Schizophrenia/Psychosis

Evaluations of new drugs, new dosage formulations and new applications for currently approved drugs were a substantial portion of the scientific program at the 40th annual NCDEU meeting, which is sponsored by the National Institute of Mental Health.

(The following are highlights of new research presented at the 2000 American Psychiatric Association Annual Meeting. Additional highlights can be found in "APA Meeting Highlights New Research," in the February issue of Psychiatric Times, p23-Ed.)

Because there is intense pressure by managed care to shorten the hospital stay for patients with anorexia nervosa, there is a need for partial-hospitalization treatment programs. Since patients gain an average of 0.5 lbs/week to 1.5 lbs/week in these less-monitored programs, as opposed to 2 lbs/week to 3 lbs/week in the inpatient behavioral specialty programs, Angela S. Guarda, M.D., and colleagues (Symposium 21B) described components that would improve the partial treatment program.

On Dec. 15, 2000, Glen O. Gabbard, M.D.; Paul Gray, M.D.; Arnold Richards, M.D.; and Arthur Valenstein, M.D., were presented with the Mary S. Sigourney Award for their outstanding contributions to psychoanalysis. This award recognizes past significant contributions to the field of psychoanalysis and is presented in the United States, Europe and the rest of the world on a rotating three-year cycle.

Smoking is not only a comorbid condition for schizophrenia; it may also have an effect on other psychiatric conditions.

Despite assertions by the manufacturers of generic clozapine that their products are equivalent to Clozapine, two new studies presented at the 2000 APA meeting have raised questions about the drugs' assessment ratings.

Results from the 1999 National Household Survey on Drug Abuse show significant increases in rates of prescription drug abuse. Other surveys show similar findings. An overview of the most commonly abused drugs and suggestions for preventing abuse are reviewed.

More patients are reaching the old-old demographic-those age 75 and above-with psychiatric conditions such as treatment-resistant depression. Research has shown that with some careful screening and precautions, ECT is a safe, effective treatment option for these patients.

Known as "the cancer of mental illness," schizophrenia can core a life, robbing a previously well-functioning person of what made the person uniquely them.

As previously discussed, new research has made us look much more closely at the influence of religion and spirituality on overall health. Now more than 30 psychiatric residencies including Harvard, Baylor, and Georgetown provide focused training on addressing patients' religious/spiritual beliefs.

Between 50% and 80% of people with mental disorders smoke cigarettes. Are the tobacco companies targeting this population, and are mental health care facilities promoting the use of tobacco? What are psychiatrists' responsibilities in the overall health of their patient?

Intrigued by preliminary research indicating that omega-3 polyunsaturated fatty acids found in fish, fish oil and flaxseed may ameliorate symptoms in bipolar disorder (BD), schizophrenia and other psychiatric disorders, investigators have launched a series of double-blind trials evaluating fatty acids as adjunctive treatment. This article will discuss studies on bipolar disorder.

The methodology of clinical trials was as much of interest as the trial results for investigators gathered at the 39th annual NCDEU (New Clinical Drug Evaluation Unit) Program meeting. This meeting was conducted in June by the National Institute of Mental Health in Boca Raton, Fla.

With the stroke of a pen, California's governor, Gray Davis, approved legislation in September that will soon bring insurance coverage to 25 million individuals suffering from severe mental illnesses. Part of a major overhaul of the state's health insurance laws, when the parity bill becomes effective in July 2000, it will require that insurance companies provide co-payments, deductibles and lifetime benefits equivalent to those for other illnesses, along with reimbursements for partial hospital stays and outpatient and inpatient services.

In the early 1960s, the Internet was born out of the idea of a "Galactic Network." By the late 1980s, technology had advanced to allow for computer-based exchange of scientific information between academic and research institutes. From these humble beginnings, the Internet has experienced explosive growth in the last five years, evolving into a powerful global information resource and new media format unto itself. Psychiatrists can now reap the full benefit of this fast-paced evolution to extend the reach of their medical practice.

The methodology of clinical trials was as much of interest as the trial results for investigators gathered at the 39th annual NCDEU (New Clinical Drug Evaluation Unit) Program meeting. This meeting was conducted in June by the National Institute of Mental Health in Boca Raton, Fla.

Present-day psychiatry has fallen into crisis because of the severe limitations of its conception of the person and, as a result, its conception of the patient. It objectifies the patient in a number of ways. Because of this reductionism, psychiatry fails to distinguish between healthy and pathological features of human life. It fails to consider adequately the psychological and social factors that cause and maintain each patient's problems.

