Army Holds Suicide-Prevention Training for All Soldiers

On September 27, the U.S. Army told all its soldiers to take a break from their regular duties and focus on suicide-prevention training. Suicides among active-duty soldiers have increased this year and could exceed last year’s 167. But lectures and suicide-awareness posters aren’t enough, said a retired Army colonel, psychiatrist Elspeth Cameron Ritchie, M.D., M.P.H., now chief clinical officer for the District of Columbia Office of Mental Health. Among Ritchie’s suggestions for her former military colleagues (outlined in her blog for Time magazine) are:

• Reevaluate policies that promote stigma;
• Reexamine the security clearance process, widely viewed as a barrier to seeking treatment;
• Revise the deployment-limiting psychiatric medications policy, which precludes soldiers from deploying if they have had any change in psychiatric medication or condition in the prior three months;
• Change the current stigmatizing process of getting treatment in the military mental health system by integrating mental health with primary care;
•  Discuss openly the contributions of alcohol abuse and gun ownership to suicidal behavior;
• Explore complementary and alternative medical approaches to care;
• Increase the behavioral health workforce, both military and civilian. 

For more in Psychiatric News about suicide and mental health in the armed forces, click here and here.

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CAM Not Ready for Prime Time

Although complementary and alternative medicine (CAM) is considered outside the usual canon of western medical practice, it is often desired by patients for any number of somatic or psychiatric complaints, including posttraumatic stress disorder (PTSD). CAM techniques for PTSD include meditation, acupuncture, and relaxation. However, the evidence base for such approaches is slim, according to an article in the fall PTSD Research Quarterly. A systematic review found just seven randomized controlled trials, and they were small and poorly designed.

“[T]he most basic question ‘Can it work?’ for PTSD has not yet been answered,” wrote Jennifer Strauss, Ph.D., of Duke University and the Department of Veterans Affairs in Washington D.C.; and Ariel Lang, Ph.D., M.P.H., of the VA San Diego Healthcare System and the University of California, San Diego.

These approaches “merit consideration” but require more research before they can be used as alternatives to current, validated treatments for PTSD, concluded the authors. However, they added, “[CAM] may be best applied as an adjunct to other PTSD treatments or as a gateway."

For more in Psychiatric News about CAM treatments in psychiatry, click here. See also the American Journal of Psychiatry here.

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Steering Residents Around Internet Perils

The Internet has revolutionized the way psychiatrists and other physicians communicate with patients and each other, but it is replete with obstacles and pitfalls that can trip up unsuspecting clinicians. A task force of the American Association of Directors of Psychiatric Residency Training has developed a curriculum, described in the new issue of Academic Psychiatry, that uses vignettes to outline principles that faculty can use to foster discussion on these critical issues with their residents. "The evidence of unprofessional behavior among physicians and the complexity of the potential issues raised with Internet use in psychiatry suggest that psychiatric residents, educators, and administrators need explicit teaching about potential clinical, ethical, and legal pitfalls of Internet use," the task force emphasizes, noting that "trainees accustomed to continual use of interactive technologies...may overlook boundary and other professionalism issues if they are not made explicit."

The curriculum's vignettes and discussions focus on nine key issues-—liability; confidentiality and privacy; psychotherapy and boundaries; safety; mandated reporting; libel; conflicts of interest; "netiquette"; and professionalism remediation.

The Academic Psychiatry article can be accessed here. Read more about psychiatrists' use of the Internet and social media in Psychiatric News here and here.

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Creatine Supplement to SSRI Antidepressant May Speed Recovery From Depression

Adding creatine—a dietary supplement—to treatment of depression with an SSRI antidepressant may be a promising therapeutic approach that speeds response to the medication, according to a report in the American Journal of Psychiatry.

Korean and American investigators enrolled 52 women with major depressive disorder in an 8-week double-blind placebo-controlled clinical trial and randomly assigned them to receive escitalopram—an SSRI antidepressant—in addition to either creatine or placebo. Efficacy was primarily assessed by changes in the Hamilton Depression Rating Scale (HAM-D).

They found that in comparison with the placebo group, patients receiving creatine augmentation showed significantly greater improvements in HAM-D score, as early as week 2 of treatment. This differential improvement was maintained at weeks 4 and 8. There were no differences between treatment groups in the proportion of patients who discontinued treatment prematurely or in the overall frequency of adverse events.

