NIDA Launches Drug Abuse Website for Adults With Limited Literacy

A new, easy-to-read Web site on drug abuse designed for adults with a low reading literacy level (eighth grade or below) was launched last week by the National Institute on Drug Abuse (NIDA). The site, which provides plain language information on neuroscience, drug-abuse prevention, and treatment, is also a resource for adult literacy educators. It has a simple design with a large default text size, motion graphic videos, and other features that make it easy to read and use. “Drug abuse and addiction affects people of all reading levels, yet there are no Web sites with drug-abuse information created specifically for adults with limited literacy,” said NIDA Director Nora Volkow, M.D. “We hope this new site will inform a large segment of our population who may not have otherwise received potentially life-saving information.”

NIDA’s new easy-to-read site can be found at www.easyread.drugabuse.gov. See NIH’s Health Literacy Initiative for more information and additional resources on health literacy.

Literacy levels might also be one of the barriers to helping rural residents with substance abuse problems. Read more about it in Psychiatric News, here.

(Image: NIDA)

Chicago Physician Sentenced to Four Life Terms for Illegal Pain Pill Prescriptions

Chicago physician Paul Volkman, M.D., was sentenced last month to more than four terms of life imprisonment for illegally prescribing and dispensing pain pills outside the scope of legitimate medical practice that resulted in the deaths of four people. Evidence presented during Volkman's trial last year showed that he prescribed and dispensed millions of dosages of drugs including diazepam, hydrocodone, oxycodone, alprazolam, and carisoprodol. Volkman operated out of four locations in Ohio before U.S. Drug Enforcement Administration investigators shut him down. A jury convicted Volkman of 18 crimes including four counts of illegal drug distribution that resulted in death. Sentences on 13 other counts ranged from 10 to 20 years and are to be served concurrently. Volkman was also ordered to forfeit $1.2 million. During the trial, the U.S. attorney prosecuting the case said Volkman "was the top physician purchaser of oxycodone in the country.”

The Centers for Disease Control and Prevention says states must take more responsibility for reining in painkiller abuse. Read more in Psychiatric News, here.

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Army in Midst of PTSD Diagnosis Controversy

The U.S. Army is investigating whether psychiatrists at Madigan Army Medical Center in Washington state reversed diagnoses of posttraumatic stress disorder (PTSD) that soldiers had received in a push to rein in the substantial costs associated with treating and paying benefits for soldiers with the illness, the Associated Press reported last week. A PTSD diagnosis can lead to a 50 percent disability rating for a soldier and can affect pension, family health, and financial benefits. The investigation has led to removal of the medical center's director, Col. Dallas Homas, who previously served as a command surgeon in Iraq and Afghanistan. Homas, who has denied that PTSD diagnoses were reversed, said in response to his removal, "I remain optimistic that the truth will come out with these investigations. I don't feel that I or my team have done anything wrong." The investigation arose last year, the AP reported, when soldiers complained to an Army ombudsman that forensic psychiatrists at the medical center had reversed PTSD diagnoses and labeled some of the affected soldiers as malingerers. The ombudsman's report led to 12 soldiers being rescreened for PTSD at Walter Reed National Military Medical Center in Maryland. If shown to be true, the allegations would be troublesome to Army brass because of their aggressive push to encourage soldiers to overcome stigma and seek mental health care.

Read about the treatment of PTSD in combat veterans in Psychiatric News here and here.

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Latest School Shooting Again Raises Bullying Concerns

Once again a teenager has brought a gun into a high school with fatal consequences. And once again teenagers, parents, school personnel, and mental health experts are confronted with the issue of whether bullying drove yet another adolescent to seek revenge through a hail of bullets directed at his peers. As of Tuesday morning one teenager is dead and another declared brain dead after a shooting in a high-school cafeteria in Chardon, Ohio. Three others were injured. Students who know the alleged shooter, who was arrested a few blocks from the school, are giving conflicting accounts of whether they believe that the shooter was bullied at the school. He had transferred to a nearby school for students with emotional or behavioral problems. Thus, even if bullying does turn out to be a factor, the student may have had additional problems that contributed to his attack.

Read about the psychiatric aspects of bullying and suggestions for preventing it in Psychiatric News here and here. In-depth information on the topic is also the focus of the new book Preventing Bullying and School Violence from American Psychiatric Publishing.

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Dopamine Can Unleash Creativity in People With Parkinson's

Some Parkinson's disease patients can suddenly become creative when they take dopamine therapy, a study to be published in the March European Journal of Neurology suggests. The study included 18 Parkinson's subjects who had become creative after they started taking dopamine, 18 Parkinson's subjects who had not become creative after taking dopamine, and 36 healthy control subjects. Eighty-three percent of the creative Parkinson's subjects produced drawings or paintings, 50 percent produced poetry or novels, and 28 percent made sculpture.

