Childhood Sexual Abuse Strong Predictor of Future Psychosis

Sexual abuse in childhood is a strong predictor of schizophrenia in later life, according to new research presented here at the International Congress of the Royal College of Psychiatrists 2011 and published in the July issue of the British Journal of Psychiatry.

Sexual abuse is a contributing cause of 17% of cases of psychotic illness, including schizophrenia, said lead study author Paul Bebbington, MD, emeritus professor of social and community psychiatry at University College London, United Kingdom.

“Sexual abuse appears likely to have considerable and lasting negative effects on individuals’ views of themselves, particularly in relation to other people, and this in turn seems likely to parallel cognitions in schizophrenia,” Dr. Bebbington told Medscape Medical News.

“Thus, at the psychological level, the association is plausibly causal, and at the moment we lack good evidence about what causes schizophrenia,” he added.

Dr. Bebbington said he has been interested in social factors affecting schizophrenia and psychosis for a long time. He also worked in a women’s prison for 6 years.

“This provided everyday clinical experience of the effects of sexual abuse, which was very common, and commonly associated with persistent auditory hallucinosis,” he said.

This long-standing interest prompted the current study. Dr. Bebbington and colleague used data from the Adult Psychiatric Morbidity Survey 2007, a representative cross-sectional sample that included 7353 adults in England….

Reported by Fran Lowry
Medscape Medical News

NIMH Outreach Partnership Program Update for July 1, 2011

The Outreach Partnership Program is a nationwide outreach initiative of the National Institute of Mental Health (NIMH) that enlists state and national organizations in a partnership to help close the gap between mental health research and clinical practice, inform the public about mental illnesses, and reduce the stigma and discrimination associated with mental illness. For more information about the program please visit: To subscribe to receive the Update every two weeks, go to:


Nationwide Recruitment: Bipolar Disorder Genetics: A Collaborative Study

Individuals who have been diagnosed with bipolar disorder may be eligible to participate in a research study at the NIH clinical Center in Bethesda, MD. The purpose of this study is to identify genes that may contribute to the development of bipolar disorder (manic depression), and related conditions. Bipolar disorder is a common and potentially life-threatening mood disorder. The tendency to develop bipolar disorder can be inherited, but this is poorly understood and probably involves multiple genes. This study will use genetic markers to map and identify genes that contribute to the illness.

Families and individuals who have the disorder are asked to contribute their personal information and a blood sample to an anonymous national database. This information will aid scientists around the world who are working together to develop better treatments for this serious mood disorder.

For more information about this study, please call 1-866-644-4363 or email us at

For more information on research conducted by the National Institute of Mental Health in Bethesda, MD click here

Outreach Partnership Program 2011 Annual Meeting: Overview

In late March 2011, nearly 90 researchers, clinicians, and national, state, and territorial nonprofit mental health organizations met in Houston, Texas for the annual meeting of the National Institute of Mental Health (NIMH) Outreach Partnership Program. Outreach Partners representing nearly all 50 United States—some hailing from as far as Alaska and Hawaii—came together to learn more about the latest scientific research and best practices in the prevention, pre-emption, and treatment of mental disorders. The Outreach Partners had the opportunity to network with each other and to learn about potential collaborations.

The meeting offered 15 plenary sessions highlighting cutting-edge research on a variety of relevant topics, including the needs of returning veterans, how to understand and respond to suicide and suicide risk, depression during early childhood and adolescence, novel interventions for at-risk youth, and the role of culture and context in mental health. Networking opportunities included an afternoon poster session, two working lunches examining mental health disparities and opportunities for change, and three concurrent break-out sessions. These sessions allowed Outreach Partners to learn about best practices and lessons learned from others who have experience in areas such as military and veteran outreach, faith community outreach, and youth mental health issues.

Here is a sampling of what attending Outreach Partners had to say about these networking activities:

Dennis Pilgrim, Southeast Alaska Regional Health Consortium: “This being my first time at the meeting. I am absolutely impressed with the amount of research going on. A lot of it was relevant and the type of thing I want to pass on to my colleagues during the tele-behavioral health seminars I organize.”

Jacque Gray, Center for Rural Health at the University of North Dakota: “I was grateful for all of the opportunities to find out what was going on in other areas—especially those that might apply to our area that we didn’t know about before. There’s so much good, cutting-edge information here and I got a lot of ideas of how to take it back to North Dakota and get it out to the providers that need it.”

