Screening for Metabolic Risk in Schizophrenia Falls Short

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August 29, 2011 — A review of current guidelines used to screen and monitor for cardiometabolic risk in patients with schizophrenia concludes there is a lot of room for improvement.

The review, led by Marc De Hert, MD, of University Psychiatric Centre, KU Leuven, Kortenberg, Belgium, was published in the August issue British Journal of Psychiatry.

“In recent years, physical health issues and specifically metabolic and cardiovascular comorbidity in different severe mental illnesses have become a major focus in both clinical care and research,” Dr. De Hert and colleagues write.

The need for screening for cardiometabolic risk among this population has been acknowledged in the psychiatric literature and general treatment guidelines, but clinicians find them suboptimal, according to the study authors.

“Not all guidelines have been developed with the same amount of rigour and authors’ independence,” they note.

“Clinicians should be able to identify and have access to guidelines, which are based on the best evidence,” but it can be difficult to actually identify a specific recommendation to use in daily practice, they write.

In this study, the authors performed a systematic review of the available clinical practice guidelines for screening and monitoring cardiometabolic risk factors for people with schizophrenia and related psychiatric disorders and used the Appraisal of Guidelines for Research and Evaluation (AGREE) to assess their quality.

The investigators looked at all guidelines and recommendations published between 2000 and 2010 and selected 18 for further evaluation.

They found that most of these guidelines scored best with regard to “scope and purpose” and “clarity of presentation: but that “rigour of development” was problematic in most guidelines.

By Fran Lowry
Medscape Medical News
http://www.medscape.com/viewarticle/748714

CDC Report identifies need for increased monitoring of adult mental illness

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The report, Mental Illness Surveillance Among Adults in the United States, appears as a supplement in today’s issue of the CDC Morbidity and Mortality Weekly Report. Prepared by the Public Health Surveillance Program Office, it is the first agency-wide compilation of data from selected surveillance and information systems that measure the prevalence and effects of mental illness in the U.S. adult population. CDC plans to issue a similar report in 2012 focusing on childhood mental illness.

The CDC report explains that numerous chronic diseases are associated with mental illnesses, such as cardiovascular disease, diabetes, and obesity. In such instances, treatment of the mental illness also can reduce the effect of the chronic disease. Authors say that increased mental health surveillance efforts will provide vital data needed to guide effective mental illness prevention and treatment programs.

CDC Media Relations
http://www.cdc.gov/media/releases/2011/a0901_adult_mental_Illness.html

Bridging the Gap Between Genes and Schizophrenia

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26 August 2011. As the search for genetic variants related to schizophrenia and other psychiatric diseases continues, researchers have begun trying to piece together how exactly some of these variants contribute to disease. Two studies published in August in the Archives of General Psychiatry combine genotyping with brain imaging to discover associations between common variants and proposed intermediate or “endo-” phenotypes of brain structure and function. One study, led by Nicholas Schork at the University of California in San Diego, finds a single nucleotide polymorphism (SNP) on 15q12 that associates with cortical thickness and cognition in schizophrenia. The other study, led by Daniel Weinberger at the National Institute of Mental Health (NIMH) in Bethesda, Maryland, links an SNP in ZNF804A to functional coupling between dorsal lateral prefrontal cortex and other regions of the brain.

These imaging genetics studies spur deeper thinking about just what associations between genetic variants and a disease mean. Researchers have begun to bridge this gap by focusing on more apparently tractable aspects of a disease, be it a discrete behavioral phenotype such as prepulse inhibition, or something closer to the underlying biology, such as changes in brain structure—both of which appear to be altered in schizophrenia. Relating genetic variants to these intermediate phenotypes may help discover more disease-related genes, or identify neural circuits that contribute to the disease (Meyer-Lindenberg et al., 2006). Though both new studies use brain imaging measures as an intermediate phenotype, one study takes the gene discovery approach, and the other a neural mechanism approach….

By Michele Solis
Schizophrenia Research Forum
http://www.schizophreniaforum.org/new/detail.asp?id=1687

SOURCES OF PAYMENT FOR MENTAL HEALTH TREATMENT FOR ADULTS

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This National Survey on Drug Use and Health report focuses on how individuals from 2005 to 2009 who received mental health services in the past year paid for services. One-third of individuals who received outpatient mental health services in the past year indicated that most of the cost for those services was paid by private health insurance; 43.7 percent of those who received inpatient mental health services indicated that most of the costs were paid for by public insurance (Medicaid and Medicare). “Self or family member” was the main source of payment for 26.2 percent of adults receiving outpatient mental health services and 18.8 percent of those receiving inpatient mental health services.

http://oas.samhsa.gov/2k11/025/WEB_SR_025.htm

TREATMENT AND RECOVERY IN BEHAVIORAL HEALTH FOR AMERICANS WITH DISABILITIES

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This new SAMHSA publication explores a range of issues associated with treatment and recovery for people with disabilities who experience substance use and mental disorders. It also discusses barriers to health care access, differences in outcomes, and options to ensure patient rights. This new publication is available in DVD, CD, and VHS formats.

DVD: http://store.samhsa.gov/product/Treatment-and-Recovery-in-Behavioral-Health-for- Americans-With-Disabilities-DVD-/All-New-Products/SMA11-4624DVD
CD: http://store.samhsa.gov/product/Treatment-and-Recovery-in-Behavioral-Health-for- Americans-With-Disabilities-Audio-CD-/All-New-Products/SMA11-4624CD
VHS: http://store.samhsa.gov/product/Treatment-and-Recovery-in-Behavioral-Health-for- Americans-With-Disabilities-VHS-/All-New-Products/SMA11-4624VHS

ARCHIVED WEBCAST: HEALTH REFORM: WHAT IT MEANS FOR PEOPLE WITH SUBSTANCE USE AND MENTAL DISORDERS

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This archived webcast explains the changes that will take effect as a result of health reform and how they may affect treatment and recovery for people with mental illness and substance abuse disorders and suggests ways for consumers to stay informed.

http://store.samhsa.gov/product/Health-Reform-What-It- Means-for-People-With-Substance-Use-and-Mental-Disorders-Audio-/SMA11-4623CD

BOOKLET: DRUG FACTS – SHATTER THE MYTHS

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Updated for 2011, the National Institute on Drug Abuse (NIDA) Drug Facts: Shatter the Myths Q&A booklet answers teens’ most frequently asked questions about drugs and drug abuse.

http://drugfactsweek.drugabuse.gov/booklet.php