DBT Appears Effective in Treating Suicidality, Self-Harm in Adolescents, Study Shows

Dialectical behavior therapy (DBT) may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior, according to a report published online in the Journal of the American Academy of Child and Adolescent Psychiatry. Researchers at Norway's National Centre for Suicide Research and Prevention at the University of Oslo, randomized 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics to receive either a shortened form of DBT or an enhanced form of usual care (EUC). Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after nine, 15, and 19 weeks, and frequency of hospitalizations and emergency department visits over the trial period were recorded.

DBT was found to be superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT, whereas effect sizes were small for outcomes in patients receiving EUC.

A form of therapy originally developed by Marsha Linehan, Ph.D., of the University of Washington to treat borderline personality disorder, DBT combines cognitive and behavioral strategies with validation and Eastern mindfulness, among other techniques, to help individuals change unwanted or unhealthy behaviors.

Psychiatrist Paula Clayton, M.D., former medical director of the American Foundation for Suicide Prevention, told Psychiatric News the results of the new study are not surprising. “There are some effective psychotherapies [for the] treatment of suicidal thoughts and actions that are based on cognitive and behavioral techniques, and DBT is one of them. It has proven successful in previous research on adults with borderline personality disorder to decrease self-harming behaviors. It combines a number of elements and is very intensive.”

To read more about the use of DBT, see the Psychiatric News article, “Several Therapies Show Success in Treatment of Personality Disorders.” For information on how clinicians can address suicide risk in their patients, see the American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.

(Image: MitarArt/shutterstock.com)

IOM Argues for Long-Term Change in Residency Funding

A complete overhaul of graduate medical education (GME) financing and governance is needed to fix the current Medicare-based part of the payment system and “produce a physician workforce that meets the evolving health needs of the population,” said an Institute of Medicine (IOM) committee in the report it released yesterday. The report is titled "Graduate Medical Education that Meets the Nation's Health Needs."

Greater transparency and accountability in the funding process are required, as well, said the IOM committee. The present direct and indirect funding streams should be merged into a single fund with two subunits that would support currently authorized GME residency programs and finance innovative GME programs.

The IOM committee recommended maintaining GME funding at present levels ($9.7 billion in 2012), but changes should be made over a period of 10 years to modernize GME payment methods based on performance, to ensure program oversight and accountability, and to reward innovation in the content and financing of GME. The plan calls for a GME policy council within the Department of Health and Human Services and a second center within CMS to manage operations of the system.

The committee also raised questions about the physician workforce of the future. Among its recommendations was the development of research and policy "regarding the sufficiency, geographic distribution, and specialty configuration of the physician workforce." Both the Association of American Medical Colleges and the AMA have issued responses raising concerns about the IOM’s comments.

“Graduate medical education is a critical issue for psychiatry, and we appreciate that the IOM has offered a major report on the future of funding for residency training,” said APA President Paul Summergrad, M.D., the Arkin Professor and Chairman of Psychiatry at Tufts University School of Medicine and Psychiatrist-in-Chief for Tufts Medical Center. “The report needs and deserves a comprehensive review, and APA will present our analysis soon. We, of course, are concerned about the shortage of physicians overall and of psychiatrists in particular, and are eager to understand the potential impact of the IOM's recommendations.”

(Image: Institute of Medicine)

Scientists Find Potential Biomarker for Suicide

Increased methylation of a gene expressed in the prefrontal cortex, when combined with increased anxiety, significantly predicted a higher risk of suicide, according to Johns Hopkins researchers.

Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine, and colleagues found higher levels of methylation in the SKA2 gene in postmortem samples of brain tissue of people who had diced by suicide, compared to controls. Then, the researchers looked at SKA2 methylation in the blood of living people diagnosed with major depression or bipolar disorder, two risk factors for suicide.

“SKA2 significantly interacted with anxiety and stress to explain about 80 percent of suicidal behavior and progression from suicidal ideation to suicide attempt,” wrote Kaminsky and colleagues, July 30 in AJP in Advance.

Methylation of SKA2 appears to inhibit regulation of the cell’s response to cortisol and increase the effects of stress, they noted.

The study opens a pathway to a potential biomarker that would identify people at greater risk for suicide, but only after further investigation, said Kaminsky et al.

“This is an intriguing study that identified a very meaningful gene,” commented Eric Caine, M.D., the John Romano Professor of Psychiatry at the University of Rochester Medical Center, who was not involved in the study. “However, before we get ahead of ourselves, we need to test this methodology and see if it applies in a larger, more general population.”

For more in Psychiatric News about research on the relationship between gene methylation and suicide, see: “Could DNA Methylation AffectSuicide Risk?”

