Monday, June 14, 2021

Anti-inflammatory Drug May Reduce Heavy Drinking in People With Alcohol Use Disorder

Ibudilast—a drug that suppresses the production of inflammatory molecules in the brain—can significantly reduce heavy drinking in adults with alcohol use disorder (AUD), suggests a small study in Translational Psychiatry.

“A growing body of literature indicates that the neuroimmune system may play a critical role in the development and maintenance of AUD, termed the neuroimmune hypothesis of alcohol addiction,” wrote Erica Grodin, Ph.D., of the University of California, Los Angeles, and colleagues. Both the blood samples and postmortem brain samples of people with AUD have shown elevated biomarkers of inflammation. Other studies have found an association between inflammation and depressed mood, which is also common in people with AUD. “Therefore, a neuroimmune modulator may treat AUD and related negative mood symptoms through similar pathways,” the authors wrote.

The researchers randomly assigned 52 adults aged 21 to 50 with mild to severe AUD (according to the DSM-5 criteria) to receive 50 mg of ibudilast or placebo twice daily over two weeks. The participants were asked to complete daily diary assessments, indicating their past-day alcohol use, alcohol cravings, and mood throughout the trial. The participants also had three in-person visits that included toxicology, blood pressure, and heart rate screenings. At the end of the first week, they also completed an assessment of their reactions to alcohol cues while receiving an MRI scan. The participants in the study were compensated up to $350 for completing the trial.

After two weeks, the researchers found no statistical differences in the number of drinking days or negative mood between the adults taking ibudilast and those taking placebo. However, adults taking ibudilast were 45% less likely to engage in heavy drinking (≥5 drinks/day for men and ≥4 drinks/day for women) during the study compared with adults taking placebo.

The MRI data revealed a potential mechanism of ibudilast’s effects. The participants who took ibudilast had less activity in their ventral striatum in response to alcohol cues compared with those who took placebo.

“[E]xploratory analyses indicated that ventral striatal activation to alcohol cues was predictive of drinking in the week following the neuroimaging scan,” Grodin and colleagues wrote. “These results suggest a biobehavioral mechanism through which ibudilast acts, namely, by reducing the rewarding response to alcohol cues in the brain leading to a reduction in heavy drinking...”

There were no significant differences in the occurrence of gastrointestinal problems or other adverse side effects between the two groups of participants. Grodin and colleagues noted that in addition to showing ibudilast is well tolerated, the side effect data support that the reduction in drinking was not due to the medication making people sick.

To read more on this topic, see the Psychiatric News article “Underage Drinking Declines, But Extreme Binge Drinking Rises.”

(Image: iStock/pedrosala)

Friday, June 11, 2021

Lybalvi Approved for Schizophrenia, Bipolar I Disorder in Adults

The Food and Drug Administration (FDA) has approved Lybalvi (olanzapine and samidorphan) for the treatment of schizophrenia in adults, Alkermes announced. The agency also approved Lybalvi for the treatment of bipolar I disorder in adults, as a monotherapy for maintenance, and as a monotherapy or an adjunct to lithium or valproate for the acute treatment of manic or mixed episodes.

Olanzapine is an antipsychotic, and samidorphan is a new chemical agent and an opioid antagonist. Lybalvi is taken once a day and may be taken with or without food. It will be available in fixed dosage strengths composed of 10 mg of samidorphan and 5 mg, 10 mg, 15 mg, or 20 mg of olanzapine.

The approval is based on data from the ENLIGHTEN clinical development program. In ENLIGHTEN-1, 403 patients who were experiencing an acute exacerbation of schizophrenia took either Lybalvi or placebo for four weeks. At the end of the study, those who had taken Lybalvi had statistically significant reductions from baseline in Positive and Negative Syndrome Scale scores compared with those who took placebo.

ENLIGHTEN-2 evaluated the weight-gain profile of Lybalvi compared with olanzapine over six months in 561 patients with stable schizophrenia. Patients who took Lybalvi had a lower mean percent weight gain at six months compared with those in the olanzapine group and a lower proportion of patients who gained 10%or more of their baseline body weight at six months. The difference in weight gain between the two groups became apparent after the fourth week of the trial, and their rates of weight gain continued to diverge for the remainder of the study. At the sixth week, weight stabilized in the Lybalvi group and remained flat for the rest of the study period.

Lybalvi has a boxed warning about increased mortality in older patients who have dementia-related psychosis. The warning also states that the medication is not approved for the treatment of patients with dementia-related psychosis.

Lybalvi should not be taken by patients who are taking opioids or who are experiencing acute opioid withdrawal. Prior to initiating Lybalvi, there should be at least a seven-day opioid-free interval from the last use of short-acting opioids and at least a 14-day opioid-free interval from the last use of long-acting opioids.

Potential side effects of Lybalvi include dry mouth, sleepiness, dizziness, increased appetite, and constipation.

For related information, see the American Journal of Psychiatry article “How Much of an Advance is the Addition of Samidorphan to Olanzapine?


Thursday, June 10, 2021

N.Y. State Program for First-Episode Psychosis Reduces Hospitalization, ER Use

Medicaid patients in New York state with a first episode of psychosis visited the emergency room and hospital significantly less after enrollment in the coordinated specialty care program OnTrackNY than prior to enrollment, according to a report in Psychiatric Services in Advance.

OnTrackNY is New York state’s early intervention program for individuals aged 16 to 30 who have experienced nonaffective psychosis for less than two years. With 23 sites throughout the state, OnTrackNY offers psychotherapy, medication management, family education and support, case management, and work and education support, depending on each individual’s needs and preferences. The Center for Practice Innovations at Columbia University, New York State Psychiatric Institute, and the New York State Office of Mental Health are partners in OnTrackNY.

“Notably, hospitalization rates have been shown to decrease during the first three months after OnTrackNY enrollment and remain relatively steady thereafter; the present study showed that these rates did not significantly increase during the first six months after discharge,” wrote Jennifer Humensky, Ph.D., of Columbia University Department of Psychiatry and New York State Psychiatric Institute and colleagues.

They compared rates of hospitalization and emergency room (ER) visits for 138 patients who were enrolled in OnTrackNY for at least six months and covered by Medicaid in the six months prior to program entry, the six months prior to OnTrackNY discharge, and the six months after OnTrackNY discharge.

