R.I. tops mental illness list

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PROVIDENCE – Rhode Island has the highest rate of serious mental illness among adults in the country, according to a new federal survey published yesterday.

The study by the Substance Abuse and Mental Health Services Administration found that 7.2 percent of Rhode Islanders ages 18 or older experienced a serious mental illness at some point in the past year.

The national rate for serious mental illness is 4.6 percent. Hawaii and South Dakota shared the lowest rate, 3.5 percent.

Serious mental illness is considered one that interferes with at least one major life activity, including working or communicating.

Rhode Island also had the highest rate of adults suffering from any mental illness in the past year, according to the study. The state rate was about 24 percent, compared to just less than 20 percent nationally.

Maryland had the lowest rate, 16.7 percent.

More than 44 million people in the United States have had some kind of mental health problem in the last 12 months.

Vivian Weisman, executive director of the Mental Health Association of Rhode Island, said the numbers do not surprise her.

The state has had a high rate of depression for years, in part because of environmental triggers like high unemployment and low wages, she said.

Weisman also said Rhode Island has traditionally had a high rate of alcoholism, which is linked to depression. Domestic violence or other trauma can also lead to depression.

But Weisman suggested that part of the reason for the high rate could also be more reporting of mental illness, as the stigma is lessened and more primary care doctors are screening for it.

“We have been seeing high incidence for a long time,’’ she said. “And there has been a lot of effort to have mental illness be seen for the chronic illness it is.’’

Only about 38 percent of those with mental health problems received treatment in the past year, said Pamela Hyde, head of the Mental Health Services Administration. She stressed that mental illness is treatable and that people can recover fully.

By Erika Niedowski

Associated Press

Referral to Talk Therapy Cuts Costs, Improves Outcomes

Adults with common mental health problems such as depression and anxiety consume more health resources than those without, a new study from the United Kingdom confirms.

“This is across the board,” Professor Simon de Lusignan, MD(Res), from the Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom, told Medscape Medical News. They have more inpatient days, outpatient and emergency department visits, and sick days than those patients without common mental health problems, he said.

Importantly, Dr. de Lusignan added, the study also shows that referring patients with common mental health problems to psychological therapy reduces healthcare utilization and sick time, and may improve adherence to drug therapy.

The improved adherence is “probably the most important finding because if people take their medications they generally will remain healthier, which will save money in the long run,” Philip R. Muskin, MD, clinical psychiatry professor at Columbia University in New York City and distinguished fellow of the American Psychiatric Association, noted in an interview with Medscape Medical News.

The study was published online October 3 in the Journal of Epidemiology and Community Health….

By Megan Brooks

Medscape

http://www.medscape.com/viewarticle/750987

A Hormone May Treat Autism, Social Disorders

Researchers are finding that a hormone in the body believed to help people form emotional bonds with each other may work to treat people with schizophrenia, autism and certain other psychiatric disorders related to social interaction.

A number of small scientific studies have been published recently suggesting that puffs of oxytocin into the nose may reduce some symptoms in people with these disorders and improve their ability to function. In particular, the hormone seemed to enhance patients’ abilities to recognize others’ emotions, which is a crucial step in improving social interactions.

Oxytocin, produced both by men and women, is nicknamed the “love hormone” because of its apparent role in building trust between people. Women, for instance produce large amounts of oxytocin during labor preceding childbirth, presumably to foster bonding with the newborn.

The hormone works by helping neurons in the brain talk to each other, although the exact mechanism isn’t understood. Researchers suggest it may increase a person’s attention to social information in the environment, make social interactions more rewarding or reduce anxiety in those situations. When sprayed in the nose, oxytocin is thought to travel along a pathway to reach the brain….

By SHIRLEY S. WANG

The Wall Street Journal

http://online.wsj.com/article/SB10001424052970204226204576603022035561638.html

Talk Therapy Lifts Severe Schizophrenics

People with severe schizophrenia who have been isolated, withdrawn and considered beyond help can learn to become more active, social and employable by engaging in a type of talk therapy that was invented to treat depression, scientists reported on Monday.

These new findings suggest that such patients have far more capability to improve their lives than was previously assumed and, if replicated, could change the way that doctors treat the one million patients for whom the disorder is profoundly limiting.

The therapy — a variant of cognitive behavior therapy, which focuses on defusing self-defeating assumptions — increased motivation and reduced symptoms. In previous studies, researchers have used cognitive techniques to help people with schizophrenia manage their hallucinations and sharpen their attention and memory. The new study is the first to rigorously test using the therapy to combat so-called negative symptoms — the listlessness, exhaustion and emotional flatness that trap many people in solitary lives, playing out their days smoking in front of the TV or holed up in their homes….

By

New York Times

http://www.nytimes.com/2011/10/04/health/research/04schiz.html

Trillion-dollar brain drain

Enormous costs of mental health problems in Europe not matched by research investment.