By using the Torrence Test of Creative Thinking to compare the three groups, the researchers found that the creative Parkinson's subjects had scores similar to those of the healthy controls, whereas noncreative Parkinson's subjects had scores significantly lower than the healthy controls. It's thus possible that the creative Parkinson's group had creative talent all along, yet did not display it until dopamine unleashed it, the researchers speculated. Determing how dopamine might trigger creative behavior in Parkinson's patients will require additional research.

Important information about the psychiatric aspects of Parkinson's can be found in Psychiatric News.

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Overeating May Be Passport to Mild Cognitive Impairment

When older people overeat, it may double their risk of mild cognitive impairment, Ronald Petersen, M.D., Ph.D., director of the  Alzheimer's Disease Research Center at the Mayo Clinic, and his colleagues have found. Their study involved  some 1,200 people aged 70 to 89. Although none had Alzheimer's, 163 did have mild cognitive impairment, which is often a prelude to Alzheimer's. The subjects were evaluated for how much they ate, and the researchers then determined whether there was any link between excessive food intake and mild cognitive impairment, even when other factors that can affect memory loss were considered. The odds of having mild cognitive impairment more than doubled for those in the highest calorie-consuming group compared with those in the lowest one.

The study results will  be reported at the annual meeting of the American Academy of Neurology in New Orleans in April.

More information about research related to mild cognitive impairment and Alzheimer's disease is reported in Psychiatric News and in the new book from American Psychiatric Publishing, Clinical Manual of Alzheimer Disease and Other Dementias.

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APA Petitions Congress to Enforce Parity in Florida

APA is petitioning Congress and the Obama administration to enforce the Mental Health Parity and Addiction Recovery Act. The petition is in response to recent actions by Blue Cross and Blue Shield of Florida, which terminated mental health care providers from their network and told them that they had to reapply and accept less-favorable contract terms if they wanted to continue seeing BCBSFL patients. APA maintains that BCBSFL’s actions discriminate against mental health patients and has learned that the insurer's actions have resulted in many such patients going without necessary care. APA is urging members and others to review this petition here and sign to show support. If you are a Florida mental health care clinician, patient, or caretaker of a patient, please also complete this survey here.

For more coverage of the Florida insurer's actions regarding mental health care, see Psychiatric News here.

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GOP Candidates Spar Over Health Reform Law

Republican presidential hopefuls Rick Santorum and Mitt Romney had a testy sparring match over who is more opposed to the Patient Protection and Affordable Care Act—the health care reform law—during Wednesday's debate in Arizona. Santorum insisted that “Romneycare”—the reform law passed in Massachusetts when Romney was governor—is the model for President Obama's health care reform law, while Romney countered that political positions taken by Santorum helped ensure the passage of the reform law. Both candidates slammed the health reform law and the individual mandate requiring people to buy health insurance or pay a penalty, and both vowed to rescind the law if elected. Today's Washington Post reported that about 50,000 Americans have so far taken advantage of the law's provision of health insurance to those who have been turned down by private plans because of preexisting conditions. 

For coverage of the individual mandate see Psychiatric News here. Learn more about the health reform law in the APA publication, "Health Care Reform: A Primer for Psychiatrists," here.

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Is Ice Cream Addictive?

Is ice cream as addictive as drugs? That's the question that research from the Oregon Research Institute, published in this week's American Journal of Clinical Nutrition, has raised. And the answer appears to be "yes." Investigators tested their hypothesis that frequent ice cream consumption would be associated with reduced activation in reward-related brain regions, such as the striatum, in response to receipt of an ice cream–based treat. They had 151 healthy-weight adolescents undergo fMRI during receipt of an ice cream milkshake and during receipt of a tasteless solution. Percentage body fat, food intake, and food craving were assessed.

Milkshake receipt robustly activated the striatal regions, yet frequent ice cream consumption was associated with a reduced response to milkshake receipt. Percentage body fat, total energy intake, percentage of energy from fat and sugar, and intake of other energy-dense foods were not related to the neural response to milkshake receipt. "Our results provide novel evidence that frequent consumption of ice cream, independent of body fat, is related to a reduction in reward-region responsivity in humans, paralleling the tolerance observed in drug addiction," they concluded.

Other recent brain-imaging studies have supported the theory that overeating is also an addiction. Read more about it in Psychiatric News here.

