Hope Continues to Grow for Ketamine in Severe Depression

Emergency psychiatrists and others who deal with patients in an acute suicidal crisis have long hoped for the discovery of a fast-acting medication to relieve the severe depression that has driven many of these patients to attempt suicide. While there are effective antidepressants on the market, they often take weeks to bring about improvement. In Houston's Ben Taub General Hospital, where about 5,000 people annually require emergency psychiatric evaluation, psychiatrists are studying whether the anesthetic ketamine might be a magic bullet to quickly bring patients out of the throes of severe depression, reported NPR on January 30. In a double-blind study, psychiatrist Sanjay Mathew, M.D., and colleagues at Baylor College of Medicine are giving ketamine to severely ill patients who have not responded to SSRIs or other antidepressants. Unlike drugs that target serotonin, ketamine activates the glutamate system.

Read more about the potential role of ketamine in treating depression in Psychiatric News.

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Army Losing Forceful Advocate for Better MH Care

The Pentagon's second-highest ranking Army general, Gen. Peter Chiarelli, is retiring today, leaving up in the air whether his successor will be as vocal an advocate for better mental health screening and care for the troops, the Washington Post reported. Chiarelli worked to convince Army troops that the stigma they attached to seeking mental health care for posttraumatic stress disorder (PTSD) and other mental illnesses was misplaced. He told the Post, "...the thing that I have done that has given me the most satisfaction is to try to at least begin the process of eliminating the stigma associated with behavioral-health issues." While his efforts have not yet lowered the Army's troubling suicide rate, he has overseen an increase in mandatory mental health screening for returning combat troops and hired more mental health care providers at Army bases. He has held frequent video conferences with commanders around the globe to review details of each reported suicide by a soldier, to identify trends and missed opportunities to intervene.

Read much more about the Army's efforts to improve mental health care and lower the number of troop suicides in Psychiatric News here and here.  For comprehensive information about the latest in treating PTSD, see Clinical Manual for Management of PTSD from American Psychiatric Publishing.

Credit: Christian DeLuca/U.S. Army

Women May Hurt More

Women are more sensitive to pain than men are, a study reported January 23 in the Journal of Pain has found. The study was based on data from 11,000 patients whose pain scores were recorded as a routine part of their care. To obtain pain scores, physicians asked patients to describe their pain on a scale from 0, for no pain, to 10, for the worst pain imaginable. For 21 out of 22 ailments, women reported higher pain levels. The ailments included joint and inflammatory pain, diabetes, ankle injuries, and even sinus infections.

When it comes to chronic pain, men are certainly not immune, however, with experts estimating that overall about 23 percent of the American population—as many as 116 million people—suffers from chronic pain.

There are a number of things that psychiatrists can do to help chronic pain patients, especially those who endure both mental illness and chronic pain. More information can be found in Psychiatric News here. Also, see Clinical Manual of Pain Management in Psychiatry, from American Psychiatric Publishing.

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Schizophrenia Patients Conquering Their Disability

Milt Greek of Athens, Ohio, has managed to build a successful life and career in spite of having schizophrenia, the New York Times reported recently. He manages his illness with medication and by mastering personal routines that steer him around many of the disabling aspects of his illness. "I have anxiety if I'm not organizing or doing some good work," he said. The time is right not just for Greek, but for many other individuals with serious mental illnesses to recover, many psychiatrists now believe.

An American Psychiatric Publishing book, Recovery From Disability: Manual of Psychiatric Rehabilitation, contains a wealth of information about how clinicians can help their patients achieve this end. For more information, click here.

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Americans Expect Supreme Court to Overturn Insurance Mandate

Most Americans expect the Supreme Court to rule that the insurance mandate in the Patient Protection and Affordable Care Act is unconstitutional, according to a Kaiser Family Foundation poll released yesterday. The telephone survey of 1,206 randomly selected Americans found that 55 percent believe the insurance mandate—which requires individuals to buy health insurance or pay a fine—will be overturned by the Court, which is expected to hear challenges to the law this summer. Interestingly, most Americans (59 percent) also said they think that the Supreme Court justices' personal ideological views will sway their decision. Poll results are posted here.

For extensive coverage of issues related to the insurance mandate, see Psychiatric News here. And to learn more about the health reform law, see a primer for psychiatrists published last year by American Psychiatric Publishing here.

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Mental Illness: All in the Water?

People on Cape Cod who were exposed during gestation and early childhood to a chemical used to line water pipes had an increased risk of bipolar disorder and posttraumatic stress disorder, according to a study by Boston University School of Public Health researchers appearing in Environmental Health. Rates of these disorders increased in those with higher exposure levels, said Ann Aschengrau, Sc.D., a professor of epidemiology, and colleagues.

