Candidates for APA Board of Trustees Announced

Earlier today the APA Nominating Committee announced the following candidates chosen to run for positions on the Board of Trustees in the Association's 2015 election.


PRESIDENT-ELECT
Barton J. Blinder, MD, PhD
Maria A. Oquendo, MD
Charles F. Reynolds III, MD

SECRETARY
Rahn K. Bailey, MD
Altha J. Stewart, MD

EARLY CAREER PSYCHIATRIST (ECP) TRUSTEE-AT-LARGE
Lama Bazzi, MD
Paul O’Leary, MD

MINORITY/UNDERREPRESENTED REPRESENTATIVE (M/UR) TRUSTEE
Curley L. Bonds, MD
Gail E. Robinson, MD

AREA 1 TRUSTEE
Jeffrey L. Geller, MD, MPH
Anthony J. Rothschild, MD

AREA 4 TRUSTEE
Ronald M. Burd, MD
Shastri Swaminathan, MD

AREA 7 TRUSTEE
Jeffrey Akaka, MD
Stephen L. Brown, MD
Annette M. Matthews, MD

RESIDENT-FELLOW MEMBER TRUSTEE-ELECT (RFMTE)
Alicia Barnes, DO, MPH
Stella Cai, MD
Sarah Schmidhofer, MD

The deadline for petition candidates is November 15. All candidates and supporters are urged to review the updated Election Guidelines. For more election information, see the Election section under "Board of Trustees" on the APA website or email election@psych.org.

The slate of candidates who have been nominated is public but not official until approved by the Board at its December 2014 meeting.

Former Surgeon General Satcher Presents Keynote at APA's Institute

"In order to eliminate health disparities, we need leaders who care enough, know enough, do enough, and will persist until the job is done," said David Satcher, M.D., Ph.D., during a keynote address at the Opening Session of APA's 2014 Institute on Psychiatric Services in San Francisco.

Satcher, who served as surgeon general under President Clinton, is director of the Satcher Health Leadership Institute at Morehouse School of Medicine. The mission of the institute is to develop a diverse group of public health leaders, foster and support leadership strategies, and influence policies toward the reduction and ultimate elimination of disparities in health.

Satcher emphasized at the institute that eliminating health disparities was not possible without addressing the mental health needs of underserved populations, noting that "there is no health without mental health." He recalled that in 1999 the first surgeon general's report on mental health was released, and he said the report brought out some important fundamental messages that he said he believes have taken root; among these is the importance of integrating mental health and general medical care. He cited statistics showing that globally mental illness is the leading cause of disability.

Satcher outlined the characteristics of leaders and the special challenges confronting the development of effective policies that can help to eliminate disparities. Prominent among these is misinformation about health and mental health--such as the stigma long attached to mental health problems. And he cited current prevalent fears about the Ebola virus--fed by relentless media coverage--as evidence that "irrational beliefs can be more powerful than science."

Linking evidenced-based science to rational public policy is the key to eliminating disparities. "We need the science," he told psychiatrists. "We need you to continue to do the science to capture the best of your practices so that everyone can learn from it. And we all need to [advocate for effective policies]. This dynamic interaction between science and public policy is critical to improving public population health."

(Image: Stuart Brinin)

Traumatic Brain Injury in Older Adults May Increase Dementia Risk, Study Suggests

A study published this week in JAMA Neurology suggests that traumatic brain injury (TBI) may be associated with an increased risk for dementia in older adults.

Researchers from the University of California, San Francisco, examined health records of approximately 52,000 adults aged 55 and older diagnosed with a traumatic injury to compare risks for dementia between those who have experienced TBI and those with non-TBI-related trauma (defined as fractures excluding the head and neck).

The analysis showed that 8.9 percent of the participants with a history of TBI developed dementia, compared with 5.9 percent of those with traumatic injury to areas other than the head or neck. Data also showed that moderate to severe TBI was associated with an increased risk for dementia in those aged 55 or older, while mild TBI was associated with an increased risk for participants who were aged 65 or older.

In an accompanying editorial, Steven DeKosky, M.D., director of the Alzheimer's Disease Research Center at University of Pittsburgh and a professor of psychiatry, commended the researchers for using a very large database to examine dementia risk following significant trauma. The findings from the research, noted DeKosky, "will enable us to ask important questions, evolve new or more informed queries, and both lead and complement the translational questions that are before us." He concluded that because dementia is both a global problem and a pathological conundrum, the complementary use of big data and basic neuroscience analyses may offer the most promise in learning more about the overlap of TBI and cognitive decline.

To read more about TBI and its associated psychiatric sequelae, see the Psychiatric News article, "Traumatic Brain Injury: Why Psychiatrists Matter." For information about issues in the assessment and treatment of TBI, see Management of Adults With Traumatic Brain Injury from American Psychiatric Publishing.

(Image: Lightspring/shutterstock.com)

Home Visits Bring Multiple Benefits to American-Indian Teen Mothers

A home-visiting program directed at teenage American-Indian mothers reduced maternal risks and improved their children’s behavior but also helped the high-school-educated workers who carried out the intervention.

"American Indian adolescents...have the highest rates of teen pregnancy, substance use, suicide, and dropping out of school of any racial or ethnic group in the country," said lead researcher Allison Barlow, M.P.H., Ph.D. (photo above), associate director of the Johns Hopkins Center for Indian Health, and colleagues, in the study "Paraprofessional-Delivered Home-Visiting Intervention for American Indian Teen Mothers and Children..." published in AJP in Advance.