Court Says Florida's Ban on Physicians Discussing Gun Ownership Is Legal

A federal appeals court has reversed a lower court's ruling that Florida's law limiting what physicians can discuss with their patients regarding gun ownership violates physicians' First Amendment right to free speech. The lower court had issued an injunction in June 2012 against enforcing the law, which was signed by Florida Gov. Rick Scott (R) in June 2011.

APA, the AMA, and several other physician organizations had submitted an amicus curiae brief to the U.S. Court of Appeals for the 11th Circuit urging the justices to reject the state's attempt to revive the law after the lower court decision, pointing out that asking about gun ownership and guns in the home is an important screening tool, like asking about substances of abuse, smoking, and eating habits, for example. But in its July 25 ruling, the appeals court found that the law did not violate free-speech rights but was instead a "legitimate regulation" of medical conduct in the service of providing patients with "good medical care." The majority of the appeals court panel ruled that the law "simply codifies that good medical care does not require inquiry or record keeping regarding firearms when unnecessary to a patient's care.... Any burden the Act places on physician speech is thus entirely incidental." The justices also said that patients' right to privacy regarding gun ownership takes precedence over physicians' right to inquire about this subject.

Paul Appelbaum, M.D., past chair of the APA Committee on Judicial Action and the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University, told Psychiatric News, "The 11th Circuit’s decision upholding Florida’s gag law is troubling because it is one more example of courts and legislatures attempting to control what doctors say to patients. Here, the judges have decided that asking routinely about the presence of guns is contrary to good medical practice and hence can be prohibited by the state. When courts set the standards for clinical interactions rather than leaving that task in medical hands, the inevitable result is harmful to the public’s health."

(image:scottlitt/shutterstock)

Odor Identification May Be Able to Detect Risk for Cognitive Decline, Study Finds

Olfactory senses may be used for more than determining pleasant or undesirable aromas, that may someday be a tool to assist in predicting risk for memory loss in late life.
From 2004 to 2010, Davangere Devanand, M.B.B.S., M.D., director of geriatric psychiatry at the New York State Psychiatric Institute and a professor of psychiatry at Columbia University, led a series of tests in a multiethnic population of 1,037 senior citizens without a diagnosis of cognitive dysfunction to determine whether a relationship exists between the inability to identify smells and a diagnosis of mild cognitive decline. Odor identification was measured by the University of Pennsylvania Smell Identification Test (UPSIT). 

The results, presented recently at the 2014 Alzheimer’s Association International Conference in Copenhagen, showed that 210 participants transitioned to either dementia or Alzheimer’s disease (AD) during follow-up two to four years after initial UPSIT was administered. Transition to dementia and AD was correlated with lower odor-identification scores on the UPSIT, even after adjusting for demographics, cognitive and functional measures, and apolipoprotein E genotype. Each one-point deduction on the UPSIT was associated with an approximately 10 percent increase in AD risk. 

Dolores Malaspina, M.D., a professor of psychiatry at New York University who has studied the link between olfactory senses and psychiatric illness, told Psychiatric News that, "while sensory and other processes can decline with aging, even in persons without dementia, olfactory process entails important connections in the areas that are most sensitive to the [amyloid-beta] accumulation that is associated with Alzheimer’s pathology. These results show that there may be a great potential in using olfactory-processing tests, along with other measures, to provide an early identification of those at risk for Alzheimer's disease."

To watch Davanand give an overview of the study, "Olfactory Identification Deficits Predict the Transition From MCI to AD in a Multiethnic Community Sample," click here. To read about research on how physiological factors might be used to predict risks of neurocognitive decline, see the Psychiatric News articles, "Plasma APOE Levels Linked to Dementia Risk," and "Hearing Loss in Seniors Linked to Cognitive Decline." 

(Image: Courtesy of the Alzheimer's Association)

Vets With Schizophrenia, Comorbid Anxiety Have Higher Rates of Other Mental Illness and Greater Service Utilization, Study Finds

Veterans with schizophrenia and a comorbid anxiety disorder have increased rates of other disorders, higher psychiatric and medical hospitalization, and increased utilization of outpatient mental health services, according to the study, “Service Utilization Among Veterans With Schizophrenia and a Comorbid Anxiety Disorder,” published in the APA journal Psychiatric Services in Advance.

Researchers from the Department of Veterans Affairs' Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor, Mich., examined diagnostic, utilization, and medication records included in the Veterans Health Administration (VHA) National Psychosis Registry. Relationships between schizophrenia and anxiety disorders were evaluated along demographic and service utilization dimensions.

