Interface Consultation Services

Interface Consultation Services - Update

2011-07-01T13:28:00.000-04:00

We are excited to annouce some changes in our services within the past year:

ReEntry Project for Offenders with Special Needs - ICS is contracted as the Regional Care Coordinators for Western Michigan providing services to 18 counties. ICS has five contractors to assist with this initiative by Michigan Department of Corrections. This speciality program is designed for mentally ill, developmentally disabled, medically fragile and youthful offenders who are returning to the community from Michigan prisons. As Care coordinators we provide linking and coordinating for housing, medical, psychiatric, specialized placements, etc as well as consultation on some very difficult cases for the program.

Passages Behavioral Health Services - Provides Mobile, Intensive, Short-term, Targeted Case Management, Psychotherapy and Psychological Testing Services located in Western Michigan. Our commitment is to providing outreach in-home services with flexibility to meet individuals with disabilities, barriers to transportation and public resources. Our staff include Michigan licensed social workers and psychologists. We are able to see clients with Medicare and some types of Medicaid insurances.

Passages House - Provides transitional housing for individual returning to the community from correctional facilities who would otherwise be homeless. Passages House focuses on support services to assist individuals who have special needs to be successful in the community.

Please contact us via email by clicking on the link to learn more about how we can service your community and provide service to those in need or call (269)929-1292.

Consuming Energy Drinks Linked to Alcohol Disorders

2010-11-28T19:24:00.000-05:00

Use of energy drinks and alcohol has become increasingly popular among youth. Medscape reports recent research linking high users of energy drinks with increased alcohol related disorders such as dependence. It is reported to be a dangerous combination that keeps an individual more alert while their judgment and impulsivity has become impaired due to alcohol consumption.

We often see clinicians neglect to assess for caffeine usage with substance abuse assessments. It clearly can assist in understanding a person's usage and risks.

Talking to Teens May Reduce Future Violence and Alcohol Use

2010-09-26T16:47:00.000-04:00

A study conducted by the University of Michigan with over 3,000 teens using motivational interviewing to counsel adolescents to stay away from potentially violence and alcohol use. A decrease of involvement in these situations by 50 percent was evidenced in the study. See more at Psychiatric Times

This study indicates the importance of what we already know that talking with our children about risky and violent situations and giving them tools to seek other options continues to be an strong prevention tool.

Method of Suicide Attempt Influences Risk of Later Suicide Completion

2010-08-06T13:09:00.000-04:00

Initial suicidal behaviors and methods such as hanging, drowning, shooting by firearm, jumping or gassing are more likely to complete suicide with subsequent attempt as published in the British Medical Journal in July online in Medscape News.

Valproic Acid in Pregnancy Linked to Congential Malfunctions

2010-06-15T09:25:00.000-04:00

A new study indicates an increased risk of spinal bifida and 5 other congential malfunctions when used in the the first trimester of life compared to no use of antiepiletic medications.

Valproic Acid is often used as a form of medication treatment for mood and bipolar disorders.

Interface Consultation Services - Update

2010-04-27T14:38:00.000-04:00

A brief overview of Interface Consultation Services current endeavors:

I. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

II. ReEntry Project for Offenders with Special Needs - ICS is contracted as the Regional Care Coordinators for Western Michigan providing services to 18 counties. ICS has hired 5 contractors to assist with this initiative. This speciality program is designed for mentally ill, developmentally disabled, medically fragile and youthful offenders who are returning to the community. As Care coordinators we provide linking and coordinating for housing, medical, psychiatric, specialized placements, etc as well as consultation on some very difficult cases for the program.

III. Passages Behavioral Health Services - Provides Mobile, Intensive, Short-term, Targeted Case Management, Psychotherapy and Psychological Testing Services located in Western Michigan. Our commitment is to providing outreach in-home services with flexibility to meet individual needs. Our staff include Michigan licensed social workers and psychologists. We are able to see clients with Medicare and some types of Medicaid insurances.

IV. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center.

V. Blog Focus - We continue to post on ICS and Counseling Connections.Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.

Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.

Primary Care Screening for Adolescent Suicide Risk

2010-04-19T10:04:00.003-04:00

A study completed by Laurie Barclay MD and published in Medscape indicated that routine screening at primary care offices for depression and suicide risk can increase early detention of suicide. Although they warn against asking questions regarding suicide if there is no availability to a mental health professional.

This statement warning against asking about suicide if there is no clear referral that can be made seems to be in contradiction of this entire study. So primary care physicians "shouldn't" know if you are suicidal if they cannot refer you out? It is understandable that a physician may not feel they have the tools or training to assess clear risk of suicide in an adolescent. Why would they not at least be encouraged to try and seek additional training, especially if there are no other options? It could mean life or death....

DSM V Changes

2010-03-05T23:20:00.002-05:00

The fifth edition of Diagnostic and Statistical Manual for Mental Disorders will be updated and published in May 2013.

There are several proposed changes:

Proposed to delete Aspergers Disorder and include it in Autism Spectrum Disorders

More stringent criteria for diagnosis of Bipolar in children and proposed new diagnosis of Temper Dysregulation Disorder.

Proposed additions to Somatoform Disorders:

"Abridged Somatization Disorder" 4 unexplained somatic conditions in men and 6 in women

"Multisomatoform Disorder" at least 3 unexplained somatic concerns from the PRIME-MD for at least 2 year of active symptoms.

Changes in the way Personality Disorders are assessed and diagnosed.
proposal to return Depressive Personality Disorder and Negativistic (Passive-Aggressive) Personality Disorder. There is also some discussion about changing the name of Borderline Personality Disorder and changing it from Axis II to Axis I disorder.

Listen to NPR regarding Bipolar Changes.

Fish Oils show Promise in Preventing Schizophrenia

2010-02-06T14:06:00.002-05:00

The Austrian study showed a 22.6% difference in the risk of progression of psychosis with high-risk indviduals treated with a 12 week fish oil supplement compared to similar individuals taking placebo. 81 Participants were placed into study groups using a random double-blind placebo controlled trial. The study was published in Feb 2010 Achives of General Psychiatry.

This study is promising as we look to prevent and not just control and manage the disease of Schizophrenia that disable many even with treatment.

Persons With Severe Mental Illness in Jails and Prisons: A Review

2009-12-28T13:32:00.002-05:00

Interface Consultation Services continues to provide re-entry services for mentally-ill individuals releasing from prison. The linked article provides greater insight into the epidemiology of criminals with mental illness. Re-entry services provide for a seamless, intensive, clinically-sound alternative to long-term incarcerations.

http://http//www.ps.psychiatryonline.org/cgi/content/abstract/49/4/483

Methamphetamine Cravings Persist, Remain Intense, Well Into Abstinence

2009-12-16T15:48:00.003-05:00

Medscape Article...

A study presented at the American Academy for Addiction Psychiatry 20th Annual Meeting conducted at the University of California, Los Angeles found that average levels of cravings and psychopathology had decreased after 2 weeks for methamphetamine dependent individuals who were abstaining from use. Conversely, up to 30% continued to have significant depressive, mood and psychotic symptoms 5 weeks post use. These finding point to the difficulties of breaking the cycle of addiction to Methamphetamines.

It is likely that even if someone has been abstaining for 5 weeks that they may show significant psychopathology that maybe more related to Amphetamine Dependence than to a co-morbid Mood or Psychotic Disorder. This information is useful as clinicians assess patients to understand the etiologies of symptoms and more accurately diagnose and treat individuals.

See the article link above for more details....

Cognitive Impairments and Psychotic Disorders

2009-12-08T10:35:00.003-05:00

Dec 6 2009 Medscape

Cognitive Impairments occur in all psychotic disorders but are found most severely and pervasively in Schizophrenia and less so with those diagnosed with Bipolar, Manic according to a study published December 1, 2009 in the American Journal of Psychiatry.

For those of us that work with these populations, we have probably witnessed this for an experiential point of view. It's promising to see the clinical data and science support our personal experiences.

Please click on the link above to read the entire article and finding.

Factitious Disorder Versus Malingering

2009-11-06T16:44:00.003-05:00

Check out this article with the Psychiatric Times. Very interesting Read..... Click on the Link at the end for more....

The Case of Factitious Disorder Versus Malingering
Courtney B. Worley, MPH, Marc D. Feldman, MD, and James C. Hamilton, PhD
Ms Worley is a graduate student in psychology, Dr Feldman is clinical professor of psychiatry, and Dr Hamilton is associate professor of psychology at the University of Alabama in Tuscaloosa. The authors report no conflicts of interest concerning the subject matter of this article.

Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions. In doing so, the treating physician may unwittingly provide support for specious claims of illness or injury by conferring official diagnoses, or by delivering treatments that transform the patient from a pretender into a person with a genuine, although iatrogenic, medical problem (eg, via adrenalectomy, pancreatectomy, serial amputation).1-3

Forensic psychiatrists may be called on during civil or criminal litigation to help determine the authenticity of a patient’s apparent medical illnesses or injuries. Even when a patient’s medical deceptions are proved beyond any doubt, the forensic psychiatrist may be asked to help determine the underlying psychological processes that led to the deception. In other cases, the patient may pursue civil damages from the treating physician for performing unnecessary interventions, and the forensic psychiatrist is asked to weigh in on the culpability of a colleague for failing to detect the deception.4-6

The forensic psychiatrist faces 2 synergistically related obstacles. First, in contrast to malingering, there is little empirical research on the nature of factitious disorder, its underlying psychological processes, or ways to assess it. Second, despite the aforementioned lack of scientific evidence, DSM-IV-TR provides an artificially definitive classification system for patients with inauthentic illness behavior, to which the examiner’s conclusions are expected to correspond.

Consciousness, intentionality, and insanity in DSM
Many decisions in legal proceedings boil down to the question of consciousness and intention. Was the defendant aware of what he or she was doing, did he intend to do it, and was the motive for doing it reasonable? Conveniently, DSM-IV-TR categories dealing with inauthentic illness behavior (ie, behaving as if one is sick when one really is not) neatly address these questions.
The DSM somatoform disorders category specifies 5 disorders for which inauthentic illness behavior presumably is neither conscious nor intentional. These are somatization disorder, hypochondriasis, conversion disorder, pain disorder, and undifferentiated somatoform disorder. It specifies another category—factitious disorder—in which inauthentic illness behavior is consciously and intentionally produced. This category is reserved for people whose motives appear to reflect severe psycho-pathology (eg, a person who would agree to prophylactic double mastectomy just to get attention from medical personnel, friends, and coworkers).7 DSM also recognizes cases of malingering (as a “V” code, not a true psychiatric diagnosis) in which the inauthentic medical behavior is conscious, intentional, and reflects more comprehensible motives (eg, faking a fall in a retail store to get millions of dollars in compensation for medical and emotional damages).

Without detailing the full DSM diagnostic criteria sets for these disorders and their relations, the following is a summary of how DSM instructs psychiatrists to diagnose cases of inauthentic illness behavior:

1. In the absence of overwhelming affirmative evidence of intentional medical deception (eg, caught on video, evidence from a room search), diagnose a somatoform disorder.

2. If there is traditional forensic evidence of overt medical deception, diagnose malingering or factitious disorder.

3. If there is any significant material or instrumental benefit from the intentional medical deception (eg, financial settlement, disability determination, access to narcotic medicine), diagnose malingering.

These 3 categories are mutually exclusive, and there is no hedging.

Anyone with even minimal experience in dealing with patients with complex and suspicious medical histories recognizes how inadequate and oversimplified DSM directives are. The criteria make it virtually impossible to diagnose a case as anything other than a somatoform disorder when intentionality cannot be proved with traditional forensic evidence. There are no psychological tests of consciousness, and even strong evidence of a relationship between the occurrence of inauthentic illness behavior and tangible benefits would not suffice to overrule a somatoform diagnosis. Thus, in cases dominated by subjective complaints like pain, fatigue, and weakness, it is virtually impossible to definitively diagnose factitious disorder or malingering.

Psychiatric Times...

Missouri's New Take on Juvenile Justice

2009-09-09T10:20:00.003-04:00

Recent reports about abuse of juvenile inmates have renewed calls for a national overhaul of a juvenile justice system that includes nearly 100,000 children.

Juvenile detention center in Missouri replaces lockdowns with hugs.
In Missouri, a different method for juvenile detention has seen surprisingly successful results, trading in the orange uniforms and cell blocks for therapists and dorm rooms.

see more ABC News:

Looks like Missouri is really trying to make a difference with his children who are struggling with criminal behavior, substance abuse and emotional problems. Let us know what your state is doing?

Words to Live By.....

2009-08-25T17:14:00.001-04:00

" Watch your thoughts; they become words. Watch your words; they become actions. Watch your actions; they become habits. Watch your habits; they become character. Watch your character; it becomes your destiny."

-Frank Outlaw

Negative Thoughts, Depression and Teens

2009-07-14T13:31:00.002-04:00

NIMH
Science UpdateJune 09, 2009
Re-shaping Negative Thoughts Shields At-Risk Teens from Depression
Cognitive Prevention Program Trumps Usual Care in “Real World” Trial

At-risk teens exposed to a program that teaches them to counteract their unrealistic and overly negative thoughts experienced significantly less depression than their peers who received usual care, NIMH-funded researchers have found. However, the cognitive behavioral prevention program failed to similarly help adolescents prone to the mood disorder if their parents were currently depressed.

NIMH grantee Judy Garber, Ph.D., of Vanderbilt University, and colleagues, report on the findings of their multi-site clinical trial in the June 3, 2009 issue of the Journal of the American Medical Association.

Background
Only a fourth of depressed youth receive any treatment and at least 20 percent develop a chronic, difficult-to-treat form of the illness. Having a history of the illness substantially increases risk for depression, which soars two to three times among children of depressed parents. An initial study had supported the efficacy of a cognitive behavioral prevention program in reducing risk in such depression-prone teens, but it was unknown whether this would hold up across diverse "real world" settings.

To find out, Garber and Drs. David Brent, the University of Pittsburgh, William Beardslee, Boston Children's Hospital and Judge Baker Children's Center, and Gregory Clarke, Kaiser Permanente Center for Health Research in Portland, OR, randomly assigned 316 at-risk adolescents (aged 13-17) to either the cognitive behavioral program or usual care.
Teens in the cognitive behavioral program received eight weekly 90-minute group cognitive behavioral sessions. Masters or doctoral-level therapists helped them learn to restructure dysfunctional thinking patterns and practice problem solving skills. This was followed by six monthly continuation sessions in which they reviewed the cognitive and problem-solving skills and also learned relaxation, assertiveness and behavioral activation techniques.

Teens in the usual care condition as well as those in the cognitive behavior program were allowed to begin or continue with any mental health or other healthcare services available in their communities.

Results of This Study
Over a 9-month follow-up period, the rate of depression in the cognitive behavioral program group was 11 percent lower than for those in the usual care condition — 21.4 percent vs. 32.7 percent. Adolescents in the prevention program also self-reported lower levels of depression symptoms than those in usual care. Among teens whose parents were not depressed at the beginning of the study, the program was more effective in preventing onset of depression than usual care — 11.7 percent vs. 40.5 percent. However, this advantage did not hold for youth in the cognitive behavioral program if they had a parent who was depressed at the start of the study. Such teens had significantly higher rates of depression than those without a currently depressed parent.

Significance
The results demonstrate that the prevention program can be effectively delivered in a variety of "real world" settings, say the researchers.
"For every 9 adolescents who received the cognitive intervention, we would expect to prevent one from developing a depressive episode," explained Garber. "This is comparable to what is seen with treatment response to medication."
Moreover, preventing recurrence of a depressive episode may arguably bring even greater benefits than treating an episode after it has already produced other negative consequences. This suggests that the program may be useful for maintaining recovery, once achieved, she noted.

What's Next?
"Our results also underscore the link between changes in parent and youth depression. Future investigations might explore combining or sequencing parental depression and prevention programs for at-risk teens."

Reference
Prevention of depression in at-risk adolescents: a randomized controlled trial. Garber J, Clarke GN, Weersing VR, Beardslee WR, Brent DA, Gladstone TR, DeBar LL, Lynch FL, D'Angelo E, Hollon SD, Shamseddeen W, Iyengar S. JAMA. 2009 Jun 3;301(21):2215-24.PMID: 19491183

STEPPS: A Viable Supplement to Treatment of Borderline Personality Disorder

2009-06-28T23:19:00.000-04:00

June 25, 2009
Psychiatric Times.
NEWS
STEPPS: A Viable Supplement to Treatment of Borderline Personality Disorder
by T. M. Ness, MD
Dr Ness is a psychiatrist currently practicing in California.

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Two randomized controlled trials have shown the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program to be effective in reducing the intensity of core aspects of borderline personality disorder (BPD), Dr Donald Black and social worker Nancee Blum announced at the annual meeting of the American Psychiatric Association held recently in San Francisco. Black summarized, “Data from several studies show that STEPPS reduced global severity as rated by clinicians and patients, borderline personality disorder symptoms, and depressive symptoms."

STEPPS is a 20-week, manual-based, psychoeducational group treatment that combines skills training with cognitive-behavioral techniques. It includes a systems component to train family members, friends, and significant others.1,2

STEPPS did not appear to reduce hospital utilization or suicidal ideation, although it reduced emergency department visits and showed a trend toward fewer suicide attempts. “The advantages of STEPPS when compared with other programs that currently treat BPD are that it is relatively easy to learn and implement, uses a short time frame, and can be added into existing treatment systems. We consider it a value-added adjunct to therapy and medications,” Black explained. “STEPPS has already been implemented in the prison population.”

STEPPS is usually delivered by 2 leaders in a weekly 2-hour group of 6 to 10 participants. It generally begins with participants filling out the BEST (Borderline Evaluation of Severity over Time) self-report scale of borderline symptom severity, and graphing their BEST score so that they can monitor weekly progress in diminishing their symptom intensity. “We developed the BEST as a way of quantifying the severity of borderline symptomatology, and of tracking utilization of positive coping skills. Studies have shown it to be a reliable and valid measure,” said Black. Participants then enjoy a brief relaxation exercise, such as deep breathing or coloring complex geometric patterns. Next, one participant will share how much time he or she spent in each of 5 domains of escalating “emotional intensity” during the past week, and what new skills she used to de-escalate herself when she was in danger of “boiling over.”

One set of skills pertains to emotion management. These skills include learning to distance or distract oneself from current problems, challenging one’s own negative schemas or “cognitive filters,” and managing daily problems. Another set of skills involve behavioral self-management. Clients learn to set goals, practice self-care, avoid substances, and normalize their eating, sleeping and exercise patterns. Group leaders present a new skill each week, and clients then preview their homework for the upcoming week, which they are supposed to use “in vivo.”

For example, a client might become progressively more upset that her boyfriend is late coming home. She may notice that her body is getting more tense and her mood more irritable. She may notice that she is having behavioral urges—such as wanting to use drugs, drive over and confront him at his workplace, or harm herself. Her thoughts may become more extreme: “He is going to break up with me! I’ll always end up alone.” With the STEPPS program, the client is taught to challenge her negative cognitions: “Not every disappointment ends in abandonment.” She learns to monitor her level of physical and emotional distress, and use soothing techniques to calm herself. She might decide to do some light exercise or distract herself with a good book. She may decide to use a more positive communication strategy—“In the future, I’d appreciate a phone call when you’re running late, because otherwise I worry.”

One unique aspect of STEPPS is that patients identify a “reinforcement team,” which consists of friends, family members, and professionals who are willing to coach the client when she is in crisis. These support people are invited to one of the training group sessions. They learn to ask simple questions that help the person with BPD when she is in crisis: “What is your level of emotional intensity? What skills can you use to reduce your distress? May I remind you of the STEPPS coping skills so you can pick which one you are going to try?” Patients are periodically reminded in the group sessions to expand their reinforcement team. “One of the best things about having a reinforcement team is that everyone speaks a common language,” explained Blum.

Blum and Black have already adapted the STEPPS program for implementation in correctional facilities in Iowa and elsewhere in the Midwest. Blum sometimes leads the prison groups via teleconference from her University of Iowa office. “The groups work well and I can see everyone’s face. We always begin with everyone holding up their emotional intensity graphs so I can see how they’ve done over the week.” Response from the correctional facilities and parole boards has been very positive. “The biggest adaptation we’ve made is to shorten the program duration to 10 sessions and increase the frequency of sessions. Otherwise, people get moved around in prison and may not be able to complete the program. We’ve also had correctional boards that didn’t want to release an inmate until she had completed the STEPPS program. Inmates with literacy challenges are welcome to come to optional weekly STEPPS homework groups. We encourage inmates who can read and write to be a model and mentor for their peers in these groups,” Blum said.

Future directions include development of a yearlong, less intense aftercare program called Stairways, and adaptations of specialized versions for adolescents, people with substance abuse disorders, and people with mental retardation. Black summarized, “We consider STEPPS a viable supplement to current treatment of BPD.”

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References
1. Blum N, St John D, Pfohl B, et al. Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry. 2008;165:468-478.
2. Van Wel B, Kockmann I, Blum N, et al. STEPPS group treatment for borderline personality disorder in The Netherlands. Ann Clin Psychiatry. 2006;18:63-67.

Serenity Now

2009-05-15T23:08:00.001-04:00

Research Suggests Children Can Recover from Autism with Behavioral Therapy

2009-05-15T22:38:00.002-04:00

Provided by: Associated PressWritten by: Lindsey Tanner, THE ASSOCIATED PRESS May. 8, 2009
CHICAGO - Leo Lytel was diagnosed with autism as a toddler. But by age nine he had overcome the disorder.

His progress is part of a growing body of research that suggests at least 10 per cent of children with autism can "recover" from it - most of them after undergoing years of intensive behavioral therapy.

