Consensus OCD Report Published

Leading international experts in obsessive compulsive disorder have published a new consensus report aimed at providing analysis and guidance to drive improved diagnosis and management of OCD worldwide.

Presented at The European Congress of Psychiatry, Madrid, 17-21 March 2007 and recently published in CNS Spectrums, the report has made a number of important recommendations including the removal of OCD from anxiety disorders to create its own category.

READ MORE @ PRNewswire

Early Response to Antidepressant Treatment Predicts Remission

Patients with depression who have an early response with certain symptoms are more likely to have a sustained remission, investigators reported here at the American Psychiatric Association 2007 Annual Meeting.

"At 2 weeks, the improvement on the Hamilton Depression Rating Scale (HAMD) significantly predicted remission for key symptoms with both duloxetine and escitalopram," said principal investigator Martin Katz, PhD, clinical researcher, University of Texas Health Science Center, San Antonio, Texas, United States.

"Improvements for depressed mood, anxiety, and somatic symptoms significantly predicted remission for both treatments," Dr. Katz said in his presentation on May 21st.

READ MORE @ DOCTOR'S GUIDE

Routine Metabolic Screening Is Necessary for Antipsychotic Treatment

Although antipsychotic treatment guidelines recommend routine metabolic screening, glucose and lipid profiles are not routinely being ordered at baseline by prescribing physicians in a patient population already at risk for diabetes and cardiovascular disease.

The purpose of the study was to evaluate the impact of abnormal laboratory test results on the selection of atypical antipsychotic treatment for patients whose lipids and fasting blood glucose (FBG) were being measured.

READ MORE @ DOCTOR'S GUIDE

Iloperidone Results Show Favorable Akathisia Profile

According to study results presented today at the 2007 American Psychiatric Association annual meeting, iloperidone, an investigational atypical antipsychotic, was shown to have a favorable akathisia profile.

Akathisia is a debilitating sensation of restlessness that manifests as an inability to sit still is a frequent side effect of antipsychotic medications. Iloperidone is being studied by Vanda Pharmaceuticals.

READ MORE @ MEDICAL NEWS TODAY

Poor Understanding Called Biggest Barrier to Antipsychotic Drug Adherence

The most common reasons patients don't adhere to antipsychotic regimens are poor insight into the nature of their illness, forgetfulness, and simply deciding to stop, surveyed physicians said....

"The other thing that can happen is that individuals can be lulled into a false sense of security. When they're doing particularly well, they think that perhaps they don't need to take their medication," he said. "One can stop taking medication in an illness like schizophrenia and not necessarily notice a change immediately."

READ MORE @ PSYCHIATRIC TIMES

Psychiatrists Want More Effective Antipsychotics

Pharmacotherapy for schizophrenia may be better than it's ever been, but it's not nearly good enough.

In a nationwide survey of psychiatrists, 95% said that there is a need for new, highly effective drug options, said Peter Buckley, M.D., of the Medical College of Georgia.

READ MORE @ PSYCHIATRIC TIMES

Insomnia and Psychiatric Illness: Presented at APA

There is a prevalence of insomnia seen in psychiatric illness although insomnia itself can be a risk factor for psychiatric disorders. That's according to research presented here on at the annual meeting of the American Psychiatric Association (APA).

READ MORE @ DOCTOR'S GUIDE

Abilify helps as add-on depression treatment-study

Bristol-Myers Squibb's Abilify proved effective as an add-on therapy for patients suffering from major depression who were not getting satisfactory relief from their regular medication, according to a clinical study.

The drugmaker is hoping to use data from the study, which were presented on Monday at the American Psychiatric Association annual meeting in San Diego, to broaden the approved uses for Abilify, which is also approved to treat bipolar disorder.

READ MORE @ REUTERS

Dosing Schedule Doesn't Matter for Antipsychotic Drug Adherence

Frequency of dosing of antipsychotic agents does not appear to affect medication adherence in most patients with schizophrenia, reported investigators here.