The solvent tetrachloroethylene (PCE) was used to line water pipes from the 1960s to the 1980s and leached into drinking water. PCE is a neurotoxin that can cause mood changes, anxiety, and depressive disorders in people in the dry-cleaning and textile industries, where it is used today. An earlier study by the same researchers found that people exposed to PCE before birth and during early childhood had 1.5-fold increase in the risk of using illegal drugs as adolescents or adults.

To read more about the effects of environmental chemicals on neurodevelopment in Psychiatric News, click here.

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Long Work Hours May Lead to Major Depression

All work and no play makes Jack a dull boy. It can also make him depressed, claimed researchers at the Finnish Institute of Occupational Health in Helsinki in a study published online January 25 in Plos One.

In their prospective cohort study, the researchers evaluated baseline working hours, psychological morbidity (an indicator of baseline depression), and depression risk factors in a group of British civil servants (1,626 men, 497 women, mean age 47 years) participating in the Whitehall II study from 1991 to 1993. After a follow-up of major depressive episode in 1997 to 1999, the researchers found that the odds ratio for a subsequent major depressive episode was 2.43 times higher for those working 11+ hours a day compared to employees working 7 to 8 hours a day, even when adjusted for sociodemographic factors at baseline. Further adjustment for chronic physical disease, smoking, alcohol use, job strain, and work-related social support had little effect on this association. “Data from middle-aged civil servants suggest that working long hours of overtime may predispose to major depressive episodes,” concluded the researchers.

Recent work has also confirmed a genomic site for major depression. Read more about it in Psychiatric News by clicking here.

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Chantix May Be Next Treatment for Cocaine Addiction

Chantix (varenicline) may be a suitable treatment for cocaine dependence. Investigators at the University of Pennsylvania's Treatment Research Center reported in the February issue of Drug and Alcohol Dependence the results of a nine-week double-blind placebo controlled clinical trial of varenicline in 37 cocaine dependent participants. Compared to placebo-treated participants, those who received varenicline had significantly decreased rates of cocaine reward, as measured by the Multiple Choice Procedure. "Varenicline appears to decrease cocaine use and reward, suggesting that further investigation of varenicline may be warranted," said the researchers.

Other recent studies suggest the smoking cessation drug may reduce some symptoms of schizophrenia. Read more about it in Psychiatric News by clicking here.

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Antidepressants Trip Up Nursing Home Residents

Many nursing home residents with dementia suffer from depression and so are prescribed antidepressants, frequently selective serotonin reuptake inhibitors (SSRIs). Now a new study from the Netherlands finds that use of SSRIs among a group of 248 nursing home residents (average age 82) was associated with an increased risk of falls compared with those not taking these drugs.

“Even at low dosages, psychotropic drugs are associated with increased fall risk,” wrote Carolyn Shanty Sterke, M.D., of the Section of Geriatric Medicine at Erasmus University Medical Center, Rotterdam, and colleagues, in the British Journal of Clinical Pharmacology (online January 19).

In the two-year study, the absolute daily risk of an injury-producing fall tripled from 0.09 percent per day to 0.28 percent among SSRI users. “Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses,” said Sterke.

For more about psychotropic medications and people with dementia in  Psychiatric News, click here.

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APA Responds to N.Y. Times Article on Proposed DSM Change

The “bereavement exclusion”—the criteria in DSM-IV that distinguish grief following a traumatic loss from depression—has been proposed for elimination in DSM-5 by the Work Group on Depressive Disorders. The Work Group says research has shown no difference in symptoms or in treatment response between grief-related depression and any other depression. Moreover, since virtually all depression arises in the context of adverse life events, it makes little sense to single out grief-related sadness for exclusion from diagnosis and treatment.

The proposed elimination of the bereavement exclusion—which like all proposals for DSM-5 is still being reviewed—is the subject of an article in the New York Times today citing researchers at Columbia who claim that removing the exclusion would medicalize normal grief.

But Jan Fawcett, M.D., chair of the work group, told Psychiatric News that people who develop the symptoms and the level of impairment associated with major depression should have access to treatment. And he wondered: Is there any difference between depression that occurs in response to grief and that which occurs in response to any other life stress? "Where do you draw the line?" he asked.