The results need to be replicated in more studies, but the researchers say the results are encouraging because antidepressants like escitalopram, despite their immediate effects at the synaptic level, usually require several weeks of administration to achieve clinical efficacy. “The present results suggest that creatine, used to augment treatment with the SSRI escitalopram, provides a promising therapeutic approach for major depressive disorder in terms of its superior efficacy, relatively good tolerability, minimal side effects, and easy attainability,” they wrote.

The AJP report is here. For more about depression and antidepressant medication see Psychiatric News, click here.

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Health Care Spending Rose Higher Than Expected in 2011

U.S. health care spending grew at a faster pace than expected in 2011, according to a report released yesterday by the Health Care Cost Institute (HCCI). HCCI found that average dollars spent on health care services for that population climbed 4.6 percent in 2011, reaching $4,547 per person. This was well above the 3.8 percent growth rate observed in 2010 and beyond expected growth for 2011.

Consumers spent more of their own dollars on health care in 2011, with out-of-pocket spending growing to $735 per person—a $32 increase from 2010—while costs covered by insurance grew at nearly the same rate. Prices rose for all major categories of health care—hospital stays, outpatient care, procedures, and prescriptions—outpacing an uptick in the use of many of these services.

“We need to continue studying these data to see whether this acceleration in spending growth is the beginning of an upward trend that will return us to pre-recession levels," said HCCI Governing Board Chair Martin Gaynor, PhD, a professor of economics and public policy at Carnegie Mellon University, in a statement.

"The Health Care Cost and Utilization Report: 2011" can be accessed here. For an analysis of recent trends in spending on psychiatric drugs, see Psychiatric Services here.

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Prevention Task Force Issues Alcohol Misuse Recommendations, Seeks Comments

The U.S. Preventive Services Task Force (USPSTF) on Monday posted a draft recommendation on screening and counseling for alcohol misuse. The public can comment on this draft recommendation until October 22. The recommendation applies specifically to screening and counseling interventions to reduce alcohol misuse in primary care settings. It has two parts: The USPSTF recommended that clinicians screen all adults 18 and older and pregnant women for alcohol misuse and provide those engaged in risky or hazardous drinking with brief counseling interventions to reduce alcohol misuse. The task force also concluded that there is not enough evidence to make a recommendation about whether it is effective to screen and provide counseling to reduce alcohol misuse for adolescents aged 12 to 17, reaffirming its 2004 recommendation.

The draft recommendation has been posted for public comment at www.uspreventiveservicestaskforce.org. The USPSTF is an independent group of national experts in prevention and evidence-based medicine working to improve the health of Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

To address alcohol misuse in older Americans, Medicare now covers alcohol screenings in primary care settings. Read more in Psychiatric News here.

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DEA Plans Prescription Drug Take Back Day

With public participation at an all-time high after four prior events, the Drug Enforcement Administration (DEA) will hold a new National Prescription Drug Take Back Day at thousands of sites on Saturday September 29. Take Back Days give the public the opportunity to prevent pill abuse and theft by ridding their homes of expired, unused, or unwanted prescription drugs. Collection sites are open 10 a.m. to 2 p.m. local time, and the service is free and anonymous.

Americans participating in previous Take Back Days turned in nearly 1.6 million pounds—almost 774 tons—of prescription drugs. Medicines that languish in home cabinets create a public-health and safety concern because they are highly susceptible to diversion and abuse. Rates of prescription drug abuse in the U.S. are alarmingly high—more Americans currently abuse prescription drugs than cocaine, hallucinogens, and heroin combined, according to the National Survey on Drug Use and Health. Studies show that a majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.  The public can find a nearby collection site by visiting www.dea.gov, clicking on the “Got Drugs?” icon, and following the links to a database where they enter their zip code. 

One promising treatment for addiction to opioid painkillers is suboxone. Read more about it in Psychiatric News here.  

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Prenatal Tobacco Exposure Can Shrink the Amygdala

Prenatal exposure to maternal cigarette smoking is a well-established risk factor for obesity, and one reason why may be because it decreases the size of the amygdala in the brain. So reported Zdenka Pausova, M.D., an associate professor of physiology at the University of Toronto, and colleagues recently in the Archives of General Psychiatry, after studying some 400 adolescents. And more distressing news about the effects of tobacco on the brain comes from a study recently reported in Brain Imaging and Behavior in which David Bennett, Ph.D., an associate professor of psychiatry at Drexel University, and colleagues found that exposure to tobacco seems to impair adolescent working memory.