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FDA Advisors Back Weight-Loss Pill

A panel of advisers convened by the Food and Drug Administration (FDA) yesterday voted 20 to 2 to approve the weight-loss drug Qnexa, a controlled-release combination of phentermine and topiramate being developed by Vivus. The FDA previously rejected Qnexa due to safety concerns, but then scheduled yesterday's review by the Endocrinologic and Metabolic Drugs Advisory Committee, which recommended Vivus be required to conduct a large, follow-up study of the pill's cardiovascular effects, but said that study could come after FDA approval because the impressive weight-loss results seen with Qnexa might outweight those concerns.


Peter Tam, president of Vivus, said the advisory-panel vote underscores the need for effective weight loss drugs. "I think they see the medical need. Right now there aren't any good treatments out there besides dieting and bariatric surgery." The FDA is not bound by the recommendations of its advisory committees, but will consider the guidance during its April 17 review of the New Drug Application that was submitted for Qnexa in October 2011.


Read about the fate of some weight-loss drugs previously approved by the FDA in Psychiatric News here.

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Antidepressant Drugs and the Placebo Effect Make Headlines

The effects of antidepressant medications are all in people's heads. That’s what a Harvard psychologist told Lesley Stahl on “60 Minutes” last Sunday. Irving Kirsch, Ph.D., said that antidepressant drugs are no better than placebo pills for people with mild to moderate depression. He agreed that people with severe cases show a much stronger response.

Kirsch’s studies of the placebo effect lead him to argue that taking the drugs may work, but that "the reason [people] get better is not because of the chemicals in the drug.” Simply the act of taking a pill or the added attention from clinicians may make patients feel better, he said.

Psychiatrists and Food and Drug Administration scientists interviewed on the program disagreed with Kirsch’s views. “It is unfortunate that ‘60 Minutes’ has provided its viewers with highly misleading information, and I encourage everyone taking antidepressants to talk with your doctor before making any changes,” said APA President John Oldham, M.D., in a statement.

APA’s treatment guidelines on depression recommend psychotherapy first for mild to moderate depression, and only if this intervention falls short should the physician decide whether antidepressants are needed.

For a discussion in Psychiatric News about the complexities of the placebo effect, click here. And for an in-depth review of medications in depression treatment, see The Evidence-Based Guide to Antidepressant Medications from American Psychiatric Publishing.

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Risk of Child Abuse, PTSD Tied to Gender Nonconformity

Researchers have found a troubling association between gender nonconformity in children and abuse. Childhood gender nonconformity is the term for differences from the norm for one’s sex as measured by feelings of femininity or masculinity and other indicators. It does not necessarily mean that a child will ultimately have a minority sexual orientation.

Exposure to childhood physical, psychological, and sexual abuse, and probable PTSD were higher in the 10 percent of youth reporting gender nonconformity, writes lead author Andrea Roberts, Ph.D., of the Harvard School of Public Health, in the March Pediatrics. The study was based on a survey of 9,864 youth as part of the Growing Up Today Study.

“[G]ender nonconformity…may be both an indicator of abuse and a risk factor for abuse, although evidence in favor of either causal direction is limited,” cautioned the researchers. Observing gender nonconformity should alert parents, teachers, and health care providers to a possibly increased risk of child abuse and therefore the chance to prevent, stop, or treat abuse, they concluded.

To read more about childhood sexual abuse in Psychiatric News, click here and here.

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Administration to Delay Implementation of ICD-10 Codes

The AMA is applauding a decision by the Obama administration to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition (ICD-10diagnosis and procedure codes (ICD-10). "The AMA appreciates [Health and Human Services] Secretary Sebelius' swift response to address the AMA’s serious concerns with ICD-10 implementation,” said AMA President Peter Carmel, M.D., in a statement yesterday. “The timing of the ICD-10 transition could not be worse for physicians....Burdens on physician practices need to be reduced--not created--as the nation's health care system undertakes significant payment and delivery reforms.”

In announcing the decision, Sebelius said, “We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

This is not the first such delay. For coverage in Psychiatric News, see here.

APA Announces Election Results

Jeffery Lieberman, M.D., is the victor in the three-way race to become APA's next president-elect. Lieberman, chair of APA's Council on Research and Quality Care and a member of the American Journal of Psychiatry Editorial Board, outpolled Renee Binder, M.D., and Mary Helen Davis, M.D. In the race for treasurer, David Fassler, M.D., bested Robert Feder, M.D., to win another term in that post. Three Area trustee positions were up for election. In Area 1, Jeffrey Geller, M.D., prevailed over Gail Robinson, M.D., while in Area 4 Judith Kashtan, M.D., defeated Ronald Burd, M.D., and in Area 7 Jeffrey Akaka, M.D., outpolled Annette Matthews, M.D. In addition, this year there were races for early career psychiatrist (ECP) trustee-at-large, and member-in-training trustee-elect (MITTE).  In the former, Molly McVoy., M.D., was the victor in a three-way race with Steve Koh, M.D., M.P.H., and Jose Vito. M.D. The MITTE contest was won by Erik Vanderlip, M.D., over Andrea Brandon, M.D., Ph.D., and Brian Hurley, M.D., M.B.A.

