This week the US Preventive Services Task Force (USPSTF) updated their recommendations on screening for depression in adults. Included in the recommendations is the screening of women for depression during pregnancy and after giving birth. This is the first time the Task Force has recommended screening for maternal mental illness.
The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women. It also reviewed the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations. The task force added that “Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women; the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations.”
The USPSTF also describes the benefits of early detection and intervention and treatment. They found adequate evidence that programs combining depression screening with adequate support systems in place improve clinical outcomes (ie, reduction or remission of depression symptoms) in adults, including pregnant and postpartum women. It also supports treatment of adults and older adults with depression identified through screening in primary care settings with antidepressants, psychotherapy, or both decreases clinical morbidity.
The USPSTF also found adequate evidence that treatment with cognitive behavioral therapy (CBT) improves clinical outcomes in pregnant and postpartum women with depression.
Posted in Antidepressant medication, Cognitive Behavior Therapy, Depression, Guideline, Mental health, Mood, Post-partum, Practice guideline, Pregnancy, Screening in Primary Care, Treatment, Wellness
A study published in the Journal of Clinical Psychiatry evaluated the risk of symptom recurrence over 3 years after antipsychotic discontinuation in a sample of functionally recovered first-episode nonaffective psychosis (FEP) patients with schizophrenia spectrum disorder.
When to discontinue antipsychotic medication in patients who have fully recovered from their initial episode of psychosis has been discussed and debated over the years. A prospective, open-label, nonrandomized study evaluated patients from an FEP intervention program at a university hospital setting. Forty-six individuals agreed to discontinue medication while 22 chose to be the control group and remain on antipsychotics. Criteria for participation in the study was: (1) a minimum of 18 months on antipsychotic treatment, (2) clinical remission for at least 12 months, (3) functional recovery for at least 6 months, and (4) stabilization at the lowest effective doses for at least 3 months. Forty-six individuals who were willing to discontinue medication were included in the discontinuation group (target group). The rates of relapse over the 3-year period were 67.4% in the discontinuation group and 31.8% in the maintenance group. The mean time to relapse was 209 (median = 122) days and 608 (median = 607) days, respectively
According to the researchers, a comparison of the two groups demonstrated that rate of symptom recurrence in functionally recovered FEP patients following the self-elected discontinuation of treatment was very high. The relapsed individuals demonstrated significant differences (P < .05) in the Assessment of Negative Symptoms scale, the Clinical Global Impressions scale, and the Disability Assessment Schedule from those who did not relapse.
Source: Journal of Clinical Psychiatry
Dr. Robert Spitzer – a psychiatrist who played a leading role in establishing the Diagnostic and Statistical Manual of Mental Disorders, or the DSM as the agreed-upon standard to describe mental disorders, died Friday December 25, 2015. Spitzer died of heart problems, said his wife, Columbia University Professor Emerita Janet Williams. Dr. Spitzer’s work on several editions of the DSM, defined all of the major disorders “so all in the profession could agree on what they were seeing,” said Williams, who worked with him on DSM which became a best-selling book.
Dr. Allen Frances, a professor emeritus of psychiatry at Duke University and editor of a later edition of the DSM manual, said that Spitzer “was by far the most influential psychiatrist of his time.”
Source: NY Times
Science now has an explanation for why many of us try out the latest diet only to find that it is not working. A study published in the journal Cell this week, has demonstrated that different people’s bodies respond to eating the same meal very differently – which means that a diet that may work wonders for one person may not have the same impact on another. A key component used in creating balanced diet plans like Atkins, Zone or South Beach called the glycemic index, developed decades ago as a measure of how certain foods impact blood sugar level, was assumed to be a fixed number. But it’s not. It turns out that it varies widely depending on the individual.
The researchers studied 800 volunteers and collected data through health questionnaires, body measurements, blood tests, glucose monitoring and stool samples. They also had the participants input lifestyle and food intake information into a mobile app that ended up collecting information on a total of 46,898 meals. They found that not only does age and body mass index impact blood glucose level after meals but that different individuals showed vastly different response to the same food even though their own responses remained the same day to day.