Undoubtedly a number of women who smoke during pregnancy would like to quit, but they are probably not getting the help that they need to do so, yet another study suggests. For more information about this study, see Psychiatric News.

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Delirium Is Too Often Ignored

"Delirium is extremely common among older adults in intensive care units and is not uncommon in other hospital units and in nursing homes, but too often it's ignored or accepted as inevitable," Babar Khan, M.D., an assistant professor of medicine at Indiana University, asserted September 18 in a press release on a new study. Delirium also markedly increases the risk of developing dementia and triples the likelihood of premature death, Khan and his colleagues found after reviewing 45 years of research and 585 studies on delirium. They reported this finding in the September Journal of Hospital Medicine.

Watch for more information about the complex relationship between delirium and dementia in the October 5 Psychiatric News.

Also on the topic of delirium, some dying patients experience agitation due to delirium, causing considerable distress for their families and adding to the families' emotional burden, Scott Irwin, M.D., Ph.D., chief of psychiatry at the Institute for Palliative Medicine at San Diego Hospice, said in an interview with Psychiatric News. For more information about this subject, click here.

More information on delirum and how to address it can be found in a new book  from American Psychiatric Publishing, Clinical Manual of Psychosomatic Medicine: A Guide to Consultation-Liaison Psychiatry, Second Edition.

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Suicide Now Leading Cause of Injury Mortality

Mortality rates for suicide rose substantially over the past decade, and suicide has passed motor-vehicle crashes as the leading cause of injury mortality, according to a report appearing yesterday in the American Journal of Public Health. Researchers at West Virginia University School of Public Health and other institutions used annual underlying cause-of-death data from the National Center for Health Statistics to describe national trends in fatal injury for 2000-2009.

Suicide ranked first as a cause of injury mortality, followed by motor-vehicle crashes, poisoning, falls, and homicide. (Good news from the study was that the unintentional motor-vehicle mortality rate declined 25 percent.) The researchers speculate that a steep increase in unintentional poisoning they found may be related to the epidemic of prescription drug abuse. They suggest that the suicide data point to a "global public-health problem" in that suicides have also surpasses motor-vehicle accident mortality in the European Union, Canada, and China. Read more about the study here.

For information about suicide prevention, see Psychiatric News here. For a comprehensive review of the subject, see The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.

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Neighborhood, Social Environment Matters to Mental Health

Moving from a high-poverty to lower-poverty neighborhood leads to long-term improvements in physical and mental health and subjective well-being finds a study appearing online yesterday in Science. Researchers from the University of Michigan collected data on participants in the Moving to Opportunity (MTO) program, a randomized housing mobility experiment. From 1994 to 1998, MTO enrolled 4,604 low-income public-housing families living in high-poverty neighborhoods in five cities. Families were randomized to three groups: one received vouchers for rent in certain more affluent neighborhoods, one received rent vouchers that could be used anywhere; and a control group that received no assistance.

The researchers found that the chance to move to less-distressed neighborhoods—while having no long-term effects on economic self-sufficiency—had a large impact on physical health and a statistically significant effect on mental health. The improvement was equal to the level of life satisfaction of someone whose annual income was $13,000 more. “Our results suggest that living in distressed neighborhoods has more important adverse impacts, and escaping from such neighborhoods has more important positive effects, on the well-being of low-income adults than was revealed by previous [studies] that focused on traditional measures of socioeconomic and health outcomes,” the researchers said. An abstract of the study is posted here. For more about the link between poverty and mental illness, see Psychiatric Services.  

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Childhood Adversity Linked to Stroke Risk in Adulthood

Psychiatrists and other physicians who treat children and adolescents may have a new reason to be concerned about the consequences that adverse childhood experiences will have on the physical health of these youth decades later. Researchers at the Rush Alzheimer's Disease Center in Chicago and the departments of Neurological Sciences and Behavioral Sciences at Rush University Medical Center, have found an association between experiencing serious adverse events in childhood and an increased risk for stroke in late adulthood. Their findings were reported online yesterday in the journal Neurology.

Study participants aged 55 and older were asked to rate the severity of adverse experiences such as emotional neglect, parental intimidation, and being the victim of violence  on a 16-point scale. They were then followed-up for a mean of 3.5 years, during which time 257 of the participants died. Brain autopsies were conducted to reveal neuropathologies. Adjusting for age, gender,
education, socioeconomic status, and cardiovascular risk factors, researchers found a link between chronic cerebral infarction and higher childhood adversity scores, with a particularly strong link to emotional neglect. The mechanism of action that underlies the link between serious childhood adversity and stroke is yet to be determined, though telomeres may play a role.

