Thursday, October 1, 2009
QD: News Every Day
ACP Internist's daily digest of primary care in the news continues with legislative jockeying for health care reform, public rejection of flu vaccination and primary care's dominance of mental health prescribing.
Health care reform
Legislation proceeds apace, with congressional members jockeying and pushing for the House and Senate bills to reach their respective chambers by mid-month. Abortion restrictions were defeated, as were other provisions. But there are many hurdles to clear as legislators threaten to cancel the Columbus Day break to get the legislation finished by either Thanksgiving or the end of the year.
Meanwhile, former Senate Majority Leader Tom Daschle said lawmakers were “flummoxed” when attempting to craft specific reform legislation, so Gary R. Gibson, FACP, has created an algorithm to help them understand it.
Flu prevention
Consumer Reports says only a third of Americans plan to get the H1N1 vaccine. More than half of adults with risk factors don't know what complications the flu could cause. They're worried about risks from the vaccine itself, or they're not confident of its efficacy. Or, they just don't think they'll get the flu.
In an NEJM perspective, authors say there's a pressing need for research into whether N95 masks work better or worse than surgical masks to prevent spreading the flu. So JAMA obliged with a study finding that surgical masks work just as well. An accompanying editorial notes that other preventive measures, such as vaccinating health care workers and hand washing, are critical but overlooked.
In case you missed it:
Mental health issues affect 1 in 4 Americans, 1 in 17 severely. Mostly, they go to their primary care clinicians for help, says the Agency for Healthcare Research and Quality.
Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, reports Researchers from Thomson Reuters and the U.S. Substance Abuse and Mental Health Services Administration. They examined 472 million prescriptions written for psychotropic drugs from August 2006 and July 2007 and found general practitioners prescribed 62 percent of antidepressants and 52 percent of stimulants, mainly drugs for treating attention deficit hyperactivity disorder.
Labels: flu, H1N1, health care reform, mental health, mental illness, QD
posted by Ryan DuBosar at
12:54 PM
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Thursday, November 13, 2008
Are we reinforcing your obsession with internal medicine?
Perhaps you've already noticed this, but the internet is bringing crazy people together in all new ways, a group of psychologists have found.
We recently covered the growth of patient-run medical web sites, where patients can compare notes on evidence and treatments for conditions like MS and AIDS. For the most part, docs seemed skeptical of the concept. But this NY Times article investigates online groups for patients with even more unusual issues. Specifically, people who believe they are being targeted for mind control have gathered on certain web sites to discuss their experiences.
This trend raises all sorts of interesting questions, like whether it's good that these people have found peer support or it's bad that they are getting reinforcement of their delusions. And at what point is their group large enough that you can't call their ideas delusional anymore? According to the APA, if a belief is held by a person's culture or subculture, it is not a delusion (the exception that prevents religion from being categorized as mental illness).
The experts say this mind-control thing is a contemporary version of belief in alien abductions, which by the way, Newsweek recently had a really interesting article about. Did you know that 90% of Americans believe in the paranormal?
Labels: mental illness
posted by Stacey Butterfield at
3:26 PM
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Monday, October 6, 2008
Is JAMA psychic?
Just two days after JAMA ran an article that found long-term psychotherapy works better than short-term for the complex mentally ill, Congress passed (and Pres. Bush signed) a bill that would effectively require many insurers to cover longer-term treatments.
So does JAMA have some sort of psychic on its payroll? (NEJM has already informed us there are psychic cats that can predict when people will die; perhaps JAMA has a psychic hedgehog that predicts the outcome of legislation?)
In all seriousness, this mental health parity legislation-- which was attached to a big bailout bill you may have heard about-- was a long time coming. To be clear, it doesn't tell insurers they must cover mental illness. It just says that if they already offer mental health coverage, it has to be equal to that of other medical coverage. In other words, treat schizophrenia like you would heart disease.
For years, mentally ill patients have paid higher copays and deductibles, and had lower visit limits, than people with other kinds of illness. This makes it difficult for internists to do anything with these patients other than write them a prescription, because doctors know that a referral to psychotherapy means a limited number of sessions-- if any at all. (An issue we addressed in a story about parity last year.)
Medication is useful, but research has shown the best approach for certain disorders, such as severe depression, is medication plus therapy. And the Oct. 1 JAMA study shows it can take quite a bit of that therapy to make a dent in complex disorders like depression and anxiety.
Specifically, the study found that patients who had at least one year or 50 sessions of psychodynamic psychotherapy were better off than 96% patients who had shorter durations of other therapies, including cognitive-behavioral and behavioral therapies. (Psychodynamic therapy focuses on the patient-therapist relationship-- not the same as the Freudian stuff.)
Study author Falk Leichsenring told the Washington Post that the ideal number of sessions varies by patient, but that most patients with acute distress will do well with 25, while those with chronic distress need about 50, and those with personality disorders need about 200.
Until the parity legislation, most insurance plans covered 20-30 sessions per year, at best.
So what do you think? Will you be more likely to refer your mentally ill patients to therapy, once this law kicks in on Jan. 1, 2010 (for most plans)?
Labels: mental health, mental illness, parity
posted by Jessica Berthold at
1:30 PM
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Tuesday, August 12, 2008
Alcohol use and PTSD in veterans
A new JAMA study says that reservists returning from Iraq and Afghanistan are at increased risk of heavy drinking and binge drinking.
The study found, for reservists who had combat exposures:
Rate of new-onset heavy weekly drinking: 8.8%
Rate of new-onset binge drinking: 25.6%
Rate of new-onset alcohol-related problems: 7.1%
New onset rates for active-duty personnel were 6.0%, 26.6%, and 4.8 percent, respectively.
It's quite possible these soldiers are using alcohol to cope with PTSD or other mental illness, the authors said, as there is a well-established link between the two. We'll discuss what internists can do to spot and treat soldiers with PTSD in the upcoming September cover story of ACP Internist.
Till then, do any of our readers want to share their stories of treating vets from the current war? Have you had many vets as patients? What have been the challenges, and how have you dealt with them?
Labels: alcoholism, mental illness, PTSD
posted by Jessica Berthold at
4:00 PM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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- QD: News Every Day--not the intended effect
- Medical news of the obvious
- QD: News Every Day--flu's growing tally
- QD: News Every Day--no holidays for Congress
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