Advantages of Long-Acting Injectable Antipsychotics

With studies showing schizophrenia to be treatment refractory in one-fifth of those affected, psychiatrists are exploring other options to the delivery of effective treatment. At APA’s Institute on Psychiatric Services in San Francisco, some of the leading experts in psychopharmacology led a research symposium on the benefits of long-acting injectable (LAI) antipsychotic medications.Said Steven Potkin, M.D., director of clinical research at the University of California, Irvine:

“Psychiatrists who were trained during my time of training, think that long-acting injectable antipsychotics should be used for the most refractory, noncompliant, and difficult to treat patients. However, there is accumulating evidence that very early in the course of illness that this should be offered as an option, since half of the patients with first-episode psychosis discontinue medication after they are discharged from a hospital.”

Research on part of the “accumulating evidence” on long-acting injectable antipsychotics was presented by Keith Nuechterlein, Ph.D., a distinguished professor of psychiatry at the University of California, Los Angeles, who led a randomized study comparing LAI risperidone with oral rispiderone in 83 individuals who had a first psychotic episode within the two years prior to the study. The results showed that after one year of treatment, participants who received the daily oral form of risperidone had a 33%relapse rate, compared with 5% in those treated weekly with LAI risperidone. In addition, individuals in the oral risperidone cohort were four times more likely to be hospitalized than those taking the LAI version.

“We were struck that these were among the most dramatic results that have occurred for long-acting injectables—and it was in first-episode patients,” said Nuechterlein, adding that not only did patients experience advantages regarding outcomes associated with LAIs, but the patients accepted LAI medication quite readily. (The study was funded by the National Institutes of Health and Janssen Pharmaceuticals.)

“This symposium was an invitation for psychiatrists to rethink when is it appropriate to offer patients long-acting injectable medication. Should it be reserved only for refractory patients, or should it be offered to people earlier in the course [of illness]… or at any stage of illness? Of course, LAIs are not for everyone, but our patients should definitely be given options.”

Higher Rehospitalization Rates for Patients With Mental Disorders According to Study

Psychiatric illness may contribute to higher 30-day hospital readmission rates for patients with heart failure (HF), acute myocardial infarction (AMI), and pneumonia, according to a study of 160,169 patients served by 11 U.S. health systems.

From 2009 to 2011, about 21.7% of patients with psychiatric comorbidity went back to the hospital within 30 days of discharge, compared with 15.5% of those without such diagnoses, said Brian Ahmedany, Ph.D., L.M.S.W., of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit and colleagues in Psychiatric Services in Advance yesterday.

“Individuals with comorbid anxiety, dementia, and depression had higher rates of readmission than persons with no psychiatric comorbidity regardless of whether the index hospitalization was for HF, AMI, or pneumonia,” the researchers found. “[H]ealth systems should consider adding elements of mental health assessment, diagnosis, monitoring, and treatment to interventions to prevent 30-day all-cause hospital readmissions.”

Those elements might include psychiatric screening and evaluation, discharge planning that includes a mental health component, and follow-up for psychiatric conditions that includes outpatient treatment.

Ahmedany and colleagues noted that the gap in readmission rates between patients with and without psychiatric comorbidities shrank from 6.0% in 2009 to 4.1% in 2011. That was an encouraging trend but might be narrowed still further by adoption of interventions specifically designed for these conditions.

For more on the interface between psychiatric and general medical conditions, see the American Psychiatric Publishing book, Integrated Care: Working at the Interface of Primary Care and Behavioral Health, edited by Lori Raney, M.D.

Youth Pastors Regularly Encounter Mental Illness, Yet Feel Ill-Equipped to Help, Study Finds

Almost all pastors who deal with adolescents will encounter a mental health and/or substance abuse issue among their congregation and can serve as a valuable source of guidance, yet only a quarter of them feel that they are qualified to recognize problems and help these troubled youth.

This finding comes from a study carried out by researchers at Baylor University who surveyed a broad scope of youth and college pastors across Texas.

The survey found almost 80 percent of youth pastors worked with at least one adolescent a year whom they knew or at least suspected had a mental health issue. However, fewer felt prepared for these situations; about 50 percent reported having some training related to mental illness, while only 26 percent felt qualified to work with young people dealing with a mental problem.

Many of these pastors did refer their adolescents to other professionals; 76 percent referred people to Christian counselors, 51 percent to a psychologist, and 34 percent to a psychiatrist. The pastors felt that a lack of connections was the biggest barrier in preventing them from working with mental health professionals with more frequency.

“Youth and college pastors want to get involved, which is a very positive sign,” said lead author Matthew Stanford, Ph.D., a professor of psychology and neuroscience at Baylor. “They could be a key group that can help build a bridge between the psychiatric and religious communities.”

To read about APA’s efforts at bringing together psychiatry and faith, see the Psychiatric News article “APA Hosts Meeting to Build Bridges Between Faith, Mental Health Communities.” You can also read APA President Paul Summergrad, M.D.’s column, “Psychiatry and the Faith Community.”

Leadership of the Mental Health and Faith Community Partnership gather after last month’s Steering Committee meeting at APA headquarters. From left: Paul Summergrad, M.D., Annelle Primm, M.D., Ginny Thornburgh, Curtis Ramsey-Lucas, M.Div., Saul Levin, M.D., M.P.A., and Paul Burke.

