FDA Warns Consumers About Counterfeit Adderall

The U.S. Food and Drug Administration (FDA) issued a press release yesterday to warn consumers and health care professionals about a counterfeit version of Teva Pharmaceutical Industries’ Adderall 30 mg tablets that is being sold on the Internet. The FDA’s preliminary laboratory tests revealed that the counterfeit tablets contained tramadol and acetaminophen, rather than Adderall's four active ingredients, which are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate.

Currently on the FDA’s drug shortage list, Adderall is in short supply due to active pharmaceutical ingredient supply issues. Teva continues to release product as it becomes available. "Consumers should be extra cautious when buying their medicines from online sources," warned the FDA. "Rogue websites and distributors may especially target medicines in short supply for counterfeiting." The  press release, which can be viewed here, includes photos of the counterfeit and authentic products for comparison. The FDA encouraged consumers who believe they have received counterfeit Adderall to contact their Office of Criminal Investigations.

The shortage of drugs used to treat ADHD may have multiple etiologies. Read more about it in Psychiatric News, here.

(Image: FDA)

Odds of Quitting Smoking Affected by Genetics

Genetics can help determine whether a person is likely to quit smoking on his or her own or need medication to improve the chances of success, according to research published online May 30 in AJP in Advance. Researchers say the study moves health care providers a step closer to one day providing more individualized treatment plans to help patients quit smoking.

"We found that the effects of smoking cessation medications depend on a person’s genes,” said lead author Li-Shiun Chen, M.D., of the Washington University School of Medicine, St. Louis. “If smokers have the risk genes, they don't quit easily on their own and will benefit greatly from the medications. If smokers don’t have the risk genes, they are likely to quit successfully without the help of medications such as nicotine replacement or bupropion.”

The study was supported by multiple components of the National Institutes of Health, including the National Institute on Drug Abuse (NIDA). “This study builds on our knowledge of genetic vulnerability to nicotine dependence, and will help us tailor smoking cessation strategies accordingly,”said NIDA Director Nora Volkow, M.D. “It also highlights the potential value of genetic screening in helping to identify individuals early on and reduce their risk for tobacco addiction and its related negative health consequences.”

Data from previous studies show that depression is strongly linked to smoking and difficult quitting. For more information, see Psychiatric News, here.

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Fast-Acting Antidepressant May Spark Treatment Advances

A fast-acting antidepressant would be a helpful addition to the psychiatrist’s tool chest. Most antidepressant medications take weeks before their full effects kick in, leaving patients vulnerable in the interim. Now researchers at the National Institute of Mental Health (NIMH) have replicated the rapid antidepressant effects of an injectable anesthetic known as ketamine in patients with bipolar disorder. The results are reported in the June 1 Biological Psychiatry.

Patients in the trial received either two doses of ketamine, two weeks apart, or a placebo. About 79 percent of patients with ketamine improved within 40 minutes, compared with none of the patients on placebo. The effect of the ketamine lasted for three days and also reduced suicidal thoughts.

“Our finding that a single infusion of ketamine produces rapid antidepressant and antisuicidal effects within one hour--and they are fairly sustained--is truly exciting,” said lead author Carlos Zarate, M.D., of NIMH, in a statement. The study “offers an avenue for developing the next generation of treatments for depression that are radically different from existing ones.”

For an earlier report in Psychiatric News on Zarate’s work, click here.

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World Health Organization Supports Better MH Care

Before closing on May 26, the World Health Organization’s Sixty-fifth World Health Assembly adopted a new resolution calling on the 194 member states to improve conditions for mentally ill persons in their countries. 

“Member States acknowledged the need for a comprehensive, coordinated response to addressing mental disorders from health and social sectors at the country level,” said the resolution. “[T]his includes approaches such as programs to reduce stigma and discrimination, reintegration of patients into workplace and society, support for care providers and families, and investment in mental health from the [national] health budget.” 

The statement also supports community-based care close to patients' homes; the need for school-based suicide prevention programs; and better understanding of how substance abuse and domestic violence contribute to and worsen mental health disorders. 

The resolution’s passage came several months after a group of U.S. psychiatrists prompted the WHO to rethink its exclusion of mental health from a list of noncommunicable diseases, as reported here in Psychiatric News.

(Image: WHO/Pierre Albouy)

Antidepressants Increase Risk of Preterm Birth

A group of Yale researchers has concluded that the use of serotonin reuptake inhibitors (SRIs) in pregnancy increases the risk of preterm birth. They performed a prospective cohort study of 2,793 pregnant women and extracted data on birth outcomes from hospital charts. Use of an SRI, both with and without a major depressive episode, was associated with preterm birth, defined as birth at 34 to 36 weeks gestation. A major depressive episode without SRI use had no clear effect on preterm birth risk. Their results were published online May 25 in Epidemiology.

