Combining Medication and Psychosocial Treatments May Benefit Patients With Early-Stage Schizophrenia

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Patients with early-stage schizophrenia who receive a combination of medication and a psychosocial intervention appear less likely to discontinue treatment or relapse — and may have improved insight, quality of life and social functioning — than those taking medication alone, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals…….

Story Source: The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals

Journal Reference: Guo et al. Effect of Antipsychotic Medication Alone vs Combined With Psychosocial Intervention on Outcomes of Early-Stage Schizophrenia: A Randomized, 1-Year Study. Archives of General Psychiatry, 2010; 67 (9): 895 DOI: 10.1001/archgenpsychiatry.2010.105

http://www.sciencedaily.com/releases/2010/09/100906203038.htm

Antipsychotics: In Search of the Holy Grail (Video)

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Hello. This is Dr. Jeffrey Lieberman of Columbia University, speaking to you today for Medscape. I’m going to speak today about antipsychotic drugs and particularly about the mechanism of action of antipsychotic drugs……..

Jeffrey A. Lieberman, MD
Medscape Psychiatry & Mental Health
http://www.medscape.com/viewarticle/735747

Strategies for Maximizing Adherence in Schizophrenia CME

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Goal

In this activity, Dr. Stephen M. Stahl discusses the importance of cognitive deficits in schizophrenia and strategies to maximize treatment adherence for more positive functional outcomes.

The following unmet needs regarding schizophrenia were revealed following a critical analysis of expert faculty assessment, literature review, and through new medical knowledge:

* Schizophrenia is a debilitating disorder associated with poor quality of life, low remission rates, and huge adherence issues.
* Cognitive impairment is severe and pervasive in the schizophrenia population and tends to be independent of other clinical symptoms, yet is not currently a diagnostic requirement.
* Several new medications are soon to be introduced, and research into additional new treatment methods is ongoing; clinicians need to be educated on these new treatment strategies as data accumulate so that they are prepared to implement these tools once they become available.

To help fill these unmet needs, quality improvement efforts need to (1) provide education regarding cognitive impairment in schizophrenia, including current research on its biology and pharmacology, proposals for its inclusion in DSM-V, and clinical guidance on how it should be measured and differentiated from negative symptoms; (2) provide education regarding optimization of treatment strategies for schizophrenia, including consideration of minimizing side effects and maximizing adherence; (3) provide education regarding new treatment strategies for schizophrenia, including novel mechanisms of action, and how these new options can help fill unmet needs within the current treatment of schizophrenia.

Learning Objectives

Upon completion of this activity, participants should be better able to:

1. Recognize the importance of cognitive factors in schizophrenia, including evolving new diagnostic criteria and methods for assessing cognition in clinical practice.
2. Differentiate antipsychotic drug treatments from each other on the basis of pharmacologic mechanisms and evidence-based clinical trial results.
3. Implement evidence-based treatment strategies that maximize adherence and patient outcomes.
4. Combine practical experience with evolving new evidence in order to integrate new and soon-to-be introduced treatments into clinical practice.

Stephen M. Stahl, MD, PhD
Adjunct Professor, Department of Psychiatry, University of California, San Diego School of Medicine; Honorary Visiting Senior Fellow, University of Cambridge, United Kingdom
Medscape Education Psychiatry and Mental Health

CME Released: 02/07/2011; Valid for credit through 02/07/2012

http://www.medscape.org/viewarticle/735992

Herbal Supplements: Talking With Your Patients

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Abstract
The popularity and prevalence of herbal products and dietary supplements in the US has grown steadily. Patients are increasingly using them to prevent disease, complement conventional therapies, and promote well being and health. Nurse practitioners play a critical role in discussion, communication, and education of herbal supplement use. This article provides a review of commonly used herbal supplements regarding recent evidence for efficacy, possible drug interactions, and safety considerations.

Introduction
Approximately 38 million US adults use herbal and dietary supplements.[1] In 2009, Americans spent $5.03 billion on herbs and other botanical supplements, and their sales are steadily growing.[2] From Sam’s Club to natural food retailer Whole Foods Market, even convenience stores sell herbal supplements such as ginkgo and echinacea alongside aspirin. Patients are regularly using herbal products to self-treat medical conditions, complement conventional therapies, and maintain their overall health and well-being. Most patients receive their information about herbs and supplements from their friends, family, and the Internet but rarely from their healthcare provider.[3]
Since the US Dietary Supplement Health and Education Act (DSHEA) became law in 1994, vitamins, minerals, and herbal supplements are presumed to be safe and freely available. However, the FDA does not regulate dietary supplements, and there are no pre-market safety or efficacy studies required. If a dietary supplement has safety issues once it is on the market, the FDA can take action against the manufacturer by issuing a warning or removing the product. In 2007, the FDA issued its final current “good manufacturing practices” (GMPs) regulations to maintain that dietary supplements are processed consistently and meet quality standards. While improvements have been made in the oversight of supplements, issues of quality and safety continue. In 2010, the US Government Accountability Office (GAO) released a report finding trace levels of lead and other contaminants (within levels accepted by the FDA and EPA) and examples of deceptive or suspect marketing claims.[4]