VA Secretary Says Veterans Are the ‘Canary in the Coal Mine’ of Mental Illness

“We are the canary in the coal mine” when it comes to mental health, said Veterans Administration Secretary Bob McDonald in an interview with Psychiatric News. “Mental health care is a problem in this country–it’s not just a problem for those who have suffered PTSD or traumatic brain injury in combat; it is a problem for football players, hockey players, police officers, and many others. We have got to get ahead as a society on mental health.”

McDonald spoke to reporters after a speech to the AMA’s House of Delegates, which held the opening session of its 2014 Interim Meeting yesterday in Dallas. During his speech to delegates outlining efforts to reform the VA in the wake of publicity about substandard care and unusually long waits for appointments in some VA facilities, McDonald specifically addressed the need for better psychiatric care, including increased reimbursement for psychiatrists. Regarding reimbursement, psychiatry won a recent victory that will bring their pay to more competitive levels effective November 30.

“As I’ve gone around the country, I’ve discovered we don’t have enough students in medical school studying mental health,” he said. “Why? Insurance reimbursement rates are low, and there’s a stigma in society about mental health.

“The good news is that at the VA we know about mental health,” McDonald said. “We are on the cutting edge of mental health….It’s a big issue, and as a society we have to get on top of it.”

For related information, see the Psychiatric News article “Psychiatrists’ Pay to Rise at Veterans Health Administration.”

The Speaker this Month is Janet Backes, the Regional Coordinator for Project Return Peer Support Network

This month’s speaker is Janet Backes, Regional Coordinator for “Project Return”.

Project Return Peer Support Network is Los Angeles County’s oldest program run for people with mental illness. Project Return Peer Support Network (PRPSN) promotes wellness, personal growth and self-determination for people who have experienced mental illness by providing social opportunities, education, and community involvement. We believe in diversity, acceptance, advocacy and empowerment while encouraging people to transform their lives.

As a non-profit peer run organization, PRPSN demonstrates that self-help is a valuable part of recovery from mental illness. Our programs illustrate the benefits of helping people with mental illness build a base of support among their peers – to share goals, conquer fears, and celebrate successes. Our services demonstrate the importance of self-help and peer programs as an integral part of mental health systems.

To learn more about PRPSN, come to the meeting and/or visit THIS SITE.

The meeting will begin at 7:30 p.m., on November 17, 2014. At 6:00 p.m., before the meeting, our monthly Caring & Sharing family support group will meet.  The Caring and Sharing Meeting is in the Fireside Room and the Speaker Meeting is in Faith Hall at the First Lutheran Church, 2900 Carson St., Torrance CA. Parking is available in the parking lot off of Carson Street and on Carson Street and Flower Avenue.


Words of Wisdom from a Social Worker

By Wayne Munchel, LCSW
Director of Transitional Age Youth Services
Star View Children & Family Services

When I was asked to write a brief article for the NAMI South Bay newsletter providing advice on how best to support ongoing growth and responsibility in a mentally ill relative – I hesitated. I hesitated because I remembered all too well the advice I freely dispensed when I was a new Social Worker and knew everything.

My first job was as a member of a psychiatric Emergency Team (PET) and I would frequently interact with desperate, stressed out families about how to best deal with their mentally ill loved one. (It’s probably worth mentioning that I had this job prior to having children of my own.) The help seeking families were often struggling with difficult issues pertaining to their child’s ability/willingness to respect limits and housing rules, and manage their own illness and behavior. Common questions about when they should protect and when to push expectations; when to accept their loved one’s diminished capacities and impaired judgments and when to confront them.

I recall with some embarrassment, giving some speech about “tough love” that I must have learned on Oprah. Demand cooperation, expect compliance or else show them the door. If I were to hear such counsel now that I’ve raised a couple of lovely daughters with my wife, I would respond by telling a professional to go do something anatomically impossible (pound sand?). I can only ask for forgiveness for my past displays of arrogant ignorance.

Today, I would respond much differently. First of all, I would acknowledge and credit these families with all they have done, often with very little support and understanding, to continue loving and supporting their son or daughter. I would want to listen carefully to what they’ve tried that has been working and what hasn’t. I would want to elicit their assessment of exhaustion and resilience, of when they recognize opportunities. To expect more and when they need to conserve energy, this calls for the kind of wisdom that we would all hope to have for our children – but it’s even more complex and challenging when the adult child has a disability.

Governor Brown Signs Bill Allowing Families to Seek Gun Restraining Order

California will become the first state that allows family members to ask a judge to remove firearms from a relative who appears to pose a threat.

The new legislation responded to the deadly rampage in May 2014 near University of California, Santa Barbara. Relatives of the victims and other supporters of the bill said the parents of 22 year old Elliot Rodger were thwarted in their attempts to seek help for their troubled son before the rampage.

Weeks before the shooting, Elliot Rodger’s parents had his therapist contact Santa Barbara County mental health officials. Sheriff deputies talked to Elliott Rodger but never entered his apartment or checked to see if he owned guns. The Sheriff’s decided that he was not a threat to himself or others and took no further action.

Elliot Rodger later wrote that had deputies searched his room, they might have found guns that the police said he used to shoot three people after stabbing to death three others.

If you have guns in your home

 please store them safely.