Brain disorders cost Europe almost €800 billion (US$1 trillion) a year — more than cancer, cardiovascular disease and diabetes put together. That’s the conclusion of a report1 commissioned by the European Brain Council that provides the most comprehensive assessment of the financial consequences of mental ailments so far.

The report’s authors argue that these enormous costs — which exceed the entire gross domestic product of the Netherlands — mean that research into brain disorders receives disproportionately little funding compared with other diseases. They call on politicians and funders to step up support for basic research on these conditions, which are so costly because they often require long-term care and erode the productivity of those affected for years or decades…

 

by Kerri Smith

Nature News

http://www.nature.com/news/2011/111004/full/478015a.html

Twin Study Reveals Epigenetic Alterations of Psychiatric Disorders

In the first study to systematically investigate genome-wide epigenetic differences in a large number of psychosis discordant twin-pairs, research at the Institute of Psychiatry (IoP) at King’s College London provides further evidence that epigenetic processes play an important role in neuropsychiatric disease.

Published in Human Molecular Genetics, the findings may offer potential new avenues for treatment.

Previous quantitative genetic analyses of schizophrenia and bipolar disorder reveal strong inherited components to both. However, although heritability for schizophrenia and bipolar disorder is estimated at 70%, disease concordance between twin-pairs is far from 100%, indicating that non-genetic factors play an important role in the onset of the diseases.

Dr. Jonathan Mill, lead author of the study at the IoP says, ‘We studied a group of 22 identical twin-pairs, so 44 individuals in all, one of the largest twin studies performed for any complex disease to date. In each twin-pair, one had either schizophrenia or bipolar disorder. Because we know that twins are genetically identical, we can rule out any genetic cause of illness in the affected twin — the aim of our study was to investigate epigenetic variations associated with these disorders.’…

by ScienceDaily staff

ScienceDaily

http://www.sciencedaily.com/releases/2011/09/110921120039.htm

 

Off-Label Atypical Use: Few Benefits, Serious Adverse Effects

Off-label use of atypical antipsychotics may do more harm than good, a new meta-analysis suggests.

A combined analysis of more than 150 efficacy trials showed significant increases in behavioral symptom scores for dementia in the elderly after they were treated with aripiprazole, olanzapine, or risperidone; benefits for nonelderly patients with generalized anxiety disorder (GAD) after they received quetiapine; and benefits for patients with obsessive-compulsive disorder (OCD) after receiving risperidone augmentation.

However, analysis of more than 200 adverse outcome studies showed that treatment-related adverse events, including death, were common in these patient groups.

“Besides the small but statistically significant effect found for dementia, the other improvements were a bit smaller than we expected, with moderate effects for GAD and OCD,” lead author Alicia Ruelaz Maher, MD, psychiatrist at the Akasha Center for Integrative Medicine in Santa Monica, California, and assistant clinical professor in psychiatry at the University of California, Los Angeles, School of Medicine, told Medscape Medical News.

“As for the other conditions that these medications commonly treat, we just did not find enough of an effect. And despite olanzapine being known to cause weight gain, I was surprised to find it was not effective in causing weight gain in eating disorders,” said Dr. Maher, who is also a clinical adjunct at the RAND Health Southern California Evidence-Based Practice Center in Santa Monica.

She noted that the study is the “largest study of its kind on this subject,” and prompted clinicians to reconsider the way they prescribe atypical antipsychotics.

“I think the biggest takeaway is that instead of just prescribing blindly, we now have evidence to guide us. There are certainly times when the cost-benefit analysis would go towards using medication, but I would hope that the side effects are kept in mind.”

The study appears in the September 28 issue of JAMA….

Reported by Deborah Brauser
Medscape
http://www.medscape.com/viewarticle/750527

Antipsychotics get mixed review for unapproved use

Newer antipsychotic drugs are often prescribed for conditions they aren’t approved to treat, with questionable benefits, according to a study.

The medications, known as atypical antipsychotics, include risperidone, sold in the United States as Risperdal, aripiprazole (Abilify), olanzapine (Zyprexa) and quetiapine (Seroquel).

While those drugs have been approved in the United States for a few psychiatric conditions, such as schizophrenia and bipolar disorder, doctors may also prescribe them “off-label” to other patients, including people with substance abuse and eating disorders, typically when they haven’t responded to more standard treatments.

“There are several conditions in psychiatry that are pretty difficult to treat,” said Alicia Ruelaz Maher from RAND Health in Santa Monica, California, the study author.

“Often in psychiatry we think, if something works for one condition, it could possibly be effective for another one.”

People with anxiety or obsessive-compulsive disorder, for example, are often treated with antidepressants known as selective serotonin reuptake inhibitors (SSRIs), but those don’t always work.

More and more, doctors are prescribing atypical antipsychotics off-label, experts say.

Yet, Maher said, there’s a general lack of evidence on whether atypical antipsychotics can help patients who don’t have schizophrenia or bipolar disorder.

