1 in 5 veterans found with mental disorder - Depression, stress called undertreated

The latest and most comprehensive study of veterans of the Iraq and Afghanistan wars has concluded that nearly 1 in every 5 veterans is suffering from depression or stress disorders and that many are not getting adequate care.
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* Wars, guns and money
* Nearly 1 in 5 troops has mental problems after war service
* Summary: Nearly 1 in 5 troops has mental problems after war
* Nearly 1 in 5 vets reports mental problems
* Study: 300,000 veterans suffer mental problems
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The study shows that mental disorders are more prevalent and lasting than previously known, surfacing belatedly and lingering after troops have been discharged into civilian and family life.

An estimated 300,000 veterans among the nearly 1.7 million who have served in Iraq and Afghanistan are battling depression or post-traumatic stress disorder. More than half of those people, according to the study conducted by the Rand Corp., are slipping through the cracks in the bureaucratic system, going without necessary treatment.

The Rand study underscores one of the hard lessons of modern counterinsurgency conflicts: Such wars might kill fewer soldiers than traditional fights but can leave deeper psychological scars.

READ MORE @ BOSTON GLOBE

Who Are We? Coming of Age on Antidepressants

“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”

At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.

But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.

It was not an issue I had seriously considered before. Most of my patients, who are adults, developed their psychiatric problems after they had a pretty clear idea of who they were as individuals. During treatment, most of them could tell me whether they were back to their normal baseline.

READ MORE @ NY TIMES

Antipsychotic Drugs Increase Risk Of Developing Pneumonia In Elderly, Study Suggests

Elderly patients who use antipsychotic drugs have a 60 percent increased risk of developing pneumonia compared to non-users. This risk is highest in the first week following prescription and decreases gradually thereafter. Antipsychotic drugs are frequently used in elderly patients for the treatment of psychosis and behavioral problems associated with dementia and delirium. This study is the first to show that the development of pneumonia is associated with antipsychotic drug use.

“The risk of developing pneumonia is not associated with long-term use, but is the highest shortly after starting the drug,” say Drs. Rob van Marum and Wilma Knol, authors of the study. They caution that “all antipsychotic drugs may be associated with pneumonia in elderly patients.”

READ MORE @ SCIENCE DAILY

Antidepressants Account For Only 10% Of Fall In Suicide Rates Among Older People

The use of antidepressants is likely to account for only 10 per cent of the fall in suicide rates among middle aged and older people, suggests a large study in the Journal of Epidemiology and Community Health.

Globally, more than 800, 000 people commit suicide every year. Rates have been falling in many countries, a factor that has been associated with better recognition of depression and the increasing use of antidepressants, particularly the newer selective serotonin reuptake inhibitors (SSRIs).

But research involving more than 2 million Danes aged 50 and above and living in Denmark between 1996 and 2000, throws this into question.

The researchers assessed changes in the numbers of middle aged and older people committing suicide during this period and the types of antidepressant drugs they had been prescribed.

READ MORE @ SCIENCE DAILY

Can Atypical Antipsychotics Reduce Suicide Risk in Patients With Schizophrenia?: An Evidence-Based Analysis

Suicide is a devastating, tragically frequent outcome for persons with varying psychiatric conditions, including schizophrenia. An estimated 5% to 10% of persons with schizophrenia commit suicide and 20% to 50% attempt suicide during their lifetime.1,2 Patients with schizophrenia have more than an 8-fold increased risk of completing suicide (based on the standardized mortality ratio) than the general population.3 Antipsychotic treatment is the cornerstone of the therapeutic approach to schizophrenia and has been thought to influence suicidal tendencies.4 Yet, both typical and atypical antipsychotics (the latter of which have been considered to have a better profile for reducing the risk of suicide than the former) have not been shown to have a net positive effect on suicidality.5,6

Atypical antipsychotics are now considered to be a first-line treatment for schizophrenia. It is therefore crucial that we have an evidence-based approach to minimizing suicidal thinking and behavior. We have recently reviewed the relationship between antipsychotic drugs and suicide in patients with schizophrenia, observing that many inconsistencies exist among the studies. This, in turn, prevents any definitive conclusions; the sole exception is clozapine, which should be considered when suicide risk is detected.7

This article reviews the evidence for the various atypical antipsychotics in potentially reducing the risk of suicide in patients with schizophrenia. A high degree of efficacy should not be expected, since 2 large reviews on premarketing data have failed to demonstrate the efficacy of atypical antipsychotics (excluding clozapine) in reducing the risk of suicidality in patients with schizophrenia.8,9 Further limitations come from methodological issues, which may be seen in some studies that originate within the pharmaceutical industry.10

READ MORE @ PSYCHIATRIC TIMES

When Drug Costs Soar Beyond Reach - Editorial

It doesn’t take a health policy expert to recognize that something has gone terribly wrong when patients have to pay thousands of dollars a month for drugs that they need to maintain their health — and possibly save their lives. Congress needs to determine why this is happening and what can be done about it.

