Study Finds Immune Molecule Levels Linked to Schizophrenia Onset

From Psychiatric News Alert: The levels of certain immune-related molecules in the cerebrospinal fluid appear to differ in individuals with schizophrenia and at risk for schizophrenia compared with healthy control subjects, scientists report in Schizophrenia Bulletin. The study was headed by Lindsay Hayes, Ph.D., a postdoctoral fellow at the Johns Hopkins Schizophrenia Center, and Akira Sawa, M.D., Ph.D., director of the center. 

Another potentially important finding the researchers reported was that the levels of these molecules in schizophrenia-risk subjects were “exacerbated” compared with the levels in subjects who already had been diagnosed with schizophrenia. Thus the levels of these molecules might serve as predictive biomarkers for the onset of schizophrenia, the researchers believe. “However, this data is very preliminary and needs to be validated with additional large cohorts and in longitudinal studies to confirm their predictive impact,” Hayes toldPsychiatric News. 

Alan Brown, M.D., a professor of psychiatry and epidemiology at Columbia University and an expert on infectious agents that have been linked to schizophrenia, said in an interview that since “the abnormalities appeared to be greater in those with at-risk mental states than in those with schizophrenia suggests that a longitudinal study with cerebrospinal fluid immunologic biomarkers in the same individuals tested at different time points could be very promising.” 

More information about the immune system’s possible links to schizophrenia can be found in the Psychiatric News article, “Immune System Protein Could Give Clue to Late-Onset Schizophrenia.” To read about the value of early schizophrenia detection and treatment, see “Early Detection of Schizophrenia: The Time Is Now,” a column by then-APA President Jeffrey Lieberman, M.D. 

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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 https://twitter.com/DrJlieberman, log in or register, and click on “Follow.”

Research Funding Cuts Described as “Devastating” by APA President

From Psychiatric News Alert: In Monday’s edition of his video series addressing key issues in mental health and its treatment, APA President Jeffrey Lieberman, M.D., discusses important scientific advances in understanding mental illness over the last several decades and how cuts in research funding are likely to stall future advances. At a time when talented researchers are devoting their careers to uncovering more of the brain’s mysteries and should be attracting increased funding, “Federal investment in research through the National Institutes of Health is currently $4 billion lower than the peak year of 2003 and at the lowest level since 2001. These deep cuts have forced hard choices,” Lieberman emphasized, “destructive choices amounting to wide-scale de-emphasis of clinically oriented, disease-relevant research.”

He called described th funding cuts as “devastating” since their effect could be to delay crucial discoveries and erode the cadre of researchers working in this field.

“It’s time that our government aligns its policies with our national interests and scientific opportunities. We need to prioritize the health of the nation to protect and to support biomedical research.”

View the video or others in the series below or by clicking here. For previous Psychiatric News Alerts, click here.

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.

 

Early Detection of Schizophrenia–The Time Is Now

A message from APA President Jeffrey Lieberman, M.D., also appearing in  Psychiatric News Alert to all interested persons. Please send your comments to pnupdate@psych.org

“I believe that we are at another game-changing moment in psychiatry with the rise of the early detection and intervention strategy (EDIS). This new therapeutic strategy and model of care could have a significant effect on our ability to treat and limit the morbidity of mental illness beginning with schizophrenia and related psychotic disorders.

“While schizophrenia has been historically associated with a therapeutic nihilism due to its devastating and often irreversible consequences, research over the last two decades has changed attitudes and inspired optimism. Studies show that the earlier patients are diagnosed and treated, the better their responses to treatment. This leads to improved outcomes and higher chances of full recovery. The corollary to this is continued engagement of patients in treatment following their recovery and relapse prevention.

“Among the reasons for this are findings from neuroimaging studies showing that the hallmark clinical deterioration of schizophrenia is associated with cortical gray matter atrophy, reflecting the loss of cell processes and synaptic connections. Unlike Alzheimer’s disease though, for which there currently is no “disease-modifying” treatment, early intervention and relapse prevention methods for schizophrenia coupled with antipsychotic medication may prevent illness progression.

“Moreover, additional research and first-person reports indicate that resilience, coping skills, and peer and family support can substantially contribute to favorable outcomes and recovery. Collectively, these findings have suggested the value of early detection, intervention, and sustained engagement with treatment to enhance recovery and prevent disability.

“Unfortunately, these encouraging research findings have been slow to translate into clinical practice in the United States. It will not come as a surprise that an important reason for the slow implementation of the EDIS model of care is a lack of adequate financing. Many individuals in the earliest stages of psychosis do not have health insurance, and even if they do, their plans do not cover comprehensive psychosocial and rehabilitative services. And while the public mental health system is designed to serve individuals without health insurance and to provide services not covered by insurance, the system favors individuals who have already become disabled by mental illness, limiting the availability of services for patients in the early stages of psychotic disorders.”

For Dr. Lieberman’s full message and call to action, CLICK HERE.