During Fiscal 2011, 23.8% of 87,006 VHA patients with schizophrenia were diagnosed with a comorbid anxiety disorder; 15.2% of the sample had a posttraumatic stress disorder (PTSD) diagnosis and 8.6% a non-PTSD anxiety disorder. The researchers found that patients without a comorbid anxiety disorder had significantly lower rates of other comorbid mental disorders than did patients with comorbid anxiety disorders. Specifically, 20.6% of patients with no anxiety disorder had depression, compared with 47.7% of those with PTSD and 46.8% of those with non-PTSD anxiety disorders. Only 3.7% of patients with no anxiety disorder had a personality disorder, compared with 11.2% of those with PTSD and 10.8% of those with non-PTSD anxiety.

“Anxiety disorders are common among individuals with schizophrenia within the VHA and appeared in this study to convey additional disability in terms of psychiatric comorbidity and the need for increased psychiatric care,” the researchers pointed out. “Future research should investigate ways to improve detection and enhance treatment provided to this population.”

For more on care of veterans with psychiatric disorders, see the Psychiatric News articles, "APA Calls for Better Training to Treat Chronic Pain, Addiction Among Vets" and "Knowledge of Military Life Facilitates Vets' MH Care."

REMINDER: Today’s APA Twitter Chat with host Gabriela Cora, M.D., will be held from noon to 1 p.m. ET on the topic "Where Does #MentalHealth Meet the Pursuit of #Happiness?" To join, use the #hashtag #YourMH (stands for "Your Mental Health"). Be part of the conversation!

(Image: Andrii Kondiuk/shutterstock.com)

Have You Registered to Review Your ‘Sunshine Act’ Data?

August 27 is the deadline to complete a two-phase registration process necessary to review data on payments or other transfers of value from pharmaceutical and medical device companies and dispute any errors with the Centers for Medicare and Medicaid Services (CMS). The collection and reporting of these data are required under the Physician Payment Sunshine Act, part of the Affordable Care Act. To make registration and review of data as easy as possible for its members, APA has posted a number of resources on its website. Registration is voluntary, but it is required to review the data and dispute any inaccuracies.

"I urge you to visit APA's website as soon as possible and complete the three-step verification and registration process to review your data," said APA CEO and Medical Director Saul Levin, M.D., M.P.A. "Registration is rather cumbersome and identity verification can take some time, so be sure to act now."

While the initial review-and-dispute period ends August 27, physicians still have until December 31 to dispute 2013 data, but disputes will not be flagged in the public database until 2015.

(image: Juergen Faelchle/shutterstock)

APA Urges to Members to Contact Congress to Support Veterans Bill

With the Ensuring Veterans Resiliency Act (EVRA) facing an uphill battle in Congress, APA is strongly urging members to contact their House and Senate representatives to register their support for this important bipartisan legislation. Among the legislation's key goals is mitigating the chronic shortage of psychiatrists in the Veterans Health Administration (VHA) by implementing a pilot program in which a limited number of psychiatrists would be recruited into long-term employment at the VHA that would include competitive medical school loan-forgiveness incentives.

This legislation is crucially needed. As a recent report from the Office of the Inspector General in the Department of Veterans Affairs found, most veterans do not receive adequate treatment for mental illnesses in a timely fashion. Each year, approximately 8,000 veterans die by suicide, and several studies place the rate of PTSD in returning veterans from Iraq and Afghanistan at approximately 40%. Veterans widely experience anxiety, depression, and substance use disorders.

In an email to members, APA CEO and Medical Director Saul Levin, M.D., M.P.A., emphasized that "APA’s grassroots and communications strategy has yielded fruitful results to date, but more work is needed. If you haven’t already contacted your elected officials through one of our Action Alerts, I urge you to do so as soon as possible! If your District Branch hasn’t already begun to take action, I urge you to act now!  Jason Young, APA’s Chief of Communications, and Jeff Regan in APA’s Department of Government Relations are standing by and happy to assist you.

He notes as well that APA has begun "a comprehensive grassroots and communications strategy to build support for EVRA and push for its inclusion in any final conference agreement that reforms the way the Department of Veterans Affairs (VA) delivers health care." One result of that strategy was publication of an op-ed column written by APA and the National Alliance on Mental Illness that appeared in the publication Stars and Stripes, which can be read here.

(Image: somartin/shutterstock)

New White House Drug Policy Strategy Focuses on Scientific Evidence

Michael Botticelli, acting director of the White House Office of National Drug Control Policy, has announced the release of the 2014 National Drug Control Strategy—the Obama’s Administration primary blueprint for drug policy in the United States.

This year's strategy focuses on the science behind drug addiction. The new policy is based on the growing body of scientific evidence that addiction is a disease of the brain that can be prevented and treated and is an illness from which people can recover—not a moral failure on the part of the individual, a once widely accepted misconception. "Public opinion on drug policy is finally catching up to what the science has demonstrated for quite some time," said Botticelli. "We cannot incarcerate addiction out of people. While law enforcement should always play a vital role in protecting communities from violent drug-related crime, at the end of the day, we must acknowledge that public-health and criminal-justice initiatives must work together to address this complex challenge in a smarter way."