Melissa Pearson, Association for Children’s Mental Health in Michigan: “The big take-away for me was the need to partner, collaborate, and connect all the dots. There are a lot of people doing great things—but they may be targeting one area, we’re targeting another, and we could each fill some gaps. But if we don’t know what the other is doing, we can’t support each other.”

On the final day of the meeting, NIMH Director Thomas Insel, M.D., addressed the Outreach Partners, offering his insights on promising ongoing research projects, as well new initiatives in which NIMH is participating. Dr. Insel emphasized that the meeting was a chance for NIMH and its Outreach Partners to engage in much-needed dialogue. He stated that the meeting is an opportunity for NIMH to inform the Outreach Partners about the Institute’s most recent scientific efforts, and to connect them with researchers who may be recruiting for clinical trials or are interested in working jointly on dissemination efforts. Dr. Insel also stressed that the meeting “…gives us at the NIMH the opportunity to hear from across the 50 States what our partners are looking for in terms of research, what they are facing in their communities in terms of immediate needs, and also listening to their questions about what kinds of things they are hoping this research will be able to provide. Truly, it’s invaluable.”

by NIMH Outreach Partnership Program

Consumer Medication Information: One Page Fits All

The topic is consumer medication information (CMI). A new report from the American Medical
Association (AMA) Council on Science and Public Health reminds us why it’s important for patients to take medications as
prescribed. Here’s why it matters.
Posted: 06/22/2011
• Nearly 75% of Americans admit they don’t always take the medications they’re prescribed;
• 33% of prescriptions go unfilled;
• About $0.75 of every US healthcare dollar is spent treating chronic diseases; and
• Only 50%-65% of patients take medications as prescribed.
Noncompliance leads to greater health concerns, both physically and fiscally:
• Noncompliant patients are more likely to be hospitalized;
• They’re more likely to die;
• And while they live they have almost twice the annual health cost compared with people who adhere to their medication regimen.

Not taking medications as prescribed means medication-related hospital admissions, which cost an estimated 100 billion dollars each year. All in all, this totals additional healthcare costs of nearly 300 billion dollars each year. That’s 13% of total health expenditures.

One possible explanation of this lack of compliance is lack of information, thus patients misunderstand the importance of taking medications as prescribed. So the AMA Council on Science and Public Health took a closer look at the types of CMI currently available.

The concept of CMI began in 1968 when the FDA first required patient package inserts (PPIs). In the 1970s, the FDA shifted its focus to patient labeling. The 1990s saw FDA-approved medication guides (Med Guides) for some high-risk drugs. Then congress stepped in and passed legislation with caveats and goals that became the action plan for the provision of useful prescription medication information. By the year 2000, 75% of people receiving new prescriptions were to get useful
information. By 2006, this percentage was to increase to 95%. The law required the Department of Health and Human Services to review initiatives to meet these goals.

Unfortunately, the FDA reports that current consumer information processes have failed. Although patients got information 94% of the time, only 75% of that information was deemed useful. This required an FDA overhaul of the current system for CMI.

In 2008, a citizen petition submitted to the FDA called for adoption of a one-document solution to replace the plethora of CMI, PPI, and Med Guides. Providing information to patients in a forum that’s concise, balanced, and understandable should improve medication adherence but such materials must be based on user testing. The AMA supports single-document CMI. It should be easily accessible and also available in electronic formats. Easy access to these tools should help enhance medication understanding and adherence. It should also provide patients with the information they need to use medications safely and effectively, but even the best information won’t help if people can’t afford to buy their medications in the first place.

By Sandra A. Fryhofer, MD
Medscape Internal Medicine

Newton, Einstein, and a Gaggle of Writers: Linking Creativity With Mental Illness

Editor’s Note: As the third in a 3-part series on highlights from the 2011 Annual Meeting of the American Psychiatric Association in Honolulu, Hawaii, below Dr. Michael Compton explores the connection between mental illness and genius and creativity.

