Friday, August 20, 2004

Loren Mosher obituary: Psychiatrist who espoused drug-free treatment for schizophrenia
British Medical Journal news story - " The US psychiatrist Loren Mosher spent his entire professional career seeking more humane and effective treatment for people with a diagnosis of schizophrenia. This caused him to be cast as a maverick and to be marginalised by mainstream psychiatry. As an advocate for patients' rights Mosher took an approach that was derived from the 'moral treatment' of mentally ill people, a tradition characterised by Philippe Pinel when he removed the chains from the men held in the Bicêtre Hospital in Paris in 1797. Mosher started a heated debate when he publicly resigned in 1998 from the American Psychiatric Association (APA)—which he called the American Psychopharmaceutical Association—charging that 'psychiatry has been almost completely bought out by the drug companies.' "  
  

Framework for Support, Third Edition (Canada)
Canadian Mental Health Association document in Adobe Acrobat format - "Since 1984, the Framework for Support model has shaped CMHA's thinking about needs and resources for people with mental illness. The Third Edition of the core document, published in 2004, updates the original concepts while still retaining the important values and principles of the model."  
  

Health Canada advises of potential adverse effects of SSRIs and other anti-depressants on newborns
HealthCanada advisory - "Health Canada is advising Canadians that newborns may be adversely affected when pregnant women take Selective Serotonin Re-uptake Inhibitors (SSRIs) and other newer anti-depressants during the third trimester of pregnancy. This advisory is intended to increase awareness among mothers and physicians of the possible symptoms that may occur in the newborn, so that symptoms can be recognized and addressed quickly..."  
  

Immigrant health rules spark debate
Boston Globe story - "Under proposed regulations slated to go into effect on Sept. 1, the federal government is offering $1 billion to hospitals and other providers that give emergency medical care to undocumented immigrants, an offer that is making many local health care administrators uneasy. The money would be distributed over the next four years by the Centers for Medicare & Medicaid Services to help emergency care centers treat uninsured patients. To receive their share, health care administrators would have to ask patients very pointed questions about their immigration status..."  
  

Structured Interview Helps Make Correct Diagnosis
Psychiatry News story - "Some surprising findings appeared when the prevalence of anxiety disorders among patients of psychiatrists in APIRE's Practice Research Network was compared with that for a community sample who had completed a structured interview. Anxiety disorders appear to be underdiagnosed and undertreated in routine psychiatric practice, according to a study reported at the 2004 AcademyHealth meeting in San Diego."  
  

Restraint Used Less After Training Program
Psychiatry News story - " A university hospital intervention involving training psychiatric patients and hospital staff in crisis-prevention techniques dramatically decreases the use of physical restraints. Recent federal regulations have mandated that psychiatric facilities use physical restraint only when patients pose a danger to themselves or others and as a last resort. Finding effective and safe alternatives to restraint or avoiding its use altogether is critical for inpatient psychiatric facilities. Researchers in the department of psychiatry at the University of Illinois at Chicago (UIC) described an effective training program in the July issue of the APA journal Psychiatric Services that led to a significant reduction in the use of restraint with adolescent and adult psychiatric inpatients..."  
  

Distinct Neural Correlates of Washing, Checking, and Hoarding Symptom Dimensions in Obsessive-Compulsive Disorder
Archives of General Psychiatry article at Medscape - " Previous studies of obsessive compulsive disorder (OCD) have indicated that there are at least 4 stable symptom dimensions: contamination/washing, aggression/checking, hoarding, and symmetry/ordering. The authors attempted to identify the neural correlates of the hand washing, checking, and hoarding groups of OCD. They took 16 patients with multisymptom OCD and 17 control subjects and exposed them to various pictures designed to stimulate the different dimensions of OCD as well as a symptom-unrelated stimulus while being scanned by a functional MRI machine. The subjects were exposed to pictures that were deemed normally disgusting to individuals as well as those depicting scenes related to contamination/washing, aggression/checking, and hoarding..." [Viewing Medscape resources requires registration, which is free].  
  

