Sites Differ in How They Diagnose Autism, Supporting Need for DSM Revisions

Clinical centers with expertise in diagnosis and treatment of autism differ dramatically in how they diagnose children with autism symptoms, according to a report published online November 7 in the Archives of General Psychiatry. A large multisite study found significant differences in how clinical centers assigned three diagnoses— autism, Asperger’s, or PDD-NOS (pervasive developmental disorder not otherwise specified)—to children with autism symptoms. Moreover, relationships between clinical diagnoses and standardized scores, particularly verbal IQ, language level, and core diagnostic features, varied across sites.

The results support revisions to the criteria for autism proposed by APA's DSM-5 Work Group on Neurodevelopmental Disorders, including the creation of a single diagnostic entity—autism spectrum disorder—and the incorporation of dimensional measures of severity for associated features such as IQ, social communication, restricted interests, and repetitive behaviors.

For more information about autism see Psychiatric News here and here.

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TBI, But Not Epilepsy, Associated With Violent Crime

Epilepsy is not associated with increased risk of violent crime, but traumatic brain injury is, according to results of a 35-year Swedish population study published December 27 in PLOS Medicine. Researchers from the Centre for Violence Prevention at Sweden's Karolinska Institute combined Swedish population registers from 1973 to 2009, and examined associations of epilepsy and traumatic brain injury with subsequent violent crime, defined as convictions for homicide, assault, robbery, arson, any sexual offense, or illegal threats or intimidation. Each case was age and gender matched with 10 general-population controls. Cases were also compared with unaffected siblings to assess familial factors.

“In this longitudinal population-based study, we found that, after adjustment for familial confounding, epilepsy was not associated with increased risk of violent crime, questioning expert opinion that has suggested a causal relationship,” wrote the researchers. “In contrast, although there was some attenuation in risk estimates after adjustment for familial factors and substance abuse in individuals with traumatic brain injury, we found a significantly increased risk of violent crime. The implications of these findings will vary for clinical services [and] the criminal justice system....”

Read about a promising—and surprising—treatment for traumatic brain injury in Psychiatric News.

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Memantine Doesn't Improve Depression and Apathy in Disabled Older Patients

Memantine doesn’t appear to offer improvement to elderly patients who suffer a disabling medical event and subsequently become depressed and apathetic. Preclinical data have suggested that memantine,  used for treatment of moderate to severe Alzheimer's disease, could reduce depressive and amotivated behavior occurring in the context of psychosocial stress. Researchers at Washington University  examined whether memantine could reduce depressive symptoms and amotivation manifesting in older adults after a disabling medical event, thereby improving their functional recovery. They recruited patients aged 60 and older who had suffered a disabling medical event and were admitted to a skilled nursing facility for rehabilitation. Participants with significant depressive symptoms and/or significant apathy symptoms were randomized to treatment with memantine or placebo for 12 weeks.

Both groups showed reduction in depressive symptoms and improved function, but no significant reduction in apathy symptoms; there were no group differences between those who received memantine and those who received placebo. “Memantine was not associated with superior affective or functional outcome compared with placebo in medically rehabilitating older adults with depressive and apathy symptoms,” wrote the researchers online December 16 in the International Journal of Geriatric Psychiatry.

Memantine's benefit in the treatment of Alzheimer's disease has also been recently questioned. Read more in the Journal Digest feature of Psychiatric News.

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Drug Companies Ready Purer Form of Highly Abused Opioid

Hydrocodone is currently the second-most-abused medication in the United States, according to a December 26 Associated Press report, and efforts underway by four pharmaceutical firms to introduce a stronger formulation of the drug could increase its potential for misuse. While the drug companies maintain that uncut hydrocodone will limit the dangers associated with such commonly used painkiller fillers as acetaminophen, experts in the substance-abuse arena have expressed major concerns about the availability of a medication that is up to 10 times more powerful than Vicodin and other powerful opioid pain pills, said the AP, which noted that the drug company Zogenix has indicated that it plans to apply for the marketing of a time-released version of the medication in the first half of 2012. Read more about the risks associated with prescribing opioids to treat pain in Psychiatric News.

