Thursday, May 31, 2018

APA Cautions Against Policy Separating Children From Parents at Border

APA is urging an immediate halt to a new Trump administration policy that separates children from their parents at the U.S. border.

“As physician experts in mental health, the American Psychiatric Association opposes any policy that separates children from their parents at the United States border,” APA President Altha Stewart, M.D., said in a statement released on Wednesday. “Children depend on their parents for safety and support. Any forced separation is highly stressful for children and can cause lifelong trauma, as well as an increased risk of other mental illnesses, such as depression, anxiety, and posttraumatic stress disorder.”

Separations are rising under the Trump administration because of a “zero tolerance” policy issued by Attorney General Jeff Sessions in April. That policy directs all U.S. Attorney’s Offices along the Southwest border to prosecute all attempted illegal entry offenses to the extent possible. Earlier this month, Sessions focused on migrant families traveling with minor children. He said such cases will now be referred to the Justice Department for federal prosecution, with the goal of prosecuting 100% of the cases. This means parents are sent to federal detention facilities or jails, where children are not permitted. Instead, the children are placed in shelters, many of whom do not know where their parents are or when they will see them again.

“The evidence is clear that this level of trauma also results in serious medical and health consequences for these children and their caregivers,” Stewart said. “Many families crossing the United States border are fleeing war and violence in their home countries and are already coping with the effects of stress and trauma. These children deserve our protection and should remain with their families as they seek asylum.”

Wednesday, May 30, 2018

Comorbid Medical Conditions May Point to Patients Most Likely to Develop Treatment-Resistant Depression

It is well known that some patients with depression will fail to respond to medications, but clinicians currently have few ways to predict those most likely to develop treatment-resistant depression (TRD). If clinicians could predict whether patients who are diagnosed with depression for the first time would develop TRD, they could monitor these patients more closely and adjust treatment more quickly.

A retrospective cohort study published in Depression and Anxiety found that more than 10% of adults newly diagnosed and treated for depression developed TRD within a year. Those who developed TRD tended to be younger and more commonly present with fatigue, substance use disorders, anxiety, psychiatric conditions, insomnia, and pain than subjects with no TRD.

“When a health care provider sees a patient who is being diagnosed with depression for the first time, the presence of these characteristics could alert her/him to the possibility that the patient could develop TRD,” M. Soledad Cepeda, M.D., Ph.D., of Janssen Research & Development and colleagues wrote.

Cepeda and colleagues analyzed data contained in two U.S. health claims databases, focusing on adults who had received pharmacotherapy for depression between 2000 and 2016. To be included in the analysis, patients were required to (1) have filled a prescription for an antidepressant for the first time as indicated in the database, (2) appear in the database for at least a year before the index date (the date the first antidepressant prescription was filled), (3) have been diagnosed for depression for the first time within 60 days of the index date, and (4) be 18 years or older at the index date. The outcome of interest was a diagnosis of TRD (defined by authors as dispensing for one antidepressant and one antipsychotic or at least three distinct antidepressants) within a year after the index date.

Of 230,801 patients included in the analysis, 10.4% developed TRD within one year. Patients who developed TRD were found to be younger at baseline (10.87% were between 18 and 19 years old versus 7.64% in the no‐TRD group, risk ratio [RR] = 1.42). Adults with TRD were also more likely to have an anxiety disorder (RR=1.38) and fatigue (RR=3.68) at baseline than those who did not have TRD.

“In addition to those factors predicting TRD, we found that the TRD group had more eating and attention-deficit disorders at baseline than the no-TRD group,” the authors reported. “We also found that compared to the no-TRD group, subjects who developed TRD had more pain diagnoses and insomnia at baseline or within 1 year before the diagnosis and treatment of depression.”

For related information, see the Psychiatric News article “Blood May Hold Secret to Biomarkers for Depression.”

(Image: iStock/AJ_Watt)

Tuesday, May 29, 2018

Financial Incentives More Likely to Get People to Quit Smoking

Financial incentives are a more effective way to get employees to quit smoking than offering free deterrents such as nicotine patches or e-cigarettes, according to a study in the New England Journal of Medicine. The trial also provided large-scale, randomized evidence that the offer of free e-cigarettes does not result in higher rates of sustained abstinence than traditional smoking-cessation aids.

The findings “suggest that employers could make their wellness programs more effective by offering money to get their employees to stop smoking instead of or in addition to cessation aids,” Scott D. Halpern, M.D., Ph.D., of the University of Pennsylvania Perelman School of Medicine, told Psychiatric News. Additionally, “they suggest that e-cigarettes may not be an effective component of a global anti-smoking campaign and may even derail this effort.”

Halpern and colleagues assigned more than 6,000 workers from 54 U.S. companies and their spouses who were current smokers to one of four smoking-cessation interventions or to usual care only. Usual care consisted of access to information regarding the benefits of smoking cessation and a motivational text-messaging service. The four interventions consisted of usual care plus one of the following free cessation aids: nicotine-replacement therapy or pharmacotherapy (with e-cigarettes if standard therapies failed), free e-cigarettes (without a requirement that standard therapies fail), free cessation aids plus $600 in earned rewards for sustained abstinence, or free cessation aids plus $600 deposited in an account, with money removed from the account if cessation milestones were not met.