Read coverage of the relationship between stroke and psychiatric and cognitive disorders in Psychiatric News here and here.

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Portland Police to Improve Crisis-Intervention Response

The Department of Justice has reached a preliminary agreement with the Portland, Ore., Police Bureau (PPB) to improve officers’ response during encounters with people with mental illness. “[W]e find reasonable cause to believe that PPB is engaging in a pattern or practice of using excessive force in encounters involving people with actual or perceived mental illness,” concluded a 42-page report released September 12. The agreement came in the wake of a report that faulted the bureau not only for use of excessive force, but also for inappropriate use of Tasers, inadequate specialized crisis-intervention teams, lack of strategic disengagement protocols involving mental health care providers, and poor supervision of officers in such cases.

The Justice Department acknowledged that the area’s mental health infrastructure “has a number of key deficiencies,” which “often shifts to law enforcement agencies throughout Oregon the burden of being first responders to individuals in mental health crisis.” Portland Police Chief Mike Reese both defended his officers’ actions and agreed to implement reforms, according to the Portland Oregonian.

To read more about how police departments use crisis-intervention teams to respond to incidents with mentally ill people, see Psychiatric News here.

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Mother's Diabetes Ups Risk of ADHD in Offspring

A study of 17,642 children in Germany confirms associations between several early risk factors and development of attention-deficit/hyperactivity disorder (ADHD). Parents’ lower socioeconomic position (education, professional status, and income), along with presence of gestational diabetes in the mother, increased the likelihood of a child having ADHD, wrote Jochen Schmitt, M.D., M.P.H., of the Technical University Dresden and Marcel Romanos, M.D., of the University Hospital of Würzburg, online September 10 in the Archives of Pediatric and Adolescent Medicine.

Furthermore, the combination of middle- or lower-class socioeconomic position with maternal gestational diabetes had an additive effect on outcomes. Other factors, such as a baby’s medical problems following birth, atopic eczema, or maternal smoking during pregnancy also contributed significantly to risk of ADHD. Schmitt and Romanos did offer some good news: breastfeeding reduced risk. "Modification of these environmental risk factors by evidence-based prevention programs may help to decrease the burden of ADHD,” they concluded.

For more in Psychiatric News about the origins of ADHD, click here and here. See also a new study in AJP in Advance here.

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Data Show Current State of Psychotherapy Training

Noting that "psychotherapy skills are at the core of clinical psychiatry," and with several forms of psychotherapy now a mandated focus of training in psychiatry residency programs, researchers conducted a nationwide survey of U.S. general-psychiatry training directors about their methods of didactic presentation, supervised clinical experience, and numbers of patients treated with the models of psychodynamic, cognitive-behavioral, and supportive therapy. Describing their findings in the new issue of Academic Psychiatry, Donna M. Sudak, M.D., and David A. Goldberg, M.D., reported a wide variation in psychotherapy education. "Psychodynamic training is the most robust, but has the greatest variability," they said, and in some programs psychodynamic psychotherapy training is "far below" a baseline set by psychiatric educators in 1990. "CBT [cognitive-behavioral therapy] training has advanced significantly over the past decade. Supportive psychotherapy is the most widely practiced, but receives the least amount of didactic time and supervision." It also has the "least-defined pedagogical base and the most limited focused training." They concluded that "[C]ore content, sequencing of training, length of training, patient availability, and faculty education must receive ongoing attention and development to ensure more effective psychotherapy training for psychiatrists."

Read more about the study in Academic Psychiatry here. And learn more about psychodynamic psychotherapy training in Psychiatric News here.

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Military's Approach to Drug, Alcohol Use Disorders Called Outdated

Outdated approaches to preventing and treating substance abuse, barriers to care, and other problems hinder the Pentagon's ability to curb substance use disorders among military service members and their families, says a new report from the Institute of Medicine. Service members' rising rate of prescription drug addiction and difficulty accessing adequate treatment for alcohol- and drug-related disorders were among the concerns that prompted Congress to request this review.

"We commend the steps that the Department of Defense and individual service branches have recently taken to improve prevention and care for substance use disorders, but the Armed Forces face many ongoing challenges," said Charles O'Brien, the Kenneth Appel Professor and vice chair of the Department of Psychiatry and director of the Center for Studies of Addiction at the University of Pennsylvania. He chaired the committee that wrote the report. "Better care for service members and their families is hampered by inadequate prevention strategies, staffing shortages, lack of coverage for services that are proved to work, and stigma associated with these disorders. This report recommends solutions to address each of these concerns."