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Congress (Again) Approves Respite From Impending Medicare Pay Cut

Early this morning the House of Representatives and Senate approved a measure to extend the payroll tax cut through February; the measure also postpones scheduled cuts in reimbursements to doctors who serve Medicare patients. And the federal Centers for Medicare and Medicaid, anticipating congressional action to avert the reduction in the 2012 Medicare Physician Fee Schedule, announced yesterday it is extending the 2012 Annual Participation Enrollment Period through February 14, 2012. The effective date for any participation status change during the extension, however, remains Sunday, January 1, 2012, and will be in force for the entire year. Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are postmarked on or before Tuesday, February 14, 2012.

Psychiatric News has provided extensive coverage of the issue of Medicare payment. To read about this issue, click here and here.

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Cortical Thickness Measured by Imaging May Predict Alzheimer's

Cortical shrinkage as measured by magnetic resonance imaging may predict risk of developing Alzheimer’s disease, according to a report in the December 13 Neurology. In the study, 19 people who had the most shrinkage in those regions were rated as being at high risk for Alzheimer’s. Another 116 were rated as at average risk, and 24 more were rated as at low risk based on their brain measurements, according to researchers at Massachusetts General Hospital and the University of Pennsylvania.

After three years, about 21 percent of people in the high-risk group were the most likely to have deficits in the way they learned and remembered words and solved problems, compared with 7 percent of those in the average-risk group, and none in the low-risk group.

Read more about how brain imaging can help predict risk of Alzheimer’s disease in Psychiatric News.

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High Birth Weight May Be Linked to Schizophrenia

Big babies may share an increased risk of eventually developing schizophrenia. Researchers in Finland investigated the link between birth weight and schizophrenia in a large schizophrenia family study sample. They used the birth-weight data of 1,051 offspring from 315 Finnish families with at least one offspring with a diagnosis of schizophrenia. "Infants with a high birth weight are nearly twice as likely to develop schizophrenia as those born with a normal weight," they wrote in the December 30 Psychiatry Research. Using information from the Medication Reimbursement Register and patient interviews, they further investigated the association of maternal type 2 diabetes and schizophrenia risk among offspring. High birth weight (>4000g) was associated with a 1.68-fold increase in schizophrenia susceptibility. Maternal diabetes at time of data collection, a proxy for gestational diabetes, was associated with a 1.66-fold increase in the risk of schizophrenia among offspring.

The researchers said their results corroborate recent findings showing an association between high birth weight and schizophrenia and point to a potential birth-weight-independent association between maternal type 2 diabetes and schizophrenia among offspring.

For information about other factors common in children who later develop schizophrenia, see Psychiatric News.

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Why "Bath Salts" Are Addictive

New research by scientists at the National Institute on Drug Abuse (NIDA) indicates that the active compounds in "bath salts" (mephedrone and methylone) bind to monoamine transporters on the surface of some neurons. This in turn leads to an increase in the brain chemical serotonin, and to a lesser extent, dopamine, suggesting a mechanism that could underlie the addictive potential of these compounds.

"Our data demonstrate that designer methcathinone analogs are substrates for monoamine transporters, with a profile of transmitter-releasing activity comparable to 3,4-methylenedioxymethamphetamine (MDMA, or 'ecstasy')," wrote NIDA researchers in the online December 14 Neuropsychopharmacology. "Given the widespread use of mephedrone and methylone, determining the consequences of repeated drug exposure warrants further study," they said.

Read more about "bath salts" in Psychiatric News. 

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Antidepressant Reduces Repetitive Behaviors in Adult Autism

Adults with autism treated with the antidepressant fluoxetine experienced a significantly greater reduction in repetitive-behavior symptoms than those on placebo, according to a report in the American Journal of Psychiatry and AJP in Advance.


