Global Study Finds Some Members of General Population Report Psychotic Experiences

Psychotic experiences, such as hallucinations and delusions, are not restricted to individuals with certain mental illnesses—the general population sometimes experiences these symptoms too, according to a study published this week in JAMA Psychiatry.

Researchers from the University of Queensland in Australia and Harvard Medical School analyzed data from the World Health Organization World Mental Health Surveys that included more than 31,000 adults to assess the lifetime prevalence of psychotic experiences among the general population. 

The analysis revealed that 5.8 percent of those surveyed reported having at least one psychotic experience in their lifetime, with hallucinatory experience being the most prevalent at 5.2 percent compared with delusional experience at 1.3 percent. The results also showed lifetime prevalence of psychotic experiences was higher among women (6.6 percent) than men (5 percent), and higher among individuals who lived in middle-income (7.2 percent) and high-income (6.8 percent) countries than those in low-income countries (3.2 percent). However, the psychotic experiences were infrequent, with 32.2 percent of respondents with lifetime psychotic experiences reporting only one episode and 31.8 percent reporting having experienced two to five episodes. 

“We are interested in learning why some people recover, while others may progress to more serious disorders such as schizophrenia,” John McGrath, M.D., Ph.D., a research professor in the Queensland Brain Institute and lead author of the study, said in a press release. “We can use these findings to start identifying whether the mechanisms causing these hallucinations are the same or different in both situations.” 

For more on psychosis in the general population, see the Psychiatric Services article “Treatment Seeking and Unmet Need for Care Among Persons Reporting Psychosis-Like Experiences.”

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For Some Women, Discontinuing Hormone Therapy May Increase Risk of Depression

During perimenopause, women face an increased risk of new and recurrent depression. Now, a new report finds that women with a history of perimenopausal depression (PMD) who discontinue hormone therapy may experience the return of depression symptoms.

For the study, published Wednesday in JAMA Psychiatry, Peter J. Schmidt, M.D., chief of the Section on Behavioral Endocrinology at the National Institute of Mental Health, and colleagues recruited asymptomatic postmenopausal women with a history of PMD whose symptoms remitted following hormone therapy (n=26) and asymptomatic postmenopausal women who were receiving or had previously received hormone therapy and had no history of depression (n=30).

For three weeks, all participants received open-label transdermal estradiol therapy (100 µg/d) before being randomized to a parallel design in which they received either estradiol (at the same dose given during the open-label period) or matched placebo skin patches for three additional weeks. During weekly clinic visits, depressive symptoms were monitored, and women rated the presence and severity of vasomotor symptoms daily.

The researchers found that while none of the women reported depressive symptoms during open-label use of estradiol, women with a history of PMD that were given the placebo skin patch experienced a significant increase in depression symptom severity. In contrast, women with a history of PMD who continued estradiol therapy and those with no history of PMD (who received estradiol or placebo) remained asymptomatic. There were no differences between the groups in reported hot flashes or plasma estradiol levels.

“These observations, in the context of similar plasma reproductive hormone levels, suggest that normal changes in ovarian estradiol secretion can trigger an abnormal behavioral state in susceptible women,” the authors wrote. “Women with a history of PMD should be alert to the risk of recurrent depression when discontinuing hormone therapy.”

For related information, see the Psychiatric News article “Antidepressant May Have Role in Treating Menopause Symptoms.”

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Children's Suicide Rates Reflect Racial Differences

Between 1993 and 2012, 657 children in the United States died by suicide, the 11^th leading cause of death among children aged 5 to 11 years. While the overall suicide rate did not change significantly over that time (from 1.18 to 1.09 per million), there were notable differences between white and black children.

“Among white children, the suicide rate decreased significantly during the study period (incident rate ratio = 0.86), whereas for black children there was a significant increase in the suicide rate (incident rate ratio = 1.27),” wrote epidemiologist Jeffrey Bridge, Ph.D., a principal investigator at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues in JAMA Pediatrics.

Those differences were largely driven by a significant decrease in suicide rates among white boys (from 1.96 per million to 1.31 per million) and a significant increase among black boys (from 1.78 to 3.47 per million). Hanging/suffocation accounted for 78 percent of all suicides.

