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Thursday, May 26, 2011

Better Evaluating, Treating Psychological Effects of War

Military mental health was a top priority for doctors at last week's APA Annual Meeting. Elspeth C. Ritchie, M.D., M.P.H., and Marvin A. Oleshansky, M.D., (back) chaired a symposium on Evaluating and Treating the Effects of War at the American Psychiatric Association 164th Annual Meeting. Also presenting were CPT Michelle Hornbaker, M.D.; John C. Bradley, M.D.; Brett Schneider, M.D., and Scott C. Moran, M.D. Research about PTSD, the impact of deployment on families, and treatment of serious mental illnesses were among many topics addressed.

Wednesday, May 18, 2011

Psychiatric Symptoms Prior to Deployment Predict Risk of New Onset PTSD in a Cohort of National Guard Troops


A poster presented in the final poster session of the APA's 164th Annual Meeting in Honolulu discussed research that looked at whether individual symptoms associated with PTSD could be predictors of whether full PTSD would develop. Predeployment depression and alcohol dependence were not associated with increased risk of PTSD after deployment but risk was significantly elevated in the case of somatization. Subclinical symptoms of PTSD and somatization assessed prior to military deployment appear to be antecedent risk factors for new onset PTSD. Despite the fact that depression and alcohol dependence are frequently comorbid with PTSD neither acted as a risk factor in this study. The presence of multiple, nonspecific ailments, however, consistent with a somatization‑like process, was associated with increased vulnerability.

Protein Decline May Link to Depression in Pregnancy


Research presented at the American Psyciatric Association Annual Meeting shows a potein important to fetal development may play a role in depression in pregnancy. Read the press release.

Gender Differences in Combat Stress


Anna Kline, PhD, presented in the New Research poster session at the APA Annual Meeting. Her study is titled Gender Differences in the Risk and Protective Factors Associated with Combat Stress Disorder.

New Research Poster: Impact of Shift Work

Research examining effects of shift work found that both excessive sleepiness and insomnia associated with shift work seriously impacted the lives of shift workers.

The research was presented Tuesday, May 17, at the American Psychiatric Association’s 164th Annual Meeting which runs Saturday, May 14, to Wednesday, May 18, 2010 in Honolulu.

The studies found shift workers do not always recognize their own symptoms of shift work disorder; and healthcare professionals believe that shift work disorder is missed two-thirds of the time.

One study used a structured online survey of 260 shift workers and 673 healthcare professionals to examine the impact of excessive sleepiness associated with shift work and diagnosis of shift work disorder.

Shift work negatively impacted respondents’ lives by affecting energy level (72 percent of respondents), emotional health (52 percent), and physical health (51 percent). As a result of their excessive sleepiness, 69 percent had made mistakes at work; 43 percent said their ability to care for dependents had been compromised; and 10 percent had had at least one work-related accident. Half of respondents wanted to change their jobs or work hours and did not feel it was possible to do so.


A second study looked at how shift work disorder was diagnosed from the perspective of healthcare professionals and shift workers. When excessive sleepiness was discussed with health professionals, shift workers initiated the conversation 82 percent of the time, while healthcare professionals initiated it 13 percent. Healthcare professionals believed that 67 percent of shift work disorder is never detected by physicians and that half is undiagnosed because it is often masked by other conditions, including depression.

Both studies were sponsored by and conducted in collaboration with Cephalon, Inc., Frazer, Penn.

The new research posters (#NR10-49 and NR10-39) were scheduled Tuesday, May 17, at the Hawaii Convention Center.

Tuesday, May 17, 2011

Women with History of Childhood Abuse At Greater Risk for Aggression in Relationships

Women with a history of childhood physical abuse may be at greater risk than men for aggression, as a victim or as a perpetrator, in adult intimate relationships, according to a study released at the American Psychiatric Association Annual Meeting.

The research was scheduled for presentation Sunday, May 15, at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18.

Researchers said the findings also suggest that anger suppression could play a role in the link between aggression in relationships and abuse history.

Details of this study, along with five other new research studies, will be presented at a press briefing from the APA Annual Meeting. Members of the media can attend in Room 307 of the Hawaii Convention Center at 8 am Hawaii time, Monday, May 16, or participate online at 11 AM PDT/2 pm EDT by registering at https://www2.gotomeeting.com/register/341505819.

Protein Decline May Link to Depression in Pregnancy

Research from the American Psychiatric Association Annual Meeting shows that a protein important to fetal development declines significantly in the mother’s bloodstream during pregnancy which can cause depression in some pregnant women.