In the pre-enrollment period, participants had an average of 1.45 ER visits, 0.80 inpatient visits, and 12.88 inpatient days. This use decreased to an average of 0.88 ER visits, 0.26 inpatient visits, and 3.7 inpatient days in the six months before discharge from OnTrackNY. Six months after discharge from ONTrackNY, the rates had not significantly changed: Patients had an average of 0.83 ER visits, 0.3 inpatient visits, and 4.9 inpatient days.

“Although more research is needed, particularly of larger populations and over a longer time frame, this study provides an initial indication that decreases in hospitalization and ER usage are maintained and do not significantly increase in the first six months after discharge from OnTrackNY,” the researchers concluded.

For related information, see the Psychiatric News article “Evidence Supporting Early Psychosis Treatment Grows as Programs Gain Ground in Communities.”

(Image: iStock/SDI Productions)


Wednesday, June 9, 2021

Matching Patients to Therapists’ Strengths Found to Improve Mental Health Outcomes

Patients who were matched to therapists with proven effectiveness in addressing the patients’ top areas of concern experienced greater improvements following treatment than those paired with therapists randomly, according to a study published today in JAMA Psychiatry.

“Mental illness is a major public health problem, and even among people who engage mental health care, more than 60% do not benefit meaningfully from care received,” wrote Michael Constantino, Ph.D., of the University of Massachusetts, Amherst, and colleagues. “These results suggest that measurement-based therapist report cards can help redirect [mental health care] toward therapists’ strengths.”

Constantino and colleagues conducted a trial across six clinics in Cleveland, Ohio, that included 48 therapists and 218 patients. To be included, the therapists had to provide outcome data from at least 15 cases, which were used to establish their performance profiles. Using 12 symptomatic or functional domains determined by the Treatment Outcome Package (TOP), the therapists were classified as effective (on average, their patients’ symptoms reliably improved), neutral (on average, their patients’ symptoms neither improved nor deteriorated), or ineffective (on average, their patients’ symptoms reliably deteriorated) within each of the domains. The TOP measures how much a patient has experienced 12 specific concerns in the past two weeks, including depression, quality of life, social conflict, substance misuse, suicidality, violence, and work functioning, among others. The TOP also measured patients’ impairment.

The patients in the 16-week trial completed the TOP to determine what interventions they needed. They were then randomly assigned to the matched group or the care-as-usual group. Those in the matched group were assigned to therapists who had proven effective in addressing the patients’ top three elevated domains as determined by their TOP results. Patients in the care-as-usual group were assigned to therapists through typical procedures, such as the therapist’s availability. The patients completed the TOP and the Symptom Checklist-10 (to measure psychological distress) at baseline and bi-weekly throughout the trial or the end of their treatment.

Patients in the matched group experienced greater reductions in their overall impairment compared with patients in the care-as-usual group. Though the matched group started treatment with higher impairment scores, on average, than the care-as-usual group, they ended the trial in the nonclinical range with an average score of about zero, which is the mean score for the general population. Impairment scores for patients in the care-as-usual group improved, but they still ended treatment in the clinically impaired range. Similarly, patients in the matched group experienced greater weekly reductions in psychological distress compared with patients in the care-as-usual group.

“Notably, the good fit in this study came not from changing what the therapists did in their treatment, but rather who they treated,” the authors wrote. “Capitalizing on whatever it is that a therapist historically does well when treating patients with certain mental health problems, the current data indicate that our match system can improve the effectiveness of that care, even with neither therapist nor patient being aware of their match status.”

For related information, see the American Journal of Psychotherapy article “Patient Choice in Depression Psychotherapy: Outcomes of Patient-Preferred Therapy Versus Randomly Allocated Therapy.”

(Image: iStock/KatarzynaBialasiewicz)

Tuesday, June 8, 2021

Alzheimer’s Antibody Therapy Receives Accelerated Approval Amid Controversy

The Food and Drug Administration (FDA) yesterday granted accelerated approval to the monoclonal antibody aducanumab for the treatment of Alzheimer’s disease.

Alzheimer’s disease is characterized by changes in the brain—which include beta-amyloid plaques and neurofibrillary, or tau, tangles—that result in the loss of neurons and their connections.

“Currently available therapies only treat symptoms of the disease; this treatment option is the first therapy to target and affect the underlying disease process of Alzheimer’s,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research.

The FDA’s accelerated approval pathway is designed to speed up the approval of medications for a serious or life-threatening illness that provides a meaningful therapeutic advantage over existing treatments. The pathway enables drug companies to provide a surrogate biomarker that they believe can reasonably suggest future clinical benefit. In the case of aducanumab, accelerated approval was granted based on data from three clinical studies (including two phase 3 studies) demonstrating a significantly greater reduction of beta-amyloid plaques in patients with early stage Alzheimer’s disease who took aducanumab compared with those who took placebo.

The phase 3 data on the effects of aducanumab on cognition were inconclusive. Though one of the phase 3 trials found that patients who received aducanumab had a slightly slower cognitive decline than those who received placebo, the other phase 3 trial did not. In fact, an FDA advisory panel voted nearly unanimously in November 2020 that the clinical data supporting aducanumab were not sufficient to warrant approval.

“Under the accelerated approval provisions, … the FDA is requiring the company, Biogen, to conduct a new randomized, controlled clinical trial to verify the drug’s clinical benefit. If the trial fails to verify clinical benefit, the FDA may initiate proceedings to withdraw approval of the drug,” the FDA release stated.

The approval of aducanumab quickly sparked debate among clinicians, researchers, and advocacy groups. Many scientists believe that the approval—even conditional—is premature.

“The most compelling argument for approval was the unmet need, but that cannot, or should not, trump regulatory standards,” said Caleb Alexander, M.D., a professor of epidemiology at Johns Hopkins University and member of the FDA advisory panel, in a news article. “It’s hard to find any scientist who thinks the data are persuasive.”

Malaz Boustani, M.D., M.P.H., the Richard M. Fairbanks Chair of Aging Research at Indiana University School of Medicine and a research scientist at the Regenstrief Institute, gave a more optimistic view in an interview with Psychiatric News. Though the data are not yet conclusive, he noted that the safety profile of aducanumab was favorable relative to other antibody-based medications such as those used in chemotherapy. Given the tremendous health care burden of Alzheimer’s, he said that he believes the benefit-harm ratio supported a conditional approval.