Skeptics question the phenomenon, but University of Connecticut psychology professor Deborah Fein is among those convinced it's real.

She presented research this week at an autism conference in Chicago that included 20 children who, according to rigorous analysis, got a correct diagnosis but years later were no longer considered autistic.

Among them was Leo, a boy in Washington, D.C., who once made no eye contact, who echoed words said to him and often spun around in circles - all classic autism symptoms. Now he is an articulate, social third-grader. His mother, Jayne Lytel, says his teachers call Leo a leader.
The study, funded by the National Institute of Mental Health, involves children ages nine to 18.
Autism researcher Geraldine Dawson, chief science officer of the advocacy group Autism Speaks, called Fein's research a breakthrough.
"Even though a number of us out in the clinical field have seen kids who appear to recover," it has never been documented as thoroughly as Fein's work, Dawson said.
"We're at a very early stage in terms of understanding" the phenomenon, Dawson said.
Previous studies have suggested between three per cent and 25 per cent of autistic kids recover. Fein says her studies have shown the range is 10 per cent to 20 per cent.
But even after lots of therapy - often carefully designed educational and social activities with rewards - most autistic children remain autistic.
Recovery is "not a realistic expectation for the majority of kids," but parents should know it can happen, Fein said.
Doubters say "either they really weren't autistic to begin with ... or they're still socially odd and obsessive, but they don't exactly meet criteria" for autism, she said.
Fein said the children in her study "really were" autistic and now they're "really not."
University of Michigan autism expert Catherine Lord said she also has seen autistic patients who recover. Most had parents who spent long hours working with them on behaviour improvement.
But, Lord added, "I don't think we can predict who this will happen for." And she does not think it's possible to make it happen.

The children in Fein's study, which is still ongoing, were diagnosed by an autism specialist before age five but no longer meet diagnostic criteria for autism. The initial diagnoses were verified through early medical records.

Because the phenomenon is so rare, Fein is still seeking children to help bolster evidence on what traits formerly autistic kids may have in common. Her team is also comparing these children with autistic and non-autistic kids.

So far, the "recovered" kids "are turning out very normal" on neuropsychological exams and verbal and non-verbal tests, she said.

The researchers are also doing imaging tests to see if the recovered kids' brains look more like those of autistic or non-autistic children. Autistic children's brains tend to be slightly larger than normal.

Imaging scans also are being done to examine brain function in formerly autistic kids. Researchers want to know if their "normal" behaviour is a result of "normal" brain activity, or if their brains process information in a non-typical way to compensate for any deficits.
Results from those tests are still being analyzed.

Most of the formerly autistic kids got long-term behaviour treatment soon after diagnosis, in some cases for 30 or 40 hours weekly.

Many also have above-average IQs and had been diagnosed with relatively mild cases of autism. At age two, many were within the normal range for motor development, able to walk, climb and hold a pencil.

Significant improvement suggesting recovery was evident by around age seven in most cases, Fein said.

None of the children has shown any sign of relapse. But nearly three-fourths of the formerly autistic kids have had other disorders, including attention-deficit problems, tics and phobias; eight still are affected.

Jayne Lytel says Leo sometimes still gets upset easily but is much more flexible than before.

On the Net
National Institute of Mental Health: http://www.nimh.nih.gov
Autism Speaks: http://www.autismspeaks.org

Mindfulness-Based Cognitive Therapy

2009-04-24T13:11:00.003-04:00

People with severe and recurrent depression could benefit from a new form of therapy that combines ancient forms of meditation with modern cognitive behaviour therapy, early-stage research by Oxford University psychologists suggests.

The results of a small-scale randomized trial of the approach, called mindfulness-based cognitive therapy (MBCT), in currently depressed patients are published in the journal Behaviour Research and Therapy.

Twenty eight people currently suffering from depression, having also had previous episodes of depression and thoughts of suicide, were randomly assigned into two groups. One received MBCT in addition to treatment as usual, while the other just received treatment as usual. Treatment with MBCT reduced the number of patients with major depression, while depression remained the same in the control group.

MBCT brings together modern cognitive behavior therapy with the ancient practice of mindfulness meditation. Participants attend classes that include meditation learning, education about depression, and advice on how participants can best look after themselves when their feelings threaten to overwhelm them. One way that the treatment benefits people is helping them to live more in the moment, rather than be caught up in upsetting memories from the past or worries about the future. More.....

So, as George's father on Seinfeld would say, Serenity Now! Check out this video clip http://www.youtube.com/watch?v=5513mXmQbw4

Former FDA chief says bad foods may hijack the brains of overeaters

2009-04-21T20:06:00.000-04:00

Provided by: Associated PressWritten by: Lauran Neergaard, THE ASSOCIATED PRESS Apr. 21, 2009
WASHINGTON - Food hijacked Dr. David Kessler's brain.

Not apples or carrots. The scientist who once led the U.S. government's attack on addictive cigarettes can't wander through part of San Francisco without craving a local shop's chocolate-covered pretzels. Stop at one cookie? Rarely.
It's not an addiction but it's similar, and he's far from alone. Kessler's research suggests millions share what he calls "conditioned hypereating" - a willpower-sapping drive to eat high-fat, high-sugar foods even when they're not hungry.

More.....

Predicting When It's Time for Alzheimer's Patients to Stop Driving

2009-04-08T23:49:00.001-04:00

Provided by: Associated PressWritten by: Lauran Neergaard, THE ASSOCIATED PRESS Apr. 7, 2009

WASHINGTON - Scientists are creating tests to show when it's time for people with early Alzheimer's disease to stop driving. \

It's one of a family's most wrenching decisions, and as Alzheimer's increasingly is diagnosed in its earliest stages, it can be hard to tell when a loved one is poised to become a danger.
Factor in that many placeslack public transportation, and quitting too soon restricts independence for someone who otherwise may function well for several years.
"That's a real cost to the individual and family and society," says Jeffrey Dawson of the University of Iowa. "You have to have some sort of trade-off between the individual's independence along with the safety of the driver and with other people on the road."

Typically, specialists say, patients gradually scale back their driving, avoiding busy freeways or night trips or left-turn intersections. Alzheimer's Association adviser Sue Pinder, 58, recently gave up big-city driving even though it meant fewer visits to a daughter in Dallas.
Shortly after Pinder's diagnosis in 2004, she signed a form designating her husband to decide when she'll quit driving altogether. He gave her a GPS system for her last birthday. It helped Pinder navigate unfamiliar streets when, to be near another daughter, the couple recently moved to West Monroe, La., from a nearby town.

"That's helped a lot where I don't have to worry, I can concentrate on my driving and not the directions," Pinder says.

Working on ways to help similar patients, Dawson's team in Iowa developed an intricate behind-the-wheel exam: A 55-kilometre drive through rural, residential and urban streets in a tricked-out Ford Taurus able to record just about every action the driver takes, much like an airplane "black box" does. Lipstick-size video cameras were positioned to show oncoming traffic, too.
Researchers recruited 40 people with early-stage Alzheimer's who still had their driver's licences to take the road test, and compared how 115 older drivers without dementia handled the same trip.

The results, reported in the journal Neurology, are striking. On average, the Alzheimer's drivers committed 42 safety mistakes, compared with 33 for the other drivers.
Lane violations, such as swerving or hugging the centre line as another car approaches, were the biggest problem for the Alzheimer's drivers. They performed 50 per cent worse.
Overall errors rose with increasing age whether or not the driver had Alzheimer's, an extra 2 1/2 mistakes for every five years of age.

But some Alzheimer's patients drove just as well as their healthier counterparts, stresses Dawson, a biostatistics professor. Here's the key: Researchers also checked whether any of a battery of neuropsychological tests given beforehand accurately predicted who would drive worse - and some did.

Flunking simple memory tests didn't make a difference. Standard neurologic tests of multitasking abilities did, ones that assess if people's cognitive, visual and motor skills work together in a way to make quick decisions. Examples include showing patients geometric figures for a few seconds and having them draw the shape from memory, or drawing paths between a sequence of numbers and letters.

Alzheimer's patients who scored average or better on those types of written tests were likewise no worse behind the wheel than other older drivers - but those who scored worse than average tended to commit about 50 per cent more errors on the road, Dawson says.
More research is needed but the ultimate goal is an easy doctor's-office exam to help guide when patients should give up the keys.

About 600,000 elderly adults stop driving in the United States for some health reason every year, according to the National Institute on Aging. But there's little clear guidance for the roughly two million people estimated to be in Alzheimer's early stages, and the disease is poised to skyrocket in two decades as the population greys.
States and provinces have varying laws on when aging drivers must pass a road test for a licence renewal, but they seldom address specific diseases; California requires reporting of Alzheimer's diagnoses so driving can be assessed. The Alzheimer's Association tells families warning signs of unsafe driving.

But as Alzheimer's worsens, patients often vehemently deny that they're a hazard, says Dr. Gary Kennedy, geriatric psychiatry chief at New York's Montefiore Medical Center.
"I can be the bad guy," he tells families, sometimes reporting patients to the Department of Motor Vehicles for a driving test or advising relatives to disable the car.

"Giving up the car is not like going into the nursing home," Kennedy counsels patients, trying to recruit relatives or friends to schedule rides. "If as a society we recognize this as a danger, we need to help them compensate."
-
On the Net:
Alzheimer's Association: http://www.alz.org/living-with-alzheimers-driving.asp
Find a driving rehabilitation specialist: http://www1.aota.org/olderdriver/index.html
Licensing laws from Insurance Institute for Highway Safety: http://www.iihs.org/laws/OlderDrivers.aspx

Insomnia Drugs and Driving

2009-03-29T22:42:00.003-04:00

Insomnia drugs and impaired driving ability by Anxiety Insights
Friday, 27 March 2009
Julie Johansen

A new study from the Norwegian Institute of Public Health shows a positive link between the amount of the hypnotic zopiclone (Imovane®, Lunesta®, Zimovane®) in the blood and the chance of being assessed as impaired in a clinical examination. The study also included drivers who only showed alcohol in their blood test.

"This could be important information in the discussion about establishing legal limits in traffic for sedatives or sleep-inducing medicines as we have for alcohol," says Ingebjørg Gustavsen from the Division for Forensic Toxicology and Drug Research.

Hypnotics that contain zopiclone and zolpidem (Ambien®, Damixan®, Stilnox®) are widely used throughout the world and it is reported that between 3 and 7 percent of the adult population uses these drugs. Researchers at the Norwegian Institute of Public Health studied if there is a link between the concentration of zopiclone or zolpidem in the blood and being assessed as impaired during a clinical examination. The study was done on anonymised material by comparing blood samples and results from clinical tests for the period January 2000 to December 2007. The same study was performed on another group of drivers who only had alcohol in the blood.

The proportion of drivers who were evaluated as impaired increased with zopiclone-concentration in the blood. A similar positive link was not found for zolpidem. For alcohol, as expected, there was a significant link between the proportion of impaired drivers and alcohol concentration in the blood.

"We know that the clinical examination performed on suspicion of driving under the influence is a test that is most sensitive for alcohol impairment, and less sensitive for other substances. Other types of impairment are therefore not necessarily picked up with this study, which can explain why we have not found positive links for zolpidem. Another reason can be that there were few drivers in our sample, particularly in the groups with low concentrations," says Gustavsen.

The proportion of drivers who were evaluated as impaired was relatively similar for the group that had 130 µg/l zopiclone or more in the blood and the group that had a blood alcohol concentration higher than 0.1 percent. A concentration of 130 µg/l zopiclone in the blood suggests intake of at least 2 large doses of zopiclone.

"Zopiclone and zolpidem are usually used in moderate amounts before bedtime, and will often be excreted from the body by the next morning. There are few users of these hypnotics that are stopped by police based on suspicion of driving under the influence. In the meantime we know that these substances also have abuse potential, as do other sedative or sleep-inducing medicines. Over 90 % of the drivers included in the study because of zopiclone- / zolpidem-use had higher concentrations of the substances in the blood than one would expect from normal therapeutic use of sleeping tablets before bedtime," concludes Gustavsen.

Gustavsen I, Al-Sammurraie M, Mørland J, Bramness JG. Impairment related to blood drug concentrations of zopiclone and zolpidem compared to alcohol in apprehended drivers.

Accid Anal Prev. 2009 Mar; doi:10.1016/j.aap.2009.01.011 [Abstract]

Comment: While this study didn't find significant impairment with zolpidem, this hypnotic has been linked to sleep walking, sleep driving and other potentially dangerous behavior. However, it is also one of the few sleeping pills approved () - with restrictions - by the USAF for use by air crew. Comment by Anxiety Insights

Tomorrow's Antidepressants: Skip the Serotonin Boost?

2009-03-19T10:23:00.001-04:00

Science UpdateFebruary 14, 2008

Scientists Reverse Depression-Like Behaviors In Mice Without Raising Serotonin Levels
New research adds to evidence of potentially better molecular targets in the brain to treat depression and other mental disorders, according to NIMH-funded scientists.
The researchers suggest that imbalances in the activity of an enzyme called GSK3ß may be closer to the root cause of mental illnesses than are low serotonin levels. Serotonin, a brain chemical, is the ultimate target of several current medications that work by indirectly increasing it to relieve symptoms. In preliminary findings, the scientists suggest that GSK3ß might be a more fundamental – and thus, perhaps, better and faster – target for new medications.
In the new study, even when serotonin levels stayed low, the scientists were able to correct abnormal, mental-illness-like behaviors in mice by blocking GSK3ß. When activated, GSK3ß plays a crucial role inside brain cells by sending chemical signals that help regulate cell function – but this activity must occur at the right time and in the right amount for the brain to function properly.
To assess the effects of blocking GSK3ß, the scientists measured anxiety- and depression-like behaviors shown earlier to be linked to low serotonin levels in mice. For example, compared to normal mice, those with low serotonin gave up sooner when held back by their tails and were slower to come out of dark hiding places to explore their surroundings.
These abnormal behaviors were reversed when scientists blocked GSK3ß in mice with low levels of serotonin. The scientists blocked the enzyme with either genetic engineering or a chemical compound. Success with both approaches strengthens the case for GSK3ß's involvement in mental illnesses – and its potential, with further research, as a new target for medications, the researchers say.

More About the Science
Serotonin is one of several neurotransmitters through which brain cells communicate with each other. Abnormalities in the serotonin system are known to occur in depression, bipolar disorder, anxiety disorder, autism, and schizophrenia, for example.
But increasingly abnormalities in the serotonin system appear to be just one part of chains of molecular events that underlie various mental disorders. Recent research reveals that components such as GSK3ß are involved in these chains of events.
In this study, scientists based their experiments on a gene that makes Tph2, another enzyme involved in serotonin production. A variation of that gene has been linked to depression in some people, and in this study, mice genetically engineered with an equivalent mutation in the Tph2 gene had an 80 percent drop in brain serotonin levels.
As serotonin levels dropped, the GSK3ß enzyme went into action, sending chemical signals into brain cells, and the mice developed abnormal behaviors. The scientists corrected the abnormal behaviors not by increasing serotonin levels, as current medications for many mental disorders do, but by blocking the GSK3ß enzyme, instead.
Taken together, the results offer evidence that both the GSK3ß enzyme and the Tph2 gene play a role in some mental disorders.

Reference
Beaulieu J-M, Zhang X, Rodriguiz RM, Sotnikova TD, Cools MJ, Wetsel WC, Gainetdinov RR, Caron MG. Role of GSK3ß in behavioral abnormalities induced by serotonin deficiency. Proceedings of the National Academy of Sciences, 105(4):1333-1338. January 29, 2008

Mindfulness

2009-02-05T15:08:00.003-05:00

Mindfulness is intentionally paying attention to the present moment while putting aside our preconceived ideas, expectations, and judgments. It is being in connection with the here and now.

Over the past 30 years there has been a buildup of evidence-based research using mindfulness practice to work with difficult medical and mental health issues such as stress, anxiety, depression, relationships, addiction, insomnia, chronic pain, immune function, cancer, trauma, and more.

Check this out: Mindfulness Blog by Dr. Goldstein:

"The practice of mindfulness teaches us a different way to relate to our thoughts, feelings, and emotions as they arise. It is about learning to approach and acknowledge whatever is happening in the present moment, setting aside our lenses of judgment and just being with whatever is there, rather than avoiding it or needing to fix it. It’s the mind’s attempt to avoid and fix things in this moment that fuels the negative mood. So, if sadness is there, instead of trying to fix it or figure it out, we might just acknowledge the sadness and let it be. If self-judgments arise (e.g., I am weak, I am a loser) out of past sensitivities to having been depressed before, we can acknowledge that they are associations from teh past, let them be, and then gently bring ourselves back to whatever we were doing. In doing this, we’re stopping the ruminative cycle that might occur between our thoughts, feelings, and physical sensations that can play off one another leading us to a relapse.

Now, this is easier said than done and it takes practice.

Practice - One way to practice mindfulness is to use the breath as an object of awareness. You can place attention at the tip of the nose or the belly and as you breathe in, just acknowledge the breath coming in and as you breathing out just acknowledge the breathe going out. As if you were greeting and saying goodbye to an old friend. When the mind wanders, as it will always do, just say to yourself “wandering” and then gently bring your attention back to the breath just noticing it coming in and going out. Most of us catch the mind wandering and gently bring it back billions of times, so know that it is normal for the mind to wander often. You can do this for as little as 1 minute or as much as 30 minutes or more."

Interface Consultation Services - Update

2009-01-12T21:11:00.002-05:00

A brief overview of Interface Consultation Services current endeavors:

I. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

II. MPRI - Michigan Prisoner Re-entry Initiative for the Mentally Ill - ICS is contracted as the Regional Care Coordinators for the Western Michigan providing services to 18 counties. ICS has hired 6 contracts to assist with this initiative. This speciality program is designed for mentally ill prisoners who are returning to the community. As Care coordinators we provide funding for housing, psychiatric medications, specialized placements as well as care coordination and consultation on some very difficult cases for the program.

III. Passages - ICS is offering Mobile, Intensive, Short-term, Targeted Case Management Services located in Western Michigan which provides a case management service option that requires an immediate, flexible, direct-service and mobile response. This service is designed to provide the intensity of services needed to the non-severely and persistently mentally ill/indigent population that are currently underserviced or are unable to obtain these services at this time through traditional providers.

IV. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center.

V. College Level Course - ICS owner/partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.

VI. Blog Focus - We continue to post on ICS and Counseling Connections.Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.

VII. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.

Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.

It takes guts and low serotonin levels to build bone

2008-12-01T06:45:00.000-05:00

By Elizabeth Streich

Bone growth is controlled in the gut through serotonin, the same naturally present chemical used by the brain to influence mood, appetite and sleep, according to a new discovery from researchers at Columbia University Medical Center. Until now, the skeleton was thought to control bone growth, and serotonin was primarily known as a neurotransmitter acting in the brain. This new insight could transform how osteoporosis is treated in the future by giving doctors a way to increase bone mass, not just slow its loss. Findings are reported in the Nov. 26, 2008 issue of Cell.

See Anxiety Insights for full article...

The Complex Relationship Between Menstrual Cyclicity and Anxiety Disorders

2008-11-30T12:00:00.001-05:00

Miki Peer, Claudio N. Soares, MD, PhD, and Meir Steiner, MD, PhD

Ms Peer reports that she has no conflicts of interest concerning the subject matter of this article. Dr Soares reports that he has received grant/research support from AstraZeneca and GlaxoSmithKline; he is a consultant for Sepracor, GlaxoSmithKline, Wyeth-Ayerst, and Neurocrine; and he is on the Promotional Speakers' Bureau of GlaxoSmithKline, Wyeth-Ayerst, Forest Laboratories, and Pfizer. Dr Steiner reports that he has received grant/ research support from Wyeth, Pfizer, and AstraZeneca; he is a consultant for Eli Lilly, Pfizer, GlaxoSmithKline, Lundbeck, Novartis, Wyeth, OrthoMcNeil, AstraZeneca, and Azevan Pharmaceuticals; he is on the advisory board of Eli Lilly, GlaxoSmithKline, Pfizer, Lundbeck, OrthoMcNeil, Wyeth, Schering, Ferring, and Azevan Pharmaceuticals; and he is on the Speakers' Bureau of AstraZeneca, GlaxoSmithKline, Eli Lilly, and Wyeth.

The ocurrence and severity of anxiety disorders have been correlated with fluctuations in female sex steroid levels in both epidemiological and experimental studies.1-5 Female reproductive hormones play a role not only in the development and course of anxiety disorders but also in treatment response.1,2,6-12 This article focuses on the premenstrual exacerbation of anxiety disorders and briefly reviews the biological pathways and physiological mechanisms thought to contribute to the expression of different anxiety disorder subtypes. Female steroid hormone influences on pharmacological properties of psychoactive drugs used to treat anxiety disorders are also addressed, because these may contribute to treatment response in women who experience premenstrual exacerbation of these disorders.

Recommendations for Clinical Practice:

A better clinical practice to manage anxiety disorders would include:
• A careful assessment of sex-specific triggers of anxiety.
• A clinical interview performed on 2 consecutive occasions (1 in the luteal phase and 1 in the follicular phase of the menstrual cycle).
• The use of a diary for at least 1 menstrual cycle to prospectively chart anxiety symptoms and help identify temporal associations with hormonal changes or possible comorbid disorders.

Once treatment is initiated, women with anxiety disorders should be evaluated during the course of the menstrual cycle for continuous effectiveness of their medications.

Women who exhibit premenstrual exacerbation of anxiety disorders may respond to increased doses immediately preceding or during the luteal phase.48,59 Progesterone augmentation may be a therapeutic option for women with anxiety disorders who do not respond, or who respond only partially, to standard therapeutic regimens.2,38

See full article at Psychiatric Times....

