Study will try to improve how mentally ill are cared for in ERs Hospitals have seen increase in mentally ill patients.

Mental health experts in Austin are hoping a research project will help them revamp the way psychiatric patients are treated in emergency rooms.

Advocacy Inc., an Austin-based organization focused on disability rights, is examining what happens to mentally ill patients brought to Austin hospitals because of a psychiatric crisis. The organization will look at things such as how they are medically cared for, how staffers treat them personally and how the environment of often-chaotic emergency rooms affects their mental illnesses.

READ MORE @ AUSTIN AMERICAN-STATESMAN

Birth Defects and SSRIs—How's a Mother to Know?

In 2006, Elissa's doctor prescribed Cymbalta to help with her depression. Shortly after starting on the antidepressant Elissa became pregnant. On her doctor's advice she continued taking Cymbalta. But it soon became apparent her baby was developing life-threatening defects.

"I had my first ultrasound at 3 months," Elissa said. "That's when I found out something wasn't right. The doctor explained that my baby appeared to have a heart defect, a hole in her heart. Shortly after Elissa's baby girl was born, prematurely, the infant had to undergo heart surgery to repair the damage that could have been induced by the antidepressant. But Elissa was not aware of the association between SSRIs—or selective serotonin reuptake inhibitors—and birth defects.

READ MORE @ LAWYERS AND SETTLEMENTS

Psych Patients With Cost-Sharing Plans Use More Services

People whose insurance plans better share the burden of the cost for mental health services use these programs more than those whose plans pick up less of the bill, a new study says.

The findings were based on a study of Medicare patients, some of whose plans provided equal cost-sharing and others whose plans put a greater cost burden on the patients. The patients in the study had recently received psychiatric discharges from facilities.

The study was published in the Dec. 24/31 issue of Journal of the American Medical Association.

U.S. health insurers have historically imposed higher out-of-pocket costs and greater restrictions for the use of mental health services than other medical illnesses.

READ MORE @ WASHINGTON POST

Florida Medicaid, Antipsychotics and Small Children

At a time when growing use of atypical antipyschotics in children is under a microscope, Florida’s Medicaid program recently revised rules that makes it possible for doctors to write prescriptions for children of all ages - including those younger than six years old.

Most of these drugs can lead to weight gain and diabetes, and one prominent study found they were no more effective than older meds. Yet the drugs are increasingly prescribed for children, with Medicaid programs in several states reporting rising expenditures for antipsychotics, sometimes to treat ADD or ADHD, which are unapproved uses (look here and here).

In general, the atypical antipsychotics - a newer class that includes AstraZeneca’s Seroquel; Bristol-Myers Squibb’s Abilify; Pfizer’s Geodon; Lilly’s Zyprexa and Johnson & Johnson’s Risperdal - were not approved by the FDA to treat small children, or those younger than 10 years old. Risperdal has been approved for children older than 5 years of age, but only for those with autistic disorder. To be eligible for Medicaid reimbursement, a drug has to be used for a medically accepted indication, which means the drug has to be approved for a specific use or supported by specific compendia (this link indicates the three compendia do not list any use of the atypicals in children younger than 5 years old).

READ MORE @ PHARMALOT

FDA Faults Drug Information for Consumers

The printed consumer information that accompanies new prescription drugs is often difficult to read or understand, the U.S. Food and Drug Administration said Tuesday.

In a new report, the FDA said the "consumer medication information" -- intended to spell out the proper use and risks of drugs -- failed to meet a Congressionally mandated goal that 95 percent of all new prescriptions be accompanied by useful guidance.

"The study reveals that consumers are not consistently getting the information they need to promote the safe and effective use of prescription medicines," Dr. Paul Seligman, associate director of safety policy and communication at the FDA's Center for Drug Evaluation and Research, said during a Tuesday teleconference.

READ MORE @ WASHINGTON POST

Medication For Depression Can Also Fight Cancer Drug Resistance

Prozac is regularly prescribed to ease the emotional pain of patients who are being treated for cancer. But can this common anti-depressant help to fight cancer itself?