Thirty-five percent of the 20 patients on fluoxetine responded, compared with none of the 13 on placebo, and 50 percent of patients on fluoxetine showed improvement in obsessive-compulsive disorder symptoms, compared with 8 percent of placebo patients, said Eric Hollander, M.D., a clinical professor of psychiatry at Albert Einstein College of Medicine and director of the Compulsive, Impulsive, and Autism Spectrum Disorder Program at Montefiore Medical Center. “Many people trying to deal with autism believe that you have to intervene early on or it gets fixed in place,” said Hollander. “This study shows that you can intervene in adulthood and get meaningful improvement.”

Hollander discusses his research in the December 21 Psychiatric News Update.

For more information, see the Textbook of Autism Spectrum Disorders from American Psychaitric Publishing.

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Both Men and Women Troops Need Full MH Evaluation

It is critical that both men and women who have served in war zones in Iraq and Afghanistan be evaluated for a full range of combat exposures, said researchers for the departments of Defense and Veterans Affairs. Female troops reported higher levels of combat exposure in this new study than in previous surveys, wrote Shira Maguen, Ph.D., of the San Francisco VA Medical Center and colleagues online December 21 in the Journal of Psychiatric Research.

The study also found that men had more high-intensity combat experiences than women, yet PTSD rates were similar regardless of gender. The association between injury and PTSD was stronger for women than for men, and women were more likely to have experienced military-related sexual trauma than men were. Women were more likely to report depressive symptoms, while men were more apt to acknowledge  problem drinking. Clinicians should be aware of these differences, particularly injury, said the authors, “as not all types of combat experiences may be equally experienced by men and women returning from military deployments."

To read more about veterans’ mental health in Psychiatric News, click here.

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States Get Power to Design Health Insurance Packages

In a decision that could result in less-generous insurance benefits for mental health care than the original promise of health reform, the Obama administration has decided that states will get to determine what will be covered in the package of minimum benefits that millions of Americans will get through private insurers. As announced by Health and Human Services Secretary Kathleen Sebelius, states could choose among several packages of benefits that will be offered to their residents. These could range from the comprehensive benefits offered to federal employees to those included in the more limited packages offered by small-business insurance plans or even through HMOs. These benefit packages would apply to those gaining private insurance through provisions of the health reform law, those already insured through plans offered by small businesses, and those purchasing individual plans. If a state declines to choose a minimum package, the default is the coverage offered in the state's most popular small-business plan.

Learn more about key aspects of the health care reform law in the APA publication "Health Care Reform: A Primer for Psychiatrists" and in Psychiatric News.

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Same-Sex Marriage Good for Men's Mental Health

It appears that the passage of laws allowing same-sex couples to marry have significant benefits that go beyond those that come with the legal advantages that marriage bestows. A study in Massachusetts, where same-sex couples have had the right to marry since 2003, found that in the first 12 months after the law was enacted, gay men's health care use and costs went down significantly. This reduction applied whether the health care visits were for mental health or physical health issues, according to research by Mark Hatzenbuehler, Ph.D., a Robert Wood Johnson Foundation Health and Society Scholar at Columbia University, and colleagues. And this apparent improvement in gay men's health did not apply only to men who had married a same-sex partner, but to gay men who were not in a partnered relationship as well. The study was published online December 15 in the American Journal of Public Health.

Read about the mental health implications of same-sex marriage laws in Psychiatric News here and here.

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Facebook Helps Suicidal Individuals

The social-media site Facebook is making it easier for people who are experiencing suicidal thoughts to get help, the Associated Press reported December 13. The program "enables users to instantly connect with a crisis counselor through Facebook's 'chat' messaging system," said Fred Wolens, public-policy manager at Facebook.

Facebook is also finding an audience among psychiatrists who find it useful professionally. At least one is using it as a tool for a multicenter psychiatric study. But psychiatrists who use Facebook caution that there can be challenges—for example, what should you do when patients send you friend requests? For more information on the pros and cons of psychiatrists' use of social media, see Psychiatric News here .

