Study Suggests Psychotic Experiences Help Predict Suicidal Behavior

????????FROM Psychiatric News Alert: Individuals with psychiatric disorders reporting psychotic experiences are more likely to report concurrent suicidal ideation and suicide attempts than those who do not report psychotic experiences, according to a study that appears online in JAMA Psychiatry. Psychotic experiences were especially prevalent among individuals reporting severe attempts and may account for nearly one-third of attempts with intent to die in the United States annually, according to the report.

Researchers from Columbia University, the New York State Psychiatric Institute, and the University of Maryland School of Social Work examined the association between 12-month suicidality and 12-month psychotic experiences. The researchers found that individuals reporting psychotic experiences were approximately five times more likely to report suicidal ideation and nearly 10 times more likely to report a suicide attempt during a 12-month period. In contrast, depressive, anxiety, and substance use disorders did not reliably identify those at risk for attempts among respondents with suicidal ideation.

Immediate past APA President Jeffrey Lieberman, M.D., a coauthor of the study, noted that the increased risk for suicidal ideation and suicide attempts was especially high among people aged 18 to 29, whether or not these young people had a primary diagnosis of psychotic disorder.

“This study of a community-based epidemiological sample identified psychotic experience as a predictor of suicidal behavior in young people in particular. This finding can be considered an important risk factor for suicide in youth in the context of a wide range of mental disorders and can be applied in clinical practice.”

For more information see the Psychiatric News article, “Teens’ Psychotic Symptoms Strongly Associated With Suicidal Behavior.”

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.”

Abnormal Retinal Blood Vessels with Schizophrenia

s_1451f1From Psychiatric News Alert: The blood vessels in the retina of the eye are abnormal in individuals with schizophrenia, according to the study “Microvascular Abnormality in Schizophrenia as Shown by Retinal Imaging” in the American Journal of Psychiatry. The senior researcher was Richie Poulton, Ph.D., codirector of the National Centre for Lifecourse Research at the University of Otago in Dunedin, New Zealand. The cohort included more than 1,000 individuals who were followed from birth to adulthood. At age 38, the subjects underwent retinal imaging. The researchers compared the retinal imaging results of 27 individuals who had developed schizophrenia with those of individuals who had not and found that the former had microvascular abnormalities reflective of insufficient brain oxygen supply.

s_1451f2These findings have both research and clinical implications, the researchers said. For example, “Longitudinal and high-risk studies can determine whether retinal vessel caliber in juveniles predicts risk of developing psychosis or accompanies the progression of schizophrenia….” And if that is indeed the case, then retinal imaging might eventually be used to track youth at high risk of developing psychosis, since it is noninvasive and available in many primary care, optometry, and ophthalmology centers, and could foster intervention earlier than is now the case.

For an in-depth review of the latest knowledge on the causes of and treatments for schizophrenia, see Essentials of Schizophrenia from American Psychiatric Publishing.

APA President Lieberman: Collaborative Care is an Integral Part of Psychiatry’s Future

A column by Jeffrey Lieberman, M.D., and Jurgen Unutzer, M.D. from Psychiatric News Alert:

In 1974, music critic Jonathan Landau penned a classic article in which he stated, “I have seen the future of rock and roll and its name is Bruce Springsteen.” Landau was commenting on his impression of the debut album of the then-fledgling rock star. If you will permit my imaginative analogy, I believe that the same can be said about the collaborative care model with respect to the future of psychiatry. For this reason I invited Jürgen Unützer to co-author this column for Psychiatric News.

With the enactment of the Affordable Care Act, the rise of accountable care organizations and patient-centered medical homes, and the increased national attention on mental health, psychiatrists and primary care providers have an unprecedented opportunity to join together and work collaboratively on increasing the overall health of millions of Americans. APA recognizes this opportunity and has been actively involved in efforts to improve integration and collaboration with our primary care colleagues.

As one of the largest medical specialties, psychiatry is an important component of the physician workforce in the United States, but psychiatrists are distributed unequally around the country. More than half of the counties in the United States don’t have a single practicing psychiatrist. Only about 1 in 10 adults with a diagnosable mental disorder receives care from a psychiatrist in any given year and patients are much more likely to receive mental health treatment from their primary care provider than from a psychiatrist. It is well known and often said that 40 percent of primary care (adult and pediatric) involves dealing with psychiatric problems. Our colleagues in primary care are well aware of the substantial challenges related to treating the millions of patients who present with mental health problems in their offices every year and report serious limitations in the support they receive from psychiatrists and other mental health specialists.

To read more, click here.

You can follow Dr. Lieberman on Twitter at @DrJlieberman. To do so, go to, log in or register, and click on “Follow.”

Kennedy: Release of Parity Rule Is Only Part of the Battle

From Psychiatric News Alert: Speaking to the APA Assembly the day after Friday’s release of the final rule implementing the federal mental health parity law, the law’s chief sponsor, Patrick Kennedy, emphasized that “while the final rule may have been written, the final word on mental health is not yet written.” It will have to be written by psychiatrists “on the front lines” who battle to make mental health care as routine as the rest of medical care, he told Assembly members. He lamented the stubborn stigma that still attaches to mental illness as well as the thousands of suicide deaths that could be prevented every year if people weren’t ashamed of having an illness affecting the brain rather than other parts of the body. He added that it was appropriate to use the slogan that AIDS activists used in their fight against stigma a couple of decades ago: “Silence = Death.”