The authors speculated on several possible explanations of this disparity in outcomes—black youth may be exposed to more violence or traumatic stress, for instance—but could not say for certain what caused the observed difference in suicide rates.

“[F]uture steps should include ongoing surveillance to monitor these emerging trends and research to identify risk, protective, and precipitating factors associated with suicide in elementary school–aged children to frame targets for early detection and culturally informed interventions,” they concluded.

For more in Psychiatric News about children and suicide, see: "CBT for Child Anxiety May Confer Long-Term Protection From Suicidality."

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Citicoline Appears to Reduce Cocaine Use in Patients With Bipolar Disorder, Study Finds

Citicoline reduced cocaine use and was well tolerated by patients with bipolar disorder, according to a report published May 22 in AJP in Advance. However, because the treatment effects diminished over time, the authors of the study suggest citicoline may work best as an acute treatment while other interventions are initiated.

For the study by E. Sherwood Brown, M.D., Ph.D., a professor of psychiatry at the University of Texas Southwestern Medical Center, and colleagues, 130 outpatients with bipolar I disorder and cocaine dependence received citicoline or placebo for 12 weeks. (Citicoline is sold as a prescription drug in Japan and Europe and over the counter as a dietary supplement in the United States. It has a mild side effect profile, is relatively inexpensive, and has no known drug-drug interactions, according to the researchers.) Assessments of mood, based on the Inventory of Depressive Symptomatology–Self Report, the Hamilton Depression Rating Scale, and the Young Mania Rating Scale, were performed weekly, and urine drug screens were conducted three times per week.

While no between-group differences in mood symptoms or side effects were observed, the researchers found that there was a significant treatment group and group-by-time effect (whether or not missing urine screens were imputed as cocaine positive).

“The effects of citicoline in reducing cocaine use appeared to occur quickly and tended to decline during the study,” the authors write. “These findings suggest that citicoline might be most effectively used in an acute treatment to reduce cocaine use in inpatient settings while other treatments are initiated rather than as a long-term monotherapy.”

For more on strategies to reduce cocaine use, see the Psychiatric News article "Cocaine Vaccination Isn't Science Fiction Anymore."

FDA Approves New Three-Month Long-Acting Antipsychotic Invega Trinza

The FDA has approved Invega Trinza (paliperidone palmitate), a long-acting atypical antipsychotic intended to treat schizophrenia, from Janssen Pharmaceuticals Inc.

The approval of the injectable antipsychotic, which remains active in the body for three months, was based on results from a two-year maintenance trial with 506 patients diagnosed with schizophrenia. The analysis, published March 29 in JAMA Psychiatry, showed that patients who were administered Invega Trinza were statistically less likely to relapse than those who were administered placebo. The most common adverse effects of the medication included injection-site reactions, weight gain, upper respiratory tract infections, and extrapyramidal symptoms.

The newly approved antipsychotic will come with a boxed warning stating that it is not approved for patients with dementia-related psychosis and that use of the drug may increase the risk for death in elderly patients with dementia.

Before patients can begin taking Invega Trinza, they must first show tolerability to Janssen's Invega Sustenna, a one-month form of paliperidone palmitate, for at least four months.

Invega Trinza was approved under the FDA's priority review process, a fast track for drugs thought to represent a significant advance in medical care. It is being marketed by Janssen.

For more information about psychotropic medications in the pipeline, see the Psychiatric News article "Candidates, Innovation Missing From Psychotropic Drug Pipeline."

Experts Discuss Mental llness, Risk for Violence, and Gun Ownership

An evidence-based assessment of dangerousness—not mental illness, per se—should guide public policies regarding restrictions on gun ownership, Jeffrey Swanson, Ph.D. (left), of Duke University School of Medicine said during the "Do Firearm Restrictions Prevent Suicide and Violence in People With Serious Mental Illness?" workshop at the APA annual meeting in Toronto. He was joined by Joshua Horwitz, executive director of the Educational Fund to Stop Gun Violence.