In a statement released last year and published on the DSM-5 Web site, former work group member Ken Kendler, M.D., who is now a member of the DSM-5 Scientific Review Committee, put forward a similar argument. "The DSM-IV position [on the grief exclusion] is not logically defensible," Kendler said. "Either the grief exclusion criterion needs to be eliminated, or [it should be] extended so that no depression that arises in the setting of adversity would be diagnosable. This latter approach would represent a major shift, unsupported by a range of scientific evidence, in the nature of our concept of depression, as epidemiologic studies show that the majority of individuals develop major depression in the setting of psychosocial adversity."

Psychiatric News coverage about the proposed exclusion is here.

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Hallucinogen May Have Power to Improve Depression

Despite the problems that come with use of hallucinogens, scientists are optimistic that that the hallucinogen psilocybin, found in some mushroom species, may be able to improve symptoms of depression. Researchers affiliated with Imperial College London studied 30 volunteers who were given psilocybin intravenously and then undewent magnetic resonance imaging. They reported in the January 24 Proceedings of the National Academy of Sciences that "Activity in the medial prefrontal cortex, which is hyperactive in depression, was consistently lowered." One of the researchers, Professor David Nutt, has applied for permission to carry out a study using the hallucinogen in a small sample of depressed patients. In an upcoming issue of the British Journal of Psychiatry, the same researchers will report that psilocybin "enhanced volunteers' recollections of positive personal memories, compared with those who took a placebo."

Psychiatric News recently reported on another study of psilocybin, this one by Johns Hopkins researchers, in which the substance was associated with positive changes in a personality trait. Read about that study here.

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AMA Registers Anger Over Medicare Fee Deadlock

The AMA yesterday called on Congress to end the "fiscally irresponsible" series of temporary patches to the formula the government uses to set physician reimbursement for treating Medicare patients. The influential physician organization sent a letter to a congressional conference committee wrestling with the issue urging an end to the formula, known as the Sustainable Growth Rate (SGR) formula. In place of implementing the huge physician fee cuts the SGR calls for—27 percent on March 1—the AMA wants the committee to recommend that Congress use projected spending that will not be needed to fund the wars in Iraq and Afghanistan, which are winding down.

"By eliminating this failed formula once and for all, Congress can stop growing the size of the problem for patients, physicians, and taxpayers," said AMA President Peter Carmel, M.D. Designating the unused war funds "to protect health care for men and women in uniform and our nation's seniors is the fiscally responsible thing to do," he said.

Read much more about the years-long fight to modify or abolish the SGR in Psychiatric News here and here.

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Obama Sets Date for Finding Alzheimer's Treatment

The Obama administration has set a date for finding an effective treatment for Alzheimer's disease. It is 2025—just 13 years away—not a prolonged period when it comes to solving a medical mystery that affects millions.

The date was created in response to the National Alzheimer's Project Act, which was signed into law a year ago by President Obama. The act was fueld in part by the increasing numbers of Americans who are getting Alzheimer's as the population ages and by the projected costs of treating them—upwards of a $1 trillion by 2050, according to some estimates.

Whether an effective treatment is found by 2025, of course, will depend on the advances that scientists are able to make in this area. And one experimental Alzheimer's drug that looks promising is called gantenerumab. It reduces plaques in the brains of patients and is being explored by the pharmaceutical company Hoffmann-Laroche.  More information about this drug can be found in the December 2, 2011 Psychiatric News. 

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Obsessions May Start Very Early in Childhood

Symptoms for obsessive-compulsive disorder may appear as early as age 3, Michael Miller, M.D., editor-in-chief of the Harvard Mental Health Letter, reported on January 17. Signs of the disorder in these young children may include concern about sameness and symmetry, insisting that things be perfect, insisting on certain bedtime routines, or developing superstitions and rituals such as avoiding cracks in the sidewalk.

Over the past decade, several randomized controlled trials as well as literature reviews have concluded that both cognitive-behavioral therapy (CBT) and medication can help children better manage obsessive-compulsive disorder, but a combination of both interventions is best, Miller said. The ideal approach is to try CBT before turning to medication, he noted.

Read much more about this topic in two volumes from American Psychiatric Publishing—Obsessive Compulsive Disorder in Children and Adolescents and Impulsivity and Compulsivity.

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Autism Spectrum Disorder Proposed for DSM-5 Would Cover Those With Asperger's

After much study, the DSM-5 Neurodevelopemental Disorders Work Group has concluded that there is no evidence to support continued separation of autism spectrum disorder (ASD) diagnoses, Susan Swedo, M.D., the work group chair, told Psychiatric News. “That is why we’ll be recommending that DSM-5 utilize a single diagnosis—ASD.”

