US Military and Mental Health

Attached a link "Branding a Soldier With ‘Personality Disorder" to an article in which the author reports that military commanders pressure clinicians to issue unwarranted psychiatric diagnoses to get rid of troops. In the case described a 50-year old female behavioral health professional was diagnosed suffering from a a personality disorder, a diagnosis that the military has used to discharge thousands of troops. Subsequently, she was sent home.She disputed the diagnosis, but it was not until months later that she found what seemed powerful ammunition buried in her medical file, portions of which she provided to The New York Times. “Her command specifically asks for a diagnosis of a personality disorder,” a document signed by the psychiatrist said. By comparison, a diagnosis of post-traumatic stress disorder is usually linked to military service and leads to a medical discharge accompanied by certain benefits. In recent weeks, questions about whether the Army manipulates psychiatric diagnoses to save money have been raised at Joint Base Lewis-McChord near Tacoma, Wash., where soldiers undergoing medical evaluations before discharge complained that psychiatrists rescinded PTSD diagnoses, leaving the soldiers with diagnoses like personality disorder that did not qualify them for medical discharges. If these ALLEGATIONS are correct then several questions and issues must be addressed: Did military psychiatrist, or those contracted by the military, violate the code of medical ethics? Should the U.S. military order their credentialed medical staff to follow evidence-based diagnostic guidelines before reaching a mental health diagnosis? Shouldn't soldiers have the right for a second-opinion BEFORE facing a potentially dishonorable discharge? Those brave man and women in uniform deserve better treatment. Yours Bernd

Deep Cuts for Mental Health and Substance Abuse Treatment Programs

Attached a link State Senate proposes $87 million cut in mental health, substance-abuse programs to an article titled " State Senate proposes $87 million cut in mental health, substance-abuse programs" reporting that a Florida Senate proposal would make deep cuts in funding for adult mental health and substance-abuse programs, and entirely eliminate support for some of them.The proposal would slash overall state spending on adult mental health and substance-abuse treatment by about 40 percent, or $87 million.The cuts would include eliminating state support for some programs — including, potentially, the Miami Behavioral Health Center and the Northside Mental Health Center in Tampa. Sen. Joe Negron, the Stuart Republican in charge of the Senate’s healthcare budget, stated that “When it comes to funding, an 85-year-old woman in a nursing home matters more to me than a 45-year-old guy with a substance-abuse problem,” he said. “It’s all about priorities.” Unfortunately, his statement reveals that most politicians have yet to understand that mental health and substance abuse treatment represents cost-effective care! The benefits of treatment far outweigh the costs. Even beyond the enormous physical and psychological costs, treatment can save money by diminishing the huge financial consequences imposed on employers and taxpayers. Comparing the direct cost of treatment to monetary benefits to society determined that on average, costs were $1,583 compared to a benefit of $11,487 (a benefit-cost ratio of 7:1)! In comparing cost offsets in Washington State of people in treatment to non-treated, the authors noted lower medical costs ($311/month); lower state hospital expenses ($48/month); lower community psychiatric hospital costs ($16/month); reduced likelihood of arrest by 16%; and reduced likelihood of felony convictions by 34%! It is a penny wise and pound foolish approach to CUT finding for mental health and substance abuse treatment because in the long run we as tax payers have to pay the higher price for short term political decisions. For more information see Cost Offset Substance Abuse. I urge you to e-mail, call or write Senator Negron! Yours Bernd

Ban on Bath Salts

Attached a link http://www.miamiherald.com/2012/02/14/2641748/lawmakers-seek-to-expand-bath.html to an interesting article titled "Lawmakers seek to expand bath-salt ban" reporting that Florida lawmakers want to make it a third-degree felony to manufacture or sell new synthetic drugs which have returned to convenience-store shelves.The drugs – which are marketed as herbal smokes, incense, bath salts, plant food and cleaning products – have been problematic throughout the state. Last year, the Florida Legislature banned several forms of synthetic cathinones, or bath salts, that had become popular among teenagers. Lawmakers also banned synthetic cannabinoids, known informally as K2. The drugs have been known to cause violent hallucinations, paranoia, muscle damage and kidney failure.In Charlotte County, three high-school students were recently hospitalized after overdosing – and a fourth had to be restrained after chasing his father around the house with a machete while hallucinating, Sheriff Bill Cameron said. I wholeheartedly support the measure but we certainly have to play catchup during the next legislative session to respond to new synthetic drugs which are going to be developed by clever chemists. We should brainstorm to develop ideas on how to respond to the synthetic drug challenge. Please feel free to share your suggestions on our blog at http://fsamnews.blogspot.com Yours Bernd

