Integrated Care Improves Mental Health Outcomes, Cuts Costs

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Integrating primary and mental healthcare in “health homes” can save lives, according to a leading mental health expert.

“It turns out, it’s actually a really great way to save money, too,” said Joseph Parks, MD, director of the Missouri Institute of Mental Health in St. Louis.

Dr. Parks, who is also chief medical officer of the Missouri Department of Mental Health, spoke to mental health advocates who gathered at the Mental Health Hope Symposium in Washington, DC, to learn about successful mental healthcare models and to raise awareness of mental health needs.

The meeting was sponsored by several behavioral health advocacy organizations. Its goal was to highlight the importance of patient access to quality care and treatment for people with mental illnesses before the US Congress Joint Select Committee on Deficit Reduction begins to slash $1.2 trillion from the federal deficit on November 23.

Through a health home initiative in Missouri that predates the Affordable Care Act’s patient-centered medical home concept, community mental health centers (CMHCs) function as healthcare homes, or medical homes.

A primary care provider is responsible for overall coordination of care. Case management is coordinated, people with serious mental illnesses have their medical diseases managed, and mental healthcare providers offer preventive healthcare screening and monitoring. Primary care nurses play an active role as agents of change at the CMHCs….

By Sandra Yin

Medscape

http://www.medscape.com/viewarticle/754122

Mouse Study: Missing Gene and Abnormal Behavior Linked

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Although many mental illnesses are uniquely human, animals sometimes exhibit abnormal behaviors similar to those seen in humans with psychological disorders. Such behaviors are called endophenotypes.

Now, researchers at the California Institute of Technology have found that mice lacking a gene that encodes a particular protein found in the synapses of the brain display a number of endophenotypes associated with schizophrenia and autism spectrum disorders.

In the study, which was published in The Journal of Neuroscience, the researchers created mutations in mice so that they were missing the gene for a protein called densin-180, which is abundant in the synapses of the brain.

These electro-chemical connections enable the formation of networks between the brain’s neurons. This protein sticks to and binds together several other proteins in a part of the neuron that is at the receiving end of a synapse, called the postsynapse.

“Our work indicates that densin-180 helps to hold together a key piece of regulatory machinery in the postsynaptic part of excitatory brain synapses,” says Mary Kennedy, the Allen and Lenabelle Davis Professor of Biology at Caltech, who was the senior author on the study.

In mice lacking densin-180, the researchers found decreased amounts of some of the other regulatory proteins normally located in the postsynapse. Kennedy and her colleagues were especially intrigued by a marked decrease in the amount of a protein called DISC1.

“A mutation that leads to loss of DISC1 function has been shown to predispose humans to development of schizophrenia and bipolar disorder,” Kennedy says.

In the study, the researchers compared the behavior of typical mice with that of mice lacking densin. Those without densin displayed impaired short-term memory, hyperactivity in response to novel or stressful situations, a deficit of normal nest-building activity, and higher levels of anxiety.

“Studies of mice with schizophrenia and autism-like features have reported similar behaviors,” Kennedy notes. “We do not know precisely how the molecular defect leads to the behavioral endophenotypes. That will be our work going forward. The molecular mechanistic links between a gene defect and defective behavior are complicated and, as yet, mostly unknown. Understanding them goes to the very heart of understanding brain function.”

The findings point to the need for a better understanding of the interactions that occur between proteins at synapses, she adds. Studies of these interactions could provide information needed to screen for new and better pharmaceuticals for the treatment of mental illnesses.

“This study really reinforces the idea that small changes in the molecular structures at synapses are linked to major problems with behavior,” Kennedy says.

By Janice Wood

Psych Central

Meditation May Help Brain Tune Out Distractions

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Study Helps Explain Why Meditation Improves Concentration

People who meditate may be able to use their brain in ways others can’t to tune out distractions and focus on the task at hand.

A new study shows that experienced meditators may have less activity in parts of the brain associated with daydreaming and distraction while meditating and in their day-to-day lives.

Researchers say this brain network, known as the “default mode network,” has also been linked to anxiety, attention deficit hyperactivity disorder (ADHD), and Alzheimer’s disease.