The plight of patients who have recently been hit with a huge increase in their insurance co-payments for high-priced prescription drugs was laid out in The Times on Monday by Gina Kolata. Instead of paying a modest $10 to $30 co-payment, as is usually the case for cheaper drugs, patients who need especially costly medicines are being forced to pay 20 percent to 33 percent of the bill (up to an annual maximum) for drugs that can cost tens of thousands of dollars, or even hundreds of thousands of dollars, a year.

These drugs — what insurers call Tier 4 medicines — are used to treat such serious illnesses as multiple sclerosis, hemophilia, certain cancers and rheumatoid arthritis. And since there are usually no cheaper alternatives, patients must either pay or do without, unless they can get their medicines through some charitable plan.

READ MORE @ NY TIMES

Area firm to test medication alert system

A Crystal Lake technology firm wants your smartphone to remind you when to take your medications.

For the last three years, Leap of Faith Technologies (www.leapoffaith.com) has been developing a software application, called eMedonline (www.emedonline.com), designed to help monitor your medications by sending you a call to remind you of your next dose.

It then can use a radio frequency identification bar to read whether you're choosing the correct container, said founder and owner Barbara Rapchak.

"It primarily works with a Treo smartphone or it could be used on any smartphone with Windows Mobile operating system," she said.

READ MORED @ CHICAGO DAILT HERALD

Co-Payments Go Way Up for Drugs With High Prices

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.
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With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.

No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.

Insurers say the new system keeps everyone’s premiums down at a time when some of the most innovative and promising new treatments for conditions like cancer and rheumatoid arthritis and multiple sclerosis can cost $100,000 and more a year.

READ MORE @ NY TIMES

Task Force Proposes New Bipolar Guidelines

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

The Diagnostic Guidelines Task Force of the International Society for Bipolar Disorder (ISBD) has been examining diagnostic issues since 2004 and recently presented its recommendations at ISBD's third biennial meeting in India and in the society's journal, Bipolar Disorders (February, part 2).

Task force chairman S. Nassir Ghaemi, MD, MPH, told Psychiatric Times that the task force brought together some of the world's clinical experts on bipolar disorder and key researchers with the goal of having them develop a more systematic and coherent set of diagnostic guidelines.

The task force's charge, originally developed by then ISBD president Samuel Gershon, MD, was to evaluate current diagnostic systems, identify key similarities and differences among them, reconcile the data, provide an organizational schema for diagnosis of bipolar disorder across cultures, and highlight continuing differences for further research.

READ MORE @ PSYCHIATRIC TIMES

FDA looks at link between medications, depression

Federal regulators warn that an array of drugs could play a role in spurring thoughts of suicide or other psychiatric symptoms.

As symptoms of depression go, there is none much clearer than having thoughts of suicide.

But a spate of recent announcements from federal health officials suggests a surprising new interpretation of suicidal fantasies and the depression they are thought to signal: Sometimes, sadness, anxiety and self-destructive thoughts are not symptoms but side effects -- of medicine.

In this year alone, federal regulators have warned that a surprising array of drugs could play a role in spurring thoughts of self-destruction. Medicines that treat epilepsy, asthma and influenza are now under suspicion, as is one that helps smokers kick the tobacco habit.

The FDA stresses that it has established no direct causal link between these medications and suicidal thoughts in patients taking them. But in all the cases, regulators acknowledge they had one of two indicators of potential trouble.

In some cases, a review of a drug's early clinical trials turned up increased rates of suicidal thinking among subjects taking the medicine. In others, the tip-off came when the FDA observed an uptick of reports that patients taking a medication for some other condition developed symptoms of depression.

READ MORE @ LOS ANGELES TIMES

Treatment With An Anti-psychotic Drug Found To Cause Changes In Metabolism Earlier Than Expected

Schizophrenia is a complex type of psychotic mental illness characterized by thoughts that are uncoupled from reality. Huge gains in the effective treatment of individuals with the disease began in the 1950s with the development of the first generation of antipsychotic drugs. The medications allowed physicians to treat the “positive” effects of the illness (delusions and hallucinations) and, to a lesser extent, the “negative” symptoms (apathy). The second generation of antipsychotics – known as atypical antipsychotics (AAP) – began in 1990. These newer medicines have proven as effective in treating the positive aspects of the disease and more effective in combating the negative ones.