The home visitors—called family health workers—were young women recruited from the same Apache and Navajo reservations in Arizona as the teen mothers and so understood their language and culture. In the study, all 322 patients received "optimized standard care," including transportation to clinic visits, information on child care, and referrals to local services. The study's goal was "to evaluate the intervention’s effects on parental competence (parenting knowledge, locus of control, stress, and behaviors) and maternal behavioral problems that impede effective parenting through early childhood.... Secondary aims were to evaluate intervention effects on early childhood emotional and behavioral outcomes."

Mothers randomized to the intervention group also received the Family Spirit program, including training in observing their babies, interpreting their cries, reading to them, and developing routines. Home visits began during pregnancy and continued until the child was 36 months old. Intervention-group mothers demonstrated more parenting knowledge, less substance use, and lower scores of depression and externalizing problems. Their children also had fewer externalizing and internalizing problems and dysregulation.

The family health workers also benefited from the program. "After they were trained by Hopkins, not one is unemployed," said Barlow in an interview. "They are either in school or working in health-related jobs."

(Image: Johns Hopkins University)

Clozapine Monotherapy More Cost-Effective Than Antipsychotic Polypharmacy, Study Shows

Treatment with clozapine alone instead of antipsychotic polypharmacy for treatment-resistant schizophrenia is associated with reduced disease-specific emergency department use and with reduced disease-specific and all-cause health care costs, according to the study “Outcomes of Medicaid Beneficiaries With Schizophrenia Receiving Clozapine Only or Antipsychotic Combinations” published in Psychiatric Services in Advance.

Researchers at the University of Texas Health Science Center at San Antonio used data from the Medicaid MarketScan database to study disease-specific and all-cause hospitalization, emergency department use, and Medicaid payments among nonelderly Medicaid beneficiaries with schizophrenia who were treated with either second-generation polypharmacy or clozapine monotherapy.

A total of 479 patients were treated with clozapine monotherapy, and 2,440 were treated with antipsychotic polypharmacy containing antipsychotics other than clozapine. After controlling for baseline differences in comorbidity, patients treated with clozapine monotherapy were less likely than those treated with antipsychotic polypharmacy to have mental-disorder–related use of the emergency department or schizophrenia-related use of the emergency department in the 12-month period following initiation of treatment.

Also, total Medicaid payments for the clozapine-monotherapy group were significantly lower across all categories, with all-cause costs reduced on average by $21,233, mental-disorder–related costs reduced by $17,457, and schizophrenia-related costs reduced by $10,582.

Deanna Kelly, Pharm.D., a professor of psychiatry at the University of Maryland School of Medicine, who reviewed the report for Psychiatric News, said that clozapine has been shown to be the most effective antipsychotic and  that much more effort should be focused on maximizing its use.

She added that the cost findings in the study are especially important. “If payers get involved and begin encouraging use of clozapine, it could cause a paradigm shift in our field,” Kelly said. “This study may be a good first step toward creating that shift.”

For related information on treating treatment-resistant schizophrenia, see the Psychiatric News article "Schizophrenia Symptoms Reduced By Combination of ECT and Clozapine."

(Image: Andrii Kondiuk/shutterstock.com)

Cocoa-derived Flavanols Can Improve Memory and Cognition, Study Finds

A daily dose of flavanols—antioxidants found in foods like tea and cocoa—helped improve the memory and cognitive brain function of middle-aged adults, reports a new study published in Nature Neuroscience.

A team led by researchers at Columbia University Medical Center randomly assigned 37 healthy volunteers aged 50 to 69 to receive either a high-flavanol (900 mg) or a low-flavanol (10 mg) cocoa drink, developed by candymaker Mars Inc., once a day for three months. Each participant also was given a brain scan and cognitive tests before and after the study; the scan involved using functional magnetic resonance imaging (fMRI) to measure blood volume in the dentate gyrus, a region of the hippocampus associated with age-related memory decline.

After three months, the researchers found noticeable improvements in both the health of the dentate gyrus and cognitive test performance among those who consumed the high-flavanol drink. As lead author Scott Small, M.D., of Columbia University explained, “If a participant had the memory of a typical 60-year-old at the beginning of the study, after three months that person on average had the memory of a typical 30- or 40-year-old.”

While this was a well-controlled clinical study, the authors noted that the results will need to be replicated in a larger population. They also cautioned that matching the flavanol doses used in the study means eating lots more chocolate than people reasonably can—and that most commercial chocolate has flavanols removed during processing anyway and will thus not produce similar effects.

In addition to providing the flavanol drink, Mars Inc. partially supported the study. Additional funding was provided by the National Institutes of Health, the James S. McDonnell Foundation, and the McKnight Brain Research Foundation.

To read more about the dentate gyrus and age-related memory loss, see the Psychiatric News article “Kandel Details Brain’s Role in Growth and Loss of Memory.”

Child Psychiatrists Discuss Impact of Marijuana Legalization

With legislation loosening restrictions on marijuana use becoming more prevalent in the U.S., researchers are investigating how its commercialization can impact society, especially youth.

