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Molecules of the Mind
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The Neurobiology of Conscious Intent
A UBM Medica Publication®
Special Report Suicide, Part 1
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Category 1 CME Atypical Depression
January 2011 • Vol. XXVIII, No. 1
www.PsychiatricTimes.com
NIMH Shifts Focus to Molecular Origins of Mental Illness by Arline Kaplan
and director of research at the Western Psychiatric Institute and Clinic, Pittsburgh, and John March, MD, MPH, director of the Division of Neurosciences Medicine at Duke Clinical Research Institute, Durham, NC. Recently, the workgroup published a report, From Discovery to Cure: Accelerating the Development of New and Personalized Interventions for Mental Illness.1 March describes it as a “policy infrastructure document” that builds on an earlier council report on transformative neurodevelopmental research in mental illness.2 In the new report, the workgroup makes several observations—that mental illnesses are brain disorders and that virtually all of them are developmental disorders; that nearly all drugs approved for mental illness have been incremental changes of compounds available 4 decades ago; that the NIMH’s practical trials, such as Clinical Antipsychotic Trials of Interventions Effectiveness (CATIE), have documented the limited effectiveness of current medications; that the NIMH receives relatively few applications proposing to translate basic findings into the development of novel interventions; and that several major phar-
o accelerate the development of personalized and preemptive treatments for those living with mental illness, the NIMH is shifting away from current-generation treatments and toward preclinical drug development and early-phase clinical pharmacology, according to the institute’s director and a workgroup co-chair. In a recent blog, Thomas Insel, MD, NIMH director, explained: “For existing treatments, we want to shift from trials studying group differences or adapting these treatments to yet another subpopulation to support trials that identify reliable predictors (eg, biomarkers) of individual response, including who may benefit from and who may experience adverse effects of a particular treatment. We are also searching for preemptive treatments—interventions that can be used early in the course of a disorder to prevent disability.” As the NIMH changes direction, Insel has relied on guidance from the National Mental Health Advisory Council’s Interventions Workgroup, made up of 20 experts from academia, private industry, nonprofit foundations and the NIH. It is co-chaired by David Lewis, MD, medical director
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(Please see NIMH, page 2)
Diagnostic Criteria for PIISD: Private Insurance–Induced Stress Disorder by Carol A. Paris, MD he essential feature of private insurance–induced stress disorder (PIISD) is the development of characteristic symptoms following exposure to an insurance-induced traumatic stressor involving direct personal experience of an event or witnessing an event that threatens another person. Traumatic events include, but are not limited to, recission of health insurance after developing a costly illness; denial of health insurance because of a preexisting condition, such as being female and fertile; or delay of needed treatment or medication secondary to requirements for pre-authorization. In the case of physicians, traumatic events include witness-
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ing the deterioration of patients from financial ruin resulting from uncovered costs of care. Similar to some forms of PTSD, this disorder is prone to be severe because the stressor is of human/ corporate design. Note: this diagnosis is not currently reimbursed by the health insurance companies. Diagnostic criteria for PIISD include a history of exposure to a traumatic insurance-induced event meeting the following criteria and symptoms: Criterion A. The person has been exposed to a traumatic insuranceinduced event in which both of the following have been present: • The person has experienced a health insurance traumatic event, due ei(Please see PIISD, page 6)
Issue Highlights ECT: The Second Most Controversial Medical Procedure Charles H. Kellner, MD
Psychiatric Assessments and Treatment in Preschool Children Joan L. Luby, MD
Understanding and Overcoming the Myths of Suicide Thomas Joiner, PhD
The Link Between Substance Abuse, Violence, and Suicide Mark Ilgen, PhD and Felicia Kleinberg, MSW COMPLETE CONTENTS, PAGE 8