A man and his family wait, and hope, as senators consider the options

Sometimes lost amid the play-by-play of healthcare reform are both the individual stories -- and the greater context.

In today's Los Angeles Times, reporters Faye Fiore and Janet Hook write of Virginia resident Parks Johnson, 34, who was diagnosed with bipolar disorder 10 years earlier:

"The low point of his troubled life wasn't the year he learned he had a mood disorder, inherited from his mother; doctors found the right combination of antipsychotic drugs to keep him sane. The low point came six years later, when the health insurance industry refused to cover him anymore because he was too sick."

Read the story, "Sick, Without a Safety Net," here. And learn more about bipolar disorder in this booklet from the National Institute of Mental Health.

As for the play-by-play coverage, there's today's news story, "Senate Healthcare Bill May Be Hard to Reconcile With House's."

But then there's this history of health reform efforts in the U.S., presented as an interactive timeline from the Kaiser Family Foundation. More on the basics of healthcare reform can be found on the site as well.

-- Tami Dennis

Photo: Parks Johnson struggles to get the medications that will keep his condition in check.

Credit: Los Angeles Times

SARS survivors continue to suffer mental health problems, study finds

Before swine flu and bird flu, there was SARS.

As you may recall, severe acute respiratory syndrome was the scary virus of 2003. It caused fever, headaches, body aches, pneumonia and diarrhea, among other symptoms. SARS originated in Asia and spread to more than two dozen countries on four continents before it was contained. Nearly 8,100 people got SARS during the outbreak, and 774 people died, according to the World Health Organization.

Whatever happened to the survivors?

After one year, patients’ physical symptoms had improved greatly, but their mental health had deteriorated. A group of researchers from the Chinese University of Hong Kong checked back with all the SARS survivors they could find in one district of the city and found that psychiatric problems persisted even four years later.

The researchers assessed 233 former patients through interviews and questionnaires. They determined that 42.5% had “active psychiatric illnesses,” including post traumatic stress disorder, depression, somatoform pain disorder, panic disorder and obsessive compulsive disorder.

In addition, 40.3% had chronic fatigue syndrome. These former SARS patients were more likely than others to have ongoing psychiatric problems, the researchers reported in Tuesday’s edition of Archives of Internal Medicine.

Among the SARS survivors, many who were working in hospitals at the time of the outbreak have abandoned their careers in medical care.

“The persistence of psychiatric morbidities among the SARS survivors who participated in our study was alarming,” they wrote. “Because new infectious diseases are emerging at an unprecedented rate and pose a global threat for pandemics, there should be better preparation in public health strategies for dealing with … the long-term potential mental health complications.”

-- Karen Kaplan

Photo: These ballerinas-in-training in Hong Kong wore masks to protect themselves from a SARS outbreak in 2003. Credit: Vincent Yu / Associated Press

Nearly half of kids with mental disorders go without treatment, study finds

If your child broke an arm or had a nasty bout of pneumonia, you’d probably visit the doctor. But a new study from researchers at the National Institute of Mental Health finds that only 55% of kids with a mental disorder sought professional treatment.

What’s more, that figure represents an increase in use of mental health services, according to a report being published online Monday by the journal Pediatrics.

The researchers wanted to establish a baseline on the prevalence of six mental health disorders affecting children and adolescents between the ages of 8 and 15. Using data from 3,042 kids who took part in the National Health and Nutrition Examination Survey, they  found:

• 8.6% had attention deficit hyperactivity disorder
• 3.7% were depressed
• 2.1% had conduct disorder
• 0.7% suffered from generalized anxiety disorder or panic disorder
• 0.1% were anorexic or bulimic
• 13% of kids surveyed had at least one of these disorders, and 1.8% had two or more.

The researchers, led by Kathleen Merikangas of NIMH, found that mental disorders – especially ADHD – were more prevalent among kids with lower socioeconomic status. One exception was the category of anxiety disorders, which were more common among children of higher socioeconomic status.