Yesterday, at the annual meeting of the American Academy of Child and Adolescent Psychiatry, researchers from the University of Colorado School of Medicine presented comparative studies on the trends in cannabis use among adolescents and negative consequences associated with such use among individuals during the pre- and post-commercialization eras of medical marijuana in Colorado.

The first study, presented by Christian Hopfer, M.D. (pictured above), an associate professor of psychiatry, showed that of 560 adolescents being treated for polysubstance use disorder from 2007 to 2013, those who entered treatment after 2009 (after commercialization of medical marijuana) were more likely to have higher amounts of delta-9-tetrahydrocabnnabinol—an active ingredient in marijuana—in their urine and more polysubstance use at admission, compared with individuals who accessed treatment for polysubstance abuse during the pre-commercialization era. In a study lead by Stacy Salomonsen-Sautel, Ph.D., a postdoctoral fellow, data showed that commercialization of medicinal marijuana in Colorado also correlated with an increase in fatal motor vehicle crashes among drivers aged 16 and older who tested positive for marijuana use, whereas no change was seen among this category of drivers living in states without laws legalizing sale of marijuana for medical purposes.

 

"Commercialization of marijuana is definitely in process throughout the nation,” Hopfer pointed out. “There is a lot of capital going towards this substance…[as well as] efforts to remarket it as a more ‘upscale’ product." During an interview with Psychiatric News, Hopfer stressed that because marijuana legalization and commercialization are bound to have a substantial impact on society, it is crucial for parents, adolescents, and psychiatrists to educate themselves on the “policy changes regarding marijuana, the pharmacology of marijuana, and the effects of marijuana on adolescent development and safety."

 

To read more about youth and marijuana use, see the Psychiatric News articles "Research Review Prompts NIDA Warning About Marijuana Use" and "Marijuana Legalization and Young Brains: Time for Serious Study."

(Image: Psychiatric News/Vabren Watts)

Psychiatrists Urged to Increase Awareness of Domestic Violence

October is National Domestic Violence Awareness Month, focusing national attention on a problem for which physicians and other health care workers—including psychiatrists—may be first responders. Psychiatrist Gail Robinson, M.D., points out that domestic violence can include physical, sexual, emotional, and verbal assault (including denigrating language and blaming the partner) and violence against objects such as punching the wall beside the partner. Robinson, who is APA’s minority and underrepresented trustee, is at the University of Toronto as director of the Women’s Mental Health Program, senior psychiatrist of the University Health Network, and a professor of psychiatry.

Robinson said risk factors for being a victim of domestic violence include observing violence between parents in the home when young; having attitudes that accept violence and gender inequality; and experiencing marital conflict or disruption. “Substance abuse and low self-esteem have been noted as increasing vulnerability to domestic violence; however, they may be a consequence of the violence rather than a cause of the violence,” she said. “Physically there may be outward signs of violence, such as bruises or fractures. If a woman is pregnant—violence continues to occur during pregnancy, often directed to the women’s abdomen—there may be at increased risk of miscarriage, premature deliveries, or small-for-date babies.”

Robinson’s advice to clinicians: “Always ask about the presence of conflict in the family when taking a history, as women find it difficult to report unless they get the sense that they will be heard and not ignored or blamed. Having pamphlets or posters about domestic violence in the waiting room can provide an atmosphere that encourages women to report. It is important for the psychiatrist to have some practical information about safety measures such as domestic violence hotlines and where to go if the woman has to leave.

Domestic violence is not exclusively a problem between heterosexual couples. A recent study found that same-sex domestic violence affects one-quarter to nearly three-quarters of lesbian, gay, and bisexual individuals—figures that equal or exceed those for straight couples. “Domestic violence can occur in LGBT families with the same frequency as it does in straight ones,” said psychiatrist Jack Drescher, M.D., past president of the Group for the Advancement of Psychiatry. “Clinicians need to be alert to domestic violence presentations in their clinical practices and to understand what kind of interventions may be helpful to their patients and their families."

Expressing support for education and outreach efforts on domestic violence, APA President Paul Summergrad, M.D., stressed that, "Domestic violence can lead to serious health problems, including anxiety, depression, posttraumatic stress disorder, and substance abuse, as well as an increased likelihood of general medical problems such as headaches, chronic pain, and poor physical health. Domestic violence is not limited by economic status, race, national origin, religion, gender, or sexual orientation.... APA strongly advocates for prevention and better detection of domestic violence, improved treatment of victims and offenders, and expanded research into causes, consequences, and prevention.” APA has posted domestic violence resources at http://psychiatry.org/domestic-violence.

APA's is holding its next #YourMH @twitter chat in observance of Domestic Violence Awareness Month. Join your APA colleagues in responding to questions and comments from the public on Friday, October 24, from noon to 1 p.m. ET. To join, use #YourMH (stands for "Your Mental Health"), @apapsychiatric, or #DVAM14. If you haven't created a Twitter account yet, click here to do so now. Here's your chance to share your knowledge and insights.

Forensic Psychiatrists Discuss Factors That Can Increase Violence Risk in Those With Mental Illness

Predicting violence among psychiatric patients “remains an inexact science,” a bit like predicting the weather, said forensic psychiatry experts Charles Scott, M.D., a professor of clinical psychiatry at the University of California, Davis, and Philip Resnick, M.D., a professor of psychiatry at Case Western Reserve University School of Medicine. While most people with mental illness are not violent, certain factors increase the risk of violence for people with psychosis or mood disorders, wrote Scott and Resnick in the October issue of CNS Spectrums.