The updated strategy will continue efforts implemented in 2013 to address the alarming rates and adverse consequences associated with opioid use by highlighting the importance of opioid overdose prevention and treatment and the administration of the overdose drug naloxone by first responders, when necessary. Also, the administration is calling for improved data collection to improve the ability of federal, state, and local officials to identify and respond to emerging drug addiction threats.

Richard Rosenthal, M.D, a professor of psychiatry at Icahn School of Medicine at Mount Sinai and an addiction expert, told Psychiatric News that "This new approach will bring more access to evidence-based prevention and treatment to those with addiction problems or disorders, which is a de facto public-health gain. The emphasis on prevention of harm, such as providing access to emergency opioid overdose medication, is consistent with other population-based interventions such as teaching the public the Heimlich maneuver or basic resuscitation techniques." Rosenthal concluded that the Obama Administration must increasingly support the National Institutes of Health and other science-based agencies for the much needed addiction research that can serve as part of the factual basis for continuing the evolution of drug policy and strategy.

To read more about the drug reform efforts of the White House, as well as Congress, see the Psychiatric News articles, "White House Wants Primary Care More Involved in Drug Treatment,", and "Bill Would Give Liability Exemption for Use of Overdose-Fighting Drugs."

(image: klublu/shutterstock.com)

Study Finds That Common Lab Test Can Help Predict Antidepressant Treatment Response

Researchers have been studying the interaction between inflammation and depression for decades. Now a team of Canadian and European scientists report in AJP in Advance on a way to help predict treatment outcomes based on levels of C-reactive protein (CRP), a biomarker of systemic inflammation. The study was part of the Genome-Based Therapeutic Drugs for Depression (GENDEP) study and compared outcomes in patients randomized to the SSRI escitalopram (n=115) or the tricyclic antidepressant nortriptyline (n=126). GENDEP is a multinational study sponsored by the European Commission designed to identify genetic markers that can help physicians decide which antidepressant is likely to be effective in a particular patient.

Patients with low baseline levels of CRP improved more with escitalopram, while those with higher CRP levels did better with nortriptyline, as measured on the Montgomery-Åsberg Depression Rating Scale, reported Rudolph Uher, M.D., Ph.D., an associate professor of psychiatry at Dalhousie University in Halifax, Nova Scotia, and colleagues. “The effect size of the differential prediction met criteria for clinical significance, suggesting that the prediction can be meaningful in individual cases.”

The study must be replicated and tested with other antidepressants, said Uher. However, this exploration of the different effects of norepinephrine and serotonin on the immune system may open doors to predict how patients respond to treatments and perhaps narrow the trial-and-error process of finding the right antidepressant for each individual.

To read more about research on the connection between inflammation and depression, see the Psychiatric News articles, “Cytokine Antagonists May Help Some Depression Patients” and "Scientists Closer to Finding Tests for Depression Biomarkers."

(Image: Angellodeco/Shutterstock.com)

APA Makes Recommendations to HHS Secretary About Community Mental Health Demonstration Programs

As the Department of Health and Human Services (HHS) prepares to implement a project called Demonstration Programs to Improve Community Mental Health Services, APA has forwarded several recommendations to HHS Secretary Sylvia Burwell that it believes will facilitate implementation of the project, whose goal is to bring comprehensive mental health treatment, especially for serious mental illness, to far more Medicaid beneficiaries who need such care. The demonstration program was included in PL-113-93, the Protecting Access to Medicare Act of 2014, which dealt with how physicians would be paid under Medicare for the next year.

In a July 11 letter, APA CEO and Medical Director Saul Levin, M.D., M.P.A., notes that chief among APA's concerns is ensuring that Community Behavioral Health Clinics (CBHCs), which will be established and certified as part of the program, "are structured to provide high-quality health care and that appropriate and efficacious quality metrics are built into the system" and that they will have a psychiatrist as medical director. The letter also addresses the need for child and adolescent psychiatrists in the CBHCs and discusses payment systems for the care provided in the CBHCs.

APA will be meeting with officials of the Centers for Medicare and Medicaid Services and the Substance Abuse and Mental Health Services Administration in the next month to discuss its recommendations in more detail.

Pre-Katrina Environment Was Critical in Children's Mental Health Outcomes, Study Finds

The social and economic circumstances surrounding children in New Orleans prior to Hurricane Katrina in 2005 more strongly affected what happened to them afterwards than did individual or personal factors, reported two sociologists in The Dialogue, according to a study published by the Substance Abuse and Mental Health Services Administration’s Disaster Technical Assistance Center.

