Louisiana Mental Health Blog

Hallucinations in Schizophrenic Linked to Brain Abnormalities by MRI

2007-08-19

In the August 2007 issue of the Journal, Radiology, researchers using magnetic resonance imaging (MRI) claim to have found structural and functional abnormalities in specific brain regions of schizophrenic patients that have experienced chronic auditory hallucinations.

The article is entitled, Chronic Auditory Hallucinations in Schizophrenic Patients: MR Analysis of the Coincidence between Functional and Morphologic Abnormalities. The lead researcher is Luis Marti-Bonmati, M.D., Ph.D., chief of magnetic resonance in the Department of Radiology at Dr. Peset University Hospital in Valencia, Spain.

Psychiatrist Claims Depression is Over-Diagnosed

2007-08-19

In an article published in the August 18, 2007 issue of the British Medical Journal, Dr. Gordon Parker, a psychiatrist at the University of New South Wales, Australia claims that too many people are being diagnosed with depression when they were merely unhappy.

Dr. Parker's 15 year study of 242 teachers found that more than three quarters of them met the current criteria for depression. Parker claims the symptoms for depression are so common that most people will meet them at some point in their lives.

Dr. Parker further stated that depression has become a "catch-all" diagnosis created by the marketing of antidepressant drugs by pharmaceutical companies.

Others, however, disagree with Dr. Parker. Dr. Andrew McCulloch of the Mental Health Foundation in the UK thought that it was more likely that depression was under diagnosed because people did not recognize the symptoms of depression.

This position seems supported a recent British Medical Journal study by Professor Ian Hickie of Sydney University which suggested that increased diagnosis of depression has reduced suicide rates. Suicide is a risk associated with severe depression.

Katrina Sets Off Mental Health Crisis in Gulf Region

2007-08-20

According to the September 2007 issue of Scientific America in an article entitled, Suffering a Slow Recovery: Failed rebuilding after Katrina sets off a mental health crisis in the Gulf, the mental health of residents of Southern Mississippi and Louisiana is deteriorating. The fact that the general mental health of the population is continuing to deteriorate two years after the disaster is unusual.

Experts believe the continued displacement resulting from a slow rebuilding process has left people with perpetuated feelings of loss of control resulting in depression and anxiety. Of course, short term mental health aid provided by the federal government after a disaster is not designed to address persistent distress from long term problems presented by the displacement occuring after Katrina.

The State of Louisiana and the federal government need to consider options for dealing with continued problem.

Risperdal Use Approved for Treating Children with Schizophrenia and Bipolar Disorder

2007-08-24

On August 22, 2007, the Food and Drug Administration approved the use of the antipsychotic drug Risperdal for use to treat children with schizophrenia and bipolar disorder. The FDA Release on this can be found at:

http://www.fda.gov/bbs/topics/NEWS/2007/NEW01686.html

More specifically, Risperdal is approved for treatment of children 13-17 with schizophrenia and for short term use in the treatment of children 10-17 with manic or mixed episodes of bipolar I disorder.

Although Risperdal has been approved for treatment of adults with schizophrenia since 1993, psychiatrists did not have an approved drug for treatment in children.

Psychologist Says Shyness May Have Violent Consequences

2007-08-26

At the recent annual meeting of the American Psychological Association, Bernardo Carducci of Indiana State University presented a hypothesis that certain forms of shyness may result in violent behavior.

He stated that his researchers had analyzed 8 school shootings over a decade. They discovered that the shooters in these incidents shared nearly all of 29 personality and behavior characteristics that Carducci categorizes as cynical shyness.

The shyness that Dr. Carducci saw in the shooters was different from ordinary shyness. "These are people who want to be with others but who are rejected in a very harsh way," While most shy people would continue efforts to connect with others, the shooters that Dr. Carducci examined internalized the rejection and alienated themselves. "As they develop a sense of disconnect, they move away from people, and as they move away from people, that makes it easier for them to hurt them. These people are becoming a cult of one."

Identifying these people may be a critical task for parents and teachers in the years ahead.

Moldy Homes May Cause Depression

2007-09-01

According to a study published in the October 2007 issue American Journal of Public Health, preliminary evidence has been found linking exposure to high levels of mold with depression. A news account of the research can also be found at Forbes.com.