To provide effective treatment, civilian mental health care clinicians must be as aware of the needs of military veterans as their counterparts in the Armed Forces are. Read more in Psychiatric News here. Also see a Psychiatric Services report on pharmacotherapy of alcohol use disorders in the Veterans Health Adminstration here.

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Patients Who Self-Harm Have Shorter Life Expectancy

Researchers reported today that people who self-harm have an increased risk of premature death. As published online in Lancet, they studied patients of all ages presenting to emergency departments in Oxford, Manchester, and Derby, England, after self-poisoning or self-injury from January 1, 2000, to December 31, 2007. Patients were followed up to the end of 2009. 

Of the 30,950 individuals who presented with self-harm, 1,832 (6.1 percent) died before the end of follow-up. Death was more likely in patients than in the general population and occurred more in males than females. Deaths due to natural causes were 2 to 7.5 times more frequent than expected. For individuals who died of any cause, mean years of life lost was 31.4 years for male patients and 30.7 years for female patients. 

"Physical health and life expectancy are severely compromised in individuals who self-harm compared with the general population," concluded the researchers, who stressed that in managing patients who self-harm, clinicians assessing patients' psychosocial problems should also consider their physical needs.

More about assessing patients who self-harm can be found in the American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition here.

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Antipsychotics Can Prime Brain's Food-Reward Circuitry

The reason why the antipsychotic medication olanzapine often causes weight gain in patients is because it activates brain circuitry known to respond to food rewards, suggests a neuroimaging study conducted on healthy subjects and published recently in the Archives of General Psychiatry. The subjects took olanzapine for only a week, but nonethelesss it caused a marked increase in food consumption and weight. The lead researcher was Jose Mathews, M.D., of Washington University.

However, olanzapine's propensity to cause weight gain may have a silver lining—helping individuals with anorexia nervosa put on much-needed weight. To learn more about this topic, see Psychiatric News.

Comprehensive information for clinicians on how to deal with antipsychotic-provoked weight gain and other sequelae of psychoactive medication use, including responding to emergency situations, can be found in a new book from American Psychiatric Publishing titled Managing the Side Effects of Psychotropic Medications.

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Hope Grows for Potential Bipolar Disorder Biomarker

A potential biomarker for bipolar disorder may have been found, Tomas Hajek, M.D., Ph.D., an associate professor of psychiatry at Dalhousie University in Canada, and his colleagues reported recently in Biological Psychiatry. The study included 154 subjects—19 adolescents or young adults with bipolar disorder, 50 nonaffected relatives of people with bipolar disorder, 36 affected relatives of people with bipolar disorder, and 49 healthy control subjects. Using MRI imaging, the scientists found that subjects with bipolar disorder as well as their affected and unaffected relatives had a significantly larger inferior frontal gyrus in the brain than controls did. "The finding that the inferior frontal gyrus may be a biomarker for bipolar disorder is exciting and important," Kiki Chang, M.D., a professor of psychiatry and director of the pediatric bipolar disorders program at Stanford University, told Psychiatric News. Chang was not connected with the study.
More information about this research will appear in the September 21 Psychiatric News.

To better appreciate the impact that bipolar disorder can have on people, view two interviews on the PBS television series "Healthy Minds" with well-known personalities who have the illness—Patty Duke and Jane Pauley. The series is hosted by Jeffrey Borenstein, M.D., editor-in-chief of Psychiatric News. Click here to view the interviews .

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Range of Neuropsychiatric Disorders Linked to Alterations in DNA

Having multiple, large “copy-number variants”— either deletions or duplications of sections of DNA—appears to significantly increase the risk for a range of neuropsychiatric disorders whose expression as a specific disorder will differ from person to person depending on other genetic and environmental factors, according to a report in the New England Journal of Medicine.


Among the disorders that may stem from these copy-number variants are autism, schizophrenia, attention-deficit/hyperactivity disorder, aggressive behaviors, epilepsy or seizures, and specific organ defects. Having more than one of the copy-number number variants significantly increases the risk for one of the disorders.

Genetic experts at more than 20 institutions and research centers analyzed the genomes of 2,312 children known to carry a copy-number variant associated with intellectual disability and congenital abnormalities. They found that among affected children, 10.1% carried a second large copy-number variant in addition to a primary genetic lesion.