After six months, sustained abstinence rates were 0.1% in the usual-care group, 0.5% in the free cessation-aids group, 1.0% in the free e-cigarettes group, 2.0% in the rewards group, and 2.9% in the redeemable-deposit group. Three between-group comparisons met the criteria for statistical significance with respect to sustained abstinence: redeemable deposits were superior to free cessation aids, rewards were superior to free cessations aids, and redeemable deposits were superior to free e-cigarettes. The sustained abstinence rates in the free e-cigarettes group, free cessation-aids group, and usual-care group did not differ significantly.

“Whether you look at all smokers or only those who are motivated to quit,” said Halpern, “paying people to stop smoking is the most effective and most cost-effective thing that employers or insurers could do to promote cessation. People who are thinking of using e-cigarettes, and FDA officials who are thinking of regulating e-cigarettes, should know that the best evidence we have suggests that e-cigarettes don’t help people quit.”

For related information, see the Psychiatric News article “National Academies Report Details Health Impact of E-Cigarettes.”

(Image: iStock/Kim_white)

Join Twitter Town Hall on ‘No Tobacco Day’

The U.S. Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention hopes to shed light on the benefits of quitting tobacco use with a Twitter Town Hall. Join the conversation on Thursday, May 31, at 1 p.m. ET to mark WHO’s “No Tobacco Day.” Use the hashtag #WNTD and follow the VA at @DeptVetAffairs and APA at @APAPsychiatric.

Friday, May 25, 2018

Women Who Receive Abortion No More Likely to Have Suicidal Thoughts Than Those Denied Abortions

A study published Thursday in AJP in Advance found that having an abortion does not place women at higher risk of experiencing suicidal thoughts than being denied an abortion. In fact, the rates of suicidal ideation were low across groups, when compared with other studies of pregnant and postpartum women.

“The study adds to the growing body of evidence that having an abortion does not lead to negative mental health outcomes,” study co-author M. Antonia Biggs, Ph.D., of the University of California, San Francisco, told Psychiatric News. “Therefore, policies requiring that women be warned that they are at increased risk of becoming suicidal if they choose abortion are not evidence based.”

Biggs and colleagues assessed the effects of having an abortion or being denied an abortion on women’s experiences of suicidal ideation over five years, using data from the University of California, San Francisco’s Turnaway Study. This longitudinal study was designed to look at the effects of receiving an abortion compared with being denied an abortion on women’s socioeconomic, mental health, and emotional well-being.

The researchers examined data from nearly 1,000 women recruited from 30 U.S. abortion facilities. Women were interviewed by telephone one week after their abortion visit, then every six months for five years. Women completed the suicidal ideation items on the Brief Symptom Interview (BSI) and the Patient Health Questionnaire (PHQ-9). Women who received abortions within two weeks of a facility’s gestational age limit (average 20 weeks pregnant) were compared with women who were denied an abortion because the length of their pregnancy exceeded the facility’s gestational age limit (average 23 weeks pregnant) and carried their pregnancies to term. For further comparison, the study also included a group who obtained a first-trimester abortion (average eight weeks pregnant).

One week after seeking an abortion, 1.9% of the near-limit group and 1.3% of those turnaway-birth group reported suicidal ideation symptoms on the BSI. Over the five-year study, the proportion of women with suicidal ideation symptoms on the BSI declined significantly to 0.25% for women in the near-limit group and nonsignificantly to 0.21% for those who were denied an abortion and later gave birth, wrote the authors.

“By following women for five years, we are able to assess whether abortion is followed by an increase in suicidal ideation and whether the suicidal ideation trajectories of women who obtained an abortion differ from those of women denied an abortion. For women having an abortion, we found that the proportion with any symptoms did not increase but rather decreased over the five-year period,” Biggs and colleagues wrote. “We also found no effect of receiving compared with being denied an abortion on either of our two suicidal ideation measures at any time point, dispelling the notion that abortion increases women’s risk for suicidal ideation over time.”

For related information, see the Psychiatric News article “Five-Year Study Suggests Abortion Does Not Lead to MH Problems.”

(Image: iStock/stock-eye)

Thursday, May 24, 2018

APA President Goes to Hill to Urge Provision of MH Services to Incarcerated Individuals

More than 2 million times every year, individuals with serious mental illness are arrested. Moreover, more than half a million people with serious mental illness are incarcerated at any given time. In fact, 44% of jail inmates and 37% of state and federal prisoners have a history of a mental illness.

“Those numbers are staggering no matter how you look at them,” said APA President Altha Stewart, M.D., at congressional briefing titled “Innovations and Challenges in Providing Mental Health Services to People in Prison and Those Reentering the Community.” APA was one of the sponsors of the briefing.

Driving the crisis are the higher rates of arrest of people with mental illness for petty crimes directly related to their disorder, such as public nuisance, public urination, drunkenness, or behavior perceived by others as dangerous, said Stewart, who is also a professor of psychiatry and director of the Center for Health in Justice-Involved Youth at the University of Tennessee Health Science Center. Longer stays for people with mental illness, coupled with low utilization of evidence-based treatments during incarceration, compounds the problem.

