1 in 5 Americans Had Mental Illness in 12-Month Period - MedPage Today

About 20% of American adults reported having had a mental illness during the preceding year, a government survey found.

The figure rose to almost 30% of those in the 18 to 25 age group, compared with 14.3% of patients 50 and older, according to researchers from the Substance Abuse and Mental Health Services Administration (SAMHSA).

And of the nearly 46 million U.S. adults who reported having had a mental, behavioral, or emotional disorder when surveyed in 2010, some 60% didn't receive any treatment for the condition.

The most common reason for not getting mental healthcare was not being able to afford it.

The researchers noted that although the 20% figure is "relatively high," just 5% reported having serious issues that interfered with their normal activities.

Although more of those with serious mental illness reported receiving treatment, a large proportion -- 39% -- didn't receive any mental health services.

The unemployed, Medicaid beneficiaries, and those living below the poverty level were more likely to have mental illness in the preceding year, as were younger patients. Women appeared to be at greater risk than men (23% versus 16.8%).

Substance use disorders were more common among those with mental illness than among those reporting no disorders (20% versus 6.1%), and the prevalence was even higher among patients with serious mental illness (25.2%).

The findings emphasize the need for mental health treatment specialists to address substance use disorders, and to more extensively integrate mental health and substance use treatment centers, the researchers wrote.

They also reported that many Americans had seriously contemplated suicide over the preceding year (8.7 million), and 2.5 million had actually made suicide plans. Just over a million patients had attempted it.

Signs of mental illness were also seen in American youth, with 8% of 12-to-17-year-olds reporting a major depressive episode -- being in a depressed mood for at least two weeks -- in the preceding year.

Children and adolescents who reported feeling this way were more likely to use drugs than those who didn't have a depressive episode (37.2% versus 17.8%), they found.

The researchers called for screening kids who've had a major depressive episode for substance use disorders.

The data come from SAMHSA's National Survey on Drug Use and Health 2010.

In a statement, SAMHSA administrator Pamela Hyde warned that mental illness is often concurrent with cardiovascular disease, diabetes, and obesity, and that "treatment of the mental illness can reduce the effects of these disorders

http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/30776

Changing Autism Definition Raises Questions - The Slatest

A new study suggests that many of those on the higher-functioning end of the autism spectrum may no longer meet the criteria for a diagnosis if a new definition makes its way into the Diagnostic and Statistical Manual of Mental Disorders (DSM), the book considered to be the standard reference for mental disorders.

The New York Times looked into both the study, which found that only 45 percent of those diagnosed with higher-functioning forms of autism might meet the new criteria, and the proposed changes to the definition.

The study is authored by Dr. Fred R. Volkmar, who resigned from the panel of experts currently working on the autism defintion. He and the panelists seem to strongly disagree on the purpose and effect of redefining autism.

Essentially, the American Psychiatric Association has appointed a panel to create a new edition of the DSM (which is long overdue; it's been 17 years since the current edition was created), and in re-defining autism, experts are trying to contend with the skyrocketing rate of diagnosis for autism and similar disorders like Asperger syndrome and "pervasive developmental disorder, not otherwise specified," abbreviated to P.D.D.-N.O.S by those in the know. They're doing this by combining all three categories of diagnosis under "autism spectrum disorder," and by narrowing the criteria that must be met for a diagnosis.

The new definition, the panel says, will provide clarity to diagnosing a disorder that badly needs it. While the panelists believe the impact of a new definition will be appropriate, Volkmar's study indicates it might have a much more widespread effect on those with Asperger's or P.D.D.-N.O.S., with a majority losing their diagnosis according to his analysis. Additionally, if he's correct, about a quarter of those currently diagnosed with autism proper would also not meet the critera.

For those who might lose their diagnosis -- or who may never be disagnosed at all -- the stakes are high: without a diagnosis, individuals will lose or be excluded from access to services like special education in schools and disability support. But some experts on autism and its related disorders believe it is often over-diagnosed: as many as 1 in 100 children have such a diagnosis, the Times reports.

You can read the full NYT story here.

http://slatest.slate.com/posts/2012/01/20/dr_fred_r_volkmar_new_dsm_autism_definition_harmful_.html?

Reports of Lost or Stolen Medications: Difficult Conversations - PainEdu.org

It is not unusual for a patient to report to their prescribing clinician that they have discovered that their prescription pain medication (or the written prescription) has been either lost or stolen, leading them to request a new prescription. It is important to distinguish between lost medications and stolenmedications.

Losing a prescription form or a vial of medications may result from the occasional lapses that all patients may have. If this occurs only once it may not have significant medical implications, and the prescriber may choose to replace it without much concern. Losing a medication more than once, however, may imply that something else is going on. There are many possibilities. Is the patient experiencing some type of cognitive impairment, perhaps one that is being made worse by the medication? Does the patient need a further neurological evaluation? Is the patient impaired by the use of other substances? Should a urine drug screen and some simple labs including CBC, metabolic panel, and thyroid function studies, be done even as early as the first incident of a lost prescription? Is the patient misusing the prescription and running out of it early because they are taking more than prescribed, giving it away, or selling it?

Taking a consistent approach to a lost prescription is made much easier if the provider has reviewed their policy about this with the patient ahead of time. If this has not been done, the first time there is a lost prescription is not too late to create a written patient/provider agreement, outlining each of their roles and responsibilities.

Clinicians in practice with multiple-providers should establish and circulate a uniform, clinic-wide policy among patients and staff, to avoid confusion about what they do. Some practices choose a "one and done" policy, (the first time you lose it I will refill it, but never again), or a stricter policy of zero-tolerance, and no early refills, under any circumstance.

If you are not replacing the lost medication, you will need to inform the patient about the potential for withdrawal, and offer to prescribe medications to help diminish withdrawal symptoms. Prescribing these medications needs to be individualized, based upon the patient's age, presence of other medical problems, use of other medications, and the patient's ability to follow-up.

The problem of reports of stolen prescriptions is more ominous because there is another person involved, and potentially, another person has been put at risk. Medication theft is a situation that requires some form of investigation and should be reported to the appropriate authorities. It is important for the patient to think about who might have stolen the medication.

In my clinical practice I do not provide an early refill for a stolen prescription. Other providers may take a "one and done" approach to stolen prescriptions as well as lost prescriptions. Again, with stolen medication, I will educate the patient about withdrawal symptoms and develop a plan to manage them if they occur.

Repeated medication loss, or theft, is a strong indication that the patient is at high risk and that it is not safe for this patient to remain on this medication. If a medical reason, like cognitive decline, is discovered, this may be successfully addressed so that the patient can continue on the medication. However, if this cannot be done, or if the patient lives in an unsafe environment, the best course may be to taper and discontinue these medications, substituting treatments that are lower risk.

Describing how you address these problems before the patient has begun treatment, and before incidents of lost or stolen medication, is part of your description of the treatment plan, and it demonstrates the principal of shared responsibility.

http://www.painedu.org/articles_timely.asp?ArticleNumber=60&