Swanson, a professor of psychiatry and behavioral science, presented evidence showing that while there are instances when those with a serious mental illness are at increased risk of violence, serious mental illness, on its own, contributes very little to overall violence towards others. (Mental illness alone carries a far greater risk for suicide.)

For instance, he showed data from a survey of public behavioral health system psychiatric outpatients with serious mental illness in five U.S. sites demonstrating that the risk of violence rose significantly when in combination with substance abuse, early victimization, and/or exposure to violence in one's current social environment.

Swanson offered these following principles to guide public policy regarding restricting access to firearms:

• Prioritize contemporaneous risk assessment based on evidence of behaviors that correlate with violence and self-harm at specific times, not mental illness or treatment history per se as a category of exclusion;


• Preempt existing gun access, rather than simply thwarting a new gun purchase by a dangerous person;


• Provide legal due process for deprivation of gun rights;


• Preserve confidential therapeutic relationships;


• Prevent the unpredictable through universal background checks, but also by reducing the social determinants of violence and investing in improved access to mental health and substance abuse services.

For more information on gun policy and mental illness, see the Psychiatric News article "Capitol Hill Gets Straight Story On Gun Violence, Mental Illness" and the Psychiatric Services article "Gun Policy and Serious Mental Illness: Priorities for Future Research and Policy."

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NIDA Director Calls for Humane Response to Addiction as a Brain Disorder

“If we as psychiatrists can embrace addiction as a disease of the brain that disrupts the systems that allow people to exert self-control, we can reduce the stigma that surrounds this disorder—for insurance companies and the wider public—and help to eliminate the shame and suffering that accompany the addict who experiences relapse after relapse after relapse.”

That was the message that Nora Volkow, M.D., (left) director of the National Institute on Drug Abuse, brought to APA members at the 59th Convocation of Distinguished Fellows at APA’s 2015 annual meeting in Toronto Monday evening.

Volkow opened her speech with a moving and emotional story of how she learned of her grandfather’s lifetime of chronic alcoholism and suicide; he had died when she was a girl of 6 in Mexico, but Volkow’s mother did not reveal the truth of her grandfather’s addiction and death until many years later, when her mother was dying and after Volkow had already achieved distinction as an addiction expert.

It was a dramatic illustration of the despair experienced by people who have an addiction and continue to engage in a behavior that they may know is destroying them—a phenomenon that Volkow has devoted her career to understanding. She gave a brief overview of her own research and the evolution of addiction science, describing how it was once believed that addiction was a disorder of hyperactive reward centers in the brain—that addicts sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.

But Volkow explained that in recent years research has revealed just the opposite: that addicts are actually less sensitive to the effects of dopamine. They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically. And it is the neurobiological reflection of the phenomenon of “diminishing effects” that addicts typically report clinically: they require more and more of the drug to get a similar effect.

"This was completely counterintuitive," Volkow said.

Moreover, she emphasized that addiction to drugs disrupts multiple systems in the brain—not simply reward centers—that govern the ability to plan, anticipate, and change behavior in response to changing circumstances. Volkow said it is this phenomenon that accounts for the “craving” experienced by addicts and alcoholics in response to environmental triggers—often leading to what she characterized in the account of her grandfather’s death as that “one last moment of self-hatred.”

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ABMS Executive Defends Importance of MOC Part 4 in Assembly Address

"I absolutely believe we should keep the performance-in-practice component of Maintenance of Certification (MOC)," said American Board of Medical Specialties (ABMS) President and Chief Executive Lois Margaret Nora, M.D., J.D., during a special address to the APA Assembly Sunday morning at APA’s 2015 annual meeting in Toronto. However, Nora did note that the MOC process itself and the Part 4 performance-in-practice component (also referred to as "Improvement in Medical Practice") needs to be improved and refined.

According to Nora, the ABMS plans to respond to physician concerns over Part 4 by a "relaxation" of requirements and an expansion of activities that count toward fulfilment of performance in practice. "With the appropriate flexibility, I believe that performance in practice will be embraced by physicians," Nora said. ("Performance in practice" refers to a requirement that physicians build into their routine practice the capacity to assess their performance continually against guidelines for best practices and make improvements to meet those guidelines.)