A 2009 study published in the American Journal of Psychiatry found that--for depressed pregnant women--both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20%. Read more in Psychiatric News here.

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A Cognitive 'Vaccine' Against Depression?

Cognitive exercises to reduce negative attention bias appear to reduce the risk of subsequent depression in individuals who were previously depressed, British researchers reported May 14 in Biological Psychiatry. Subjects with at least two previous episodes of depression were randomized to receive either a positive or a negative computer-based attention-bias-modification regime. The former were required to focus on photos of happy faces, whereas the latter were required to focus on photos of either happy or sad faces. Follow-up showed that the subjects who had focused on happy faces exclusively were less susceptible to subsequent depression than were the subjects who had focused on either happy or sad faces.

While this is an interesting study, there are still other interventions to prevent depression, such as exercising and challenging irrational, unrealistic, or overly negative thoughts. For more information about these findings, see Psychiatric News here and here and here .

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Diabetes, Depression Combo Raises Risk for Dementia

Individuals with diabetes who also have depression have a greater risk of dementia than do diabetes patients who do not have concurrent depression. That was the finding of a study that surveyed a racially and ethnically stratified random sample of patients with type 2 diabetes in a large, integrated, nonprofit managed care setting in Northern California.

Patients with comorbid depression had a 100 percent increased risk of dementia during a period three to five years after the initiation of the study, according to the report “Association of Depression With Increased Risk of Dementia in Patients With Type 2 Diabetes: The Diabetes and Aging Study.” It appeared in the April Archives of General Psychiatry.

“Up to 20 percent of people with diabetes have clinically significant depression,” lead author Wayne Katon, M.D., told Psychiatric News. “This study shows that comorbid depression has an added increased risk of macro- and micro-complications and an increased risk for dementia. It speaks to the importance of providing integrated quality mental health and general health care.”
For more information about diabetes and mental illness, and about integrated psychiatric care of diabetes and other medical conditions, see Psychiatric News here and here.

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PMDD Proposed as New Category in DSM-5

Premenstrual dysphoric disorder (PMDD) is being proposed for inclusion as a new category in DSM-5, rather than remaining as a set of criteria in the appendix of DSM. Inclusion of PMDD as a distinct category will provide greater legitimacy for the disorder and encourage the growth of evidence-based research, ultimately leading to new treatments, said Neill Epperson, M.D., and other members of the sub-work group that has developed the proposed criteria. Their report on this topic was published online March 28 in AJP in Advance.

In an interview with Psychiatric News, Epperson said an “explosion” of research in the last 20 years has validated the existence of severe and distinct symptoms—marked most prominently by emotional lability, irritability, and anger—during the luteal phase of the menstrual cycle. Epperson said probably only 2-5 percent of women would qualify for the diagnosis.

She pointed out that actual changes to the criteria that are currently in DSM-IV are modest. More important has been a reordering of symptoms, giving priority to the symptoms of emotional lability, irritability, and anger rather than depressed mood. For the article by Epperson and colleagues, click here. For additional coverage, see Psychiatric News here.

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Suicidal Behavior, Severe Neuropsychiatric Disorders Follow Glucocorticoid Prescription

Glucocorticoids increase the risk of suicidal behavior and neuropsychiatric disorders. Researchers in London recently examined data from all adult patients registered between 1990 and 2008 at general practices contributing to the United Kingdom's Health Improvement Network primary care database. Overall, 372,696 patients received 786,868 courses of oral glucocorticoids. The researchers identified 109 cases of suicide or suicide attempt and 10,220 cases of severe neuropsychiatric disorders in these patients. They found that people treated with glucocorticoids have a twofold higher risk of developing depression, a fourfold to fivefold higher risk of developing mania or delirium/confusion/disorientation, and nearly a sevenfold higher risk of committing or attempting suicide compared with people unexposed to glucocorticoids.

"Educating patients and their families about these adverse events and increasing primary care physicians' awareness about their occurrence should facilitate early monitoring," wrote the researchers in the May American Journal of Psychiatry.

Read more about the study in Psychiatric News, here.

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Times Calls Reparative Therapy "Pseudopsychiatry"

In an editorial in today's edition, the New York Times condemns as dangerous so-called reparative therapy, which its adherents claim can change homosexuals into heterosexuals, labeling it "absurd, potentially harmful, pseudopsychiatry."

