Uneven Global Progress On Treatment Of Mental Illness

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Four years ago, the influential medical journal The Lancet ran six papers and assorted editorials on mental illnesses. The themed collection, under the banner “No health without mental health,” was a call to action for the world humanitarian community.

So how much influence did the articles have? The journal’s editors commissioned a new batch of papers to find out. The latest reports come from researchers and policy analysts at universities, non-governmental organizations and governments around the world.

Turns out there’s been some encouraging progress in figuring out what needs to be done, but progress in actually getting help for people has been slow.

One of the things the new studies show is that different treatments work, but they have to be selected carefully.

For example, an analysis of programs that address poverty — a fellow traveler with mental illness — show that just giving people money, in the form of microloans or cash, often doesn’t help. The study showed more consistent improvement with interventions such as individual or group talk therapy, or psychiatric drugs.

An analysis of psychiatric aid offered to victims of traumatic situations such as war or natural disaster found that at least for adults, psychotherapy and setting up social supports like education and group discussions helps. But the authors of the report say funders often lose interest after the initial crisis passes.

That’s a common refrain. Spend any time talking to folks who work with mentally ill people in poor countries, and they’ll tell you that they consider their programs seriously underfunded, in no small part because of stigma. “Many people don’t want to be associated with mental illness,” says Julius Kayiira, who runs Mental Health Uganda. And others “think there’s no hope,” he adds.

A survey of 87 countries showed more than half the countries reported more or much more awareness of mental illnesses in the past three years. The downside? There’s not a whole lot of new money behind that awareness.

There are other signs that show mental illnesses are struggling to get the attention of funders. World Mental Health Day came and went last week without much notice.

In September, the United Nations sponsored a major conference on non-communicable diseases. Mental illnesses got a short mention in the list of goals, but the conference itself focused on cardiovascular diseases, lung diseases, diabetes and cancer. There was almost nothing on mental illness.

That’s despite an analysis by the World Economic Forum that showed that the direct and indirect costs of mental illnesses in 2010 totaled $2.5 trillion — three times the cost of cardiovascular diseases.

Christina Ntulo, a co-author of one of the papers in The Lancet and head of the Uganda division of BasicNeeds, a mental health NGO, says the trick may be to show how mental health affects physical health. “And in the last three years, there’s been a lot of research showing links between mental health, maternal health and child health,” she says.

Another author — a leader of the global mental health movement — says what’s holding things back is the lack of appreciation of mental illnesses as real diseases, with real burdens. What’s needed, says Vikram Patel of the London School of Hygiene and Tropical Medicine, is for the various advocates to get together and speak with one voice about the need for the global health community to focus on mental illness. Will that happen? “Yes,” he says, “because there’s growing demand for it.”

By Joanne Silberner
NPR

Schizophrenia Genetics Linked to Disruption in How Brain Processes Sound

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Recent studies have identified many genes that may put people with schizophrenia at risk for the disease. But, what links genetic differences to changes in altered brain activity in schizophrenia is not clear. Now, three labs at the Perelman School of Medicine at the University of Pennsylvania have come together using electrophysiological, anatomical, and immunohistochemical approaches — along with a unique high-speed imaging technique — to understand how schizophrenia works at the cellular level, especially in identifying how changes in the interaction between different types of nerve cells leads to symptoms of the disease.

The findings are reported this week in the Proceedings of the National Academy of Sciences.

“Our work provides a model linking genetic risk factors for schizophrenia to a functional disruption in how the brain responds to sound, by identifying reduced activity in special nerve cells that are designed to make other cells in the brain work together at a very fast pace” explains lead author Gregory Carlson, PhD, assistant professor of Neuroscience in Psychiatry. “We know that in schizophrenia this ability is reduced, and now, knowing more about why this happens may help explain how loss of a protein called dysbindin leads to some symptoms of schizophrenia.”

Previous genetic studies had found that some forms of the gene for dysbindin were found in people with schizophrenia. Most importantly, a prior finding at Penn showed that the dysbindin protein is reduced in a majority of schizophrenia patients, suggesting it is involved in a common cause of the disease….

The above story is reprinted from materials provided by University of Pennsylvania School of Medicine.

ScienceDaily

http://www.sciencedaily.com/releases/2011/10/111013153945.htm

People With Mental Health Issues More Likely to Be Uninsured

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Americans with frequent bouts of mental distress are more likely to lack health insurance than those with frequent physical distress, a new study says.

Researchers examined national data collected from 1993 through 2009 and found that 22.6 percent of people with frequent mental distress (indicative of mental illness) were uninsured, compared with 17.7 percent of those with frequent physical distress (indicative of chronic disease). About 16.6 percent of people with neither mental or physical distress were uninsured.

People with only frequent mental distress and those with both frequent mental and physical distress were equally likely to not have insurance, which suggests that mental distress was the main factor, according to the researchers.

The study appears in the October issue of the journal Psychiatric Services.

Compared to adults with insurance, those who are uninsured have less access to recommended care, receive poorer quality care, and have worse health outcomes, the researchers noted in an American Psychiatric Association news release.