Up to now it has been a chilly embrace. In an interview with Psychiatric News last year, Larry Faulkner, M.D., president of the American Board of Psychiatry and Neurology (ABPN), explained that the "the performance-in-practice issue is a controversial and difficult one. … It boils down to a quality-improvement process. In general, physicians are going to have to demonstrate that they have looked at their practices and identified issues that need to be improved."

But Part 4 has been the object of widespread physician concern and even anger. At the March meeting of the APA Board of Trustees, the Board voted to write a letter to Faulkner requesting that ABPN advocate to the ABMS that Part 4 be eliminated. (ABPN operates under criteria established by the ABMS).

The letter was the result of a motion, spurred by the Assembly Executive Committee and made at the Board of Trustees meeting in March, reflecting concerns over the limited evidence base for Part 4. Also at its March meeting, the Board established a joint Board-Assembly work group to evaluate the broad issue of MOC in psychiatry and its relationship to maintenance of state licensure and requirements of other accrediting bodies.

Note: Just prior to the start of APA's annual meeting, the ABPN announced that the feedback module in Part 4 will become optional as of January 1, 2016. The Part 4 Clinical Module component (chart review) will remain a requirement, and additional approved activities are now available on ABPN’s website. This change is in compliance with current MOC standards as mandated by the ABMS.

For more on APA’s efforts to eliminate Part 4 of MOC program, see the Psychiatric News article “APA Urges ABPN to Advocate for Elimination of MOC Part 4.”

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Study Finds Long-Term Depression Increases Risk for Stroke in Older Adults

Persistent symptoms of depression in adults ages 50 and older may double their risk for stroke, according to a recent study published in the Journal of the American Heart Association.

Researchers from Harvard T.H. Chan School of Public Health analyzed medical records of more than 16,000 older adults who participated in the Health and Retirement Study between 1998 and 2010. As part of the study, participants were interviewed every two years about their depressive symptoms, history of stroke, and stroke risks factors.

Nearly 2,000 strokes among the participants were reported over the course of the study. The researchers found that individuals who displayed high levels of depressive symptoms during two consecutive interviews (over a four-year period) were more than twice as likely to experience a stroke during the subsequent two years compared with participants who had low depressive symptoms during two consecutive interviews. Even people who had depressive symptoms at the first interview but not the second had a 66 percent higher stroke risk, the study reports.

The researchers hypothesized that depression may influence stroke risk through physiological changes involving the accumulation of vascular damage over time.

“This is the first study evaluating how changes in depressive symptoms predict changes in stroke risk," lead author Paola Gilsanz, Sc.D, a postdoctoral research fellow at Harvard, said in a press release. “If replicated, these findings suggest that clinicians should seek to identify and treat depressive symptoms as close to onset as possible, before harmful effects on stroke risk start to accumulate.”

To read more about the relationship between depression and stroke, see the Psychiatric News article "Collaborative Care for Depression Can Reduce Risk for Heart Attacks, Strokes."

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Treating Depressed Mothers With Escitalopram May Have Greater Benefit to Children, Study Finds

School-age children of mothers with major depression consistently have elevated rates of depression. Now a study in the May American Journal of Psychiatry finds that the children of depressed mothers who took escitalopram for 12 weeks showed significant improvements in depressive symptoms and functioning compared with those whose mothers took bupropion or a combination of the two drugs.

For the study, Myrna Weissman, Ph.D., of Columbia University and colleagues independently assessed 135 children (ages 7-17) and 76 depressed mothers participating in a 12-week double-blind randomized clinical trial testing the effects of escitalopram (10 mg to 40 mg daily), bupropion (150 mg to 450 mg daily), or a combination of the two.

While depressed mothers receiving escitalopram monotherapy, bupropion monotherapy, or combination treatment had a high remission rate overall (67%) and a significant reduction in symptoms over 12 weeks, only in the escitalopram group was significant improvement of the mothers' depression associated with improvement in the child’s symptoms.

The researchers suggest this difference may be due to changes in parental functioning. "Mothers in the escitalopram group reported significantly greater improvement, compared with the other groups, in their ability to listen and talk to their children, who as a group reported that their mothers were more caring over the 12 weeks," they wrote.