Kennedy, a former member of Congress who fought for 12 years to get the mental health parity law passed, said that the battle against mental illness discrimination “is part of the march toward progress embodied in the civil rights movement in our country and in the historic human rights movement that occurred in South Africa.”

“What you’re fighting for at APA,” he said, “is giving a connection to human beings who feel marginalized because their illness is so shamed and stigmatized, much like Americans who are marginalized because of the color of their skin, their gender, their sexual orientation, or their religious ethnicity.”

He ended by describing how receiving mental health treatment changed his life for the better, allowing him to experience the joy of seeing the parity law enacted, its final rule issued, and of being a father able to give his children the foundation in life that all children need. Kennedy now serves as a senior advisor to APA.

Institute on Psychiatric Services Update

APA’s 2013 Conference

The 2013 Institute on Psychiatric Services is underway now (October 10-13) in Philadelphia. The conference theme is “Transforming Psychiatric Practice, Reforming Health Care Delivery,” and the conference is featuring two special events. Thanks to the support of the American Psychiatric Foundation, former Rep. Patrick Kennedy, a strong advocate for improved access to mental health services as part of health care reform, has joined APA President Jeffrey Lieberman, M.D., for a session in the “Conversations” format, discussing changes in psychiatric practice, stigma, and the need for increased advocacy to improve access to psychiatric treatment. Dr. Lieberman is also chairing a special symposium on the role of psychiatrists in the transformed health care system with esteemed colleagues Ellen Katz, Ann Sullivan, and Grant Mitchell.

Kennedy Says This is a Critical Time for Parity

Kennedy and Lieberman spoke before a packed hall, and the former congressman, who was instrumental in the landmark 2008 parity bill, discussed his own journey toward understanding the importance of equal treatment for mental illness and substance abuse. He recounted his mother’s struggle with alcoholism and his problems with addiction, as well as his Aunt Rosemary’s intellectual disability, saying that within his own family mental illness and substance abuse were “the elephant in the living room that no one talked about.” He recounted parking his car three blocks away from his psychiatrist’s office to avoid being recognized during his political career.Yet, ironically, Kennedy found himself, along with his late father, Sen. Edward Kennedy, championing the 2008 federal parity law.

Kennedy emphasized that now—with a “final rule” from the government that will provide a regulatory framework for implementing the 2008 law expected very soon—is a decisive moment. He said transparency in the way insurance companies make medical-necessity decisions will be crucial to ensuring the full implementation of parity.

“The exciting thing for all of you is that with health care reform, we are rewriting the rules. Organizations like APA need to be even more aggressive than ever before, because we are at a formative point….This is the moment in history when we really have the opportunity to change the landscape.”

What is Parity?

“Parity” refers to fair and equal coverage of mental health and substance use disorders. In states with comprehensive parity laws, plans subject to state law must provide coverage for a broad range of mental health and substance use disorders in a manner that is equitable with coverage for other health conditions. Parity leads to complex legal issues and about half of all covered Americans are enrolled in large self-insured health insurance plans that are subject to federal, not state, law.

NAMI’s Position on Parity

NAMI supports full parity in both private (individual and employer-based) and public (Medicare, Medicaid, and other government-sponsored) insurance coverage for mental illnesses. Central to an understanding that mental illnesses are both “blameless” and treatable is non-discriminatory coverage for the necessary medical care for these illnesses. One key to unlocking the prisons of these illnesses is research, and research is driven by funding.

The discrimination in access to care is evidenced by limited coverage, punitive co-pays, and restricted access to hospitalization during acute episodes and what one would logically conclude would occur for other untreated or under-treated serious illnesses. That is to say: the outcomes for people with untreated or under-treated illnesses are disastrous and too frequently results in death or permanent disability. To that effect NAMI has been actively pursuing non-discrimination clauses in both federal and state insurance laws.

For more information about parity, visit NAMI’s Parity Policy Web Page.


Psychotic Symptoms Linked to Adolescent Suicide Risk

From Psychiatric News Alert (8/12/13): According to a recent study, psychotic symptoms alone (as distinguished from diagnosed psychotic disorders) are a striking marker of suicide danger in adolescents, especially in those adolescents who demonstrate other types of psychiatric pathology.

“This is a very interesting study,” said child and adolescent psychiatrist Kayla Pope, M.D., of Boys Town National Research Hospital in Nebraska. “We need better markers for assessing suicide risk, and the finding in this study is an important step in that direction.”

The finding, from a team of European researchers in JAMA Psychiatry, came as a surprise to the lead researcher, Ian Kelleher, M.D., Ph.D.

“While we knew that people with psychotic disorders are at high risk of suicidal behavior, we did not know that there was such a strong relationship between psychotic experiences (which are much more common than psychotic disorders) and suicidal behavior in the population.”

More information about suicide risks can be found in Psychiatric News herehere, andhere. Information about suicide is also available in The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.