“[I]ndividuals who suffer from persecutory delusions and negative affect are more likely to act on their delusions,” they said. Angry affect is a critical variable, especially when coupled with feelings of being spied upon, followed, plotted against, or being under external control. They pointed out as well that depression may be a risk factor when accompanied by a recent history of violence and/or alcohol use. Active manic symptoms are also associated with increased risk of engaging in a violent crime, but mostly when associated with comorbid substance abuse.

Scott and Resnick suggest using structured risk assessments to help gather appropriate data and reviewing research findings to identify violence-related risk factors associated with psychotic and mood disorder symptoms. “Like a good weather forecaster, the clinician does not state with certainty that an event will occur,” they concluded. “Instead, he or she estimates the likelihood that a future event will occur.

For more in Psychiatric News about assessment of risk for violence, see the article, “Experts Discuss Factors That May Lead to Violence Among Mentally Ill People.”

(Image: Lisa F. Young/Shutterstock.com)

Don't Miss Your Chance to Hear Lectures From National Experts

There is still time to make plans to attend the APA Institute on Psychiatric Services (IPS) October 30 to November 2 in San Francisco and take advantage of a program that will explore in depth critical topics in mental health care today. One of the highlights will be a forum on Thursday, October 30 from 6 p.m. to 8:30 p.m., devoted to issues affecting the mental well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals.

Titled "Achieving Wellness in the LGBT Community: Mind, Body, and Spirit," the free forum will be open to the community and features a keynote address by Darlene Nipper, deputy executive director to the National Gay and Lesbian Task Force. Among the roster of speakers and panelists are Annelle Primm, M.D., M.P.H., deputy medical director of APA; Dan Karasic, M.D., a clinical professor in the Department of Psychiatry at the University of California, San Francisco (UCSF); Robert Cabaj, M.D., medical director of San Mateo Behavioral Health and Recovery Services; Dr. Jei Africa, health equity initiatives director of San Mateo Behavioral Health and Recovery Services; Jamison Green, Ph.D., president of the World Professional Association for Transgender Health; and Lori Thoemmes, L.M.F.T., director of the UCSF Alliance Health Project. The forum is being organized by the APA Division of Diversity and Health Equity.

The IPS program will also feature lectures by some of the mental health field's nationally recognized experts who will address critical issues in patient care and psychiatric practice. The impressive lineup includes Howard Goldman, M.D., Ph.D., on "Implementing First-Episode Psychosis Services: Policy Issues," Tanya Luhrmann, Ph.D., on "Hearing Voices in Three Cultures: A Comparison With Implications for Recovery," Charles Marmar, M.D., on "How Biomarkers for PTSD Will Advance Diagnosis and Treatment," David Pollack, M.D., on "Doin' the Community Waltz: A Saging and Raging Trip With the Walts: i.e., Whitman to White (With Visits to Kelly and Cronkite on the Way)," and Altha Stewart, M.D., on "Blacks and American Psychiatry: After 170 Years of APA and 50 Years of Civil Rights, What's Next?"

Click here to learn more about IPS program highlights and registration information.

FDA Approves New Abuse-Deterrent Labeling for Opioid Analgesic

The U.S. Food and Drug Administration (FDA) approved new labeling for Embeda, an opioid analgesic to treat severe pain. The new labeling includes a statement indicating that Embeda has properties that are expected to reduce oral abuse of the drug when the product is crushed.

Embeda becomes the third opioid analgesic to be approved with an abuse-deterrent label, in line with the FDA’s 2013 draft guidance, Abuse-Deterrent Opioids – Evaluation and Labeling.

Embeda, which is manufactured by Pfizer, is a combination of morphine sulfate and naltrexone hydrochloride. These agents have competing actions on the opioid receptor; when capsules are swallowed intact, only the morphine is released, producing pain relief but creating the risk of abuse and addiction. When crushed, the naltrexone is also activated, blocking some of the euphoric effects of morphine. This reduces the risk of abuse, though not completely preventing it, for people who improperly use the drug such as by inhaling it.

Though the new labeling is approved, the FDA will require additional postmarketing studies of Embeda to further assess the effects of the abuse-deterrent features on the risk—and consequences—of abuse, particularly in regard to intravenous use. The agency is also holding a public meeting on October 30-31 in Silver Spring, Md., to further discuss the development of abuse-deterrent opioids.

To read about initiatives and recommendations for reducing opioid abuse, see the Psychiatric News article, "Caution Urged for Clinicians Who Prescribe Opioids."

Pipeline and Innovation for Psychotropic Drugs Are Limited, Study Finds

As development of drugs to treat psychiatric disorders lags behind that of drugs for other illnesses, a recent study published in Psychiatric Services in Advance sheds light on why the pipeline for psychotropic medicines is nearly empty.

Researchers from Brandeis University and Truven Health Analytics led an investigation of the current state of psychotropic drugs in the pipeline and potential barriers that may keep these drugs from reaching distribution in the United States. Sifting through industry reports, company press releases, and the National Institutes of Health clinical trials website, the researchers gathered information on phase 3 trials for drugs being developed to treat major psychiatric disorders, including alcohol use disorder, schizophrenia, and depression. All studies involved adults aged 18 or older.