Patients who are stable on an antipsychotic agent are just as likely to adhere to their regimen whether the drug is prescribed once or twice daily, according to Paul Pfeiffer, M.D., and colleagues of the VA Center for Practice Management and Outcomes Research and the University of Michigan, both in Ann Arbor.

READ MORE @ MEDPAGE TODAY

Objective Monitoring of Schizophrenic Patients Doesn't Measure Up

Psychiatrists need to do more objective measurement of the physical and mental health of their schizophrenic patients, researchers said here.Psychiatrists have been relying on clinical judgment, doing minimal medical record-keeping, and sometimes haphazard monitoring of physical consequences of antipsychotic medication for schizophrenic patients, according to a panel of speakers at an industry-funded satellite symposium here held in conjunction with the American Psychiatric Association.

That needs to change, both for the health of patients and to get ahead of pay-for-performance trends, said John M. Kane, M.D., of the Albert Einstein College of Medicine in New York.

READ MORE @ PSYCHIATRIC TIMES

Chemical Maps Hint At Drug's Effects On Schizophrenia

Antipsychotic drugs do most of their work in the brain, but they also leave behind in the bloodstream a trail of hundreds of chemicals that may be used in the future to direct better treatment for schizophrenia and other psychiatric conditions, say Duke University Medical Center researchers.

READ MORE @ SCIENCE DAILY

Antidepressants Help More Kids Than They Harm

Whether depressed or troubled kids should take antidepressants has been the question at the center of an intense public debate in recent years, and the latest evidence suggests the answer is "yes."

A study in the April 18 issue of the Journal of the American Medical Association found that the benefits of antidepressants outweighed the risks for children and adolescents under the age of 19.

READ MORE @ WASHINGTON POST

Minorities prefer depression counseling to drugs

NEW YORK (Reuters Health) - When it comes to depression therapy, minorities are more likely than whites to prefer counseling to medication, according to a large U.S. survey.

In an Internet survey of about 75,000 Americans, researchers found that African Americans, Hispanics and Asian Americans were two to three times more likely than whites to say they'd rather be treated with talk therapy than with drugs for depression.

READ MORE @ REUTERS

Epilepsy Drug Can Increase Risk for Newborns, Study Says

Doctors reported yesterday that expectant mothers with epilepsy who took a commonly prescribed drug to control seizures were at increased risk of having a child with mental deficits.

Toddlers who had been exposed in the womb to the drug Depakote, from Abbott Laboratories, scored seven to eight points lower on I.Q. tests at age 2 than those whose mothers had been taking other epilepsy drugs while pregnant, the study found. They were twice as likely to score in the range associated with mental retardation, according to the authors, who presented the findings at the annual meeting of the American Academy of Neurology in Boston.

READ MORE @ NY TIMES

Country walks 'can help reduce depression'

Country walks can help reduce depression and raise self-esteem according to research published today, leading to calls for "ecotherapy" to become a recognised treatment for people with mental health problems.

Ecotherapy: the green agenda for mental health is the first study looking at how "green" exercise specifically affects those suffering from depression.

READ MORE @ INDEPENDENT

Study: Diabetes Drug Use Spikes in Girls

TRENTON, N.J. (AP) -- The number of adolescent girls taking drugs for Type 2 diabetes nearly tripled in just five years, while use of chronic medicines for psychotic behavior and insomnia roughly doubled among boys and girls aged 10 to 19, a study shows.

Meanwhile, adolescents' use of drugs for depression and attention deficit hyperactivity disorder, or ADHD, leveled off or dropped in the last two years, after widespread new warnings about safety concerns.

The study, an analysis of prescription drug use from 2001 to 2006 among 370,000 insured children aged 10 to 19, was conducted by Medco Health Inc. of Franklin Lakes, N.J., the country's biggest prescription benefit manager, and released exclusively to The Associated Press.

READ MORE @ AP

Antidepressant prescribing soars

The number of prescriptions for antidepressants in England has hit a record high despite national guidance advocating alternative treatments.

More than 31 million prescriptions for drugs such as Prozac were issued in 2006 - a 6% rise on the year before.