“I think this approval could also have a ripple effect in improving Alzheimer’s recognition,” Boustani said. “Currently, we miss anywhere from 50% to 80% of patients with Alzheimer’s because brain scans are not routinely provided as a standard of care.” Now that an early stage Alzheimer’s treatment exists, physicians may be more willing to recommend scans for patients, which can help confirm the type of neurodegeneration a patient is experiencing, he said.

For related information, see the Psychiatric News article “New Report Suggests Alzheimer’s Prevalence May Triple by 2050.”

(Image: iStock/wenht)


Monday, June 7, 2021

APA Honors Rep. Bonnie Watson Coleman for Her Work to Improve Mental Health Care

APA has selected Rep. Bonnie Watson Coleman (D-N.J.) as this year’s winner of its Jacob K. Javits Award for Public Service for her commitment and dedication to increase patient access to mental health and substance use disorder services.

The Javits Award recognizes a federal and/or state public servant who has made outstanding contributions to the mental health community. It honors the legacy of Sen. Jacob K. Javits of New York, who achieved many successes on behalf of those with mental illness. The award was presented this past weekend during APA’s online federal advocacy conference.

“Rep. Watson Coleman’s leadership is critical to our nation’s mental health,” said APA President Vivian Pender, M.D., in an APA news release. “Her focus on health equities goes beyond simply funding the services that are needed, but to a wider lens of understanding how social determinants are impacting the mental health of diverse communities around the nation.”

In 2018, Watson Coleman convened a congressional hearing to discuss suicides among Black youth after data revealed that their suicide death rate was increasing faster than in other racial/ethnic groups. The following year, Watson Coleman helped to establish the Congressional Black Caucus (CBC) Emergency Taskforce on Black Youth Suicide and Mental Health. The task force created a work group of Black mental health experts and advocates to identify the causes driving this crisis and possible solutions (past APA President Altha Stewart, M.D., was a member of this work group). In December 2019, the task force released a comprehensive report titled “Ring the Alarm: The Crisis of Black Youth Suicide in America.” In conjunction with the release of the report, Watson Coleman introduced the Pursuing Equity in Mental Health Act of 2019 (HR 5469), a bill aimed at addressing disparities in access, care, and study of mental health issues among people of color. The bill passed the House but did not get a vote in the Senate. This past March, Watson Coleman and Rep. John Katko (R-N.Y.) reintroduced the Pursuing Equity in Mental Health Act (HR 1475). This bill is strongly supported by APA.

Watson Coleman, who is serving her fourth term in the U.S. House of Representatives, is the first Black woman to represent New Jersey in Congress. Before her election to the House, Watson Coleman served eight consecutive terms in the New Jersey General Assembly, where she became the first Black woman to serve as majority leader and chair of the New Jersey Democratic State Committee. She is also the first Black woman to win the Javits Award.

“I’m deeply honored to receive the Javits Award. I am also grateful to the APA for their efforts in fighting youth suicide,” Watson Coleman said. “When I formed the Congressional Black Caucus’s Emergency Taskforce on Black Youth Suicide and Mental Health, I immediately recognized the seriousness of the work we were doing. … I was also humbled by the outpouring of support and resources by the mental health community including organizations like the American Psychiatric Association and recognize that the work we’ve accomplished so far would not have been possible without their efforts.”

“I’m so pleased APA is presenting Rep. Watson Coleman with this award,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “She is such an important ally in Congress for us and for all people with mental illness and substance use disorders, and her leadership is bringing real, positive change to communities.”

For related information, see the Psychiatric News articles “Congress Considering Bills to Curb Black Youth Suicide” and “Alarming Black Youth Suicide Trend Must Be Addressed, Experts Say.”




Looking to Learn More About Apps?

Join members of App Advisor’s Expert Panel tomorrow, Tuesday, June 8, at 3 p.m. ET, for a webinar on HIPAA Privacy and Security Rules and how they relate to the use of apps for patient care. Experts will discuss the use of Business Associate Agreements between clinicians and app developers and more. For the second part of this event, registrants are asked to pre-submit questions about the App Evaluation Model. Presenters will respond to these questions and, if there is time, address other questions using the Q&A feature of Zoom.

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Friday, June 4, 2021

Medical Students Often Perceive Lack of Respect for Diversity Among Faculty

Nearly 18% of graduating medical students who responded to a survey in 2016 and 2017 perceived that medical school faculty show a lack of respect for diversity, a study published today in JAMA Network Open has found.

“Our observation that a perceived lack of respect was prevalent among medical students may reflect students’ perceptions regarding faculty-patient interactions, their experiences within the overall learning environment, and the direct social interaction or lack thereof between students and faculty,” wrote Jasmine Weiss, M.D., of Yale School of Medicine and colleagues. “During each clinical encounter in a teaching context, faculty should exemplify respectful interpersonal communication and effective patient engagement despite differences in culture, beliefs, and background.”

Weiss and colleagues analyzed data from 28,778 graduating medical students who responded to the Association of American Medical Colleges’ 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 medical schools in the United States.

Overall, 17.7% of the respondents reported perceiving that faculty showed a lack of respect for diversity. Students who identified as Black/African American had 3.24 times the odds of perceiving a lack of respect for diversity among faculty compared with White students. Those who identified as American Indian/Alaska Native/Native Hawaiian/Pacific Islander, Asian, or Hispanic/Latinx also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds of perceiving a lack of faculty respect for diversity compared with male students; and students who identified as lesbian, gay, or bisexual or whose sexual orientation was unknown had greater odds of perceiving a lack of faculty respect for diversity compared with heterosexual students. Students aged 33 years or older had greater odds of reporting perceived lack of faculty respect for diversity compared with students aged 26 years or younger.

“This perceived lack of respect for diversity has important implications for patient care, the learning environment, and social interactions with trainees,” the researchers wrote. “Further studies are needed to assess the mediators of students’ perceptions of faculty respect for diversity and how these perceptions may more directly impact student well-being as well as to identify optimal interventions to improve role modeling of respect for diversity among faculty.”

For related information, see the American Journal of Psychiatry articles “Dismantling Structural Racism in Academic Psychiatry to Achieve Workforce Diversity” and “Psychiatry Diversity Leadership in Academic Medicine: Guidelines for Success.”