Dr. Dan Peer of the Department of Cell Research and Immunology at Tel Aviv University is proving that it can. A study he and his colleagues recently completed validates that Prozac (chemical name fluoxetine) dramatically enhances the effectiveness of a widely used anti-cancer drug.

“The good news is that the medical community won't have to wait — Prozac can be used for this purpose right away,” says Dr. Peer, noting that doctors in the U.S. already prescribe it to treat depression in chemotherapy patients.

READ MORE @ SCIENCE DAILY

Older Antidepressants May Be Better for Parkinson's Patients

For Parkinson's disease patients with depression, an older tricyclic antidepressant outperformed a newer selective serotonin reuptake inhibitor, one of a class that is commonly prescribed, according to researchers here.

In a randomized trial, the older tricyclic antidepressant, nortriptyline, significantly improved symptoms of depression after eight weeks compared with placebo (P<0.002) Matthew Menza, M.D., of Robert Wood Johnson Medical School here, and colleagues reported online in Neurology. A newer SSRI, paroxetine CR, did not (P=0.165) help.

The percentage of patients who had at least a 50% reduction in their depression symptoms was significantly higher in those taking nortriptyline than in those taking paroxetine CR (53% versus 11%, P=0.034).

READ MORE @ MEDPAGE TODAY

FDA Adds Suicide Warning to Epilepsy Drugs

The U.S. Food and Drug Administration announced Tuesday that it was adding a label warning on heightened suicide risk for users of antiepileptic drugs.

The move, which follows the advice last summer of an FDA advisory panel, stops short of slapping the strongest "black box" warning on this class of drugs, which includes widely used medications such as clonazepam (Klonopin), phenytoin (Dilantin) and topiramate (Topamax).

"Patients being treated with antiepileptic drugs for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior," Dr. Russell Katz, director of the division of neurology products in the FDA's Center for Drug Evaluation and Research, said in an agency news release.

READ MORE @ WASHINGTON POST

Studies Try to Tease Apart the Links Between Depression and Heart Disease

People who are depressed are literally sick at heart: they have a significantly increased risk for cardiovascular disease, and no one knows exactly why. Now three new studies have tried to explain this, and they arrive at subtly different conclusions.

The first, led by Dr. Mary A. Whooley of the Veterans Affairs Medical Center in San Francisco, studied 1,017 patients with coronary artery disease for an average of more than four years. Although the study found an association of depression with heart disease, when researchers statistically corrected for other medical conditions, disease severity and physical inactivity, the association disappeared.

READ MORE @ NY TIMES

'Not enough support' for mentally ill people to work

Government risks 'writing off' people with mental health problems due to lack of trained professionals

The government needs to take urgent action to make sure support and training is available to get more people with mental illness into work, say campaigners in a new report today.

The Sainsbury Centre for Mental Health (SCMH) and the College of Occupational Therapists have published a joint paper arguing that the government risks "writing off" people with mental health problems during the recession if it doesn't take action on employment support immediately.

The paper, 'Vocational Rehabilitation: what is it, who can deliver it and who pays?' claims there is a serious shortage of professionals "with the skills they need to offer expert help" to people who need it most. It says that without expert advisers trained to assess the employment needs of people with mental illness and to offer necessary support once jobs are found, the government will fail to keep its promise to help millions of people with mental health problems long term employment.

READ MORE @ THE GUARDIAN

Is There Really an Epidemic of Depression? A new book argues that the mental illness is being overdiagnosed

LEHRER: In your book, you take a critical look at major depressive disorder (MDD), a mental illness that will afflict approximately 10 percent of individuals at some point during their life. In recent decades, the number of cases of MDD has sharply increased. Are we currently experiencing an epidemic of depression? Or is this surge due to changes in diagnosis?

HORWITZ AND WAKEFIELD: Our book argues that, despite widespread beliefs to the contrary, the rate of depressive disorders in the population has not undergone a general upsurge. In fact, careful studies that use the same criterion for diagnosis over time reveal no change in the prevalence of depression. What has changed is the growing number of people who seek treatment for this condition, the increase in prescriptions for antidepressant medications, the number of articles about depression in the media and scientific literature, and the growing presence of depression as a phenomenon in popular culture. It is also true that epidemiological studies of the general population appear to reveal immense amounts of untreated depression. All of these changes lead to the perception that the disorder itself has become more common.