"Disasters are often depicted as events that affect everyone indiscriminately, regardless of social status,” wrote Lori Peek, Ph.D., an associate professor of sociology and co-director of the Center for Disaster and Risk Analysis at Colorado State University, and Alice Fothergill, Ph.D., an associate professor of sociology at the University of Vermont. However, when pre-storm poverty, parental unemployment, poor housing, insecure neighborhoods, and unreliable access to health care and nutritious food were combined with exposure to life-threatening situations, the result was a “declining trajectory,” the researchers said. Children from poor families struggled later with increased behavioral problems, higher anxiety levels, and trouble concentrating in school, noted Peek and Fothergill. Those families often ended up in mass shelters, compared with middle-class children who could stay with family or friends outside the storm zone and had more resources to draw on as they recovered from the disaster. “Our work demonstrates how pre-existing disadvantage—the crisis before the crisis—and the profound disruption caused by a disaster like Katrina can send already vulnerable children on a downward spiral,” said the authors.

For more in Psychiatric News about the effects of disasters on vulnerable populations, see the article, “MH Recovery Effort Tailored To Diverse Needs of Sandy’s Victims.” More information can be found in the American Psychiatric Publishing book Disaster Psychiatry: Readiness, Evaluation, and Treatment.

(Image: Zack Frank/Shutterstock.com)

CBT, Psychodynamic Therapy Appear to Benefit Social Anxiety Disorder in Long Term, Study Finds

Both cognitive-behavioral therapy (CBT) and psychodynamic therapy appear to be efficacious in treating social anxiety disorder, in both the short term and long term, according to the report, "Long-Term Outcome of Psychodynamic Therapy and Cognitive Behavioral Therapy in Social Anxiety Disorder," published online yesterday in AJP in Advance.

German researchers, led by Falk Leichsenring, D.Sc., of the Clinic of Psychosomatics and Psychotherapy at Justus-Liebig University Giessen, last year reported the short-term results of a comparison of the two therapies in the American Journal of Psychiatry, in which both were found more effective than a wait-list control. In the current study, they assessed outpatients with social anxiety disorder who were treated with CBT (N=209) or psychodynamic therapy (N=207) in the previous study at six, 12, and 24 months after the end of therapy. Primary outcome measures were rates of remission and response.

For both CBT and psychodynamic therapy, response rates were approximately 70 percent by the two-year follow-up. Remission rates were nearly 40 percent for both treatment conditions. Rates of response and remission were stable or tended to increase for both treatments over the 24-month follow-up period, and no significant differences were found between the treatment conditions after six months.

“For psychodynamic therapy, improvements in interpersonal problems increased significantly during the follow-up period, suggesting that after the end of treatment, patients treated with psychodynamic therapy continued to work on their interpersonal problems,” the researchers said. “CBT appears to improve interpersonal problems faster, whereas in psychodynamic therapy, improvements seem to take time to emerge following the end of therapy, but eventually the same level of interpersonal problems as in CBT is achieved.”

To read more about research on CBT in patients with anxiety disorders, see the Psychiatric News article, "Imaging Helps Predict Anxiety Patients Who May Benefit From CBT."

(Image: Tashatuvango/shutterstock.com)

Parents of Veterans Who Died by Suicide Criticize VA's Mental Health Care

On Thursday, the House Veterans Affairs Committee listened to emotional stories from family members of soldiers who lost their lives as a result of what they say is inadequate mental health care provided by the Veterans Health Administration.

"We have held a full series of oversight hearings over the last several weeks to evaluate the systemic access and integrity failures that have consumed the VA health care system," said committee Chair Rep. Jeff Miller (R-Fla.) at the hearing's start. "Perhaps none of these hearings have presented the all-too-human face of the VA’s failure so much as today’s hearings will."

Three families and retired military personnel testified before the committee about the barriers uniformed men and women face in accessing effective mental health care. Susan Selke, mother of Marine Sgt. Clay Hunt, 28, who lost his life to suicide in 2011, said that her son was prescribed a brand-name antidepressant that worked well, but was forced to switch drugs because no generic equivalent of the original, and effective, antidepressant was available. Army Sgt. Josh Renschler, who was being treated for anxiety and other medical conditions resulting from a mortar blast in Iraq, explained that he was receiving excellent care through an integrative health initiative until VA "medical center leadership concluded that… [it] was too costly." Other topics discussed were lack of available mental health professionals, long waiting lists, and ineffective communication between the VA and Department of Defense as it concerns veterans’ health records.

"I think that today's hearings went well" said Selke, in an interview with Psychiatric News after her testimony. "I was very pleased at the level of interest, and hopefully some major responses are underway." Later that afternoon, Selke, along with her husband, Richard, and Rep. Tammy Duckworth (D-Ill.), an Iraq war veteran, announced the Clay Hunt Suicide Prevention for American Veterans Act, a bill that would provide suicide-awareness education for veterans and educational loan assistance to those seeking a career in mental health care at the VA.