While APA has made these results public, they are not official until approved by the Board of Trustees at its March meeting. Complete vote totals and deadlines for next year's election are posted on APA's Web site under "Association Governance."

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Physicians Win Another Medicare Fee Cut Reprieve

The House and Senate last week passed yet another postponement of the huge looming cuts in the fees physicians receive for treating Medicare beneficiaries. If the lawmakers hadn't agreed to this delay, fees would have been slashed by about 27 percent on March 1. The new target date for implementing the fee cuts is January 1, 2013, assuming that President Obama, as expected, signs the legislation.

This is, however, one of those silver linings with a dark cloud around it, because each time the cut is put off—and Congress has done so annually for more than a dozen years—the size of the cut increases. Unless there is another postponement, January's average cut jumps to 32 percent. The physician fee adjustments, which usually involve cuts, are mandated by the complex formula known as the Sustainable Growth Rate (SGR) in which increases in the costs in one or more parts of the Medicare program must be offset by cuts elsewhere in its budget. APA and the AMA have for years urged Congress to throw out the SGR and develop a new, fairer system for setting Medicare reimbursements, but with such a daunting task, lawmakers have found it easier to just vote another postponement.

Read more about the SGR and physician Medicare fees in Psychiatric News here and here.

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Groundbreaking AJP Study Finds Early Brain Changes in Autism

The changes in brain development that underlie autism spectrum disorder may be detectable in children as young as 6 months, according to a groundbreaking study appearing online today in the American Journal of Psychiatry. Researchers at four clinical sites prospectively examined the growth and organization of white matter in the brains of infants deemed to be at high risk of autism spectrum disorder. They found that there was an aberrant pattern of white matter development in those infants who went on to display autism spectrum disorder by 24 months, compared to those who did not. The finding is receiving wide publicity, including coverage on ABC News and CNN, because it suggests that autism may be detectable before symptoms begin.

Study coauthor Geri Dawson, Ph.D., who is chief science officer of the advocacy group Autism Speaks, said in a statement released today, “These results offer promise that we may one day be able to identify infants at risk for autism before the behavioral symptoms are present. The goal is to intervene as early as possible to prevent or reduce the onset of disabling symptoms. One promising area of follow-up research is to identify the specific genetic and biological mechanisms behind the observed differences in brain development.”

Click here to read the AJP study.

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DEA Shuts Down Pharmacies for Filling Excessive Painkiller Scripts

The Miami Field Division of the U.S. Drug Enforcement Administration (DEA) announced that it has issued Immediate Suspension Orders (ISO) to Cardinal Health, a pharmaceutical wholesale distributor in Lakeland, Fla., and two of its customers, CVS/Pharmacy #219 and CVS/Pharmacy #5195, both located in Sanford, Fla. An ISO is served when a DEA-registered business or individual (“registrant”) constitutes an imminent danger to the public safety and suspends a registrant’s ability to handle or distribute a controlled substance pending a judicial proceeding.

According to a Reuters’ report, Florida's drug enforcers have been cracking down on pharmacies for several years, but this is the first time they have targeted a major chain. Last year the two pharmacies ordered 3 million doses of the painkiller oxycodone, compared to a national average of 69,000 doses. The DEA said the pharmacies either knew, or should have known, that a large number of the prescriptions it filled were not issued for a legitimate medical  Read the DEA’s press release about the action here.

The CDC recently reported on its analysis of the epidemic of painkiller overdoses in the United States, saying states could do more to rein in the abuse. Read about it in Psychiatric News here.

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FDA Adds Metabolic Warnings to Fanapt

The U.S. Food and Drug Administration has enacted a major change to the "Warnings and Precautions" portion of the prescribing information for the atypical antipsychotic Fanapt (iloperidone). The label now includes information about the metabolic changes associated with atypical antipsychotic drugs that may increase cardiovascular and cerebrovascular risk. These changes include hyperglycemia, dyslipidemia, and weight gain. The revised label is posted at http://www.pharma.us.novartis.com/product/pi/pdf/fanapt.pdf. Fanapt was approved by the FDA in 2009 for the treatment of schizophrenia after initially being turned down. Read more about it in Psychiatric News here.