Mental Illness and Creativity: Introduction

In Lecture 24, on Tuesday, May 17, Dr. Nancy C. Andreasen (Andrew H. Woods Chair of Psychiatry at the University of Iowa Carver College of Medicine) spoke on “A Journey into Chaos: Creativity and the Unconscious.”[1] In this presentation on the connection between genius/creativity and mental illness, she spoke about having interviewed the renowned playwright Neil Simon, who indicated that he “slipped into a state that is apart from reality” during his most productive and creative periods. He also said “I don’t write consciously–it is as if the muse sits on my shoulder.”

Similar examples of the creative process have come from other forms of art (eg, Mozart, who saw his music as a 3-dimensional matrix), as well as from science and mathematics, such as Henri Poincaré. These observations have clearly influenced Dr. Andreasen’s work……

By Michael T. Compton, MD, MPH
Medscape Psychiatry

Typology of Adults Diagnosed with Mental Disorders Based on Socio-demographics and Clinical and Service Use Characteristics


Background: Mental disorder is a leading cause of morbidity worldwide. Its cost and negative impact on productivity are substantial. Consequently, improving mental health-care system efficiency – especially service utilisation – is a priority. Few studies have explored the use of services by specific subgroups of persons with mental disorder; a better understanding of these individuals is key to improving service planning. This study develops a typology of individuals, diagnosed with mental disorder in a 12-month period, based on their individual characteristics and use of services within a Canadian urban catchment area of 258,000 persons served by a psychiatric hospital.
Methods: From among the 2,443 people who took part in the survey, 406 (17%) experienced at least one episode of mental disorder (as per the Composite International Diagnostic Interview (CIDI)) in the 12 months pre-interview. These individuals were selected for cluster analysis.
Results: Analysis yielded four user clusters: people who experienced mainly anxiety disorder; depressive disorder; alcohol and/or drug disorder; and multiple mental and dependence disorder. Two clusters were more closely associated with females and anxiety or depressive disorders. In the two other clusters, males were over-represented compared with the sample as a whole, namely, substance abuses with or without concomitant mental disorder. Clusters with the greatest number of mental disorders per subject used a greater number of mental health-care services. Conversely, clusters associated exclusively with dependence disorders used few services.
Conclusion: The study found considerable heterogeneity among socio-demographic characteristics, number of disorders, and number of health-care services used by individuals with mental or dependence disorders. Cluster analysis revealed important differences in service use with regard to gender and age. It reinforces the relevance of developing targeted programs for subgroups of individuals with mental and/or dependence disorders. Strategies aimed at changing low service users’ attitude (youths and males) or instituting specialised programs for that particular clientele should be promoted. Finally, as concomitant disorders are frequent among individuals with mental disorder, psychological services and/or addiction programs must be prioritised as components of integrated services when planning treatment.

By Marie-Josée Fleury; Guy Grenier; Jean-Marie Bamvita; Michel Perreault; Jean-Caron
BMC Psychiatry

Target for Smoking Cessation and Weight Control Identified

New research in mice has revealed a brain mechanism that could lead to novel treatments for smoking cessation and obesity.

In various experiments, scientists found that nicotine decreases food intake and body weight in mice by influencing the hypothalamic melanocortin system, an essential brain pathway involved in regulating energy balance and food intake.

“We found that nicotine reduced eating and body fat through receptors implicated in nicotine aversion and withdrawal rather than reward and reinforcement,” senior author Marina Picciotto, PhD, from Yale University School of Medicine in New Haven, Connecticut, said in a statement.

The research is published in the June 10 issue of Science.

It is well-known that smoking suppresses appetite. Smokers are often thinner than nonsmokers and often gain weight when they quit smoking, which may keep some smokers from attempting to kick the habit.

Until now, little was known about the potential central nervous system pathways responsible for nicotine’s effects on appetite and weight. ……

By Megan Brooks
Medscape Medical News

Clozapine Rarely Prescribed for Refractory Schizophrenia

Clozapine, an effective antipsychotic medication for treatment-resistant schizophrenia, is not being prescribed as often as it should be, researchers reported here at the New Clinical Drug Evaluation Unit (NCDEU) 51st Annual Meeting, sponsored by the American Society of Clinical Psychopharmacology.

“Study after study shows clozapine, which is the first of the second-generation antipsychotics, to be the most effective antipsychotic out there, but it’s hardly being used,” Susan M. Essock, PhD, from the New York State Psychiatric Institute and Columbia University, New York, New York, told Medscape Medical News at a poster session……

By Fran Lowry
Medscape Medical News