“We propose that a combination of rare and disruptive variants of large effect can contribute to different phenotypic outcomes, including intellectual disability, epilepsy, autism, and schizophrenia,” the researchers stated in the article.

The report can be accessed here. For more information see Psychiatric News here and here.

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Census Bureau Reports Decrease in People Without Health Insurance

The U.S. Census Bureau announced this week that the percentage of people without health insurance coverage decreased.

The number of people without health insurance coverage declined from 50.0 million in 2010 to 48.6 million in 2011, as did the percentage without coverage - from 16.3 percent in 2010 to 15.7 percent in 2011. These findings are contained in the report “Income, Poverty, and Health Insurance Coverage in the United States: 2011.”

The decrease in uninsurance may be at least partly attributable to a provision in the Affordable Care Act, already in effect, that allows young adults to remain on their parents’ insurance plans. The rate of uninsurance declined for people aged 19 to 25, though it remained unchanged for children under 19 and adults aged 26 to 34, according to the report.

The Census Bureau report can be accessed here. For information about lack of insurance and mental illness, see Psychiatric News here. And for information about the Affordable Care Act, see Psychiatric News here.

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APA Joins Senate Discussion on Physician Payments Sunshine Act

APA Medical Director James H. Scully Jr., M.D, joined the U.S. Senate Special Committee on Aging yesterday in a roundtable discussion on implementation of the Physician Payments Sunshine Act (PPSA). APA generally supports the PPSA and urged the Centers for Medicare and Medicaid Service (CMS) to implement it in a way that gives physicians adequate time to comply fully with its provisions. Enacted into law as part of the Affordable Care Act, the PPSA is intended to increase the transparency of financial relationships among the drug industry, physicians, and teaching hospitals. Scully joined industry, policy, and advocacy leaders, including psychiatrist Jeremy Lazarus, M.D., president of the AMA, in the discussion.

In his remarks Scully said, “APA supports the underlying objectives of the PPSA, which complement our own initiatives to reduce perceived or potential conflicts of interest between industry and our member-driven activities.”

APA has made key recommendations to CMS to consider in its final rule on implementation of the PPSA. Read more about APA's position on the law in Psychiatric News.

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DEA Revokes Registration of Two National Chain Pharmacies

The Drug Enforcement Administration (DEA) announced yesterday that it has revoked the registration of two Florida CVS pharmacies. This action marks the first time the DEA has revoked the registration of a branch of a large national chain. The action follows the February 4 Immediate Suspension Order (ISO) that the DEA previously filed on the two pharmacies. An ISO is served when a DEA-registered business or individual constitutes an imminent danger to the public safety and DEA suspends that registrant’s ability to handle or distribute a controlled substance such as oxycodone, hydrocodone, and others pending a judicial proceeding. A Final Order of Revocation filed by the DEA will be published in the Federal Register; the ISO will remain in effect until then.

These actions are part of the DEA Miami Field Division’s efforts to combat the state’s prescription drug abuse epidemic and its role as a major source of diverted prescription drugs to other states. Florida also has a 24-hour “Pill Mill” tip line that allows callers to leave information about a doctor or clinic that concerns them and over 100 collection sites for people to dispose of unused, unwanted, or expired prescription drugs. 

The Centers for Disease Control and Prevention recently tasked states with achieving control over opioid pain prescriptions, saying that state agencies, as regulators of health-care practice, have the responsibility and authority to monitor and correct inappropriate and illegal prescribing. Read more about it in Psychiatric News, here.
 

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Mobile App Helps Post-Disaster Mental Health Responders

The next time disaster strikes, mental health and other response workers may find help in delivering psychological first aid (PFA) as near as their smartphones. “PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress and to foster short and long-term adaptive functioning,” says the Department of Veterans Affairs’ National Center for PTSD, a codeveloper of the app along with the Department of Defense’s National Center for Telehealth and Technology and the National Child Traumatic Stress Network.

Responders should learn PFA before a disaster occurs, say the developers. “This app is a supplement to other resources [that] trained individuals utilize before, during, and after a disaster response.” Armed with that knowledge, users can then read summaries of PFA actions; match interventions to specific stress reactions of survivors; evaluate survivors’ needs and track them to simplify data collection and referrals; and use self-assessments to judge their own readiness to conduct PFA. The PFA mobile app is available for Apple iPhone users; an Android version will appear in 2013.

To learn more about key factors in preparing for the mental health aftermath of disasters, see Psychiatric News here.