The Beginnings of Personalized Dieting and Nutrition
The researchers said these findings show that tailoring meal plans to individuals’ biology may be the future of dieting and that the study yielded many surprises for individuals. For example, a middle-aged woman in the study tried and failed many diets. Tests revealed that her blood sugar levels spiked after eating tomatoes – indicating it is a poor diet choice for her since blood sugar has been associated with cardiovascular problems, obesity and diabetes – but since she didn’t know this, she was eating them as part of her healthy diet plans several times a week.
The authors collected extensive phenotypic data from these individuals, which were then used to train a machine-learning algorithm that could accurately predict glycemic response to various meals. This study is an important proof-of-principle for the utility of tailoring nutritional and/or pharmaceutical interventions to each individual. Precise predictions of glycemic response could represent a powerful tool to optimize dosing of insulin (or dietary interventions) in type 1 or even type 2 diabetics to avoid hypoglycemic episodes and more. According to the lead author, the work “really enlightened us on how inaccurate we all were about one of the most basic concepts of our existence, which is how we eat and how we integrate nutrition into our daily life.”
Researchers at Gothenburg University have developed a reference method for standardized measurements that diagnose Alzheimer’s disease decades before symptoms appear. The method has now formally been classified as the international reference method, which means that it will be used as the standard in Alzheimer’s diagnostics worldwide.
Beta amyloid protein is commonly found in the brain. While the protein’s normal function is not completely understood, it is believed that it participates in the formation and removal of synapses, which is essential in enabling the brain to form new memories. In healthy people, beta amyloid is quickly transported out to the spinal fluid and blood. But in individuals with Alzheimer’s disease, the beta amyloids remain in the brain, where they clump together and begin to damage the synapses, which leads to nerve cell death.
This process can begin in middle age and continue unnoticed for decades until the nerve cells are so damaged that symptoms take the form of a memory disorder and impaired cognitive abilities. At that point, the disease is felt to be too advanced to be treated, so intensive worldwide research is underway to find methods that diagnose Alzheimer’s sooner. After decades of research, Henrik Zetterberg and Kaj Blennow at Sahlgrenska Academy, Gothenburg University, were able to develop a method that measures the exact amount of beta amyloid in spinal fluid and diagnose Alzheimer’s ten to thirty years before the disease becomes symptomatic.
The Gothenburg researchers’ pioneering studies have gained wide international recognition since the measurement method they developed was approved as the international reference method by the Joint Committee for Traceability in Laboratory Medicine (JCTLM), whose goal is to promote and provide guidance on equivalent, internationally recognized and accepted measurements within laboratory medicine. The new method will be used as the norm for standardizing beta amyloid measurements around the world.
Source: University of Gothenberg
October 8th is National Depression Screening Day
This year commemorates the 25th Annual National Depression Screening Day
Screenings in schools
Mental health professionals are using screenings as a way to identify potential physical and mental health conditions. Just as a blood pressure screen helps to detect warning signs, a mental health screening provides a quick and effective way to recognize students who are at risk for treatable mental health disorders.
Screening at work
Early detection, assessment, and treatment can have a significant impact on the lives of those who experience mental health issues. Not only can this prevent mental health problems from worsening, but it can also improve worker productivity and decrease the cost of providing health insurance.
Many community organizations are offering free screening for depression and other mental health issues
Mental Health Screening
The choice of antidepressant in primary care can directly affect outcomes and quality of care for patients with depression. Faculty at the Mayo Clinic developed the Depression Medication Choice (DMC) encounter decision aid, designed to help patients and clinicians consider the available antidepressants and the extent to which they improved depression and other issues important to patients.
A tool to help patients with depression make informed decisions about appropriate antidepressants improves the antidepressant decision-making process without extending the length of primary care visits, according to a report in JAMA Internal Medicine. The tool, developed by researchers at the Mayo Clinic in Rochester, Minn., is called Depression Medication Choice (DMC). DMC consists of a series of cards that present general information about antidepressant efficacy and highlight various features of antidepressants—for instance, effects on sleep, sexual issues, and weight gain. The cards are used by the patient with the clinician during the primary care visit.