The analysis showed that the pipeline for psychotropic drug development—99 clinical trials were included—is limited, with little product innovation evident. Most of the examined drugs were a combination of existing of U.S. Food and Drug Administration-approved medicines or individually approved medicines that were being tested for new indications or delivery-system approaches (such as an injectable version that is similar to an approved oral form). Only three drugs differed substantially from existing drugs.

Among the barriers that hindered development of psychotropic drugs were incentives that encourage firms to focus on incremental innovation—such as a new version with fewer associated side effects—rather than taking risk on radically new molecular approaches, the failure of animal studies to translate well to human trials, and drug-approval thresholds set by the FDA that developers and manufacturers may perceive as too high to attain.

In an interview with Psychiatric News, Alan Schatzberg, M.D., a professor of psychiatry at Stanford University and former APA president, said that the departure by pharmaceutical companies to develop innovative psychotropic medicines could result in serious problems for the field of psychiatry, especially for patients.

“There is a number of initiatives by various organizations to help with this problem, including the European College of Neuropsychopharmacology, which is working with companies to provide investigators with compounds that have been shelved, and NIMH's Research Domain Criteria [RDoC], which promotes research on specific [and new] biological targets," he said. Schatzberg emphasized that it will take a concerted effort on the parts of governmental agencies, industry, as well as APA to advocate for investment and innovative psychiatric drug development. “Silence will not be helpful to our patients,” he concluded.

To read more about psychotropic drugs in the pipeline and initiatives to steer drug development and innovation, read this month's "Med Check" in Psychiatric News.

(Image: Florianopulopulos/shutterstock.com)

Psychiatry Appointments Often Difficult to Obtain, Study FInds

Considerable attention is being focused on the unmet need for mental health care in this country and how critical it is to improve insurance coverage so more people can enter treatment. But a new study finds that expanded insurance coverage might not be the answer, since even with insurance, treatment for mental illness can be hard to obtain.

Researchers at Maimonides Medical Center in Brooklyn, N.,Y., and Harvard Medical School examined the availability of outpatient psychiatric appointments in three large cities—Boston, Chicago, and Houston. As they reported yesterday in the study "Availability of Outpatient Care From Psychiatrists: A Simulated Patient Study in Three U.S. Cities" in Psychiatric Services in Advance, "Obtaining an outpatient appointment with a psychiatrist was difficult in the three cities we surveyed, and the appointments given were an average of one month away. Our findings add to the growing evidence that the mental health system is difficult for consumers to access. The findings are in line with national data demonstrating that two-thirds of primary care physicians cannot obtain outpatient mental health services for patients who need them."

Posing as patients, researchers called 120 numbers in each of the cities that were listed for individual in-network psychiatrists (as opposed to psychiatric clinics) in a Blue Cross/Blue Shield (BCBS) database. For each city, 40 callers each said they had either BCBS PPO insurance, Medicare, or were self-pay. Only 40% of the calls were answered in the first round of calling, and 16% of the numbers were found to be incorrect. After two rounds of calling, the callers obtained appointments with only 93 psychiatrists, or 26% of the sample. The differences between being in the BCBS PPO, Medicare, or self-pay were insignificant when it came to lining up the psychiatric appointment. There was, however, a significant difference in "success rate" for appointments among the cities, with psychiatrists in Boston least likely to offer an appointment (18%), while in Houston appointments were obtained 34% of the time. Chicago was in the middle at 25%.

The researchers concluded that "Expanding health insurance coverage through the Affordable Care Act may thus do little to change the conditions that made it difficult for us to obtain outpatient appointments with psychiatrists—or worse, expansion of coverage might further overwhelm the capacity of available services from these providers." As remedies, they suggest ways in which psychiatry might be made more attractive to medical students and urge an increase in insurance reimbursement for psychiatric care.

For more on these issues, see the Psychiatric News articles "Knocking Down the Barriers to Care" and "Shift to Population Health Called Critical to Psychiatry's Future."

(image: Anton Prado Photo/shuttterstock)

Breakthrough in Cultured Neural Cells With Alzheimer's Could Speed Drug Testing

Neural cells with the genes for Alzheimer’s disease (AD) were successfully grown in culture, developing the amyloid-β plaques and neurofibrillary tangles believed to be characteristic of the disease.

Researchers at the Genetics and Aging Research Unit at the Massachusetts General Institute for Neurodegenerative Disease and several other institutions have successfully grown “Alzheimer’s in a petri dish,” as the breakthrough was called in a New York Times article. The work was published in a report in the journal Nature. “We have successfully recapitulated amyloid-β and tau pathology in a single 3D human neural cell culture system,” the researchers stated.

Alzheimer’s experts say the breakthrough could dramatically speed the testing of drugs for treating AD. “This is a ground breaking study that will enable researchers to investigate the process of progression of Alzheimer’s disease and, more importantly, test large numbers of possible treatments in a relatively short order,” past APA President Dilip Jeste, M.D., (pictured above) told Psychiatric News. “Clinical trials take a long time to complete, and animal models such as those using mice or rats have uncertain applicability to the human disease. I believe these investigators’ work will open the door to study many other brain diseases too.” Jeste is a distinguished professor of psychiatry and neurosciences and the director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego.