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Reservists Need Extra Mental Health Help

More than 2 million U.S. troops have served in Iraq and Afghanistan over the last decade, and about one third (665,000) were from Reserve or National Guard units. “[T]hese service members report higher rates of mental health problems and related ills than active-duty troops, according to current and former officials, troops, experts, and government studies,” said a report from the Medill National Security Reporting Project team, which spent three months looking at the challenges facing these forces.

National Guard and Reserve personnel often lack many of the supports of their active duty counterparts. Their units may come together for training just once a month. Access to medical and mental health care through the Military Health System or the Veterans Administration may be distant or otherwise difficult to obtain. They may rely on civilian practitioners who have little knowledge of the military experience. So last April, the Army National Guard increased demobilization time and required leaders to sign off on the status of each soldier.

In recent congressional testimony, Gen. Craig McKinley, head of the Pentagon’s National Guard Bureau, praised the guard’s reform efforts. However, he said, “we will have decades to go to make sure we do not leave any guardsman or woman behind.”

For more in Psychiatric News about efforts to help returning troops and their families, click here.

 

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Delay on Medicare Reimbursement Cuts Proposed

Congressional negotiators tentatively agreed Tuesday to maintain Medicare payment rates for doctors as part of a plan that also continues unemployment benefits and extends a reduction in the payroll tax until the end of the year. Current Medicare payments to doctors would be paid by cutting Medicare reimbursements to hospitals and reducing by half an $8 billion program for a prevention and public health fund established in the new health care law. However, nothing is set in stone because, as of this morning, the actual text of the legislation has not been made public. The bill must also pass the full House and the Senate, as well. Should the proposed bill pass, it will prevent a 27 percent cut in Medicare reimbursement to physicians.

APA and other medical organizations continue to work with members of Congress to eliminate such repeated short-term fixes and replace them with a permanent system to fairly reimburse physicians, including psychiatrists, for their services under Medicare. To read a letter that APA has sent to members of Congress on the matter recently, click here. APA is also urging its members to contact their representatives in Congress and ask them to sign on to this letter.

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Medicaid Kids Admitted to ED Often Don't Get Follow-up Care

A substantial proportion of young Medicaid beneficiaries taken to the hospital as a result of self-harm are discharged without receiving emergency mental health assessments or follow-up outpatient mental health care, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry. A retrospective analysis of national 2006 Medicaid claims data and other sources found that of youth 10 to 19 years old admitted to the emergency department (ED) for self-harm, most patients (72.9%) were discharged to the community. Thirty-nine percent of discharged patients received a mental health assessment in the ED and a roughly similar percentage (43.0%) received follow-up outpatient mental health care. 

Read more about suicide among young people in Psychiatric News and a book by American Psychiatric Publishing, Concise Guide to Child and Adolescent Psychiatry, Fourth Edition.

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When It Comes to Romance, It May Be Best to Call It In

It might seem old fashioned, but nothing beats a face-to-face interaction for creating the spark that may lead to lasting love. This according to Eli Finkel, associate professor of psychology at Northwestern University and lead author of a new study on the effectiveness of online and mobile dating to be published in Public Interest, a journal of the Association for Psychological Science. Traditional dating sites like Match.com provide scant information about an overwhelming number of potential mates, while sites that boast the benefit of high-tech matching capabilities may not deliver on what they promise, finds Finkel. Alternatively, looking for love with new GPS-enabled smartphone applications is a much more immediate process, notes Finkel, increasing the chances of an in-person connection. Read more about the research of romance in Psychiatric News and a book by American Psychiatric Publishing, Dreams of Love and Fateful Encounters: The Power of Romantic Passion.

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Depression Can Lead to an Accidental Medicine Overdose

There is a link between psychiatric illness and accidental medication overdose, a study in the January American Journal of Psychiatry suggests. Indeed, depressive disorders and anxiety disorders other than posttraumatic stress disorder were found to have a stronger association with the risk of death from a medication-related overdose than with the risk of death from an alcohol overdose or an illegal-drug overdose. Researchers are unsure why, however.

The study, which was conducted on all patients treated in Veterans Health Administration facilities from 1999 to 2000--over three million subjects--appears to be the first to look at the longitudinal relationship between psychiatric disorders and death from accidental medication overdose in an adult clinical population.

Click here for an abstract of the study.

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Pop Singer Sensation Whitney Houston Struggled With Substance Abuse

Pop singer sensation Whitney Houston’s sudden death at the age of 48 shocked fans all over the world this weekend, and today ABC News is reporting that although autopsy results won’t be conclusive for weeks, substance abuse may have contributed to her death. Houston was found with her head under water in a bathtub in a Beverly Hills hotel. Houston was a superstar in the 1980s and 1990s but led a tumultuous personal life that included bouts with addiction and several admissions to drug rehab. For extensive coverage of substance abuse, see Psychiatric News and Cocaine and Metamphetamine Addiction: Advances in Treatment, from American Psychiatric Publishing.