(Image: iStock/SDI Productions)


Thursday, June 3, 2021

FDA Authorizes Marketing of New Aid to Diagnose Autism

Yesterday, the Food and Drug Administration (FDA) authorized marketing of a new device meant to help in the diagnosis of autism spectrum disorder (ASD), according to a news release. The Cognoa ASD Diagnosis Aid uses a machine learning algorithm to aid physicians when evaluating patients from 18 months through 5 years of age who are at risk of ASD.

According to the Centers for Disease Control and Prevention, ASD is estimated to affect 1 in 54 children in the United States. The disorder can be difficult to diagnose as symptoms can vary, which can delay treatment and early interventions. The average age of diagnosis is 4.3 years, according to the FDA.

“Autism spectrum disorder can delay a child’s physical, cognitive, and social development, including motor skill development, learning, communication, and interacting with others,” Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health, said in the release. “The earlier ASD can be diagnosed, the more quickly intervention strategies and appropriate therapies can begin.”

The ASD Diagnosis Aid allows parents, caregivers, and health care professionals to input details about their children or patients, then the software processes the information to make a diagnosis. It consists of three components: a mobile app that allows parents and caregivers to upload videos of their children and answer questions about behaviors; a video analysis portal through which certified specialists view and analyze uploaded videos; and a portal for physicians and other health care professionals to answer questions about patients’ behavior problems, track information about them, and review the software’s diagnostic report. The device issues reports that the child is positive or negative for ASD to help determine a diagnosis or that there is insufficient information.

A study compared the device’s assessments of ASD diagnoses among 425 patients aged 18 months to 5 years against assessments made by a panel of clinical experts. The ASD Diagnosis Aid provided a positive or negative result for ASD for 32% of patients. The device matched assessments made by the panel of clinical experts for 81% of patients who tested positive and 98% of patients who tested negative.

According to the release, the device accurately made an ASD determination in 98.4% of patients with ASD and 78.9% of patients without the disorder. The device provided a false positive result in 15 out of 303 patients without ASD and a false negative in 1 out of 122 patients with ASD.

“The Cognoa ASD Diagnosis Aid is indicated as an aid in the diagnosis of ASD for patients 18 months through 5 years of age who are at risk of developmental delay based on concerns of a parent, caregiver, or health care provider. The device is not indicated for use as a stand-alone diagnostic device but as an adjunct to the diagnostic process,” the release concluded.

For related information, see the American Journal of Psychiatry article “Variable Emergence of Autism Spectrum Disorder Symptoms From Childhood to Early Adulthood.”


Wednesday, June 2, 2021

ECT, Medication Combo Found as Safe as Medication Alone to Maintain Remission From MDD

Older adults being treated for depression with a combination of electroconvulsive therapy (ECT) and medication appear to have similar cognitive improvements over time as those treated with medication only, according to a report in the American Journal of Geriatric Psychiatry.

Sarah Lisanby, M.D., director of the Noninvasive Neuromodulation Unit at the National Institute of Mental Health, and colleagues looked at neurocognitive outcomes in adults aged 60 and over enrolled in the multicenter Prolonging Remission in Depressed Elderly (PRIDE) study. A 2016 analysis of that study, which appeared in the American Journal of Psychiatry, found that patients receiving a combination ECT and medication for six months experienced greater improvements in mood compared with those who received pharmacotherapy alone.

For the current study, Lisanby and colleagues examined six-month neurocognitive outcomes for a total of 120 patients with remitted depression who received either a combination of ECT (right unilateral ultrabrief pulse ECT), venlafaxine, and lithium or venlafaxine and lithium only as part of the PRIDE study. The researchers used standard instruments to assess attention and processing speed, verbal fluency, verbal learning and memory, memory of personal events in one’s own life, and executive functions.

With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to six-month follow-up for both groups of patients—those who received ECT, venlafaxine, and lithium as well as those who received medication alone. There were no significant differences between the two treatment groups at six months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility.

“Our key finding is that neurocognitive function improved over the six-month follow-up period,” Lisanby and colleagues wrote. “Given that [the combination of ECT, venlafaxine, and lithium] was more effective in sustaining antidepressant remission than [medication alone] without increasing the risk of neurocognitive side effects, these results support the use of [the combination of ECT, venlafaxine, and lithium] to prolong remission from depression,” Lisanby and colleagues wrote.

Lisanby and colleagues acknowledged that some of the patients in the study could have cognitive difficulties following the six-month time point. “Future research is warranted to examine the longer term cognitive, and antidepressant, trajectory,” they wrote.

For related news, see the Psychiatric News article “Older Patients With Depression May Benefit From ECT, Medication Combo.”

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Tuesday, June 1, 2021

U.S. Youth Increasingly Aware of Dangers of E-Cigarettes

U.S. youth appear more aware of the dangers of e-cigarettes than they were just five years ago, according to a report in the American Journal of Preventive Medicine. The findings suggest that efforts to educate adolescents about e-cigarettes may be working and point to groups of adolescents who may need additional support.

Joseph L. Rapp, M.P.H., Karen M. Wilson, M.D., Ph.D., and colleagues at the Icahn School of Medicine at Mount Sinai analyzed data collected between 2015 and 2019 from the National Youth Tobacco Survey. This survey is given to U.S. middle- and high-school students annually.

In addition to assessing the number of students who had smoked cigarettes or used e-cigarettes in the past 30 days, the researchers specifically focused on how the students responded to the following two survey questions:

  • “How much do you think people harm themselves when they smoke e-cigarettes some days, but not every day?” (Response options: no harm, a little harm, some harm, and a lot of harm)
  • “Do you believe that e-cigarettes are less, equally, or more addictive than cigarettes?” (Response options: less addictive, equally addictive, more addictive, I have never heard of e-cigarettes, and I don’t know enough about these products)

The sample included 83,779 students (average age 14.5 years). While there was a slight drop in the percentage of students who reported smoking cigarettes over time (5.78% in 2015 compared with 3.93% in 2019), there was a significant increase in the percentage of students who reported using e-cigarettes during that period (10.77% in 2015 compared with 19.80% in 2019).

Students’ perceptions of the harm associated with vaping increased over time: In 2015, 23.58% believed occasional e-cigarette use caused a lot of harm compared with 32.21% in 2019. Similarly, students’ perception of the addictiveness of e-cigarettes compared with cigarettes also increased: In 2016 (the first year this question was asked), 7.26% said they considered e-cigarettes to be more addictive than cigarettes; by 2019, 26.31% of students considered e-cigarettes to be more addictive.