The purpose of their study was to establish baseline data that can be used to assess the impact of the Affordable Care Act, which is scheduled to be fully implemented in January 2014 and will provide insurance coverage to millions of previously uninsured Americans.

U.S. News & World Report

Drugs Used for Psychotics Go to Youths in Foster Care

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Foster children are being prescribed cocktails of powerful antipsychosis drugs just as frequently as some of the most mentally disabled youngsters on Medicaid, a new study suggests.

The report, published Monday in the journal Pediatrics, is the first to investigate how often youngsters in foster care are given two antipsychotic drugs at once, the authors said. The drugs include Risperdal, Seroquel and Zyprexa — among other so-called major tranquilizers — which were developed for schizophrenia but are now used as all-purpose drugs for almost any psychiatric symptoms.

“The kids in foster care may come from bad homes, but they do not have the sort of complex medical issues that those in the disabled population do,” said Susan dosReis, an associate professor in the University of Maryland School of Pharmacy and the lead author.

The implication, Dr. dosReis and other experts said: Doctors are treating foster children’s behavioral problems with the same powerful drugs given to people with schizophrenia and severe bipolar disorder. “We simply don’t have evidence to support this kind of use, especially in young children,” Dr. dosReis said….

By

The New York Times

http://www.nytimes.com/2011/11/21/health/research/study-finds-foster-children-often-given-antipsychosis-drugs.html

 

Suicide Risk Increased for All Psychiatric Disorders

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Clinical Context

All mental disorders are associated with an increased risk for death from suicide. This risk is often expressed as the odds ratio for suicide in those who have contact with mental health services. No studies have actually conducted lifetime follow-up after psychiatric contact, but lifetime risk is mentioned in many reports. Estimates range from 4% for schizophrenia to 15% for unipolar disorder.

This is a population-based cohort study of the Danish population to examine the lifetime risk for death from suicide among men and women with psychiatric contact and the general population.

Study Synopsis and Perspective

Patients with any major psychiatric disorder are at significant risk for suicide after their first hospital visit, according to new research.

In a Danish registry study of more than 175,000 individuals who were followed-up for up to 36 years, investigators found that among men, those with bipolar disorder or unipolar affective disorder had the highest absolute risk for suicide. Schizophrenia, followed closely by bipolar disorder, represented the highest risks for women.

Comorbidities were also significant risk factors for both sexes, and the cooccurrence of deliberate self-harm increased the risk by 2-fold.

“The steepest increase in suicide incidence occurs during the first years after first contact,” write lead author Merete Nordentoft, MD, from the Psychiatric Center Copenhagen and Copenhagen University in Denmark, and colleagues.

The investigators note that the absolute risk for suicide varied between 2% and 8% for the different psychiatric disorders studied.

“Our estimates are lower than those most often cited, but they are still substantial and indicate the continuous need for prevention of suicide among people with mental disorders,” the authors write.

The study appears in the October issue of the Archives of General Psychiatry….

By Deborah Brauser and Désirée Lie, MD, MSEd

Medscape

http://www.medscape.org/viewarticle/751701

Marker Predicts Heart Disease in People with Schizophrenia

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Elevated C-reactive protein (CRP) levels in patients with schizophreniaare associated with a higher 10-year risk for cardiovascular disease, new research suggests.

Past studies have shown that schizophrenia is associated with significant coexisting health concerns. This includes an increased risk for the metabolic syndrome — which is also a risk factor for cardiovascular disease (also known as heart disease).

Antoni Sicras-Mainar from Badalona Serveis Assistencials in Spain and colleagues conducted a cross-sectional analysis of administrative claims in 705 individuals who has a diagnosis of schizophrenia.

The team used a formula devised by the Framingham Heart Study researchers to determine 10-year risk for fatal or nonfatal cardiovascular disease. The researchers then collated the results with patient levels of CRP, an inflammatory marker associated with diabetes, hypertension, and cardiovascular disease in the general population.

In the present study, the average 10-year risk for heart disease was nearly 12 percent. The average CRP level was 2.6 mg/l.

Patients with heart disease were nearly 5 times more likely than those without heart disease to have above-normal values (patients with heart disease had mean CRP levels of 3.7 mg/l).

After adjusting for multiple cofounds, CRP levels were linearly associated with the 10-year risk for cardiovascular disease — the greater the CRP levels, the greater the risk for heart disease.

“The findings of this study support the general hypothesis of CRP also being involved or playing an independent role in risk or the development of cardiovascular disease in schizophrenics,” concluded Sicras-Mainar.

The study is slated to appear in the journal European Psychiatry.

By Psych Central News Editor

Psych Central

Help Wanted: a Good Therapist Amid Increasing Choices, How to Know What Treatments Work, When to Move On

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Therese Borchard likens herself to Goldilocks of the mental-health world: She tried six psychiatrists before she found one that was “just right.” One learned she was a writer and asked for help with a book proposal. Another put her on sleeping pills, ignoring her history of substance abuse. One even wanted to try hypnotic regression by candlelight to address unresolved childhood issues.

Finally, No. 7 diagnosed bipolar disorder, found medication that was effective, helped her to be less hard on herself and “salvaged the last crumb of my self-esteem,” says Ms. Borchard, who writes the popular “Beyond Blue” blog on Beliefnet.com.