Despite increasingly common usage, only one-third of patients tell their physician about their use of supplements.[1] Physicians do not commonly ask patients about their complementary and alternative medicine (CAM) use, and patients may feel uncomfortable discussing it. But concomitant use of herbal supplements with prescription drugs or over-the-counter (OTC) medications can put patients at risk for a variety of serious drug interactions. Herbs and drugs often interact when they use the same transport or metabolic protein, commonly cytochrome P450 (CYP) enzymes, glucuronosyltransferases (UGT), and P-glycoprotein (Pgp), resulting in induction or inhibition activity.[5] However, many
factors, including the dose, schedule, and route of administration, can affect the potential drug-botanical interaction. If the botanical and drug are administered at different times, it is less likely that a clinically relevant interaction will occur. [5]

Joyce K. Anastasi, PhD, DrNP, FAAN, Lac; Michelle Chang, MS, Lac; Bernadette Capili, DNSc, NP-C. Herbal Supplements: Talking With Your Patients. Journal for Nurse Practitioners. 2011;7(1):29-35.

Disclose Herbal Supplements with Provider.pdf

National Children’s Mental Health Awareness Day May 3, 2011

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Now Is the Time to Ask the Experts!
As part of National Children’s Mental Health Awareness Day, NIMH is sponsoring a videocast panel of children’s mental health researchers. It’s a great chance to hear directly from experts working in the field.
Learn the state of the science in children’s mental health and ask top NIH scientists about topics ranging from normal brain development to anxiety, bipolar disorder, and ADHD.

When: May 3rd from 2:00 to 3:30 PM EST
Where: National Institutes of Health campus in Bethesda, MD
Building 31C, 6th Floor, Conference Room 6

Those who live in the area are welcome to join us as part of the live audience. Audience members will also be invited to ask questions. Seating is limited.
Please stand by for further instructions on registration, videocast instructions, and other details as we get closer to May 3rd.
Don’t miss this chance to speak with the experts on children’s mental health!

NIMH OUTREACH PARTNERSHIP PROGRAM UPDATE for February 15, 2011

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The Outreach Partnership Program a nationwide outreach initiative of the National Institute of Mental Health (NIMH) that enlists state and national organizations in a partnership to help close the gap between mental health research and clinical practice, inform the public about mental illnesses, and reduce the stigma and discrimination associated with mental illness. For more information about the program please visit: http://www.nimh.nih.gov/outreach/partners. To subscribe to receive the Update every two weeks, go to: http://www.nimh.nih.gov/outreach/partnership-program/subscribe-to-the-update.shtml

The information provided in the Update is intended for use by NIMH Outreach Partners, National Partners and their associates for the express purpose of exchanging information that may be useful in the development of state and local mental health outreach, information, education and partnership programs.

NIMH_Update_2-15-11

Teen Brains Over-Process Rewards, Suggesting Root of Risky Behavior, Mental Ills

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University of Pittsburgh researchers have recorded neuron activity in adolescent rat brains that could reveal the biological root of the teenage propensity to consider rewards over consequences and explain why adolescents are more vulnerable to drug addiction, behavioral disorders, and other psychological ills.

The team reports in the Journal of Neuroscience that electrode recordings of adult and adolescent brain-cell activity during the performance of a reward-driven task show that adolescent brains react to rewards with far greater excitement than adult brains. This frenzy of stimulation occurred with varying intensity throughout the study along with a greater degree of disorganization in adolescent brains. The brains of adult rats, on the other hand, processed their prizes with a consistent balance of excitation and inhibition.

The extreme difference in brain activity provides a possible physiological explanation as to why teenagers are more prone than adults to rash behavior, addiction, and mental diseases, said lead researcher Bita Moghaddam, a professor of neuroscience in Pitt’s School of Arts and Sciences. She and coauthor David Sturman, a Pitt neuroscience doctoral student, observed the disparate reactions to reward in individual neurons in the orbitofrontal cortex, a brain region that weighs payoff and punishment to plan and make decisions.

“The disorganized and excess excitatory activity we saw in this part of the brain means that reward and other stimuli are processed differently by adolescents,” Moghaddam said. “This could intensify the effect of reward on decision making and answer several questions regarding adolescent behavior, from their greater susceptibility to substance abuse to their more extreme reactions to pleasurable and upsetting experiences.”

In addition, malfunctions in the orbitofrontal cortex have been observed in cases of schizophrenia, mood disorders, and other psychological disturbances, Moghaddam said. The type of erratic activity in the cortex that she and Sturman observed could aggravate these conditions at a time when the maturing brain is vulnerable…..

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Pittsburgh.

http://www.sciencedaily.com/releases/2011/01/110126121732.htm

New Research May Lead to Treatment of a Variety of Mental Disorders

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One of the first studies published from the University of Missouri Brain Imaging Center (BIC) gives researchers insight into the brain and memory and may provide researchers clues to treating a variety of debilitating disorders.