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Computer Intervention May Help Offspring of Alcoholics

The adult children of alcoholics are often at risk not only for substance abuse, but also for depression and other psychological problems. An online resource may be of some value to them, a small pilot study in the Journal of Addiction Medicine suggests. The study randomized 23 adult children of alcoholics to three interventions for eight weeks. The interventions were group therapy only, an online resource called CHESS (Comprehensive Health Enhancement Support System), and CHESS plus group therapy. The subjects who had received CHESS plus group therapy were found to have attended group therapy 82 percent of the time, compared with only 43 percent for the group-therapy-only group. Moreover, subjects who received CHESS showed the best psychological health. Thus, CHESS deserves more consideration and study, the researchers believe.

Next week is Children of Alcoholics Week. Information about treatment for alcoholics can be found in the American Psychiatric Publishing book Clinical Manual for Treatment of Alcoholism and Addictions.

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Intensive Sleep Retraining Offers Rapid Improvement for Insomniacs

Intensive sleep retraining (ISR) may help insomniacs get the rest they need. Sleep researchers in Australia studied 79 volunteers with chronic sleep-onset insomnia (with and without sleep maintenance dificulties), randomly assigning them to intensive sleep retraining (ISR), stimulus control therapy (SCT), ISR plus SCT, or a control group.  

IRS consists of 25 hours divided into 50 30-minute sessions. During each one, the person tries to fall asleep. If successful, the participant is woken up after just three minutes of sleep, asked if he or she had been asleep, and told that he or she had indeed fallen asleep. The sleep deprivation that builds up over the course of this pattern helps even the most hard-core insomniac fall asleep a few times. The goal of the therapy is to help people feel what it’s like to fall asleep rapidly and learn that they can do it. All three active treatment groups had significant improvements in sleep onset and total sleep time, compared to controls, but ISR provided the most rapid improvement. The researchers, who published their results in the January 1 Sleep, said eventual development of home-based versions of ISR should make it more widely available.

Recent concerns have been raised over the use of the antipsychotic quetiapine as a sleep aid. Read more here in Psychiatric News.

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Smoking Causes Cognitive Decline in Middle-Aged Men

Men who smoke suffer greater cognitive decline during the transition from midlife to old age than those who have never smoked, researchers at University College London found in a study published online February 6 in the Archives of General Psychiatry. The results came from the Whitehall II study, a cohort study of 5,099 men and 2,137 women (mean age 56) performed in three phases: 1997 to 1999, 2002 to 2004, and 2007 to 2009. The cognitive test battery included tests of memory, vocabulary, executive function, and a global cognitive score summarizing performance across all tests. Smoking status was assessed over the entire study period.

In women, cognitive decline did not vary with smoking status. Ex-smokers with at least a 10-year cessation were also unaffected.

Smoking is also high on the list of suicide risk factors. Read more about that topic in Psychiatric News. 

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APA Urges Members to Contact Congress on Medicare Fees

The complex formula used to determine how much physicians will be reimbursed for treating Medicare beneficiaries continues to be a thorn in the side of Congress, as well as the nation's doctors. With the House and Senate negotiating a bill that includes the fate of that formula—the Sustainable Growth Rate (SGR)—APA is urging its members to take advantage of the opportunity to affect the outcome of the negotiation. One option on the table is to repeal the SGR and end the annual cycle of adjustment postponements that just keeps compounding the size of the cut with which physicians will be saddled. If no action is taken, they are facing a 27 percent fee cut in the near future. One solution urged by Reps. Joseph Crowley (D-N.Y.) and Dan Benishek (R-Mich.) is to use funding saved from the drawdown of troops in Iraq and Afghanistan to fund the offset in Medicare fees.

APA wants members to contact their member of Congress and urge them to sign a letter being circulated by Crowley and Benishek that advocates for this offset option and a repeal of the SGR. By clicking here, psychiatrists can see a toll-free phone number to reach their representative and sample wording they can use in an e-mail or regular letter.

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Federal Court Says Gays Should Have Right to Marry

A federal appeals court panel ruled on February 7 that California's ban on same-sex marriage violates Americans' constitutional right to equal protection under the law, stating that the ban "fails to advance any rational basis in singling out gay men and lesbians for denial of a marriage license." This ruling upholds a 2010 decision by a lower court judge that overturned Proposition 8, a voter passed referendum that reversed a law that had legalized marriage between same-sex couples. The ruling still has to be reviewed by the full appeals court, after which legal experts expect it to make its way to the Supreme Court.