U.S. researchers call off controversial autism study

2008-11-28T23:56:00.000-05:00

Provided by: Associated PressWritten by: THE ASSOCIATED PRESS Sep. 17, 2008

CHICAGO - A government agency in the United States has dropped plans to test a controversial treatment for autism that critics had called an unethical experiment on children.

The National Institute of Mental Health said in a statement Wednesday that the study of chelation (kee-LAY'-shun) has been discontinued. The statement says the agency decided the money would be better used testing other potential therapies for autism and related disorders.
The study had been on hold because of safety concerns . A study published last year linked a chemical used in the treatment to lasting brain problems in rats.

The treatment removes heavy metals from the body and is based on the fringe theory that mercury in vaccines triggers autism - a theory never proved and rejected by mainstream science.

Wanted - Experienced Mental Health Clinicians

2008-08-22T22:29:00.001-04:00

Experienced mental health clinicians sought. Community Mental Health Experience Preferred. Masters degree in Psychology or Social Work, licensed in State of Michigan.
Contractual positions.

Submit Resume and Cover Letter: Interface@pcsjxn.com

Interface Consultation Services - Update

2008-08-10T00:31:00.004-04:00

A brief overview of Interface Consultation Services current endeavors:

I. Blog Focus - We continue to post weekly on ICS and Counseling Connections.Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.

II. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.

III. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

IV. MPRI - Michigan Prisoner Re-entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Western Michigan providing services to 18 counties. ICS has hired 5 contracts to assist with this initiative. This program continues to grow at a very fast pace and it the only program of it's kind in the US. This speciality program is designed for mentally ill prisoners who are returning to the community. As Care coordinators we provide funding for housing, psychiatric medications, specialized placements as well as care coordination and consultation on some very difficult cases for the program.

V. Passages - ICS is offering Mobile, Intensive, Short-term, Targeted Case Management Services located in Western Michigan will provide case management service option that requires an immediate, flexible, direct-service and mobile response.

This service is designed to provide the intensity of services needed to the non-severely and persistently mentally ill/indigent population that are currently underserviced or are unable to obtain these services at this time through traditional providers.

VI. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center.

VII. College Level Course - ICS owner/partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.

Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.

Co-Creators

2008-06-10T09:10:00.002-04:00

You create your own adventures.

Lyme Disease and Psychiatric Symptoms

2008-06-10T09:02:00.002-04:00

We cannot overemphasize the important of differential diagnosis in evaluation of physical and mental health. This article clearly describes an instances of misdiagnosis.

We hope you find this informative during the mosquito season....

Lyme disease can masquerade as a host of psychiatric ills, confounding doctors and driving patients to question their very sanity.
By: Pamela Weintraub
1993, I spread a map across the living room of our apartment in Forest Hills, Queens, and marked a bull's-eye at Grand Central Station, where trains come in from the 'burbs. I drew a 50-mile radius around the mark, and spent the next three months searching, with my husband, Mark, for a house. We sought top-rated schools for our two boys, proximity to a train en route to Manhattan, and an ample yard. As chance would have it, we ended our hunt at the most devastatingly beautiful spot, a winding country road abutting a spruce forest in the tony suburban hamlet of Chappaqua, in Westchester County, New York.

It would be the biggest mistake of our lives. If only we'd known how infected we'd get living on that land and how much skepticism we would face as we sought treatment, if only we'd understood that we, ourselves, would be the bull's-eye. We never would have left Queens. It took years for us to understand that the vague headaches, joint pain, and bone-weariness we initially experienced were more than just symptoms of our busy suburban lives: Instead of receiving early diagnoses and treatment for what really ailed us—Lyme disease—our infections were allowed to smolder, eventually becoming neurological and eluding the simple cure that could have worked at the start.

It was all so gradual. In the fall of '93, I began to feel ill. Though I never took a day off work, I functioned for years through an avalanche of impediments. Migraines with nausea had become my steady companion. I had intermittently sore and swollen knees, and the buzzing in my left hand was so intense my fingers sometimes formed claws. My vision, at 20/20 for most of my life, had begun a sudden, precipitous decline.

Mark, meanwhile, was teetering. An avid tennis player with great coordination, he began stumbling and bumping into walls. Formerly affable, he began exploding at offenses as slight as someone spilling water on the floor. He was an award-winning journalist with a love of literature and a vocabulary so vast he was our stand-in dictionary. But gradually he began struggling with memory and groping for words. He left his job as an editor after realizing, one day, that he'd spent hours trying to read a single, simple paragraph.

Our younger son, David, began to sleep—first so long that he could not do his homework or see friends; eventually, so much (15 hours a day) that he could not get to class. Violating the strict attendance policy at his prep school but without a medical diagnosis, he was asked to leave. Hardest hit was Jason, the elder, who suffered fatigue and shooting pains starting at age 9, the summer we took up residence in our fairy-tale house. The doctors called these growing pains normal, but by age 16 in the year 2000, Jason was essentially disabled. He couldn't think, walk, or tolerate sound and light. His joints ached all day. On medical leave from high school, he spent his days in the tub. As his condition worsened and doctors at the teaching hospitals of Manhattan eliminated one diagnosis after the next, I began to wonder about Lyme disease. Yet throughout most of Jason's decline, our pediatrician dismissed the notion out of hand.

Psychology Today Magazine, May/Jun 2008Last Reviewed 3 Jun 2008Article ID: 4579

A Psychiatric Review of Symptoms by the American Academy of Family Physicians

2008-05-15T11:11:00.004-04:00

This work by the author of the article below provide useful tools for quick and fairly accurate examination of symptoms which can lend a provisional psychiatric diagnosis. That being said, interviewing techniques can be used to increase the accuracy of self-report but collateral information from physiological evidence and other sources (other clinicians, family, etc) greatly improves the accuracy of these evaluations.

Please link to the site for the full article.
The Psychiatric Review of Symptoms: A Screening Tool for Family Physicians

DANIEL J. CARLAT, M.D.,
Anna Jacques Hospital,
Newburyport, Massachusetts

The psychiatric review of symptoms is a useful screening tool for identifying patients who have psychiatric disorders. The approach begins with a mnemonic encompassing the major psychiatric disorders: depression, personality disorders, substance abuse disorders, anxiety disorders, somatization disorder, eating disorders, cognitive disorders and psychotic disorders. For each category, an initial screening question is used, with a positive response leading to more detailed diagnostic questions. Useful interviewing techniques include transitioning from one subject to another rather than abruptly changing subjects, normalization (phrasing a question to convey to the patient that such behavior is normal or understandable) and symptom assumption (phrasing a question to imply that it is assumed the patient has engaged in such behavior). The psychiatric review of symptoms is both rapid and thorough, and can be readily incorporated into the standard history and physical examination. For More.......

Research on Effectiveness of Psychotherapies for Children

2008-04-20T13:45:00.002-04:00

The National Instititute of Mental Health has completed en evaluation of research and the effectiveness for mental disorders for children. Please see NIMH site and below..

Reviews of the current research on psychosocial and behavioral therapies, or psychotherapies, for children and adolescents found a number of "well established" and "probably efficacious" treatments for many mental disorders. For example, six were "probably efficacious" for anxiety disorders, and two were "well established" for attention deficit hyperactivity disorder (ADHD), according to scientists funded by NIMH and the National Institute on Drug Abuse, divisions of the National Institutes of Health.

The results were published in a special issue of the Journal of Clinical Child and Adolescent Psychology, and cover the current state of research psychotherapies for children and adolescents with mental disorders. NIMH grantees Wendy Silverman, Ph.D., of Florida International University, Miami, and Stephen Hinshaw, Ph.D., of the University of California, Berkeley, served as guest editors. This special issue provides a 10-year update on the original special issue on psychosocial treatments, published in 1998.

"Even for the most effective interventions, there is substantial individual variability in treatment response," said Benedetto Vitiello, chief of NIMH's Child and Adolescent Treatment and Preventive Intervention Research Branch. "Further research is needed to understand the factors accounting for treatment effects and to identify predictors of response, in order to eventually arrive at more targeted and specific intervention strategies."

Overall, the 10 articles in the special issue reveal considerable advances over the past decade in the quality and quantity of research on psychosocial treatments for children with mental disorders. Among notable findings:

A review of 32 studies by Silverman and her colleagues concluded that six therapies for anxiety disorders have substantial research support and met the criteria for "probably efficacious" and may be helpful for treating children and adolescents with anxiety disorders. These treatments are:

Individual cognitive behavioral therapy.
Group cognitive behavioral therapy (GCBT).
GCBT with parents.
GCBT for social phobia.
Social effectiveness training for children with social phobia.

Few large-scale trials on anxiety disorders have compared specific psychosocial therapies with credible control conditions. As a result, to date, no specific psychotherapies met the most stringent criteria for "well-established treatments" used for this article. However, the second-highest ranking of "probably efficacious" denotes considerable research evidence supporting a treatment's usefulness, so mental health care providers can be confident in using the therapies listed, Silverman says.

A review of 46 studies by William Pelham, Jr., Ph.D., and Gregory Fabiano, Ph.D., both of the State University of New York at Buffalo, found that two psychosocial treatments are "well-established" for treating ADHD in children and adolescents:

Behavioral parent training.
Behavioral classroom management.

The authors also found a third type of well-established behavioral intervention called the Summer Treatment Program (STP), which focuses on peer relationships and is often given in recreational, summer camp-like settings. Children in STP typically receive more hours of treatment in a week compared to other weekly forms of psychotherapy, but STP is more expensive, and harder to provide in the community, and harder to find than behavioral parent training and behavioral classroom management.

In addition to anxiety and ADHD, the special issue also evaluates evidence-based psychosocial treatments for autism, eating disorders, depression, obsessive-compulsive disorder, exposure to traumatic events, disruptive behavior, and substance abuse. In addition, one of the articles focused on psychotherapies and treatment approaches specific to different ethnic and cultural backgrounds.

Mental disorders are generally treated with psychotherapy, medications, or a combination of the two. As scientists find out more about how mental disorders affect the brain and behavior, they also better understand what makes a treatment work for certain disorders or certain people. This can sometimes lead to new medications or therapies, or new uses for existing treatments. However, such treatments may not be proven by research (evidence-based).

The special issue helps address knowledge gaps by reporting on the current state of evidence-based psychosocial treatments in children and adolescents. For each article, scientists provided a review of the research literature in their field of expertise. The articles also:
Identify the most effective psychosocial treatments, using and building on guidelines developed in 1995 by the American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures.

Discuss factors that may affect a child's response to treatment.
Suggest directions for future research.

Each article also discusses practice recommendations based on available research for doctors and other mental health care providers. However, these recommendations are intended more as a guide to current treatments and are not a requirement or prescription for best care.
"We can only hope that the current generation of child and adolescent psychosocial treatment researchers will heed the call expressed in these articles for even more sophisticated, more rigorous, and more statistically powerful studies," said Drs. Silverman and Hinshaw.

Reference
Silverman WK, Hinshaw SP. The Second Special Issue on Evidence-Based Psychosocial Treatments for Children and Adolescents: A Ten-Year Update. J Clin Child Adolesc Psychol. 2008 Jan-Mar;37(1)

Genetic Variations may Increase Risk of Autism

2008-01-27T20:50:00.000-05:00

(AP) -- A rare genetic variation dramatically raises the risk of developing autism, a large study showed, opening new research targets for better understanding the disorder and for treating it.
Research into the causes of autism has focused on genetic causes because so many families have multiple children with the disorder. Thus far, only about 10 percent of autism cases have a known genetic cause. Boston, Massachusetts-area researchers estimate the gene glitch they've identified accounts for an additional 1 percent of cases.
They found that in people with autism, a segment of a chromosome that has genes linked to brain development and various developmental disorders was either missing or duplicated far more often. The defect was inherited in some cases, but more often the result of a random genetic accident.
The results from the Autism Consortium study, released online Wednesday by the New England Journal of Medicine, confirm those of smaller studies by U.S. and Canadian research groups in the past year. The consortium verified its findings by checking two other DNA databases.

To read more go to CNN.....

Our Deepest Fear.......MLK Day!

2008-01-21T08:33:00.000-05:00

Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous?
Actually, who are you not to be?
We were born to make manifest the glory of God that is within us.
And as we let our own light shine, we unconsciously give other people permission to do the same.

-Martin Luther King, Jr.

Interface Consultation Services - Update

2008-01-20T11:50:00.000-05:00

A brief overview of Interface Consultation Services (ICS) current endeavors:

I. PESI Seminars by ICS:

High Risk Callers: Responding to Psychiatric Emergencies Over the Phone. New and exciting sorely needed seminar designed specifically for clinicians, call centers, triage nurses who provide efficient assessment and treatment over the phone. Psychiatric Emergencies over the phone line are DIFFICULT and extremely anxiety provoking. General Medical Clinics are seeing more psychiatric patients. Learn the skills you didn't learn in school to assist these patients.

II. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

III. Utilization Management - We continue to provide acute care authorization for Riverwood Center, a community mental health center.

IV. MPRI - Michigan Prisoner Re-Entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Western Michigan providing services to 17 counties.
ICS has four care coordinators and an administrative assistant to assist with this initiative. This program continues to grow at a fast pace and it the only program of it's kind in the US. This speciality program is designed for mentally ill prisoners who are returning to the community. As care coordinators and regional administrators, we assist enrollees with housing, psychiatric medications, specialized placements as well as care coordination and consultation on some difficult cases for the program.

V. College Level Course - ICS partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.

We are seeking other opportunities to expand these kinds of services to agencies in our region.

Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.

Mother's Stress Appears to Boost Kid's Asthma Risk

2008-01-20T11:43:00.000-05:00

Provided by: Canadian PressWritten by: Sheryl Ubelacker, Health Reporter, THE CANADIAN PRESS Jan. 15, 2008

TORONTO - Children whose mothers suffer prolonged depression or anxiety appear to have a higher rate of asthma than other youngsters, independent of other risk factors for the increasingly common respiratory condition, a Canadian study suggests.

The study, which analyzed seven years of health records for almost 14,000 Manitoba children born in 1995, found that kids whose mothers were chronically distressed during those childhood years had a 25 per cent increased risk of developing asthma.

The finding, reported in the American Journal of Respiratory and Critical Care Medicine, was independent of other factors associated with childhood asthma, such as genetic predisposition, household income, being male or female, or living in an urban or rural environment.

Lead investigator Dr. Anita Kozyrskyj, an associate professor of pharmacy at the University of Manitoba, said she and her colleagues determined through the health records whether children had asthma by age seven and related it to maternal distress as defined by doctor visits, hospitalizations and prescriptions for depression and anxiety.

Maternal distress was categorized by onset and duration into four categories: no distress, postpartum distress, short-term distress and long-term distress.

"And it's those mothers in the long-term or persistent category who had the greatest number of health-care visits and prescription medications," Kozyrskyj said Tuesday from Winnipeg. "So that may be an indication of more severe depression and/or anxiety."

Even taking other major risk factors for childhood asthma into account, she said, "the persistent maternal distress measure still is significantly associated with the development of asthma at age seven."

But she stressed that mothers should not take the findings to mean that they are to blame for their children's asthma.

"I think the significance of the results is that there is an association," she said, noting that the study design cannot determine direct cause.

"We know that genetics, a maternal history of asthma, maternal smoking are also very important risk factors for the development of asthma. So this is another risk factor."

At this point, scientists don't know how maternal distress might contribute to a child becoming asthmatic.

But Kozyrskyj said depressed or anxious mothers are more likely to indulge in behaviours that are known to contribute to asthma in youngsters, such as using tobacco that creates second-hand smoke.

"Aside from that ... depressed mothers are less likely to interact with their infants," she said, noting that studies of laboratory rats show that pups with inattentive mothers have abnormal immune and stress responses. The same may be true for humans, she added.

Kozyrskyj said too many mothers, particularly in low-income families, are raising children in environments that contribute to chronic distress.

"Some moms live in environments with low social support and high family conflict or violence, so environment leads to the depression or the anxiety," she said. "So it hardly could be mother's fault when mother is responding to a very stressful environment."

Public health programs that help mothers deal with depression and anxiety - and families with conflict and other issues - may need to be beefed up and expanded, she said.

"So if you can prevent (maternal distress), therefore you decrease your likelihood of asthma and other childhood conditions, too."

Prisoner with Mental Illness Community Reentry

2007-12-30T22:29:00.000-05:00

Collaborations Between Criminal Justice and Mental Health Systems for Prisoner Reentry
Amy Blank Wilson, L.S.W. and Jeffrey Draine, Ph.D., M.S.W.

OBJECTIVE: This study assessed reentry programs throughout the nation for people with mental illness who were leaving prisons or jails and developed a classification of service strategies based on practices that are emerging in the field in response to this need.
METHODS: A national survey identified service strategies that assist people who are incarcerated in prisons or jail and have a mental illness reenter the community. Data were used to develop a typology of reentry service strategies.
RESULTS: Fifty-eight reentry programs were identified. Program descriptions were developed for 50. Findings supported the use of a 2x2 typology of initiatives, with one factor being whether the criminal justice or mental health system initiated the program and the other being the degree of collaboration between the two systems.
CONCLUSIONS: If the funding trend indicated by this survey continues, the criminal justice system will become a primary funder of treatment services for offenders with mental illness who are returning to the community. No one knows how this shift in funding will affect the provision of mental health services.

Deliberate self-harm

2007-12-03T09:20:00.000-05:00

The characteristics of young patients who commit acts of deliberate self-harm vary widely, but the risk of suicide is very high in this population, UK investigators report.

"Deliberate self-harm and suicide are both major problems in young people," Drs. Keith Hawton and Louise Harriss, of the University of Oxford, point out.

"Rates of deliberate self-harm, the term used for the intentional self-poisoning or self-injury in many European countries because of the mixed motivation that is often involved, are highest in young persons," the researchers write in Journal of Clinical Psychiatry.

The researchers collected information on consecutive deliberate self-harm patients between the ages of 15 and 24 years who were seen at a general hospital over a 20-year period (1978 to 1997). National mortality registers were used to identify deaths recorded up to the end of 2000.

Read this important article by linking to: http://www.nlm.nih.gov/medlineplus/news/fullstory_57882.html

Children and Video Games: How Much Do We Know?

2007-11-16T21:10:00.000-05:00

Psychiatric Times
October 01, 2007 Vol. 24 No. 12
Cheryl K. Olson, ScD, Lawrence Kutner, PhD, and Eugene V. Beresin, MD

Dr Olson and Dr Kutner teach in the department of psychiatry at Massachusetts General Hospital (MGH) and Harvard Medical School, Boston, and are codirectors at the Center for Mental Health and Media. Dr Beresin is professor of psychiatry at Harvard Medical School and director of the Child and Adolescent Psychiatry Residency Training Program at MGH and McLean Hospital and Medical Director of the MGH Child Psychiatry Outpatient Clinic in Boston. The authors report no conflicts of interest concerning the subject matter of this article.

There is no shortage of hyperbole when politicians of all stripes describe the nature and effects of video games. Republican presidential candidate Mitt Romney proclaimed, "Pornography and violence poison our music and movies and TV and video games. The Virginia Tech shooter, like the Columbine shooters before him, had drunk from this cesspool."1 Democratic presidential candidate Hillary Clinton spoke of the game, "Grand Theft Auto, which has so many demeaning messages about women, and so encourages violent imagination and activities, and it scares parents."2

Some researchers have echoed similar sentiments, noting that Columbine High School shooters Dylan Harris and Eric Klebold were avid computer gamers.3 Several television pundits quickly drew a link between the recent Virginia Tech shootings and video games, as well. (Ironically, Seung-Hui Cho's college roommates found it odd that he never joined them in playing video games.4)

Do these assumptions about video-game violence leading to similarly violent behavior among child and adolescent players make sense? A review of the research gives us insights into which patterns of video game play may serve as potential markers of more serious problems among children and adolescents, and which are normal or even possibly beneficial.

Additional research and case studies may shed some light on parents' concerns, such as whether video games are addictive or dangerous. Finally, we will offer recommendations on what parents can do to reduce potential risks and to maximize potential benefits of video game play. Read More.....

Compulsive Buying Disorder Affects 1-20

2007-10-28T20:26:00.000-04:00

December 01, 2006 Vol. 23 No. 14
Compulsive Buying Disorder Affects 1 in 20 Adults, Causes Marked Distress

Arline Kaplan
Page 1 of 3

More than 1 in 20 adults nationwide suffer from compulsive buying, according to a telephone survey of 2500 adults. And contrary to popular opinion, "compulsive buying appears to be almost as common in men as in women," according to Lorrin M. Koran, MD, first author of a recently published prevalence study of compulsive buying behavior in the United States.1 Six percent of women and 5.5% of men in the study reported symptoms considered to be consistent with compulsive buying disorder.

These findings are significant because, as documented in previous research, a considerable amount of suffering and impairment may be associated with compulsive shopping. In addition to serious financial problems, compulsive shoppers may suffer from marked distress, and "preliminary evidence suggests that compulsive buyers suffer from abnormally high levels of depression and anxiety . . . and experience higher rates of comorbid mood and anxiety disorders than comparison groups," the study in the October issue of The American Journal of Psychiatry pointed out.
For the study, Koran and colleagues conducted a random sample, national household telephone survey in which trained laypersons interviewed 2513 adults using the clinically validated Compulsive Buying Scale (CBS) embedded in a computerized structured interview. The researchers found a point prevalence of compulsive buying of 5.8% in the survey.
According to Koran, who is emeritus professor of psychiatry and behavioral sciences at Stanford University in California, compulsive buying can be classified in the DSM-IV category of impulse control disorder not otherwise specified, although it is not actually mentioned in DSM-IV. Proposed diagnostic criteria include being frequently preoccupied with buying or subject to irresistible, intrusive, and/or senseless impulses to buy; frequently buying unneeded items or more than can be afforded; shopping for periods longer than intended; and experiencing adverse consequences, such as marked distress, impaired social or occupational functioning, and/or financial problems.2

"Compulsive shoppers are actively acquiring the items, but they don't care about them after they have them," Koran told Psychiatric Times. "Women will hang new clothes in the closet, yet never take them out of the bag and never take off the tags. Men will leave the CDs wrapped in plastic and never listen to them." According to earlier research, men tend to buy electronic gadgets, tools, books, and compact discs, while women tend to buy clothes, makeup, craft items, and objects for the home.