Psychiatrists are the most highly trained, highly skilled physicians to manage the treatment of incarcerated individuals with serious mental disorders, yet are underrepresented in correctional settings, with typically just one provider for every 150 inmates, Stewart said. The costs, too, are staggering: total expenditures on prisons is nearly $43 billion and states are spending $33,000 per inmate per year.

To help prevent recidivism and encourage successful reentry into the community, Stewart urged support for HR 4005, a bipartisan bill introduced by Rep. Paul Tonko (D-N.Y.) to permit the use of federal Medicaid funds for health care services for incarcerated individuals during the 30-day period preceding their release. Currently, under Title XIX of the Social Security Act, federal Medicaid funds are prohibited to be spent on people who are incarcerated. Securing an individual’s Medicaid coverage prior to their release would give individuals “a leg up and reduce their risk of relapse of mental health conditions or overdose while also lowering their risk of recidivism back into the criminal justice system,” Stewart said.

Robert Morgan, Ph.D., chair of the Department of Psychological Sciences at Texas State University, said that by treating inmates for mental illness only, prison systems are missing half the equation for helping these individuals. Instead, research has zeroed in on several central “criminogenic risk factors” that increase people’s risk for becoming enmeshed in the criminal justice system, regardless of whether they are mentally ill. These factors include antisocial behavior and personality traits, antisocial associations, criminal thinking and associates, family problems, marital problems, and poor work or school performance. 

“We need to target the issues that are putting these people at risk for future contact with the criminal justice system,” Morgan said. Services aimed at reducing the criminogenic factors are no more expensive than traditional programs, yet result in a 30% to 50% reduction of recidivism, depending on the type of service provided. For instance, one such program in a probation office in Texas was associated with a reduction in participants’ re-arrests by 50% at the two-year mark, he said.

For information on a program to help people readjust to community life after incarceration, see the Psychiatric News article “APA Foundation Gives ‘Helping Hand’ to Former Inmates.”

(Image: David Hathcox)

Wednesday, May 23, 2018

Extending Weekend Sleep May Reduce Risk of Death in Some Adults Under 65

Adults under the age of 65 who regularly sleep five or less hours on weeknights but more hours on weekend nights appear to have a lower risk of death than those who sleep five or less hours a night on weekends, according to a study in the Journal of Sleep Research.

“The results imply that short (weekday) sleep is not a risk factor for mortality if it is combined with a medium or long weekend sleep,” Torbjörn Åkerstedt, Ph.D., of the Karolinska Institutet in Stockholm and colleagues wrote. “This suggests that short weekday sleep may be compensated for during the weekend, and that this has implications for mortality.”

To examine the association of both weekday and weekend sleep duration on overall mortality, Åkerstedt and colleagues tracked mortality in a cohort of 38,015 Swedish adults aged 18 and over from October 1997 through the end of 2010. At the start of the study, each participant was asked to assess both the number of hours he or she regularly slept on a workday night and a weekend night. The researchers relied on the Swedish National Register of Death to obtain information on date of death and the underlying causes of death in participants from the cohort study.

Of the 38,015 people included in the analysis, 3,234 deaths occurred during study. Statistical analysis revealed that among individuals under age 65, short weekend sleep was associated with a significant 52% higher mortality rate compared with those who slept seven hours on the weekend, while no association was found for long (nine or more hours) weekend sleep. Additional analysis revealed that consistently sleeping five or less hours on both weekdays and weekends was associated with a 65% higher mortality rate compared with consistently sleeping six or seven hours a night, and consistently sleeping eight or more hours was associated with a 25% higher mortality rate. The associations between weekend sleep or weekday/weekend sleep durations and mortality were not observed among individuals aged 65 and older.

“In conclusion, our findings indicate that mortality is increased when both weekday and weekend sleep is short or when both are long in subjects below the age of 65 years. However, when weekend sleep is extended after short weekday sleep, no association with mortality is seen,” the authors wrote. “We suggest that this may reflect positive effects of compensatory sleep. However, this issue needs to be addressed in longitudinal studies of changes in sleep duration and their link to mortality.”

For related information on this topic, see the APA Publishing book Sleep Disorders and Psychiatry, edited by Daniel J. Buysse, M.D.

(Image: iStock/andresr)

Tuesday, May 22, 2018

Social Communication Impairments in Childhood Sometimes Linked to Later Suicidal Behavior

Children who have difficulty communicating in social situations—a trait common in children with autism spectrum disorder (ASD)—may be at higher risk for suicidal ideation and behavior in late adolescence compared with those without these problems, according to a report in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Suicidal behavior in individuals with autism is often underreported, particularly in those with impaired communicative abilities and comorbid self-injurious behavior,” Iryna Culpin, Ph.D., of the University of Bristol and colleagues wrote. “Our findings emphasize the potential importance of assessing whether self-injurious behavior occurs in the context of suicidal ideation.”

For the study, the authors analyzed data on a subset of children who were participants in the Avon Longitudinal Study of Parents and Children, a large birth cohort study in the United Kingdom. The starting sample included children who had received a diagnosis of ASD or showed signs of difficulties in at least one of four ASD traits—social communication, pragmatic language, repetitive behavior, and sociability—measured by parent report on validated instruments. Culpin and colleagues also examined how these youth responded to questions about self-harm and suicidal thoughts or plans at age 16. Complete outcome data on suicidal behavior and ideation at age 16 years were available for 5,031 adolescents.