Female and non-White students were more likely to think that e-cigarettes were at least as addictive as cigarettes but also reported less knowledge about e-cigarettes, the researchers noted. They also found that minority students were more likely than their non-Hispanic White peers to perceive that intermittent use of either E-cigarettes or cigarettes was not as harmful as daily use.

“Concerted efforts should be made to expand education about e-cigarettes and should be combined with stringent regulations on their sale and advertisement,” they concluded.

For related information, see the Psychiatric News article “FDA Bans Some Flavored E-Cigarettes, but Advocates Say Policy Falls Short.”

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Friday, May 28, 2021

Popularity of Telehealth Services Has Been Rising Since Start of Pandemic, Survey Finds

Nearly 4 in 10 Americans—38%—have used telehealth services to meet with a medical or mental health professional, up from 31% in the fall of 2020, an APA-sponsored online survey has found. The survey was conducted between March 26 and April 5 and included 1,000 adults 18 years old and older.

Among survey respondents who reported using telehealth services, 82% used the services since the start of the COVID-19 pandemic; 69% used a video platform, and 38% used only phone calls.

Other key findings of the survey include the following:

  • 45% of respondents said that telehealth services can offer the same quality of care as in-person services, up from 40% last year.
  • 59% would use telehealth services for mental health care, up from 49% last year.
  • 43% want to continue using telehealth services when the pandemic is over.
  • 34% prefer using telehealth services rather than an in-person doctor’s office visit, up from 31% last year.

“The quick pivot to providing telehealth services at the start of the pandemic was vital to providing continued access to care, and this poll shows the important potential role for telehealth going forward,” said APA President Vivian Pender, M.D., in a statement. “Telepsychiatry especially helps those facing barriers such as lack of transportation, the inability to take time off work for appointments, or family responsibilities.”

“Continued access to telehealth during and after the pandemic is vital, and the poll indicates increasing public support for it,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “As we continue to face the long tail of the pandemic, we have an opportunity to innovate and continue to improve access through telehealth.”

For related information, see the Psychiatric News articles “CMS Lifts Restrictions on Telehealth for Psychiatry, Other Services to Meet COVID-19 Challenge” and “The COVID-19 Pandemic and Virtual Care: The Transformation of Psychiatry.”

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APA Members Invited to Apply for Council and Committee Appointments

APA President-elect Rebecca W. Brendel, M.D., J.D., invites APA voting members to indicate their interest in serving on an APA council or committee. Members who are willing to share their expertise and make a significant time commitment to serve APA, the field of psychiatry, and patients are asked to submit their names or nominate a colleague through the online nomination form. Members who represent the varied demographics of APA’s member and patient populations are highly encouraged to apply. The deadline for nominations is Wednesday, September 1.

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Thursday, May 27, 2021

Patients With Social Anxiety Disorder Treated for Sleep Problems May Have Better Outcomes

For patients with social anxiety disorder who received exposure therapy, poor sleep quality was associated with slower symptom improvement over time, according to a study published in Depression & Anxiety.

“Social anxiety disorder, a prevalent psychiatric diagnosis, is often associated with sleep disturbance,” wrote Christina D. Dutcher, M.Ed., of the University of Texas at Austin; Sheila Dowd, Ph.D., of the Rush University Medical Center; and colleagues. “Sleep difficulties may prove an obstacle for optimizing therapeutic gains; thus, clinicians should consider assessing for sleep difficulties and incorporate sleep-relevant techniques into their treatment plans.”

Dutcher and colleagues analyzed data from a clinical trial involving 152 participants that tested the efficacy of D-cycloserine (DCS) augmentation of exposure therapy. All participants had a score of 60 or greater on the Liebowitz Social Anxiety Scale and underwent a five-week group exposure therapy protocol that included 90-minute treatment sessions per week. Symptom severity was assessed at baseline; across the course of the intervention; and during one-week, one-month, and three-month follow-up visits. The participants reported their baseline sleep quality using the Pittsburgh Sleep Quality Index, then completed sleep diaries assessing sleep duration and quality on the nights before and after treatment.

Participants’ scores on the Pittsburgh Sleep Quality Index indicated that 56% identified as poor sleepers. Poorer sleep quality at baseline was significantly associated with slower improvement of social anxiety symptoms over time and predicted worse outcomes at the three-month follow-up visit. Further, participants who slept more before the exposure therapy sessions showed improvement at the next session. There was, however, no significant association between the quality of sleep the night before or after a session with symptoms at the next session.

“Reduced sleep duration impairs the acquisition of new information and the ability to recall previously stored information; thus, it is possible new learning in the session was impaired for individuals with reduced sleep duration before treatment sessions,” the authors wrote. “[I]mplementing interventions that target poor sleep (e.g., stimulus control, relaxation, and cognitive restructuring of sleep-related beliefs) before and throughout the course of exposure-based therapy may assist in maximizing therapeutic outcomes for [social anxiety disorder].”

For related information, see the Psychiatric News article “Overlapping Symptoms Complicate Diagnosis, Treatment of Psychiatric and Sleep Disorders.”

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Wednesday, May 26, 2021

Cognitive Therapy While Tapering Antidepressants May Be Alternative to Maintenance Medication

Treating patients whose depression is in remission with preventive cognitive therapy (PCT) or mindfulness-based cognitive therapy (MBCT) as they taper an antidepressant medication appears to be a safe alternative to maintenance antidepressant therapy, suggests a report in JAMA Psychiatry.

“Current clinical guidelines recommend the continued use of antidepressant medication for patients at high risk for depressive relapse,” wrote Claudi L. Bockting, Ph.D., of Amsterdam University Medical Center and colleagues. “These results suggest that even for patients with a poor clinical prognosis, it may be possible to recommend offering PCT or MBCT during and after tapering of antidepressants as an alternative to continuing the use of antidepressants.”

Bockting and colleagues performed a literature search for studies that compared adults with depression fully or partially in remission who received preventive psychological intervention while being tapered off their antidepressant with those who continued antidepressant treatment only. Six studies met the researchers’ criteria; the researchers were able to obtain individual patient data for four of these studies (714 patients total), which made up the final sample. Three of the studies involved patients who received MBCT during the tapering period; the fourth involved patients who received PCT during and/or after the tapering period.