Mayo researchers conducted a cluster randomized trial of adults with moderate to severe depression considering treatment with an antidepressant. Primary care practices in 10 rural, suburban, and urban primary care practices across Minnesota and Wisconsin were randomly allocated to treatment of depression with or without use of the DMC decision aid. Compared with usual care, use of DMC significantly improved patients’ decisional comfort, knowledge, satisfaction, and involvement. It also improved clinicians’ decisional comfort. There were no differences in encounter duration, medication adherence, or improvement of depression control between study arms.
Source: JAMA Internal Medicine
A recent Harris Poll survey about attitudes toward mental health was conducted on behalf of the Anxiety and Depression Associations of America, American Foundation for Suicide Prevention and the National Alliance for Suicide Prevention. Over 2,000 US adults over 18 responded. Results revealed that “ majority (65%) of U.S. adults has seen a primary care physician within the past 12 months, yet only 12% have seen a mental health counselor or therapist. Despite this, about 9 in 10 adults (89%) feel that mental health and physical health are equally important for their own overall health. However, more than half (56%) say that, in our current healthcare system, physical health is treated as more important than mental health, and less than one-third (28%) feel that mental and physical health are treated equally. It is not surprising then that the overwhelming majority (92%) of adults feel that health services that address mental health, such as treatment for depression and suicide prevention, are fundamental to overall health and should be part of any basic health care plan.”
While nearly two in five adults (38%) believe that seeing a mental health professional is a sign of strength, more than four in ten (43%) believe it is something that most people can’t afford. Similarly, three in ten feel it is not accessible for most people (31%) or something people do not know where to find (30%). The most common diagnoses were depression (21%) and anxiety/panic disorder (20%). While only a third of adults have ever been diagnosed, nearly half (47%) admit that they have thought they may have had a mental health condition at some point. Nearly a third (31%) presumed they had anxiety/panic disorder (31%), while more than a quarter (28%) considered that they may have depression.
- Among adults who have been employed in the past 12 months, more than 1 in 10 have missed work days because they were too anxious (14%) or too depressed (16%) to go to work.
- Nearly two in five (38%) adults have ever received treatment for a mental health condition. Talk therapy (29%) is the most commonly used treatment resource, followed by prescription medication (25%).
Source: American Foundation for Suicide Prevention Website
The American Psychiatric Association has released the third edition of the Practice Guidelines for the Psychiatric Evaluation of Adults. These guidelines are different from previous versions in that they represent the first APA guidance developed using a new process that addresses standards set forth in a 2011 Institute of Medicine (IOM) report titled “Clinical Practice Guidelines We can Trust.”
In line with the IOM recommendations, this new edition of the practice guidelines was developed following an extensive review of the literature as well as input from around 800 experts in the field. The most noticeable change in the third edition of the Practice Guidelines for the Psychiatric Evaluation of Adults is the way it is organized. Rather than resembling a manual, these new guidelines are divided into nine separate guideline “modules” that are connected by the overarching theme of psychiatric evaluation. These are the nine guidelines:
Review of Psychiatric Symptoms, Trauma History, and Psychiatric Treatment History
Substance Use Assessment
Suicide Risk Assessment
Assessment of Risk for Aggressive Behaviors
Assessment of Cultural Factors
Assessment of Medical Health
Involvement of the Patient in Treatment Decisions
Documentation of the Psychiatric Evaluation
In situations where there may be less expert consensus, the guidelines offered “suggestions” instead of recommendations. When writing out the recommendations, care was taken to avoid unclear words like “consider” which can be hard to implement and may vary in interpretation. There is a section in each of the modules on implementation that discusses barriers to carrying out the recommendations and adjustments for patient preferences. As new science informs the evaluation process, the iterative design of the practice guidelines will allow them to be reviewed and updated as needed.
Source: Psych News