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Holidays Especially Hard on Those Who Are Grieving

The Christmas/New Year holiday season is often the most difficult time of the year for people who are grieving, Michael Miller, M.D., editor-in-chief of the Harvard Mental Health Letter, notes in its December 2011 issue. Among strategies he suggests to help grieving individuals ease their pain at this time of year are placing a lighted candle on the dinner table or leaving an empty chair on behalf of the deceased loved one. Another suggestion to ease the pain is to make a donation to a favorite cause in memory of that person.

The death of a loved one, however, is just one of the types of loss that creates emotional pain and can be interpreted as a blow to one's ego, James Frosch, M.D., an assistant clinical professor of psychiatry at Harvard Medical School, maintains. To spare themselves the anguish, rage, or other negative emotions provoked by a serious loss, people need to develop a capacity to tolerate loss, Frosch asserts. For more information about Frosch's views on this subject, see Psychiatric News here.

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Growth Factor in Blood May Predict Antidepressant Response

A blood test for a protein called vascular endothelial growth factor (VEGF) may help predict response to antidepressant treatment, according to researchers at Loyola University Medical Center who presented their findings at the 2011 annual meeting of the Society of Biological Psychiatry and the 4th Annual Illinois Brain, Behavior, and Immunity Meeting.

The study found that among depressed patients who had higher than normal blood levels of VEGF, more than 85 percent experienced partial or complete relief from depression after taking escitalopram, while fewer than 10 percent of patients who had low levels of VEGF responded to the drug. Some scientists have proposed that SSRIs like escitalopram promote neurogenesis, the regeneration of cells in specific parts of the brain that have atrophied in depressed patients. The Loyola study supports the neurogenesis theory; in the brain, VEGF stimulates the growth of blood vessels and works in other ways to keep brain cells healthy and active.

Predicting who will best respond to antidepressant treatment is an important goal for individualizing therapy. For more information on this subject see Psychiatric News here.

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Antidepressants Can Play Role When Older Drivers Crash

Prescriptions for second-generation antidepressants in older adults are associated with a modest increased risk of motor vehicle crashes, when combined with other medications that can impair cognition, finds a collaborative study by the Institute for Clinical Evaluative Sciences, Ontario Ministries of Health and Transportation, and Sunnybrook Health Sciences Centre, reported in the December American Journal of Geriatric Psychiatry.

Researchers reviewed databases for adults age 65 and older in Ontario, Canada, between January 1, 2000, and October 31, 2007. A total of 159,678 individuals had a crash during the study, of whom 7,393 (5 percent) received an antidepressant in the month prior to the crash, but antidepressants alone did not lead to a heightened risk of a motor vehicle crash. Rather, risk was associated with crashes in which the individual used another strong, centrally acting medication, such as a benzodiazepine or anticholinergic as well. Noted limitations to the study included a lack of information about the dose of the antidepressants and the possible effects of dementia. Much more research is needed on the effect of depression and antidepressants on driving, the researchers noted.

For more about antidepressant use in geriatric patients, see the Essentials of Geriatry Psychiatry, Second Edition, available from American Psychiatric Publishing in January.

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Opioid-Dependent Patients Lack Knowledge About Treatment

Patients with opioid dependence may not have the information they need to make good treatment decisions, even if they think they do. Researchers at the European Monitoring Centre of Drugs and Drug Addiction in Lisbon, Portugal, report in the December The Psychiatrist the results of a cross-sectional survey to assess patient knowledge and information about opioid substitution treatment among individuals with opiate dependence receiving treatment at four centers in London. The 118 study participants answered correctly a mean of 14 out of 34 questions assessing knowledge about medication, blood-borne viruses, and overdose. Participants overestimated their performance on average by almost 40 percent. Individuals with a history of previous treatments scored significantly higher than those in their first treatment episode. The majority reported having received written information on most of the topics assessed.

“Poorly informed patients are unlikely to make optimal treatment choices,” wrote the researchers. “Improving patients’ knowledge and understanding about treatment may lead to better engagement, retention, treatment adherence, and ultimately, better health outcomes.”

For more about treatment of opioid dependence, see the Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence, from American Psychiatric Publishing.