The researchers specifically compared whether the patients who received the psychological interventions while tapering antidepressants differed in time to depressive relapse compared with those who continued to take antidepressants. Relapse of depression was measured using the Structured Clinical Interview for DSM-IV Axis I disorders.

Bockting and colleagues found no significant difference in time to relapse between use of a psychological intervention during the tapering period versus antidepressant therapy alone. Younger age at onset, shorter duration of remission, and higher levels of residual depressive symptoms at baseline were associated with a higher overall risk of relapse.

“Although these findings suggest that psychological interventions may be an alternative for continued antidepressant medication use for all individuals, collaborative decision-making between patients and practitioners is crucial,” the authors concluded.

For related information, see the Psychiatric News article “AJP Board Member Responds to NYT Story on Antidepressant Withdrawal.”

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Tuesday, May 25, 2021

How to Incorporate Anti-Racism Into Psychiatric Practice

The murder of George Floyd by a police officer one year ago today “forced overdue conversations about the structural racism in the very roots of our nation. It also caused many to examine what was once considered business as usual,” APA wrote in a statement released today. “The American Psychiatric Association and psychiatry were forced to confront our own past [as well as] to examine how racism had entwined itself into our current operations and how racism was impacting our patients on a daily basis.”

“We recommit as an organization and a field to staying vigilant to injustices that impact our patients and taking action to achieve mental health equity for all,” the statement concluded.

What actions can individual psychiatrists take to achieve mental health equity for all?

In an article appearing in the June issue of Psychiatric News, psychiatrists shared suggestions on how to adopt anti-racist practices within and outside of clinical practice. “To eradicate racism, in all its forms, everyone must embrace the concept of anti-racism,” said Rahn Bailey, M.D., APA’s minority/underrepresented trustee and chief medical officer of the Kedren Community Health Systems in Los Angeles. “Anti-racism is proactive and assertive,” he said. “It is taking an active stance against racism in every facet of your life and career.”

Acknowledge that racism exists everywhere: The first step to centering racial equity is starting the process of self-reflection and self-education, Lucy Ogbu-Nwobodo, M.D., M.S., an APA/APAF SAMHSA Minority Fellow and PGY-3 psychiatry resident at the Harvard Massachusetts General Hospital/McLean Psychiatry Program, told Psychiatric News. “It’s being willing to take an honest inventory of yourself, your role, and who you are in society.” Jessica Isom, M.D., M.P.H., a psychiatrist at Codman Square Health Center and a voluntary faculty member at Yale School of Medicine, emphasized that building awareness of racism is a skill that individuals must hone over time by committing themselves to doing so. Acknowledging racism’s role both individually and within the field of psychiatry can lead to better outcomes for patients.

Incorporate anti-racist values into your practice: There are many ways to bring anti-racist values into psychiatric practice, said Michael Mensah, M.D., M.P.H., APA’s immediate past resident-fellow member trustee and a PGY-4 psychiatry resident and co-chief of the residency program at the Semel Institute of Neuroscience of the University of California, Los Angeles. “Ask yourself: What does it look like for you to center anti-racism? Does it mean introducing a sliding scale to help patients who can’t pay? Does it mean taking more Medicare and Medicaid patients than before? Does it mean taking a more active role in your local residency program to advocate for a more diverse residency class?” Ayala Danzig, M.D., M.S.W., a fourth-year resident in the Yale University Department of Psychiatry, chair of the Assembly Committee of Resident-Fellow Members, and the Assembly’s Area 1 resident-fellow member representative, described how she regularly audits her own panel of patients, for example, to see if she is disproportionally diagnosing her Black patients with psychotic illnesses or if she’s prescribing more controlled substances to her White patients.

Ask for guidance: Mensah noted there are multiple resources about how psychiatrists can incorporate anti-racism into clinical practice. APA staff can direct psychiatrists to anti-racism advocacy opportunities, and district branches may be able to help identify local anti-racism experts who can offer valuable insights. He encouraged psychiatrists to reach out to other experts to ask for guidance.

“In medicine, we sometimes think that racial equity is not in our lane or our issue to tackle,” Ogbu-Nwobodo said. “But unless we all think of it as our duty as physicians to address these issues, they’re never going to be tackled. We all need to roll up our sleeves and get into the discomfort of this work.”

For more information, see the Psychiatric Services article “Racism and Mental Health Equity: History Repeating Itself,” the APA resource document “How Psychiatrists Can Talk With Patients and Their Families About Race and Racism,” and APA’s structural racism task force hub.

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Monday, May 24, 2021

Off-Label Psychiatric Use of Gabapentin Found to Be Frequent, Risky

An analysis in Psychiatric Services in Advance reports that over 99% of prescriptions for the anticonvulsant gabapentin are off label, including many prescriptions for psychiatric disorders. In addition, nearly 60% of the patients prescribed gabapentin were also found to be taking central nervous system depressants (CNS-D) such as benzodiazepines, a combination that the Food and Drug Administration (FDA) recently warned against.

To better understand gabapentin prescribing for psychiatric disorders, Brianna Costales, B.S., and Amie J. Goodin, Ph.D., M.P.P., of the University of Florida analyzed data from the National Ambulatory Medical Care Survey (NAMCS)—an annual survey of office-based physicians that captures national practices in outpatient medicine.

The authors specifically focused on data gathered from 2011 to 2016, which included 205,417 office visits involving patients aged 18 and older. Of these visits, 5,732 involved a prescription for gabapentin. Compared with those who were not prescribed gabapentin, the patients who were prescribed gabapentin were older (average age of 59.8), about 87% were White, and more than 60% were female.

Only 0.6% of all gabapentin prescriptions were for an approved indication, namely, focal seizures or shingles-related neurological pain. In contrast, 5.3% of all gabapentin prescriptions were for a depressive disorder, 3.5% were for an anxiety disorder, 1.8% were for bipolar disorder, and 0.7% for alcohol use disorder.

Costales and Goodin also found that for 33.1% of the visits in which gabapentin was prescribed, the patient was also taking one CNS-D drug; 25.3% of gabapentin visits involved a patient taking two or more CNS-D drugs. Antidepressants were the most common CNS-D being taken, followed by opioids and benzodiazepines. In December 2019, the FDA issued a safety warning advising against concomitant use of gabapentin and CNS-D drugs due to risks such as sedation, breathing problems, and respiratory arrest.