The paper published the editorial in response to its article a few days earlier describing psychiatrist Robert Spitzer, M.D.'s, renouncing of a widely publicized—and widely condemned—study a decade ago in which he said he found evidence that reparative therapy can indeed change sexual orientation. Spitzer gained fame as one of the lead architects behind APA's 1973 deletion of homosexuality as a mental disorder from its Diagnostic and Statistical Manual and became a hero of the gay-rights movement, thus making his claims about reparative therapy especially shocking. However, he recently admitted that his study was flawed, relying solely on the personal accounts of people who said they had successfully changed their sexual orientation and whose names were supplied by organizations promoting reparative therapy. There was no control group or standard definition of what the so-called therapy involved. In its condemnation of the practice, the Times stated that evidence exists showing that "reparative therapy can lead to depression or suicidal thoughts and behavior.... It should have been rejected long ago."

Read an account of Spitzer's original study in Psychiatric News, and for a comprehensive review of mental health issues related to sexual orientation, see The LGBT Casebook, new from American Psychiatric Publishing.

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Pharmacists Warn Senate on Drug Shortages

The National Community Pharmacists Association said in a letter to senators considering new legislation for the Food and Drug Administration that drug shortages, especially of those used to treat attention-deficit/hyperactivity disorder, may be due to manufacturing restrictions imposed by the Drug Enforcement Administration. “The Drug Enforcement Administration has to walk a fine line between managing dangerous controlled substances like painkillers and making sure there are adequate supplies for legitimate medicine,” Sen. Chuck Grassley (R-Iowa) said in a statement.

The Senate bill would authorize a task force and mandate at least one study into the drug shortages. “A nonpartisan study by a neutral entity is needed to ensure that the proper balance is struck in the best interests of everyone involved,” said Grassley. The Senate should vote on the measure (S. 3187) this week. A House version is ready for a floor vote.

To read more detail about shortages of psychiatric medications, see Psychiatric News here.

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PTSD in Elderly Tied to Several Stressful Events

A national sample of 9,463 American adults aged 60 and older finds that PTSD is more prevalent than was believed and is associated with significant comorbid psychiatric problems, according to a report in Geriatric Psychiatry by researchers at the VA Connecticut Healthcare System and the Department of Psychiatry at Yale University School of Medicine.

Using data from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, Robert Pietrzak, Ph.D., M.P.H., and colleagues found that 4.5 percent reported having PTSD and 5.5 percent had some symptoms of PTSD. Rates were higher in women (5.7 percent for PTSD and 6.5 percent for PTSD symptoms) than in men (3.1 percent and 4.3 percent, respectively).

The unexpected death of someone close, a serious illness or injury to someone close, or their own serious or life-threatening illness were most commonly reported as the subjects' most stressful events. A PTSD diagnosis was associated with higher odds of lifetime mood, anxiety, drug use, and borderline and narcissistic personality disorders and decreased psychosocial functioning.

For more information about issues in geriatric psychiatry, see Psychiatric News  here. For a comprehensive review of the latest knowledge in geriatric psychiatry research and treatment, see American Psychiatric Publishing's
Essentials of Geriatric Psychiatry, Second Edition.

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Psychosis Development Linked to Multiple Brain Changes

Researchers have recently identified specific changes in the brains of adolescents that are linked to development of psychosis. The adolescents who were studied were deemed to be at "ultra high risk" of developing schizophrenia due to genetic risk; level of functioning in school, work or social situations; and early signs of psychotic symptoms. The high-risk adolescents were studied for two years and compared with controls subjects. The researchers, affiliated with the Rudolf Magnus Institute of Neuroscience at the University Medical Center in Utrecht, the Netherlands, said their findings "suggest that the development of psychosis is related to modest, but detectable, changes in grey matter and white matter over time." Of the 43 adolescents at ultra high risk of psychosis, eight became psychotic. These individuals showed "a smaller increase in cerebral white matter over time and more cortical thinning in the left middle temporal gyrus than was found in control subjects." The researchers eliminated use of antipsychotic medications as a cause of the brain changes.

Read more detail about this study in Psychiatric News.

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Chinese Herb May Counter Alcoholism

An extract of the Chinese herb kudzu dramatically reduces drinking and may be useful in the treatment of alcoholism, a small pilot study conducted by researchers at McLean Hospital and Harvard Medical School suggests. The researchers used a major component of the kudzu root called isoflavone puerarin since its safety and efficacy have been established in humans, particularly in studies in China where it is approved for intravenous injection to treat coronary heart disease, myocardial infarction, and angina.

In yet another recent, larger study using more traditional medication to treat alcohol-dependent individuals, the addition of gabapentin to naltrexone improved drinking outcomes when compared with use of naltrexone alone. For more information about this study see Psychiatric News. A comprehensive review of alcoholism and its treatment can be found in Clinical Manual for Treatment of Alcoholism and Addictions, from American Psychiatric Publishing.