In the prevalence study, compulsive buying behavior was associated with substantial financial adverse effects in every income group, Koran added. Compared with other respondents, compulsive buyers were more likely to have their credit cards within $500 and $100 of their credit limit and were 4 times as likely to "very often" or "often" make the minimum payment on credit card balances. Compulsive buyers also were younger and more likely to have reported incomes under $50,000.

Compulsive buying is "not a trivial disorder in its own right," Koran said. Adverse consequences have included bankruptcy, family conflict, divorce, illegal activities, and suicide attempts.1
Continue......

Wanted - Experienced Mental Health Clinicians

2007-10-26T11:12:00.000-04:00

Experienced mental health clinicians sought. Community Mental Health Experience Preferred. Masters degree in Psychology or Social Work, licensed in State of Michigan.
Contractual positions.
Submit Resume and Cover Letter: Interface@pcsjxn.com

What Occupation Has Highest Depression Rates?

2007-10-20T11:55:00.001-04:00

Provided by: Associated PressWritten by: Kevin Freking, THE ASSOCIATED PRESS Oct. 13, 2007

WASHINGTON - People who tend to the elderly, change diapers and serve up food and drinks have the highest rates of depression among U.S. workers.

Overall, seven per cent of full-time workers battled depression in the past year, according to a government report available Saturday.

Women were more likely than men to have had a major bout of depression, and younger workers had higher rates of depression than their older colleagues.
Almost 11 per cent of personal care workers - which includes child care and helping the elderly and severely disabled with their daily needs - reported depression lasting two weeks or longer.

During such episodes there is loss of interest and pleasure, and at least four other symptoms surface, including problems with sleep, eating, energy, concentration and self-image.
Workers who prepare and serve food - cooks, bartenders, waiters and waitresses - had the second highest rate of depression among full-time employees at 10.3 per cent.
In a tie for third were health care workers and social workers at 9.6 per cent.
The lowest rate of depression, 4.3 per cent, occurred in the job category that covers engineers, architects and surveyors.

Government officials tracked depression within 21 major occupational categories. They combined data from 2004 through 2006 to estimate episodes of depression within the past year. That information came from the National Survey on Drug Use and Health, which registers lifetime and past-year depression bouts.

Depression leads to $30 billion to $44 billion in lost productivity annually, said the report from the Substance Abuse and Mental Health Services Administration.

The report was available Saturday on the agency's website at http://oas.samhsa.gov/
The various job categories tracked could be quite broad, with employees grouped in the same category seemingly having little in common.

For example, one category included workers in the arts, media, entertainment and sports. In the personal care category, a worker caring for toddlers at a daycare centre would have quite a different job from a nursing aide who helps an older person live at home rather than in a nursing home.

Just working full-time would appear to be beneficial in preventing depression. The overall rate of depression for full-time workers, seven per cent, compares with the 12.7 per cent rate registered by those who are unemployed.

The percentage of full-time workers age 18 to 64 reporting depression lasting two weeks or longer, by categories of occupation, as provided by the National Survey on Drug Use and Health using 2004 through 2006 data:
-Personal care and service: 10.8
-Food preparation and serving related: 10.3
-Community and social services: 9.6
-Health care practitioners and technical: 9.6
-Arts, design, entertainment, sports and media: 9.1
-Education, training and library: 8.7
-Office and administrative support: 8.1
-Building and grounds cleaning and maintenance: 7.3
-Financial: 6.7
-Sales and related: 6.7
-Legal: 6.4
-Transportation and material moving: 6.4
-Mathematical and computer scientists: 6.2
-Production: 5.9
-Management: 5.8
-Farming, fishing and forestry: 5.6
-Protective service: 5.5
-Construction and extraction: 4.8
-Installation, maintenance and repair: 4.4
-Life, physical and social science: 4.4
-Engineering, architecture and surveyors: 4.3

Source: Substance Abuse and Mental Health Services Administration.

Cognitive Therapy: What Is It's Role in Depression Treatment?

2007-10-20T11:41:00.000-04:00

Psychiatric Times
Edward S. Friedman, MD
Dr Friedman is associate professor of psychiatry at the University of Pittsburgh School of Medicine. He served as the Pittsburgh regional site director and as the national cognitive therapy director for the STAR*D study. He reports that he has received research support from AstraZeneca, Pfizer, GlaxoSmithKline, and Medscape; he is on the Speakers' Bureau of Sanofi-Aventis, Bristol-Myers Squibb, Pfizer, Wyeth, Novartis, Cyberonics, and Northstar Neuroscience; and he holds stock in Cephalon. The research for this article was supported in part by grants MH-71799, MH-58356, and MH-69618 from the National Institute of Mental Health.

Although cognitive therapy (CT)1 is the best-studied form of psychotherapy, its effectivenes compared with antidepressant medication remains controversial. Over the years, there has been some variability in the results of randomized controlled trials and other types of clinical trials, as well as meta-analyses. A review of the findings of the STAR*D trial may help shed more light on this important treatment issue.2

Historical clinical studies
Efforts to compare the efficacy of CT with that of antidepressant medication date to a 1977 study by Rush and colleagues.3 In randomized controlled trials, CT was generally shown to be as effective as—if not superior to—antidepressant medications. This is also true in a number of studies using other designs and comparison groups (eg, wait lists, placebo, and other psychotherapies). Several meta-analytical reviews also have reported CT as superior to no treatment (ie, untreated control groups), wait list, pharmacotherapy with tricyclic antidepressants, and other therapies.4

However, the results of the influential NIMH Treatment of Depression Collaborative Research Program (TDCRP)5 initially appeared to be inconsistent with these findings. This early (1989) but large trial used a randomized, controlled study design at 3 sites. The researchers found that CT was as effective as the tricyclic antidepressant imipramine in the full study sample. However, neither CT nor imipramine was significantly more effective than the control condition—supportive clinical management and pill placebo. Furthermore, in the more severely ill patients and in patients with greater functional impairment, CT appeared to be less effective than imipramine. As a result, the appropriateness of CT for severe depression was questioned. In addition, the adequacy of CT provided by the therapists in the TDCRP trial has been questioned,6 as has the role of the therapeutic alliance in the outcomes of this study.7
More recently, DeRubeis and colleagues8 conducted another NIMH-sponsored controlled 3-site clinical trial to attempt to resolve these issues. The investigators randomized 240 patients with moderate to severe depression to CT, paroxetine, or pill placebo. Overall, CT was shown to be as effective as paroxetine in the treatment of moderate to severe depression when CT was provided by highly experienced cognitive therapists. As in the TDCRP study, there was a significant difference in results among the study sites.9

CT and the STAR*D findings
The recent, multisite, NIMH-sponsored STAR*D study compared CT with second-step medications in patients who did not achieve sufficient benefit from, or could not tolerate, an adequate trial of the SSRI, citalopram.1 STAR*D aimed for symptomatic remission, not just response, since remission has been shown to result in better daily functioning and a better long-term prognosis. STAR*D used an equipoise-stratified randomization that enabled participants, in consultation with their physicians, to eliminate the possibility of being randomized to a condition they found unacceptable. This was done to best represent clinical practice. Unfortunately, as it turned out, few patients accepted all treatments, making patient acceptance an important limitation of this study. It is interesting to note that CT acceptance was primarily associated with sociodemographic characteristics (eg, higher level of education or family history of depression were indicative of increased likelihood for CT acceptance).10

One second-step strategy compared switching from citalopram to an alternative antidepressant or CT. There was no statistical difference in the intent- to-treat remission rate among those switched to the SSRI, sertraline (18%); the dopamine-norepinephrine reuptake inhibitor, bupropion (21%); or the serotonin-norepinephrine reuptake inhibitor, venlafaxine (25%). Outcomes in patients who were switched to CT (n = 36; remission rate, 25%) did not significantly differ from those whose medications were switched (n = 86; remission rate, 27.9%), except for lower reported adverse effects in the CT group.

The other second-step strategy involved augmenting citalopram with CT, bupropion, or the serotonin partial agonist, buspirone (both antidepressant treatments resulted in intent-to-treat remission rates of 30%). Patients in whom citalopram was augmented with CT (n = 65; remission rate, 23.1%) did not significantly differ in outcome from those in whom citalopram was augmented with a second medication (n = 117; remission rate, 33.3%). The patients in whom citalopram was augmented with another medication generally had a more rapid response and remission than those in the CT augmentation group (40.1 ± 25.8 days vs 55.3 ± 31.2 days).2
Despite its size, a major limitation of the STAR*D study was the lack of statistical power to detect moderate between-group differences. There were also some limitations associated with the psychotherapy comparison, including:

All patients agreed to a pharmacotherapy trial with multiple steps, which may have resulted in a population more accepting of medication therapy.

A smaller number of people than expected accepted a CT condition. Because only 26% of patients were willing to accept CT assignment, it is difficult to make comparisons.
Medications were dosed aggressively,11 and the fidelity of patients to CT was not independently validated. Thus, adherence and compliance may not have been optimal.
In the study, patients who were switched to CT, or for whom CT was an augmentation treatment, were not found to have statistically different response and remission rates from those who received medications. For those patients who continued on citalopram, medication augmentation produced a significantly more rapid remission than did augmentation with CT; and both treatments were equally well tolerated.

There was a trend and a numerical advantage favoring medication augmentation—which might have reached clinical significance if there had been a larger sample size. Patients who discontinued citalopram showed no significant differences in outcome. However, those who switched to a different antidepressant experienced significantly more adverse effects than those who switched to CT alone. It is important to note that the STAR*D study population included very ill patients, with 75% reporting recurrent depressive episodes and 27% reporting chronic depression. Furthermore, many patients had comorbid Axis I or medical disorders.
Thus, the STAR*D study demonstrated that CT was no less effective than antidepressant medications in patients who switched treatments and that there was improved tolerability with CT compared with the medications. Those who augmented citalopram treatment with antidepressant medications versus CT demonstrated a numerical advantage in remission rate that did not reach statistical significance but may have been significant with a larger sample size.12

Clinical implications and lessons learned
What clinical recommendations can we draw from the STAR*D study and related literature on CT and medication treatment? The evidence for the equal efficacy of CT versus wait list control, medications, and other psychotherapies as a first-step treatment is well established4,9 and justifies the use of CT as a first-step treatment for many patients with mild to moderate depression. However, there appear to be significant site differences in most studies despite rigorous attempts to ensure adequate CT implementation.5,13 This may result from varying therapist skill levels. Successful CT outcomes require adequate adherence, just as medication efficacy requires adequate adherence. Therefore, successful CT implementation may require explicit levels of skill training and oversight, such as ongoing supervision, to resolve obstacles and prevent therapeutic drift. This may limit the efficacy of CT as a first-step treatment in many community settings if systematically trained therapists are not available or access to supervision (eg, from supervisors accredited by the Academy of Cognitive Therapy) is limited.
The STAR*D study employed close monitoring of care progression with the use of the measurement-based care model11 and monthly group supervision with the national CT director for the study.14 Clinical supervision focused on case conceptualization and the provision of explicit guidance for optimizing technical CT interventions. Thus, although there were varying degrees of CT experience among the therapists, CT may have enjoyed favorable outcomes as a result of the monitoring.

New technologies for CT dissemination and the provision of case supervision with supervisory feedback for CT therapists may offer a way to provide adequate treatment in a manner that is accessible and acceptable to many patients. Studies are under way that examine Web-based CT provision. One such preliminary study by Wright and colleagues15 demonstrated efficacy and acceptability of computer-based CT treatment.

The STAR*D data also show that CT is a reasonable second-step treatment for those who do not achieve adequate benefit from, or are intolerant to, an initial trial of antidepressant medication. Indeed, the data show that CT monotherapy is a good and reasonable option for patients who are willing to switch from an antidepressant to CT. For those patients who obtained some benefit but not symptom remission from an initial trial of an antidepressant, augmentation with medication produced a more rapid remission and a relative numerical advantage over CT. CT augmentation could then be considered as a next-step treatment after a partially successful pharmacotherapy augmentation treatment strategy has been implemented and further treatment is indicated.

Finally, the STAR*D study reported disappointing relapse rates for all treatments, highlighting the overall lack of durability of remission in patients with moderate to severe depression. This suggests that there is a need for innovative combined and/or sequential psychotherapy and medication treatment strategies to optimally treat the greatest number of patients with depression.13,16 In the meantime, we must disseminate the message that major depression is a serious illness requiring long-term aggressive treatment with the best evidence-based treatments we have to offer. Beyond acute-phase care, we must develop programs for the prevention of relapse and maintenance of remission to help our patients function well and sustain a high quality of life.

REFERENCE GUIDE
Therapeutic Agents Mentioned in This Article
Bupropion (Wellbutrin)
Buspirone (BuSpar)
Citalopram (Celexa)
Imipramine (Tofranil)
Paroxetine (Paxil)
Sertraline (Zoloft)
Venlafaxine (Effexor)
Brand names are listed in parentheses only if a drug is not available generically and is marketed as no more than two trademarked or registered products. More familiar alternative generic designations may also be included parenthetically.

EVIDENCE-BASED MEDICINE:
Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2007;163:1905-1917.
Thase ME, Friedman ES, Biggs MM, et al. Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report. Am J Psychiatry. 2007;164:739-752. References1. Beck AT, Rush AJ, Shaw BF, et al. Cognitive Therapy of Depression. New York: Guilford Press; 1979.2. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163:1905-1917.3. Rush AJ, Beck AT, Kovacs M, et al. Comparative efficacy of cognitive behavioral therapy and pharmacotherapy in the treatment of depressed outpatients. Cognit Ther Res. 1977;1:17-37.4. Friedman EF, Thase ME. Cognitive-behavioral therapy for depression and dysthymia. In: Stein DJ, Kupfer DJ, Schatzberg AF, eds. The American Psychiatric Publishing Textbook of Mood Disorders. Washington, DC: American Psychiatric Publishing, Inc; 2006:353-371.5. Elkin I, Shea MT, Watkins JT, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Arch Gen Psychiatry. 1989;46:971-982.6. Thase ME. After the fall: cognitive-behavior therapy of depression in the "postcollaborative" era. Behav Ther. 1994;17:48-52.7. Krupnick JL, Sotsky SM, Simmens S, et al. The role of therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol. 1996;64: 532-539.8. DeRubeis RJ, Hollon SD, Amsterdam JD, et al. Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry. 2005;62: 409-416.9. Friedman EF, Thase ME, Wright JH. Cognitive and behavioral therapies. In: Tasman A, Kay J, Lieberman JA, eds. Psychiatry. 2nd ed. West Sussex, England: John Wiley and Sons; 2003:1753-1777.10. Wisniewski SR, Fava M, Trivedi MH, et al. Acceptibility of second-step treatments to depressed outpatients: a STAR*D report. Am J Psychiatry. 2007;164:753-760. 11. Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163:1-13.12. Thase ME, Friedman ES, Biggs MM, et al. Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report. Am J Psychiatry. 2007;164:739-752.13. Hollon SD, DeRubeis RJ, Shelton RC, et al. Prevention of relapse following cognitive therapy vs medication in moderate to severe depression. Arch Gen Psychiatry. 2005;62:417-422.14. Friedman EF, Thase ME, Kornblith SJ, et al. Implementation of cognitive therapy in STAR*D. Cognit Ther Res. 2004;28:819-833.15. Wright JH, Wright AS, Beck AT. Good days ahead: the multimedia program for cognitive therapy. Louisville, Ky: Mindstreet; 2004.16. Friedman ES, Wright JH, Jarrett RB, Thase ME. Combining cognitive therapy and medication for mood disorders. Psychiatr Ann. 2006;36:320-328.

Marijuana Use Linked to Increase in Psychotic Disorders

2007-09-07T10:04:00.000-04:00

Psychiatric Times

CARDIFF, Wales, July 27 -- Marijuana users face a risk of psychotic illness that increases with the frequency of exposure, results of a systematic review suggest. Individuals who reported any use of cannabis had a 41% greater risk of psychotic illness than people who had never used it, investigators here reported in the July 28 issue of The Lancet.

And risk increased with use -- the most frequent users had a psychosis risk double that of never-users.

"We conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life," concluded Stanley Zammit, Ph.D., of Cardiff University, and colleagues.

Evidence of an adverse effect of cannabis on affect is less compelling, they added.
Marijuana, or cannabis -- the parent plant -- is the most commonly used illegal substance in most countries, the authors noted. About 20% of young people report using the hallucinogen at least once a week or heavy use, defined as using on more than 100 occasions.

Experimental evidence and surveys of users have indicated that cannabis intoxication can lead to transient, usually mild, psychotic and affective experiences. The development of chronic symptoms that persist beyond or independently of intoxication provides reason for greater concern, the authors wrote.

MedPage Today Action Points
Tell interested patients that a review of data from 35 studies suggests that use of marijuana and other cannabis-derived drugs may increase the risk of developing a psychotic disorder.
Note that the findings are not based on a clinical study.
CARDIFF, Wales, July 27 -- Marijuana users face a risk of psychotic illness that increases with the frequency of exposure, results of a systematic review suggest. Individuals who reported any use of cannabis had a 41% greater risk of psychotic illness than people who had never used it, investigators here reported in the July 28 issue of The Lancet.
And risk increased with use -- the most frequent users had a psychosis risk double that of never-users.
"We conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life," concluded Stanley Zammit, Ph.D., of Cardiff University, and colleagues.
Evidence of an adverse effect of cannabis on affect is less compelling, they added.
Marijuana, or cannabis -- the parent plant -- is the most commonly used illegal substance in most countries, the authors noted. About 20% of young people report using the hallucinogen at least once a week or heavy use, defined as using on more than 100 occasions.
Experimental evidence and surveys of users have indicated that cannabis intoxication can lead to transient, usually mild, psychotic and affective experiences. The development of chronic symptoms that persist beyond or independently of intoxication provides reason for greater concern, the authors wrote.

Whether cannabis use increases the incidence of established syndromes, such as schizophrenia or depression, is unclear, they added.

In an attempt to clarify the relationship between cannabis use and psychotic or affective disorders, Dr. Zammit and his associates systematically reviewed longitudinal studies of cannabis use and subsequent psychotic or affective symptoms.

The review identified 35 reports from 22 cohort studies: 11 reports involving cannabis use and psychotic outcomes and 24 related to affective outcomes.

The unadjusted results of all the psychosis studies provided evidence of an increased risk of psychotic outcomes among cannabis users versus non-users. Pooling of adjusted estimates resulted in an odds ratio of 1.41 for cannabis users.

Pooled estimates from studies that examined frequency of cannabis use resulted in an adjusted odds ratio of 2.09 for frequent or heavy cannabis users versus non-users. Separate analysis of disabling psychotic outcomes, such as schizophrenia, yielded similar results.

"A dose-response effect was observed in all studies that examined the relation to increasing cannabis exposure," Dr. Zammit and his co-authors wrote.

Cannabis use and depression was evaluated in all 15 of the cohort studies. Analysis of pooled risk estimates suggested a possible relationship between frequency of cannabis use and depressive symptoms, but overall, the results failed to substantiate an association.

Studies that evaluated suicidal ideation produced little evidence of an association with cannabis use, the authors stated. The same was true of studies that examined anxiety and cannabis use.
Although the review was unable to prove causality in the association between cannabis use and psychosis, the results do provide policymakers with information to advise the public about the risks of a widely used drug, the authors concluded.

In an accompanying commentary, Merete Nordentoft and Carsten Hjorthoj, of Copenhagen University, noted that Dr. Zammit and colleagues were able to adjust for the effect of psychotic or imminent psychotic symptoms and thus were able "to ensure that psychotic outcomes were not related to the transitory effect of intoxication."

Although the ultimate proof of a causal relationship between cannabis and psychosis would be a large-scale placebo-controlled randomized trial, they said, such a trial cannot be done "because of practical and ethical reasons."

Several authors disclosed relationships with commercial interests that did not have an impact on the study. The study was funded by the U.K. Department of Health. Dr. Zammit's work is funded through a Clinician Scientist Award funded by the National Assembly for Wales.

Primary source: The LancetSource reference: Moore THM et al. "Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review." Lancet 2007;370:epub

Computers, Internet and Psychotherapy

2007-08-06T15:20:00.000-04:00

The demand of psychotherapy often exceeds the availability of therapists. Two studies published in the journal Psychotherapy and Psychosomatics review how modern computer and communication technologies can provide novel opportunities for the provision of stepped care for patients with mental disorders.

In a a review and an accompanying editorial by Prof. Isaac Marks and collaborators point out that therapist time is not saved by conducting cognitive behavior therapies (CBT) via e-mail, telephone or video-conference exchanges between patient and therapist in real time. However, time can be saved when treatment tasks are delegated to patient-computer interactions.

Many patients may also prefer to access CBT at home by computer for reasons of greater confidentiality, lessening of stigma and reduction of time needed to travel to a therapist.

This concept was explored by Indra Tumur and colleges in a analysis of 4 studies to compare the effectiveness of a computerized cognitive behavior therapy (CCBT) program, BTSteps, for the treatment for obsessive-compulsive disorder (OCD) against the traditional therapist-led cognitive behaviour therapy (TCBT) and relaxation.