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FDA Says Link Between SSRIs and Rare Newborn Disease Is Unproven

It's premature to reach any conclusion about a possible link between SSRI use in pregnancy and a rare heart and lung condition known as persistent pulmonary hypertension of the newborn (PPHN), according to the Food and Drug Administration (FDA). In a “Safety Communication” released yesterday, FDA said it has reviewed data and concluded that given the conflicting results from different studies, it is premature to reach a conclusion about a link between SSRI use in pregnancy and PPHN. FDA will update SSRI drug labels to reflect the new data and the conflicting results. An initial Public Health Advisory in July 2006 on this possible risk was based on a single published study, and since then, there have been conflicting findings from studies evaluating this potential risk. Based on its data review, FDA advises health care professionals not to alter their current clinical practice of treating depression during pregnancy. The FDA Safety Communication is posted at www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm283696.htm.
 To read coverage of this issue in Psychiatric News, click here.

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No Change in Mental Health Problems After Abortion

A systematic review of 44 published studies finds that rates of mental health problems among women with unwanted pregnancies are equal regardless of whether they gave birth or had an abortion. The National Collaborating Centre for Mental Health at Britain’s Royal College of Psychiatrists reported what it said was “the world’s largest, most comprehensive, and systematic review into the mental health outcomes of induced abortion.

 Having a history of mental health problems most strongly predicted having similar problems after an abortion, according to the study. Also, an unwanted pregnancy was associated with a greater risk of mental health problems. “Our review shows that abortion is not associated with an increase in mental health problems,” said Roch Cantwell, M.B.B.Ch., a consultant perinatal psychiatrist at Southern General Hospital, Glasgow, and chair of the study’s steering group.

The report suggests that future practice and research should focus on the mental health needs associated with an unwanted pregnancy, rather than on the resolution of the pregnancy.

For another story in Psychiatric News about mental health and abortion, click here

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Resilience Training Boosts Military Families

A program designed to promote resiliency within military families helps alleviate stress caused by deployment to war zones, according to a preliminary report in the American Journal of Public Health. Data covering 488 families in the Families OverComing Under Stress program were gathered between 2008 and 2010 at 11 U.S. military bases. Psychological distress levels were already higher for service members, civilian parents, and children at baseline than in comparable civilian families. The resilience training resulted in “significant improvements across all measures” for all three groups, according to study director Patricia Lester, M.D., of the Semel Institute for Neuroscience and Human Behavior at UCLA. For more information about military families in Psychiatric News, click here.

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No Link Found Between Cardiac Risk, ADHD Medications

At the FDA's insistence, stimulant medications for treatment of attention-deficit/hyperactivity disorder (ADHD) include a black-box label warning about potential heart attacks and other cardiovascular adverse effects. But a study reported in the New England Journal of Medicine last month found no link between use of these drugs and serious cardiac problems in either children or adults.

William Cooper, M.D., of Vanderbilt University, and colleagues conducted a retrospective analysis of health records of more than 1.2 million children and adults representing a diverse population from 1986 to 2005 and compared them with data from the National Death Index to verify reports of serious cardiac events. No significant difference was found for cardiac events between ADHD medication users and a control group of randomly selected nonusers.

To read more about this study, which is reported in the December 2 issue of Psychiatric News, click here. To learn more about treatment and other ADHD-related topics, see the APA publication "Let's Talk Facts About Attention-Deficit/Hyperactivity Disorder (ADHD)".

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Teens' Lower Smoking Rates Mask Troubling Trend

Government surveys over the last few years have found a steady decline in the percentage of teens who say they smoke tobacco, but that decline hides a new trend that is cause for concern—while fewer teens are smoking cigarettes, many are replacing cigarettes with new flavored small cigars, whose popularity is soaring, according to a report in the December 13 Washington Post. These products are cheaper than cigarettes, come in colorful wrappers and assorted flavors, and particularly troubling, are perceived by teens as far less addictive than cigarettes. They do, however, have the same cancer-causing ingredients as cigarettes. A survey among Maryland teens recently found that use of these mini cigars has surpassed that of cigarettes. About 14 percent of high school students have taken up cigar smoking, according to data from the CDC.