Erich P. Rapp.

Diagnosis of Bipolar Disorder in Children and Adolescents Soars Forty Fold in Last Decade

2007-09-04

According to an article published in the September issue of the Archives of General Psychiatry entitled, National Trends in Outpatient Diagnosis and Treatment of Bipolar Disorder in Youths, the number of children and adolescents diagnosed with bipolar disorder increased from 20,000 in 1994 to 800,000 in 2003. Further, the researchers believe the trend has continued further since 2003. This amounts to a forty fold increase in diagnosis of bipolar disorder in children and adolescents.

The study is based upon a review of data from the National Center for Health Statistics consisting of a survey of office visits that focused on doctors in private or group practices. The senior author of the study is Dr. Mark Olfson of the New York State Psychiatric Institute at Columbia University Medical Center.

Erich P. Rapp

Depression Worsens Health More than Other Chronic Diseases

2007-09-15

According to a research article by Dr. Samnath Chatterji in the September 8, 2007 issue of the UK medical journal, Lancet, Depression worsens health more than angina, arthritis, asthma, and diabetes. People with depression plus one or more chronic diseases had the worst health scores of all the disease states. According to the article authors, these results indicate the urgency of addressing depression as a public health priority to reduce disease burden and disability, and to improve the overall health of populations.

Erich P. Rapp

Research Reveals Genes Related to Bipolar Disorder and Schizophrenia

2007-10-08

In a study discussed in BP (Bipolar) Magazine's Fall 2007, a study of the brains of deceased bipolar and schizophrenia patients at Harvard's McLean Hospital identified 25 genes that may be related to bipolar disorder and schizophrenia. All 25 genes are involved with GABA, an amino acid associated with complex information transmission in the hippocampus area of the brain. Of the 25 genes identified, 10 of the genes were found only in patients that had been bipolar and 12 of the genes were found only in the patients that had been schizophrenic. None of the 25 genes were found in the brains of the control patients in the study.

A discussion of this study is found in the Gather.com blog.

Erich P Rapp

Mental Illness Awareness Week October 7-13

2007-10-08

Since 1990, Congress has designated the first full week of October as mental illness awareness week. This year the week is October 7-13. Mental health professionals around the United States will be attempting to stimulate open and public discussions about the realities mental illness. These discussions are part of an overall effort to decrease the stigma associated with mental illness.

For more information on Mental Illness Awareness week, check out the National Alliance on Mental Health web site.

Erich P. Rapp

Once-Daily Lithium Treatment for Mania Symptoms of Bipolar Disorder Failed a Phase 3 Clinical Study

2007-10-09

Noven Pharmaceuticals announced on October 8, 2007 that a phase 3 clinical trial for Lithium QD failed to demonstrate effectiveness compared to a placebo. Lithium QD was designed to treat mania symptoms associated with bipolar disorder in a once-daily treatment. Researchers were surprised by the test results, Noven Pharmaceuticals intends to continue analyzing the associated data with a belief that this treatment option is viable.

Erich P. Rapp.

October 10th is World Mental Health Day

2007-10-09

October 10th is World Mental Health Day. This is a global mental health education, awareness and advocacy project of the World Federation for Mental Health. The federation has members and contacts in over 150 countries.

The theme for World Mental Health Day in 2007 is Mental Health in a Changing World: The Impact of Culture and Diversity. The federation has prepared a booklet on the 2007 theme that addresses many issues related to culture and mental illness.

Erich P Rapp

Research Reveals that Depression is a Predictor of Further Intellectual Decline in Older Patients

2007-10-10

Researchers have concluded that depression is a predictor of further intellectual decline in older patients. Dr. Jeffrey M. Lyness, professor of psychiatry, at the University of Rochester and a team of researchers studied 700 patients over 65 years old for two years.

Their findings were published in the September 2007 issue of the American Journal of Psychiatry in an article entitled Does Depression Procede or Follow Executive Dysfunction? Outcomes in Older Primary Care Patients.

Researchers conducted interviews and asssessements of executive functions that involved high level mental processes such as making decisions, organizing, planning and doing a series of things in sequence. They also reviewed primary care medical records.