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New Strategy Plan for Suicide Prevention Announced

The Action Alliance for Suicide Prevention and the U.S. surgeon general on September 10 issued an updated National Strategy for Suicide Prevention. The strategy seeks to lessen the stigma that deters discussion of suicide and interventions to prevent it; promote the integration of general and mental health care; enhance clinical and community preventive services; promote the availability of timely treatment and support services; and improve suicide-prevention surveillance collection and research.

Research is a major component of the new strategy, said Thomas Insel, M.D., director of the National Institute of Mental Health. “This is a tough scientific problem.... The factors that contribute to suicide are multiple and complex. No single approach will suffice, and there are no simple answers to why any one individual takes his or her own life.” A separate suicide-related research agenda will be ready in 2013 and will guide studies of risks and interventions, Insel noted.

To read more about suicide-prevention strategies, see Psychiatric News here. For a comprehensive review of suicide-related issues, see the new publication, The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition here.

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Experimental Alzheimer's Drug Might Work if Given Earlier

It may be too soon to kick bapineuzumab to the curb, according to researchers at the Congress of the European Federation of Neurological Societies in Stockholm, Sweden, this week. The monoclonal antibody, which was being developed by Pfizer and Johnson & Johnson, recently failed to demonstrate improvements in Alzheimer's disease (AD) patients in two major trials, causing the companies to discontinue the trials. But an analysis of the effect of the drug on biomarkers in the study subjects shows significantly reduced levels of beta amyloid on the brain scans of patients who carry the ApoE4 gene mutation, a marker for increased AD risk.

"We were very disappointed that we were not able to come up with a treatment to provide to our dementia patients in the near term," Reisa Sperling, M.D., director of the Alzheimer's center at Brigham and Women's Hospital in Boston and leader of one of the studies, told the Associated Press. But she said brain imaging and spinal fluid tests are very encouraging and suggest "we were doing something to the biology of the disease." Eli Lilly has been evaluating a similar drug, solanezumab, and also found slight benefit in patients with mild AD.

Read more about the developmental history of both drugs in Psychiatric News, here and here. For new research on genetic risk factors related to cognitive decline in AD, see the September American Journal of Psychiatry.

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Children of Mothers Who Smoked During Pregnancy Face High Obesity Risk

Pregnant women who smoke may be sentencing their child to adolescent obesity, in part due to subtle structural variations in the child's amygdala. Researchers presented in the online September 3 Archives of General Psychiatry the results of their evaluation of 378 adolescents enrolled in the Saguenay Youth Study in Quebec, Canada. Half of the subjects were exposed prenatally to maternal cigarette smoking, and those teens exhibited a higher total body fat than peers who were not exposed. They also exhibited a lower amygdala volume. Consistent with its possible role in limiting fat intake, amygdala volume correlated inversely with fat intake.

The study population had high genetic and cultural homogeneity, and both exposed and nonexposed participants did not differ on factors such as number of family meals, intake of fruits and vegetables, and family income. The researchers said their findings are consistent with the fetal-programming hypothesis of obesity and suggest that prenatal exposure to maternal cigarette smoking may contribute by modifying fat intake through neural mechanisms involving the amygdala.

In the general population, women smoke less than men, but among depressed individuals, men's and women's smoking rates are the same. Read more about that topic in Psychiatric News, here.

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Could GHRH Keep Seniors Mentally Sharp?

Could injections of growth hormone-releasing hormone (GHRH) keep seniors sharp regardless of whether they have mild cognitive impairment? An intriguing study published recently in the Archives of Neurology suggests that they could. The lead scientist was Michael Vitiello, Ph.D., a professor of psychiatry at the University of Washington. Vitiello and colleagues first found in a six-month study of 89 healthy older adults that daily injections of GHRH improved executive function significantly more than a placebo did. They have now now confirmed those results in a larger study and extended them to subjects with mild cognitive impairment.

Their sample included 137 older adults aged 55 to 87, of whom 76 had normal cognitive status and 61 had mild cognitive impairment. The subjects self-administered daily subcutaneous injections of a synthetic analog of human GHRH (1 mg/d) or a placebo 30 minutes before bedtime for 20 weeks. At baseline, at weeks 10 and 20 of treatment, and after a 10-week washout period (week 30), cognitive tests were administered. The executive-function results for the GHRH group were significantly better than for the placebo group. And even though the healthy adults outperformed those with mild cognitive impairment, the cognitive benefit of GHRH relative to placebo was comparable for both groups.