Noting the deleterious mental health aspects of discrimination against gays and lesbians, APA has adopted an official position statement in favor of the right of same-sex couples to civil marriage, emphasizing that "Same-sex couples are currently denied the important legal benefits, rights, and responsibilities of civil marriage [and] therefore experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health." Read APA's statement on the issue here. In addition, recent data suggest that allowing same-sex marriage might be good for the health of gay men and lower their medical care expenses. For more about that study, see Psychiatric News.

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What Accounts for Strong Link Between Epilepsy, Mental Illness?

People discharged from the hospital with diagnoses of depression, bipolar disorder, psychosis, anxiety disorders, or suicide attempts have more than twice the risk of developing epileptic seizures compared with controls, according to a new study.

The risk of developing unprovoked epileptic seizures was highest in the two years before and two years after a first psychiatric diagnosis, wrote Cecelia Adelow, M.D., of Stockholm’s Karolinska Institutet, in the February 7 Neurology. The study reports an association but not a cause and effect. Psychiatric illness might cause seizures or vice versa, or there might be some now-unknown underlying common cause for both, an explanation Adelow and colleagues prefer at the moment.

“Physicians need to be aware that patients with severe psychiatric conditions such as psychoses and depression, as well as those with previous suicide attempts, are at increased risk of developing epilepsy and vice versa,” concluded the authors.

To read coverage in Psychiatric News about the purported link between epilepsy drugs and mental illness, click here.

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Alcohol Abuse Leading Cause for Treatment in College Students

Among college students, almost half of all substance abuse treatment admissions were due to alcohol problems, according to a new report from the Substance Abuse and Mental Health Services Administrations (SAMHSA). About 47 percent of 12,000 treatment admissions involving college students in 2009 were related to alcohol. Among nonstudents the rate was 31 percent.

Rates for marijuana-related admissions were similar for both groups—31 percent of student admissions, and 30 percent for nonstudents. However, rates of admissions related to heroin, other opiates, cocaine, and methamphetamine use were all lower among college students than nonstudents.

SAMHSA Administrator Pamela Hyde, J.D., pointed out that “This report confirms the pervasive and potentially devastating role that alcohol plays on far too many college campuses.”

More about substance abuse treatment can be found in The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition. For more information on this book, click here.

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Irritable Youngsters May Be Depressed

When youngsters are irritable, what does it signify? More likely depression than delinquency, a study published in the January American Journal of Psychiatry suggests.

A sample of some 2,500 youngsters were studied to see whether two components of oppositional behavior—irritability and headstrong/hurtful behavior—were related to depression or delinquency. Irritability showed a significantly stronger link with depression than with delinquency, while headstrong/hurtful behavior was more strongly related to delinquency than to depression, the researchers found. It thus appears that irritability has a stronger genetic link with depression than it does with delinquency.

For more information about this study in the American Journal of Psychiatry, click here .

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Antipsychotics May Cause Diabetes By Thwarting Crucial Pathway

Antipsychotics—some of the most prescribed medications in the United States—can interfere with normal metabolism by activating a protein in the transforming growth factor beta pathway, scientists reported January 31 in Molecular Psychiatry. This pathway regulates cell growth, inflammation, insulin signaling, and other biological processes. Moreover, antipsychotics known to cause obesity and diabetes were found to activate this pathway, whereas antipsychotics that are not known to raise risk of obesity and diabetes did not. Thus the scientists believe that those antipsychotics that cause obesity and diabetes do so by activating this pathway.

Other up-to-date information about antipsychotic medications—both FDA-approved and off-label indications, strengths, formulations, pharmacokinetics, dosing, and common side effects—can be found in the American Psychiatric Publishing book The Evidence-Based Guide to Antipsychotic Medications. For more information on this publication, click here.


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Put On Your Red Dress

Are you wearing red today?

It’s "National Wear Red Day®" sponsored by the U.S. Department of Health and Human Services and the American Heart Association to promote women’s heart health and educate everyone about heart disease in women. Heart disease is the number-one killer of women, and all over the nation people will be wearing red, and offices and cubicles will be the festooned with the color, to promote awareness of the issue.

Increasingly, researchers are documenting a strong link between heart disease and depression. For information on the important topic, see Psychiatric News here and here.

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Researchers Discover Crucial Finding About Progression of Alzheimer's

Alzheimer’s disease appears to progress like an infection, by the spread—from neuron to neuron—of a distorting protein known as tau.