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Spitzer Reportedly Recants Controversial Reparative Therapy Study

The “patina of scientific credibility” to which leaders of the so-called “ex-gay” movement have been clinging in their embrace of a deeply controversial 2001 study on “reparative therapy” has been taken away.

   That’s what psychiatrist Jack Drescher, M.D., told Psychiatric News about reports that Robert Spitzer, M.D., the author of the study that concluded that some “highly motivated” individuals could change their sexual orientation through so-called reparative therapy, had essentially repudiated it. “There’s very little scientific evidence that people can change their sexual orientation, but individuals in the ex-gay movement try to lend their beliefs a patina of scientific credibility,” Drescher said. “Spitzer’s study seemed to give them that patina, which he himself has just taken away.”

An article appearing Friday in the New York Times reported that Spitzer—who is well known to APA members as a leader in the development of DSM-III and DSM-IV, and renowned as one of those most responsible for getting homosexuality removed from the DSM in 1973—had renounced his 2001 study. The study had been presented at the 2001 annual meeting of APA and published in the Archives of Sexual Behavior in 2003.

 “I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy,” Spitzer wrote in the letter to Ken Zucker, M.D., editor of the Archives of Sexual Behavior. “I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some `highly motivated’ individuals.”

Psychiatric News could not reach Spitzer for verification. But Drescher, who is a friend and colleague of Spitzer's, said he has spoken many times with Spitzer over the years and that he has long acknowledged the study’s failures. “I don’t think Spitzer realized at the time how his name, which is well known, would be used by people for purposes with which he didn’t agree,” Drescher told Psychiatric News.  The Times article is here. The letter to Zucker is here.  For coverage of the original study see Psychiatric News here.

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Multiple Genes Found to Contribute to Alzheimer's

Although three dominantly inherited genes are known to cause Alzheimer's disease, 11 other genes have also been identified that appear to contribute to the illness, Richard Mayeux, M.D., a professor of neurology and psychiatry at Columbia University, reported at an Alzheimer summit held at the National Institutes of Health May 14 and 15. These diverse genes influence not just beta-amyloid, from which Alzheimer plaques are made, but also affect cholesterol, inflammation and immune responses. Scientists are now trying to sequence the proteins made by these genes, Mayeux said.

Comprehensive information about Alzheimer's disease can be found in the Clinicial Manual of Alzheimer Disease and Other Dementias, recently available from American Psychiatric Publishing. And to read more about recent research in Alzheimer's disease, see Psychiatric News here and here.

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Parents Support School-based Depression and Suicide Screening

A statewide survey showed that parents support school-based depression and suicide screening and that parents of school-aged children were generally well-educated about the need for such screening. That’s the finding of researchers at the University of Minnesota’s Department of Pediatrics who conducted a random sample by mail of 1,300 Minnesota households with children aged 5-18. In the study, published in the April 18 Maternal and Child Health Journal, chi-square tests and regression analyses were used to detect differences in parent support for depression and suicide screening and education across demographic categories, as well as their beliefs and knowledge about depression and suicide.

“Parent education to decrease stigmatizing beliefs and increase knowledge about depression and suicide may increase support among the minority of parents who do not endorse such programs,” wrote the researchers.

Recent studies of the neurotransmitters involved in adolescent depression are discussed in Psychiatric News here. More information on issues of relevant to adolescent depression is available in the recently published Concise Guide to Child and Adolescent Psychiatry, Fourth Edition, available from American Psychiatric Publishing here.

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Veterans With Blast Injuries Show Signs of Chronic Traumatic Encephalopathy

Blast exposure is associated with traumatic brain injury (TBI), neuropsychiatric symptoms, and long-term cognitive effects, reported Boston University School of Medicine researchers in the May 16 Science Translational Medicine. After examining postmortem brains from U.S. military veterans exposed to blast and/or concussive injury, they found evidence of chronic traumatic encephalopathy (CTE), a neurodegenerative disease, that was similar to the CTE neuropathology seen in young American football players and a professional wrestler with histories of concussive injuries.

The researchers developed a blast neurotrauma mouse model and used it to determine that head immobilization during blast exposure prevented blast-induced learning and memory deficits. “The contribution of blast wind to injurious head acceleration may be a primary injury mechanism leading to blast-related TBI and CTE,” they wrote. They said their results identify common pathogenic determinants leading to CTE in blast-exposed military veterans and head-injured athletes and provide evidence linking blast exposure to persistent impairments in neurophysiological function, learning, and memory.”

For more information about TBI, see the Textbook of Traumatic Brain Injury, Second Edition, available from American Psychiatric Publishing, here.