This trend may be cause for alarm since nicotine dependence has been linked to suicide risk (see Psychiatric News here). To read about tools that have been designed to help psychiatrists integrate smoking-cessation treatment into their clinical practices, click here.

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Kids With a Bipolar Parent Face Mental Health Risks

Children who have a parent with bipolar disorder are more likely to display symptoms of affective and behavioral dysfunction than are children who do not have a parent with the condition, a study headed by Rasim Diler of the University of Pittsburgh and published in the November-December issue of Bipolar Disorders has found. 

And another recent study has shown that these children are at risk for a variety of psychiatric illnesses—anxiety disorders, major depression, and schizoaffective disorder, bipolar type, among others. For more details about this study, see the December 2 Psychiatric News here.
The good news, however, is that even though bipolar disorder has a strong heritable component, a substantial number of children of parents with bipolar disorder do not experience the illness themselves.

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Youth Suicide Attempts Often Start Early in Life

Forty percent of youth who attempt suicide make their first attempt even before they reach high school, a study headed by James Mazza of the University of Washington and published in the November Journal of Adolescent Health has found. The researchers also found that suicide attempts during childhood and adolescence were linked to higher scores on measures of depression at the time of the attempts.

For an in-depth exploration of the link between depression and suicide in youngsters, see the American Psychiatric Publishing book The Many Faces of Depression in Children and Adolescents. It reviews not just what is known about the causes of depression and suicide in youth, but discusses state-of-the-art pharmacotherapy and psychotherapy for youth with depression who are at greater suicide risk. 

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House Republican Pay Roll Tax Plan Includes Physician Medicare Pay Revision

House Republican leaders have agreed to include a two-year extension of the current Medicare physician pay rates, including a 1 percent increase beginning in January for 2012 and 2013, in a large legislative package primarily aimed at extending an expiring payroll tax cut. Barring Congressional action, a whopping 30 percent across-the-board pay cut is scheduled for physicians participating in the Medicare program.  Physicians have long argued that the payment formula for Medicare needs to be scrapped.For more information, see Psychiatric News.

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What Are You Doing in Integrated Care? AIMS Center Wants to Know

What are you doing with integrated care? The AIMS (Advancing Integrated Mental Health Solutions) at the University of Washington is seeking psychiatrists who are collaborating with primary care in a variety of settings to complete a short survey. The goal is to use the survey information to develop more resources to support this growing area of psychiatric practice. The survey should take about 15 minutes and is posted online at https://catalyst.uw.edu/webq/survey/jbc/149180. Responses are due by Dec. 30. (Pictured is David Estes, M.D., an internist who heads behavioral health-medical services at Kings County Hospital Center, Brooklyn, who spoke about integrated care during APA's Institute on Psychiatric Services in October.

Read more about the integrated-care movement in Psychiatric News.

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Reporting of Clinical Trials Still Lacking

Despite the Food and Drug Administration Amendment Act (FDAAA) of 2007 requiring that certain prescription drug clinical trials be registered on the public database ClinicalTrials.gov, only 12% of studies are reported within one year of being completed. Michael Law, Ph.D., of the University of British Columbia, and his colleagues reported on the topic in the December 2011 Health Affairs. They were surprised to find that clinical trials funded by the pharmaceutical industry are three times more likely to disclose results on the site than trials funded by the National Institutes of Health. An incomplete record of trial results could skew the information that trials provide, the researchers stated. They called for additional enforcement of reporting requirements to enable more comprehensive and less-biased studies and meta-analyses of the clinical efficacy, off-label use, and safety of prescription drugs.

To read more about the FDAAA, see Psychiatric News.

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Future of Treatment for Cocaine Dependence Promising

A review of the most recent human clinical trials of potential medications for treatment of cocaine dependence and the cocaine vaccine foretell a promising future. Daryl Shorter, M.D., of Baylor College of Medicine, and Thomas Kosten, M.D., of the Michael E. DeBakey VA Medical Center, recently reviewed available treatments for cocaine dependence in the November 3 BMC Medicine, saying their work highlights the need for further, larger studies to determine optimal clinical usage. They believe future work may also confirm specific subgroups of patients for treatment response based on clinical characteristics, biomarkers, and pharmacogenetics.