As is the case with nearly all medications, antipsychotics have side affects, including weight gain and some other risk factors of metabolic syndrome, which puts an individual at greater risk of heart disease and type 2 diabetes. Physicians are concerned that these side effects may cause their patients to stop taking their medicine.

A team of French researchers has found, in an animal model, that the consumption of at least one atypical antipsychotic exhibits some of the risks for metabolic syndrome in humans. This model allows researchers to explore the sequence of early metabolic events that may result from atypical medications.

READ MORE @ SCIENCE DAILY

Injectable Risperidone Demonstrates Response, Lowers Relapse

With medication compliance is a significant issue in some people who grapple with schizophrenia, drug companies often look toward injectable forms of their psychiatric medications to help with this issue. A new study suggests that an atypical antipsychotic in injectable form looks to be just as effective as its non-injectable counterpart. Patients with psychosis treated early on in the course of their illness with risperidone long-acting injection demonstrated high response and remission rates with low relapse rates according to the study.

A reduction of the Positive and Negative Syndrome Scale (PANSS) total score of at least 50% was experienced by 84% of the 51 patients included in the study, with only four of these patients relapsing by the study endpoint. During the two-year trial period, the study also showed 64% of patients achieved remission.

Non-compliance or partial compliance remain key barriers in the management of schizophrenia and are often significant contributing factors in relapse. Relapse is associated with increased risk of hospitalization and a dramatically poorer quality of life. Patients experiencing numerous relapses are at high risk of never regaining previous levels of functioning.

READ MORE @ PSYCHCENTRAL

Link Between Insomnia And Depression In Young Adults - New Study In The Journal SLEEP

A study published in the April 1 issue of the journal SLEEP confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia.

The study, conducted by Jules Angst, MD, of Zurich University Psychiatric Hospital in Switzerland, focused on 591 young adults, whose psychiatric, physical, and sleep symptoms were assessed with six interviews spanning 20 years. Four duration-based subtypes of insomnia were distinguished: one-month insomnia associated with significant distress, two-to-three-week insomnia, recurrent brief insomnia, and occasional brief insomnia.

According to the results, the annual prevalence of one-month insomnia increased gradually over time, with a cumulative prevalence rate of 20 percent and a greater than two-fold risk among women. In 40 percent of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting two weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews. Seventeen to 50 percent of subjects with insomnia lasting two weeks or longer developed a major depressive episode in a later interview. "Pure" insomnia and "pure" depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both.

READ MORE @ MEDICAL NEWS TODAY

2.5m children on drugs in US

Antipsychotic drugs for children have taken off in the US on the back of a willingness to diagnose those with behavioural problems as having manic depression. Even children barely out of babyhood are getting a diagnosis of bipolar disorder, the modern term for the condition.

The chief symptoms are mood swings, which, however, are common in children of any age.

David Healy, an expert on bipolar disorder, said there were now 2.5 million American children on antipsychotics. However, the UK guidelines on the disorder, from the National Institute for Health and Clinical Excellence, urge caution.

One drug which prompted concern was Risperdal, originally to be sold for children with "irritability" or difficult behaviour in autism. It was reviewed by experts for the Medicines and Healthcare products Regulatory Agency because of "concern about the potential misuse of [it] as ... long-term chemical control". The drug's maker, Janssen-Cilag, though it won a licence for it, withdrew its application, citing differences with the authority.

READ MORE @ GUARDIAN

Drug Makers Near Old Goal: A Legal Shield

For years, Johnson & Johnson obscured evidence that its popular Ortho Evra birth control patch delivered much more estrogen than standard birth control pills, potentially increasing the risk of blood clots and strokes, according to internal company documents.

But because the Food and Drug Administration approved the patch, the company is arguing in court that it cannot be sued by women who claim that they were injured by the product — even though its old label inaccurately described the amount of estrogen it released.

This legal argument is called pre-emption. After decades of being dismissed by courts, the tactic now appears to be on the verge of success, lawyers for plaintiffs and drug companies say.

The Bush administration has argued strongly in favor of the doctrine, which holds that the F.D.A. is the only agency with enough expertise to regulate drug makers and that its decisions should not be second-guessed by courts. The Supreme Court is to rule on a case next term that could make pre-emption a legal standard for drug cases. The court already ruled in February that many suits against the makers of medical devices like pacemakers are pre-empted.