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CDC Lowers Threshold for Dangerous Lead Levels in Children

The Centers for Disease Control and Prevention (CDC) yesterday lowered the recommended limit for lead exposure in young children for the first time in 20 years, which the CDC says could add 200,000 children to those believed to have unsafe lead levels in their blood. The new standard, applicable to children under age 6, lowers the threshold to 5 micrograms of lead per deciliter of blood, from 10 micrograms per deciliter.

High lead levels in young children have been found to affect cognitive development and may lead to a lower I.Q. In 2010 the AMA House of Delegates approved a report by the AMA Council on Science and Public Health on lead levels in children, which noted that data since 1994 have shown impaired cognition, lowered IQ, and behavioral problems for children exposed to lead at blood concentrations below the CDC's then-current "level of concern" of 10 micrograms per deciliter.

For a report on the AMA's action regarding lead levels in children, see Psychiatric News.

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Drug to Prevent Alzheimer's to Be Tested

In a clinical trial that could lead to treatments that prevent Alzheimer’s disease, people who are genetically destined to develop the disease—but who do not yet have any symptoms—will for the first time be given a drug intended to stop it, the New York Times reported yesterday. The drug, crenezumab, attacks amyloid plaques in the brain. Many Alzheimer’s researchers believe that development of amyloid plaques is a primary cause of Alzheimer’s. The five-year trial will be sponsored by NIH with funding from Genentech, the drug's manufacturer. 

Study participants will come from the world’s largest family to experience Alzheimer’s, an extended clan of 5,000 people who live in Medellín, Colombia, many of whom have a genetic mutation that ensures that they will develop the disease. Three hundred family members will participate in the initial trial, some of whom will be years away from symptoms, some as young as age 30.
  
The Times report is here. To read the latest information on Alzheimer's diagnosis and treatment, see the new edition of the Clinical Manual of Alzheimer Disease and Other Dementias from American Psychiatric Publishing. To read more about Alzheimer's research, see Psychiatric News here.

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Deployment, not Military Service, Stresses Reservists

Deployment appears to lead to greater stress and suicidality risk among U.S. military reservists than among active-duty troops, according to a study in the June American Journal of Public Health. "Deployment...represents unique threats to all service members’ mental well-being,” wrote Marian Lane, Ph.D., of the Substance Abuse, Epidemiology, and Military Behavioral Health Program of RTI International. Lane and colleagues collected data from 18,342 reservists and 16,146 active-duty personnel for their study.

After adjustment for potentially confounding factors, reservists reported similar or less work and family stress, depression, and anxiety symptoms than did active-duty personnel. However, reservists who had been deployed reported higher rates of suicidality than deployed active-duty personnel and higher rates of posttraumatic stress disorder symptoms than active-duty personnel and reservists who had not been deployed.

Click here to read coverage of military mental health issues in Psychiatric News. To read the latest information on posttraumatic stress disorder, including among military personnel, see The Clinical Manual for Management of PTSD from American Psychiatric Publishing.

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Childhood Impairment May Presage Schizophrenia

Even before they develop signs of mental illness, some people can exhibit risk factors for disorders such as schizophrenia or bipolar disorder. Larry Seidman, Ph.D., a professor of psychology at Harvard Medical School, and colleagues looked at the associations of neuropsychological data collected at age 7 for 45 adults later diagnosed with schizophrenia, 35 with bipolar disorder, and 101 controls.

Neuropsychological impairments were identified in 42.2% of those who developed schizophrenia, 22.9% of those with bipolar disorder, and 7% of controls. The profile of childhood deficits for those with schizophrenia did not differ significantly from those in bipolar disorder subjects, said the authors, online May 11 in Psychological Medicine. Psychosis in first-degree relatives significantly increased the severity of childhood neuropsychological impairment in schizophrenia subjects but not those with bipolar disorder.

“[This suggests] especially impaired neurodevelopment underlying cognition in pre-schizophrenia children,” said the researchers. “Future work should assess genetic and environmental factors that explain this family history effect.”

To read more in Psychiatric News about risk factors for schizophrenia, click here.

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Experts Gather to Map Alzheimer's Research Agenda

Hundreds of international experts on Alzheimer's disease convened at the National Institutes of Health (NIH) in Bethesda, Md., yesterday and today to recommend a research agenda aimed at eventually preventing and treating the disorder. The summit is a key part of the National Plan to Address Alzheimer's Disease, which was signed into law in January 2011 and requires the Secretary of Health and Human Services to implement a national strategy on Alzheimer's research and care.