Bipolar Depression: Long-term Challenges for the Clinician
A new CME unit from Medscape - "Of the 2 poles of bipolar disorder, mania is the more dramatic, and indeed the defining, characteristic. Not surprisingly, it has been the major focus of clinical and research attention, while bipolar depression has been relatively neglected. But a growing body of evidence suggests that depression accounts for the greater burden of morbidity and mortality in bipolar disorder and is an underrecognized clinical challenge. Bipolar depression is often misdiagnosed, inappropriately treated in the acute phase, and undertreated in the maintenance phase. Fortunately, increasing interest in bipolar depression has led to an expanding pharmacopoeia, the establishment of international consensus treatment guidelines, and an improved understanding of bipolar disorder as a severe, recurrent illness requiring long-term pharmacotherapy and psychosocial support." [Viewing Medscape resources requires registration, which is free].  
  

Mental health plan watered down (UK)
BBC story - "Significant concessions to proposed new laws on mental health are being offered by ministers to head off criticisms, according to new reports. The compromise comes on controversial plans to allow potentially dangerous people to be forced to get treatment, says the Health Service Journal..." See also the draft mental health bill (Adobe Acrobat format) and the Health Service Journal story, Mental health bill set for major climbdowns. [Viewing HSJ resources requires registration, which is free].  
  

Antidepressant Study Seen to Back Expert
New York Times story - "A top government scientist who concluded last year that most antidepressants are too dangerous for children because of a suicide risk wrote in a memo this week that a new study confirms his findings. The official, Dr. Andrew D. Mosholder, a senior epidemiologist at the Food and Drug Administration who assesses the safety of medicines, found last year that 22 studies showed that children given antidepressants were nearly twice as likely to become suicidal as those given placebos. His bosses, however, strongly disagreed with his findings, kept his recommendations secret and initiated a new analysis. In his memo, dated Monday, Dr. Mosholder said that the results of the new analysis, undertaken in part at Columbia University, matched his own. Though the two studies used different methods and different numbers, they came to similar conclusions..." [Viewing New York Times resources requires registration, which is free]. See also FDA Analysis Backs Antidepressant Concern (AP story at Yahoo) and FDA Sees Changes to Antidepressant Labels (Reuters story at Yahoo) - "The U.S. Food and Drug Administration plans to update antidepressant labels to reflect studies that suggest a link between the drugs and suicide in youths, according to documents released on Friday."   
  

Depression Traced to Overactive Brain Circuit
Kansas City InfoZine story - "A brain imaging study by the NIH's National Institute of Mental Health (NIMH) has found that an emotion-regulating brain circuit is overactive in people prone to depression — even when they are not depressed. Researchers discovered the abnormality in brains of those whose depressions relapsed when a key brain chemical messenger was experimentally reduced. Even when in remission, most subjects with a history of mood disorder experienced a temporary recurrence of symptoms when their brains were experimentally sapped of tryptophan, the chemical precursor of serotonin, the neurotransmitter that is boosted by antidepressants"  
  

New program to provide treatment for alcoholism and mental illness (Maine)
Bangor News story - "A new network of centers around Maine aims to combine treatment for people who have both substance abuse problems and mental health issues. The Co-occurring Collaborative of Southern Maine has developed the "Centers of Excellence" with $200,000 in funding from the Maine Health Access Foundation and $55,000 from the state Office of Substance Abuse. The group will use the money to train staff and expand services at the Spring Harbor Hospital in Westbrook, Day One in South Portland, Crisis and Counseling Centers in Augusta and Arostook Mental Health Services in Caribou..."  
  

Medical Necessity Definition Could Set Harmful Precedent
Psychiatric News story - "Psychiatrists sound the alarm about a new definition of medical necessity that could result in reduced access to health care for Medicaid beneficiaries throughout the country. Tennessee state officials have developed a definition of the term "medical necessity" that could weaken federal requirements concerning access to care through its Medicaid program called TennCare. At the urging of Gov. Phil Bredesen (D), the legislature passed a bill in May that would result in copayments of $1 to $40 for certain services for most beneficiaries, cap coverage at six prescription drugs a month, and require most beneficiaries to use the cheapest prescription drugs available. It would also limit days of hospitalization and doctor's visits annually..."