The move to a single diagnosis of autism spectrum disorder would eliminate Asperger’s disorder and pervasive developmental disorder-not otherwise specified as separate diagnoses. They are included in DSM-IV. The possible elimination of Asperger’s has proven controversial, as evidenced by an article in the New York Times yesterday suggesting that the proposed change would narrow the definition and exclude people in need of a diagnosis and treatment. But in fact, adults or children diagnosed with Asperger’s according to DSM-IV criteria would meet criteria for autism spectrum disorder, with “specifiers” that help clinicians identify patients who have individual differences.

Swedo explained that a major reason for the proposed change is that much research has indicated that there is little concordance among experts treating autism in how the DSM-IV criteria are applied: in other words, a child diagnosed with Asperger’s in one clinic would as likely be diagnosed with autism in another. “The improvement we are proposing for DSM-5 is to have specifiers in place that allow us to identify for other clinicians the differences presented by individual patients.” Final decisions on DSM-5’s content are still months away.

A comprehensive article on proposed changes to the chapter on neurodevelopmental disorders will appear in the February 3 issue of Psychiatric News.

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SAMHSA Releases 2010 Survey on Drug Use and Health

A new national report reveals that 45.9 million American adults aged 18 or older, or 20 percent of this age group, experienced mental illness in 2010.

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2010 National Survey on Drug Use and Health also showed that 11.4 million adults (5 percent of the adult population) suffered from serious mental illness, defined as one that resulted in serious functional impairment that substantially interfered with or limited one or more major life activities. The report also noted that an estimated 8.7 million American adults had serious thoughts of suicide, of whom 2.5 million made suicide plans and 1.1 million attempted suicide. Complete survey findings are available on the SAMHSA Web site here.

SAMHSA’s National Survey on Drug Use and Health is released annually, and data are then released in separate reports throughout the year. For instance, in October state-level data from the 2009 National Survey on Drug Use and Health were released. For reporting on those data, see Psychiatric News here.

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New Guidelines for Alzheimer's Diagnosis at Autopsy

The neuropathology guidelines used since 1997 to diagnose Alzheimer’s disease at autopsy have been updated to reflect a deeper understanding of Alzheimer’s and other dementias. The effort, a project of the National Institutes of Health and the Alzheimer’s Association, will help pathologists characterize Alzheimer’s-related brain changes at death in people diagnosed with dementia and those who have not yet shown clinical symptoms. Further, the new guidelines recognize the importance of reporting pathology findings for all diseases that contribute to dementia—not just Alzheimer’s-related changes—and to correlate those findings with clinical symptoms. The new National Institute on Aging–Alzheimer’s Association Guidelines for the Neuropathologic Assessment of Alzheimer’s Disease were published online on January 18, in advance of print publication by Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association.

These guidelines are distinct from, though consistent with, guidelines for diagnosis of Alzheimer's disease in live patients published last March. Read more in Psychiatric News. An in-depth review of Alzheimer's treatment and research can be found in the American Psychiatric Publishing Textbook of Alzheimer Disease and Other Dementias.

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New NIDA Resource Helps Families Navigate Addiction Treatment Options

A new resource, Seeking Drug Abuse Treatment: Know What to Ask, will help individuals and families struggling with addiction ask the right questions before choosing a drug treatment program. It was developed by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. “Treatment options can vary considerably, and families often don’t know where to begin,” said NIDA Director Nora Volkow, M.D. “This booklet highlights the treatment components that research has shown are critical for success, to help people make an informed choice during a very stressful time.”

Seeking Drug Abuse Treatment: Know What to Ask is posted at www.drugabuse.gov/publications/seeking-drug-abuse-treatment. Free hard copies can be ordered by calling 1-877-NIDA-NIH or online at http://drugpubs.drugabuse.gov/.

Principles of Drug Addiction Treatment: A Research Based Guide, which is the basis of this new publication, can be found at www.drugabuse.gov/PODAT/PODATIndex.html.

A recent study funded by NIDA found that substance abusers in rural areas may be particularly difficult to treat. Read more about this problem in Psychiatric News.

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Disparities Exist in Depression Diagnosis, Care

Significant racial and ethnic disparities in the diagnosis and treatment of depression exist among community-dwelling elderly people, according to a study in the February American Journal of Public Health. Researchers from Rutgers University and Columbia University analyzed Medicare Current Beneficiary Survey data for 33, 708 people covering 2001 through 2005 to estimate the association of race or ethnicity with the likelihood of being diagnosed and treated for depression.

Depression diagnosis rates were 6.4 percent for non-Hispanic whites, 4.2 percent for African Americans, 7.2 percent for Hispanics, and 3.8 percent for others. “Vigorous clinical and public-health initiatives are needed to address this persisting disparity in care,” wrote the authors.