“One note of caution is that we do not know to what extent plaques and tangles in a petri dish replicate the complex living brain of a person with Alzheimer’s disease,” Jeste added. “Nonetheless, this work opens a new and exciting line of research into neurodegenerative and other brain diseases.”

For more on AD research, see the Psychiatric News article, “High BDNF Levels May Offer Protection Against Alzheimer’s.” Also see the book Clinical Manual of Alzheimer Disease and Other Dementias from American Psychiatric Publishing.

Mental Health Response to Ebola Outbreak Still in Early Stages

As infectious disease specialists and health officials work to stem the Ebola outbreak in Africa, mental health personnel are patching together their own response to the disaster.

"The totality of the response has been quite slow, and the mental health response has even been slower,” said Benjamin Harris, M.D. (pictured above), in an email to Psychiatric News. Harris is an associate professor at Dogliotti College of Medicine in Monrovia, Liberia. He is also the only psychiatrist working in that country.

Health professionals are both overworked and exposed to the virus, said Mardia Stone, M.D., M.P.H., an advisor to the Division of Global Psychiatry at Massachusetts General Hospital and Harvard Medical School, who returned recently from the region. Their families are also a vulnerable group, fearing that these workers will catch the disease or inadvertently bring the pathogen home.

Neighboring Sierra Leone also has just one psychiatrist, but nongovernmental organizations there have been working to give some nurses and other health workers a basic understanding of mental health.

Liberia, Sierra Leone, and Guinea—where almost all of the Ebola cases have arisen—are collaborating to develop a psychosocial program that will focus on the children and widowed spouses of Ebola victims, said Harris.

Halting the spread of virus is the first priority of public-health personnel, but the psychological aftereffects of the epidemic will become even more apparent once the disease's spread is contained.

To read more in Psychiatric News about the mental health response to the Ebola epidemic, see the article "Response to Ebola Crisis Will Require Attention to MH Needs." Ebola factsheets from the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences are posted at http://www.cstsonline.org/ebola/.

(Image: Massachusetts General Hospital)

The Americas Must Continue Move to Community-Based Mental Health Services

“The [mental health] treatment gap is the great challenge we face today,” said Jorge Rodriguez, M.D., Ph.D., unit chief for Mental Health and Substance Use at the Pan American Health Organization (PAHO) in Washington.

Tearing down barriers to access to services should come as part of universal health coverage and include the integration of mental health into general health services, and not in some parallel track, said Rodriguez, recounting provisions of PAHO’s strategic plan for 2014-2019 at a symposium today at PAHO headquarters on World Mental Health Day. Meeting that challenge will require cooperation by governments, health professionals, families and consumers.

However, in 20 of the 27 countries in North and South America with psychiatric hospitals, more than 50% of the mental health budget still goes to those institutions rather than to community-based systems, he said.

“We need a new vision of research, policy, clinical services, and education,” added Eliot Sorel, M.D., a clinical professor of global health, health services management and leadership and of psychiatry and behavioral sciences at George Washington University, who helped organize the program. “Primary care physicians, pediatricians, and public-health people must be our allies. It is a shared responsibility.”

For more in Psychiatric News about international mental health, see: “WHO Report Emphasizes Need to Make Suicide Prevention a Global Priority.”

 (Image: Aaron Levin)

Lack of Culturally Competent Care Prevents Hispanics From Seeking Care

In observance of National Hispanic Heritage Month, APA’s Diversity at Work program sponsored a "Lunch and Learn" program this week to celebrate the contributions of Hispanics and Latin Americans and highlight the importance of cultural competence when providing mental health services to Hispanic populations.

“Mental health involves more than the brain,” said the program’s guest speaker, Jane Delgado, Ph.D., M.S., a clinical psychologist and president and CEO of the National Alliance for Hispanic Health. “We really need to understand the people who we serve … and listen to them.” During an interview with Psychiatric News, Delgado, a Cuban American, said that one of the main factors that keep Hispanic Americans from accessing mental health care, as well as other health care services, is the fear of not being understood due to language barriers and the lack of cultural competence by clinicians, particularly when patients are describing their symptoms.

Delgado described one situation in which a person of Hispanic descent visited the emergency department and repeatedly said “débil” when asked to describe their symptoms. Under the assumption that the patient was trying to convey that he was seeing the devil, the health care professionals concluded that the patient's illness was related to mental illness. “ 'Débil' means ‘weak’ in Spanish,” Delgado explained to Psychiatric News. "This is one of many examples of how misunderstandings" of a patient’s ethnic background and language can affect the health care they receive.

Delgado, who advocates for minority health on Capitol Hill, also stressed the importance of increasing the number of diverse clinical trials, particularly involving mental health care. “Hispanics metabolize fat differently from the general population—making certain medications intended for diabetes more effective in this population. Certain heart medications are more effective in African Americans. … Does this [concept] hold true for psychiatric medication that we give patients? We need to know." She added that "mental health professionals must push for better and more diverse data to make the best decision for our patients."

To read more about mental health issues in Hispanic Americans, see the Psychiatric News article "For Better Mental Health Care for Latinos, Look at Neighborhoods."

Note: Join your APA colleagues in responding to questions and comments from the public and patients in this week's #YourMH @twitter chat tomorrow (Friday, October 10) from noon to 1 p.m. ET. The topic is serious mental illnesses (schizophrenia, major depression, bipolar disorder). To join, use #YourMH (stands for "Your Mental Health"), @apapsychiatric, or #MIAW14. If you haven't created a Twitter account yet, click here to do so now. Here's your chance to share your knowledge and insights.