Researchers working with genetically engineered mice independently at Columbia and Harvard found that destruction and death of brain cells, corrupted by tau, is spread from brain cell to brain cell. The finding answers a long puzzling question for Alzheimer’s researchers about how the disease progresses in the brain, incrementally destroying cognitive functions. And it holds out the promise that the disease could be halted in its early stages by the introduction of an antibody to tau. The report was in yesterday's New York Times and can be found here.

To read much more about Alzheimer’s see Psychiatric News here. And information about Alzheimer’s can also be found in The American Psychiatric Publishing Textbook of Geriatric Neuropsychiatry: Third Edition. Purchasing information is posted here.

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Questionnaire May Clarify Relationship Between PTSD and Smoking

Veterans with posttraumatic stress disorder (PTSD) who smoke are more likely than others to believe in the positive effects of smoking, including reducing negative affect, relieving boredom, and facilitating social interactions, and these beliefs may increase their risk for continuing to smoke. "Further understanding of smoking expectancies in this group may help in developing interventions tailored for this vulnerable population," said researchers at the San Francisco VA Medical Center in the June 2011 Journal of Trauma and Stress. The group followed up this work in an online January 23 report in Nicotine and Tobacco Research showing that the Smoking Consequences Questionnaire-Adult (SCQ-A) is a valid measure of expectancies about smoking in military veteran smokers with PTSD. They said that their results suggest that smoking outcome expectancies may play an important role in explaining the relationship between PTSD and cigarette smoking.

Depression plays a significant role in whether people smoke and whether they are heavy smokers. Read more about this topic in Psychiatric News.

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Pediatric Experts Offer Updated Neonatal Drug Withdrawal Guidance

The American Academy of Pediatrics (AAP) released a detailed, 23-page guide to neonatal drug withdrawal online January 30 in the journal Pediatrics. The guide is an update of previous information published in 1979 and 1998. Jointly prepared by the AAP's Committee on Drugs and Committee on Fetus and Newborn, the guide provides detailed descriptions of symptoms consistent with withdrawal from the different classes of medications and illicit drugs, a scoring system for evaluating neonates, and step-by-step weaning protocols. While the information is extensive, the authors note the existence of "significant gaps" in knowledge concerning the optimal treatment strategy for infants with neonatal drug withdrawal and call for further studies to address short-term outcomes and to provide for long-term follow-up.

The Food and Drug Administration recently warned physicians that neonates may suffer withdrawal symptoms when their mothers are treated with antipsychotic medications during the third trimester. Read more about it in Psychiatric News.

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MH Services and Neuroscience Research Both Needed

Which comes first, cure or care? That’s the question Thomas Insel, M.D., director of the National Institute of Mental Health, raised in a recent blog. Insel was reporting on discussion arising during a meeting of the National Advisory Mental Health Council. Some panel members urged more funding to implement existing knowledge that would directly improve care for patients with mental illnesses. Others took a different view, which Insel summarized as follows: “Current treatments are not good enough for too many,” he said. “[W]e need invest in the fundamental science of brain and behavior so that we can understand how to develop better treatments.” Funding both lines of research is important, said Insel.

However, long-term success depend on new discoveries. “[I]n many cases patients receiving the best of current care are not recovering,” said Insel. “We can blame the mental health care system, the absence of insurance or providers, or stigma, but the inconvenient truth is that our treatments are not good enough. NIMH has a critical role for ensuring that more effective medications, devices, and psychosocial treatments are available in the future.”


For more about future research direction in mental health in Psychiatric News, click here.

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Mildred Mitchell-Bateman Dies at Age 89

Pioneering African-American psychiatrist Mildred Mitchell-Bateman, M.D., died on January 25 in Charleston, W.Va., at  age 89. Mitchell-Bateman received her M.D. degree from the Women’s Medical College of Pennsylvania in 1946, trained at Harlem Hospital, and completed a residency at the Menninger School of Psychiatry in Topeka. In 1962, she was named director of West Virginia’s Department of Mental Health, making her the first African-American woman to head a state agency there. During her 15-year tenure, she emphasized that care for the mentally ill in the state system must include both treatment and rehabilitation.

 

Mitchell-Bateman became the founding chair of the Department of Psychiatry at Marshall University’s new School of Medicine in 1977. There, she developed a close working relationship with state hospitals to enhance training opportunities and improve patient care. She was elected a vice-president of APA in 1973 and received the organization’s Lifetime Achievement Award in 2000. Huntington State Hospital was renamed in her honor in 1999.

More about Mildred Mitchell-Bateman and other African-American psychiatrists can be found in the book, Black Psychiatrists and American Psychiatry, edited by Jeanne Spurlock, M.D., from American Psychiatric Press.

(Image: West Virginia Division of Culture and History)