“[T]he FDA also warned that elderly patients are at an increased risk when co-prescribed gabapentin and CNS-D drugs,” Costales and Goodin wrote. “Our sample had a large representation of older patients, which highlights the need for providers to be aware of this risk when considering whether to continue gabapentin when a patient is also prescribed a CNS-D medication.”

Costales and Goodin added that gabapentin has carried a warning for suicidal behavior and ideation in its package insert since 2008. “These added risks warrant a reevaluation of gabapentin’s risk-benefit profile in psychiatry, specifically to prevent unintended consequences of exacerbating a psychiatric disorder.”

To read more on this topic, see the Psychiatric News article “Suicide Attempts Involving Gabapentin, Baclofen Rising.”

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Serve Your Association and Make a Difference

Members of the Board of Trustees make the important decisions that ultimately steer the organization and have a real-life impact on patients. To reflect APA’s diversity in leadership positions, members of minority or underrepresented groups are especially encouraged to run for office. Nominate yourself or a colleague for the following national offices for 2022: president-elect, treasurer, trustee-at-large, Area 3 and 6 trustee, and resident-fellow member trustee-elect. The deadline for nominations is Wednesday, September 1.

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Friday, May 21, 2021

Youth Who Seek Hospital Care for Self-Harm May Be at Increased Risk of Psychotic, Bipolar Disorders

Adolescents and young adults who go to a hospital for treatment of self-harm may have an increased risk of developing a psychotic or bipolar disorder by the time they are 28 years old, a study in Schizophrenia Bulletin has found.

Koen Bolhuis, M.D., Ph.D., of the Royal College of Surgeons in Dublin, Ireland, and colleagues analyzed data from 59,476 people in the 1987 Finnish Birth Cohort study. The study comprises information from nationwide registers for all children who were born in Finland that year and includes data on inpatient care and outpatient visits at public hospitals. Bolhuis and colleagues followed individuals in the study from birth until the end of 2015, and the maximum age of people included in their study was 28 years.

Approximately 18% of people who visited a hospital for treatment of self-harm when they were between 11 and 28 years old went on to be diagnosed with a psychotic or bipolar disorder by the end of the study. People 21 years and younger had higher risk: 21% of those who were 18 to 21 years old and 29% of those who were younger than 18 years old at their first visit to the hospital for self-harm were diagnosed with a psychotic or bipolar disorder.

Overall, nearly 13% of the people who visited the hospital for treatment of self-harm went on to receive a diagnosis of psychosis, suggesting that they had more than six times the risk of developing psychosis compared with their peers who did not go to the hospital for self-harm. More than 9% visited the hospital for treatment of self-harm went on to receive a diagnosis of bipolar disorder, suggesting that they had nearly eight times the risk of developing bipolar disorder compared with their peers who did not go to the hospital for self-harm.

Bolhuis and colleagues noted that fewer than 1 in 10 adolescents who self-harm goes to the hospital because of their injuries. Therefore, the results of the study do not suggest that self-harm by itself increases the risk of psychotic or bipolar disorders. Rather, the findings suggest that going to the hospital for treatment of self-harm indicates a higher risk.

“[E]xisting health care systems (i.e., hospital registrations for self-harm) can be used as a strategy to identify individuals at elevated risk for psychosis and bipolar disorder,” the researchers wrote. “Our findings suggest that young people presenting to hospital emergency departments with self-harm should be carefully assessed for psychotic or bipolar disorders.”

For related information, see the Psychiatric Services article “Emergency Department Use and Inpatient Admissions and Costs Among Adolescents With Deliberate Self-Harm: A Five-Year Follow-Up Study.”

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Thursday, May 20, 2021

Court Ruling in Wit v. UBH Should be Upheld, Urges APA

Managed care organizations must use medical necessity criteria and assessment tools developed by nonprofit mental health and substance use disorder specialty organizations when making coverage-related determinations.

That’s what APA and seven other medical organizations told the United States Court of Appeals for the Ninth Circuit in a friend-of-the-court brief filed yesterday in the case David Wit, et. al., v. United Behavioral Health (UBH). The brief is informed by a 2020 APA Position Statement on Level of Care Criteria for Acute Psychiatric Treatment.

UBH is appealing an October 2020 ruling by Judge Joseph Spero of the United States District Court for the Northern District of California ordering the company to re-process more than 67,000 claims for mental health and substance use disorder (MH/SUD) treatment, using level of care and clinical guidelines developed by nonprofit mental health and substance use disorder associations. Spero’s injunction followed a 2019 ruling by the same court that UBH had illegally denied those claims based on flawed medical necessity criteria.

The 2019 ruling and the 2020 injunction are groundbreaking because managed care companies have traditionally created their own guidelines for level of care and medical necessity, factoring costs into the coverage decisions. “Such guidelines may lead to denial of coverage for treatment that is recommended by a patient’s physician and even cut off coverage when treatment is already being delivered,” according to the APA brief.

In the brief, APA outlined eight requirements for coverage decisions derived from guidelines developed by APA, the American Society of Addiction Medicine, and other mental health specialty groups:

  • Practitioners must undertake a multidimensional assessment prior to designing a treatment plan.
  • Effective MH/SUD treatment requires addressing underlying conditions, not merely presenting symptoms.
  • Proper treatment of MH/SUDs requires coordinated treatment of co-occurring conditions.
  • Patients should be placed in the least-restrictive level of care that is both safe and effective.
  • When the proper level of care is ambiguous, physicians should exercise caution and place the patient in the higher level of care.
  • Effective MH/SUD treatment often requires providing continuing services to support recovery and prevent relapse or deterioration.
  • Duration of care should be individualized and not subject to arbitrary limits.
  • Treatment plans for children and adolescents must account for their unique needs.

“Standards of care should be based on the best treatment for patients, not the bottom line,” APA President Vivian Pender, M.D., said in an APA news release. “Some managed care organizations develop their own coverage guidelines that are overly focused on stabilizing acute symptoms of mental health and substance use disorders, rather than treating the underlying illness. When the injury is physical, insurers treat the underlying disease and not just the symptoms. Discrimination against patients with mental illness must end.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., noted that failure to provide appropriate levels of care for treatment of patients with mental illness and/or substance use disorders can lead to relapse, overdose, transmission of infectious diseases, and death. “APA calls upon courts, legislatures, and insurance commissioners to require insurance companies to deliver the care for which patients and employers have paid based upon evidence-based, objective, and patient-centered guidelines, rather than company profits.”