For more on disparities in depression care in Psychiatric News, click here.

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Pediatricians Avoid Discussing ADHD Medication Risks

A recent survey of 525 pediatricians finds that while most (93 percent) completed a routine history and physical before starting children on stimulant medications for attention-deficit/hyperactivity disorder (ADHD), only 48 percent performed an in-depth cardiac history and physical, and just 15 percent ordered an electrocardiogram. Only 48 percent of the sample talked to patients and their families about cardiac risks associated with stimulant use, noted Laurel Leslie, M.D., M.P.H., an associate professor of medicine and pediatrics at Tufts University School of Medicine, and colleagues in the February Pediatrics, and published online January 16.

About 81 percent of the pediatricians responding to the survey felt that a family’s knowledge of the risk of sudden cardiac death would deter stimulant use, the authors noted. “The fact that physicians might not discuss potential risks with families, despite lay media publicity, suggests that, as a field, we are not adequately prepared to discuss these risks in an efficient, negotiated manner,” they said.

For more on the cardiac risks of ADHD medications, see Psychiatric News.

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SSRI Use Increases Risk of Bleeding for Heart Attack Patients

While individuals with cardiovascular disease often experience concurrent depression, a new study in the Canadian Medical Association Journal finds that taking selective serotonin reuptake inhibitor (SSRI) antidepressants enhances the bleeding risk already associated with antiplatelet medications commonly prescribed for those who have suffered a heart attack. The retrospective study followed 27,058 patients over age 50 who were hospitalized for a heart attack and subsequently prescribed acetylsalicylic acid and/or clopidogrel—both with and without the addition of an SSRI for depression. When added to either a single or dual antiplatelet medication regime, SSRIs were found to increase patients’ risk of bleeding.

Read more about the link between antidepressants and bleeding risk in Psychiatric News.

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Vitamin D Levels Linked to Depression Risk

Researchers have identified a relationship between vitamin D levels and an individual's risk of depression. The finding comes from a four-year cross-sectional study of more than 12,000 participants conducted by researchers at the University of Texas Southwestern Medical Center in Dallas, who reported their findings in the Mayo Clinic Proceedings. Depression was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). Data pointed to a decreased risk of current depression in those with the highest vitamin D levels. The association was strongest in subjects with a history of depression. The researchers urge assessment of vitamin D levels in primary care patients who have a history of depression.

Depression isn't the only mental illness associated with vitamin D levels. Psychiatric News has reported on a link between vitamin D levels in newborns and risk of developing schizophrenia. Click here to read that article.

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APA President Meets With First Lady to Reaffirm Commitment to Troops

APA President John Oldham, M.D., met with First Lady Michelle Obama at the White House on Wednesday along with leaders of several national health care organizations and the Department of Defense and Veterans Administration to reaffirm APA’s pledge of active participation in the Joining Forces program, which supports returning veterans and their families. The program was established by Michelle Obama and Jill Biden, wife of Vice President Joe Biden.

APA, which has been involved with the program for over a year, has played an important role in easing the transition for service members returning from combat and for their families who may find it difficult to readjust to having them home. APA and the American Psychiatric Foundation have also partnered with the nonprofit organization Give an Hour to enhance awareness of military mental health issues and provide countless hours of free office-based care to returning veterans and their families. In addition, APA has developed training courses for psychiatrists and mental health professionals to deal with unique issues facing veterans such as PTSD and TBI.

Psychiatric News has provided extensive coverage of issues related to the mental health needs of combat soldiers and returning veterans. For information about the Joining Forces program see Psychiatric News here.

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Borenstein Named Editor-in-Chief of Psychiatric News

Jeffrey Borenstein, M.D., chief executive officer and medical director of Holliswood Hospital in Holliswood, N.Y. and chair of the APA Council on Communications, has been named editor in chief of Psychiatric News, APA's official newspaper.

Borenstein is the host of the television series "Healthy Minds,” which airs on public television stations across the country. He is chair of the Mental Health Services Council of New York State and serves on the Commissioner’s Medical Advisory Panel of the Office of Alcoholism and Substance Abuse Services and is chair of the Section on Psychiatry at the New York Academy of Medicine.

“I am passionate about the mission of Psychiatric News and am honored to serve as editor in chief,” said Borenstein said. “Psychiatric News is the most trusted source of information for APA members, other health professionals, and the public about developments in the field of psychiatry that impact clinical care and professional practice…I hope to receive feedback from our members so that Psychiatric News can continue to be the first and last word in psychiatry.

To read the latest edition of Psychiatric News, click here.