These findings were presented Tuesday, May 17, at the 164th American Psychiatric Association Annual Meeting, being held in Honolulu May 14-18.

Researchers looked at levels of brain-derived neurotrophic factor, known as BDNF, a growth-related protein important to healthy fetal development, in the bloodstream of a group of healthy women who were pregnant and compared BDNF levels to women who were not pregnant. Serum BDNF was significantly lower in pregnant women.

Authors concluded that BDNF may be sequestered by the fetus during pregnancy, and that low levels of the protein during pregnancy could put some women at risk for developing depression during pregnancy. The presenters suggested future research on BDNF levels in depressed pregnant women.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at http://www.psych.org/  and http://www.healthyminds.org/.

Study Looks at PTSD Risk Factors

National Guard troops who had some symptoms of posttraumatic stress disorder but not enough to receive a diagnosis before deployment were more vulnerable to PTSD when exposed to combat trauma than other troops, according to a new study released at the American Psychiatric Association Annual Meeting. Researchers found pre-deployment depression and alcohol dependence were not associated with an increased risk for PTSD.

The longitudinal study was scheduled for presentation Tuesday at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18.

Researchers from the University of Medicine and Dentistry, New Jersey, surveyed National Guard Members before and after deployment and compared pre-deployment and post-deployment data for 922 Guard members. The researchers looked at symptoms like intrusive memories, hyperarousal, and avoidance of stimuli associated with a trauma as well as for symptoms of depression and alcohol dependence.

When any of the PTSD symptoms were present prior to deployment, Guard members were at higher risk for a new onset of PTSD after exposure to combat trauma. Guard members screening positive for two out of three components prior to deployment had higher risk than those screen positive for one.

Despite the fact that depression and alcohol dependence frequently found with PTSD, neither was a risk factor in the study.

Study Shows Relationship Between Low Unit Cohesion, Suicidal Thoughts

Unit cohesion appears to be an important factor in determining whether soldiers think about suicide during a period after combat exposure, according to a study presented at the American Psychiatric Association Annual Meeting.

U.S. Army researchers surveyed more than 1,600 soldiers from two combat brigades who had been deployed once. The survey was designed to measure of combat exposure, unit cohesion and self-reported thoughts of suicide. Soldiers who reported higher combat exposure and lower unit cohesion had the greatest odds for reporting suicidal thoughts during the previous four weeks. In addition, soldiers with similar combat exposure were more likely to have suicidal thoughts if they reported less unit cohesion.

The research was scheduled for presentation Tuesday, May 17, at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18.

Annual Meeting Course Simulates Chaos of Disaster Mental Health Interventions

In a year of disasters that has included tornados, fatal floods of the Mississippi River, Japan’s nuclear crisis, and the 10th anniversary of 9/11, Disaster Psychiatry is more relevant than ever. This morning at the Annual Meeting, the Committee on Psychiatric Dimensions of Disasters sponsored a basic course on Disaster Psychiatry.

Highlights included a role play featuring Colonel David Benedek of USUHS playing a stressed pilot, Dr. Kristina Jones of NYU as a well-intended but hyperactive flight attendant, and Dr. Anand Pandya of UCLA as a traumatized whiskey-gulping bereaved man. Dr. Fred Stoddard of Harvard Medical School came to the rescue as the Disaster Psychiatrist. Audience members helped simulate the chaos of disaster mental health interventions.

“If only our new book, Disaster Psychiatry : Readiness, Evaluation and Treatment, were available in these kinds of situations!” said Dr. Stoddard, lead editor of the book, co-authored by the Group for the Advancement of Psychiatry and Disaster Psychiatry Outreach. “The role play exercise certainly engaged the audience and stimulated discussion, and as a career Army guy, I was happy to play a flyboy for a brief moment,” said Dr. Benedek.

Questions from national and international members of the audience from the Netherlands, Denmark, and Haiti highlighted that American Psychiatry has developed a strong body of knowledge for how psychiatry can intervene in human-made and man-made disasters.

“Given all the tragedies that have occurred this year, it is tempting to want to believe that we have somehow reached our quota, and can now rest easy. But the course helped the audience to consider how to prepare for future disasters and ensure that psychiatry is appropriately integrated into response and aftercare," said Dr. Pandya.

Delirium Following Cardiac Surgery Common in Older Patients

Delirium following cardiac surgery, a serious postoperative complication, is fairly common in older patients, affecting more than one-third of those over 70 according to research being presented at the American Psychiatric Association Annual Meeting in Honolulu.

The research poster (NR01-37) is scheduled for presentation on Saturday, May 14, at 10:00 a.m. at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18 at the Hawaii Convention Center.