The National Institute on Aging, which will lead the effort, indicated that the summit's goal is "to identify the resources, infrastructure, and partnerships necessary to accelerate progress" on Alzheimer's disease research. The need to advance knowledge of the disease's prevention and treatment is critical, with about 5 million current cases of Alzheimer's and a projected spike in the number of cases as the population of the U.S. and other countries ages. NIH Director Francis Collins, M.D., noted that "there's a sense of optimism thanks to some new discoveries, [but] we need to figure out exactly where is the best window of opportunity to battle back Alzheimer's."

Read about promising research in Alzheimer's disease in Psychiatric News here and here. For the latest knowledge about diagnosis and treatment of the disorder, see the new edition of The Clinical Manual of Alzheimer Disease and Other Dementias from American Psychiatric Publishing.

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Facebook Joins Fight Against Military Suicides

The world's most popular social-networking site is putting its immense scope to work in the cause of trying to reduce the troubling number of suicides by military personnel and veterans. Facebook announced earlier this month that it is offering specialized suicide-prevention services for veterans, active-duty members of the military, and their families. The initiative was developed in conjunction with the Department of Veterans Affairs and the nonprofit organization Blue Star Families, founded by military families to help other such families adjust to the challenges of military life. Through Facebook, friends and families of service members and veterans who are concerned about the mental health or suicide potential of their loved ones can connect with a crisis line through which VA personnel can respond via phone, online chat, or text message. They can also send military-related mental health and counseling information to their loved ones via Facebook. 

U.S. military officials have over the last several years initiated several programs to try to stem and reverse a steadily increasing number of service members who have taken their own lives. To read more about efforts to reduce the epidemic of suicides in the military, see Psychiatric News, here and here.

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Naltrexone May Help Alcohol-Dependent Smokers

Cigarette smoking predicts more severe alcohol dependence and poorer addiction treatment response. Yet a medication used to treat alcohol dependence—naltrexone—might benefit alcohol-dependent individuals who smoke, a study published online April 30 in Biological Psychiatry suggests.

The study cohort included some 1,400 alcohol-dependent individuals, more than half of whom also smoked. At the end of the 16-week trial, alcohol-dependent subjects who smoked and who received naltrexone had better outcomes than alcohol-dependent subjects who smoked and who received a placebo. Alcohol-dependent, nonsmoking subjects who received naltrexone did not have better outcomes than alcohol-dependent, nonsmoking subjects who got a placebo.

In yet another study, the addition of gabapentin to naltrexone improved drinking outcomes over naltrexone alone in 150 alcohol-dependent subjects. For more information about this study, see Psychiatric News .

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Lithium May Be Neuroprotective

The element lithium may be neuroprotective in individuals with bipolar disorder, a study published in the May issue of Bipolar Disorders suggests. Fuctional magnetic resonance imaging (fMRI) was used to visualize and compare the brains of subjects with bipolar disorder who were being treated with lithium, the brains of subjects with bipolar disorder who were not taking lithium, and the brains of healthy controls. Results showed that there was no significant difference in hippocampal volume between bipolar subjects who were getting lithium and the controls. But bipolar subjects who were not getting lithium had a smaller left hippocampus.

Lithium's beneficial effects may not be limited to people with bipolar disorder though. Two other studies have found that lithium in drinking water may be able to protect some people against suicide. For more information about these studies, see Psychiatric News.

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On Progress in Social Integration of the Mentally Ill

The strides made and setbacks suffered in efforts to achieve social inclusion for individuals with mental illness are highlighted in a special section of the May Psychiatric Services comprising five research reports and two commentaries. Included are studies of separate housing programs for chronically homeless and formerly homeless adults, a new British antistigma campaign, the use of community-based participatory research methods in the creation of an instrument that can help clinicians design more targeted interventions to promote integration, and use of critical time intervention in promoting integration of formerly homeless adults following hospital discharge. The commentaries address the “mixed legacy” of supported housing and alternative approaches to achieving social integration.

Why Is Anorexia So Persistent?

Compulsive dieting associated with anorexia nervosa may be a learned habit that becomes ingrained over time and extraordinarily difficult to break. So suggested Timothy Walsh, M.D., Ruane Professor of Pediatric Psychopharmacology at Columbia University, in a lecture Tuesday at APA's annual meeting in Philadelphia titled "The Persistent Enigma of Anorexia Nervosa."

Walsh proposed a new conceptual model that attempts to explain why compulsive dieting—despite its potentially deadly consequences—is so remarkably durable. Drawing on learning theory, Walsh suggested that dieting, initially rewarding, becomes a fixed habit that occurs automatically and involves a structured behavioral sequence prone to be elicited by a particular context or stimulus. Walsh said such a model helps explain why early intervention with adolescents is more effective, accounts for notable similarities between anorexia nervosa and substance use disorders, and suggests that specific neural circuits are involved.