For related information, see the Psychiatric News article “UBH Ruling Called an Enormous Victory for Patients, Wake-Up Call to Insurers.”




Serve Your Association and Make a Difference

Members of the Board of Trustees make the important decisions that ultimately steer the organization and have a real-life impact on patients. To reflect APA’s diversity, members of minority or underrepresented groups are especially encouraged to run for office. Nominate yourself or a colleague for the following national offices for 2022: president-elect, treasurer, trustee-at-large, Area 3 and 6 trustees, and resident-fellow member trustee-elect. The deadline for nominations is Wednesday, September 1.

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Wednesday, May 19, 2021

HHS to Establish Behavioral Health Coordinating Council, Distribute $3 Billion in MH, SUD Funding

The Department of Health and Human Services (HHS) on Tuesday announced plans to establish a Behavioral Health Coordinating Council focused on collaboration and strategic planning across the department. The council will “ensure that millions of Americans receive prevention, early intervention, treatment, and recovery services for mental illness and substance use disorders,” an APA news release stated.

APA applauded the Biden-Harris administration for creating the council, which will be composed of senior leadership from across HHS. It will be co-chaired by Assistant Secretary for Health Rachel Levine, M.D., and Acting Assistant Secretary for Mental Health and Substance Use Tom Coderre. In an HHS news release, HHS Secretary Xavier Becerra noted that he is convening the council because the COVID-19 pandemic “calls for department-wide coordination.”

“APA looks forward to continuing to work with the Assistant Secretary for Mental Health and Substance Use, the Assistant Secretary for Health, and other HHS leadership on innovative and action-oriented approaches,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., said in the APA release. “This Council has great potential to ease the challenges we face as we begin to recover from the pandemic’s impact on our society, and APA looks forward to assisting in [these] efforts.”<

HHS also announced that the Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in funding made available through the American Rescue Plan Act of 2021, which Congress passed earlier this year. The Community Mental Health Services Block Grant (MHBG) and the Substance Abuse Prevention and Treatment Block Grant (SABG) programs will each disperse $1.5 billion to states and territories.

During a virtual event announcing the plans, Coderre said the MHBG funds will be used for a variety of treatment and recovery services for children with serious emotional disturbances and adults with serious mental illness (SMI). The SABG will be used to plan, carry out, and evaluate prevention, intervention, treatment, and recovery services for communities impacted by substance use. “These supplements to the block grants triple the amount of money available to help people who are suffering from mental and substance use disorders,” Coderre said.

The MHBG requires states to set aside 10% of their total allocation for first-episode psychosis or early SMI programs, Coderre continued, and SAMHSA is recommending states set aside 5% for crisis services.

“In the wake of the pandemic an unprecedented, and as of yet untold, number of Americans are faced with mental health and substance use disorders, particularly in communities impacted by structural racism,” APA President Vivian Pender, M.D., said in APA’s news release. “With the creation of this Council and this investment in mental health, the administration is taking a huge step forward.”

For related information, see the Psychiatric News article “APA Applauds Passage of COVID-19 Relief Package.”




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APA advocates on behalf of psychiatrists to increase reimbursement and decrease administrative burdens from public and private payers, legislators, and regulatory agencies. To ensure APA is well equipped to fight for better payment for clinical services, we need to know about our members’ experience with outpatient insurance participation. Your responses to questions regarding the nature of your outpatient practice and your experience with participating in health plan networks will help strengthen our arguments for appropriate reimbursement.

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Tuesday, May 18, 2021

ABCD Study Asks Children About Experiences With Racism

There is ample evidence that racism has negative effects on the health of youth, but few studies have examined the numbers of children in the United States who experience racism and discrimination directly. Data from the Adolescent Brain Cognitive Development (ABCD) Study—a national NIH-funded study tracking the biological and behavioral development of nearly 12,000 U.S. children beginning at age 9 and 10 through adolescence into young adulthood—may point to those at greatest risk and suggest ways to mitigate the effects of racism.

“Identifying the prevalence of racism and discrimination among a crucial developmental age group is imperative to curtail poor outcomes, adjust public health measures, and improve medical and mental health assessments and treatments,” wrote Jason M. Nagata, M.D., M.Sc., of the University of California, San Francisco, and colleagues in a research letter published Monday in JAMA Pediatrics.

During a one-year follow-up assessment of ABCD Study participants, children aged 10 and 11 years completed the Perceived Discrimination Scale. This assessment asked the children about their experiences of being treated unfairly or feeling unaccepted due to race, ethnicity, or color. The analysis included 10,354 children (49% girls; 51% boys), more than 45% of whom were identified by their parents or other caregivers as members of racial/ethnic minorities (19.2% Latino/Hispanic, 16.0% Black, 5.5% Asian/Pacific Islander children, 3.0% Native American, and 1.3% Other).

About 5% of the children reported discrimination due to their race/ethnicity, with the prevalence of discrimination highest among Black children (10%). After adjusting for other demographic factors, Asian/Pacific Islander (adjusted odds ratio [AOR], 2.76); Black (AOR, 2.64); Native American (AOR, 1.86); and Latino/Hispanic (AOR, 1.84) children had higher odds of perceived racism compared with White children. Additional analysis revealed that annual household income modified the association between being Black and perceived racism. Black race was associated with 8.23 higher odds of perceived racism among children with household incomes of $75,000 or higher compared with 2.43 higher odds of perceived racism among children with household incomes less than $75,000. This association was not seen in other racial/ethnic groups.

Although the children indicated that their peers were mostly the perpetuators of racism, “teachers and other adults were often reported as the source of this unfair treatment, highlighting the critical need to ensure antiracism practice and address structural racism within educational communities, which are important social determinants of health,” Nagata and colleagues wrote. “Mitigating the effects of racism on health should start with interventions in childhood.”

For related information, see the Psychiatric News article “Psychiatrists Discuss Impact of Racism Across Generations.”

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APA advocates on behalf of psychiatrists to increase reimbursement and decrease administrative burdens from public and private payers, legislators, and regulatory agencies. To ensure APA is well equipped to fight for better payment for clinical services, we need to know about our members’ experience with outpatient insurance participation. Your responses to questions regarding the nature of your outpatient practice and your experience with participating in health plan networks will help strengthen our arguments for appropriate reimbursement.

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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.