Delirium is characterized by reduced clarity of awareness of the environment with reduced ability to focus, sustain, or shift attention. The presence of delirium after cardiac surgery has been associated with increase in intensive care stay, in length of hospital stay, sternal wound stability, sternal wound correction, and increased incidence of intubation. Previous research has found rates of delirium following cardiac surgery from two percent to 73 percent.

Researchers led by Adam Lau, M.D. evaluated 50 patients following cardiac surgery and found an overall incidence of delirium of 20 percent with a significant increase in incidence with age. For those over 70 years old, the incidence was 38 percent and for those over age 80, 43 percent. No patients under age 70 developed delirium.

Study: Peer-Led Therapy May Reduce Suicide Risk

Participation in peer-led therapy groups can help at-risk patients become less vulnerable for suicide according to new research to be presented at the American Psychiatric Association Annual Meeting in Honolulu.

Suicide risk assessment has become increasingly refined and utilized in public and private medical and psychiatric facilities across the nation including within the military where high suicide rates have been reported among recently returning military and older veterans.

The research examined whether identifying and reinforcing a primary care patient’s suicide protective factors, such as responsibilities toward children and family, optimism, hope, and positive coping skills, spiritual, moral, and religious factors, and social supports, may help lessen the impact of crises and depression and reduce the risk for suicide.

The study involved screening primary care patients at Department of Veterans Affairs Medical Centers for suicide risk using the Patient Health Questionnaire-2. Patients identified as at-risk were invited to a 4-week peer-led therapy group aimed at providing social support and educating patients on the importance of these protective factors and ways to integrate the factors more fully into their lives and ongoing awareness.

Data collected thus far, author Shabnam Balai, M.D., reports, are encouraging and show that by participating in a low-intensive, peer-led therapy group, primary care patients can become less vulnerable for suicide.

The research was presented at the APA Annual Meeting in Honolulu. The meeting was May 14-18, 2010.

Monday, May 16, 2011

Fascinating Science and Networking in Paradise

By Iqbal “Ike” Ahmed, M.D.

I am writing from the perspective of an APA member who lives in Honolulu. I am excited about so many fellow psychiatrists and other mental health providers visiting my home town and enjoying what it has to offer-Aloha, warm hospitality, friendly people, interesting culture, great weather, and beautiful surrounding such as our beaches and mountains.

My own experience of the meeting has been one of trying to make the meeting informative and enjoyable for my friends and fellow psychiatrists visiting the island. In between, I have had the opportunity to chair a few fascinating scientific sessions. In one of those a study suggests that a cognitive screening instrument, the Montreal Cognitive Assessment (MOCA) was better in the recognition of cognitive impairment in depressed patients. The importance of this is that cognitive impairment can affect function in depressed patients. I also heard that loneliness appears to be associated with increased development of dementia in a Dutch population. In another session, I heard about use of PHQ-9 used as a screening instrument to recognize depression in Kaiser patients with medical problems and then having them followed by care managers.

The most interesting thing I learnt was about the development of serum biomarkers to distinguish schizophrenia from patients with other psychiatric disorders, and from those without mental illness. This was presented by Prof. Sabine Bahn, of Cambridge and Erasmus Universities as a “Frontiers of Science Lecture”. I was fascinated about the underlying science behind this about insulin resistance, glucose uptake in the brain, oxidative stress in the neurons, and the associated changes in the serum of patients leading to a biomarker fingerprint. It is amazing, that this biomarker test is already commercially being marketed.

Well, it is now time to run along and try to get in to hear Rev. Desmond Tutu, talk about his work on the reconciliation commission in South Africa at the Convocation of Fellows. Hope to then spend an evening with friends from Mainland attending the meeting-one of my favorite parts of the Annual Meeting.

Children of Deployed Parents More Likely to Experience Psychiatric Hospitalization

Children of military service members are more likely to be hospitalized for a psychiatric condition when a parent has been deployed, according to a new study presented at the American Psychiatric Association Annual Meeting.

The research was scheduled for presentation in a press briefing Monday, May 16, at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18
Researchers looked at records for nearly 380,000 children ages 9 to 17 years of active duty military personnel. The children’s data was linked to the parent’s deployment records.

The odds of psychiatric hospitalization increased by 10 percent among children age 9 to 17 years when a military parent was deployed, according to the study. The odds of hospitalization increased with increasing length of a parent’s deployment.