The researchers stated that the next step is to determine if treatment or prevention of depression will also prevent the intellectual decline.

Erich P Rapp

Review of Studies Concludes that the Longevity Gap Between People Suffering from Schizophrenia and the General Public Has Grown Worse

2007-10-11

The death rate for people suffering from schizophrenia is 2.5 times the death rate of the general public. People suffering from schizophrenia are also 13 times more likely to commit suicide. Further in recent decades, this death rate gap between the general public and those suffering from schizophrenia has grown worse.

These are the conclusions of a review of studies published in the October2007 issue of Archives of General Psychiatry. The review is entitled, A Systematic Review of Mortality in Schizophrenia by John McGrath, a professor at the Queensland Centre for Mental Health Research in Australia and a team of other authors and researchers. The review looked at 37 studies published between 1980 and 2006.

The researchers found that many of the medications used to treat schizophrenia have negative side effects including weight gain and increased risk of type 2 diabetes. The patients also report a reduced "joie de vivre" or joy in living. The patients, thus, often periodically discontinued their medications and again began suffering the ill effects of schizophrenia. The result is a cycle of taking and discontinuing their medications, suffering ill effects of the schizophrenia and then suffering ill effects of the medications.

As quoted in MaxHealth.com, McGrath stated that the team's conclusions were "a tragic reflection on how suboptimal our current treatments [for schizophrenia] are."

Erich P Rapp.

Mental Health Parity Bill Approved by House Subcommittee

2007-10-11

The House Energy and Commerce Health Subcommittee approved a mental health parity bill on Wednesday. Republicans members of the subcommittee attempted to amend the bill (HR 1424) to make it more like legislation (S 558) the Senate passed last month. These efforts were defeated.

The Senate and the House versions of the Mental Health Parity bill would require health insurers that offer mental health benefits in a health insurance plan to make them equal to traditional medical benefits.

The House version is somewhat more demanding than the Senate version. The House version has a broader definition of mental illness and an earlier implementation date.

Erich P Rapp

Enrollment Period for Medicare Part D Prescription Drug Plans

2008-02-03

From November 15, 2007 to December 31, 2007, Medicare recipients may enroll in Part D Prescription Drug Plans. Recipients who are already enrolled in a Part D Prescription Drug Plan can also change plans during this period.

The Centers for Medicare/Medicaid Services ("CMS") has an online tool to assist recipients in evaluating plans based upon their specific medicines. It is located on the CMS website, http://www.medicare.gov. This information can also be obtained by calling 1-800-MEDICARE.

Pharmacists at Walgreens are also offering a free, personalized report to Medicare Part D recipients. Their report will help recipients choose a Part D plan that is most beneficial.

Medicare Part D Related Web Site Based Information Fails to Meet Federal Standards

2007-12-04

Medicare Part D Prescription Drug Plan (PDP) Sponsor Internet Web Sites: Content and Accessibility (OEI-06-06-00340) http://www.oig.hhs.gov/oei/reports/oei-06-06-00340.pdf

This evaluation found that 33 percent of the 84 PDP sponsor Web sites reviewed did not contain all federally required content. The most commonly omitted information pertained to enrollee disenrollment rights and responsibilities, the potential for PDP contract termination, and information related to the formulary. Using two electronic tools that enable page-level testing of Web-based information and applications, the evaluation also found that 85 percent of sponsor Web sites did not meet at least one of the Federal requirements for Web site accessibility. These problems could affect access to content by Medicare beneficiaries.

Study of Effectiveness of Omega-3 Fatty Acids in Treating Major Depression

2007-12-31

The effectiveness of Omega-3 fatty acids found in fish oil, flaxseed and walnuts as a treatment for major depression is being researched by Dr. Mark Hyman Rapaport and a team of researchers at the Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosceinces in Los Angeles. This study is sponsored by the National Institutes of Health.

The working title for the research is Poly-Unsaturated Fatty Acids for Treatment of Major Depression: Differential Effects of EPA vs. DHA Therapy. EPA is eicosapentanoic acid and DHA is docosahexanoic acid. The study will take five years.

It is already known that Omega-3 Acids have an anti-inflammatory properties that help stabilize brain cell membranes both of which have a role in mood regulation.