The figures come as two studies showed "startling" benefits of country walks in people with depression.

READ MORE @ BBC

Narcotic Maker Guilty of Deceit Over Marketing

The company that makes the painkiller OxyContin and three of its current and former executives pleaded guilty Thursday in federal court here to criminal charges that it had misled doctors and patients when it claimed the drug was less likely to be abused than traditional narcotics.

The company, Purdue Pharma, agreed to pay $600 million in fines and other payments to resolve the criminal charge of “misbranding” the product, one of the largest amounts ever paid by a drug company in such a case.

The three executives, including its president and its top lawyer, also pleaded guilty to misdemeanor charges of misbranding the drug. Together, they agreed to pay $34.5 million in fines.

The guilty plea — by Purdue Frederick, an affiliate of Purdue Pharma — is the latest of a number of cases brought by the Justice Department against pharmaceutical makers that accuse them of misbranding, a broad statute that makes it a crime to put false or misleading information about a drug on its label or in ads, or to promote it for unapproved use.

Plea Agreement as to The Purdue Frederick Company (pdf)
Plea Agreement as to Howard R. Udell (pdf)
Plea Agreement as to Michael Friedman (pdf)
Plea Agreement as to Paul D. Goldenheim (pdf)

READ MORE @ New York Times
READ MORE @ Scientific American

Feds seek to punish drug companies for off-label marketing

U.S. District Court Judge Patti Saris had seen cases like this before, and she was fed up.

Another pharmaceutical company was in her court, waiting to be slapped with a multi-million-dollar fine for marketing its drugs for uses that had not been approved by the federal Food & Drug Administration.

“You can't thumb your nose at the FDA,” Saris said. She sentenced Schering Sales Corp. and its parent company, Schering-Plough Corp. earlier this year to pay $435 million to settle allegations it lied to the government about drug prices and illegally promoted the drugs Temodar and Intron A for the treatment of cancers for which they were not approved.

READ MORE @ Associated Press

Industry’s Role in Childrens’ Antipsychotics

When Anya Bailey developed an eating disorder after her 12th birthday, her mother took her to a psychiatrist at the University of Minnesota who prescribed a powerful antipsychotic drug called Risperdal. Anya Bailey has a painful nerve condition called dystonia, in which the muscles in her back clench as a result of taking an antipsychotic drug.

Created for schizophrenia, Risperdal is not approved to treat eating disorders, but increased appetite is a common side effect and doctors may prescribe drugs as they see fit. Anya gained weight but within two years developed a crippling knot in her back. She now receives regular injections of Botox to unclench her back muscles. She often awakens crying in pain.

Isabella Bailey, Anya’s mother, said she had no idea that children might be especially susceptible to Risperdal’s side effects. Nor did she know that Risperdal and similar medicines were not approved at the time to treat children, or that medical trials often cited to justify the use of such drugs had as few as eight children taking the drug by the end.

READ MORE @ New York Times

Mental Health Law Should Stress Coordinated Care, Lawmakers Told

Federal grants should do a better job of tying scattered local treatment services into comprehensive plans of care for those with mental illnesses, substance abuse problems or both, witnesses and lawmakers said at a Senate, Health, Education, Labor, and Pensions Committee hearing Tuesday.

Grants shouldn’t dictate the details of treatment programs but should be awarded based on the results those programs get, witnesses said Tuesday.

“Everybody’s problem is a little bit unique,” observed North Carolina Republican Senator Richard M. Burr, who emphasized that local communities know best the nature of their substance abuse problems, for example. “Outcome measures” evaluating programs rather than the “processes” those programs follow should be key, Burr said. “In this town, we don’t hear outcome, we hear process and that’s disturbing to me.”

READ MORE @ CQ.com

LISTEN & LEARN @ full hearing transcript

Bipolar spectrum disorder may be underrecognized and improperly treated

A new study supports earlier estimates of the prevalence of bipolar disorder in the U.S. population, and suggests the illness may be more accurately characterized as a spectrum disorder. It also finds that many people with the illness are not receiving appropriate treatment. The study, published in the May 2007 issue of Archives of General Psychiatry, analyzed data from the National Comorbidity Survey Replication (NCS-R), a nationwide survey of mental disorders among 9,282 Americans ages 18 and older. The NCS-R was funded by the National Institutes of Health's National Institute of Mental Health (NIMH).