(Image: Vabren Watts/Psychiatric News)

APA Tells Senate Leaders It Supports Drug-Policy Nominee

In a letter to the chair and ranking Republican of the Senate Judiciary Committee, APA has conveyed its support for the nomination of Michael Botticelli to head the White House Office of National Drug Control Policy (ONDCP). Botticelli has been acting director of the office since 2012. In the letter to the Senate leaders, APA President Paul Summergrad, M.D., and CEO and Medical Director Saul Levin, M.D., M.P.A., emphasize that Botticelli has demonstrated the ability to understand the significant challenges facing the ONDCP, including "a growing epidemic of prescription drug and heroin abuse."

The APA leaders also praised Botticelli willingness "to work collaboratively with federal partners, state authorities, and professional associations like APA to reduce drug use and to promote prevention, intervention, treatment, and recovery services."

Prior to going to the White House, Botticelli headed the Bureau of Substance Abuse Services in the Massachusetts Department of Public Health. He also served on advisory committees to the Center for Substance Abuse Prevention (a division of the Substance Abuse and Mental Health Services Administration) and the National Action Alliance for Suicide Prevention.

In a recent interview with Psychiatric News, Botticelli, who openly discusses his recovery from alcohol abuse over the past 25 years, said that by intensifying efforts to reduce stigma associated with mental health and substance use disorders, more people will be encouraged to access mental health care services.

Read more about Botticelli in the Psychiatric News articles "SAMHSA Uses Recovery Event to Report Rise in Substance Abuse" and "New White House Drug Policy Focuses on Science of Addiction."

Study Suggests Chronic Smoking Could Increase Suicide Risk in Males

Chronic smoking may be an independent contributor to suicide in males. An analysis of data comparing suicide decedents with accident and homicide decedents found that longer lifetime smoking was associated with increased odds of death by suicide, while quitting smoking and longer periods of abstinence were associated with lower odds of suicide. The results were seen only in males. The findings are in the report, “Independent Association of Chronic Smoking and Abstinence With Suicide,” published online in Psychiatric Services in Advance.

Canadian researchers used data from the 1993 U.S. National Mortality Followback Survey to compare natural, accidental, suicide, and homicide deaths. The data included information on lifetime smoking duration, history of ever quitting smoking, and duration of abstinence from smoking. And it also included a “psychological autopsy” drawn from interviews with next of kin that collected information on history of depressive disorders, alcohol consumption or drug use, living alone in the last year of life, and keeping a firearm—all potential risk factors for violent death. Veteran status was obtained from the death certificate.

They found that male suicide decedents smoked for a larger fraction of their lives compared with decedents in the control groups, were less likely to have quit smoking at any point in their life, and abstained from smoking for a smaller fraction of their life. And the association between chronic smoking and risk for suicide remained after controlling for other possible risk factors, suggesting that smoking itself could be an independent risk factor.

“Smoking is a form of self-medication that is addictive,” lead researcher Lloyd Balbuena, M.S., Ph.D., of the University of Saskatchewan Department of Psychiatry told Psychiatric News. “In the very short-term, smoking improves mood, but in the long run...smoking worsens mood and impairs cognitive function. It is not far-fetched to believe that with these challenges, the person is more vulnerable to stressors that could otherwise be handled more easily.”

 To read more about research on suicide, see the Psychiatric News article, “Preventing Patient Suicide: Know Thy Patient.”

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Mental Illness Awareness Week Webinars Address Key Issues

October 5 to 11 is Mental Illness Awareness Week (MIAW), and in observance, APA leaders will be participating in two webinars on Wednesday, October 8.

First, from 2 p.m. to 3 p.m. EDT, APA President Paul Summergrad, M.D., be one of the presenters in a webinar sponsored by the Substance Abuse and Mental Health Services Administration, titled “Providing Integrated Care for People With Serious Mental Illness.” Dr. Summergrad and co-speaker Jeremy Lazarus, M.D., past president of the American Medical Association and former APA Assembly speaker, will discuss the importance of addressing the medical needs of people with serious mental illness and strategies for effectively integrating primary and behavioral care.

From 4 p.m. to 5 p.m. EDT, APA’s CEO and Medical Director Saul Levin, M.D., M.P.A., will host the webinar “Mental Health in the Mainstream.” Dr. Levin will be joined by four speakers from community organizations to discuss how local communities and national public health groups can work together to create a world where mental health is viewed and treated with the same gravity as physical health. The webinar is sponsored by Screening for Mental Health Inc., on whose Board of Directors Dr. Levin serves.

In addition to MIAW, these educational and public-awareness events also recognize National Depression Screening Day, which is being held this year on Thursday, October 9. The public is urged to take a free, anonymous mental health screening at www.helpyourselfhelpothers.org. Also listed on this site are locations for in-person screenings.

Those interested in participating in the webinar “Providing Integrated Care for People With Serious Mental Illness” can read more and register here.

Those interested in participating in the webinar “Mental Health in the Mainstream” can read more and register here.

Length of Time Between Pregnancies Associated With ASD in Offspring, Study Finds

A study published in this month's Journal of Child and Adolescent Psychiatry found that children who are conceived either less than one year or more than five years after the birth of a sibling may be at high risk for autism spectrum disorder (ASD).