“The default mode is when you ruminate, think about yourself, or daydream,” says study researcher Judson Brewer, MD, PhD, medical director of the Yale Therapeutic Neuroscience Clinic. “Everybody has it, but experienced meditators have a different type.”

Brewer found that people who meditate are able to link up other parts of their brains to monitor activity in the default mode network that tell them to get back on task when distractions arise and be present in the moment.

The study is published in the Proceedings of the National Academy of Sciences.

Experts say the results help explain the benefits of meditation on concentration and open the door to future research using meditation to treat and potentially prevent a variety of psychiatric and neurological disorders….

By

WebMD  Health News

http://www.webmd.com/balance/news/20111120/meditation-may-help-brain-tune-out-distractions

New study shows smokers underutilize proven treatment and services for quitting

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70 percent of smokers want to quit as nation approaches the Great American Smokeout

Most American adults who smoke wish they could quit, and more than half have tried within the past year, according to a report by the Centers for Disease Control and Prevention.

The report says 68.8 percent of current American adult smokers say they want to quit and 52.4 percent of adult smokers tried to quit within the past year.  The report says 48.3 percent of smokers who saw a health professional in the past year recalled getting advice to quit and 31.7 percent used counseling and/or medications in the past year. The use of these effective treatments can almost double to triple rates of successfully quitting.

“More than two thirds of smokers want to quit smoking and more than half tried to quit last year,” said CDC Director Thomas R. Frieden, M.D., M.P.H.  “Smokers who try to quit can double or triple their chances by getting counseling, medicine, or both.  Other measures of increasing the likelihood that smokers will quit as they want to include hard–hitting media campaigns, 100 percent smoke–free policies, and higher tobacco prices.”

The analysis is in CDC’s Morbidity and Mortality Weekly Report. The report is being published in conjunction with the annual Great American Smokeout, observed this year on Nov. 17. Sponsored by the American Cancer Society, the Smokeout encourages smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day.

According to the report, making health care settings as well as all workplaces and public places smoke-free offers smokers additional encouragement to help them quit.  The report also notes the health care industry can increase successful quit attempts by providing comprehensive insurance coverage with no deductibles or co-payments for cessation treatments and services.

Smokers can get free resources and help quitting by calling 1-800-QUIT-NOW (784-8669) or visiting www.smokefree.govExternal Web Site Icon….

CDC Online Newsroom

Centers for Disease Control and Prevention

http://www.cdc.gov/media/releases/2011/p1110_smoking_treatment.html

Perinatal Antidepressant May Affect Brain Development

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Rats exposed to an antidepressant just before and after birth had altered behaviors and substantial brain abnormalities. The findings raise questions about how perinatal antidepressants might influence brain development in people.

Serotonin—a chemical messenger in the brain—plays an important role in brain development. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) work by boosting serotonin activity in the brain. However, recent studies have found associations between women taking SSRIs during pregnancy and potential development problems in their offspring, including an increased risk for autism….

NIH Research Matters

National Institute of Health

http://www.nih.gov/researchmatters/october2011/10312011antidepressant.htm

Psychiatric Drug Use Spreads

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The medicating of Americans for mental illnesses continued to grow over the past decade, with one in five adults now taking at least one psychiatric drug such as antidepressants, antipsychotics and anti-anxiety medications, according to an analysis of pharmacy-claims data.

Among the most striking findings was a big increase in the use of powerful antipsychotic drugs across all ages, as well as growth in adult use of drugs for attention-deficit hyperactivity disorder—a condition typically diagnosed in childhood. Use of ADHD drugs such as Concerta and Vyvanse tripled among those aged 20 to 44 between 2001 and 2010, and it doubled over that time among women in the 45-to-65 group, according to the report.

Overall use of psychiatric medications among adults grew 22% from 2001 to 2010. The new figures, released Wednesday, are based on prescription-drug pharmacy claims of two million U.S. insured adults and children reported by Medco Health Solutions Inc., a pharmacy-benefit manager.

“People from all walks of life are taking medications for mental-health conditions,” said David Muzina, a psychiatrist and head of Medco’s Neuroscience Therapeutic Resource Center, whose team compiled the report….