NIMH researcher Kathleen Merikangas, Ph.D. and colleagues identified prevalence rates of three subtypes of bipolar spectrum disorder among adults. Bipolar I is considered the classic form of the illness, in which a person experiences recurrent episodes of mania and depression. People with bipolar II experience a milder form of mania called hypomania that alternates with depressive episodes. People with bipolar disorder not otherwise specified (BD-NOS), sometimes called subthreshold bipolar disorder, have manic and depressive symptoms as well, but they do not meet strict criteria for any specific type of bipolar disorder noted in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), the reference manual for psychiatric disorders. Nonetheless, BD-NOS still can significantly impair those who have it.

READ MORE @ NIMH

Self-Nonmedication

Long autobiographical essay in the NY Times today by Bruce Stutz, a writer on science and the environment, titled Self-Nonmedication.

Seven years ago, not long after my father died, with my editing job lost, my finances frail, my 26-year marriage failing, a child in college and a mortgage to pay, my brain seemed to lose its way. Sometimes it could barely think at all. Sometimes it tortured a single thought for hours. And sometimes, in desperation and without aim, it released a barrage of anger upon itself.

I could come up with a hundred descriptions of how I felt — as if the train I’d been riding had gone off track, as if the ground beneath me had given way and swallowed me up, as if I were in a black hole being compressed to nothingness — none of them very original, I suppose, because this was not, for a man just past 50, a very extraordinary midlife situation. But it was mine, and I saw no way out of it. Immobilized by indecision or agitated to the point of exhaustion, I could enumerate every stressful circumstance, but I was simply unable or unwilling to resolve any of them. Instead, I dithered miserably while I staved off creditors, struggled to write, sparred with marriage counselors and rued the emotional havoc I was wreaking on myself and everyone around me. Frustrated, I felt angered and at times utterly hopeless. I needed help.

READ MORE @ New York Times

Troops at Odds With Ethics Standards

Army Also Finds More Deployment Means More Mental Illness

More than one-third of U.S. soldiers in Iraq surveyed by the Army said they believe torture should be allowed if it helps gather important information about insurgents, the Pentagon disclosed yesterday. Four in 10 said they approve of such illegal abuse if it would save the life of a fellow soldier.

In addition, about two-thirds of Marines and half the Army troops surveyed said they would not report a team member for mistreating a civilian or for destroying civilian property unnecessarily. "Less than half of Soldiers and Marines believed that non-combatants should be treated with dignity and respect," the Army report stated.

READ MORE @ Washington Post

STAR*D Depression Study Finds Cognitive Therapy Equivalent To Medication But Selected By Fewer Patients

In the federally funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, outcomes for cognitive therapy as a second-step treatment were not different from outcomes of medication therapy. However, random assignment in this STAR*D level was based on each patient's treatment preferences, and only 26 percent of the patients accepted cognitive therapy as an option. These findings are reported in two articles in the May issue of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association (APA).

The treatment results are presented in "Cognitive Therapy as a Second-Step Treatment: A STAR*D Report," by Michael E. Thase, M.D., of the University of Pittsburgh, and other STAR*D investigators. The patients in the second treatment step had discontinued citalopram in the first treatment phase, either because it was not effective for them or because the side effects were too burdensome.

READ MORE @ Medical News Today

READ MORE @ NIMH

Following the Script: How Drug Reps Make Friends and Influence Doctors

It's my job to figure out what a physician's price is. For some it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship...but at the most basic level, everything is for sale and everything is an exchange. —Shahram Ahari

You are absolutely buying love. —James Reidy

In 2000, pharmaceutical companies spent more than 15.7 billion dollars on promoting prescription drugs in the United States. More than 4.8 billion dollars was spent on detailing, the one-on-one promotion of drugs to doctors by pharmaceutical sales representatives, commonly called drug reps. The average sales force expenditure for pharmaceutical companies is $875 million annually.