Erich P. Rapp.

Mental Health America Ranks States for Incidence of Depression

2008-01-22

Mental Health America, a national nonprofit organization promoting mental wellness, has ranked the fifty (50) states and the District of Columbia with respect to depression. Hawaii received the best ranking, and Utah had the highest incidence of depression. Louisiana scored near the top and is ranked no. 7.

Mental Health America’s report can be viewed at http://www.nmha.org/go/state-ranking.

Eli Lilly & Co. Annual Sales Up 19% for 2007

2008-02-04

Total sales were slightly under $15.7 billion dollars. Of its ten top sellers, three (Zyprexa, Cymbalta & Strattera) treat mental disorders. Annual Zyprexa sales rose 9% despite recent class action products liability lawsuits. Sales of Cymbalta, an antidepressant, rose 60%. Two of Lilly’s remaining top ten sellers are drugs used to treat diabetes, a potential side effect of Zyprexa.

Survey Points to Poor Overall Health of Those Suffering From Schizophrenia

2008-02-03

Mental Health America’s recent survey shows poor overall health of people with schizophrenia. Prior statistics showed that schizophrenia reduces lifespan by an average of 25 years.

Obesity in those that suffer schizophrenia occurs at almost twice the rate of the general population. Diabetes occurs about three times as often. Diabetes and weight gain are known side effects of antipsychotic medications.

69% of those surveyed reported discontinuing medication use due to side effects. Almost 40% reported that their longest use of antipsychotic medication was less than one year.

Clearly, mental health professionals need to examine more effective delivery of healthcare to people with schizophrenia. What we are doing is not working.

For more information, go to http://www.nmha.org/index.cfm?objectid=C1B7B8EA-1372-4D20-C8875ACC90F01AE2

Baton Rouge Area Law Enforcement Receives Training to Help Mentally Ill

2008-02-02

Twenty (20) police officers and two (2) deputies attended a forty hour class. The class instructed how to de-escalate situations with the mentally ill and to educate regarding community resources available for mental health patients. Attendees learned the signs and symptoms of schizophrenia.

Police Chief Leduff wants all of his officers to receive the training. He cited successes with such training in other communities.

We commend Chief Leduff. With the increase in mental health emergency calls since Hurricane Katrina, this is a timely issue.

Mental illness is not a crime. It should not be criminalized. We hope more public officials will, like Chief Leduff, look for ways to assist the mentally ill.

Mental Health Care Shortage Cited in Killing of New Orleans Police Officer

2008-02-03

The recent killing of New Orleans Police Officer Nicola Cotton “underscores severe shortages in acute mental health care in Louisiana, even for potentially violent patients.” This according to Dr. Jeffrey Rouse, New Orleans deputy psychiatric coroner, interviewed for an article in the Times-Picayune.

Bernel Johnson allegedly killed Officer Cotton after Johnson created a disturbance at a New Orleans bank. Johnson’s family told of his history of paranoid schizophrenia. The family had attempted to secure long-term treatment. The family had even hired an attorney and filed a civil suit, attempting to commit Johnson permanently.

Proper mental health treatment can and usually does prevent violence by the mentally ill. Unfortunately, many suffering from mental illness do not receive appropriate care. They discontinue taking their medicine, which exacerbates their illness.

Government and managed care often cite the high cost of care for mental illness. Officer Cotton’s death shows the much higher cost of not providing care.

Eli Lilly & Co. Responds to Critical Article in New England Journal of Medicine

2008-02-04

In a recent news release, Lilly objected to implications in a New York Times article that Lilly suppressed results of negative clinical trials. The New York Times comments on a recent article in the New England Journal of Medicine. The NEJM listed two Cymbalta studies, among others, as being unpublished.

Prescribers and consumers depend heavily upon the pharmaceutical industry’s own clinical trials in evaluating the safety and efficacy of prescription drugs. Hopefully, the pharmaceutical industry is fully committed to the recent movement toward transparency in these studies.

People Suffering from Insomnia and Comorbid Mental Illness Often Lack Treatment Specific to Insomnia

2008-02-05

A Journal of Medical Economics article cites a recent study of patients suffering from both insomnia and other mental illnesses. The study concludes that many patients suffering from insomnia also suffer from anxiety, mood disorders, and depression. The study also concludes that those suffering from anxiety, mood disorders, and depression often receive no pharmacological therapy specific for insomnia.