Nelson Cowan, director of the BIC and Curator’s Professor in the Department of Psychological Sciences, used the BIC’s magnetic resonance imaging (MRI) to produce graphics that depict the structure and function of the brain during various mental tasks in an effort to understand abstract working memory. People use their abstract working memories to assign meaning when trying to recall facts — for example, when someone dials a set of phone numbers, their abstract memory brings forth an image of the person they are calling.

Previous studies identified an area of the brain responsible for holding abstract working memory, although it was assumed by some researchers to hold only visual information. At the BIC, Cowan found that this same part of the brain can hold auditory information as well. For example, when people hear “Jingle Bells” they relate it to the Christmas season and retain the meaning of the song temporarily.

“This research has given us better understanding of an area of the brain that may be affected in people with various learning disabilities, autism and schizophrenia,” said Cowan. “For example, recent research has shown that people with schizophrenia simply hold fewer items in their working memories, rather having an inability to disregard unimportant items, as previously thought. Thus, discovering more about working memory will enable scientists to better target schizophrenia, among other disorders.”

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Missouri-Columbia.

Journal Reference: Nelson Cowan, Dawei Li, Amanda Moffitt, Theresa M. Becker, Elizabeth A. Martin, J. Scott Saults, Shawn E. Christ. A Neural Region of Abstract Working Memory. Journal of Cognitive Neuroscience, 2011; : 1 DOI: 10.1162/jocn.2011.21625

http://www.sciencedaily.com/releases/2011/01/110125152522.htm

Neuronal Migration Errors: Right Cells, Wrong Place

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Normally, cortical nerve cells or neurons reside in the brain’s gray matter with only a few scattered neurons in the white matter, but some people with schizophrenia have a higher number of neurons in the white matter. Neuronal migration errors may arise in schizophrenia as a consequence of both genetic and environmental factors.

The phenomenon of aberrant cellular localization has now been studied in detail in a paper by Yang and colleagues, published in the current issue of Biological Psychiatry.

Using a specialized technique that involves staining cells, the researchers were able to determine the distribution of nerve cells in brain tissue from people who had been diagnosed with schizophrenia in comparison to tissue from people who did not carry this diagnosis prior to their death.

Their results linked two main findings emerging from analyses of brain tissue in schizophrenia: abnormalities in the inhibitory neurons within the cortex and increases in neurons in white matter below the cortex…..

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Elsevier, via AlphaGalileo.

Journal Reference: Yang Yang, Samantha J. Fung, Alice Rothwell, Si Tianmei, Cynthia Shannon Weickert. Increased Interstitial White Matter Neuron Density in the Dorsolateral Prefrontal Cortex of People with Schizophrenia. Biological Psychiatry, 2011; 69 (1): 63 DOI: 10.1016/j.biopsych.2010.08.020

http://www.sciencedaily.com/releases/2011/01/110104082412.htm

U.S. Sees Slowdown in Spending on Mental Health: People who need help still aren’t getting it, official says

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The amount of money spent on psychiatric drugs in the United States continues to grow but at a much slower rate than in previous years, a new federal government study has found.

From 2004 to 2005, spending on psychiatric drugs rose 5.6 percent, compared with an increase of 27.3 percent between 1999 and 2000, according to the Substance Abuse and Mental Health Services Administration.

The agency’s analysis of health-care costs from 1986 to 2005, the latest year comparable data is available, also found that spending on behavioral health accounts for a decreasing portion of overall health-care costs.

Of the $1.85 trillion spent on all health-care services in the United States in 2005, behavioral health spending accounted for 7.3 percent ($135 billion). During the 20 years analyzed in the study, spending for mental health and substance abuse health care grew more slowly than all other health spending: 4.8 percent a year for substance abuse; 6.9 percent a year for mental health and 7.9 percent a year for all health-care services.

From 2002 to 2005, spending rose 5 percent for substance abuse, 6.4 percent for mental health and 7.3 percent for all health-care services, according to the study, published Feb. 3 in Health Affairs.

Among the other findings:

* Spending on addiction medications grew from $10 million in 1992 to $141 million in 2005. However, the $141 million represents only 0.6 percent of the $22 billion spent on substance abuse treatment in 2005.
* In 2005, behavioral health treatment accounted for 4.8 percent of private health insurance spending, compared with 11.5 percent of total Medicaid spending. The agency said that the figures can be used as a baseline for evaluating the effect of the Mental Health Parity and Addictions Equity Act and the Affordable Care Act.
* Unlike overall health spending, the largest portion of behavioral health spending is publicly funded. In 2005, public money paid for 79 percent of spending on substance abuse treatment and 58 percent of mental health services spending, compared with 46 percent of all health spending.

“Behavioral health services are critical to health systems and community strategies that improve health status, and they lower costs for individuals, families, businesses and governments,” Pamela S. Hyde, the SAMHSA administrator, said in an agency news release. “The value of behavioral health services is well documented. Studies have shown that every dollar invested in evidence-based treatments yields $2 to $10 in savings in health costs, criminal and juvenile justice costs, educational costs and lost productivity. Yet, too many people don’t get needed help for substance abuse or mental health problems, and health-care costs continue to skyrocket.”

Robert Preidt
Bloomberg Businessweek
HealthDay News

http://www.businessweek.com/lifestyle/content/healthday/649565.html