Culpin and colleagues found a statistically significant association between impaired social communication and self-harm with suicidal intent, suicidal thoughts, and suicidal plans. There was no association between an ASD diagnosis, per se, and suicidal behavior.

Additional statistical analysis revealed that “children with impaired social communication skills were at increased risk for depressive symptoms in early adolescence, which, in turn, was a strong risk factor for suicidal behavior later in adolescence,” they wrote. While “depression explained about a third of the variance of the association between childhood autistic traits and suicidal behavior, substantial variance remained unexplained,” they added.

“These results are important in identifying difficulty with social communication as a potential risk factor for suicidality in the context of depressive symptoms,” wrote Jeremy Veenstra-VanderWeele, M.D. (pictured above), director of the division of child and adolescent psychiatry at Columbia University, in an accompanying editorial. “As a clinician who works with the ASD population, I am dismayed but not surprised to see data support our experience with youth who are suffering and considering suicide at elevated rates compared to their peers. …This is an urgent and obvious area for further research to try to prevent what we now recognize.”

For related information, see the Psychiatric News article “Basis of Inability to Regulate Emotions in Autism Identified.”

Monday, May 21, 2018

Depression in Men May Impact Pregnancy Chances in Couples Seeking Treatment for Infertility

Among couples being treated for infertility, depression in the male partner was linked to lower pregnancy chances, according to a study in Fertility and Sterility. In contrast, depression in the female partner was not found to influence the rate of pregnancy or live birth.

Depression rates are known to be high among couples seeking fertility treatments, with previous research finding 41% of women and nearly 50% of men in such couples show signs of depression, wrote Emily A. Evans-Hoeker, M.D., of Virginia Tech Carilion, and colleagues.

To investigate the role of depression on pregnancy outcomes in couples seeking non-IVF treatments, the researchers combined data from two multi-site, randomized, controlled clinical trials, including 1,650 women and 1,608 men. Only couples not undergoing in-vitro fertilization (IVF) were included, and only the women in the studies were asked about antidepressant use. In both studies, the men and women took the Patient Health Questionnaire (PHQ-9) to screen for depression. A PHQ-9 score ≥10 was used to define currently active major depression.

Among those studied, 5.96% of the women and 2.28% of the men were rated as having currently active major depression. Couples in which the male partner had major depression were 60% less likely to conceive and have a live birth than those in which the male partner did not have major depression.

Additional analysis revealed that antidepressant use in women undergoing non-IVF fertility treatments did not increase pregnancy rates. However, women using non-SSRI antidepressants (n=6) were about 3.5 times more likely to have a first trimester pregnancy loss, compared with those not using antidepressants—a difference not seen in women who took SSRIs only.

“Our study provides infertility patients and their physicians with new information to consider when making treatment decisions,” study co-author Esther Eisenberg, M.D., of the Fertility and Infertility Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development said in a press release.

(Image: iStock/PeopleImages)

Friday, May 18, 2018

Coordinated Specialty Care Program in NY Shows Promise in Early Treatment of Psychosis

Patients with recent-onset psychosis who participated in a coordinated specialty care program in New York state experienced significant improvements in health, function, and education/employment within months, according to a report published this week in Psychiatric Services in Advance. The findings add to the growing body of evidence that early intervention programs can reduce symptoms and improve quality of life for patients recently diagnosed with psychosis.

Ilana Nossel, M.D., of Columbia University Medical Center and NYS Psychiatric Institute and colleagues tracked the progress of 325 patients aged 16 to 30 who had experienced nonaffective psychosis for less than two years and participated in OnTrackNY, a statewide program that connects patients with a multidisciplinary care team. OnTrackNY provides coordinated specialty care, including evidence-based psychosocial interventions and medication. At the beginning of the program and follow-up every three months, clinicians evaluated the patients using Global Assessment of Functioning (GAF) symptom, occupational, and social functioning scales; education and employment status; and psychiatric hospitalization rate.

Nossel and colleagues compared data from admission and months 3, 6, 9, and 12 following enrollment, although the length of the follow-up periods varied by participant, depending on the date of enrollment. After three months in the program, the patients’ hospitalization rates decreased from 70% to 10%. After six months in the program, the patients’ education and employment rates increased from 40% to 80%; GAF scores continued to improve for the duration of the study.

“[This study] helps to further solidify CSC [coordinated specialty care] as a standard of care for young people with the recent onset of a psychotic illness,” Nossel told Psychiatric News. “Often young people with psychosis or schizophrenia may be hesitant to engage in treatment or may not believe they have an illness. The CSC approach is to meet people where they are, use a shared decision-making approach, and help people achieve the goals that are important to them.”

For related information, see the Psychiatric News article “Participation in Early Psychosis Program May Reduce Risk of Death.”

(Image: Alexander Raths/Shutterstock)

Thursday, May 17, 2018

First Non-Opioid Medication Approved to Reduce Opioid Withdrawal Symptoms in Adults

The Food and Drug Administration (FDA) on Wednesday announced the approval of Lucemyra (lofexidine hydrochloride) for the treatment of symptoms associated with opioid withdrawal in adults 18 and older. These can include anxiety, agitation, drug craving, muscle aches, sleep problems, stomach cramps, and more. Lucemyra—an oral, selective alpha 2-adrenergic receptor agonist—is approved for treatment up to 14 days.