"This is a well-conducted trial by an outstanding group of investigators with expertise in cognitive disorders of later life," APA President Dilip Jeste, M.D., chair in aging at the University of California, San Diego, told Psychiatric News.

Look for more information about this study in an upcoming issue of Psychiatric News.

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Can a New Eye Test Detect Schizophrenia?

A mathematical model that assesses eye movements known to be abnormal in individuals with schizophrenia appears to discriminate schizophrenia cases from controls with near-perfect accuracy. The lead scientist was Philip Benson, Ph.D., of the University of Aberdeen in Scotland, and study findings were published in Biological Psychiatry.

"This is a very interesting study," L. Elliot Hong, M.D., a professor of psychiatry at the University of Maryland and a schizophrenia expert, commented to Psychiatric News. "[However] the important next steps are [determining] whether these measures are specific only to schizophrenia or whether they can also separate different psychiatric diagnoses...." Benson agreed. "We already know that the model can distinguish cases diagnosed with bipolar disorder [from those diagnosed with schizophrenia] with around 95 percent accuracy. We have preliminary data suggesting that major depressive disorder can also be distinguished [from schizophrenia], which is a tremendously exciting finding."

To read more about this study, see the latest issue of Psychiatric News.

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Football Players Face Elevated Risk of Death From Neurological Causes

Professional football players may be at increased risk of death from Alzheimer’s disease (AD) and other neurological disorders, according to a new study in Neurology. Risk of death related to all neurological causes among professional football players who played in the National Football League from 1959 to 1988 was three times higher than for the general U.S. population, and the risk was four times higher for two of the major neurodegenerative subcategories—AD and amyotrophic lateral sclerosis (ALS). Moreover, players who played “speed” positions—those such as receiver or running back that require acceleration before being hit or tackled—had a higher risk for neurological disorders than did those who played “non-speed” positions, such as lineman, that are more stationary.

The number of neurologically associated deaths in the study sample of more than 3,400 players was small, so the findings are not conclusive. But they echo previous research that found an association between head injury or multiple concussions and Alzheimer’s and other neurological disorders. And last year a study in Psychiatric Services showed an association between traumatic injury and psychiatric illness. For more information on that study, see Psychiatric News here.

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IOM Report Cites $750 Billion in Health Spending Waste

A staggering 30% of U.S. health spending in 2009—roughly $750 billion—was wasted on unnecessary services, excessive administrative costs, fraud, and other problems, according to a report released yesterday by the Institute of Medicine. The report,  “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” identifies six major areas of waste and their annual cost: unnecessary services ($210 billion), inefficient delivery of care ($130 billion), excess administrative costs ($190 billion), inflated prices ($105 billion), prevention failures ($55 billion), and fraud ($75 billion).

The report also lists 10 recommendations emphasizing tools that are available now—such as better use of health data systems and and a focus on patient-centered care—for creating a leaner health care system. Read the report here.

A 2011 report by the IOM stressed that when determining what benefits are essential to new insurance plans offered under the federal health care reform law, the government should consider both breadth of coverage and affordability and that the success of the Affordable Care Act will hinge on its ability to manage costs. For more information, see Psychiatric News here.

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Teens With Autism Spectrum Disorder Often Bullying Victims

Core deficits characteristic of adolescents with autism spectrum disorder (ASD), such as poor conversational ability and deficient social skills, make it hard for them to integrate with their school peers and increase the likelihood that they will be the victims of bullying. Approximately 46% of adolescents with ASD have been bullied, a rate considerably higher than for teens with mental retardation, speech/language impairments, or learning disabilities, reported Paul Sterzing, Ph.D., MSSW, of Washington University and colleagues Monday in the Archives of Pediatric and Adolescent Medicine. And the greater the adolescent's social skills, the less likely he or she is to be a bullying victim. The prevalence of bullying victimization among those with ASD is also much higher than the rate for adolescents in general, which is 10.6%. The rates for perpetrating bullying were about the same for those with ASD and "typically developing adolescents" (14.8% and 13%, respectively). Data were derived from parent interviews conducted nationwide.

Citing the public-health implications of their findings, the researchers stressed that schools "need to increase the social integration of adolescents with an ASD into protective peer groups while also enhancing the empathy and social skills of typically developing students toward their peers with ASD and other developmental disabilities."

Read more about autism and ASD in Psychiatric News here and here and in the Textbook of Autism Spectrum Disorders, from American Psychiatric Publishing.

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