological and emotional traumas in many patients, researchers from the Mayo Clinic reported at the American College of Gastroenterology's annual meeting in Washington, D.C. this week. Childhood and adult traumas are more common among adults with IBS, and general life traumas were more commonly reported than were physical, emotional, or sexual abuse.

"While stress has been linked to IBS, and childhood abuse has been reported to be present in up to 50 percent of patients with IBS, at a prevalence twice that of patients without IBS, most studies of abuse have focused on sexual abuse with sparse detail and also have not looked at other forms of psychological trauma," said Yuri Saito-Loftus, M.D., who presented the findings. "This is the first study that looks at multiple forms of trauma, the time of those traumas, and traumas in a family setting."

Stress and anxiety also characterize patients who develop IBS after a bout of viral or bacterial gastroenteritis. Read more about this topic in Psychiatric News.

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Military Must Do More to Curb Suicides

“America is losing its battle against suicide by veterans and service members,” write Dr. Margaret C. Harrell and Nancy Berglass in a report from the Center for a New American Security, a Washington think tank. “And, as more troops return from deployment, the risk will only grow.” While the authors credit military officials for taking steps to reduce suicide, they also note a number of obstacles that remain. These include frequent relocation, unwillingness to answer mental health questions truthfully following deployment, and a military culture that stigmatizes mental health care. “Understanding and addressing the challenge of suicide requires cooperation beyond the traditional jurisdictional boundaries for many organizations, including the Departments of Defense, Veterans Affairs, Health and Human Services, and the Congress,” wrote Harrell and Berglass.

For more about military mental health, see Psychiatric News.

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Law Professor With Schizophrenia Endows Institute

Elyn Saks, J.D., a professor of law at the University of Southern California and an individual with schizophrenia, has received a $500,000 MacArthur Foundation genius award, according to the October 23 New York Times. Saks has used her award money to establish the Saks Institute for Mental Health Law, Policy, and Ethics at the University of Southern California. More information about Saks and her fight against, and triumph over, schizophrenia can be found in Psychiatric News.

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Binge Eating Not Just an Issue for Women

It appears that men are just as likely to binge eat as women, as well as to suffer from such associated conditions as depression, stress, and sleeplessness, finds a new study featured in the October 26 online edition of the International Journal of Eating Disorders. According to lead study author Ruth Striegel-Moore, Ph.D., a professor of psychiatry at Wesleyan University, the findings point to a need for education and outreach across gender lines, as men may be less likely than women to seek treatment. Of the 24,608 women and 21,743 men completing self-administered health risk assessments, 11.2 percent and 7.5 percent, respectively, reported behavior indicative of binge eating. More about the diagnosis of binge eating can be found in American Psychiatric Publishing’s Developing an Evidence-Based Classification of Eating Disorders, co-edited by Striegel-Moore.

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Indicators of Mental Illness Found in the Developing Brain

Most genes associated with mental illness, including those previously linked with autism and schizophrenia, are expressed before birth. So finds a new study led by Yale University and featured in the October 27 Nature. An international team of researchers identified when and where in the brain genes were expressed in more than 1,000 tissue samples taken from 57 subjects aged from 40 days after conception to 82 years old. According to Yale, the study’s findings show how much of the human brain is shaped in the womb. Further exploration of the genetic foundation of mental illnesses can be found in Developmental Psychopathology and Wellness and Psychopathology in the Genome and Neuroscience Era, both by American Psychiatric Publishing.

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