This medication “provides a new option that allows providers to work with patients to select the treatment best suited to an individual’s needs,” said Sharon Hertz, M.D., director of the Division of Anesthesia, Analgesia, and Addiction Products in the FDA’s Center for Drug Evaluation and Research, in a statement.

The decision to approve Lucemyra was based in part on the results of two randomized, double-blind, placebo-controlled clinical trials of 866 adults who met DSM-IV criteria for opioid dependence and were physically dependent on opioids and undergoing abrupt opioid discontinuation. Participants assigned to Lucemyra and placebo were asked to rate the severity of opioid withdrawal symptoms using the Short Opiate Withdrawal Scale of Gossop (SOWS-Gossop) using one of four response options (none, mild, moderate, and severe), with the SOWS-Gossop total score ranging from 0 to 30 (higher score indicates a greater severity of withdrawal symptoms).

According to the FDA, SOWS-Gossop scores were lower for patients treated with Lucemyra compared with placebo, and more patients completed the studies’ treatment period in the Lucemyra group compared with the placebo group. The most common side effects reported by study participants on Lucemyra included low blood pressure, slow heart rate, sleepiness, sedation, and dizziness. Lucemyra was also associated with a few cases of fainting. When Lucemyra is stopped, patients may experience a marked increase in blood pressure, the agency cautioned.

The long-term effects of Lucemyra will be among several factors evaluated in ongoing postmarketing studies. “Clinical studies will be required to evaluate the safety of Lucemyra in clinical situations where use could be expected to exceed the maximum 14-day treatment period for which the product is currently approved, such as gradual opioid taper; to gather additional safety data on the effects of lofexidine on the liver; and to further characterize the effects on blood pressure after lofexidine is stopped,” the agency stated.

According to a press release by US WorldMeds, the manufacturer of Lucemyra, the medication is usually administered in three 0.18 mg tablets taken orally four times daily at five- to six-hour intervals during the period of peak withdrawal symptoms (generally five to seven days following last use of opioids). Lucemyra should be discontinued with gradual dose reduction over two to four days.

Lucemyra is expected to be commercially available in the United States in August 2018, according to US WorldMeds.

Wednesday, May 16, 2018

Visits for Suicide Ideation, Attempts More Than Doubled at U.S. Children’s Hospitals Since 2008

Surveillance studies have reported that the number of suicide ideation and suicide attempts have been increasing among children in the United States over the last decade. A study published in Pediatrics now shows that from 2008 to 2015 emergency department (ED) visits and hospitalizations for suicide ideation/attempts more than doubled at U.S. children’s hospitals and accounted for an increasing percentage of all children’s hospital encounters.

“Our findings that ED and inpatient children’s hospital encounters for SI [suicide ideation] or SA [suicide attempts] have increased over the past decade underscore the increasing impact of mental health disorders in youth on children’s hospital services,” wrote Gregory Plemmons, M.D., of Monroe Carell Jr. Children’s Hospital at Vanderbilt and colleagues. “Recognition of this increasing burden on children’s hospitals is paramount in helping to inform future strategies for suicide prevention and treatment and to ensure that interventions to reverse this concerning trend continue to reach the individuals at highest risk.”

Plemmons and colleagues used the Pediatric Health Information System database—which contains clinical and billing data from 49 children’s hospitals in the United States—to collect information on ED visits and hospitalizations for suicide ideation/attempts by children and adolescents aged 5 to 17 between 2008 and 2015.

During the study period, the investigators identified 115,856 encounters for suicide ideation and suicide attempts at 31 hospitals (the other 18 had incomplete data during the study timeframe and were excluded), representing 1.21% of total hospital encounters. Half of the patients were aged 15 to 17, 37% were aged 12 to 14, and 13% were aged 5 to 11; 64% of the patients were girls.

The yearly rate of hospital visits for suicide ideation/attempts more than doubled over the study period, increasing from 0.66% of all visits in 2008 to 1.82% of all visits in 2015. The researchers also observed seasonal trends in visits for suicide ideation/attempts throughout the study period, with the lowest percentage of visits occurring during summer months (June to August) and the highest percentage occurring during spring and fall—during the academic year.

“[O]ur findings … underscore the need for future work to explore the relationship between school and suicidal ideation, recognizing that the role of academics is a complex one, and there may also be other additional influences at play regarding seasonality,” Plemmons and colleagues wrote.

To read more on this topic, see the Psychiatric News article “Impulsivity May Be Strong Contributor to Childhood Suicides” and the Psychiatric Services article “Utilization Patterns at a Specialized Children's Comprehensive Psychiatric Emergency Program.”

(Image: izusek/

Tuesday, May 15, 2018

Resistance Exercise Training May Reduce Symptoms of Depression

Resistance exercise training appears to significantly reduce depressive symptoms among adults regardless of health status, the time spent exercising, or whether the training resulted in significant improvements in strength, according to a meta-analysis in JAMA Psychiatry. The best results were found among those with mild to moderate depression scores—as opposed to no depression—suggesting that resistance training should be considered as an adjuct treatment for depression. 