For information on how to get involved in the push for better mental health care services for military men and women, visit APA’s Legislative Action Center. To read about the recent mental health issues concerning the Veterans Health Administration, see the Psychiatric News articles, "Pentagon, VA Lack Data to Assess PTSD Care Systems," and "Veterans Affairs Scheduling Scandal Leads to Turmoil at the Top."

(photo: Vabren Watts, Psychiatric News)

APA Hosts Meeting of the Mental Health and Faith Community Partnership

“My life today is built on a spiritual foundation, living in the sunlight of the spirit,” said former Congressman Patrick Kennedy in an address this morning at the headquarters of APA. Speaking at a remarkable gathering hosted by APA of more than 40 leaders from the faith and mental health communities, the former congressman and co-sponsor of the Mental Health Parity and Addiction Equity Act described his own recovery from alcohol and substance abuse and the important role that spirituality played in that recovery.

Today’s event at APA inaugurates the Mental Health and Faith Community Partnership, a collaboration between psychiatrists and clergy aimed at fostering a dialogue between the two fields, reducing stigma, and accounting for spiritual dimensions as people seek care. The convening organizations are APA, the American Psychiatric Foundation (APF), and the Interfaith Disability Advocacy Coalition (IDAC), a program of the American Association of People With Disabilities.

Also speaking this morning were Charles Nemeroff, M.D., who described the neurobiological and genetic basis of mental illness; Nancy Kehoe, R.S.C.J., Ph.D., a Roman Catholic nun and clinical psychologist who spoke about building bridges between faith and mental health; Curtis Ramsey Lucas, M.Div., managing director of resource development at American Baptist Home Mission Societies, who is coordinating IDAC’s partnership with APF, who spoke about current efforts within the faith community to reach out to those with mental illness; and Annelle Primm, M.D., M.P.H., director of APA’s Office of Diversity and Health Equity, who spoke about APA’s efforts to reach out to minority and faith communities.

"The agenda for this partnership is ambitious but reflects the scope of the challenges we face,” said APA President Paul Summergrad, M.D. “There is much to be done to reduce stigma, enhance education about, and address the prevalence of, mental illness in our society, so working together is imperative. This July also marks APA's Diversity Mental Health Month, which matters because studies have shown that many groups, such as Hispanics and African Americans, are more inclined to reach out to a member of their faith community than to a mental health professional when experiencing signs of mental illness. APA is deeply committed to entering into a respectful dialogue with faith-based leaders and to listen, learn, and provide the best evidence-based education about mental illness we can provide."

For more on the partnership, see the Psychiatric News article "APA, Foundation Partner With Interfaith Disability Coalition."

(image: Sylvia Johnson)

APA Provides Resources in Conjunction With Diversity Mental Health Month

APA has designated July as Diversity Mental Health Month, a time to bring attention to mental health disparities and to focus on the mental health needs within diverse communities. "The richness of the United States is reflected in our great diversity. Likewise, APA is strengthened by our broad and diverse membership who come together to support the goals of improving patient care and scientific advances in psychiatry," commented APA President Paul Summergrad, M.D. "Diversity mental health month is a time for reflection on the respectful engagement we need to have with all who need our help."

In a video, APA CEO and Medical Director Saul Levin, M.D., M.P.A., introduces the concept behind Diversity Mental Health Month and the many resources that APA's Division of Diversity and Health Equity has put together for your use not only in July but on an ongoing basis. The video can be accessed at APA's Diversity Mental Health Month webpage here. Additional resources and an infographic on diverse populations are also posted on the webpage. There are also links to a special toolkit that members can download that includes fact sheets, brochures, and community outreach ideas, and educational videos about mental health issues in African-American and Latino populations.

"APA has designated July as the first annual Diversity Mental Health Month as part of our ongoing effort to enhance awareness about the mental health needs of individuals from diverse communities and promote the use of cultural competency in clinical practice and research among psychiatrists and other clinicians," said Levin. "This month is an opportunity to reflect on how we can provide optimal, high-quality care to every one of our patients, regardless of their race, ethnicity, sexual orientation, gender identity, socioeconomic status, religion, or other cultural attributes."

Methamphetamine-related Emergency Visits on Rise, SAMHSA Reports

A new report on emergency department (ED) visits for adverse health events associated with illicit use of methamphetamine, with its high potential for abuse and addiction, suggests that unlawful use of the drug is on the rise.

The Substance Abuse and Mental Health Services Administration (SAMHSA) conducted an analysis to assess the prevalence ED visits related to illicit use of methamphetamine from 2007 to 2011. Findings showed that ED visits jumped dramatically from 67,954 in 2007 to 102,961 in 2011. In addition, 62% of the methamphetamine-related ED visits in 2011 involved the use of at least one other substance. Marijuana (22%) and alcohol (16%) were the two substances most frequently associated with methamphetamine-related ED visits.