More than 430 psychiatrists, research donors and others gathered in late October for the National Alliance for Research on Schizophrenia and Depression (NARSAD)'s awards dinner in New York City. The black-tie fundraising event was held in conjunction with the organization's 10th annual scientific symposium at which 15 selected NARSAD grantees presented their ongoing research over two days of sessions devoted to basic science, schizophrenia and depression.

Schizophrenic patients treated with olanzapine (Zyprexa) required less health care services and incurred less overall health care costs over a 28-week period than patients treated with risperidone (Risperdal). This was the result of a study presented by Eli Lilly and Company researchers at the European College of Neuropsychopharmacology meeting held in Paris from Oct. 31, 1998 to Nov. 4, 1998.

Other Hormones on Behavior - Poetry of the Times

One day after Eli Lilly and Company researchers reported finding olanzapine (Zyprexa) superior to risperidone (Risperdal) on some measures in a 28-week comparative study presented to the American College of Neuropsychopharmacology (ACNP) meeting in 1996, Janssen Pharmaceutica Inc. issued a press statement critical of the methodology and results of the study. Janssen then announced it would undertake its own comparative trial. The results of this trial's initial eight-week acute treatment phase were presented at the European College of Neuro-psychopharmacology meeting held Oct. 31, 1998, through Nov. 4, 1998, in Paris. They indicate risperidone has an advantage for positive symptoms such as hallucinations and delusions, and for anxiety/depression in patients with schizophrenia and schizo-affective disorder.

Tina, a 35-year-old legal secretary, is admitted to the hospital hearing voices that demand she gouge out her own eyes as punishment for having lived a sinful life. She was seen in the local emergency room prior to admission, both for involuntary certification and treatment for corneal damage from having attempted to harm herself. She states to the admitting psychiatrist, "If thine eye offend thee, pluck it out!"

Recent advances in the treatment of mental and addictive disorders, along with research findings in basic neuroscience, molecular genetics and molecular biology that contribute to the understanding of such disorders, were discussed at the American College of Neuropsychopharmacology's 37th annual meeting in Puerto Rico. The following are brief reports from selected presentations.

More than 80 medications are in development to treat mental illnesses, including 18 for depression, 15 for schizophrenia and 16 for anxiety disorders, according to the Pharmaceutical Researchers and Manufacturers of America (1998). Which ones will most likely come to market in the United States?

Myron Liptzin, M.D., is a respected psychiatrist who specialized in the treatment of university students. Liptzin retired last year as chief of psychiatry of student health at the University of North Carolina at Chapel Hill, where he had earned a reputation as a skillful clinician who was particularly adept at crisis intervention. If Liptzin had hoped to go on to a less hectic and stressful life, his expectations were shattered when he found himself accused of negligence in one of the most unusual cases of psychiatric malpractice of this century. A former patient went on a rampage-killing two people-and then blamed Liptzin. The verdict against the psychiatrist was front-page news, and CBS's "60 Minutes" went to North Carolina to do a story that aired mid-November 1998. Like a bolt out of the blue, Liptzin had gotten his 15 minutes of unwanted fame.

It is more cost-effective for psychiatrists to provide medication and psychotherapy to depressed patients than it is to split treatment between medical doctors and other mental health care providers

Aware that there is a "rush to hold all providers delivering mental health and chemical dependency services accountable for the accessibility, quality and satisfaction of such services," the American Managed Behavioral Healthcare Association (AMBHA) recently released the second version of its Performance Measures for Managed Behavioral Healthcare Programs (PERMS 2.0).

In Western psychiatry, depression is considered a major cause of suicide. But research from China calls that assumption into question. More than 300,000 suicides occur annually in China, nearly 10 times the number of suicides in the United States.

Verdicts in separate malpractice cases have heightened apprehension over the erosion of patient-physician confidentiality and the increase in malpractice liability exposure. Psychiatrists now face the more serious prospect that they could end up, in essence, having to guarantee society that their patients won't act dangerously.

Insufficient intake of essential fatty acids (EFAs) may contribute to the pathogenesis of mental diseases, while their supplementation may relieve some symptoms, according to researchers who attended the National Institutes of Health (NIH) Workshop on Omega-3 Essential Fatty Acids and Psychiatric Disorders held in Bethesda, Md., in September 1998.