Brett R. Gordon, M.Sc., of the University of Limerick, Ireland, and colleagues performed a literature search for clinical trials in which individuals were randomly assigned to either a resistance exercise training intervention or a nonactive control condition and which included a validated self-report or clinician-rated measure of depressive symptoms assessed at baseline and at mid-intervention and/or post-intervention.

They identified 33 randomized, controlled trials (RCTs), including 1,877 participants (947 in the resistance exercise training group; 930 in the control group). The mean prescribed resistance exercise training program duration was 16 weeks. The frequency of resistance exercise training sessions ranged from two to seven days a week; the most common frequency was three days a week.

The meta-analysis revealed that resistance exercise training was associated with a significant reduction in depressive symptoms regardless of the age, sex, and health status of the participants or the features of the exercise program (including session duration, intensity, or frequency). Resistance exercise training appeared to have a greater effect on people with mild to moderate depression compared with those who did not have depression.

“The larger percentage reduction found from RCTs of participants with elevated depressive symptoms, coupled with the significant difference based on initial severity of depressive symptoms, suggests that RET [resistance exercise training] may be particularly helpful for reducing depressive symptoms in people with greater depressive symptoms,” Gordon and colleagues wrote.

Although the authors acknowledged several limitations of the meta-analysis and emphasized the need for studies comparing resistance exercise training with other therapies for depression, they noted, “The available empirical evidence supports RET as an alternative or adjuvant therapy for depressive symptoms.”

For related information, see the Psychiatric News article “Minimal Exercise May Help Prevent Future Depression.”

(Image: shapecharge/

Monday, May 14, 2018

Reducing Job Strain May Reduce Mental Health Risks in Midlife

Exposure to high job strain—a combination of high job demands (such as work pace and intensity) and low job control (such as one’s ability to make work-related decisions)—in midlife may increase the risk of mental health problems, according to a study in Lancet Psychiatry.

While previous studies have suggested an association between job strain and mental illness, this study provides some of the first evidence of causality on the part of the workplace.

For the study, Samuel Harvey, Ph.D., of the University of New South Wales in Sydney, Australia, analyzed data from the National Child Development Study—a large United Kingdom study that periodically surveyed over 17,000 people born between March 3, 1958, and March 9, 1958, over a 50-year period—to investigate the prospective association between job strain variables at age 45 and risk of common mental health disorders (depression and/or anxiety) at age 50.

The analysis focused on 6,870 participants who completed their surveys at age 45 and had a full- or part-time job, had not recently switched jobs, and had no depressive symptoms in the past 30 days. In this group, 2,212 individuals reported low job control, 1,737 reported high job demands, and 1,768 reported high job strain (having elevated scores in both job control and job demand).

At the 50 year survey, 10% of all participants reported new symptoms of depression and/or anxiety (measured with the psychological subscale of the Malaise Inventory). After adjusting for numerous potential contributing factors, including prior psychiatric history, Harvey and colleagues found that workers with high job demands had 1.70 times the odds of developing symptoms of depression and/or anxiety at age 50; workers with low job control had 1.89 times the odds; and workers with high job strain had 2.22 times the odds.

Further analysis suggested that if workplaces could have identified and reduced all 1,768 cases of job strain, the emergence of new mental disorders would have been reduced by 14%.

The study highlights “the potential public health effect of addressing job strain factors in the workplace,” the authors concluded. “Previous research on interventions aimed at increasing employee control or improving job design has shown some promise in the promotion of mental health and reduction of stress in the workplace.”

To read more about this topic, see the Psychiatric News article “Rebirth of APAF’s Center for Workplace Mental Health,” by APA Past President Anita Everett, M.D.


Friday, May 11, 2018

Third-Line Electroconvulsive Therapy May Be Best for Patients With Treatment-Resistant Depression

Clinicians may want to consider electroconvulsive therapy (ECT) for patients with major depressive disorder who have failed to respond to two trials of pharmacotherapy and/or psychotherapy, according to the authors of a study published this week in JAMA Psychiatry.

“As clinicians we always worry about patients getting routed through treatment after treatment, at which point they become more treatment resistant,” senior author Daniel Maixner, M.D., who directs the ECT program at Michigan Medicine, told Psychiatric News. Decades of research have shown that ECT is the most effective way of achieving remission in patients with treatment-resistant depression (TRD), he noted. The findings of this study suggest ECT is also cost-effective earlier in the treatment course of depression.

Relying on data from published depression studies, including the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial, Maixner, Eric Ross, M.D., and Kara Zivin, Ph.D., of the University of Michigan Department of Psychiatry used a mathematical model to simulate cost and quality-of-life outcomes for patients with TRD who are exposed to different treatments.

The model projected that over four years, ECT would reduce time with uncontrolled depression from 50% of life-years to between 32% and 37% of life-years, with greater improvements the earlier ECT is offered. The model also predicted that offering ECT as a third-line treatment for depression would cost an estimated $54,000 per quality-adjusted life-year gained, well below the commonly accepted cost-effectiveness threshold of $100,000 per quality-of-life year, according to the authors.

Ross noted that cost-effectiveness does not mean cost saving. “When we say ECT is cost-effective, we are not saying that it’s going to save money, but we are saying that the money that is spent on ECT will get a very good return in terms of its improvement in health.”