READ MORE @ SCIENTIFIC AMERICAN

Not All Antipsychotics Created Equal: Analysis Reveals Important Differences

An analysis of studies on antipsychotics reveals multiple differences among the newer, second-generation antipsychotics as well as the older medications, and suggests the current classification system blurs important differences, rendering it unhelpful. The analysis, partially funded by NIMH, was published online December 5, 2008, in The Lancet.

An analysis of studies on antipsychotics reveals multiple differences among the newer, second-generation antipsychotics as well as the older medications, and suggests the current classification system blurs important differences, rendering it unhelpful. The analysis, partially funded by NIMH, was published online December 5, 2008, in The Lancet.

Stefan Leucht, M.D., of Technische Universität München in Munich, Germany, and colleagues looked at 150 studies from all parts of the world with a total of 21,533 participants. By examining these double-blind studies, they were able to compare nine second-generation—also called atypical—antipsychotics with first-generation antipsychotics. They examined symptom reduction; quality of life; side effects such as movement disorders, weight gain and sedation ( sleepiness ); and other factors.

READ MORE @ MEDIA NEWSWIRE

Generic drug prices falling in US

Finally, a little good health care news for consumers: U.S. prices for generic prescription drugs, which already cost as little as one-third what their brand-name cousins do, have been getting cheaper and likely will keep doing so.

The causes? The ultra-low prices for generic prescriptions offered by giant retailers and drugstore chains and intense competition among the many generic drugmakers fighting for sales, according to health information firm IMS Health.

Those pricing pressures forced down dollar sales of generic drugs in the U.S. by 2.7 percent in the year ending in September, even though the number of generic prescriptions filled actually increased by 5.4 percent over the year before, IMS reported Wednesday.

"We're seeing the combination of pressure from large retailers to make generics available at ever-lower prices for their customers" and the intensified competition among generic drugmakers leading them to cut prices, said Murray Aitken, senior vice president of the Healthcare Insight unit at IMS.

READ MORE @ AP

Is There a Gene for Postpartum Depression?

"The transition to parenthood is filled to the brim with behavioral extremes. Parents who are otherwise emotionally stable are in one moment thrilled and happier than they have ever been and confused and fearful the next. Afriend of mine once theorized that these reactions occur because "parenting is an amateur sport" played by persons who are highly motivated to do the right thing but who often have no idea what that right thing is."

For some couples, the transition to parenthood is not filled with this rich mixture of great perplexity and great joy. For them, parenthood is mostly filled with sadness and even despair. Postpartum depression was originally coined to describe this experience in the mother, although it is becoming clear that fathers can experience very similar emotions too.

Is there a molecular basis for postpartum depression—at least for the type that mothers experience? Recent findings, which I describe here, may answer this question. First, we will focus on several background behavioral and molecular issues and then move on to some interesting data about births in genetically manipulated laboratory animals. Feel free to skip to the “Data” section if postpartum depression rates and g-aminobutyric acid (GABA) receptor biology are working parts of your vocabulary.

READ MORE @ PSYCHIATRIC TIMES

Experts urge wider use of brain-boosting drugs

Three job candidates sit in a quiet room, straining over a tough exam. But one of them has taken a memory-enhancing drug the other two couldn't afford. Is the test fair?

In another futuristic scenario, a drug can help airline pilots keep focused during a long flight, though it causes some side effects. May an airline require pilots to take the drug?

Get ready to confront such questions in daily life, a group of scientists and policy experts urge in a thought-provoking commentary published online Sunday by the journal Nature.

Brain research is accelerating, and a new era of "cognitive enhancement" - the use of brain-stimulating drugs and devices by healthy people - is approaching, the authors said.

READ MORE @ S.F. CHRONICLE

Antipsychotics in Children: Experts Report Mixed Results

Studies of antipsychotics in child prenpresented at the 48th Annual New Clinical Drugs Evaluation Unit (NCDEU) Meeting, conducted by the NIMH in Phoenix, May 27-30, provide some data where there have been relatively little on the increasing use of these agents.

