News in Brief
WE WISH TO THANK JOHN NIELANDER, MANAGING EDITOR OF PSYCHOTHERAPY FINANCES, FOR HIS GRACIOUS RECIPROCAL EXCHANGE OF PUBLICATIONS. FOR THOSE UNFAMILIAR, PSYCHOTHERAPY FINANCES IS A VERY WORTHWHILE READ, PUBLISHED MONTHLY AND FILLED WITH PRACTICE BUILDING TIPS. WE RECOMMEND TAKING A LOOK (Eds).
Psychotherapy Finances: Jan, Feb, March, 2006. “Fee, Practice and Managed Care Survey.”
A comprehensive listing of all types of fee and practice data from all the primary mental health professions. A true wealth of data to help you see where you stand compared to your peers and other professions.
ALL THE ARTICLES BELOW ARE EXCERPTS FROM THE WONDERFUL EMAIL LIST RUN BY KEN POPE, A DAILY DIGEST OF RELEVANT NEWS IN PSYCHOLOGY. TO JOIN CONTACT DR POPE AT kspope@kspope.com THE EDITORS OF THE IP APPLAUD HIS CONSISTENT CONTRIBUTION!
Journal of Consulting & Clinical Psychology (vol. 73, #6). “The Characteristics of Persistent Sexual Offenders: A Meta-Analysis of Recidivism Studies” by R.Hanson and K. Morton-Bourgon.
The study found that “Many of the variables commonly addressed in sex offender treatment programs (e.g., psychological distress, denial of sex crime, victim empathy, stated motivation for treatment) had little or no relationship with sexual or violent recidivism.”
The National Institute of Mental Health released its report:
“The Numbers Count: Mental Disorders in America.”
The report begins: “Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages and older -- about one in four adults -- suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.2 Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion -- about 6 percent, or 1 in 17 -- who suffer from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44.3 Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.”
Below are a few stats from the report:
- Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.
- Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
- Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.
- The highest suicide rates in the U.S. are found in white men over age 85.8
- Four times as many men as women die by suicide; however, women attempt suicide two to three times as often as men.
- Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year, have schizophrenia.
- Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder.
- Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD.
- The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.
- Autism is about four times more common in boys than girls. Girls with the disorder, however, tend to have more severe symptoms and greater cognitive impairment.
- Alzheimer’s Disease affects an estimated 4.5 million Americans. The number of Americans with AD has more than doubled since 1980.
The report is online at http://tinyurl.com/jlpt2
American Medical News (vol. 49, #9).
“Is it really Alzheimer’s? There are several differentials; Early diagnosis is critical, but so is heightened awareness of a range of conditions that trigger reversible dementia” by K.Tomaselli.
The article describes how the following conditions can create dementia-like symptoms and “can go untreated or be confused with Alzheimer’s”:
- Medication problems: prescription, over the counter and herbal.
- B12 deficiency or other poor nutrition issues.
- Depression.
- Infections such as urinary tract infection or pneumonia.
- Normal pressure hydrocephalus.
- Out-of-control diabetes.
- Electrolyte imbalance.
- Hyper- or hypothyroidism.
- Hyper- or hypoglycemia.
- Alcoholism.
- Neurosyphilis.
- Subdural hematoma
American Journal of Psychiatry (vol. 163, #3.). Review of “Divided Minds” P. Wagner and C. Spiro. (St. Martins Press, 2005, 316 pp.).
The review is by Harvard Medical School professor George Vaillant, who terms it “the best book on schizophrenia since Eugen Bleuler¹s The Group of Schizophrenias” and states that “every resident in America should read Divided Minds.”
New York Times (3/21/06)”Revisiting Schizophrenia: Are Drugs Always Needed?” by B. Carey.
The only responsible way to manage schizophrenia, most psychiatrists have long insisted, is to treat its symptoms when they first surface with antipsychotic drugs, which help dissolve hallucinations and quiet imaginary voices. Delaying treatment, some researchers say, may damage the brain.
But a report appearing next month in one of the field’s premier journals suggests that when some people first develop psychosis they can function without medication ‹ or with far less than is typically prescribed (as well as they can with the drugs. And the long-term advantage of treating first psychotic episodes with antipsychotics, the report found, was not clear.
The analysis, based on a review of six studies carried out from 1959 to 2003, exposes deep divisions in the field that are rarely discussed in public.
Washington Post (3/21/06). “Mood Machine – Now There’s a Device to Treat Depression. If Only There Were Solid Evidence That It Works” by S. Boodman.
The pocket-watch-sized device is billed as “a pacemaker for the brain,” the newest cutting-edge treatment for as many as 4 million adults whose severe depression is not relieved by psychotherapy, drugs or even shock treatments.
Since its approval under unusual circumstances eight months ago by the Food and Drug Administration (FDA), more than 550 Americans have undergone surgery to have a vagus nerve stimulator (VNS) implanted in their chests to activate parts of their brains. More than 3,700 psychiatrists, have been trained in the use of VNS, the first device ever approved to treat depression. It consists of a battery-operated generator attached to an electrode implanted in the vagus nerve in the neck. The generator emits regular pulses of electricity that are supposed to stimulate serotonin and other brain chemicals believed to regulate mood, according to Cyberonics.