“This study highlights the complexity of interpreting the benefit of mothers’ medication treatment alone on children’s short-term outcomes,” Mary Jo Coiro, Ph.D., an assistant professor of psychology at Loyola University Maryland, wrote in an accompanying Perspectives piece in the journal. “Ultimately, a public health perspective that incorporates screening, prevention, and treatment of both parents and children is likely to be most effective in reducing the burden of parental depression. Interventions must offer a range of services and be flexible enough to identify which families require parenting support, medication, psychotherapy, home- or school-based services, and social services."

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Psychosis Seldom Leads to Violent Acts, Study Finds

Contrary to the common belief that mental illness is associated with violence, hallucinations and delusions associated with psychiatric disorders seldom foreshadow acts of aggression, according to findings published in Clinical Psychological Science.

For the study, Jennifer Skeem, a clinical psychologist at the University of California, Berkeley, and colleagues examined data from the MacArthur Violence Risk Assessment Study—a project that tracked the prevalence of community violence in a sample of more than 1,100 men and women during the year following their discharge from acute psychiatric facilities—to identify 100 former inpatients who had been involved in two or more violent incidents. In addition to reviewing the patient records, the authors conducted interviews with the former inpatients and family members and friends to assess the factors that preceded their violent acts (defined as battery resulting in physical injury, sexual assault, and assaults or threats with a weapon).

The authors concluded that psychosis immediately preceded 12 percent of violent incidents following the release from psychiatric facilities. Additionally, the authors found that individuals with exclusively “non-psychosis-preceded” violence could be distinguished from a small group who also had some psychosis-preceded violence.

"High-profile mass shootings capture public attention and increase vigilance of people with mental illness," Skeem stated in a press release. "These findings suggest that psychosis sometimes foreshadows violence for a fraction of high-risk individuals, but violence prevention efforts should also target factors like anger and social deviance."

For more on violence and mental illness, see the Psychiatric News article “Capitol Hill Gets Straight Story on Gun Violence, Mental Illness.” Also, see a related article in Psychiatric Services, "Applicability of the Risk-Need-Responsivity Model to Persons With Mental Illness Involved in the Criminal Justice System."

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Researchers Propose Strategies to Minimize Adverse Events Associated With SSRIs in Youth

In a paper published in the journal Translational Psychiatry, researchers from Johns Hopkins University proposed two SSRI-treatment strategies for depression in children and adolescents that they believe may be able to reduce the destabilization that often accompanies acute antidepressant initiation in this patient population.

The researchers, led by Adam Kaplin, M.D., Ph.D., an assistant professor of psychiatry and neurology at Johns Hopkins University School of Medicine, examined data from a 2004 report by the Food and Drug Administration—the same report that led the agency’s decision to issue the black-box warning and guidelines on pediatric SSRI treatment—to determine the relationship between the half-life of six antidepressants (fluoxetine, citalopram, venlafaxine, sertraline, paroxetine, and fluvoxamine) and the rate of suicide-related events (SREs) in pediatric patients. The researchers found a significant positive correlation between the two factors, indicating that the faster the loading rate of an SSRI, the higher the chances of an SRE occurring (P<0.05).

Based on these findings, the team used a computer-generated dosing simulation to develop novel treatment regimens for citalopram, venlafaxine, sertraline, paroxetine, and fluvoxamine that mimic the pharmacological profile of fluoxetine—the antidepressant with the longest half-life and lowest relative risk of SREs in pediatric populations.

The researchers also looked for ways to reverse the acute negative behavioral effects of antidepressants in a rodent model. They found that co-administration of the 5-HT1A receptor (5-HT1AR) antagonist WAY-100635 reversed the negative effects of acute fluoxetine, but not reboxetine, suggesting the involvement of 5-HT1AR in mediating the negative consequences of acute SSRI treatment.

“The combination drug-treatment strategy of a 5-HT1AR antagonist administered in combination with an SSRI reversed the acute anxiogenic effects of an SSRI alone in rodents,” the authors wrote. “We are hopeful that this treatment strategy can be developed and tested for future use in humans.”