Still, only 32% of those kids visited a doctor for the condition. Overall, African American and Mexican American children were less likely than whites to get treatment.

-- Karen Kaplan

Photo: U.S. scientists say more than 1 out of 10 kids suffers from some kind of mental disorder. Credit: Stacey Wescott / Chicago Tribune

'Listening to Prozac' author feels 'vindicated' by new antidepressant study

Peter D. Kramer, the psychiatrist and author of the path-breaking 1993 book "Listening to Prozac," said in an interview today that he felt "vindicated" by a newly published study ("Personality Change During Depression Treatment," by Tony Z. Tang et al) finding that selective serotonin reuptake inhibitor (SSRI) antidepressants cause dramatic personality changes in depressed patients who take them.

"It's hard not to feel justified" in the view--offered long before it became fashionable--that antidepressants now taken by 7% of American adults do more than lift depression: They nudge underlying personalities--even those of healthy people--into brighter, more appealing territory, and in so doing, raise ethical concerns about "cosmetic psychiatry."

The study offers evidence that people who are unassertive, pessimistic, prone to worry and prefer to be by themselves or in small groups are more likely to develop depression, and that, when they take SSRIs, those underlying personality traits change more than most peoples' change in an adult lifetime--in the span of 16 weeks. That change in basic outlook not only seems to be the thing that lifts them out of depression; it may even reduce the likelihood that they'll relapse. (You can read our detailed account of the study and its findings here.)

While a group of subjects undergoing cognitive therapy had some of the same effects, they weren't nearly as powerful as those that came from a pill--which in this case was paroxetine, marketed as Paxil.

Kramer found one possible inference from the study particularly striking: that it might turn on its head the view that many clinicians have of the value of drugs and/or cognitive therapy for their patients. "It looks like medicine is good for chronic personality traits and cognitive therapy is good for acute illness," he said. Translation: Maybe any of us who are given to sad or worried rumination should be on SSRIs, and then, if we fall into depression anyway, we can get some time-consuming and expensive cognitive therapy. (That DOES sound like a treatment algorithm that would appeal to insurance companies.)

Not surprisingly, Kramer thought this study might have been funded by the makers of Paxil--GlaxoSmithKline--or some other SSRI. Because in many ways, those companies would seem to benefit from the idea that the medications might be used to prevent depression (creating a much larger market for them), saving more costly measures like psychotherapy for when bad mood, irritability and worry tip into impairment.

In fact, the study was funded by Northwestern University initially, and then continued under a pair of grants from the National Institute of Mental Health.

-- Melissa Healy

Reflections on H.M., a man who couldn't remember

Memories can haunt, torment, energize, sustain, amuse, irritate ... and most people take their abilities to form them for granted. A man who couldn't do this managed to teach the rest of us.

"Henry Molaison lived in relative obscurity, but he possessed one of the world's most famous brains. Known to generations of scientists and psychology students as H.M., Molaison lost the ability to form new memories after surgery removed part of his brain and, by agreeing to be studied over several decades, transformed the way we understand memory. H.M. died last December, but science isn't done with his brain..."

So begins today's story in the L.A. Times. Read more.

For more on memory and how it works, McGill University in Montreal offers this primer: The Brain From Top to Bottom.

From NPR, we have audio recordings of Molaison and Brenda Milner, who studied Molaison for years. Hear his voice, and read the transcript here.

Here's a reprint from the original article about Molaison by Milner and surgeon William Beecher Scoville. It was published in 1957 in the Journal of Neurology, Neurosurgery and Psychiatry.

And, finally, there's this reflection, published earlier this year in the McGill Science Undergrad Research Journal, shortly after Molaison's death a year ago.

— Tami Dennis

Photo: Henry G. Molaison, long known only as H.M., is shown in the 1970s, years after the surgery that devastated his memory.

Too much emphasis on holiday stress can be stressful

To those people who thought they were handling the holidays with aplomb: Think again. We're all threatened by the extra shopping, cooking and travel that the end of the year often brings.