Prior to his lecture, Walsh described his theory in an interview with Psychiatric News. Watch the video http://youtu.be/9d0l-0i4IPQ.

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Ludwig van Beethoven: Tortured but Remarkably Resilient

APA's 2012 meeting in Philadelphia concluded yesterday in Philadelphia. We'd like to end our coverage with a lecture that marries mind and brain through music. 

Ludwig van Beethoven may have been a mad genius and tortured artist, but he is an ultimate example of the quality of resilience, according to psychiatrist and award-winning pianist Richard Kogan, M.D. In this video, taken at APA's 2012 annual meeting, Kogan discusses the great composer and plays a selection from his works. Watch the video.

(Video: David Hathcox; photo courtesy of Richard Kogan, M.D.)

People With Schizophrenia More Likely to Be Victims, Not Perpetrators of Violence

Popular media typically invert the real message about violence and schizophrenia—which is that people with schizophrenia have a much higher risk of being the victim of violence, said Peter Buckley, M.D., at APA's 2012 annual meeting in Philadelphia in the presidential symposium titled “The Role of Psychiatrists in the Prevention of Violence at the Level of Nations, Communities, and Individuals.” Buckley is a professor and chair of the Department of Psychiatry at the Medical College of Georgia. He was joined at the symposium by APA President John Oldham, M.D., Sue Bailey, M.D., and Dinesh Bhugra, Ph.D.

Buckley said that popular media—movies and television—more typically focus on the risk of violence committed by mentally ill individuals. But psychiatrists need to send the message that the greater risk is the other way around: that patients are more likely to be victims.

"It's a difficult message to send to the media,” Buckley said. “We need to be clear, and we cannot say there is not a high rate of violence among people with schizophrenia, but it is limited to a subgroup of people with active illness. This speaks to the importance of early access to care.”

Buckley spoke with Psychiatric News about his presentation. Watch the video.

 

University of Texas at Houston Wins APA's MindGames

1. Atomoxetine is a selective reuptake inhibitor of what neurotransmitter?
2. Grapefruit juice inhibits this enzyme in the gut leading to higher levels of some medications.

Know the answers? (1. norepinephrine, 2. cytochrome P450). Those were just two of the questions residents from New York Presbyterian Hospital (Cornell Campus), the University of Texas at Houston, and New York Presbyterian Hospital (Columbia Campus)/New York State Psychiatric Institute answered during this year’s MindGames competition at APA’s annual meeting, the fun and entertaining “Jeopardy”-like competition, moderated by Glen Gabbard, M.D., that pits psychiatrists from residency programs around the country against each other.

The University of Texas at Houston walked away with the honors. The team members were Connie Zajicek, M.D., Melissa Allen, M.D., and Garima Arora, M.D., and the residency director is Vineth John, M.D.

MindGames is open to all residency programs in the United States and Canada. The competition begins during the last two weeks of February, when teams of three residents each take a 60-minute online examination consisting of 100 multiple-choice questions. The questions follow the ABPN Part I content outline. Watch a video of the exciting conclusion of MindGames.

(photo: David Hathcox)

Kay Redfield Jamison Calls Grief 'Necessary'

APA's 2012 annual meeting in Philadelphia wraps up today. Here is more news from the meeting.

Kay Redfield Jamison Compares Grief and Depression
“Grief is not a disease, it’s necessary,” Kay Redfield Jamison, Ph.D., told a large and appreciative audience at APA’s 2012 annual meeting. She is a coauthor of Manic Depressive Illness: Bipolar Disorders and Recurrent Depression, the definitive book on the topic, and a best-selling memoir about her life experiences with mental illness, An Unquiet Mind. She gave a moving and eloquent presentation in which she described her perspective on the similarities and differences between grief and depression, having suffered the ravages of bipolar disorder as well as the 2002 loss of her husband. Read more.

Raise Your Energy and Performance With Sports Strategies
Sports psychiatrists are developing new strategies for athletes and nonathletes to counteract the ways in which competitive pressure degrades quality of life and performance, according to David McDuff, M.D. McDuff is a clinical professor of psychiatry at the University of Maryland School of Medicine and author of Sports Psychiatry: Strategies for Life Balance & Peak Performance by American Psychiatric Publishing. Read more.

Advances in Sleep Disorders: What’s New Under the Moon?
More than half of all psychiatric patients complain of disturbances of sleep and wakefulness. Sleep disorders are associated with impaired daytime functioning and predict a heightened vulnerability to psychiatric illness. They are also associated with physiological impairments and diminished lifespan. Their comorbid presence complicates psychiatric disorders, and their management may offer the potential for greater efficacy in the alleviation of emotional symptoms. These were some of the key points made by Karl Doghramji, M.D., a professor of psychiatry, neurology, and medicine at Thomas Jefferson University. Read more.