“I think the construct that there could be an agent that could help with the destabilizing process at beginning of SSRI treatment is a worthwhile concept worthy of more research,” Louis Kraus, M.D., a professor of child and adolescent psychiatry at Rush University Medical Center, told Psychiatric News. “But, even now we have safe and effective ways of treating depression using therapy and medication management that has shown time and time again to help depression and save lives.”

“My concern is for children and adolescents with depression who are not taking SSRIs when indicated, leading to an increased risk of suicide and worsening depression,” Kraus added.

For more information on efforts to treat depression in children and adolescents, see the Psychiatric News article “Are FDA Antidepressant Warnings Linked to Rise in Youth Suicides?”

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PTSD Found to Accelerate Aging Process

A new analysis has linked posttraumatic stress disorder (PTSD) with accelerated aging, a biological process that can lead to a wide range of medical problems. These findings, reported in the American Journal of Geriatric Psychiatry, suggest that PTSD may not just be a mental illness, but a full systemic disorder.

A research team led by former APA President Dilip Jeste, M.D., the Distinguished Professor of Psychiatry and Neurosciences at the University of California at San Diego reviewed over 60 PTSD studies that assessed some aging-related process. They found multiple lines of evidence connecting PTSD with age-related biomarkers or health conditions.

For example, the studies consistently showed that people with PTSD had shorter telomeres—segments on the ends of chromosomes that are a measure of cellular age—than healthy counterparts, as well as higher levels of chemicals associated with inflammation. Also, people with PTSD showed higher rates of diseases associated with aging, including heart disease, diabetes, and dementia.

More studies will be needed to clarify the relationship between PTSD and aging, but this work does suggest that PTSD therapies should encompass a more integrated physical-psychiatric strategy.

Jeste is the co-editor of the new book Positive Psychiatry: A Clinical Handbook, published by American Psychiatric Publishing.

APF Program Recognized During National Children’s Mental Health Awareness Day Event

In celebration of National Children’s Mental Health Awareness Day, APA and the American Psychiatric Foundation (APF) joined with the Substance Abuse and Mental Health Services Administration (SAMHSA) in Washington, D.C., yesterday to honor those dedicated to improving the mental health of children.

The event recognized the work of the APF’s Typical or Troubled? program—which has trained more than 70,000 teachers and school administrators, as well as more than 10,000 parents, to recognize signs of mental illness in children and adolescents.

“Through years of research, we know that early recognition, intervention, and treatment of a mental disorder can make a positive difference for a child growing up in challenging and traumatic circumstances,” said APA President Paul Summergrad, M.D. “That’s why increasing awareness of the signs of mental illness is so critical—whether it is through a targeted program such as 'Typical or Troubled?' or awareness events like National Children’s Mental Health Day.”

Grammy-nominated singer and songwriter Mary Lambert (left) was presented as the honorary chairperson of this year’s celebration by the Department of Health and Human Services Secretary Sylvia Mathews Burwell (right). Lambert has been outspoken about her own challenges living with bipolar disorder, which was highlighted in her song "Secrets."

“We are really trying to help people understand that mental health conditions are just like any other condition—they need to be prevented or identified and addressed so that people can recover from them while receiving needed support,” SAMHSA Administrator Pamela Hyde, J.D., told Psychiatric News. “Today’s program emphasized that SAMHSA, as well as our partners who were recognized, have resources that the public can use to truly address mental health issues in children and their families.”

To read more about the "Typical or Troubled?" program, see the Psychiatric News article "Miami-Dade Schools Adopt Foundation’s ‘Typical or Troubled?’ Program."

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'Housing First' Model Key to Improving Lives of Homeless, Study Finds

Participation in a program that connects people who are homeless and have severe mental illness to housing quickly led to greater improvements in housing stability, quality of life, and community functioning one year later, according to a study in Psychiatric Services.