They found that CCBT was as good as TCBT for reducing time spent in rituals and obsessions and and was superior to RLX treatment. Improvement of OCD persisted beyond the end of the CCBT treatment. Therapist guided CBT was more effective than CCBT for all patients overall though not in those who went on to start self-exposure.

In the third study, University of Heidelberg researchers investigated the effectiveness of group therapy delivered through an Internet chat room following inpatient treatment.

The main goal of the program was to reduce the risk of losing the therapeutic benefits gained during the inpatient treatment. 114 patients participated in one of two parallel groups of 8-10 patients that met with a group therapist in an Internet chat room.

The groups met weekly for 12-15 weeks for 90 min. Controls were 114 patients who did not participate in the chat groups and were matched by application of propensity score methods.
The main criterion was derived from comprehensive assessments of changes in health status comprising the psychological and physical condition of the patients.

Assessments were conducted at admission, discharge and 12 months after discharge. 12 months after discharge, chat participants showed a substantially lower risk (24.7%) for negative outcome than controls (38.5%). Furthermore, a low dropout rate and the high session attendance suggest this novel offer met patients' needs, and thus, opens new avenues for optimizing care for patients with mental disorders.

Baer L, Greist J, Marks IM. Computer-Aided Cognitive Behaviour Therapy Psychother Psychosom 2007;76:193-195 (no abstract)Tumur I, Kaltenthaler E, Ferriter M, et al. Computerised Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: A Systematic Review Psychother Psychosom 2007;76:196-202
[Abstract]
Golkaramnay V, Bauer S, Haug S, et al. The Exploration of the Effectiveness of Group Therapy through an Internet Chat as Aftercare: A Controlled Naturalistic Study Psychother Psychosom 2007;76:219-225 [Abstract]

Mental Health Courts Reduce Incarceration, Save Money

2007-08-06T15:12:00.000-04:00

Psychiatric Times
July 01, 2007 Vol. 24 No. 8
by Arline Kaplin

Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.

Now a study from the RAND Corporation has demonstrated that an MHC in Pennsylvania was successful in increasing mental health services and reducing jail time for participants while reducing costs to taxpayers.1 The study, sponsored by the Council of State Governments Justice Center, was the first to evaluate the fiscal impact of an MHC anywhere in the United States, according to economist John Engberg, PhD, one of the authors. It found that the court saved taxpayers $3.5 million over a 2-year period, Engberg told Psychiatric Times.

While the study focused on the Allegheny County MHC in Pittsburgh, the findings are applicable to many other MHCs in the United States, the study's director, M. Susan Ridgely, explained in a press statement.

Based on drug court models, an MHC is a special docket of a criminal court. "Essentially, mental health courts offer participants an opportunity to avoid incarceration if they agree to comply with community supervision and mandated treatment. Compliance is monitored through a series of reinforcement hearings before a dedicated jurist," the RAND research team wrote.
To determine the fiscal impact of the Allegheny County MHC, 1 of 4 such courts in Pennsylvania, the RAND researchers gathered information on the treatment, criminal justice, and entitlement program costs from 6 state and county public agencies. These costs were compared with the costs government would have incurred during a comparable period had MHC participants gone through the traditional criminal court system and the costs before and after an arrest in the years prior to their entry into the MHC program. From the study population of 352, the researchers extracted data on 3 subsamples to develop their analyses.

The MHC participants were predominantly male (62%), and half were between the ages of 29 and 44. Slightly more than half (54.6%) were white (non-Hispanic) and 41.2% were black.
When the participants entered the MHC program, diagnoses were missing for nearly one third. Among the remainder, 20.5% had bipolar disorder; 21.6% had schizophrenia, schizoaffective disorder, or other psychotic disorders; 6.3% had major depression; and 13.1% had depressive disorder, not otherwise specified. About half of the population showed evidence of alcohol or drug abuse. Although Global Assessment of Functioning scores were missing for one quarter of the participants, the majority scored below 50, indicating that they had severe symptoms and impairment.

In their report conclusions, the RAND researchers determined that the Allegheny County MHC program "is a success in achieving its mission to divert nonviolent offenders with serious mental illnesses out of the penal system and into community-based health treatment and other services"; that the diversion of seriously mentally ill individuals into the MHC program did not pose any increased risk to public safety; and that the MHC program "did not result in substantial incremental costs, at least in the short term," over the status quo.
In the short run, Engberg elaborated, Allegheny County broke even financially. The MHC program resulted in an increase in the use of mental health treatment services, but a reduction in jail time. The decrease in jail expenditures mostly offset the cost of the treatment services, he explained.

In the second year of study, both the average mental health services and jail costs were reduced, the latter dramatically, suggesting that the MHC program may help decrease total taxpayer costs over time, Engberg said. Allegheny County and the state, he added, also benefited because Medicaid, which is jointly funded by the state and federal government, primarily pays for mental health costs. MORE from Psychiatic Times Article....

Interface Consultation Services Update

2007-07-11T12:58:00.000-04:00

A brief overview of Interface Consultation Services current endeavors:

I. Blog Focus - We continue to post weekly on ICS and Counseling Connections.

Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.

II. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.

III. PESI Seminars by ICS:

High Risk Callers: Responding to Psychiatric Emergencies Over the Phone. New and exciting sorely needed seminar designed specifically for clinicians, call centers, triage nurses who provide efficient assessment and treatment over the phone. Psychiatric Emergencies over the phone line are DIFFICULT and extremely anxiety provoking. General Medical Clinics are seeing more psychiatric patients. Learn the skills you didn't learn in school to assist these patients.

IV. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

V. MPRI - Michigan Prisoner Re-entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Western Michigan providing services to 17 counties. ICS has hired Lee Burdick March 2007 to assist with this initiative. This program continues to grow at a very fast pace and it the only program of it's kind in the US. This speciality program is designed for mentally ill prisoners who are returning to the community. As Care coordinators we provide funding for housing, psychiatric medications, specialized placements as well as care coordination and consultation on some very difficult cases for the program.

VI. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center.

VII. College Level Course - ICS partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.We are seeking other opportunities to expand these kinds of services to agencies in our region.

Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.

Mental Health Equal to Medical Reimbursement in North Carolina

2007-07-10T08:19:00.000-04:00

NC Senate Votes in Favor of Mental-health Parity - Winston-Salem Journal, James RomoserJuly 05, 2007

Workers with severe depression, schizophrenia or other mental illnesses would be entitled to the same health-insurance benefits as workers with physical ailments under a bill approved by the N.C. Senate yesterday.

Despite some senators' concerns about increased costs to small businesses, the bill was approved by a vote of 36 to 12. It is now being sent back to the N.C. House of Representatives, which previously approved the bill in a different version.
The vote took North Carolina another step closer to a system known as mental-health parity, in which employers' group health insurance plans are required to treat mental illnesses on par with physical illnesses.

Supporters of parity have long tried to get bills through the legislature, but without much luck.
"Mental health parity legislation has been debated by this General Assembly for over 15 years now, and I'm pleased to say that we've reached some common ground," said Sen. William Purcell, D-Scotland.

But while a majority of legislators have now voted in favor of some form of parity, there are still details to be worked out.

The version of the bill approved by the House would require full coverage for all mental illnesses -- except at small businesses with group insurance plans of 25 or fewer people. Those small businesses would be exempt from the bill.

The Senate version would apply to businesses of any size, but it would not require full coverage for all illnesses. It would require full coverage for nine of the most common mental illnesses, but it would allow insurers to place certain restrictions on care for other mental illnesses, such as autism and attention-deficit disorder.

And neither the House nor the Senate version would capture all of the state's workers.
Many large companies are self-insured and would not be affected by legislation requiring mental-health parity because state insurance mandates do not apply to self-insured companies.
Under current state law, group-insurance plans are not required to provide coverage for mental-health care.

The state's largest health insurer, BlueCross BlueShield of North Carolina, was heavily involved in drafting the Senate version of the parity bill, and the company said the Senate version provides sensible mandates.

BlueCross said that the Senate version would cost the company an additional $9.6 million in the first year. That comes out to $1.38 in increased costs per member per month.
Some senators worried the increase would be passed down to businesses already squeezed by rising insurance costs.

"This is just another burden on small business. They have about 48 separate mandates for coverage now, and how much more can we put on them?" said Sen. Robert Pittenger, R-Mecklenburg.

The N.C. Chamber, which represents businesses across the state, opposed the original version of the bill. A spokeswoman for the chamber said yesterday that the revised versions of the bill are somewhat improved, but that the chamber continues to be concerned about increased insurance costs.

"We know that business in North Carolina is already being strangled by the cost of health care, particularly small businesses, and we know that mandates increase costs," said the spokeswoman, Sherry Melton.

Supporters of parity said that it has not been shown to cause large cost increases in many other states. They said that providing more coverage for mental-health issues would actually reduce the state's overall health-care costs, because people would get good care earlier and would be less likely to fall into the public system of mental-health care.

That system has been widely criticized over the past 10 years as being overburdened and under-financed.

Suicide Attempts Fall After Depression Treatment Begins

2007-07-03T12:42:00.000-04:00

Suicide attempts dropped among people with depression soon after they started treatment, either with antidepressant drugs or psychotherapy, a study of more than 109,000 patients shows.

The study results come after a controversial 2004 recommendation on antidepressant labeling from the U.S. Food and Drug Administration (FDA). That move slapped a strong "black box" warning on the labeling of drugs called selective serotonin reuptake inhibitors (SSRIs), which include Celexa, Paxil, Prozac and Zoloft.

The warning outlined the potential for an increase in suicidal thoughts among teenagers and young adults prescribed the medications. The warning also urged closer clinical monitoring of these patients.

Additional clinical research material is available @ http://health.msn.com/centers/mentalhealth/articlepage.aspx?cp-documentid=100165625

5 Keys to Good Results with Supportive Therapy

2007-06-13T13:29:00.000-04:00

Evidence-based technique gains new respect as a valuable clinical tool.

John Battaglia, MD
Medical director, Program of Assertive Community Treatment, clinical associate professor, department of psychiatry, University of Wisconsin Medical School, Madison, WI

Supportive psychotherapy began as a second-class treatment whose only operating principle was “being friendly” with the patient (Box).1 Critics called it “simple-minded”2 and sniffed, “if it is supportive, it is not therapy…if it is therapy, it is not supportive.”3

Since its lowly beginning, however, supportive psychotherapy has been proven highly effective, and clinicians have developed operating principles...More

Discovering Our True Nature - Online Radio Show

2007-06-11T15:22:00.000-04:00

Discovering Our True Nature - Online Radio Show with Host Branden Cohen (click on link to listen to recent shows...

Join Branden for his weekly internet radio show on Tuesday at 1pm or go to link above for live or achived shows.

Each begins with a guided meditation and Branden welcomes guests and callers to share their personal experiences and ask questions. The show explores a variety of psychological and spiritual topics. Branden Cohen is a MA Clinical Psychologist. email him at brandencohen@hughes.net

This week show and guest talk about addiction and ways to heal the most difficult of addictions and the heart.contact us at... interface_consultation@comcast.net

Alzheimer's sufferers on antipsychotics have higher death risk

2007-06-06T07:48:00.000-04:00

Provided by: Canadian Press
Written by: ANNE-MARIE TOBIN Jun. 4, 2007

TORONTO (CP) - Older adults who suffer dementia and are given antipsychotic drugs have a slightly higher risk of death than those who aren't prescribed these medications, a large Canadian study suggests.

And the older variety of antipsychotics - known as conventional agents - seems to be associated with a higher risk of death than newer atypical antipsychotics, researchers said in the study of Ontario patients, published Tuesday in the journal Annals of Internal Medicine.

The study builds on previous research that led to warnings in the spring of 2005 from Health Canada and the U.S. Food and Drug Administration on atypical antipsychotics and dementia.

Conventional antipsychotic drugs include chlorpromazine (brand names Largactil and Thorazine) and haloperidol (brand name Haldol). Examples of atypical antipsychotics are olanzapine, risperidone and quetiapine (brand names Zyprexa, Risperdal and Seroquel, respectively).

Lead author Dr. Sudeep Gill, a geriatric specialist and adjunct scientist for the Institute for Clinical Evaluative Sciences, said behavioural symptoms in people with dementia can run a full spectrum. Some people have hallucinations and are very suspicious and paranoid, and those symptoms are "well targeted" by antipsychotics.

But sometimes patients with dementia seem agitated and may articulate that they feel restless.
"Paradoxically these drugs may actually worsen that particular symptom," said Gill, an assistant professor of medicine at Queen's University in Kingston, Ont.

He said it's significant that conventional antipsychotics were associated with an even higher mortality risk than atypicals.

After the warnings of two years ago, he noted that some physicians had switched their patients over from the atypical to conventional drugs.

"We were hoping that at a policy level there might be some interest from the drug regulatory agencies, Health Canada, and its comparative agencies in other countries, to look at maybe expanding the warning labels that they apply to atypical antipsychotics to the older conventional antipsychotics," he said.

A statement from Health Canada noted that there are no placebo-controlled clinical trial data on relative risks for illness and death in elderly dementia patients treated with conventional antipsychotics.

"Nevertheless, the data do suggest that the risks associated with treating elderly dementia patients with conventional antipsychotics may be similar to those associated with atypical antipsychotics," Renee Bergeron, a spokeswoman for Health Canada, said in an e-mail Monday.
"Health Canada is currently updating the Product Monographs for all conventional antispychotics to reflect findings from the available data."

The study was based on anonymous patient data, and the researchers did not have access to causes of death. So they could not determine why it was that people taking the drugs were more likely to die.

But they did find that the risk of death associated with these drugs, either atypicals or conventional agents, emerges quickly.

"Within a month the risk is evident," Gill said, adding that the risk persisted for at least six months.

A recent study by Dr. Paula Rochon, who was also senior author on this study, found that 32 per cent of residents in Ontario nursing homes were given anti-psychotic drugs during one sample month in 2003.

For this new study, the investigators used several databases to track Ontario residents aged 66 and older with dementia from April 1997 to March 2002. More than 27,000 matched pairs were identified.

The report looked at people both in the community and in long-term care homes, and Gill said the higher risk of death was comparable in both settings.

"It's a small risk, but it's one that's definitely statistically significant," he said in an interview Monday. "And I would argue it's clinically important."

Antipsychotics are often prescribed to people with schizophrenia, and their use on people with dementia is very common and, for the most part, what's known as "off-label" prescribing, Gill said.

"Our hope is that the individual clinician level and at the level of individual patients, that the patients, their caregivers and physicians really try and think critically about the potential benefits and risks before prescribing these drugs, and think of alternatives, in particular, non-drug treatments."

Non-drug treatments that might help include recollection of pleasant events, physical activity, music therapy and behavioural analysis to find out what's going on, said Gill.

"For example if there's a behaviour that seems to be occurring predictably when the patient's going for a bath - trying to figure out if it's something with the temperature of the water, or the attendant at the bath," he said.

"If it's, say, a male attendant and the patient is female, maybe the behaviour, the disturbance or the lashing out, might be their articulation of some level of discomfort with that situation."
Dr. Michael Borrie, chair of the division of geriatric medicine at the University of Western Ontario, said this study has "real findings" that are consistent with the medical literature in the field of antipsychotics.

He suggested that caregivers may need more training on dealing with the behaviour of someone who might become aggressive because the person doesn't want a bath, for instance.
"So if a person is aggressive at that time, you don't carry on with what you're doing. You back off, let them go, and maybe having the bath at that particular time that day is not important," said Borrie, who is medical director of a dementia special care unit at Parkwood Hospital, in London, Ont.

Dr. David Conn, co-chair of the Canadian Coalition for Seniors' Mental Health, said the organization released guidelines more than a year ago that focus on treating depression and behaviour in long-term care facilities.

"In our guidelines we say you should only use atypical antipsychotics if there's a risk of harm or if there's great suffering or disability caused by the symptoms," he said.

Increase in Suicide and Mental Health in Japan

2007-05-22T01:10:00.000-04:00

Provided by: Associated PressMay. 17, 2007
TOKYO (AP) - The number of Japanese who killed themselves because of work jumped by 52 per cent last year, while work-induced mental illness also hit a record high, a health official said Thursday.

Compensation paid to the families of workers who committed suicide due to work-related stress was paid out in a record 65 cases in 2006, compared with 42 the previous year, said Health Ministry official Junichiro Kurashige.The number of workers who received compensation for work-induced mental illness hit 205, up 61 per cent from a year earlier, Kurashige said, citing a recent government report.

Efforts by the government to encourage workers to apply for compensation were partly behind the rise, said Kurashige.Japan's suicide rate is among the highest in the industrialized world. More than 32,000 Japanese took their own lives in 2004, the bulk of them older Japanese suffering financial woes as the country struggled through a decade of economic stagnation.

The Japanese government has earmarked a substantial budget for programs to help those with depression and other mental illnesses.

See C-Health for more mental health news...

Spirituality, Suicide and Mental Health

2007-05-04T11:03:00.000-04:00

Canoe Health Reports....An Canadian conference is drawing attention to the key role spirituality plays in mental health and even for suicidal patients.

Medical schools have started to raise awareness about spirituality, so students entering the health-care field will inquire about their patients' belief systems to better understand their attitudes toward life and death.

To shed more light, the University of Ottawa's department of psychiatry, the Ontario Multifaith Council on Spiritual and Religious Care and Saint Paul University are hosting the third annual international conference on Spirituality and Mental Health today and tomorrow.

Developing a greater understanding of the link between mental health and spirituality is necessary for health-care workers who truly want to help their patients, said Dr. Andre Gagnon, chairman of the conference organizing committee. The same can be said of workers dealing with suicidal patients.

Suicidality has been VIEWED AS AMORAL.
Historically, suicidal thoughts were viewed by religions as amoral and people who suffered from them could be forbidden access to a place of worship and even burial rights, said Gagnon.
Over time, religions have grown more accepting of the reality that these people need help.
Researching links between suicide rates and spirituality poses difficulties due to the many other variables associated with suicide.

Gagnon said that even the awareness of spirituality in suicide can aid health providers in providing appropriate care.

"A lot of people at first want to stop the suffering they are in, they don't wish to die as much as to stop feeling so badly," he said.

We are all spiritual beings and to neglect this part of a person in who is experiencing significant distress and psychiatric pain can delay a person's recovery. Treating people as whole beings - mental, physical, spiritual and emotional is key.

Binge Eating/Compulsive Eating Disorder

2007-05-02T12:33:00.000-04:00

Psychiatric Times indicates that this disorder is more common than anorexia and bulimia combined, according to a national survey.

In DSM- IV this disorder was being reviewed and was indicated to require more research and study to determine if it would be appropriate for admission into the DSM (Diagnostic and Statistical Manual for Mental Disorders).

Most physicians, however, aren't aware of the problem, says James Hudson, MD, director of the Psychiatric Epidemiology Research Program at McLean Hospital and a professor of psychiatry at Harvard.
"Doctors have a reasonable degree of awareness about anorexia and bulimia, but they're not tuned into binge eating. It's just not as well known," says Hudson, lead author of "The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication". The study, published Feb. 1 in Biological Psychiatry, found that 2.8 percent of the general population has binge-eating disorder -- more than bulimia (1 percent prevalence) and anorexia (0.6 percent) combined.

Treatment for this disorder experts recommend a comprehensive eating disorders program. The programs take a multidisciplinary approach that typically includes nutrition counseling; a behavioral weight control plan with healthy meals spaced throughout the day; medication in some cases; and a strong foundation in cognitive behavioral therapy (CBT) -- considered the gold standard for treating the disorder.

Due to this disorder not being an official diagnosis many insurances will not pay for treatment. Self help programs include reading books with CBT focus and drug treatment with SSRI, appetite suppressants and mood stabilizers. See Psychiatric Times for more information.

College Shooters - Prevention or Solutions?

2007-04-19T20:26:00.000-04:00

Our local community college - Kalamazoo Valley Community College had a threat today and the school has been closed for the rest of the week.

I asked my students today....What can we do as a community to help people who feel this desperate and protect the greater community?

"Kevin's Law" is an involuntary outpatient order. The law is called Kevin's Law after the college student who was killed by a mentally ill individual in Kalamazoo, Michigan. Does this provide some protection and also encourage mentally ill individuals to get the help that they need?

Whether, it's a threat or someone is sincerely planning to take action.... What is the motivation behind this behavior? Is it mental illness? It is criminal behavior? It is "evil"?

Following Monday's shooting at Virginia Tech, colleges across the globe are evaluating their student mental health programs. Anchor Lisa Mullins speaks with Iain Guthrie. National Public Radio, The World Iain from Scotland describes a program called Mental Health First Aid. He describes that they are increasing awareness and training students, teacher, mentors and anyone who can make s difference in the community about mental health conditions and how to intervene. College age students are extremely vulerable to mental illness such as depression, anxiety and psychotic disorders. These are stressful times in people's lives. 20 to 25% of us at some point in our lives will experience some sort of mental disorder. Programs like this can make a difference...contact us...

Virginia Tech Shooter - Mentally Ill?

2007-04-18T15:16:00.000-04:00

This is such a horrible tragedy! Only time will tell as the authorities continue to search Cho Seung-Hui possessions for understanding of why this has happened. A previous teacher noticed extreme anger and from the small amount of information given by the police to the media regarding his writing. The possibility of paranoia and a psychotic disorder is not out of the question. See CNN...

As a society what can we do to provide protection for the community and give support to someone who was so tormented that he took the lives of so many people and himself. Of course, hindsight is always clearer.