Donna Norris Honored During APA Annual Meeting

Donna Norris Recognized for Efforts on Behalf of Women, Minorities
Donna Norris, M.D., is being presented with the 2012 Jeanne M. Spurlock, M.D., Social Justice Award by the Association of Women Psychiatrists (AWP) in conjunction with APA’s 2012 annual meeting. She will receive the award during the joint meeting of the AWP and APA’s Women’s Caucus at the AWP Annual Awards Evening tonight. Norris is being recognized for her extraordinary dedication to and creative leadership efforts in the personal and professional development of women and minorities. Norris, a former speaker of the APA Assembly, is an assistant clinical professor of psychiatry at Harvard Medical
School and an editor of the new book Women in Psychiatry: Personal Perspectives by American Psychiatric Publishing.

Untangling Psychiatric Myths From Truth
During her training, Sparsha Reddy, M.D., suspected that many of the “facts” she had learned were actually anecdotes, which, through repetition, had evolved from “rules of thumb” to “accepted truth.” To pursue this idea, she asked several distinguished experts in her future subspecialty to present their own favorite examples. Read more here.

Experts Discuss PTSD Treatments
As a result of concern for this country’s returning combat veterans, much attention has been devoted to PTSD in the past several years. The Department of Defense and Department of Veterans Affairs as well as the National Institutes of Health have sponsored a variety of investigations into pharmacological and psychotherapy treatments as well as alternative treatment modalities and methods, according to Col. David Benedek, M.C. Read more.

Ted Kennedy Presents Convocation Lecture

APA's 2012 annual meeting continues in Philadelphia. Here's more news from the meeting.

Ted Kennedy Jr. Brings Message of Support to Psychiatrists
Last night at APA’s Convocation of Distinguished Fellows, Edward “Ted” Kennedy Jr. urged psychiatrists to be active advocates for their patients and their practices in state and federal legislative bodies. His address came exactly 20 years after his father—the renowned late senator from Massachusetts—spoke at APA’s Convocation. Read more here.

Schizophrenia Expert Proposes New Model for Understanding Psychosis
Psychosis may be essentially a disorder of learning and memory mediated by impaired glutamate signaling in the hippocampus, causing disruptions in synaptic encoding of memories, according to schizophrenia expert Carol Tamminga, M.D. Read more here.

Understanding Group Dynamics Key to Eliminating Bullying
Can we eliminate bullying from our schools and communities? The answer is complicated but taking certain steps advised by psychiatrist Stuart Twemlow, M.D., can lead to positive outcomes. Read more here.

Motivational Interviewing Supports Behavioral Change
Fundamentally, motivational interviewing is not a method or a “bag of tricks,” not something that can be done to someone, but something that is done with someone in a way that increases the likelihood that the patient will become more committed to change, according to Petros Levounis, M.D. Read more here.

Psychotherapy, Addiction Among Popular Topics at APA Annual Meeting

Psychotherapy Under Microscope but Undeservedly So
The role of psychotherapy in psychiatric practice and training is under scrutiny, said Jerald Kay, M.D., at APA's 2012 annual meeting today. Read more here.

Psychiatrists Need to Collaborate With Other Medical Specialists, Says Lazarus
You can’t practice alone. That’s the message Jeremy Lazarus, M.D., president-elect of the AMA, gave to psychiatrists at the APA annual meeting symposium “Psychiatry and the Role of Psychiatrists as Leaders in the Field of Medicine in Terms of Health Policy and the Changes in Health Care Delivery” at APA’s 2012 annual meeting in Philadelphia. In this video, Lazarus talks about the goals and priorities of the coming year and why psychiatrists need to pay attention to organized medicine.

Challenges in Addiction Treatment Examined
The lack of effective pharmacologic treatments for alcohol dependence is a solvable problem, said Henry Kranzler, M.D., a professor of psychiatry, associate scientific director of the Alcohol Research Center and program director of the General Clinical Research Center at the University of Connecticut School of Medicine. At APA’s annual meeting, Kranzler reviewed the four FDA-approved medications for alcohol dependence: Antabuse, Revia, Campral, and Vivitrol. Read more here.

Power of ‘Mindfulness’ Can Be Harnessed for Healing
Mindfulness—the practice of training the mind to be fully attentive to the present moment, without judgment—has in the last two decades entered the lexicon of medicine, psychiatry, and social work with the potential to transform the way we think of mind, body, and healing. That’s what Jon Kabat-Zinn, Ph.D., said at a presidential symposium at APA’s annual meeting. Read more here.