For the study, Sam Tsemberis, Ph.D. (pictured left), founder of Pathways to Housing and the “housing-first” model, and colleagues compared one-year outcomes in 950 high-need individuals participating in Housing First (a program that helps individuals establish stable housing within a year without requiring treatment or sobriety restrictions) with treatment-as-usual programs (including shelters, general medical health, addiction, social services, and more) across five Canadian cities. In-person interviews were conducted at the beginning of the study and at six and 12 months; participants’ housing history was documented every three months.

At the 12-month follow-up, 73 percent of Housing First participants and 31 percent of treatment-as-usual participants resided in stable housing. Participation in a Housing First program also produced improvements in overall quality of life compared with treatment-as-usual participants and greater improvements in community functioning compared with treatment-as-usual participants.

While the authors noted that “[i]t remains to be seen whether Housing First participants will show greater improvements than treatment-as-usual participants on clinical and other outcomes during the second year of this trial, [o]ur interim findings provide support for the redirection of programs and policies toward adopting Housing First to address chronic and episodic homelessness.”

The Washington Post recently featured a profile of Tsemberis, where it describes how the housing-first model is leading to gains in efforts to keep homeless people off of the streets across the country.

For more, see the Psychiatric News article “Housing Programs Effective, but Studies Plagued by Limitations.”

(Image: Sam Tsemberis, Ph.D.)

APF Joins in Initiative to Reduce Numbers of Mentally Ill People in Jails

The American Psychiatric Foundation (APF) joined the National Association of Counties and the Council of State Governments Justice Center on Capitol Hill yesterday to launch the Stepping Up Initiative, a national effort to reduce the number of people with mental illnesses in jails across the country.

The initiative calls on county governments to enact strategies to collect data on the status and needs of people with mental illnesses in local jails, determine treatment capacity, and develop plans with measurable outcomes to reduce their overrepresentation in the criminal justice system.

“We know the impact these changes can have on our counties’ budgets, on our public safety, and most importantly, on individuals with mental illnesses and their families,” said Toni Carter (left), a commissioner of Ramsey County, Minn., during the Hill event. “But this battle won’t be won in individual counties. We need a national movement to change the way we treat people with mental illnesses.”

While some counties have made progress in their efforts to facilitate access to treatment and promote appropriate alternatives to jail, scaling up successful efforts has proven more difficult. As part of its ongoing work in the criminal justice field, APF will convene a national summit meeting on the subject in spring 2016.

A recent report noted that there were now 10 times as many people with mental illness in jails and prisons than in psychiatric hospitals, said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We must ensure that every one of our patients, every individual who needs and deserves treatment—particularly in the criminal justice system—receives that treatment.”

“We need sweeping change in the overrepresentation of people with mental illness in the criminal justice system,” said Denise O’Donnell, J.D., M.S.W., director of the Bureau of Justice Assistance in the U.S. Department of Justice. “The current system in which our jails provide mental health services is not affordable, nor is it sustainable or right.”

For more in Psychiatric News about the mental health crisis in America’s jails, see “Counties Seek Help to Reduce Numbers of Mentally Ill Inmates.” Also, see the Psychiatric Services in Advance article “Prospective Study of Violence Risk Reduction Among Mental Health Court Participants,” coauthored by APA President-elect Renée Binder, M.D.

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Benefits of Early Intervention for ASD Persist Two Years Later, Study Shows

The positive effects of an early intervention for very young children with Autism Spectrum Disorder (ASD) appear to be maintained two years after the intervention ends, according to a report online in the Journal of the American Academy of Child and Adolescent Psychiatry.

Annette Estes, Ph.D., director of the University of Washington Autism Center, and colleagues prospectively examined evidence for the sustained effects of the Early Start Denver Model (ESDM), a comprehensive behavioral early intervention approach for children with autism, ages 12 to 48 months. The study included 39 children with ASD who began participation in a randomized clinical trial of ESDM between 18 and 30 months; clinicians who were naïve to previous intervention group status later assessed the children across multiple domains of functioning at age six, two years after ESDM ended.

The researchers found that the ESDM group maintained the gains made during early intervention across symptom domains at age six, including overall intellectual ability, adaptive behavior, symptom severity, and challenging behavior. While no group differences in core autism symptoms were found immediately posttreatment, the ESDM group demonstrated improved core autism symptoms compared with the community-intervention-as-usual group two years later. The two groups received equivalent intervention hours during the original study, but the ESDM group received fewer hours during the follow-up period, according to the report.