Unfortunately, there is no consensus regarding whether insomnia causes depression, anxiety, or mood disorders. Mental health professionals are left to engage in chicken or egg discussions. Does insomnia cause mental disorders, or is insomnia a symptom of a developing mental disorder? Apparently, we need more studies to arrive at an answer.

I cannot find a clear answer. If you know of one, send me an email at kpayne@antareshealth.com.

Many Mental Health Consumers Need Education Concerning Their Medicines

2008-02-06

Clinicians in our Shreveport, Louisiana outpatient mental health clinic are piloting a medication education program called Your Medicine. The nurse and psychiatrist designing the program asked me to help edit the project, so I follow our pilot program with great interest. Medication noncompliance could be the most significant factor in relapses and hospitalizations among the chronically mentally ill.

Before beginning the education program, we give consumers a pre-test. Our social workers also lead a group discussion, asking group members to talk about problems they have had with medication compliance. Here are some interesting trends we see at the outset of treatment:

Virtually all consumers either fail to recognize or minimize the effects of past medication noncompliance.
Initially, few consumers can list or narrate the names of their medicines, dosing information, or what condition the medicine treats without significant errors or omissions.
Even among consumers that take numerous medicines, many are not using pill planners or any other method to organize their medicines.
Many consumers do not know how to recognize or interpret basic information from a prescription label, such as the number of refills remaining.
Many consumers need a better understanding about how to have their prescriptions refilled or reissued before they run out.

After consumers complete Your Medicine, we give a post test. This provides insight into how much help a particular consumer will need with his medicines after discharge. We communicate these needs to the consumer’s family or others providing support.

Education is probably not the silver bullet for combating medication noncompliance. Nevertheless, it is hard to envision widespread success if our consumers and their support systems lack insight into medications. Education is but one of many tools we use in medication management.

LSUHSC-S's Psychopharmacology Research Clinical Trials

2008-02-07

LSU Health Sciences Center Shreveport announced that it seeks participants for three (3) clinical trials it is conducting:

· A 6 month study switching to Abilify versus continued treatment with Zyprexa, Risperdal, and Seroquel

· A study on Paliperidone ER in Adolescents

· A 10 week study evaluating the effects of metyrapone/oxazepam versus placebo on cocaine craving and abstinence.

For more details, including criteria for participation, call (318) 813-2073

Inventors Try Creative Ways to Assist With Medication Compliance

2008-02-12

A recent invention is the “smart pillbox,” which flashes lights and sounds a buzzer when it is time to take medicine. Additional technology is being developed which will allow vital signs to be recorded and transmitted by mobile phones. Some pillboxes even have key devices that health care providers can use to document that they have visited a patient.

CNN Runs Feature on Memphis Crisis Intervention Team

2008-02-18

As part of its feature, “Criminally Insane,” CNN featured the Memphis Police Department’s Crisis Intervention Team (“CIT”). Memphis formed the CIT about 18 years ago. It has been replicated all over the country. CIT members initially receive forty (40) hours of treatment in handling encounters with the mentally ill.

CNN’s feature showed a police encounter at a drop in shelter for the homeless. A disruptive mentally ill consumer had a knife and initially refused to give it to the officer. The officer calmly spoke with the consumer. Ultimately, he surrendered the knife. The officer transported him to a treatment center.

CIT tries to “defuse an intense situation with little or no force.” The CIT are trained to immediately get the mentally ill into. The focus is on treatment, not punishment. Public safety goals are furthered by stopping the mentally ill from being disruptive. They are taken to treatment facilities.

We had previously blogged Baton Rouge’s crisis intervention program, which appears similar to that of Memphis. Hopefully, we will see more of these programs in Louisiana. Mental illness should be treated, not punished

FDA Panel Recommends Approval of Long-Acting, Injectable Zyprexa

2008-02-19

A long-acting, injectable form of the drug Zyprexa is “acceptably safe” for use in certain schizophrenia patients, a U.S. Food and Drug Administration panel recommended.