We Are Making Progress

Attached a link http://www.sun-sentinel.com/news/opinion/editorials/os-pain-pills-editorial-0209-20120209,0,3698549.story to an interesting article published in the Sun Sentinel titled "Pill mill law sends 'pillbillies' packing." Indeed, we are making great progress: "In a state that had garnered the humiliating national reputation as the go-to state for Oxycontin, the number of oxycodone pills purchased last year by Florida doctors plunged an astonishing 97 percent. Overall oxycodone sales dropped 20 percent, according to figures from the Drug Enforcement Administration. Didn't hurt that the roster of the top 100 oxycodone-buying doctors shed its overwhelmingly Florida vibe. Two years ago, 90 of the top 100 doctors hailed from Florida; last year, only 13 made the list." But more work needs to be done!! We need to create awareness among our fellow colleagues to sign up for and to use the PDMP in their daily practice of medicine; we need to close loopholes that exempt doctors from using the PDMP which includes ALL physicians employed by the Veteran Administration resulting in a sharp increase of opioid use by VA patients. I also suspect that those patients represent a source for illegal prescription opioid street sales. Furthermore, we must identify those doctors in the community which still prescribe prescription opioids in large amounts contributing to overdose deaths of patients. Even though I believe in educating them about safe prescription practices I also advocate for swift revocation of their licenses to protect the public from their actions. Looking forward to your comments. Yours Bernd

Addiction and Brain Changes

Attached a link Abnormal Brain Structure Implicated in Stimulant Drug Addiction to an interesting article published in a recent edition of Science. The authors report that they discovered abnormalities in fronto-striatal brain systems implicated in self-control in both stimulant-dependent individuals and their biological siblings who have no history of chronic drug abuse; these findings support the idea of an underlying neurocognitive endophenotype for stimulant drug addiction.
Drug dependence is increasingly recognized as a “relapsing brain disorder”and, in support of this view, marked structural changes in striatal and prefrontal brain regions have been reported in people dependent on stimulant drugs . These reports, however, raise the question of whether these brain abnormalities may have predated drug-taking, rendering individuals vulnerable for the development of dependence.
Individuals at risk for drug dependence typically have deficits in self-control, which may reflect a diminished ability to recruit prefrontal networks for regulating behavior. Stimulant drugs are highly reinforcing, because they directly affect brain systems implicated in motivated behavior, such as the basal ganglia and the limbic system, and they modulate control systems in the prefrontal cortex. Malfunction of these circuitries may increase the susceptibility for stimulant-induced neuroadaptive changes and facilitate the development of drug dependence.
In the study they compared brain structure and the ability to regulate behavior in 50 biological sibling pairs; within each pair, one sibling satisfied the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for dependence on stimulant drugs and the other had no history of chronic drug or alcohol abuse. The sib-pairs were also compared with 50 unrelated healthy volunteers matched for age and intelligence quotient.
The findings indicate that gray matter changes in the dorsal striatum, together with abnormal inferior prefrontal cortical connectivity, underlie an increased risk for developing stimulant drug dependence. However, the almost equivalent impairments in SSRT (Stop-Signal Reaction Time) in both the stimulant-dependent individuals and their unaffected siblings need careful interpretation, as they do not reflect the classic pattern for endophenotypes, i.e., that the first-degree relatives have trait values intermediate between the patients and the unrelated healthy volunteers. Presumably, the siblings must have some other resilience factors that counteract the familial vulnerability to drug dependence. The identification of these brain and behavioral biomarkers for familial risk of drug dependence demonstrates that an individual’s predisposition to become addicted to stimulant drugs may be mediated by brain abnormalities linked to impaired self-control.

Stratify Patients for Opioid Misuse and Abuse Risk : Internal Medicine News

Attached a link Stratify Patients for Opioid Misuse and Abuse Risk : Internal Medicine News to an interesting article titled " Stratify Patients for Opioid Misuse and Abuse Risk" to assess which of your patients is likely to misuse or abuse opioid medications.
The risk stratification tool utilized in the article is based on quantitative opioid misuse assessment such as the Opioid Risk Tool (ORT) http://www.opioidrisk.com/node/887
Looking forward to your comments.
Yours
Bernd