By SHIRLEY S. WANG

THE WALL STREET JOURNAL

http://online.wsj.com/article/SB10001424052970203503204577040431792673066.html

No Myth: Creativity and Mental Disorders Are Linked

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Creative individuals have a disproportionately higher rate of mental illness, including schizophrenia and bipolar disorder, and they and their relatives are more likely to work in artistic and scientific occupations, according to new research published in the November 2011 issue of the British Journal of Psychiatry.

“Creativity has long been associated with mental disorder, epitomized by Aristotle’s claim that ‘no great genius has ever existed without a strain of madness,’ ” lead author Simon Kyaga, MD, from the Karolinska Institute, Stockholm, Sweden, told Medscape Medical News.

“Working as a psychiatrist, I have many times encountered patients who, despite severe psychiatric disorder, were able to create in artistic and scientific areas, as well as being successful entrepreneurs,” Dr. Kyaga said. “I was therefore intrigued by the idea of a connection between creativity and madness, and together with my supervisors, we initiated the study, trying to provide answers to this old question.”

Dr. Kyaga and colleagues performed a nested case-control study using a variety of sources to obtain information on the association between creativity and mental illness.

These data sources included the Hospital Discharge Register, which provided discharge diagnoses for all in-patient treatment episodes for schizophrenia, bipolar disorder, and unipolar depression in Sweden between 1973 and 2003; the Multi-Generation Register, which identified biological relatives of patients; and national censuses for 1960, 1970, 1980, and 1990, which provided information on professions in the entire Swedish population….

By Fran Lowry

Medscape

http://www.medscape.com/viewarticle/753286

 

Many Inoculated Against Science In Understanding Schizophrenia

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In earlier posts (“Too Much Pop Psytchology and “Alzheimer’s and Schizophrenia”), I talked about the medical and scientific evidence that exists demonstrating that schizophrenia (and other serious mental illnesses) are diseases of the brain. While these are diseases, many people commonly refer to them as mental health issues or mental health problems.

Issues and problems are terms that, frankly, I fail to understand. After all, we do not call insulin-dependent diabetes a pancreatic issue or a pancreatic problem. Even type II diabetes which has a considerable life style cause, is not referred to as a problem or an issue. Why, then, do we not recognize schizophrenia and other serious mental illnesses as diseases?…

By Marvin Ross

The Huffington Post Canada

http://www.huffingtonpost.ca/marvin-ross/schizophrenia_b_1023721.html

Family Crisis Therapy Helps Suicidal Teens

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A new UCLA study suggests a specialized mental health intervention for suicidal youth can help troubled teens. The new approach is welcomed as experts say that roughly 1 million people die by suicide each year.

In the U.S., where nearly 36,000 people take their own lives annually, more than 4,600 victims are between the ages of 10 and 24, making suicide the third leading cause of death in this age group.

In the new investigation, researchers discover a program that helps to link follow-up care after treatment in emergency rooms improves outcomes among the high risk youths.

This program has been developed in response to the U.S. Department of Health and Human Service’s National Strategy for Suicide Prevention call to increase rates of follow-up care after discharge for patients who come to the emergency department due to suicidal behavior.

Reporting in the November issue of the journal Psychiatric Services, Joan Asarnow, Ph.D., a professor of psychiatry at UCLA, and colleagues show that a family-based intervention conducted while troubled youths were still being treated in the emergency department led to dramatic improvements in linking these youths to outpatient treatment following their discharge.

“Youths who are treated for suicidal behavior in emergency departments are at very high risk for future attempts,” said Asarnow, the study’s first author.

“Because a large proportion of youths seen in the emergency department for suicide don’t receive outpatient treatment after discharge, the United States National Strategy for Suicide Prevention identifies the ED as an important suicide prevention site. So, a national objective is to increase the rates of mental health follow-up treatment for suicidal patients coming out of emergency departments.”

Researchers studied 181 suicidal youths at two emergency departments in Los Angeles County, with a mean age of 15. of the group, 69 percent were female, and 67 percent were from racial or ethnic minority groups.

For 53 percent of the participants, their emergency department visit was due to a suicide attempt. The remainder were seen because they had thoughts of suicide.

The youths were randomly assigned to either the usual emergency department treatment or an enhanced mental health intervention that involved a family-based crisis-therapy session designed to increase motivation for outpatient follow-up treatment and improve the youths’ safety, supplemented by telephone contacts aimed at supporting families in linking to further outpatient treatment.