Researchers from the Department of Psychiatry at Columbia University analyzed records of nearly 7,400 children born between 1987 and 2005 in Finland to investigate the impact of maternal interpregnancy intervals and a diagnosis for ASD in offspring.

The results showed that children who were conceived less than 1 year after the birth of a sibling were 1.5 times more likely to be diagnosed with ASD, compared with those conceived between a two- to three-year interpregnancy interval. Children born five to 10 years after their siblings were 30 percent more likely to be diagnosed with ASD. Risk for the disorder was further increased in children conceived after interpregnancy intervals of more than 10 years.

“This study provides further evidence that environmental factors occurring during or near the prenatal period play a role in autism, a serious and disabling condition that afflicts millions of individuals and that is increasing in prevalence,” commented Alan Brown, M.D., M.P.H., senior author and professor of psychiatry and epidemiology at Columbia. The researchers noted that the study results do not suggest that the length of time between pregnancies per se is a cause of ASD, but rather it is a proxy of other factors (such as the prenatal environment) that are more directly related to the chance of a child's developing the condition.

To read more about potential risk factors for ASD, see the Psychiatric News articles "If Relative Has Schizophrenia, Autism Risk Increases" and "Infants’ Eyes May Reveal Clue to Autism Risk."

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Today's Twitter Chat: Join your APA colleagues in responding to questions and comments from the public in this week's #YourMH @TWITTER chat today from noon to 1 p.m. The topic is bullying, in observance of National Bullying Prevention Month. To join, use #YourMH (stands for "Your Mental Health"), @APAPSYCHIATRIC, or #stopbullying. If you haven't created a Twitter account yet, click here to do so now. And during the chats, don't just sit on the sidelines—be a part of the conversation!

Four-Year Outcome of Teen Anorexia Generally Stable Following Remission, Study Suggests

Outcomes for adolescent anorexia nervosa are generally stable after treatment—regardless of treatment type—once remission is achieved, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers at the University of Chicago and Stanford University assessed 79 adolescents with anorexia from an original cohort of 121 participants who had achieved remission from anorexia nervosa after completing a randomized clinical trial comparing family-based therapy (FBT) and adolescent focused therapy (AFT). Follow-up assessments were completed up to four years post-treatment. Participants completed the Eating Disorder Examination as well as self-report measures of self-esteem and depression at two to four years post-treatment.

Two participants relapsed, but there were no differences based on treatment group assignment in either relapse from full remission or new remission during long-term follow-up. Other psychopathology was stable over time.

“There were few changes in the clinical presentation of participants who were assessed at long-term follow-up,” the researchers stated. “These data suggest that outcomes are generally stable post-treatment regardless of treatment type once remission is achieved.”

Angela Guarda, M.D., an expert in eating disorders at Johns Hopkins University of School of Medicine, told Psychiatric News that the study is important “as it validates that remission is a very important marker of treatment progress and is generally associated with longer-term recovery if sustained” and “reinforces that early treatment is critical as it may help prevent chronicity in what can be a very serious and even life-threatening condition.”

She cautioned, however, that vulnerability to relapse may still remain in remitted cases. “It is not unusual to elicit a distant history of a brief episode of adolescent anorexia nervosa in patients who present clinically with the disorder as adults,” she said.

For more on the subject, see the Psychiatric News article "Expert Hopeful About Future of Treatment for Eating Disorders."

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Therapy With Horses Appears to Lessen Violent Incidents

A horse is only a horse, of course, unless the horse is an adjunctive psychotherapist.

Researchers at New Jew Jersey’s Greystone Park Psychiatric Hospital, a 500-bed state facility, tested the relative effects of animal-assisted therapy on violent behavior among a group of 90 patients randomized to receive either therapy with horses, dogs, enhanced social skills training, or usual care, reported Jeffry Nurnberg, M.D., and colleagues online today in Psychiatric Services in Advance. Most of the patients were diagnosed with schizophrenia or schizoaffective disorder and had been hospitalized for an average of 5.4 years.

Dogs have been used for therapeutic interventions, but studies using horses are rare. Nurnberg and his colleagues used “two or three therapy horses tested and credentialed as suitable for direct patient contact in clinical environments.” Patients did not ride the horses but led them around a course under the instruction of therapists. Comparing before-and-after incident reports, the researchers found decreases in violence and aggression for patients working with horses but not for the other cohorts.

“Unique effects from therapy horses may come from interacting with physically imposing animals that appear quite capable of causing harm but do not,” wrote the authors. “Equine interactions may model nonviolent behavioral strategies, resulting in patients’ greater tolerance of provocative interpersonal stimuli.”

For more in Psychiatric News about using animals as an adjunct to traditional therapies, see “Farm Has Spent 100 Years Helping Those With Serious Mental Illness.”

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APA's Next Twitter Chat: Join your APA colleagues in responding to questions and comments from the public and patients in this week's #YourMH @TWITTER chat on Friday, October 3. The topic is bullying, in observance of National Bullying Prevention Month. To join, use #YourMH (stands for "Your Mental Health"), @APAPSYCHIATRIC, or #stopbullying. If you haven't created a Twitter account yet, click here to do so now. And during the chats, don't just sit on the sidelines—be a part of the conversation!