Yet despite the imprimatur of the FDA and an aggressive marketing campaign, the most basic question about the treatment remains unanswered: Does it work? At the heart of the debate is this: The only rigorous clinical trial of the device -- which is approved to treat severe epilepsy -- failed to demonstrate effectiveness in alleviating depression. That study involved 235 patients, all of whom received the device, which was turned on in only half the group. At the end of three months, there was no statistically significant difference between the two groups. A second study of 174 VNS recipients found that 30 percent showed significant improvement after one year. Because that study lacked a control group and because patients received other depression treatments after the device was implanted, there is no way to know whether the device was responsible. For years experts have known that depression -- unlike, say, type 1 diabetes -- can get better without treatment.
New Scientist (3/31/06) “Prescribing of hyperactivity drugs is out of control” by P. Aldhous.
Nearly 4 million Americans, most of them children and young adults, are being prescribed amphetamine-like stimulants to treat attention deficit hyperactivity disorder (ADHD). Up to a million more may be taking the drugs illegally. Leading researchers and doctors are calling for a review of the way ADHD is dealt with. Many prescriptions are being written by family doctors with little expertise in diagnosing ADHD, raising doubts about how many people on these stimulants really need them. Just as worrying, large numbers of children who do have ADHD are going undiagnosed. Both trends could lead to problems with drug dependency, argue specialists in addiction.
Harvard Mental Health Letter (March ’06). “The therapeutic relationship: What patients want.”
Interviewers requested specifics: something either the patient or the therapist did or said, something they did together, or something else that happened in connection with the therapeutic sessions. Patients were asked why and how the critical incident helped to form or strengthen the relationship.
Examples:
- Nonverbal communication. The therapist made eye contact, leaned forward in her chair.
- Active listening. He remembered and repeated what I said in an earlier session; she paraphrased what I said.
- Self-disclosure. She said she had had an experience similar to mine
- Encouraging comments. He congratulated me for what I was doing to help myself; she said I was intelligent.
- Emphasis on choice. She said, “You know yourself best.”
- Greetings and farewells. He greeted me with a smile; she opened the door for me to leave; he introduced himself in the waiting room.
- Openness to personal criticism. She responded well when I said she used too much perfume.
- Validation of feelings. He gave me a tissue when I cried; shesupported me when I criticized a previous therapist.
Humor and laughter were important as well. Patients also mentioned clothes and grooming and the lighting, decorations, and books in the therapist¹s office.
Massachusetts Passes Bill to Require Health Insurance for All Its Residents.
Lawmakers overwhelmingly approved a bill Tuesday that would make Massachusetts the first state to require that all of its citizens have some form of health insurance. The plan -- hailed as a national model and approved just 24 hours after the final details were released -- would dramatically expand access to health care over the next three years.
Psychiatric Services (vol. 57, #4). “Legal Concerns for Psychiatrists Who Maintain Web Sites” by P. Recupero, J.D., M.D.
Abstract: “Courts recognize three types of Web sites: passive, which provide basic information; business, on which business is conducted; and intermediate, which are somewhat interactive but conduct no business. Inviting contact from site visitors may lead to inadvertent doctor-patient relationships, with ensuing legal duties. Statements made may be considered explicit warranties, which are subject to lawsuits when not fulfilled. Providing services to out-of-state clients may amount to practicing without a license. The author reviews federation of State Medical Boards guidelines for appropriate use of the Internet in medical practice and offers ethical principles to help guide decisions about structure and content of passive sites.”
Behavioral Science & The Law (vol. 24, #2). “Cues they use: clinicians’ endorsement of risk cuesin predictions of dangerousness.” M. Odeh, R. Zeiss, M. Huss.
Abstract: “Clinical predictions of violence are a necessary part of clinical practice despite extensive literature validating the use of actuarial rather than clinical prediction. The current study examined clinicians’ use of risk cues in predictions of violence.
Clinicians identifyed several risk cues as significant in clinical assessments of risk, including a history of assaults, hostility, medication noncompliance, paranoid delusions, presence of psychosis, and family problems. However, further results indicated that clinician- endorsed risk cues lack predictive power in the present sample.”
The study found that the clinicians reported the following factors most frequently as cues to predict violence:
- past assaults
- non-compliance with medication
- history of substance abuse
- presence of psychosis
- violent thoughts
- previous admission to a psychiatric hospital
- paranoid delusions
- a diagnosis of mental illness
- uncooperativeness
- a history of poor impulse control
- prior use of a weapon
- hostility
- family problems
According to this study, these variables did NOT accurately predict those patients who became violent in the following 2 years.
Rreprint requests may be sent to Matthew T. Huss, Creighton University, Department of Psychology, Omaha, NE 68178
Herald-Leader (6/5/06).“At 2 colleges, 17% have purposely hurt themselves” by L. Tanner.
One in every six students at two Ivy League schools say they have purposely injured themselves by cutting, burning or other methods. The results of the survey at Cornell and Princeton are similar to other estimates of this behavior. Counselors say it’s happening at colleges, high schools and middle schools across the country. Separate research found more than 400 Web sites devoted to the subject, including many that glorify self-injury.