"Specific barriers to developing better treatments," they wrote, "are clearly related to the overall challenges of getting industry support and U.S. Food and Drug Administration approval when no previous medication has been approved for cocaine dependence."

Kosten is the primary author of Cocaine and Methamphetamine Dependence: Advances in Treatment, a new book available from American Psychiatric Publishing. For more information on the cocaine vaccine, see Psychiatric News.

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Gulf Oil Spill Leaves Distress, Resilience

The Deepwater Horizon oil spill in the summer of 2010 affected not just the waters of the Gulf of Mexico but also the people who live along its shores. Many residents developed symptoms of depression, anxiety, and posttraumatic stress, depending on how much the spill disrupted their lives, wrote researchers from the Louisiana State University Health Sciences Center in New Orleans in the December issue of Disaster Medicine and Public Health Preparedness. The earlier effects of Hurricane Katrina in 2005 increased residents’ vulnerability to the oil spill’s effects; nonetheless, many other residents were able to rebound, wrote the authors. “[It] may be that having survived Hurricane Katrina, individuals believed that they learned from experience and were able to adapt to and cope with adversity,” they said. For more about the mental health aspects of the Deepwater Horizon oil spill, see Psychiatric News.

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Antiseizure Medication Raises Risk of Autism

Children whose mothers were prescribed the antiseizure medication valproate during pregnancy had a relatively higher chance of developing autism, although the absolute rate is still small, reported researchers at the American Epilepsy Society annual meeting in Baltimore. The study of national health records covering 656,000 children born in Denmark between 1996 and 2006 revealed that 508 were exposed to valproate in the womb, and 14 (or 2.8 percent) developed autism. Only 0.8 percent (or roughly 5 per 508) of the children not exposed to valproate developed autism. The study adds to a growing body of knowledge indicating that valproate or related drugs can increase rates of birth defects, now including neuropsychological effects, said Jakob Christensen, M.D., a consultant neurologist at Aarhus University Hospital in Denmark.

For more about prenatal medications and autism, see Psychiatric News: http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=115871
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=116615

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Less Than Half of California’s Mentally Ill Get Treatment

Roughly one in 12 adults in California report having serious mental health needs, but more than 50 percent of these individuals failed to get treatment. This according to a new report from the UCLA Center for Health Policy Research. For the study, researchers used 2007 survey data. They found that traditionally disadvantaged groups such as American Indians and Alaska Natives, mixed-race Californians, and lesbian, gay, and bisexual adults reported higher levels of mental health needs than other groups. The researchers also noted that increased needs were associated with a lack of insurance coverage and higher rates of chronic health conditions. These findings counter earlier research showing the benefits that accrued from California’s Mental Health Services Act of 2004, which imposed a tax on those with annual incomes over $1 million that was used to fund an expansion of mental health services. Read more about the state’s approach to meeting mental health needs in Psychiatric News.

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Little Difference Found in Efficacy of Newer Antidepressants

A new meta-analysis of studies evaluating the efficacy of second-generation antidepressants in treating major depressive disorder finds that there is very little difference among these medications, and thus the evidence does not warrant recommending a particular antidepressant over another based on efficacy. The analysis, which assessed 234 studies that each had at least 1,000 participants, was conducted by researchers in Austria and the United States and is published in the Annals of Internal Medicine. The researchers concluded that "No clinically relevant differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life."

To learn about the latest knowledge in the use of antidepressants, see the new volume from American Psychiatric Publishing titled The Evidence-Based Guide to Antidepressant Medications.

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Later Bar Hours Linked With Increased Violence

Even a one-hour extension in bar closing hours can lead to a 16 percent increase in violent incidents, Norwegian researchers reported November 29 in the journal Addiction. The study was based on data from 18 Norwegian cities that expanded or restricted their closing hours by up to two hours during the decade 2000-2010.