That's the only explanation for the seemingly endless advice on how to de-stress the holidays. It began arriving before the turkey and Tofurky leftovers were put away, and it hasn't slowed since....

There's the ready-for-public-consumption primers found following such headlines as "Coping with holiday stress," "To reduce holiday stress, reduce your expectations," "How to de-stress this holiday season," "Ease holiday stress with dose of 'me-time'."

And then there's the standing-by-with-tips experts:

• We have psychiatrists warning against waiting until the last minute to make plans. But we're to schedule in time to help others, presumably the less fortunate.

• There's the integrative medicine expert recommending homeopathy for those anxious moments when "you have too much on your mind and the demands of  job, children and family make you feel like you will lose it."

• And the psychologist suggesting avoiding, or reducing, alcohol consumption, lest we succumb to the blues. 

• And, of course, a neurobiology professor, not to be outdone, who's available to discuss stress' potential damage to the prefrontal cortex.

If you weren't stressed before, you will be soon.

May we suggest this very basic advice on maintaining holiday cheer.

-- Tami Dennis

Photo: Not that these post-Thanksgiving shoppers don't appear to be having fun...

Credit: Associated Press

Mental-health parity laws require oversight

Consumers need more information regarding new laws that mandate insurance coverage for mental-health treatment, according to an analysis of the first five years of the mental-health parity law in California. Based on California's experience, the authors suggest that government oversight is needed to monitor not only costs and coverage issues but also access to care and quality of care issues.
 
The review, published today in the journal Psychiatric Services, describes the experiences of consumers, health plans and doctors in responding to the mental-health parity law in California that went into effect in 2000. Lessons from California's experience could be valuable to the success of the new national parity law that will take effect in January. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act will provide mental health services and substance abuse coverage to 113 million Americans.
 
The study, by researchers at Mathematica Policy Research and the Substance Abuse and Mental Health Services Administration, used data from interviews and focus groups to draw conclusions about the success and failures of the California law from 2000 to 2005. Among the findings:

• Costs associated with parity were in line with, or even below, the projections.
• Most health plans responded to the parity law by lifting limits on the annual number of days allowed for inpatient treatments and the number of visits allowed for outpatient treatment.
• Concerns arose over the use of "medical necessity" clauses to authorize treatments and control costs. Medical necessity is typically defined as the need to supply a service for a condition that could endanger life or cause significant illness, suffering or disability and for which there is no adequate, less costly alternative available.
• Consumers also complained about being referred to lists of mental-health providers only to find out that providers on the list were not taking new patients.
• Health insurance providers felt the list of diagnoses covered under the parity law was arbitrary in excluding certain diagnoses.
• Some doctors reported that they chose a parity diagnosis for a patient in order to ensure insurance coverage although it wasn't the most accurate diagnosis. Some doctors said they had little flexibility to change a client's diagnosis if he or she improved because they believed the health plan would then stop providing coverage for continuing care or care for a lesser diagnosis.
• Nearly half of Californians polled in focus groups were unaware of the parity law.
   
  Public education campaigns should accompany the introduction of the federal parity law, the authors of the paper wrote, noting that the effort could yield another benefit. "Enhanced public education may also lead to reduced stigma associated with mental illness."

-- Shari Roan
 
Photo credit: Tim Teebken / For The Times

Emotional value of pets is underestimated, expert says

Having a pet can meet many human psychosocial needs and has been undervalued in the field of mental health, says the author of a comprehensive review of human-pet bonds published today in the journal Family Process.

The research, by Dr. Froma Walsh of the Center for Family Health at the University of Chicago, finds that pets provide stress reduction, companionship, affection, comfort, security and unconditional love to their owners. Having a pet can even confer physical health benefits. For example, heart attack survivors who have pets are likely to live longer if they have a pet. Pets can become so entwined in family dynamics that they are often the source of conflict in divorces. Some women have refused to leave a partner who is abusive if she thinks the pet will be harmed in her absence, Walsh said. Other studies in recent years show that many animals possess a strong ability to connect emotionally with humans and communicate with them, in their own ways, of course. Thus, relationships with pets help people through hard times and provide connectedness in an era when family connections are fragmented.