The authors acknowledged that many clinicians may find ECT as a third-line treatment to be “overly aggressive,” as ECT is often considered a “last-resort treatment for depression.” They wrote, “To understand how third-line ECT can be reasonable and cost-effective, it is crucial to recognize how challenging treatment-resistant depression is to manage.”

Charles Kellner, M.D., chief of Electroconvulsive Therapy at New York Community Hospital in Brooklyn, N.Y., who was not involved with the study, spoke enthusiastically of the findings. “I think this is a landmark study,” he told Psychiatric News. “The importance of the article is that it finally provides data for a rationale to use ECT earlier rather than at the very end of other treatment options. It is what the field has needed to put ECT in the correct context.”

For related information, see the Psychiatric News article “ECT Can Be Considered Earlier for Severe Depression, Expert Says.”


Thursday, May 10, 2018

Disputes on Your Sunshine Act 2017 Payments Must Be Resolved by May 15

Physicians have less than one week to review and, if necessary, dispute data on 2017 payments or other transfers of value from manufacturers of drugs, medical devices, and biologicals that were reported to the Centers for Medicare and Medicaid Services (CMS) as part of the Open Payments program. All disputes must be resolved directly with manufacturers by Tuesday, May 15.

CMS will release this information to the public beginning June 30. After the review period closes on May 15, physicians can still initiate disputes, but updated data will not be displayed until the next reporting cycle.

The collection and reporting of these data are required under the Physician Payment Sunshine Act, which is part of the Affordable Care Act. The Sunshine Act requires manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals. CMS is required to report this information annually.

The review process is voluntary, but registration in both the CMS Enterprise Identity Management System (EIDM) and the Open Payments system is required to review the data and file disputes. If you plan to review your data, test your CMS Enterprise Identity Management (EIDM) system log-in credentials beforehand here. Accounts that have not been accessed recently are locked; if your account has been locked, click here. APA members who have not yet registered on the Open Payments database can review APA’s resources here.

More information about how to review and dispute payment records in the Open Payments database can be found here.

(Image: barbaliss/Shutterstock)

Wednesday, May 9, 2018

Novel Treatments for BPD, Gun Talk, and More From APA’s 2018 Annual Meeting: Day Five

Highlights of day five coverage from APA’s Annual Meeting include novel interventions for treating patients with borderline personality disorder, tips on how to talk with your patients about firearms, and reflections on how identifying neural circuit dysfunction could transform psychiatry.

Look for future coverage of APA’s 2018 Annual Meeting in upcoming issues of Psychiatric News.

Nora Volkow, M.D., Outlines NIDA’s Marijuana, Opioid Research Goals

Among other areas of focus, the National Institute on Drug Abuse (NIDA) is paying close attention to what the decision to legalize marijuana in many states across the country will mean for the long-term health of Americans, particularly adolescents, and remains heavily invested in finding new medications for pain that are effective but not addictive. Read More >

Alan Schatzberg, M.D., Honored for Research Connecting Cortisol and Psychotic Depression

During the 2018 Judd Marmor Award lecture, Schatzberg described decades of research that has advanced understandings of psychotic depression. Read More >

Researchers Describe Novel Interventions for Borderline Personality Disorder

Psychoeducation, family support, and ketamine augmentation may be able to help patients with borderline personality disorder. Read More >

Grown-Up Researchers Look Closely at Young Minds in Major New Study

Adolescence is known as a time of vulnerability for the start of mental disorders and substance use, but not enough is known about normal brain development. To fill that gap, a collaborative federal program is starting to take a comprehensive look at young Americans.
Read More >

Talking About Firearms With Patients Necessary, But Examine Your Gun Beliefs First

It is possible—and necessary—to hold a conversation with patients that enables them to move incrementally to safer gun storage practices drawing on the principles of motivational interviewing. Read More >

Researcher Investigates Brain Neurocircuits to Better Understand Mental Illness

Psychiatrist Amit Etkin, M.D., Ph.D., sees a gathering wave that will transform how mental illness is perceived, identified, treated, and monitored in the coming years.
Read More >

Tuesday, May 8, 2018

First Chester M. Pierce Human Rights Award, Antipsychotic Use and Gestational Diabetes Risk, and More From APA’s 2018 Annual Meeting: Day Four

Highlights of day four coverage from APA’s Annual Meeting include the presentation of the first Chester M. Pierce Human Rights Award, a study that suggests a link between antipsychotic use during pregnancy and gestational diabetes, and a fellow’s efforts to help Haitians and other foreign nationals in the United States residing under Temporary Protected Status.

Through tomorrow, Psychiatric News is delivering an evening digest of some of the day’s highlights. Whether you are here in New York or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

APA Presents First Chester M. Pierce Human Rights Award to Global MH Rights NGO

APA’s 2018 Chester M. Pierce Human Rights Award was presented to Janos Fiala-Butora, the executive director of the Validity Foundation at APA’s Annual Meeting on Monday. Validity works by filing lawsuits on behalf of individuals with mental illness and mental disabilities in Europe and Africa with the goal of setting legal precedents that will help all persons with mental disabilities attain inclusion, education, and equality. Read More >

Assembly Announces 2018 Election Results

At its meeting held in conjunction with APA’s 2018 Annual Meeting in New York, members of the APA Assembly chose Paul O’Leary, M.D. (right), of Birmingham, Ala., as the group’s next speaker-elect. He is currently the Assembly’s recorder. Seeth Vivek, M.D., of Queens, N.Y., was elected recorder. Vivek is the Area 2 representative. The new officers will begin their terms at the close of the Annual Meeting, at which time James (Bob) R. Batterson, M.D., will become the speaker of the Assembly.