In a panel discussion on ethics applications in child and adolescent psychopharmacology research and practice, panel chair Christopher Kratochvil, MD, University of Nebraska, noted, “while children have additional protections as a vulnerable population in research, recognition of underserved treatment needs is driving demand for psychopharmacology progress.”

As psychopharmacotherapy in children may be expanding faster than its evidence base, however, there is also increasing concern that risk-benefit is not being adequately assessed. In the October issue of the Archives of Pediatric and Adolescent Medicine, a retrospective cohort study of antipsychotic use in children and adolescents reveals that these agents are associated with increased risk of adverse metabolic and cardiovascular events.[1] Neurological adverse events in this cohort were reported separately in the Journal of Child Neurology.[2]

READ MORE @ PSYCHIATRIC TIMES

AstraZeneca Was Aware of Seroquel Risks in 2000, Records Show

AstraZeneca Plc., facing more than 15,000 consumer claims alleging the antipsychotic drug Seroquel causes diabetes, knew about the risk as far back as 2000, according to company documents shown in federal court.

AstraZeneca Global Safety Officer Wayne Geller concluded there was “reasonable evidence to suggest Seroquel therapy can cause” diabetes and related conditions, according to documents presented yesterday in federal court in Tampa, Florida. Geller drew his conclusions following a review of available studies and internal trials, according to the documents.

The internal documents were shown publicly for the first time during a hearing over the qualifications of expert witnesses the plaintiffs plan to use at trial. They are to testify in a lawsuit over the drug’s effects when the proceeding begins in February. While portions of the documents were shown in court, the filings remain sealed at the request of the London-based pharmaceutical company.

READ MORE @ BLOOMBERG

No Reason to Prefer Atypical Antipsychotics over Older Drugs

The common distinction between first- and second-generation antipsychotic drugs has no scientific basis and should be dropped, said researchers here.

A meta-analysis of 150 double-blind studies found little evidence that newer, so-called atypical antipsychotic drugs are more effective than older drugs for symptoms of schizophrenia, reported Stefan Leucht, M.D., of Munich Technical University, and colleagues online in The Lancet.

The researchers also found that although newer drugs induced fewer extrapyramidal effects than haloperidol (Haldol) that was not the case when compared with low-potency first-generation agents.

"Second-generation antipsychotic drugs differ in many properties" -- including structure and mode of action as well as clinical effects -- "and are not a homogeneous class," the researchers concluded.

"Improper generalization creates confusion and, as a result, the classification [of first- versus second-generation agents] might be abandoned," they said.

READ MORE @ MEDPAGE TODAY

Stress-Related Disorders Affect Brain's Processing of Memory

Researchers using functional MRI (fMRI) have determined that the circuitry in the area of the brain responsible for suppressing memory is dysfunctional in patients suffering from stress-related psychiatric disorders. Results of the study will be presented today at the annual meeting of the Radiological Society of North America (RSNA).

"For patients with major depression and other stress-related disorders, traumatic memories are a source of anxiety," said Nivedita Agarwal, M.D., radiology resident at the University of Udine in Italy, where the study is being conducted, and research fellow at the Brain Imaging Center of McLean Hospital, Department of Psychiatry at Harvard Medical School in Boston. "Because traumatic memories are not adequately suppressed by the brain, they continue to interfere with the patient's life."

READ MORE @ MARKET WATCH

Few Young Adults Seek Treatment for Psych Disorders Alcohol, nicotine use, personality illnesses common, study shows

Psychiatric disorders are common among young adults in the United States, but few seek treatment, a new report shows.

To reach this finding, U.S. researchers analyzed data from more than 5,000 respondents, aged 19 to 25, who took part in the National Epidemiologic Survey on Alcohol and Related Conditions.

The study found that 45.8 percent of the 2,188 college students and 47.7 percent of the young adults not in college met the criteria for at least one psychiatric disorder, but only 25 percent of those with disorders sought treatment over a one-year period.

Among college students, the most common disorders were alcohol use (20.4 percent) and personality disorders (17.7 percent). The most common disorders among young adults not in college were personality disorders (21.6 percent) and nicotine dependence (20.7 percent).

READ MORE @ U.S. NEWS & WORLD REPORT