Since violence is endemic in modern Western society, mental health professionals need to be skilled in assessing and managing violence in patients. A book from American Psychiatric Publishing, the Textbook of Violence Assessment and Management can help professionals deal with violence ideation and behavior in their patients.

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Larger Brain May Signal Regressive Autism

Three-year-old boys with regressive autism, but not early-onset autism, have larger brains than their healthy counterparts, scientists reported November 28 in the Proceedings of the National Academy of Sciences.

More information explaining the increasing body of knowledge about biological markers for autism, as well as many other aspects of the disorder—such as risk factors; diagnostic tests; and treatment options, including experimental, novel, and alternative therapies—can be found in the Textbook of Autism Spectrum Disorders, a new book from American Psychiatric Publishing that provides a comprehensive, up-to-date look at these disorders. The volume should be of considerable value to psychiatrists, psychologists, neurologists, social workers, speech therapists, educators, and patients and their families.

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Follow Your Doctor's Orders...And Pet Your Pooch

Never underestimate the power of puppies, or other four-legged friends, to make two-legged, stressed out animals relax. The Washington Post reports today that George Mason University School of Law­ in Arlington, Va.,—following an example set by the Yale Law Library—has instituted a “Pooch Party” during exam time, allowing students to cuddle with puppies as a way to relieve stress during a period when, as one student says, “law school can ruin your life.”

The concept is not new, however. Dogs, horses, and other animals have long been used as an adjunct to therapy for people with mental illness. Read about this topic in Psychiatric News here and here.   

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A Loaf of Bread, a Jug of Wine, My Stethoscope, and Thou

Renowned poets John Keats and William Carlos Williams, among others, were trained as doctors, and between poetry and medicine—or between medicine and any creative endeavor—there is some blood relationship, a reminder of the not-yet-anachronistic concept of medicine as both art and science. An article in the New York Times Thursday by Pauline Chen, M.D., reports on the remarkable response of medical students at Yale University School of Medicine and the University College London Medical School to poetry contests offered at the two schools. “It was rare in my generation for doctors to write poems, but I think there’s a new interest in poetry and how it can arise from what we do,” said John Martin, M.D., organizer of the competition and a professor of cardiovascular medicine at University College London.

At least one psychiatrist, Richard Berlin, M.D., has achieved acclaim for his work as a poet. For a report on Berlin, see Psychiatric News.

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VA Shuffles Schedules to See More First-Time Patients

Pressure to see U.S. veterans seeking mental health care at VA medical centers has led to scheduling more new patients but putting off follow-up visits for existing patients to create the needed additional clinic time, argued a witness at a Senate Veterans Affairs Committee hearing in Washington yesterday.

While new patients may be seen within 14 days to meet VA goals, returning patients may have to wait four to six weeks for appointments, according to the Washington Post. The Pentagon and VA have sought to encourage voluntary mental health care among troops and veterans, but delays such as those described at the Senate hearing may discourage many from remaining in treatment, testified Michelle Washington, director of PTSD services at the Wilmington, Del., VA Medical Center. Committee chair Sen. Patty Murray (D-Wash.) asked the VA inspector general to investigate.

For more on veterans' mental health care, particularly PTSD care, see Psychiatric News.

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Training Peers Helps Autistic Kids With Social Interactions

Training classmates of children with autism spectrum disorder (ASD) in ways to improve social interaction resulted in more long-lasting social connections than training only the children with ASD, according to a new report from the National Institute of Mental Health published online November 28 in the Journal of Child Psychology and Psychiatry. Children in the study were assigned to four groups. In one, children with ASD were trained to practice social skills. In another, three “typically developing” children were trained in engaging students with social difficulties, but the ASD students received no training. In the third, both groups were trained, and in the fourth, no students were trained.

“The findings suggest that peer-mediated interventions can provide better and more persistent outcomes than child-focused strategies, and that child-focused interventions may only be effective when paired with peer-mediated intervention,” said the researchers.

To read more about autism spectrum disorder, see Psychiatric News.
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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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