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Clinicians May Have Negative Attitudes Toward Patients With Eating Disorders

A group of Boston-based researchers have found that inexperienced clinicians hold more negative attitudes toward patients with eating disorders than toward other patient groups, unlike experienced psychotherapists, according to a study in the January Psychiatric Services. Nonetheless, clinicians treating patients with eating disorders feel frustrated, helpless, incompetent, and worried. "Clinician attitudes, knowledge, and stigma likely adversely affect both the quality and the availability of services for patients with eating disorders," said the researchers. To read an abstract of the study, click here.

Also in the news, a number of diagnostic changes regarding eating disorders has been proposed for DSM-5. Read more in Psychiatric News by clicking here.

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E-Cigarettes May Be New Smoking-Cessation Option

“E-cigarettes” may help smokers quit when other methods have failed them. Italian researchers studying the effectiveness of “electronic” cigarettes (E-cigarettes) for smoking cessation published a report of the experiences of three smokers who found success with E-cigarettes in the January 3 Journal of Medical Case Reports. All three had failed in previous attempts with professional smoking-cessation assistance using the usual nicotine-dependence treatments and smoking-cessation counseling.

The three heavy smokers (two men aged 47 and 65 and one woman aged 38) were able to quit smoking tobacco products and remain abstinent for at least six months after they began using an E-cigarette with a nicotine cartridge. “Larger, controlled studies are needed to confirm this interesting finding, particularly for those smokers for whom the handling and manipulation of their cigarettes play an important part in the ritual of smoking,” noted the researchers, who said the E-cigarette may be a gateway to smoking cessation.

Serious psychological distress has been linked to heavy smoking and an inability to quit. Read more in the Journal Digest column of Psychiatric News.

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Stressful Events Linked to Smaller Brain Size

Adverse life events can reduce the brain’s gray matter, according to a study published online January 2 in Biological Psychiatry. Yale University researchers performed MRI scans on 103 healthy individuals, aged 18 to 48, and interviewed them about stressful events and adversity in their lives, like job loss, divorce, or the death of a loved one.

Both cumulative and recent stress were associated with reductions in several parts of the brain, especially the medial prefrontal cortex and the limbic regions. These areas are involved in stress, emotion and reward regulation, and impulse control and may be involved in depression, addiction, and other stress-related psychopathology. “The accumulation of stressful life events may make it more challenging for these individuals to deal with future stress, particularly if the next demanding event requires effortful control, emotion regulation, or integrated social processing to overcome it,” said lead author Emily Ansell, M.D., an assistant professor of psychiatry at Yale, in a statement.

Read more about the relationship between stress and brain changes in Psychiatric News.

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Reciprocal Support Helps Mental Health Consumers

What happens when people with mental illnesses help others with the same problems move toward recovery? Researchers from the Mailman School of Public Health at Columbia University spent 10 weeks observing participants in a consumer-led program that helps with employment, housing, and advocacy, along with clinical services. Members chat at the program site, check on each other by phone when someone doesn’t come to the center, and help one another resist relapse and stick to their medications.

The mutual accountability arising through stable and authentic relationships may develop the capability for obtaining gainful employment, housing, and psychiatric stability, wrote Sara Lewis, M.A., L.M.S.W., and colleagues in the January Psychiatric Services. “Our study suggests that a local culture of reciprocal support—where one is just as responsible for providing support as for receiving it—promotes an ethic of accountability, a factor we argue may enhance recovery."

To read more about consumer-operated service programs in Psychiatric News, click here.

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Changes to Eating Disorder Criteria Proposed for DSM-5

The work group reviewing criteria for the diagnoses of feeding and eating disorders for the next edition of APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is proposing several changes to the criteria for that category of disorders, including the addition of a diagnosis of "binge eating disorder." The proposed criteria for this disorder are being tested in field trials, and the results will be extensively reviewed before a decision about inclusion in the upcoming revision is made. Also proposed is the addition of criteria for "avoidant/restrictive food intake disorder," which identifies primarily children with idiosyncratic food requirements that are of a severity that causes a failure to meet energy or nutritional needs. Some changes to criteria for anorexia nervosa are also under consideration. DSM-5 is scheduled for publication in May 2013.

For an extensive discussion of the changes to eating disorder criteria proposed for DSM-5, see the January 6 issue of Psychiatric News.