She and her colleagues looked at scientific literature and combined data from 162 studies that compared an atypical antipsychotic to a drug-free placebo pill for conditions that fell outside the drug’s approved uses. They found another 231 studies that kept track of side effects linked to the drugs. Nearly all of the research was funded by drugmakers.

Taken together, the studies showed that atypical antipsychotics had no effect in patients with eating disorders or drug and alcohol abuse, and it wasn’t clear if they helped people with personality disorders or post-traumatic stress disorder.

The drugs did have a small but consistent benefit for dementia patients with psychotic symptoms, however.

More people with an anxiety disorder taking Seroquel in particular got better compared with patients who took a placebo. And for those with obsessive-compulsive disorder, Risperdal worked better than a placebo. Still, those specific findings came from just three studies each.

But according to the findings, published in the Journal of the American Medical Association, the drugs also had side effects.

For instance, one in 10 elderly people treated with Zyprexa developed tremors and one in 53 on Risperdal suffered a stroke. Younger people on the drugs experienced weight gain, fatigue and other side effects.

Maher said that the decision to use one of these drugs for a non-approved condition should be based on a discussion between patients and their doctors, especially because some people may be more susceptible to side effects than others.

“Each individual patient needs to be considered as opposed to, ‘This is good for this condition,'” she said.

by Genevra Pittman
Reuters

When Your Therapist Is Only a Click Away

THE event reminder on Melissa Weinblatt’s iPhone buzzed: 15 minutes till her shrink appointment.

She mixed herself a mojito, added a sprig of mint, put on her sunglasses and headed outside to her friend’s pool. Settling into a lounge chair, she tapped the Skype app on her phone. Hundreds of miles away, her face popped up on her therapist’s computer monitor; he smiled back on her phone’s screen.

She took a sip of her cocktail. The session began.

Ms. Weinblatt, a 30-year-old high school teacher in Oregon, used to be in treatment the conventional way — with face-to-face office appointments. Now, with her new doctor, she said: “I can have a Skype therapy session with my morning coffee or before a night on the town with the girls. I can take a break from shopping for a session. I took my doctor with me through three states this summer!”

And, she added, “I even e-mailed him that I was panicked about a first date, and he wrote back and said we could do a 20-minute mini-session.”

Since telepsychiatry was introduced decades ago, video conferencing has been an increasingly accepted way to reach patients in hospitals, prisons, veterans’ health care facilities and rural clinics — all supervised sites.

But today Skype, and encrypted digital software through third-party sites like CaliforniaLiveVisit.com, have made online private practice accessible for a broader swath of patients, including those who shun office treatment or who simply like the convenience of therapy on the fly….

Reported by JAN HOFFMAN
The New York Times
http://www.nytimes.com/2011/09/25/fashion/therapists-are-seeing-patients-online.html?pagewanted=all

Training to Save Lives: How Metro Police Help the Mentally Ill

LEE’S SUMMIT, Mo.—
Since 2001, officers with the Lee’s Summit Police Dept. have received a special kind of preparation.

It’s called Crisis Intervention Team – or CIT – training and it teaches officers how to deal with the mentally ill, specifically those engaged in criminal activity or posing a danger to themselves.
“This program does one great thing – it offers insight into mental illness for the officers where they gain empathy and understanding so they can better handle the situation,” said CIT trained Lee’s Summit Police Sgt. Brian Wilson.

This week, the Lee’s Summit Police Dept. cerebrated ten years of the program and honored the original officers who voluntarily enrolled in it, including Chief Joe Piccinini.

In the past, anyone suspected of criminal activity would have been carted off to jail. But with the CIT program, officers are trained to use jail as a last resort for people in crisis.

While the Memphis, Tenn. Police Dept. started the program, Lee’s Summit was the first in the state to embrace it. Now officers across the metro, Missouri and beyond have been CIT trained and certified.

“This truly is a win win situation,” said Guyla Stidmon, National Alliance on Mental Illness or NAMI. “We can track a person from the time they come in crisis to getting them care. When before the only other option was to put them in jail.”

Lee’s Summit police were the first in the state to be trained. After Lee’s Summit officers became CIT certified, they began training other departments, including police Blue Springs, Independence, Kansas City and evenSt. Louis.

In the last decade more than 1,600 in Missouri have learned how to deal with the mentally ill and get them the help they need.

“Rather than putting people in jail, it redirects them to the appropriate treatment,” said Stidmon. “It can alleviate incarceration many times.”

Because jails are not equipped to handle the mentally ill and they even exacerbate the problem in many cases.

Meanwhile, Lee’s Summit police hope to train more officers and start training first responders like firefighters and paramedics, so they too can help those in need find healing.

Reported by Terra Hall
FOX 4 News
http://www.fox4kc.com/news/wdaf-training-to-save-lives-how-metro-police-help-the-mentally-ill-20110922,0,2336835.story