Details of this study, along with five other new research studies, will be presented at a press briefing from the APA Annual Meeting. Members of the media can attend in Room 307 of the Hawaii Convention Center at 8 am Hawaii time, Monday, May 16, or participate online at 11 AM PDT/2 pm EDT by registering at https://www2.gotomeeting.com/register/341505819.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at http://www.psych.org/ and http://www.healthyminds.org/.

Hawaii Study Shows Increasing Psychiatric Emergency Room Visits Among Elderly

A study of emergency room visits by elderly patients in Hawaii shows an increase in geriatric psychiatric visits with longer stays, a trend that suggests a coming mental health crisis for an aging population and a need for services for this population.

The research was scheduled for presentation Monday, May 16, at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18.  Researchers from The Queen’s Medical Center in Honolulu showed psychiatric emergency room visits by elderly patients increasing by 30 percent from 2008 to 2009.

Details of this study, along with five other new research studies, will be presented at a media briefing from the APA Annual Meeting. Members of the media can attend in Room 307 of the Hawaii Convention Center at 8 am Hawaii time, Monday, May 16, or participate online at 11 AM PDT/2 pm EDT by registering at https://www2.gotomeeting.com/register/341505819.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.

Sunday, May 15, 2011

Study Looks at Connection between Economic Stress, Suicide

If the United States follows the pattern that occurred after the economic crisis in Japan, public health officials should watch for a significant increase in suicides, particularly among Baby Boomers, concluded a study scheduled for presentation at the American Psychiatric Association's Annual Meeting.

The new research was scheduled for presentation Sunday, May 15, at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18.

Researchers looked at suicide rates in Japan during the late 1990s when that country experienced an economic downturn similar to recent trends in the United States and Europe. The study examined suicides in Japan by age, gender, and year in relation to a series of economic variables. If the U.S. rates of increased suicide approximate those in Japan, the country would experience a yearly increase of deaths due to suicide estimated at 14,610 per year, the study concluded.

Details of this study, along with five other new research studies, will be presented at a press briefing from the APA Annual Meeting. Members of the media can attend in Room 307 of the Hawaii Convention Center at 8 am Hawaii time, Monday, May 16, or participate online at 11 AM PDT/2 pm EDT by registering at https://www2.gotomeeting.com/register/341505819.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at http://www.psych.org/ and http://www.healthyminds.org/.

Saturday, May 14, 2011

Case Studies: Synthetic Cannabis Linked to Extended Psychosis

Case studies indicate the recreational use of synthetic cannabis may in some cases lead to psychosis that can last for days or months in some cases, according to a study at the American Psychiatric Association Annual Meeting in Hawaii.

Researchers at the Naval Medical Center in San Diego followed ten patients hospitalized for psychosis apparently induced by the use of synthetic cannabis, commonly known as “Spice,” “K2,” “Blaze,” and “Red X Dawn.” These are plant material coated with varying combinations of synthetic cannabinoids, which act on the body in a similar way to chemicals found in cannabis. The compounds have not been approved by the FDA for human consumption and little is known about their safety.

The ten patients studied ranged in age from 21 to 25 years old and after use of “Spice” experienced ongoing psychotic symptoms, including auditory and visual hallucinations, paranoid delusions, odd or flat affect, thought blocking, disorganized speech, thoughts of suicide, insomnia, slowed reaction times, agitation and anxiety. Psychotic symptoms generally resolved between five and eight days after admission, but in some cases continued three months or longer.

The research was scheduled for presentation at 1 p.m. Saturday, May 14, at the American Psychiatric Association 164th Annual Meeting, which runs May 14-18 at the Hawaii Convention Center in Honolulu.

Electronic Patient Records used to help Identify Biological Causality

Research demonstrating the use of data mining of electronic patient records to study co-morbidity, family predisposition, and finding biological causes for medical conditions otherwise hidden to the eye will be presented at the APA Annual Meeting in Honolulu.

The APA’s 164th Annual Meeting, the world’s largest psychiatric meeting, will run Saturday, May 14 to Wednesday, May 18, 2010 at the Hawaii Convention Center in Honolulu.

The study looked at 10 years of records from Mental Health Centre Sct. Hans, a regional psychiatric hospital in Denmark, on 3,290 patients’ records involving 674 different diagnoses. Of the assigned diagnoses 24% were mental and behavioral disorders. Researchers identified about 270 co-morbidities as unexpected with no know relation. These unexpected co-morbidities were further analyzed to examine whether the co-morbidity could be explained by shared genes, gene-complex, or biological pathways.

For one of these, researchers discovered a previously unrecognized shared biology underlying the two clinical conditions which can be interpreted as a shared genetic predisposition to side effects or to an autoimmune condition.
The new research posters (#NR02-60) were scheduled for presentation Saturday, May 14, at the Hawaii Convention Center.