My question is what can we learn from this? Is there anything that we (mental health professionals) can do to decrease the possibility of the happening in the future? What about more awareness and training for the non-mental health community. What does a teacher or fellow student do when they encounter someone that they are concerned about? What actions do they take and when is it appropriate to take action? Is this someone who is just angry OR someone who is mentally ill and possible a risk to himself or others? As mental health providers, we feel it is our obligation to educate those who do not have the training in the area to at least be able to recognize signs, have a system in place for evaluation and referral. Contact us for more information.

25% of Hospital Patients Have Mental Illness

2007-04-12T09:10:00.000-04:00

Fierce HealthCare Notes:

A new study by the HHS Agency for Healthcare Research and Quality has concluded that one in four adults admitted to hospitals has a mental health or substance-abuse problem. Only 2 million of the 32 million hospital stays in 2004 were primarily to treat a mental health diagnosis, but another six million were diagnosed with mental health problems while hospitalized for another condition. All told, almost 8 million stays involved depression, bipolar disorder, schizophrenia and other mental illnesses. Also, while suicide attempts accounted for only 179,000 million of the hospital stays, 93 percent involved a mental health condition. Researchers found that two-thirds of the cost of this treatment is carried by governments. Medicare paid for about half of these stays, and Medicaid paid for 18 percent.

To learn more about the study:
read this United Press International item
ALSO: An experimental cancer therapy may help point the way to a new treatment for clinical depression. Report

Anxiety in the Medical Patient

2007-04-12T09:03:00.000-04:00

Psychiatric Times March 01, 2007 Vol. 24 No. 3
Malcolm P. Rogers, MD and David J. Wolfe, MD, MPH

Anxiety is a ubiquitous, natural affective state that is essential for evolutionary survival. Nearly as common, however, are experiences of anxiety that exceed social, psychological, or physiological needs, leading to functional impairment. Indeed, primary anxiety disorders, including panic disorder, social phobia, and generalized anxiety disorder (GAD), represent the most common category of mental illness in the United States. Secondary, or reactive, anxiety is also widespread and can arise not only from numerous medical causes but also from the psychological process of coping with illness. Consequently, it is not surprising that diagnosing and treating anxiety poses a common question for the consultation-liaison psychiatrist. In this article, we review 5 themes concerning the interaction between anxiety and medical illness, and comment on the implications for treatment.

Anxiety secondary to medical illness
Medication- or drug-induced anxiety
Anxiety as an impersonator of medical illness
Anxiety and the course of medical illness
Anxiety and vulnerability to medical illness

Read More at Psychiatric Times...

Recovery from Mental Illness

2007-04-04T17:19:00.000-04:00

The Luminosity Within - 2001
oil on canvas
48"x 78"

By Tim Sabados He is an artist and registered nurse. He is not recoverying from mental illness. He is compassionate and understands the power of the healing nature of artistic creativity.

Recovery...some say art heals, art has a heart..or just plan "ART IT". Enjoy!

Bipolar Disorder

2007-04-04T17:13:00.002-04:00

Check out more information and posts regarding Bipolar on ICS by typing "Bipolar" in the search box at the top left. Click on the title of this blog Interface Consultation Services to view the most recent posts. Thanks for viewing....

2007-04-04T17:13:00.001-04:00

Bipolar Disorder

2007-04-04T17:11:00.000-04:00

Check out other posts related to Bipolar Disorder at Interface Consultation Services (ICS)....

Increase In Use of Antidepressants and Antipsychotic Medications

2007-04-02T14:02:00.000-04:00

A new report says that U.S. spending on antidepressant and antipsychotic meds rose dramatically from 1997 to 2004.

Better living through pharmacology....big business!

Wonder how much direct drug advertising to patients which began in the early 1980's contributed to the increase?

See United Press International for more information.

Massachusetts Girl's Overdose Raises Questions

2007-03-27T11:22:00.000-04:00

In the final months of Rebecca Riley's life, a school nurse said the little girl was so weak she was like a "floppy doll." The preschool principal had to help Rebecca off the bus because the 4-year-old was shaking so badly. And a pharmacist complained that Rebecca's mother kept coming up with excuses for why her daughter needed more and more medication. None of their concerns was enough to save Rebecca.

Rebecca — who had been diagnosed with attention deficit hyperactivity and bipolar disorder, or what used to be called manic depression — died Dec. 13 of an overdose of prescribed drugs, and her parents have been arrested on murder charges, accused of intentionally overmedicating their daughter to keep her quiet and out of their hair.
But the tragic case is more than a story about one child. It raises troubling, larger questions about the state of child psychiatry, namely: Can children as young as Rebecca be accurately diagnosed with mental illnesses? Are rambunctious youngsters being medicated for their parents' convenience? And should children so young be prescribed powerful psychotropic drugs meant for adults?

Dispensing drugs to children diagnosed with mood or behavior problems is "the easiest thing to do, but it's not always the best thing to do," said Jon McClellan, medical director of the Child Study and Treatment Center in Lakewood, Wash. "At some level, I would hope that you'd also be teaching kids ways to control their behavior."

For the complete USATODAY article, link to Children & Psychotropics

Psychopharmacologic Therapy in Pregnancy: Effects on Newborns

2007-03-22T10:05:00.000-04:00

Psychiatric Times
By Emilio J. Sanz, MD, PhD and Carlos De las Cuevas, MD, PhD

Although there is a tendency to avoid psychiatric medications during pregnancy, the high prevalence of psychiatric disorders in pregnant women—15% to 25%, according to recent epidemiologic studies.1-3—means that women and their physicians often face impromptu decisions regarding the initiation or continuation of drug therapy during pregnancy.

The management of psychiatric problems and pharmacologic treatment in pregnancy is complex and burdened with many biologic and personal factors.Psychiatrists need to consider the impact of untreated illness on the mother and the fetus, as well as the possibility of increased risk for obstetric complications and congenital malformations associated with pharmacologic treatment. It should be stressed that untreated psychiatric illnesses pose a tremendous threat to the fetus because of maternal behavior and that discontinuing effective psychotropic treatments may exacerbate maternal mental illness and cause secondary effects on the fetus.

All currently available psychopharmacologic agents and their metabolites cross the placenta,6 and in some cases, intrauterine exposure to psychiatric drugs may lead to neonatal withdrawal syndrome (NWS), also called neonatal abstinence syndrome.

NWS occurs in newborns going through withdrawal symptoms as a result of the mother's use of psychoactive drugs during pregnancy. It is characterized by signs and symptoms of CNS hyper-irritability, GI dysfunction, and respiratory distress; and by vague autonomic signs and symptoms that include yawning, sneezing, mottling, and fever. This syndrome usually begins within 72 hours but may appear up to 2 weeks after birth.6,7 The clinical presentation of neonatal drug with withdrawal varies depending on the drug(s), timing, and amount of the last maternal use, maternal and infant metabolism and excretion, and other unidentified factors.

Go to Psychiatric Times for more specific on effects of Antipsychotics, Antidepressants, Anxiolytics (Anti-Anxiety), Antiepileptic drugs to the fetus and conclusion by the authors.

Interface Consultation Services Update

2007-03-20T11:08:00.000-04:00

A brief overview of Interface Consultation Services current endeavors:

I. Blog Focus - We continue to post 2 times a week on ICS and Counseling Connections. Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.

II. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.

III. PESI Seminars by ICS:

Behavioral Managed Care - How to get what your clients Need in Georgia with key information for success with managed care in April 2007. Managed Care is no fun but these skills are necessary to navigate our complicated health care system!

High Risk Callers: Responding to Psychiatric Emergencies Over the Phone. New and exciting sorely needed seminar designed specifically for clinicians, call centers, triage nurses who provide efficient assessment and treatment over the phone. Psychiatric Emergencies over the phone line are DIFFICULT and extremely anxiety provoking. General Medical Clinics are seeing more psychiatric patients. Learn the skills you didn't learn in school to assist these patients.

IV. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

V. MPRI - Michigan prisoner Re-entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Southwest Michigan Region providing services to 8 counties.

VI. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center and in March 2007 will be providing continuing stay reviews and management of patients entire acute care episodes.

VII. College Level Course - ICS partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.We are seeking other opportunities to expand these kinds of services to agencies in our region.

Please contact us for personalized in-house and agency training for your staff via e-mail by clicking the link or call (269)929-1292.

Depression and Diabetes Increase Risk for Heart Patients

2007-03-12T13:32:00.000-04:00

Having both depression and type 2 diabetes increases the risk of death for heart patients. Each factor had been known to increase the risk of heart disease deaths by itself, but together they're even more deadly.

In an analysis of more than 900 patients with established coronary artery disease, Duke University Medical Center psychologists found that those with both type 2 diabetes and symptoms of depression were more likely to die than heart patients without those conditions.
The study showed that among type 2 diabetes patients, having high depression scores increased the risk of dying by 20 to 30 percent compared to patients with similar depression scores but no type 2 diabetes.

"We found a trend showing that the probability of death increases as the level of depression increases in diabetic patients with coronary artery disease," said Duke researcher Anastasia Georgiades, Ph.D. She presented the results of the Duke analysis on Friday, March 9, 2007, at the annual meeting of the American Psychosomatic Society, in Budapest, Hungary. "Our data appear to show an important interaction between type 2 diabetes and depression, meaning that physicians should closely monitor their heart patients who have both of these disorders.
"There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand," Georgiades said. "In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association."

The researchers followed 933 heart patients for more than four years and correlated the 135 deaths that occurred during that period with the presence of type 2 diabetes and depression alone and together.

Georgiades said there are some possible explanations for the link between depression and diabetes.

"Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise and numerous appointments with their doctor," she said. "It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk."

Depression has also been linked to other cardiovascular risk factors such as insulin resistance, hypertension, obesity, increased cigarette smoking, alcohol abuse and physical inactivity.
The research was supported by the National Heart, Lung, Blood Institute.

Georgiades A, Blumenthal JA, McCants CB, Davidson JR, et al. Depression Related Mortality Among CAD Patients with and without Type 2 Diabetes Presentation, APS meeting Mar 9, 2007.

Check out Aniexty Insights for more.....

Treatment for ADHD with Less Addictive Medications

2007-02-28T16:18:00.000-05:00

Psychiatric Times
By Peggy Peck Feb 27, 2007

ROCKVILLE, Md., Feb. 27 -- The FDA has approved lisdexamfetamine dimesylate (Vyvanse), formerly known as NRP104, for attention deficit hyperactivity disorder.

The amphetamine, to be marketed by Shire, is said to have limited abuse potential, but it was designated Schedule II by the DEA. Shire plc said in a statement that the drug has a lower potential for abuse than other amphetamines used to treat ADHD.

"The label we received with the approval letter includes information about the extended duration of effect and abuse-related drug liking characteristics of Vyvanse, which illustrate benefits that differentiate this compound from other ADHD medicines," said Matthew Emmens, Shire's CEO.

Data from phase II and phase III clinical trials demonstrated statistically significant improvements in ADHD symptoms for patients ages six to 12 years treated with lisdexamfetamine compared to patients treated with placebo. These studies demonstrated significant efficacy at all time points tested (including 6 p.m.) for doses of 30 mg, 50 mg, and 70 mg.

In the phase II, analog classroom study, patients showed significantly improved behavior when receiving either lisdexamfetamine or Adderall XR (another Shire drug) as measured by the Swanson, Kotkin, Agler, M. Flynn and Pelham (SKAMP) deportment rating scale, a standardized, validated classroom assessment tool used for evaluating ADHD behavioral symptoms.

See Psychiatric Times for more information.......

The Secret

2007-02-19T13:51:00.000-05:00

On the The Oprah Show last week she had a panel of people talking about "The Secret". This movie, The Secret, and book was created by Australian Rhonda Byrne, and she says that if you follow its philosophy, you can create the life you want—whether that means getting out of debt, finding a more fulfilling job or even falling in love.

Rhonda defines The Secret as the law of attraction, which is the principle that "like attracts like." Rhonda calls it "the most powerful law in the universe," and says it is working all the time. "What we do is we attract into our lives the things we want, and that is based on what we're thinking and feeling," Rhonda says. The principle explains that we create our own circumstances by the choices we make in life. And the choices we make are fueled by our thoughts—which means our thoughts are the most powerful things we have here on earth.

See more about the show at the link above... Sound a little like Cogntive Behavioral Therapy, Hmmmm?

Binge Drinking Among High Schoolers

2007-02-17T15:00:00.000-05:00

By Crystal Phend
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. Jan 02, 2007

ATLANTA, Jan. 2 -- Binge drinking is the most common way that high schoolers consume alcohol and is tied to other risky behaviors, according to a national survey by the Centers for Disease Control and Prevention.

Among the more than 15,000 teens surveyed, nearly half reported drinking alcohol in the prior month, and more than 60% of those who drank had binged on five or more drinks, said Jacqueline W. Miller, M.D., of the CDC here, and colleagues.

These "alarming" findings call for stronger interventions to reduce both youth drinking and excessive drinking in the general population, they said in the January issue of Pediatrics.

"Pediatricians and family practice physicians should be aware that most of their high school-aged patients drink alcohol and usually do so to the point of intoxication," they wrote. "Some studies have shown that screening and brief intervention in medical settings may be helpful for youth who screen positive for alcohol problems."

The school-based National Youth Risk Behavior Survey included a nationally representative sample of students in grades nine through 12 at public and private schools. The survey was anonymous, self-administered and voluntary (overall response rate 67%).

The researchers found:

44.9% of the students (representing 7.4 million high schoolers) reported drinking alcohol during the prior 30 days,
28.8% binge drank (representing 2.6 million students),
16.1% drank alcohol but did not binge drink (representing 4.7 million teens), and
67.4% of male- and 61.1% of female-current drinkers reported binge drinking.

Among binge drinkers across all grade levels, the findings were:

68.7% (representing 3.2 million teens) reported doing so at least once in the prior month.
73.3% (or 1.8 million) of boys and 63.7% (or 1.4 million) of girls binged on at least two days.
28.2% (representing 700,000) and 18.3% (representing 400,000) binged on at least six days.
13.6% (or 340,000) and 6.8% (or 150,000), respectively, binge drank on at least 10 days.

While any alcohol consumption was associated with increased health risk behaviors, the association was especially strong for binge drinking.

Compared with students who reported no drinking, the findings were:

Riding with a drunk driver was 3.5 times (95% confidence interval 2.8 to 4.2) times more common among current drinkers and 10.8 times more likely (95% CI 9.0 to 13.1) among binge drinkers.
Being sexually active was 2.2 more likely (95% CI 1.9 to 2.6) among drinkers and 5.5 times (95% CI 4.5 to 6.5) more likely among binge drinkers.
Smoking tobacco was 4.2 times (95% CI 3.3 to 5.3) more likely among drinkers and 18.9-fold (95% CI 15.3 to 23.4) more likely among binge drinkers.
Being a victim of dating violence was 1.9-fold (95% CI 1.5 to 2.3) and 3.7 times (95% CI 3.0 to 4.5) more likely, respectively.
Attempting suicide was 2.0-fold (95% CI 1.6 to 2.7) more likely among drinkers and 4.3 times (95% CI 3.5 to 5.4) more likely among binge drinkers.
Using illegal drugs was 3.2 to 5.9 times more likely among drinkers for various drugs while it was 12.3 to 63.2 times more likely among binge drinkers.

There was a strong dose-response relationship....for more link to Pyschiatric Times.

Prevalence of Eating Disorders

2007-02-12T11:11:00.000-05:00

Results from a large-scale national survey suggest that binge-eating disorder is more prevalent than both anorexia nervosa and bulimia nervosa. The study, published in the February 1, 2007, issue of Biological Psychiatry, was based on data gleaned from the NIMH-funded National Comorbidity Survey Replication (NCS-R), a nationally representative survey conducted between February 2001 and December 2003.

Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and extremely disturbed eating behaviors, such as deliberate self-starvation. Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (binging) during which a person feels a lack of control over the eating, followed by purging behavior such as vomiting, fasting, use of diuretics (water pills), or excessive exercise. Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control similar to bulimia. Unlike bulimia, however, binge-eating episodes are not followed by purging, excessive exercise or fasting.

Further details and findings associated with this topic are found at Eating Disorders.

Teen Suicide Rates Increase

2007-02-07T12:32:00.000-05:00

Provided by: Associated Press
Written by: LUNDSEY TANNER Feb. 5, 2007

CHICAGO (AP) - New government figures show a surprising increase in youth suicides after a decade of decline, and some mental health experts think a drop in use of antidepressant drugs may be to blame.

The suicide rate climbed 18 per cent from 2003 to 2004 for Americans under age 20, from 1,737 deaths to 1,985. Most suicides occurred in older teens, according to the data - the most current to date from the federal Centers for Disease Control and Prevention.
By contrast, the suicide rate among 15-to 19-year-olds fell in previous years, from about 11 per 100,000 in 1990 to 7.3 per 100,000 in 2003.

Suicides were the only cause of death that increased for children through age 19 from 2003-04, according to a CDC report released Monday.

See More...........

Intermittent Explosive Disorder

2007-02-05T08:58:00.000-05:00

By Arline Kaplan (Psychiatric Times)
January 2007, Vol. XXIV, No. 1

Intermittent explosive disorder (IED) is not yet on the radar screens of many psychiatrists, but it is more prevalent than panic disorder and warrants extensive research and attention, 2 experts on IED said recently.

In exclusive interviews, Ronald Kessler, PhD, professor of health care policy at Harvard Medical School, and Emil Coccaro, MD, Ellen C. Manning professor and chair of the University of Chicago's department of psychiatry, discussed their recently released study of the prevalence and correlates of IED1 and current as well as planned treatment research.

Depending on how it is defined, IED affects between 5.4% and 7.3% of adults (11.5 to 16 million Americans) in their lifetimes. The prevalence study, funded by the National Institute of Mental Health, was based on data from the National Comorbidity Survey Replication, a national representative, face-to-face household survey of 9282 US adults aged 18 years and older. The diagnoses used in that survey emanated from version 3.0 of the World Health Organization Composite International Diagnostic Interview, which included an assessment of DSM-IV IED.
Findings of the survey indicate that IED is a lot more common than it was previously thought to be, Kessler told Psychiatric Times. It is more common than panic disorder, and anger attacks are more common than panic attacks.

"When you look at the impairment data about the impact on people's lives, IED is very important there, too, because it not only affects the person who has it, but . . . the people around the person with the disorder—the people whom the lamp gets thrown at rather than the person who is throwing the lamp," Kessler added. "Isn't it amazing that something this important has been going on . . . under the radar screen?"

Read More from Psychiatric Times.....

North Carolina Not Alone

2007-01-30T12:56:00.000-05:00

Interface Consultation Services knows all-to-well the challenges and struggles experienced by both community-based and private mental health providers. In today's market, several key areas of concern for all mental health providers include access to mental health services, appropriate clinical assessments & interventions, level of care coordination and management of the mental health resources based on the right service, at the right time, in the right amount.

Our business' work in Michigan with several Community Mental Health agencies has given us a unique perspective on helping agencies achieve this delicate balance between their providing services while efficiently and responsibly managing the available monies. It is always a difficult balance for mental health providers who typically are oriented toward helping and giving and who struggle with any perception of rejecting or denying people help. Achieving this balance requires a willingness to consider both clinical and fiscal concerns simultaneously and address decisions diplomatically and with sensitivity.

Some States and local agencies continue to struggle with obtaining and then maintaining this balance. As an example, North Carolina is currently addressing this very issue. To illustrate their circumstance, link to http://www.fayobserver.com/article?id=253143.

Our motto is "key people, in key positions". It is one thing to conceptualize the problem and develop some policies and procedures; it's quite another to implement and operationalize those guidelines. This is were Interface Consultation Services fits in.

Contact Us: Interface_Consultation@comcast.net or phone at 1-269-929-1292

Link Between Genetic Family Traits and Schizophrenia

2007-01-26T10:51:00.000-05:00

McLean researchers explore genetic links between schizophrenia and family traits
By Carey Goldberg, Globe Staff January 22, 2007

They are not things anyone would typically notice: Do your eyes fall behind as you try to follow a cursor zipping across a computer screen? Is the roof of your mouth a touch high? Do you sometimes use words in a way that, on closer examination, does not quite make sense?

They don't matter at all in daily life, those funny little traits. But researchers at Harvard's McLean Hospital believe they may contain important clues about the elusive genes of schizophrenia, the devastating psychiatric disorder that affects 1 percent of the population.
To further explore this provocative theory, the hospital's Psychology Research Laboratory recently won a $3 million federal grant.
Consider, said Deborah Levy , the lab's director: "The incidence of schizophrenia is stable at about 1 percent, and schizophrenics have very low reproductive rates. So what is keeping those genes going? One hypothesis is that most of the people carrying the schizophrenia genes are not the patients. Rather, they are some of the well parents and well siblings, most of whom never show signs of the illness."
The idea, she and other researchers say, is that schizophrenia results from a critical combination of genes, perhaps a variable handful of them. Well relatives may carry one or more of those genes, but not the critical complement that bring on the disease.
The effects of such genes may show up in a variety of subtle ways, they say -- including faulty eye-tracking and asymmetry in facial features so hard to detect that it is best measured by highly specialized 3-D cameras.
Figuring out the genetics of a complex disease like schizophrenia is like fitting together an incredibly hard jigsaw puzzle, said Dr. Linda Brzustowicz , a psychiatrist and professor of genetics at Rutgers University who is collaborating with Levy.

Recent genomic research suggests that perhaps 15 genes may be involved in schizophrenia, she said, but "there's still a lot of murkiness," and many findings initially offer hope but then cannot be replicated.

The traits that Levy's lab is exploring are unlikely to tell the whole genetic story of schizophrenia, Brzustowicz said, and many other geneticists are pinning their hopes instead on high-powered examination of the entire genome.