Unlike the door-to-door vendors of cosmetics and vacuum cleaners, drug reps do not sell their product directly to buyers. Consumers pay for prescription drugs, but physicians control access. Drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship. This article, which grew out of conversations between a former drug rep (SA) and a physician who researches pharmaceutical marketing (AFB), reveals the strategies used by reps to manipulate physician prescribing.

READ MORE @ PLoS Medicine

READ MORE @ Pharmalot

Mental health worsens as deployments lengthen

The Mental Health Advisory Team (MHAT) IV Operation Iraqi Freedom Final Report, (2.3 MB pdf) dated November 17, 2006(!) surfaced today.

READ MORE @ CNN

Several findings, including one-third of troops report mental conditions, including acute stress, but clearly the report evaded stating clearly the effect of war and suffering on soldiers.

Who is the biggest purchaser of psychiatric medication in the world? That's right - the US Government. (General Motors is the largest buyer of Viagra and Lipitor.)

READ MORE @ transcript of the DoD press conference

READ MORE @ Army Times

The Doctor-Patient Relationship in Pharmacotherapy

The Doctor-Patient Relationship in Pharmacotherapy
Improving Treatment Effectiveness
By Allan Tasman, Michelle B. Riba, and Kenneth R. Silk
182 Pages - May 2000

"It's the relationship that matters! That message encapsulates this volume's critically important lesson for psychiatrists. Even when medications are the primary modality of treatment and sessions are brief, the psychiatrist patient relationship is the hinge on which the efficacy of treatment depends. Attention paid to our patients as unique individuals rewards them as well as ourselves."

-Paul S. Appelbaum, MD, University of Massachusetts Medical School

Buy it cheap @ $7.50 from Guilford Press

Behind The Curtain: Lilly Discloses Grants

In a long overdue move, Lilly today will release a report detailing the grant money given to non-profit groups and educational institutions. In this year's first quarter, for instance, the drugmaker gave $11.8 million to universities, foundations devoted to disease research and awareness, and companies that are in the continuing education business.

For instance, the largest single grant was $825,000 to Massachusetts General Hospital's psychiatry department for a year-long educational program with more than 150,000 registrants. And the National Alliance for the Mentally Ill, an advocacy group for patients, received $544,500. Of that, $450,000 went to fund a project called "Campaign for the Mind of America."

READ MORE @ Pharmalot

Antidepressant Warnings, Health Benefits in Coffee

NPR's News & Notes kicks off a regular, Thursday conversation on health, medicine and the black community. This week, Dr. Ivan Walks, former Chief Health Officer of the District of Columbia, talks to Tony Cox about new warnings about antidepressants, as well as the possible benefits of a morning cup of coffee.

LISTEN @ NPR's News & Notes

Puzzle of antipsychotic drug weight gain solved

Researchers said on Monday they have pinpointed the reason some drugs used to treat mental illnesses like schizophrenia cause patients to gain a lot of weight, raising hope for developing drugs without this side effect.

Antipsychotic medications such as Zyprexa, made by Eli Lilly and Co., increase the activity of an enzyme called AMPK in cells in the part of the brain that regulates eating behavior, according to research in mice led by scientists at Johns Hopkins University in Baltimore.

READ MORE @ Reuters

FDA expands antidepressant warning to young adults

Young adults beginning treatment with antidepressants should be warned about an increased risk of suicidal thoughts and behavior, federal health officials said Wednesday.

The Food and Drug Administration proposed labeling changes that would expand a warning now on all antidepressants. The current language applies only to children and adolescents. The expanded warning would apply to adults 18-24 during the first month or two of treatment with the drugs, the FDA said.

The proposed labeling changes also would note that studies have not shown this increased risk in adults older than 24, and that adults 65 and older taking antidepressants have a decreased risk of suicidal thoughts and behavior, it said.

http://www.cnn.com/2007/HEALTH/05/02/antidepressants.suicide.ap/index.html