Researchers discovered the enhanced mental health intervention was associated with higher rates of follow-up treatment.

Of the participants in the enhanced intervention, 92 percent received follow-up treatment after discharge, compared with 76 percent in the standard emergency department treatment arm — a clinically significant difference.

While the results are positive, the study is only a first step, according to Asarnow, who also directs UCLA’s Youth Stress and Mood Program.

“The results underscore the urgent need for improved community outpatient treatment for suicidal youths,” she said. “Unfortunately, the follow-up data collected at about two months after discharge did not indicate clinical or functioning differences among youths who received community outpatient treatment and those who did not.”

Still, Asarnow said, the data from the new study underscores the critical importance of this work.

Researchers say that follow-up treatment is needed for troubled youth. In accordance, current studies at UCLA are aimed at evaluating outpatient treatments for preventing suicide and suicide attempts.

By Rick Nauert PhD

Psych Central

Low Levels of Vitamin D Linked to Teen Delusions, Hallucinations

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Researchers have shown before that low vitamin D levels are linked with psychiatric disorders like major depression.

Now, a presentation at the annual meeting of the American Academy of Child and Adolescent Psychiatry signals the importance of testing those who suffer from psychotic symptoms—delusions (fixed and false beliefs) and hallucinations—for vitamin D deficiency.

A group of researchers led by Dr. Barbara L. Gracious, a psychiatrist at Nationwide Children’s Hospital in Columbus, Ohio, presented data at that meeting showing that adolescents who were vitamin D deficient showed a fourfold (400 percent) increased rate of psychotic symptoms, compared to other adolescents with normal vitamin D levels who sought psychiatric treatment at the University of Rochester, in New York.

In other words, in the group of adolescents asking for psychiatric help that Gracious studied, low vitamin D was very, very powerfully connected to the likelihood that they would report symptoms like delusions (like paranoia) or hearing voices or seeing visions.

Delusions and hallucinations are among the most serious symptoms we psychiatrists treat. And the idea that vitamin D deficiency could be so substantially linked to psychotic symptoms is a tantalizing prospect. It suggests that it is time to routinely measure the Vitamin D levels of those complaining of such symptoms.

When vitamin D levels are found to be low, they should, of course, be corrected. Whether or not this will lessen psychotic symptoms remains to be definitively proven.

The vitamin D-mental health connection is particularly interesting given the fact that millions of Americans report symptoms of seasonal affective disorder—depression that typically seems to recur each late fall, or early winter—when exposure to sunlight is limited. Vitamin D plummets, of course, when people are deprived of sunlight.

Gracious’ findings are yet another reason why psychiatry would be wise to drop all resistance to considering the impact of vitamin and nutritional deficiencies of one kind or another on mental well-being.

We know, after all, that Deplin, an altered form of folic acid that can reach the nervous system without being metabolized, shows powerful promise in the treatment of mood disorders. Indeed, Deplin, which I have written about on FoxNews.com before, is already approved by the FDA as a “medical food” that can be used to treat depression. We also know that taking high doses of fish oil can impact mood and may significantly decrease aggression.

These findings on vitamins and other nutrients come at a time when psychiatry’s traditional medications—like serotonin reuptake inhibitors and antipsychotic medications—are under siege. Recent studies have questioned whether many of these agents are any better than placebos. A large study of the very common use of the antipsychotic Risperdal in veterans with post-traumatic stress disorder (PTSD) showed it had essentially no value at all. Yet, such medications can be very, very expensive and can have very serious side effects, including movement disorders, suicidal thinking, cardiac abnormalities and significant weight gain.

I am not saying that traditional psychoactive medications are not important. Used judiciously, with expertise, in the right patients, they can be lifesaving. I’m certain of that. But it is time to open our minds to treatments based on vitamins and other nutrients, as well as other alternative ways of affecting the brain, like repetitive transcranial magnetic stimulation (rTMS, about which I have also written at FoxNews.com).

It is possible that a large percentage of those who now suffer from major depression, for example—even when that depression is severe enough to spark psychotic symptoms—could soon be most effectively treated with psychotherapy, magnetic therapy and nutritional/vitamin therapy. That’s would represent a massive shift in the way psychiatry treats that illness. And other illnesses may be no different.

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Fox News