But the traits are easily tested and do seem to be linked. In a jigsaw puzzle, Brzustowicz said, "the more pieces you can get in initially, the easier it is to fit in the remaining pieces. And there's no shame in starting with the corners and the edges."

Levy's approach also raises a question about whether past research overlooked genes involved in schizophrenia. Researchers have typically assumed that genes carried by healthy relatives could not contribute to risk for schizophrenia. But if the relatives actually carried the genes for traits linked to schizophrenia, it would be wrong to rule them out. More......

Copyright 2007 Globe Newspaper Company

Cognitive Function Boosted by Folic Acid Supplements

2007-01-24T15:27:00.000-05:00

By Crystal PhendReviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine Jan 19, 2007

WAGENINGEN, The Netherlands, Jan. 19 -- Folic acid supplementation appears to improve cognitive function, particularly memory, among older adults with poor folate status, Dutch researchers said.
Three years of daily 800 ?g folic acid orally bestowed on patients the equivalent of a 4.7- to 6.9 years of younger memory, reported Jane Durga, Ph.D., of Wageningen University here, and colleagues, in the Jan. 20 issue of The Lancet.
These results follow on the heels of an observational study in New York that found a weak link between higher folate levels and a lowered risk of Alzheimer's disease in older Americans.

more....... by the Psychiatric Times

Explain to interested patients that folic acid supplementation may benefit cognitive function among older adults who have poor folate status.
Inform interested patients that in the United States, where grain is fortified with folic acid, less than 1% of the population may have inadequate folate status

Interface Consultation Services - Update

2007-01-22T11:08:00.000-05:00

A brief overview of Interface Consultation Services current endeavors:

I. Blog Focus - We continue to post 2-3 times a week on ICS and Counseling Connections. Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.

II. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.

II. PESI Seminars by ICS:
Behavioral Managed Care - How to get what your clients Need in Georgia with key information for success with managed care in April 2007. Managed Care is no fun but these skills are necessary to navigate our complicated health care system!

High Risk Mental Health Emergencies - "How To" Techniques & Interventions in Nebraska with state specific statistics and research...Don't Miss It! Coming in February.

Cclients in Crisis: Assess, Intervene and Succeed in Virginia.
Tips and research on risk and warning signs for the suicidal and homicidal patient, Intervene with Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) skills for the person in distress, liability and much more.........

High Risk Callers: Responding to Psychiatric Emergencies Over the Phone
New and exciting sorely needed seminar designed specifically for clinicians, call centers, triage nurses who provide efficient assessment and treatment over the phone. Psychiatric Emergencies over the phone line are DIFFICULT and extremely anxiety provoking. General Medical Clinics are seeing more psychiatric patients. Learn the skills you didn't learn in school to assist these patients.

IV. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

V. MPRI - Michigan prisoner Re-entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Southwest Michigan Region providing services to 8 counties.

VI. Utilization Management opportunities - We continue to provide acute care preauthorization services for Riverwood Center and in March 2007 will be providing continuing stay reviews and management of patients entire acute care episodes.

VII. College Level Course - ICS partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.

We are seeking other opportunities to expand these kinds of services to agencies in our region. Please contact us for personalized in-house and agency training for your staff via e-mail by clicking the link or call (269)929-1292.

Our Deepest Fear.......

2007-01-15T10:07:00.000-05:00

Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous?
Actually, who are you not to be?
We were born to make manifest the glory of God that is within us.
And as we let our own light shine, we unconsciously give other people permission to do the same.
-Martin Luther King, Jr.

Did You Know? Universal Healthcare Gaining Ground

2007-01-12T17:48:00.000-05:00

The drumbeat is getting louder: Massachusetts, Pennsylvania, Maryland, Illinois, San Francisco (and possibly California) took action on the issue of covering the uninsured this year, gaining traction for reforms that might have been shot down with little comment a few years ago. Among the highest-profile changes is taking place in Massachusetts, where legislators are looking at a mix of Medicaid expansion efforts, required purchase of insurance and employer incentives to fund health coverage for all citizens. Other states, such as Illinois and Maryland, are considering related measures.

Meanwhile, interest in a federal universal healthcare measure seems to be rising. For example, a universal coverage plan by Oregon Senator Ron Wyden, which would call for offering access through a pool of private insurance plans, has attracted some support from both conservative and liberal legislators. While Wyden's plan may not be the horse that crosses the finish line, it seems likely that there will be some significant federal health access reforms, so fasten your seat belt. This will be a critical issue to track in the coming year!

Older Antipsychotics Just as Good

2007-01-11T10:04:00.000-05:00

Psychiatric TimesBy Richard A. Sherer
December 2006, Vol. XXIII, No. 14
A new study comparing the benefits of second-generation antipsychotics (SGAs) with their older counterparts in patients with schizophrenia has yielded a surprising result. The study, funded by the UK National Health Service, found that the overall differences between first- and second-generation antipsychotics "did not reach statistical significance."

Appearing in the October 2006 issue of Archives of General Psychiatry, the findings from the project called the Cost Utility of the Latest Antipsychotics in Schizophrenia Study (CUtLASS) surprised the research team that reported them.

"If the investigators themselves had any bias or previous expectations, it was in favor of SGAs; we were surprised to refute that hypothesis," they wrote. "The results of this pragmatic randomized trial refute the hypothesis that the use of SGAs is superior to the use of FGAs [first-generation antipsychotics] in terms of quality of life at 1 year," they wrote, adding, "The confidence intervals for this effect in the opposite direction were wide, including the possibility of a small benefit for SGAs, but much smaller than we had hypothesized."

"What this study and the CATIE [Clinical Antipsychotic Trials of Intervention Effectiveness] study suggest is that FGAs, which are much cheaper than the SGAs, are a reasonable choice," said Anthony F. Lehman, MD, chair of the department of psychiatry at the University of Maryland School of Medicine. "In the recent era, one felt like he was giving inferior care if he prescribed an older drug."

But Lehman noted that treatment for schizophrenia is not a one-size-fits-all proposition. "Taking it from the data to actual practice, what we have to remember is that no one is average. All of these studies tell us about average effects. On average, the agents yield about the same results. That doesn't really predict for an individual patient what's going to happen.
"In clinical practice, you select a drug based on a variety of factors for the needs of the patients: the history of side effects, the prior response to a particular agent, the preference the patient has. You can even add cost into this. You make an informed choice for the patient [of] the best drug to at least start with. What these studies show is that the advantages of one or the other drug may be less than we might have thought they were."

In recent years, second-generation or atypical antipsychotics have attracted a following based in part on concerns that patients receiving the older, or first-generation, drugs "have had a suboptimal outcome, with symptomatic relapses and disabling adverse effects, particularly sedation and extrapyramidal symptoms [EPS]," according to the CUtLASS researchers.
Peter B. Jones, MD, PhD, of the department of psychiatry at the University of Cambridge, the lead researcher on the study, summarized the attitude of clinicians as "beguiled" by the appeal of atypicals.

The UK study involved 227 persons aged 18 to 64 with DSM-IV schizophrenia and related disorders whose psychiatrists had elected to change their treatment because of inadequate clinical response or intolerance of their current medication. They were randomized into 2 groups, one receiving an older antipsychotic and the other an SGA. The patients' own psychiatrists selected one of the agents designated for the appropriate treatment group.
FGAs in the study were chlorpromazine hydrochloride (Thorazine), flupenthixol (Fluanxol), haloperidol (Haldol), loxapine (Loxitane), methotrimeprazine (Nozinan), sulpiride (Dolmatil, Sulpitil), trifluoperazine hydrochloride (Stelazine), zuclopenthixol (Clopixol), and the depot preparations of fluphenazine (Prolixin, others), flupentixol (Depixol), haloperidol, pipotiazine (Piportil), and zuclopenthixol. Two other drugs, thioridazine hydrochloride and droperidol, had been included in the trial protocol but were dropped because they were withdrawn from licensed use.

SGAs used in the trial were risperidone (Risperdol), olanzapine (Zyprexa), amisulpride (Solian), zotepine (Zoleptil), and quetiapine (Seroquel). Another atypical, ziprasidone, was not included because it has not been licensed in England. Not all of the drugs used in the trial are available in the United States.

The patients were evaluated using the Quality of Life Scale (QLS) at baseline and again at 12, 26, and 52 weeks. Secondary outcome measures included the Positive and Negative Syndrome Scale (PANSS); Calgary Depression Scale; the Drug Attitude Inventory and a 7-point drug adherence scale; Global Assessment of Functioning Scale; and several adverse effects scales to monitor for negative reactions.

In the end, "participants in the FGA arm tended to have greater improvements in QLS and symptom measures than those in the SGA arm, suggesting that the failure to find an advantage for SGAs was not due to the sample simply being too small. We emphasize that we do not present a null result; the hypothesis that SGAs are superior was clearly rejected," the researchers wrote.

Manufacturers of the newer drugs were quick to respond to the study. "I see at least design flaws with the study," said James Minnick, a spokesman for AstraZeneca, which makes the SGA Seroquel (quetiapine). "Patients were randomized to either first-generation or second-generation treatment, but the choice of medication wasn't random. Patients weren't blinded to what they were taking. The other point might be that every medication is different, and by lumping all second-generation drugs together and inferring they are the same, their unique attributes are undermined."

But Robert W. Baker, MD, group director of global product safety in therapeutic areas for Eli Lilly and Company, put a more positive face on the results. "It's valuable and interesting information for clinicians," he said. "It is useful if they . . . [learn] from this study and the vast existing literature on antipsychotics. It reinforces the notion that because individual drugs and patients differ from each other, clinicians can help their patients best if they are well informed and aggressively pursue the best choice." Eli Lilly's Zyprexa (olanzapine) was one of the SGAs included in the study and fared reasonably well in terms of acceptance. At the end of the study, 74% of the SGA patients for whom olanzapine had been prescribed were still taking the drug.
While quality of care was a principal focus of the study, the cost of care was clearly the driving force. "The key question was whether the additional acquisition costs of SGAs over FGAs would be offset by improvements in health- related quality of life or savings in the use of other health and social care services in people with schizophrenia for whom a change in drug treatment was being considered for clinical reasons, most commonly suboptimal efficacy or adverse effects," the researchers wrote.

In their findings, however, they note that although the mean costs for patients in the FGA arm of the study were lower, the "major cost in both groups was psychiatric hospital inpatient admissions: 93.2% of total costs in the FGA arm and 81.5% in the SGA arm. Antipsychotic drug costs accounted for a small proportion of total costs (2.1% in the FGA arm and 3.8% in the SGA arm).

"This calls into question how valuable it is to think of these drugs as a class as opposed to trying to think about the right treatment for each individual," Baker noted. "Some people may take a headline, just choose only cost, but [this applies] only the farther away you are from patients and clinical realities. This signals how much you have to individualize the choices."

Lehman also worries that policy makers will use cost considerations as a way of restricting treatment options. "When we go for treatment, we don't want our choices to be constrained by costs. It would be a shame for someone not to have access to a treatment that might be better for them because of a policy decision only to have the cheaper drugs or to have to fail with a cheaper drug first. That's true for other medical conditions, as well. We are balancing a range of choices with cost.

"Instead we should look at prescribing practices that tend to drive costs up more, such as inappropriate prescribing for other indications. This is not always done by mental health practitioners but by family physicians and others who are not as familiar with the literature. We see people using multiple drugs in the same class. Why do you need to take 3 antipsychotics?
"There are lots of ways of reducing costs without restricting the nature of drugs available. That's just a blunt instrument, although policy often uses blunt instruments."

Women, Depression and Binge Drinking

2007-01-05T16:08:00.000-05:00

Provided by: Canadian PressWritten by: SHERYL UBELACKER Jan. 3, 2007
TORONTO (CP) - Severe depression and binge drinking are more likely to go hand-in-hand among women than men, a Canadian study has found, suggesting that a more gender-specific approach may be needed in diagnosing and treating this common mental illness.

"If you're treating a person for depression, especially if it's a woman who's suffering from major depression, it would be a good idea to look at their drinking pattern - and especially looking at how much they drink per occasion," said lead author Kathryn Graham, a senior scientist for the Centre for Addiction and Mental Health.

"I think men are more likely to be asked about their drinking than women are by physicians, so this would be a particular trigger to at least caution them (women) about not drinking too much per occasion."

Graham, an adjunct professor of psychology at the University of Western Ontario, said the 14-month study found that a pattern of frequent but low-quantity drinking was not associated with depression. "In fact, those who usually drink less than two drinks per occasion and never drink as much as five drinks are less depressed . . . than former drinkers."

"With drinking, what you find is that for frequency (how often) there's no relationship with depression; for volume (the number of drinks), there's a modest relationship," Graham said from London, Ont.

"Where the relationship is much larger is how much you drink per occasion and especially if you drink a lot per occasion. That's what they mean by binge drinking."

The study, published in the January issue of the journal Alcoholism: Clinical and Experimental Research, involved lengthy telephone surveys of more than 6,000 men and 8,000 women aged 18 to 76, randomly chosen from across Canada between January 2004 and March 2005.

Participants were asked about their behaviour in the previous year and in the week before the study: how often they drank alcohol; how much they drank per occasion; how often they downed five drinks or more; and what their maximum number of drinks was at any one time.

The researchers also asked respondents about episodes of depression during the previous year and in the week prior to the survey: whether they had experienced recent periods of "the blues" or suffered serious bouts that lasted a minimum of two weeks.

Analysis showed that the overall relationship between depression and alcohol consumption is stronger for women than for men - but only when the person's symptoms correspond to a clinical diagnosis of major depression. "It has to have enduring feeling and a big impact," Graham said.

No gender difference was found when respondents identified having "recent depressed feelings," a measure commonly used in research on this topic.

Prof. Sharon Wilsnack of the University of North Dakota School of Medicine and Health Sciences called the research "an important study" because it looks at the link between depression and alcohol use separately for women and men.

"It is clear from the study's results that it is a mistake to analyze relationships between depression and alcohol consumption without specifying which manifestations of depression are linked to which drinking patterns," Wilsnack said in a statement.

"This pattern of associations is more consistent with women using alcohol to counteract depression - by high-quantity drinking and intoxication - than with chronic alcohol consumption tending to make women depressed," said Wilsnack. "However, a vicious circle could possibly begin with drinking in response to depression."

No study has been able to tease out a definite cause-and-effect relationship between depression and alcohol, Graham said. "We don't know if you're depressed because you drink too much or you drink too much because you're depressed."

Still, some link does seem to exist: It's known that among people treated for alcohol problems, the rate of depression goes down when they abstain from drinking and conversely, feelings of depression can occur when someone has a hangover, she said.

"For sure drinking four or five drinks or more on an occasion is not going to help depression and it may actually be contributing to depression," particularly in women, Graham speculated. "That would be a drinking pattern that should be avoided."

Fentanyl: Situation Report

2006-12-29T09:38:00.000-05:00

Clandestinely produced Fentanyl has been linked to hundreds of fatal and nonfatal overdoses across the Midwest, Northeast, and Mid-Atlantic Regions of the United States since late 2005. Fentanyl is a synthetic opiate approximately 50 times more potent than heroin.

Clandestinely produced Fentanyl powders, fentanyl mixed with heroin, and, to a lesser extent, fentanyl mixed with cocaine have been distributed in the Midwest, Northeast, and Mid-Atlantic Regions. The primary markets have been Chicago (IL), Detroit (MI), and Philadelphia (PA)/Camden (NJ). Overdoses linked to Fentanyl have been reported in areas of Delaware, Illinois, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Wisconsin

Fentanyl has been sold to drug abusers, primarily heroin abusers, in drug markets in each of the aforementioned areas, and abusers typically reflect the population demographics of those areas. Currently, there are an estimated 800,000 to 1,000,000 hard-core and casual heroin abusers in the United States who constitute the potential Fentanyl market. An intravenous dose of Fentanyl hydrochloride for pain relief is approximately 45 micrograms (a grain of salt is approximately 60 micrograms); however, depending on the weight of the abuser and his or her level of opiate tolerance, an abuser may tolerate a higher or lower dose. Accordingly, a small error in diluting, or cutting, Fentanyl can easily lead to an overdose.

U.S. Department of Justice
National Drug Intelligence Center
Date: June 5, 2006

Lilly Accused of Promoting Off-Label Zyprexa Use

2006-12-27T09:05:00.000-05:00

December 18, 2006 · In: Healthcare Companies Healthcare Regulations

Has drugmaker Eli Lilly been promoting the off-label use of antipsychotic Zyprexa for elderly patients with dementia symptoms?

According to an investigation by The New York Times, Lilly has been doing just that since late 2000, despite FDA rules to the contrary. Materials given to the NYT outline a campaign called Viva Zyprexa, in which sales reps are told to suggest the drug for older dementia patients. However, such marketing would run afoul of FDA rules, as Zyprexa is approved to treat bipolar disorder and schizophrenia, not dementia or dementia-related psychosis. In fact, Zyprexa actually carries an FDA warning stating that the drug can increase the risk of death in older patients with dementia-related psychosis. A Lilly spokesperson contended that older patients who seem to have dementia may actually have untreated schizophrenia, but psychiatrists have strongly contested that claim. Lilly is currently facing federal and state investigations over its marketing of Zyprexa, which at $4.2 billion in 2005 sales is Lilly's best-selling product.

FDA Proposes Expanding Antidepressant Suicide Warning

2006-12-19T12:56:00.000-05:00

Provided by: Associated PressWritten by: ANDREW BRIDGES Dec. 13, 2006

WASHINGTON (AP) - Antidepressants increase the risk of suicidal behaviour for people up to age 24, the government said Wednesday. It plans new warning labels, and says users of all ages should be closely monitored.The label change proposed Wednesday would expand a warning now on the antidepressants that applies only to children and adolescents.T

The Food and Drug Administration presented its plan to update the drug labels at a meeting of outside advisers on the issue. They endorsed the plan.The FDA also stressed that patients of all ages should continue to be carefully monitored for signs of suicidal tendencies when they are beginning treatment on the drugs.

Public reaction was split, with some saying the changes were overdue and others arguing they could keep drugs from those who need them.In emotional testimony illustrated at times by slides of family photos, relatives of suicide victims pleaded for the new warnings.Suzanne Gonzalez, shouting and in tears, goaded the panel to action, telling the experts that her 40-year-old husband who had been taking Paxil shot himself."I wake up every morning thinking, 'Oh my God, he's dead. He is freaking dead.' Do you wake up and think, 'How many people are going to die today because I am doing nothing?"' Gonzalez asked.

Still, mental health experts worry that additional warnings could curtail use of the drugs and ultimately do more harm than good.Dr. John Mann, a Columbia University psychiatrist, suggested simply replacing the proposed expanded warnings with the recommendation that doctors more closely monitor their patients.

"We can do more good by providing more treatment for depressed children and adults," Mann said.

The FDA proposed the changes after completing a review that found use of the drugs may increase the risk of suicidal thoughts and behaviour among young adults 18 to 24, as well as among younger patients.

Psychiatrists testified Wednesday that the 2004 addition of a warning for children led to a falloff in antidepressant prescriptions being written for patients under 18 - and an increase in suicides in that age group.Still, overall use of antidepressants continues to grow, with nearly 190 million prescriptions dispensed in the United States last year, according to IMS Health, a health care information company.That suggests doctors have placed more weight on the long-term benefits of the drugs than on any short-term risks, said Dr. Thomas Laughren, director of the FDA's division of psychiatry products.

Expanding the "black box" or other warnings on the drugs could dissuade patients from seeking or starting treatment, mental health experts said. They warned that people with untreated depression - about half of those who suffer from the disease - face an estimated 15 per cent greater likelihood of death by suicide.

Dr. Joseph Glenmullen, a Harvard Medical School clinical instructor in psychiatry and author of "Prozac Backlash," said expanding the warnings wouldn't scare off patients, but instead would allow them to make informed choices. The FDA recently completed a review of 372 studies involving about 100,000 patients and 11 antidepressants, including Lexapro, Zoloft, Prozac and Paxil. When the results were analyzed by age, it became clear there was an elevated though small and short-term risk for suicidal thoughts and behavior among adults 18 to 24, the FDA said in documents released ahead of Wednesday's meeting of its psychopharmacologic drugs advisory committee.The FDA's analysis of the multiple studies suggests an age-related shift in the risk of suicidal thoughts and behavior associated with treatment with the drugs. For instance, antidepressants seem to protect against suicidal thoughts and behavior in adults 30 and older, with the effect most pronounced in patients over 65.

The FDA said the increased risk could mean as many as 14 additional cases of suicidal thoughts or behavior in every 1,000 children treated with antidepressants. For adults 18 to 24, there could be four additional such cases per 1,000.

In May, GlaxoSmithKline and the FDA warned Paxil may raise the risk of suicidal behavior in young adults and added that to the drug's label."Anytime suicide is involved it is a tragic outcome. It is one of the things that keeps us motivated to search for better treatments because depression can be treated.

Self-Disclosure & Healing

2006-12-19T12:37:00.000-05:00

As therapists, we generally are cast as the support-person, the listeners, the helpers, the objective re-framers and other client-focused “providers”. Clinicians, some more than others, tend not to self-disclose much with their clients; some prefer to keep their own feelings, life trials and even personal mental health experiences separate from the therapy relationship. Like most aspects of the client-therapist relationship there are no real hard and fast boundaries about how to act, what to say, what to reveal, when to set limits, etc; it is the art of therapy and the clinician experience that determines how the relationship develops.

Therapist self-disclosing can be an effective teaching opportunity that has real, human information and it can be a tremendously powerful client-therapist relationship building tool, remembering always that self-disclosure has its limits and the therapy session is for the client. I have personally known clinicians that quickly get caught up in self-disclosure to the degree the roles in therapy become reversed and therapist’s personal issues become the primary focus of the sessions; not good.