Mental health professionals, however, often ignore the role of pets when assessing emotional health or relationships, Walsh said. Grief over the loss of a pet, moreover, is trivialized. And people who seem overly attached to their pets are sometimes viewed as strange, dysfunctional or lacking in social skills.

But, Walsh wrote: "As researchers have seriously examined human-animal bonds in their own right their findings suggest that feeling even closer to a pet than to others is not uncommon, and the vast majority of pet lovers are not socially inept or trying to replace their human companions. Most people who connect strongly with animals also have a large capacity for love, empathy and compassion."

More than 63% of U.S. households -- and 75% of households with children -- have at least one pet, according to the American Pet Products Manufacturers Assn. National Pet Owners Survey.

-- Shari Roan

Photo credit: Michael Chow  /  The Arizona Republic  /  Associated Press

Drawing back the curtain on binge eating

With psychiatrists mulling whether to classify binge eating as a bona fide eating disorder -- laid out in a package of stories in today's Health section -- the blog Jezebel launches a more personal discussion of the problem.

That post notes: "As someone who has been fortunate enough to receive proper treatment for an eating disorder, I find it somewhat troublesome that the concern over including binge eating disorder in the DSM comes back to worrying about doctors over prescribing medication or patients who rely on the diagnosis as some excuse to continue engaging in unhealthy behavior. ... I was able to get proper treatment because my eating disorder was clearly defined in the DSM."

People who have struggled with binge eating then weigh in. Others opine about the merits of the DSM classification.

Here's the L.A. Times' story, by staff writer Melissa Healy: Is binge eating a psychiatric disorder?

It begins: "Rina Silverman's refrigerator is almost always empty. She keeps it that way to avert episodes of frantic food consumption, often at night after a full meal, in which she tastes nothing and feels nothing but can polish off a party-sized bag of chips or a container of ice cream, maybe a whole box of cereal. The food she's eating at these moments hardly matters."
 
And here are the related stories in the package:

Trying to define binge eating disorder

Binge eating: Is it a form of addiction?

Holidays can feed binge eaters' problems

And for more on binge eating, check out this collection of information, tips and resources from helpguide.org.

— Tami Dennis

Photo: For binge eaters, one serving isn't enough.

Credit: Tim Boyle / Getty Images

When making public statements, shouldn't those statements actually state?

When news breaks out, organizations frequently offer up their two cents on the topic at hand. Sometimes these statements clarify the issue or a group's stance -- but only sometimes.

Today, we received this official statement from the American Psychiatric Assn. on the Fort Hood, Texas, shootings:

“The American Psychiatric Association is saddened and shocked by the events at Fort Hood on Thursday, November 5. Our hearts are with the soldiers, the families, and all the members of the Fort Hood and military community affected by this tragedy.”

Couldn't the same be said of most people's reactions -- and the location of their hearts? Here's what the position looked like in its entirety.

And last week, there was this from the National Women's Law Center on the gang rape of a 15-year-old California girl who'd attended a dance:

“The circumstances reported about this brutal assault, as well as the shocking inaction of those who stood by and watched it happen, are shocking – and should be widely condemned."

Again, society didn't seem to need much urging.

If you're going to make a statement, then do so. Here's one this week from the National Right to Life Committee on a legislative move in the House:

"The Ellsworth language is a political fig leaf made out of cellophane -- it directs the federal Secretary of Health to hire a contractor to deliver to abortion providers the payments for elective abortions, payments that are explicitly authorized by the bill [on page 110].  This is a money-laundering scheme -- a federally funded 'bag man' will deliver government funds to abortionists.  This is federal funding of elective abortion."

Here is that statement in its entirety.

Whether you think the statement is an accurate reflection or a grotesque parody of the current political debate, at least there's a point in saying it.

-- Tami Dennis

Photo: Sometimes the point isn't what is said, just that something is said.

Credit: Los Angeles Times