Computational Psychiatry Might Be a Game Changer, says NIMH Director

Most clinicians might think of data mining when the term computational psychiatry comes up, but there are other applications facilitated by computers that researchers may be able to use to better understand the complexity of the brain. Read More >

Continuing Olanzapine, Quetiapine During Pregnancy Appears to Raise Risk of Gestational Diabetes

Women who continue use of the antipsychotic drugs olanzapine and quetiapine during pregnancy have an increased risk of gestational diabetes, according to a study in AJP in Advance that was released at APA’s Annual Meeting. Read More >

Columbia Fellow From Haiti Leads Effort to Help Haitians and Others Losing ‘Protected Status’

Jennifer Severe, M.D., a public psychiatry fellow at Columbia University, is leading an effort by a small group of physicians to rally support for Haitians and other foreign nationals in the United States residing under Temporary Protected Status. Part of that effort involved reaching out to attendees at APA’s 2018 Annual Meeting by sponsoring a booth in the Exhibit Hall. Read More >

Switzerland Halts War on Drugs, Cuts Opioid Deaths by Offering Range of Treatments for Heroin Users

Switzerland has found an unorthodox method—at least by U.S. standards—of solving its opioid crisis: decriminalizing substance use; offering 24-hour-a-day access to methadone programs; and for treatment-resistant cases, offering pharmaceutical-grade heroin in clinics.
Read More >

Winners of Resident/Medical Student Poster Competition Announced

The Resident/Medical Student Poster Competition is an APA Annual Meeting tradition that allows residents and medical students to attend the meeting, present their research, and be recognized for quality work.
Read More >

Monday, May 7, 2018

Americans’ Anxiety on Rise, Postpartum Depression Findings, and More From APA’s 2018 Annual Meeting: Day Three

Day three of APA’s Annual Meeting included an address by the first assistant secretary for mental health and substance use in HHS; the release of a study in the American Journal of Psychiatry, which found a family history of psychiatric disorders increases the risk of postpartum depression; and the results of an APA poll, which found Americans are concerned about gun violence and the opioid crisis.

From now through May 9, Psychiatric News will deliver an evening digest of some of the day’s highlights. Whether you are here in New York or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

McCance-Katz Leads Effort to Focus SAMHSA on Serious Mental Illness, Substance Use

The federal government can work to serve patients and physicians, said Elinore McCance-Katz, M.D., Ph.D., at the Convocation of Distinguished Fellows at APA’s 2018 Annual Meeting tonight. Read More >

Familial History of Psychiatric Disorders Key in Predicting Postpartum Risk

A family history of psychiatric disorders, especially bipolar disorder, is an important risk factor among pregnant women for postpartum psychiatric disorder, according to a population-based cohort study published in AJP in Advance and released today at APA’s Annual Meeting. Read More >

APA Poll Finds Americans’ Anxiety Is Increasing, Especially About Health, Safety, and Finances

Anxiety levels are up across all ages and demographic groups, according to a national survey of Americans aged 18 and older released today by APA. The results reflect a striking unity around the issue of gun violence (see story below) and a sadly intimate familiarity with the opioid crisis: nearly a third of people know someone addicted to opioids. Read More >

Most Americans Agree That Gun Violence Is Public Health Problem, Call for Action

Most Americans (87 percent) see gun violence as a public health threat, including 77 percent of Republicans and 96 percent of Democrats, according to the results of a national poll released by APA today. Read More >

2018 Bolivar Award Winner Uses Modern Spectroscopy to Answer Century-Old Questions

Using proton magnetic resonance spectroscopy, Juan Bustillo, M.D., and his group have found that the brains of people with schizophrenia contain more glutamate per volume than controls and that this glutamate concentration increases gradually with age. Read More >

Leaders Know Who They Are, Not Just What They Do, Says Hertling

In his address last night, retired Lt. Gen. Mark Hertling said the skills of leadership—which are taught in the military as a discrete discipline—can be incorporated into medicine. “Leadership is the art of understanding motivations, influencing people, building teams, and communicating purpose in order to accomplish stated goals while improving the profession,” he said.
Read More >

Black Psychiatrists, Patients Share History of Trauma

In accepting the 2018 Solomon Carter Fuller Award, Patricia Newton, M.D., M.A., M.P.H., noted that many of the same challenges that Fuller, recognized as the first African-American psychiatrist, faced a century ago are still present for African-American psychiatrists and patients. Read More >

APA Raises $20,00 for Victim Assistance Project

As part of APA’s annual APA Gives Back program, APA President Anita Everett, M.D., presented a donation of $20,000 to this year’s recipient, Safe Horizon: The Streetwork Project, at the Opening Session of APA’s 2018 Annual Meeting. Safe Horizon has been helping victims of violence and abuse in New York City since 1978. Read More >


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.