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Omega-3 May Have Some Value as ADHD Drug Supplement

Claims for the benefits of omega-3 fatty acids have been attached to a range of disorders including psychiatric ones. One of the more recent suggested uses is with children who have attention-deficit/hyperactivity disorder (ADHD). An extensive review of dietary supplements published January 9 in Pediatrics suggests that there could be minor improvement in ADHD symptoms with use of omega-3 supplements, though a shift from a fat-laden "Western-style" diet is probably a more constructive alternative. Psychiatrist Stephen Grcevich, M.D., is quoted in WebMD as saying that "medication and behavioral changes should always come first, especially for children with issues in addition to ADHD, such as anxiety or depression."

Read more about the hope that omega-3 fatty acids could benefit those with mental illness in Psychiatric News. American Psychiatric Publishing has several resources on ADHD including Attention-Deficit/Hyperactivity Disorder: A Clinical Guide to Diagnosis and Treatment for Health and Mental Health Professionals.

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Deep Brain Stimulation May Benefit Bipolar Patients

Individuals with bipolar disorder who do not respond to medications for their depressive episodes might be able to find relief from those episodes via deep brain stimulation, a small pilot study published January 2 in the Archives of General Psychiatry suggests. Seven subjects received single-blind sham stimulation of subcallosal cingulate white matter for four weeks followed by active stimulation for 24 weeks. The subjects experienced a significant decrease in depression and an increase in functioning. At the same time, the treatment was found to be safe and well-tolerated, and none of the subjects experienced hypomanic or manic episodes.

More information about treatment advances for bipolar disorder can be found in two American Psychiatric Publishing books—Advances in Treatment of Bipolar Disorder and Handbook of Diagnosis and Treatment of Bipolar Disorders .

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People With Schizophrenia Can Profit From Individual Employment Help

Middle-aged and older individuals with schizophrenia can benefit from individual placement and supported-employment programs, according to a study published last December in Schizophrenia Research. The researchers recruited 58 individuals with schizophrenia aged 45 years or older to participate in the study. Half were assigned to an individual-placement and support program for 12 months, while the other half were assigned to a conventional vocational rehabilitation program during that period. More than 50 percent of the subjects who took part in the former program attained competitive employment, whereas only 29 percent of those who took part in the latter program did.

More information on how people with schizophrenia can recover from their illness can be found in an American Psychiatric Publishing book Recovery From Disability—Manual of Psychiatric Rehabilitation.

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Father and Son Tell a Tale of Severe Mental Illness

Severe mental illness is often a family affair.

Henry’s Demons: Living With Schizophrenia, A Father and Son’s Story, by British journalist Patrick Cockburn and his son Henry, tells a story—through alternating father and son chapters—of Henry’s slow descent into and emergence from severe mental illness. Published by Scribner in 2011, the book is reviewed by psychiatrist Lloyd Sederer, M.D., in the January American Journal of Psychiatry. Sederer strongly recommends the book to both clinicians and patients and their families. “Through father and son, we enter the world of mental illness in personal and painful ways,” he writes. “What distinguishes this book are the plethora of lessons learned, none delivered in didactic or pedantic ways but instead through narrative and experience.” The review is online here.

For more information about how families and patients can participate in treatment of schizophrenia see Psychiatric News.

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Age-Related Cognitive Decline Begins as Early as Age 45

For those over age 40 who can’t find their keys, it may come as no surprise that British researchers have found that age-relate cognitive decline begins as early as age 45. 

In a study published in the British Medical Journal, researchers tested memory, reasoning, vocabulary, and semantic fluency at different period over 10 years in more than 7,000 British civil servants in five age categories (45-49, 50-54, 55-59, 60-64 and 65-70). All cognitive scores, except vocabulary, declined in all five age categories, with evidence of faster decline in older people. 

To read about brain imaging of early cognitive decline related to Alzheimer’s disease see Psychiatric News.

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Some Secrets of the Savant Brain Revealed

Is the brain of an autistic savant different from any other brain? That’s what researchers at the University of Washington recently tried to determine when they investigated the neuroanatomy, regional brain connectivity, and neurochemistry of a 63-year-old male autistic savant with prodigious artistic skills. No gross anatomical differences were observed, but “utilization of conventional as well as newer MR imaging technologies revealed several atypical structural and chemical features that may be involved in the special skills of this prodigious savant,” the researchers wrote online December 29 in Comprehensive Psychology. They also felt that the multimodal imaging approach presented in the study is suitable for evaluating larger samples of savants with a range of talents. And there may be other advantages, as well: “Given the high co-occurrence of the two syndromes, elucidating the underlying neurophysiologic basis of savant syndrome may also lead to a better understanding of autism spectrum disorder,” they said.

Psychiatrist Darold Treffert, M.D., a leading expert on savant syndrome, believes the condition may yield lessons about the nature of creativity and the dormant potential in all human beings. Read about it in Psychiatric News.

