NEW PULSE PUBLICATION: The inaugural issue of the PULSE Quarterly Briefing was published in late June and has already received a great deal of praise ("Brilliant" - Fran Silvestri, Director: International Initiative for Mental Health Leadership; "A triumphant inaugural issue" - Paul Lefkovitz, CEO: Behavioral Pathway Systems; "Very useful..." - Elaine Alfano, Bazelon Center for Mental Health Law). The PQB comes bundled with two other services, the "PULSE Bulletin" (40 issues/year) and "Recent Resources" (10 issues /year) and organizational subscriptions include access to a set of Internet-based tools for distributing news and announcements. For details on subscriptions, please see the new PULSE Community Site.

 Wednesday, July 20, 2005

Good patient-physician relationship important for treatment adherence Psychiatry Matters article - "The quality of the relationship that a patient with schizophrenia forms with their physician appears to be an important determinant of their attitude toward treatment and the likelihood that they will adhere to medication, UK study findings show. ... Noting that nonadherence to antipsychotic medication is a major cause of psychotic relapse and is strongly influenced by attitudes toward treatment, the researchers explored potential clinical variables that may impact such attitudes. Measures including symptoms, insight, drug adverse effects, self-reported adherence, attitudes toward treatment, perceived relationship with the prescriber, ward atmosphere, and admission experience were assessed in 228 patients with schizophrenia or schizoaffective disorder."  
  

Efficacy of antidepressants in adults  British Medical Journal article - "The National Institute for Health and Clinical Excellence (NICE) recently recommended that antidepressants, in particular selective serotonin reuptake inhibitors, should be first line treatment for moderate or severe depression.1 This conclusion has broadly been accepted as valid.2 The message is essentially the same as that of the Defeat Depression Campaign in the early 1990s, which probably contributed to the 253% rise in antidepressant prescribing in 10 years. From our involvement in commenting on the evidence base for the guideline we believe these recommendations ignore NICE data. The continuing concern that selective serotonin reuptake inhibitors may increase the risk of suicidal behaviour means there needs to be further consideration of evidence for the efficacy of antidepressants in adults as there has been in children." See also Antidepressant Efficacy May Be Overblown, Investigators Say, a Reuters Health story at Medscape that includes interviews with the study's authors. [Viewing Medscape resources requires registration, which is free].  
  

Governor Adds Muscle to Curb Medicaid Fraud (New York) New York Times story - "Gov. George E. Pataki yesterday ordered a broad overhaul of the state agencies that protect Medicaid from fraud and abuse, creating an independent inspector general's office and bringing in a former federal prosecutor to help reorganize the policing of the program, which is New York State's largest expense. The inspector general is expected to take over some authority from the State Department of Health, which administers the overall $44.5 billion program but has fared poorly in detecting Medicaid fraud and waste compared with its counterparts in other states. The changes will be carried out by executive order, the governor said, and will not require the approval of the Legislature." [Viewing New York Times resources requires registration, which is free].  
  

Psychiatric Illness May Affect Data on `Healthy' Subjects  Psychiatric News story - "Some people who volunteer to be 'healthy' controls in psychiatric or other medical research may have personality disorders. Most such volunteers, however, are not screened for Axis II disorders before the study begins. One of the hallmarks of medical research, including psychiatric studies, is the use of 'healthy control' subjects against which a population of interest is compared. Yet it looks as though a large number of persons who volunteer to serve as control subjects have personality disorders, a new study suggests. The study was conducted by Emil Coccaro, M.D., chair of psychiatry at the University of Chicago, and colleagues. Results appear in the July Journal of Psychiatric Research."  
  

Governors Seek Escape Route From Medicaid Funding Crisis  Psychiatric News story - "Governors want more flexibility to decide who gets what in terms of Medicaid benefits and lower costs for prescription drugs. In testimony presented on Capitol Hill last month, the National Governors Association (NGA) offered a plan to reform the Medicaid program that seems to contain something to please and to offend nearly everyone. NGA Chair Mark Warner (D), governor of Virginia, and Vice Chair Mike Huckabee (R), governor of Arkansas, presented a bipartisan proposal that aims to restrain expenditures and provide governors more flexibility to administer the program. The NGA noted in written testimony that it is 'difficult to overstate the impact of Medicaid on state budgets.' On average, Medicaid accounts for about 22 percent of a state's budget and is the largest single item of expenditure."  
  

Genomics Promises Revolution In Psychiatric Treatment  Psychiatric News story - "The challenge today is making the leap between genomic variation and behavioral or functional variation at the level of individuals. Breakneck advances in genomics promise to usher in an era of "individualized medicine" based on a thorough understanding of the molecular pathophysiology of mental illness. So said Thomas Insel, M.D., director of the National Institute of Mental Health, in the Judd Marmor Award Lecture at APA's 2005 annual meeting in May in Atlanta. Insel sketched a portrait of a not-too-distant future when clinicians will treat precise targets along a pathophysiological chain from genes to cells to distributive systems within the brain based on a patient's unique genetic variation."  
  

Improve coverage for mental health care (Michigan) Kalamazoo Gazette editorial - "If Michigan residents with cancer were told by their health care insurers they could only have a limited number of cancer treatments a year, or have a lifetime cap on cancer treatment, there would be an uproar in the Legislature. If those with diabetes were charged a higher copay or deductible for diabetes treatment than for other illnesses, we'd expect the state to step in to halt discrimination against diabetics. Yet, people who have mental illnesses are often limited in the amount of psychiatric care their private insurers are willing to pay for. Often, insurers limit the number of outpatient visits a person with a mental illness may have in a given year, or limit the number of days in a psychiatric hospital..."  
  

Former first lady calls for mental health awareness, funding AP story at AccessNorthGa.com - "Calling the nation's mental health care system a 'shambles,' former First Lady Rosalynn Carter on Wednesday urged public officials to increase funding and insurance companies to pay more for treatment. 'The mental health system is in shambles in our country and to think we're continuing to cut it,' Carter said to members of the Atlanta Press Club. 'It's a terrible situation and the thing that's so sad about it is that so many of these people could be contributing citizens.' "  
  

Army: mental health among soldiers in Iraq improves, morale still low WIS-TV story - "The Army says there are fewer suicides among its personnel in Iraq and Kuwait, but morale is still low. The Army has released a mental health assessment based on interviews conducted last year. It finds mental health services for the troops have improved and there are more workers to help them handle combat stress. The report covered late last August through mid-October. But, 54 percent of the soldiers say morale in their units is low, or very low. That's an improvement from a 72 percent a year earlier..."