Director of SAMHSA’s Center for Substance Abuse Treatment H. Westley Clark, M.D., J.D., M.P.H., commented that “this report shows that methamphetamine use may be on the rise again, and we must do everything we can to address this serious public-health problem." Clark stressed that it is of utmost importance to use ED visits as a critical opportunity to talk and intervene with people who have a substance use disorder involving methamphetamine so that they can more fully understand its dangers and know where to they can turn to for help.

To read more about illicit use of methamphetamines and associated adverse health events, see the Psychiatric News articles, "Abused Substances Differ in Rural, Urban," and "Psychotic Symptoms Increase With More Frequent Meth Use."

Youth in Various Ethnic Groups Give Different Reasons for Receiving MH Treatment, Study Finds

Racial and ethnic minorities were more likely than whites to endorse externalizing or interpersonal problems and less likely to endorse internalizing problems as reasons for mental health treatment, according to a report online in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers at Emory University and colleagues analyzed data from the 2005-2008 editions of the National Survey on Drug Use and Health on nearly 2,800 adolescent participants who experienced a major depressive disorder and received mental health treatment in the prior year. Racial/ethnic differences in endorsing each of 11 possible reasons for receiving treatment were examined and adjusted for sociodemographic characteristics, health and mental health status, treatment setting, and survey year.

The researchers found that despite similar depressive symptom profiles, Hispanic adolescents were more likely than whites to endorse “breaking the rules or physical fighting” as reasons for mental health treatment. Black adolescents were more likely than whites to endorse “problems at school,” but less likely to endorse “feeling afraid/anxious” or “trouble eating” as reasons for treatment. Asian adolescents were more likely to endorse “interpersonal problems” but less likely than whites to endorse “suicidal thoughts/attempt” and “feeling depressed” as reasons for treatment.

“These findings are not surprising," said Annelle Primm, M.D., APA deputy medical director and director of APA's Division of Diversity and Health Equity, who reviewed the study. "They illustrate that culture counts with respect to a group’s conceptualization of mental illness. Giving reasons of externalizing or interpersonal problems may represent a person's preference for embracing explanations that fit within the realms of cultural norms versus accepting pathological labels, which can be severely stigmatizing and humiliating in some cultural groups.”

For related information, see the Psychiatric News articles, "For Better Mental Health Care for Latinos, Look at Neighborhoods" and "How Americans' View of Black Men Affects Mental Health Care."

(Image: Christy Thomposon/shutterstock.com)

SAMHSA Sounds Alarm Over Teens' Combined Use of Alcohol, Drugs

A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) sheds light on a public-health concern regarding combined use of alcohol and drugs among adolescents.

SAMHSA’s Drug Abuse Warning Network (DAWN) gathered data from hospital emergency departments nationwide to assess the association between underage drinking and serious health outcomes in people aged 12 to 20. The analysis showed that nearly 188,000 alcohol-related emergency department visits involved youth in this age group—with 20 percent of the visits resulting in serious health outcomes including death. Of the alcohol-related hospital visits that resulted in serious health outcomes, 33% were associated with underage drinking and concurrent drug use, compared with 12% which were associated with underage drinking alone.

“The 9.3 million underage drinkers across America are putting their health and futures at risk—even more so when they combine alcohol with drugs,” stated SAMHSA Administrator Pamela Hyde, J.D. “The start of summer is a good opportunity for parents and other concerned adults to talk with teens and young adults about the dangers of underage drinking and drug use.”

As part of a stepped-up education effort focused on this problem, SAMHSA has started an underage drinking prevention campaign titled “Talk. They Hear You” to help parents and other caregivers initiate a dialogue with children and teenagers on the often-serious risks they face when they drink alcohol.

Information on SAMHSA’s prevention efforts to reduce underage drinking is posted here. To read about other research on alcohol and substance use in youth, see the Psychiatric News article, “News Is Mixed on Teenagers and Substance Use.” For more on this issue, see American Psychiatric Publishing's Clinical Manual of Adolescent Substance Abuse Treatment.

Cognitive Remediation Therapy May Be Useful in Early-Onset Schizophrenia, Study Shows

Cognitive remediation therapy (CRT) appears to be an effective intervention for adolescents having cognitive impairments associated with early-onset schizophrenia (EOS), according to a report published online in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers in the Department of Child and Adolescent Psychiatry in Spain's conducted a randomized, controlled trial of individually delivered CRT plus treatment-as-usual compared with treatment-as-usual (TAU) alone. Fifty adolescents with EOS were randomly assigned to receive CRT or TAU. The researchers used a manualized model of CRT, a strategy-learning program involving tasks of progressive complexity implemented on an individual basis, using mainly paper-and-pencil tasks. Clinical symptoms and cognitive and functional performance were assessed before and after treatment in both groups and after three months in the CRT group. Cognitive domains were defined according to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus battery and averaged in a global cognitive composite score.