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"Silent Strokes" Lead to Memory Loss in Elderly

New research links "silent strokes"—small spots of dead brain cells, found in about 1 of 4 older adults—to memory loss in the elderly. "The new aspect of this study of memory loss in the elderly is that it examines silent strokes and hippocampal shrinkage simultaneously,” explained researchers at the Columbia University Medical Center in the January 3 Neurology. For the study, 658 people aged 65 and older and free of dementia were given MRI brain scans and tests that measured  memory, language, speed at processing information, and visual perception. A total of 174 of the participants had silent strokes.

The study found people with silent strokes scored worse on memory tests than those without silent strokes.

“Given that conditions like Alzheimer’s disease are defined mainly by memory problems, our results may lead to further insight into what causes symptoms and the development of new interventions for prevention.... Our results also support stroke prevention as a means for staving off memory problems,” said the researchers.

Read more about recent research on the relationship between stroke and cognitive decline in Psychiatric News.

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Will Plunging Drug Spending Deter Future Product Investment?

Analysis of a decade's worth of information from multiple databases on trends in spending for psychotropic medications shows that the average rate of growth in such spending dropped dramatically from 18.5 percent in the period 1997-2001 to 6.3 percent from 2001-2008.  In addition, growth in the per-day cost of a psychotropic medication declined from 8 percent to 2 percent during the same time frame. A key factor in the growth slowdown was the steadily increasing popularity of generic versions of once-branded psychiatric medications. The researchers conducting the analysis, led by Tami Mark, Ph.D., M.B.A., of Thomson Reuters, suggest that as pharmaceutical companies see their profits from the sale of brand-name psychotropics decline, they may become loath to invest heavily in new products to treat psychiatric illnesses.

Read more about this study in the January 6 issue of Psychiatric News and the January issue of the journal Psychiatric Services.

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Treating Agitation in Emergency Room Requires Delicate Balancing Act

Verbal de-escalation should take precedence over use of medication or seclusion and restraint when psychiatrists and other emergency department staff have to intervene with a severely agitated patient, emphasizes Garland Holloman, M.D., director of emergency psychiatric services at the University of Mississippi. Holloman headed an American Association for Emergency Psychiatry panel that developed guidelines that describe best practices in evaluating and treating agitation in the emergency department. Speaking at APA's Institute on Psychiatric Services, he pointed out that using less-physical methods to help patients regain control increases their trust and cooperation, improving the outlook for future treatment.

Read more about treating agitation in the emergency department in Psychiatric News and in the Clinical Manual of Emergency Psychiatry from American Psychiatric Publishing.

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Worldwide Treatment Gap Found for People With Schizophrenia

In low- and middle-income countries, most people with schizophrenic disorders go without treatment, according to a report in the Bulletin of the World Health Organization. The study used data collected in 50 countries between 2005 and 2010 to define a treatment gap, that is, "the proportion of individuals affected by schizophrenic disorders who fail to receive treatment,” wrote Antonio Lora, M.D., of Ospedale de Lecco in Lecco, Italy, and colleagues.

Overall, about 69 percent of those people were not receiving treatment, but the gap was greater in lower-income countries (89 percent) and lower-middle-income countries (69 percent) than in upper-middle-income countries (63 percent). Most psychosis treatment takes place in outpatient settings, and the main factor limiting care appears to be the number of psychiatrists and nurses working in specialized mental health facilities.

But the gap may be even greater than these data suggest, the authors noted. “We did not assess treatment adequacy,” they said. “Hence, our data could be greatly overestimating the number of people who received appropriate treatment.”

Read more about international aspects of mental health epidemiology in Psychiatric News.

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Black Families Benefit From Preventive Mental Health Intervention

A study covering 502 African-American families in rural Georgia found that a preventive intervention reduced mental health and substance use problems over a follow-up period of almost two years, according to research by Gene Brody, Ph.D., of the Center for Family Research at the University of Georgia, and colleagues in the January Pediatrics.

The Strong African American Families–Teen (SAAF–T) program included five meetings for adolescents and their caregivers held in the community. Adults and teens learned about protective practices like setting limits, monitoring adolescents’ whereabouts, instilling a sense of racial pride, strategies for dealing with discrimination, monitoring and supporting academic achievement, solving problems cooperatively, and promoting adolescent self-regulation. “This study demonstrates that participation in a family-centered preventive intervention reduces conduct problems, substance use, and substance use problems among black adolescents by more than 30% compared with adolescents in an attention control condition across nearly two years,” said the authors.

For more about mental health issues among rural populations in Psychiatric News, click here.

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