Ask Dr. Michael Knable about an Online Guide to Mental Health Apps

To help you decide which of these software apps might best help you or your loved one, there is a new website managed by IMHRO called PsyberGuide rates and profiles a wide range of apps and other software aimed at treating or managing psychiatric illness. In this month’s Brain Waves segment, Dr. Michael Knable, PsyberGuide’s Project Manager, joins us to tell us about its service.

From February 26-28, 2014, Dr. Knable will be available to answer your questions. Watch his interview, then feel free to sign in and ask him what’s on your mind.

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BITs and BYTEs

One of the upsides of so many snowstorms this winter has been the chance to catch up on reading. I’ve been enjoying Erik Brynjolfsson and Andrew McAfee’s book the Second Machine Age about the social revolution instigated by the digital revolution. One story they recount is about the Dutch chess grand master Jan Hein Donner.  When the authors ask Donner how he would prepare for a match with a supercomputer, he replies, “I’d bring a hammer.”

Computers are getting faster at an awesome or alarming rate, depending on your point of view. Brynjolfsson and McAfee, who are both awed and alarmed, describe the exponential rate of progress over the past decade. Quoting Hemingway about how a man goes broke (“gradually and then all of a sudden”), they see a recent sudden burst in progress in technology. Whether in cars that drive themselves, Jeopardy-winning computers, or smartphones with SIRI, technological challenges facing profound obstacles only a decade ago are now milestones in the rear view mirror of progress.

All of this brings to mind how technology will change the diagnosis and treatment of mental disorders. On the diagnostic side, we already have sensors built in to many of our devices—smart phones, computers, appliances—that are constantly capturing data on location, movement, and communication and can help to create real-time pictures of functional status. Activity monitors that can monitor sleep and movement have been around for three decades. Phone sensors can “diagnose” depression from changes in voice quality. Some have suggested that credit card companies may be the first to detect the onset of a manic episode, although that information seems largely neglected. Qualcomm has recently announced a $10 million XPRIZE for a “tricorder”—a 5-pound device that can diagnose 15 diseases non-invasively.  Imagine how technology could provide the sensors to detect signs of mental disorders. This may not win the XPRIZE, but the potential is real.

by Thomas Insel, National Institute of Mental Health (NIMH)

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The Cost of Assisted Outpatient Treatment: Can It Save States Money?

Objective: The authors assessed a state’s net costs for assisted outpatient treatment, a controversial court-ordered program of community-based mental health services designed to improve outcomes for persons with serious mental illness and a history of repeated hospitalizations attributable to nonadherence with outpatient treatment.

Conclusions: Assisted outpatient treat- ment requires a substantial investment of state resources but can reduce overall service costs for persons with serious mental illness. For those who do not qualify for assisted outpatient treatment, voluntary participation in intensive community-based services may also re- duce overall service costs over time, de- pending on characteristics of the target population and local service system.

–Jeffrey W. Swanson, Ph.D., et al.

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You Can Change Schizophrenia’s Name, But the Stigma Will Be the Same

Bill MacPhee, the publisher of SZ Magazine (formerly known as Schizophrenia Digest), has just launched a campaign to change the name of schizophrenia in order to, as he says, “stop stigma.” The name change suggestion is not new, but what is different is his proposal to change the name to MacPhee Syndrome.

Mr. MacPhee argues, “When people hear the word ‘schizophrenia’ they think the worst. They research the word and find the media reference people like James Holmes the Colorado movie shooter or John Hinckley who shot president Reagan.” He goes on to say that when people think of schizophrenia, they never think of someone like him. Mr. MacPhee does have schizophrenia, but he is also the publisher of Magpie Media in Fort Erie, Ont., and a man with a wife and three kids.

by Marvin Ross, Huffington Post

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A New Research Agenda for Suicide Prevention

More than 38,000 Americans died by suicide in 2010, the most recent year for which we have national data. This makes suicide, once again, the tenth leading cause of death for all ages; the second leading cause of death for young adults ages 25 to 34. Despite changes in recent decades that might reasonably have been expected to reduce suicide rates—increased awareness about mental disorders, the availability of treatment, and community-based public health efforts aimed directly at preventing suicide—U.S. rates of suicide deaths have not decreased. In fact, suicide has proven stubbornly difficult to understand, to predict, and to prevent.

This grim reality contrasts with the successes achieved in other areas of medicine and prevention. Death rates from heart disease, cancer, traffic accidents, and homicides are all declining. For heart disease and cancer, research has identified risk factors as well as new pathways to prevention and treatment. Changes in automobile design along with road safety measures have contributed to an ongoing reduction in traffic deaths. Homicides now number less than half the annual total of deaths by suicide in this country.

Why is suicide different? There are a number of public health approaches, from redesigned bridges and buildings to firearm safety, that need the kind of aggressive engineering and policy approaches we have seen with automobile safety. And, learning from heart disease and cancer, we can do better detecting and helping individuals at risk. Despite our best efforts, it remains very difficult to predict who will attempt suicide and, thus, difficult to intervene. The presence of mental illness is a risk factor, but it is not universally present or identified in those who attempt suicide. Treatment can be effective, but too many high-risk individuals are not getting the effective care they need. Suicide remains one of the top five sentinel events (unanticipated events resulting in serious injury or death) for health care systems.2 To reduce suicide, we need to know how to target our efforts: to be able to reliably identify who is at risk, how to reach them, and how to deter them from acting on suicidal thoughts.