READ MORE @ NY TIMES

Restrictive Prescription Drug Policies Hurt Schizophrenics

Harvard study found program made patients 29% more likely to stop, disrupt their meds

Restrictive prescription drug policies can cause schizophrenia patients to stop taking their medications, a Harvard Medical School study suggests.

Researchers looked at Medicare beneficiaries with schizophrenia in Maine before, during and after a policy that required patients to use an authorized medication (step treatment) before they were permitted to be prescribed drugs not on the preferred list. They were compared to Medicare beneficiaries with schizophrenia in New Hampshire, where there was no such regulation.

The study found that the Maine patients were 29 percent more likely to stop or disrupt medication when subject to the tightened policy. In addition, the restrictive drug policy -- originally designed to reduce costs -- provided only minimal savings.

READ MORE @ US NEWS & WORLD REPORT

New Findings in Early-Onset Schizophrenia

The Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study, funded by the NIMH, was a multicenter, controlled treatment trial of children and adolescents.1 The aim of the TEOSS study was to compare the efficacy and safety of risperidone and olanzapine with that of a traditional antipsychotic agent—molindone.

In this double-blind, parallel-group study, patients were randomized to receive risperidone, olanzapine, or molindone for 8 weeks followed by a 44-week, double-blind maintenance phase for responders. A total of 119 children and adolescents were randomized in the study. The results of the study, which should be reported in the near future, will provide needed information about the safety and tolerability of antipsychotic medications in youths with schizophrenia spectrum disorders.

The clinical characteristics of this large sample were recently reported and provide important information about the demographics and severity of illness in children and adolescents with early-onset schizophrenia and schizoaffective disorder.2 The mean age of onset of illness was 11.1 years. At the time of enrollment, the mean age of the patients was 13.8 years. The sex distribution was 66% male and 34% female. The racial breakdown was 62% white, 31% African Amer-ican, 3.4% Asian, 2.5% mixed, and 0.8% Pacific Islander. The average IQ of the sample was 93. Most of the youths lived with their family, 4% were hospitalized, and 7% lived in a group home or residential facility.

READ MORE @ PSYCHIATRIC TIMES

Medication 'worsens Alzheimer's

Anti-psychotic drugs commonly given to Alzheimer's patients often make their condition worse, a UK study suggests.

Neuroleptics provided no benefit for patients with mild behavioural problems, but were associated with a marked deterioration in verbal skills.

The research focused on 165 people with advanced Alzheimer's who were living in nursing homes in four British cities.

Up to 60% of Alzheimer's patients in nursing homes are given the drugs to control behaviour such as aggression.

The study appears in the journal Public Library of Science Medicine.

The researchers, from Kings College London and the Universities of Oxford and Newcastle, found the drugs offered no long-term benefit for most patients with mild symptoms of disturbed behaviour.

But just six months of treatment was enough for patients to show a marked deterioration in their verbal fluency.

READ MORE @ BBC

Psychiatric drugs causing weight gain: doctors

The very drugs millions of Canadians are taking to get through their day can cause dramatic weight gain, doctors are warning.

Psychiatric drug-related weight gain "is a huge problem," says Dr. David Lau, chair of the diabetes and endocrine research group at the University of Calgary and president of Obesity Canada.

"You can see patients gaining 10, 20, 30, 40 pounds," Lau says.
Not everyone taking antidepressants, mood stabilizers or newer generation antipsychotics will gain weight, he stressed. What's more, he said new antipsychotics, so-called "atypical antipsychotics" have been "tremendous in terms of bringing back the functionality of people with schizophrenia, bipolar disorders and depression."

But Harvard University psychologist Paula Caplan warns of a vicious cycle, where patients who experience weight gain after taking psychotropic drugs are reluctant to discontinue their use.

"If they gain weight, they think 'I can avoid fast foods, or I can take smaller portion sizes or I can exercise more.' But to think, 'go off my medication that I believe is responsible for my being able to function, is too scary.'"

READ MORE@ VANCOUVER SUN

Second-Generation Antipsychotics Are No Better Than First-Generation Drugs for Schizophrenia

Second-generation antipsychotic drugs are not necessarily better than the first-generation drug haloperidol at treating a first episode of schizophrenia. This is the conclusion of authors of an article published in this week's issue of The Lancet.

Second-generation drugs, introduced over a decade ago, are purported to be more effective and less likely to induce motor side effects, such as stiffness and tremors, than first-generation drugs. However, results from studies comparing the 2 types of drugs have not been reliable -- studies have over-represented men and under-represented those with other issues such as drug abuse. Moreover, these trials were often too short. The question of which drugs are more effective is an important one, as many of the newer drugs are more expensive.

READ MORE @ DOCTOR'S GUIDE