Tuesday, September 14, 2004

Continuity of Care in Mental Health Services: Toward Clarifying the Construct
Article in the Canadian Journal of Psychiatry - "Continuity of care (COC) is widely regarded as central to the provision of mental health services. It has recently assumed greater importance in conjunction with the decentralization of service delivery in mental health systems across Europe and North America. Clinicians commonly assume that, if COC is absent from the services provided to patients with chronic and debilitating conditions, the result may be social isolation, economic hardship, and threats to quality of life. The concept has been characterized by some as a “strategic first choice” in the case of service planning and delivery for patients with severe and persistent mental illness. Theoretical statements regarding COC have emphasized multiple component dimensions, reflecting its status as a theoretical construct, but as yet, there are no definitive statements on which dimensions are critical. In this study, we systematically examined the COC construct with the intent of identifying those critical dimensions."  
  

The Boundary Between Borderline Personality Disorder and Bipolar Disorder: Current Concepts and Challenges
Article in the Canadian Journal of Psychiatry - "There appears to be sufficient evidence to consider BPD to be a valid diagnosis. Both disorders apply to heterogeneous populations, and their characteristics require further clarification. In diagnostically challenging situations, careful consideration of a patient’s longitudinal history is essential. Future research will be important to ensure that our diagnostic classifications reflect clinically useful entities."  
  

Adult ADHD Costs Americans $77 Billion in Lost Income
Reuters Health story at Medscape - "Attention deficit hyperactivity disorder costs adult Americans with the condition about $77 billion in lost income a year, more than the total costs of drug abuse or depression, a Harvard researcher said on Thursday. Usually considered a childhood disorder, ADHD also affects about 8 million U.S. adults and is linked to job loss, lower income, higher divorce rates and more driving accidents, said Dr. Joseph Biederman, professor of psychiatry at Harvard Medical School..."  
  

Elections 2004 and Mental Health Policy
Page at the NAMI web site - "Whatever the outcome of the 2004 presidential election, President W. Bush or Senator John F. Kerry will face massive budget deficits next year, ABC News anchor George Stephanapoulos told NAMI’s 25th annual convention. Declining federal resources will continue to squeeze state budgets -- with implications for mental health policy. In 2003, President Bush’s New Freedom Commission on Mental Health reported that the nation’s fragmented mental health care system is 'a system in shambles.' Medicaid in particular is in crisis. It is the second largest, fastest growing part of state budgets -- a total of almost $250 billion in 2002. But states are under pressure to cut budget cuts across the board, which often leads to pressure to cut Medicaid costs and in turn cutting services or even transforming systems..."  
  

Americans’ Views About The Adequacy Of Health Care For Children And The Elderly
Health Affairs article - " Recent attempts to increase health coverage for specific populations incrementally have been more successful than efforts to dramatically reconfigure the health care system. We present findings from a survey to assess support for programs for children compared with those for the elderly, as well as the public’s desire to prioritize whether the needs of one should be addressed over the needs of the other. Americans believe that the health care needs of both children and the elderly are not being met, and there is clear and widespread support for a government role in ensuring adequate health care."  
  

Veil of secrecy to lift on drug tests
Christian Science Monitor story - "Growing concerns over the safety and efficacy of anti- depressant drugs prescribed to children have caught the eye of Congress and the New York state attorney general. Now they're becoming the catalyst for calls to reform the way clinical trials of all drugs are reported. Pressure is already causing some changes within the pharmaceutical industry. And it has put the US Food and Drug Administration (FDA), which approves new drugs, in the hot seat. If reforms are carried out, they could bring an unprecedented level of transparency to drug research. The solution now under consideration: a public database, or registry, of drug trials, where companies would post the results of those trials..."  
  

Feds Warn on Children and Antidepressants
AP story reprinted at The State (South Carolina) - "Federal health advisers considering more stringent warning labels for antidpressants linked to suicidal thoughts among children told the Food and Drug Administration on Tuesday that they may consider more than just a label change. One member of the panel asked the drug agency whether they could require that those prescribing the drugs undergo training to better recognize warning signs. ... Data presented to the FDA show that 65 percent of antidepressants taken by children are prescribed by psychiatrists. Independent experts and FDA scientists have said there a definite link between antidepressants and the worsening suicidal fixations of children taking the drugs. The latest analysis forms the heart of data FDA advisers were considering during the second day of hearings on antidepressants. Even Prozac - shown in earlier studies to be the most benign antidepressant for youth - increases the odds of suicidal thoughts and actions." See also FDA Confirms Antidepressants Raise Children's Suicide Risk (Washington Post, reprinted at PsycPORT), US Reviewer Maintains Antidepressant/Suicide Link (Medscape - free registration required) and Health advisers weigh emotion, science in anti-depressant inquiry (Boston Globe).  
  

New law not working for mentally ill children (Missouri)
Brief KTVO story - "A state law that took effect last month was supposed to spare parents from giving up custody of their children to get them mental health treatment. But some have grown impatient at the lack of change..."  
  

Reforms pledged on mental health of children (UK)
Story in the Guardian - "The government last night pledged fundamental reform of children's mental health services after the Guardian published evidence of a sharp increase in emotional and behavioural problems among teenagers. The health secretary, John Reid, will tomorrow announce plans to provide 24-hour access to psychiatric services for the seriously disturbed and more help for troubled children through schools and local authorities. The Children and Adolescent Mental Health Service (CAMHS) will be instructed to include 16 and 17-year-olds, who have previously been treated as adults, and hospitals will be told that it is no longer acceptable to admit young people to adult wards. The initiative comes in response to mounting concern about the deterioration of teenagers' mental health over the past 25 years..."