In a blog post last September, I talked about a newly updated National Strategy for Suicide Prevention and the research agenda being developed by a task force of the National Action Alliance for Suicide Prevention . This week, the Research Prioritization Task Force (RPTF) released A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives . (pdf)

The stated goal of the Research Agenda is to reduce suicides by 20 percent in five years and 40 percent in the next ten (assuming all recommendations are fully implemented). The Research Agenda bases its recommendations on the impact of currently known interventions and the potential number of suicide attempts and deaths prevented. For instance, it was estimated that in 2010 there were 735 suicides from motor vehicle carbon monoxide inhalation.3 One model illustrated the hypothetical effect of shut-off devices in cars linked to carbon monoxide sensors, a technology that could be inexpensive per vehicle and is currently feasible. The results suggest that installing devices the way we install seat belts could prevent most suicides from carbon monoxide poisoning in automobiles.

What are we doing to jumpstart this agenda? Two new initiatives will focus on priorities of the Research Agenda. First, NIH recently announced  funding opportunities calling for research on violence with particular focus on firearm violence. This call for proposals was developed in response to the Presidential memorandum  in January 2013 directing science agencies within the U.S. Department of Health and Human Services to fund research into the causes of firearm violence and ways to prevent it. The resulting research will help us understand the risk factors for firearm violence and prevention opportunities, directed at self as well as others.

In 2010, suicide was the third leading cause of death for adolescents. It remains a challenge to predict individual risk, and once a young person screens positive for suicide risk, there are few, if any, strategies to guide matching of individuals to the appropriate intervention. As a second initiative, NIMH released a request for applications  to support research that addresses both issues: developing and testing screening approaches for use in emergency departments (EDs) to identify children and adolescents at risk for suicide; and developing methods to help assign youth who screen positive to appropriate interventions. Given the numbers of young people who may be at risk, and the high number of them who visit the ED, developing effective screening and assessment approaches to gauge the level of risk can give providers the tools they need to better use limited resources.

A friend who lost his son to suicide told me that every suicide has at least 11 victims: the person who dies and at least ten others who will never be the same. This is a problem that sooner or later, unfortunately, touches us all. Developing the Research Agenda was a 3-year effort by the RPTF, chaired by Phillip Satow, chair of the board at the Jed Foundation , and myself. The RPTF called on more than 60 national and international research experts and more than 700 individuals representing stakeholders in this research to identify priorities. We believe the Research Agenda gives us a roadmap to save lives.

by Thomas Insel, NIMH

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Wed. Feb 26th: Healthy People 2020 Webinar

Healthy People 2020In 2010, the U.S. Department of Health and Human Services (DHHS) launched Healthy People 2020, which provides science-based, 10-year national objectives for improving the health of Americans. The overarching goals are to:

  • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
  • Achieve health equity, eliminate disparities, and improve the health of all groups.
  • Create social and physical environments that promote good health for all.
  • Promote quality of life, healthy development, and healthy behaviors across all life stages.

Health and Human Services logo

Healthy People 2020 covers 42 public health areas. The National Institute of Mental Health (NIMH) contributes to the objectives related to mental health and mental disorders .

Please join us on Wednesday, February 26, 2014, from 12:30 to 2:00 pm ET for a Healthy People 2020 Progress Review Webinar on “Substance Use and Mental Disorders: Early Detection, Prevention, and Treatment.” NIMH Deputy Director Philip Wang, M.D., Dr.P.H. will present on the state of science for mental health and mental disorders, with a focus on NIMH efforts related to suicide prevention and early detection of serious mental illness, including schizophrenia and related disorders.

The webinar will also feature Howard Koh, M.D., M.P.H., Assistant Secretary for Health, DHHS, and presenters from other federal agencies including the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

More Info and Registration

One-Third of Female Inmates Appear to Meet Criteria for Serious Mental Illness, Study Shows

Almost 1 in 3 incarcerated women meet criteria for past-year serious mental illness, and almost half of this group have severe functional impairment, according to the new study.

“The prevalence of serious mental illness and its co-occurrence with substance use disorders and PTSD in this multisite sample suggest the critical need for comprehensive assessment of mental health at the point of women’s entry into the criminal justice system and the necessity for more programs that offer alternatives to incarceration and that can address the complexity of female offenders’ treatment need,” the researchers said.

–Psychiatric News Alert

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The Mood Patient-Powered Research Network

The mission of the Mood-PPRN is to improve the lives of people with mood disorders through patient centered comparative effectiveness research that identifies the most effective interventions.  The Mood Patient-Powered Research Network (“Mood-PPRN”) seeks to create a network of over 50,000 patients with mood disorders.  We are currently in the process of building the Mood-PPRN website.  Anyone interested in joining the network, please have them email Leah Shesler at We will contact everyone once the website is completed about how to join.

A Prioritized Research Agenda: An Action Plan to Save Lives

In February 2014, the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force (RPTF) released A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives, which outlines the research areas that show the most promise in helping to reduce the rates of suicide attempts and deaths in the next 5-10 years, if optimally implemented. As a companion piece to the Prioritized Research Agenda, the RPTF also developed a Suicide Research Prioritization Plan of Action, which outlines the research pathways and short- and long-term objectives presented in the full Prioritized Research Agenda. These documents are available for download here.

We hope this will help to move the suicide prevention research field forward and to save lives!

Research Prioritization Task Force

National Action Alliance for Suicide Prevention

Childhood Infection May Increase Risk for Psychosis In Adulthood, Study Suggests

Findings from a study published in Schizophrenia Bulletin suggest that hospital admission for infections during childhood may put individuals at risk for the onset of a nonaffective mental disorder, such as schizophrenia.

Researchers also found that bacterial infection and infection of the central nervous system during the preadolescent years (ages 10 to 13) further increased the risk for developing nonaffective psychosis in adulthood.

–Psychiatric News Alert

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