The search for the right therapist can be baffling—and it comes at a time when would-be patients are feeling most vulnerable.

Patients who aren’t sure what’s wrong with them can be stumped about the type of therapist to call and ill-equipped to evaluate what they’re told during treatment. How well a therapist’s personal style matches a patient’s individual needs can be critical. But experts also say that patients shouldn’t be shy about pressing their therapist for a diagnosis and setting measurable goals….

 

By MELINDA BECK

THE WALL STREET JOURNAL

http://online.wsj.com/article/SB10001424052970204346104576636923254728228.html

CDC: Antidepressant use skyrockets 400% in past 20 years

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Use of antidepressant drugs has soared nearly 400% since 1988, making the medication the most frequently used by people ages 18-44, a report from the Centers for Disease Control and Prevention shows.

Eleven percent of Americans ages 12 years and older took antidepressants during the 2005-08 study period, the authors write. They add that though the majority of antidepressants were taken to treat depression, the drugs also can be used for anxiety disorders and other conditions.

The data are from the National Health and Nutrition Examination Surveys, which included information from 12,637 participants about prescription-drug use, antidepressant use, length of use, severity of depressive symptoms and contact with a health professional.

Mental-health professionals not associated with the survey cited several reasons as possible explanations for the spike:

•The struggling economy and the record number of layoffs and home foreclosures. “These drugs can be very helpful for people who need them,” says Elaine Ducharme, a psychologist and public educator in Connecticut for the American Psychological Association. “People should expect to be depressed after a layoff. They should not be put on a drug, though, unless they have an acute problem.”

•Ad campaigns waged by pharmaceutical companies citing benefits of the drugs.

•Families who might be reimbursed by health insurance companies for a prescription but may delay getting therapy from a mental-health professional because of the cost of treatment.

In fact, less than one-third of Americans taking one antidepressant and less than one-half of those taking multiple antidepressants have seen a mental-health professional in the past year, the report shows.

“Unfortunately, some families are looking for a quick fix, but a pill is never going to get to the root of the problem,” says David Palmiter, a psychologist and author of Working Parents, Thriving Families: 10 Strategies That Make a Difference.

Ducharme agrees. “That is the thing that bothers me the most,” she says. “These drugs can be dangerous, and there needs to be follow-up care.”

The survey also found that nearly one in four women ages 40 to 59 are taking antidepressants. Women are more likely to take antidepressants; however, among those taking antidepressants, men were more likely than women to have seen a mental-health professional in the past year.

The survey found that about one in 25 teens take the medication.

By Janice Lloyd

USA TODAY

 

Community colleges awarded $7 million for mental health training

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California community colleges have been awarded nearly $7 million to help students cope with stress, anxiety, depression and other mental health issues.

The grant from the California Mental Health Services Authority will be used to help train faculty and staff in the state’s 112 community colleges to better respond to students who exhibit signs of mental distress.

About $1 million of the grant will be awarded competitively to 12 colleges to develop campus-based projects.

“Our most recent data shows that stress, anxiety and depression are among the top factors that affect student academic performance,” California Community Colleges Chancellor Jack Scott said in a statement.

A 2010 survey of community college students found that 50% reported feeling very sad, very lonely and hopeless and more than a third said it was difficult to function because they were so depressed, Scott said.

In addition, 8% of respondents reported they had considered suicide and another 3% said they had attempted suicide. California’s community colleges face particular challenges as part of the largest system of higher education in the nation, serving nearly 2.6 million students.

A significant number are returning veterans with combat experience who are suffering from post-traumatic stress disorder, traumatic brain injury and depression. Other students may have previously diagnosed psychological disorders or may be stressed from work, school or relationships.

Projects are likely to include developing crisis intervention teams, connecting with community partners and helping students overcome the stigma associated with seeking services. Community colleges will also collaborate with the University of California and California State University on projects targeted to veterans, officials said.

By Carla Rivera

Los Angeles Times

America’s Mental Health, State By State

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Nearly 20 percent of Americans — 44.5 million adults — experienced some sort of mental illness over the last year, according to a new report from the U.S. Substance Abuse and Mental Health Agency (SAMHSA).

The report details state by state the percent of the population who has suffered a mental illness.

“Mental illnesses are treatable and people can recover to live full, productive lives. Unfortunately in the past year only 37.9 percent of adults with mental health problems received any type of care,” SAMHSA Administrator Pamela S. Hyde said in a statement. “The chasm between need and care is costly both in terms of personal health because of missed opportunities to prevent disability and health care expenditures related to illness such as cardiovascular disease, diabetes, and obesity.”

The report counts “mental illness” as any sort of mental, behavioral or emotional disorder that is diagnosable from the DSM-IV. The disorder must cause “substantial functional impairment” or must be defined as a serious mental illness that requires treatment.

Click through the slideshow to see, from lowest to highest, how many people in each state experienced a mental illness (according to 2008 and 2009 data that included 68,936 adults).

By

The Huffington Post

http://www.huffingtonpost.com/2011/10/13/mental-health-states-america_n_1007844.html