Gaming, Internet Have Negative Impact on Teen Sleep


Gaming and Internet activity are more likely to have a negative impact on self-reported teen sleep duration than watching television, according to a study presented at the American Psychiatric Association Annual Meeting.

The research was scheduled for presentation Saturday, May 14, at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18.

Researchers analyzed data about media usage and physical activity from the 2009 Youth Risk Behavioral Survey maintained by the Centers for Disease Control. The researchers found different types of media exposure have different impact on self-reported teen sleep patterns. Gaming and Internet usage negatively impacted reported sleep time, while television had no impact, and physical activity improved sleep time.

Details of this study, along with five other new research presentations, will be addressed at a press briefing from the APA Annual Meeting. Members of the media can attend in Room 307 of the Hawaii Convention Center at 8 am Hawaii time, Monday, May 16, or participate online at 11 AM PDT/2 pm EDT by registering at https://www2.gotomeeting.com/register/341505819.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at http://www.psych.org/ and http://www.healthyminds.org/.

Placebo Treatment: Informed Consent not to be Informed

Research examining attitude about use of placebos found people very willing to accept the use of placebos for first line treatment of depression and for other medical conditions. The research will be presented at the Annual Meeting of the American Psychiatric Association in Honolulu, Hawaii on May 14.


Researchers led by Uri Nitzan, M.D., used a cross sectional survey to investigate whether subjects suffering from medical conditions in general and depression in particular would consent to receive placebo, and whether receiving placebo would negatively affect their autonomy or doctor patient relationship.

Study participants, 344 college, medical and law school students from Israel, were provided a thorough explanation about the placebo effect and its efficacy and limitations in the treatment of depression and then completed a self report questionnaire.

Seventy percent of study participants expressed consent to receive placebo as a first line treatment if they were they to suffer from depression in the future and 73 percent consented to receive placebo treatment for other medical conditions. Nearly 90 percent did not consider a physician administering a placebo deceitful, nor the act of prescribing it a deceit.

The researchers concluded that “despite the declared disapproval of placebo treatments by the medical establishment, the majority of our study population was willing to use placebo medication in general, and as first line treatment for depression in particular.” The authors invite physicians to rethink and discuss the legitimacy of administering placebos in clinical practice.

The study (NR01 44) will be part of the new research poster session scheduled for May 14, 10 to 11:30 a.m., in room Kamehameha Hall 3, Level 1 (adjacent to the exhibits) in the Hawaii Convention Center at the APA Annual Meeting in Honolulu.

The APA’s 16th Annual Meeting, the world’s largest psychiatric meeting, will run Saturday, May 14 to Wednesday, May 18, 2010 in Honolulu.

Friday, May 13, 2011

Traumatic Brain Injury in Student Athletes Among Topcs Address by Sports Psychiatrists at APA

By Claudia L. Reardon, MD

The International Society for Sport Psychiatry (ISSP) has a full line-up of events to satisfy those with dual interests in sport and psychiatry and the intersections between the two. These ISSP events are open to all Annual Meeting registrants:
Saturday, May 14, 2-5 p.m.: ISSP Scientific Session, South Pacific I/II, Mid-Pacific Conference Center, Hilton Hawaiian Village. Come to hear the latest and greatest in sport psychiatry. Topics to be presented include: concussion management in sport psychiatry (Eric Morse, MD), Ta Kwon Do combined with group therapy (David Conant-Norville, MD), and psychiatric medication use by athletes (Claudia Reardon, MD).

Sunday, May 15, 12-3 p.m.: ISSP Symposium on the hot topic of “Traumatic Brain Injury in the Athlete: Psychiatric Implications”, 319 A/B, Convention Center. The Symposium will be moderated by ISSP Board Member Toni Baum, MD. Speakers include David Baron, DO (concussion in sports and experience with the NFL), William Tsushima, PhD and Vincent Tsushima, PhD (father/son team of Hawaiian neuropsychologist speaking on the use of a computerized neuropsychological test battery for the evaluation of concussions in Hawaii high school athletes), Ira Glick, MD and Claudia Reardon, MD (the role of the sport psychiatrist in concussion management), and Brandon Cornejo, MD, PhD (an athlete-psychiatrist’s personal experience with traumatic head injury).

For more information on the ISSP, check out the group’s website at www.theissp.com or join their Facebook page.
Dr. Reardon is a Board Member, International Society for Sport Psychiatry and APA Member Expert in Sport Psychiatry.