For example, recently my family learned my mother has been diagnosed with cancer; she is 76 years old. I am very fortunate to have a loving family with generally healthy siblings and parents; none of us really ever experiencing any tremendous life tragedies. Perhaps this is one reason the “news” has been emotionally devastating to me. My emotions have been flooding in since learning of her cancer diagnosis. I am scared for her, scared for me, scared for my Dad, wondering how I will balance being the ever-supportive “helper” and at the same time taking care of myself. I am preoccupied with all of this, at times finding myself in a daze when driving down the road or other times when I am generally attentive and focused. I have this ever-streaming thought process going on, saying to myself, “I want to know the outcome, I want to fix it, I know I can’t fix it, she’ll pull through this, am I ready to deal with this, how will I deal with this, why?, I will be there for her, she can count on me” and on and on. I know my Mom wants to fight for a cure, fight for more time. I want more time with my Mom yet I want to be unselfish as well. This is one of my life trials, perhaps the biggest yet for me. Deep down I know I can’t control this outcome, I am trying to settle for “maybe I can influence the outcome” through my support to her, my love for her, to my Dad, staying optimistic, praying for her/for us. My partner once told me, “Thoughts are things”. I will be trying to center on healing thoughts.

I hope you can see that struggling is part of our humanness, even healers need to heal and self-disclosure can open the path for others to become helpers too. When you may think that your life-challenges are overwhelming, unbearable or misunderstood, let someone know your pain, your struggle. By allowing ourselves to share our experiences we may influence the nature of our relationships and perhaps even the outcome of our struggle.

Alternative Treatments: Coach and Professional Organizer for Treatment of ADHD

2006-12-08T16:03:00.000-05:00

NEW ORLEANS, Nov. 22 -- Although pharmacological treatments are the mainstay of therapy for attention-deficit hyperactivity disorder (ADHD) in adults, psychosocial treatments may be a useful adjunct and improve patients' quality of life.

Psychosocial treatments include not only psychotherapy and counseling but less-well known approaches such as an ADHD "coach" and a professional organizer, said Carol E. Watkins, M.D., of Northern Country Psychiatric Associates in Baltimore. Dr. Watkins outlined the array of psychosocial treatments available to adults with ADHD at the U.S. Psychiatric & Mental Health Congress here.

Individual psychotherapy: This approach can help patients identify "maladaptive patterns" related to the ADHD and find better ways of coping with them. Both the insight-oriented therapy and cognitive and behavioral therapy can be useful, Dr. Watkins said.
Couples and family therapy: ADHD can put a major strain on a marriage, Dr. Watkins said. Spouses may not understand that their partner's inattention and forgetfulness is not intentional. Extended couples therapy may help the non-ADHD spouse learn to give supportive structure without being controlling, Dr. Watkins said.
Group therapy may be useful for helping patients build a system of support, Dr. Watkins said. If, during group therapy, patients are able to make suggestions that help other group members, they may begin to feel a sense of competence. For patients who can not sit still in a chair for an entire therapy hour, psychodrama may be a better approach, Dr. Watkins added.
12 Step Groups are useful for adults with ADHD who are substance abusers. "These meetings help foster a sense of shared community and help the individual deal with issues of blame and responsibility," Dr. Watkins said.

ADHD Coaching is distinct from psychotherapy, Dr. Watkins said. An ADHD coach talks to patients at regular, daily intervals and helps them define, clarify, and prioritize their goals. Since ADHD coaching is relatively new phenomenon and there is no regulation or oversight of this profession, it is important to make sure that coaches are trained and have experience. However, in a pinch, even a mentor, a sympathetic teacher, or a friend can serve as a coach, Dr. Watkins said.

Electronic Organizers: "I am a big believer in the use of electronic organizers," Dr. Watkins said. "Unfortunately, many patients start out with them enthusiastically but then trail off within a month." A seminar that teaches patients how to set up and use the organizer is often useful. Some seminars will also follow up with encouragement and reminders to use the planner, Dr. Watkins noted.

A Professional Home Organizer can be hired for patients with cluttered, disorganized homes. Professional organizers come to the house and help determine what can be thrown away. Professional organizers are not the same as cleaning services, Dr. Watkins stressed, "although a cleaning service is probably also a good idea," she said.

Primary source: U.S. Psychiatric & Mental Health Congress
(C) 2006 MedPage Today LLC. All Rights Reserved.

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Pregnant Women recommended to Avoid Paxil

2006-12-06T11:52:00.000-05:00

WASHINGTON (AP) - Pregnant women and those who plan to become pregnant should avoid taking the antidepressant Paxil if possible because of the risk of birth defects, a group of U.S. obstetricians said Thursday.

The opinion issued by the obstetric practice committee of the American College of Obstetricians and Gynecologists comes nearly a year after the U.S. Food and Drug Administration and manufacturer GlaxoSmithKline reclassified the drug to reflect studies in pregnant women that showed the drug poses a risk to the fetus.

Two studies of pregnant women who were taking Paxil during their first trimester have shown that their babies have heart defects at a rate that is as much as twice the norm, the FDA said at the time.

The American College of Obstetricians and Gynecologists also said the decision whether to treat pregnant women with SSRIs, a class of antidepressants that includes Prozac, Zoloft and Lexapro as well as Paxil, should be considered on an individual basis.

Exposure to SSRIs late in pregnancy has been associated with short-term complications in newborns, the doctors said.

However, reproductive-age women have the highest prevalence of major depressive disorders. The benefit to the mother of treatment with any of the drugs may outweigh the risk to the fetus.

The opinion appears in the December issue of the Journal Obstetrics & Gynecology.

Chinese College Students at Risk for Suicide

2006-11-29T13:22:00.000-05:00

Chinese students are facing mounting pressure when they graduate from China's thousands of Ivory Towers due to an influx of students who also expect to join the work force.

The number of university students has increased by 750,000, rising to 4.13 million. A total of 1.24 million will fail to find a job in 2006, state media reported.

Wang Gang, deputy director of the depression treatment center at the Capital University of Medical Sciences affiliated Beijing Anding Hospital, says his center has seen an increasing number of university students turning to doctors for help.

"At least half of these students are in danger of committing suicide. Some have attempted but failed," says Wang.

More...

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Happiness Can be Learned

2006-11-28T08:34:00.000-05:00

Long-term studies aim to pinpoint, prolong whatever it takes to make humans feel good.
Malcolm Ritter / Associated Press

NEW YORK -- For decades, a widely accepted view has been that people are stuck with a basic setting on their happiness thermostat. It says the effects of good or bad life events like marriage, a raise, divorce, or disability will simply fade with time.
But recent long-term studies have revealed that the happiness thermostat is more malleable than the popular theory maintained.
One new study showing change in happiness levels followed thousands of Germans for 17 years. It found that about a quarter changed significantly over that time in their basic level of satisfaction with life.

Other studies show long-lasting shadows associated with specific life events like serious disability, divorce, widowhood and getting laid off. The boost from getting married, on the other hand, seems to dissipate after about two years, says psychologist Richard E. Lucas of Michigan State University.

Many people want to be happier. What can they do? That's where research by Martin Seligman of the University of Pennsylvania and others comes in.

Seligman's group is testing several exercises. Among them:
Every night, think of three good things that happened that day and analyze why they occurred.

Discover your personal strengths and choose the five most prominent ones. Then, every day for a week, apply one or more of your strengths in a new way. Work on savoring the pleasing things in your life, like a warm shower or a good breakfast, Seligman colleague Acacia Parks said.
Write down what you want to be remembered for, to help you bring your daily activities in line with what's important to you.

In fact, happiness probably is really about work and striving, said psychologist Ed Diener of the University of Illinois.

"Happiness is the process, not the place," he said.

Massachusetts to Stop Accepting Patients in State Hospitals

2006-11-22T10:26:00.000-05:00

Faced with substantial state budget cuts, the Massachusetts Department of Mental Health will stop accepting inpatient admissions to all state hospitals and psych units as of Wednesday. The state currently manages about 850 inpatient psych beds, but those are full. Clinicians will only be able to accept more patients when the patient population begins to recede. The closure comes in response to the elimination of 170 Department of Mental Health positions, taking place as part of Governor Mitt Romney's emergency budget cut. Romney's budget reduction also cuts the roster of staff caring for emotionally disturbed children and adolescents by 37 percent, along with dozens of inpatient nurses, psychiatrists and aides. The Massachusetts Hospital Association is publicizing the cuts in hopes of rallying public support for reversing the decision.

To find out more about the situation:
read this Boston Globe article
read this blog entry by Boston hospital CEO Paul Levy

Kaiser Faces Charges for Dumping Disoriented Homeless Patient

2006-11-17T09:49:00.000-05:00

All Things Considered November 16, 2006 National Public Radio

The Los Angeles city attorney's office has filed criminal charges against hospital giant Kaiser Permanente for endangering a former patient. The charges allege Kaiser dumped a homeless patient on the city's downtown Skid Row.

The charges stem from video captured by security cameras in March. The footage shows a 63-year-old patient from Kaiser Permanente's Bellflower hospital, dressed in a hospital gown and slippers, exiting a taxicab on Skid Row. She is later seen shuffling toward the Union Rescue Mission, the city's largest homeless shelter.

Prosecutors describe what happened to Carol Ann Reyes in a 20-page document supporting the false imprisonment and dependent-care abuse charges. Reyes lived mostly in a public park in Gardena before she was hospitalized. When she was discharged, prosecutors say, she wasn't told she was being taken to Skid Row.

For many months, L.A. city officials have suspected that medical centers and law-enforcement officials from elsewhere are dropping off their indigent patients in the city's tough Skid Row area. The criminal charges against Kaiser are the first to be filed in the city's efforts to crack down on the practice.

Skid Row has one of the nation's largest concentrations of homeless people, and is known for the shelters and services for them that are concentrated in the area. Ten other L.A. hospitals are under investigation for allegedly discharging homeless patients onto the streets, instead of into the custody of a relative or shelter.

The Associated Press contributed to this report.

Caffeine Drinks Buzzing Teenagers

2006-11-14T09:37:00.000-05:00

More than 500 new energy drinks launched worldwide this year, and coffee fans are probably too old to understand why.

Energy drinks attract fan mail on their own MySpace pages. They spawn urban legends. They get reviewed by bloggers. They're a US$3.4-billion a year industry that grew by 80 per cent last year. They taste like carbonated cough syrup.
Thirty-one per cent of U.S. teenagers say they drink energy drinks, according to Simmons Research. That represents 7.6 million teens, a jump of almost three million in three years.

Nutritionists warn that the drinks, laden with caffeine and sugar, can hook kids on an unhealthy jolt-and-crash cycle. The caffeine comes from multiple sources, making it hard to tell how much the drinks contain. Some have B vitamins, which when taken in megadoses can cause rapid heartbeat, and numbness and tingling in the hands and feet.

Danger only adds to the appeal, said Bryan Greenberg, a marketing consultant.
Greenberg said the fierce competition among hundreds of new drinks, with Austria-based Red Bull guarding the biggest market share, leads to a "ratcheting up" of taboo names as companies try to break out from the crowd.

Cocaine Energy Drink, which launched in September and now sells in convenience stores and nightclubs in six states, is the latest example, following a twisted logic set by drinks named Pimpjuice and Bawls.

Hannah Kirby of the Las Vegas company behind Cocaine Energy Drink, said she and her husband, Redux Beverage founder James Kirby, had wanted to call their drink Reboot. When they found out the name was taken, they decided to get provocative.

"We knew we would get noticed against a thousand other energy drinks," she said. "We knew kids would find it cool, but we also wanted to stress the idea that it's an energy drink, you don't need drugs." Their slogan is The Legal Alternative.

The Kirbys' 18-year-old grew up hearing he shouldn't drink energy drinks on a school night.
Red Bull founder Dietrich Mateschitz based his product on tonics sold in Asia. He started selling Red Bull in 1987 in his native Austria, and today 2.5 billion cans are sold a year in more than 130 countries.

Rumors have swirled around Red Bull for years. Contrary to hearsay, the ingredient taurine (an amino acid important in making bile to aid digestion) is not made from bull urine, and Mateschitz did not learn about Red Bull from rickshaw drivers in Thailand. The urban legends-debunking website www.snopes.com has a page devoted to exposing the false claim that Red Bull contains a banned substance linked to brain tumours.

No evidence was ever found that sudden deaths were caused by people drinking Red Bull. But it's true that a Swedish government study recommended that energy drinks not be used to quench thirst or replenish liquid when exercising. And they should not be mixed with alcohol.
Too late. Anheuser-Busch and Miller Brewing now produce several "energy beers" - beer containing caffeine. And Red Bull and vodka - mixed up by bartenders who call it a Friday Flattener or a Dirty Pompadour - has been popular for a decade.

A Brazilian study found college students didn't feel as drunk as they actually were after drinking vodka and Red Bull. Their perception of their co-ordination and reaction time didn't match objective tests.

The potential for accidents and alcohol poisoning worries Dr. Sandra Braganza, a pediatrician and nutrition expert at the Children's Hospital at Montefiore in New York. As she prepared to write an article about energy drinks for a pediatrics journal, she was surprised how little published research she could find on them.

"The truth is, we don't know what kind of effects these ingredients can have," Braganza said of taurine, glucuronolactone and guarana. "We have to start doing more studies on this."
Earlier this month, a new study found a surprising number of caffeine overdose reports to a Chicago poison control centre. These involved young people taking alertness pills such as NoDoz or energy drinks, sometimes mixed with alcohol or other drugs. During three years of reports to the centre, the researchers found 265 cases of caffeine abuse. Twelve per cent of those required a trip to the hospital. The average age of the caffeine user was 21.

"Young people are taking caffeine to stay awake, or perhaps to get high, and many of them are ending up in the emergency department," said Dr. Danielle McCarthy of Northwestern University, who conducted the study. "Caffeine is a drug and should be treated with caution, as any drug is."

How much caffeine do energy drinks contain? A University of Florida study found that some products, although served in cans two-thirds the size of a standard can of Coke, contain two to four times the amount of caffeine as that Coke. Energy drinks are unregulated in the United States, but the authors of the University of Florida paper suggest warning labels for them.
And now energy drinks are moving toward bigger cans with some products raising the caffeine content to gain a competitive edge, said John Sicher of Beverage Digest. The biggest, so far, is 680 ml.

Full of sugar and caffeine, energy drinks share the same health problems as soft drinks, says dietitian Molly Morgan. But some parents and coaches have bought the message that the drinks can enhance kids' performance in sports and increase concentration in school.
The evidence is weak, involving tiny studies. British research by a scientist who has since received funding from Red Bull found that among 36 volunteers, those who drank the product improved aerobic endurance and recalled numbers better. A British study of 42 people found Red Bull had no effect on memory, but did improve attention and verbal reasoning.
A University of Wisconsin study of 14 students found that two energy drink ingredients, caffeine and taurine, didn't improve short-term memory but led to slower heart rates and higher blood pressure. Since some energy drink ingredients generally speed up heart rates, the researchers could only speculate on the cause.

Carol Ann Rinzler, author of "Nutrition for Dummies," examined the labels of the top three energy drinks.

"The labels simply don't deliver all the facts," she said. "For example, while all list caffeine as an ingredient, and most tell you exactly how much caffeine is in the drink, they also list guarana, a caffeine source, as a separate ingredient but don't tell how much caffeine one gets from the guarana."

Rinzler said energy drinks also deliver a huge hit of sugar.
"Drink more than one and you get lots of sugar - 14 teaspoons (70 ml) in two cans, 21 teaspoons (105 ml) in three," she said. Add in megadoses of some vitamins; unnecessary nutrients (taurine) and more caffeine than plain sodas and you get "a fast up-and-down sugar high and a really rough caffeine buzz," she said. "And drinking two or three cans a day for a period of weeks or months might trigger some side effects from the vitamin megadoses."

Provided by: Associated PressWritten by: CARLA K. JOHNSON

National Institute of Health Researcher Leaving Due to Stricter Ethical Guidelines

2006-11-01T14:25:00.000-05:00

Almost 40% of NIH tenure and tenure-track scientists have begun or have considered efforts to seek new employment because of new agency ethics rules "that have curtailed their opportunity to earn outside income," according to an internal survey, AP/USA Today reports. NIH implemented the rules last year after a review found that "dozens of scientists had run afoul of existing restrictions on private consulting deals that had enriched them with money from drug and biotechnology companies," AP/USA Today reports (Beamish, AP/USA Today, 10/28). Under the rules, the top 200 NIH officials must maintain holdings at or less than $15,000 in individual pharmaceutical and biotechnology companies. They also must limit their investments in health care sector funds at or less than $50,000. Lower-level NIH employees must inform their supervisors about potential conflicts of interest in their investments but do not have to file disclosures. In addition, NIH employees cannot accept consulting fees from pharmaceutical, biotech or medical device companies; health care providers; health insurers; or research institutions sponsored by the agency (Kaiser Daily Health Policy Report, 8/26/05).

Death Penalty and People with Mental Illness

2006-11-01T14:23:00.000-05:00

Over the past thirty years, the number of people with mental illness and other mental disabilities on death row has steadily increased. Although precise statistics are not available, it is estimated that 5-10 percent of people on death row have a serious mental illness.

NMHA believes that mental illness can influence an individual’s mental state at the time he or she commits a crime, can affect how “voluntary” and reliable an individual’s statements might be, can compromise a person’s competence to stand trial and to waive his or her rights, and may have an effect upon a person’s knowledge of the criminal justice system.

The process of determining guilt and imposing sentence is necessarily more complex for individuals with mental illness. A high standard of care is essential with regard to legal representation as well as psychological / psychiatric evaluation for individuals with mental illness involved in death penalty cases. NMHA believes mental illness should always be taken into account during all phases of a potential death penalty case. Moreover, the assessment of competency to stand trial as well as competency to be executed should be conducted by a multi-disciplinary team of qualified professionals, including professionals with expertise in the defendant’s particular mental illness.

The National Mental Health Association offers a full position related to both adult and juvenile offenders and can be accessed at NMHA - Death Penalty.

Cognitive Behavioral Therapy for the Treatment of Child and Adolescent OCD

2006-10-23T11:39:00.000-04:00

Cognitive behavioral therapy reduces the severity of obsessive compulsive disorder in children and adolescents, according to a new review. This form of treatment helps relieve the overall distress and reduces the interference that OCD symptoms can cause in young people's lives.
Further, the evidence indicates that cognitive behavioral therapy (CBT) and medication are equally effective in treating pediatric OCD, say lead researcher Richard O'Kearney and colleagues.

"When CBT is combined with medication, treatment is more effective than medication alone. Health professionals need to consider this therapy - particularly in view of the controversy about prescribing psychotropic medications to children and teens," said O'Kearney, director of clinical training for psychology at the Australian National University, in Canberra.

This review appears in the October 18 issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

OCD can start at a very early age - review participants were as young as 7 years old. The disorder affects an estimated 0.5 percent to 4 percent of children and adolescents.

Carol A. Mathews, M.D., with the department of psychiatry at the University of California, San Francisco, called the systematic review "excellent" and said it represents an important step forward in the understanding of the effectiveness of various types of treatment for pediatric OCD. Pediatric OCD is frequently under diagnosed and under treated, she said, and this could be because of limited treatment options parents have for their children.

"This study shows convincingly that CBT is superior to placebo, not only in reducing the number of OCD symptoms, but also in effecting remission in many cases. The study also shows that CBT plus medication is more effective than medication alone in children - an important confirmation of what has been believed clinically, but never proven," said Mathews, who was not involved with the study.

"The results of this paper provide clinicians and parents with an additional effective treatment option - CBT or CBT plus medication - a treatment that involves only about 14 to 21 hours, in general," Mathews said.

"Probably the most important issue related to our findings is that while the evidence suggests that CBT is as effective as medication, relatively few children and adolescents get CBT treatment," O'Kearney said. "Part of this is because of access and part is because primary care doctors often prescribe medicine before they refer patients to CBT. Hopefully this review will make them think more about this practice."

O'Kearney said that although attempts have been made to use telephone and computer-assisted delivery to increase access, "overall, there need to be more trained CBT therapists skilled in treating pediatric OCD."

O'Kearney RT, Anstey KJ, von Sanden C. Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents (Review). The Cochrane Database of Systematic Reviews 2006, Issue 4. No abstract

Use of Ritalin with Preschoolers

2006-10-20T16:38:00.000-04:00

The National Institute of Mental Health sponsored a study, The Preschool ADHD Treatment Study that took 303 preschoolers from age 3-5 who were diagnosed with ADHD. The study included 10 weeks of behavioral treatment along with parent training and about one year of drug treatment. Nearly 300 families were enrolled, but many dropped out after the first phase, either because the behavior treatment worked or because they didn't want to put their children on drugs.

The drug phase started with 165 children, more than a dozen dropped out because of side effects. It found that the children taking methylphenidate had a more marked reduction of their ADHD symptoms compared to children taking a placebo.

Throughout the duration of the study, the children grew about half an inch less in height and weighed about 3 pounds less than expected, based on average growth rates established prior to the study.

"This is a catastrophe. It just opens up the way for drugging the younger kids," said Dr. Peter Breggin, a New York psychiatrist and longtime critic of psychiatric drug use in children.

Breggin said the research is part of a marketing push by the drug industry to expand drug use to the youngest children.
The study appears in the November edition of the Journal of the American Academy of Child and Adolescent Psychiatry. Several of the researchers have financial ties to makers of ADHD drugs, including Ritalin.

Lead author Dr. Laurence Greenhill, a psychiatrist with Columbia University and New York State Psychiatric Institute, has been a paid speaker for most companies that make the drugs.

What do you think???