“These results provide evidence that gains from early intensive intervention are maintained two years later,” the authors state. “This is the first study to examine the role of early ESDM behavioral intervention initiated below 30 months of age in altering the longer term developmental course of autism.”

For more information about early ASD interventions, see the Psychiatric News article, “Intensive, Two-Year Intervention Benefits Kids With Autism.”

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New York State Project Shows Progress in Reducing Use of Seclusion, Restraint for Children With Mental Illness

Three New York State mental health treatment facilities participating in a project to decrease the use of seclusion and restraint for children with severe emotional disorders demonstrated significant decreases in restraint and seclusion episodes per 1,000 client-days, according to a report published online Friday in Psychiatric Services in Advance titled "The New York State Office of Mental Health Positive Alternatives to Restraint and Seclusion (PARS) Project." Moreover, each facility identified specific activities that contributed to success, including ways to facilitate open, respectful two-way communication between management and staff and between staff and youth, and greater involvement of youth in program decision making.

The intervention used by the three facilities included training, on-site mentors and peer specialists, and on-site consultation from the Office of Technical Assistance of the National Association of State Mental Health Program Directors (NASMHPD). The intervention’s primary methodology was implementation of NASMHPD’s “Six Core Strategies to Reduce the Use of Seclusion and Restraint.”

The study authors examined data from the New York State Incident Management and Reporting System on restraint and seclusion episodes per 1,000 client days over a four-year period (2007–2011). Qualitative data were collected via notes from facility consultations, site visits, steering committee reviews, site conference calls with the New York State Office of Mental Health (OMH), and site reports.

At facility one, the number of incidents per 1,000 client-days decreased from 67 to 25; at facility two, the decrease was from 63 to 7; and at facility three, the decrease was from 99 to 13.

“The primary finding of this project was that the creation of coercion- and violence-free environments where use of restraint and seclusion is markedly decreased requires a major commitment by all staff over an extended period to fully understand and internalize the strategies involved and embrace the changes in facility culture,” Lloyd Sederer, M.D., medical director of the New York State Office of Mental Health and a coauthor of the report, told Psychiatric News. “In New York, OMH is promoting facilities’ engagement in learning collaboratives so that facilities can reduce use of restraint and seclusion and realize significant positive outcomes."

For related information, see the Psychiatric News article, "Psychiatric Hospital Aesthetics Affect Seclusion, Restraint Use."

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APA Event Addresses Mental Health Needs of American Indians

American Indians have long experienced lower health status when compared with other Americans. During an APA-sponsored event in Sioux Falls, S.D., on Thursday, community leaders and mental health professionals called for more to be done to address the mental health needs of this population.

“We know what the health inequities are among the Native American population,” APA CEO and Medical Director Saul Levin, M.D., M.P.A, told conference attendees. “It’s time for us to do something. APA is here to help and can use its lobbyists to help address these issues to legislatures.”

Debanjana Bhattacharya, M.D., M.P.H. (left), a fourth-year psychiatry resident at the Sanford School of Medicine at the University of South Dakota and APA minority fellow, described the toll mental illness was having on the people of South Dakota alone. “Suicide rates for American Indians in South Dakota are 2.5 times than the rates in the surrounding states of Iowa, Nebraska, and North Dakota,” said Bhattacharya, who helped organize the event. Alcohol use disorder is also one of the leading causes of death among American Indians residing in South Dakota.

To help address these needs, individuals from the public and private sectors recently formed the Alliance for American Indian Behavioral Health, which aims to advance health equity for Native Americans within the Sioux Falls area through the promotion of available resources and training in cultural competence for non-Native American health care professionals.

Yesterday's event was sponsored by APA’s Division of Diversity and Health Equity in conjunction with the South Dakota Psychiatric Association.

To read more about efforts in addressing mental health issues among American Indians, see the Psychiatric News article "White House Hosts Briefing on Federal Suicide Prevention Efforts."

(Image: Vabren Watts/Psychiatric News)