After CRT, significant improvements were found in verbal memory and executive functions, with medium-to-large effect sizes. This change was reliable in more than two-thirds of treated patients. Medium effect sizes were found for improvements after CRT in daily living and adaptive functioning, while large effect sizes were observed for improvements in family burden. With the exception of functional gains, these changes were maintained after three months. “Cognitive improvements can be achieved through CRT, although further research is warranted to determine the durability of functional gains,” the researchers state.

To read more about cognitive remediation in patients with mental illness, see the Psychiatric News article, "Cognitive Training Augments Benefits of Supported Employment."

(Image: pogonici/shutterstock.com)

Inflammation in Maternal Sera Linked to Schizophrenia in Offspring, Study Finds

Maternal inflammation as indicated by the presence in maternal sera of early gestational C-reactive protein—an established inflammatory biomarker—appears to be associated with greater risk for schizophrenia in offspring. That’s a key finding from the study, "Elevated Maternal C-Reactive Protein and Increased Risk of Schizophrenia in a National Birth Cohort," published online in AJP in Advance.

American and Finnish researchers conducted a case-control analysis of data from the Finnish Prenatal Study of Schizophrenia, a large, national birth cohort with an extensive serum biobank. They tested for the presence of C-reactive protein in the maternal sera of 777 offspring with schizophrenia and compared the findings with those from 777 control subjects. Maternal C-reactive protein levels were assessed using a latex immunoassay from archived maternal serum specimens.

They found that increasing maternal C-reactive protein levels were significantly associated with development of schizophrenia in offspring. This finding remained significant after adjusting for potential confounders such as parental history of psychiatric disorders, twin/singleton birth, urbanicity, province of birth, and maternal socioeconomic status.

“This is the first time that this association has been demonstrated, indicating that an infection or increased inflammation during pregnancy could increase the risk of schizophrenia in the offspring,” lead author Alan Brown, M.D. (shown in photo above), a professor of psychiatry and epidemiology at Columbia University, told Psychiatric News. “Inflammation has been shown to alter brain development in previous studies, and schizophrenia is a neurodevelopmental disorder,” he noted. “Thus, this study provides an important link between inflammation and schizophrenia and may help us to better understand the biological mechanisms that lead to this disorder.... To the extent that the increased inflammation is due to infection, this work may suggest that approaches aimed at preventing infection may have the potential to reduce risk of schizophrenia.”

To read more about research on potential schizophrenia risk factors, see the Psychiatric News article, "Link Found Between Childhood Infections, Later Psychosis."

HIgh Court Lets Law Banning Reparative Therapies for Minors Take Effect

The U.S. Supreme Court yesterday declined to hear the appeal of a case challenging California's law barring use of so-called "conversion therapies" or "reparative therapies" to change the sexual orientation of minors from homosexual to heterosexual. The Ninth Circuit Court of Appeals had upheld the constitutionality of the law in a ruling issued last August, finding that the ban on these therapies served the state's interest in protecting minors from harm and did not violate the free-speech rights of practitioners who want to use these interventions. By declining to hear an appeal of that decision from a Christian legal aid group known as Liberty Counsel, the High Court allowed the appeals court's ruling to stand and the state to begin enforcing the law. As is customary when it declines to hear an appeal, the Supreme Court gave no explanation for its decision. New Jersey Gov. Chris Christie signed a similar law last year, but it too is facing a legal challenge.

"The Supreme Court has cement shut any possible opening to allow further psychological child abuse in California," state Sen. Ted Lieu, the law's sponsor, said Monday. "The Court's refusal to accept the appeal of extreme ideological therapists who practice the quackery of gay conversion therapy is a victory for child welfare, science and basic humane principles."

Psychiatrist Jack Drescher, M.D., who in 2000 drafted APA's position statement opposing sexual orientation conversion or reparative therapies, told Psychiatric News that,"While legislation is not the ideal way to promote best clinical practices in psychotherapy settings, the reality of what is happening on the ground left few options. The fact is that vulnerable children are being brought by their parents to 'therapists' engaging in questionable practices in order to change their sexual orientation. APA and other mainstream health and mental health organizations have found no scientific basis for the efficacy of conversion therapies, and in refusing to hear an appeal of California's gay conversion 'therapy' ban for minors, the Supreme Court has rightly acknowledged that regulating what licensed professionals can say to their patients is not the same thing as regulating free speech."

APA's position statement on reparative and conversion therapies is posted here.

(image: Brandon Bourdages/Shutterstock)