Zyprexa LAI is an investigational formulation that combines the atypical antipsychotic medication Zyprexa (olanzapine) with a pamoate salt, resulting in an extended delivery of up to four weeks. Risperdal Consta, another atypical antipsychotic available in injectable form, is administered every two weeks.

But the group of outside medical experts did express concern that the drug was associated with “profound sedation” so severe that it caused loss of consciousness and coma in some people taking part in clinical studies, Dow Jones Newswires reported. This occurred in 24 of 2,045 patients who received the drug. All of these patients recovered and most went on to receive additional injections of the drug.

Use of long-acting, injectable Zyprexa should be limited to schizophrenia patients with a history of chronic non-compliance with oral medications, the panel said. Some of the experts also suggested the FDA approve the product as a second-line treatment, meaning that other treatments should be tried first.

While not required to do so, the FDA usually follows the recommendations of its expert panels.

The clinical studies also found that long-acting Zyprexa, made by Eli Lilly & Co., was associated with weight gain, changes in blood sugar, and high cholesterol. These side effects also are associated with the oral form of Zyprexa and similar drugs.

Currently, Zyprexa has FDA approval as an oral, once-daily medication to treat schizophrenia and bipolar disorder. There’s also a short-acting injectable form of Zyprexa, used to treat agitated, non-cooperative patients with schizophrenia or bipolar mania, usually in an emergency setting, Dow Jones reported.

DHH Announces Mental Health Improvement Plan

2008-02-26

Alan Levine, head of Louisiana’s Department of Health and Hospitals since January, states, “In my short tenure, the problem with the mental health system has quickly become the dominating issue. It’s not just a problem in New Orleans – although it has manifested itself here in a more visible way. This issue is overwhelming hospitals, law enforcement, community agencies … and most importantly, families who have a loved one who is suffering,”

To address this issue, DHH has announced a plan to revamp New Orleans’ mental health system. Gov. Jindal has added $89.7 million more to this year’s budget, for a grand total of $484.7 million for mental health initiatives. Among other things, the revamp includes Assertive Community Treatment (“ACT”) teams, a crisis line, and regional triage teams. If successful, this plan may be duplicated throughout Louisiana.

Charity Hospital in New Orleans had a 98 bed psychiatric unit. This unit has not been replaced since Hurricane Katrina, causing a great shortage in mental health care in the New Orleans area.

The Department of Health and Hospitals created a transformation team to accomplish its revamp. Leading the team is James McDonough, who reformed Florida’s prison system.

FDA Refuses to Approve Long-Acting Zyprexa Injection

2008-02-28

According to the Wall Street Journal, the FDA cited concerns with “profound sedation” occurring in 1% of patients. The director of FDA’s psychiatric products division noted that the sedation effects are unique to the injectable form of Zyprexa and are not seen in Risperdal Consta, another long-acting, injectable antipsychotic drug.

LSU Health Sciences Center Shreveport Announces Schizophrenia Study

2008-03-04

LSU Health Sciences Center-Shreveport’s Psychopharmacology Research Clinic is currently enrolling participants in its CAMP schizophrenia study. CAMP is an acronym for Comparison of Antipsychotics for Metabolic Problems. To be eligible, you must:

· Be 18 through 65 years of age.

· Be diagnosed with Schizophrenia or Schizoaffective disorder.

· Currently be taking Risperdal, Seroquel or Zyprexa.

· Have a problem with weight or cholesterol.

Eligible study participants will receive study medication, study-related medical care, and lab work, all at no cost.

For further details, call Barbara Roggero at (318) 813-2070,email at brogge@lsuhsc.edu or go to the web page.

DHH Names Head of Office of Mental Health

2008-03-06

The Department of Health and Hospitals announced on 5 March 2008 Jennifer Kopke's appointment as Assistant Secretary for the Office of Mental Health. For the last four (4) years, Kopke served as Executive Director for the Jefferson Parish Human Services Authority. Kopke will be responsible for overseeing the programs and facilities associated with DHH’s Office of Mental Health. This includes the state’s mental hospitals, mental health clinics, the four human services districts and programs such as Louisiana Spirit, the Child-Adolescent Response Team and Louisiana Youth Enhanced Services.