The FDA has approved the prodrug stimulant lisdexamfetamine for treating attention-deficit/hyperactivity disorder (ADHD) in adults.
FDA based approval on a double-blind, placebo-controlled study that followed 414 adults ages 18 to 55 over 4 weeks.1 At study’s end, participants who received lisdexamfetamine at 30, 50, or 70 mg/d showed a mean 16.2- to 18.6-point improvement in ADHD Rating Scale scores compared with placebo.
Lisdexamfetamine—marketed as Vyvanse—also is indicated for treating ADHD in children ages 6 to 12. The drug entered the market last year.
Reference
1. Adler L, Goodman DW, Kollins SH, et al. Efficacy and safety of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder. Poster presented at: American Academy of Child and Adolescent Psychiatry annual meeting; Boston, MA; October 23-28, 2007.
The American Psychiatric Association (APA) is pushing for lower Medicare beneficiary co-payments for outpatient mental health services.
Medicare covers only 50% of most mental health care service costs, compared with 80% of most other outpatient medical service costs.
“Medicare was established to serve the elderly and people with disabilities, two groups with high mental health needs,” says Robert Roca, MD, MPH, vice president and medical director, Sheppard Pratt Health System (Baltimore, MD). “Ironically, the 50% coinsurance creates an unusually high barrier for people who need mental health services.”
APA is urging lawmakers to increase Medicare’s share of mental health coverage. A spokeswoman notes that several bills are before Congress:
• One measure (S-1715) would reduce the 50% beneficiary co-pay for outpatient mental health services to 20 % over 6 years.
• A companion bill, the Seniors Access to Mental Health Act of 2007 (HR-1571), also would reduce the co-pay over time.
• Under the Children’s Health and Medicare Protection (CHAMP) Act (HR-3162), which passed the House in August 2007, Medicare would cover mental health outpatient treatment at the same rate as other outpatient services.
Too few geriatric psychiatrists are available to handle the increasing mental health needs of an expanding elderly population, specialty advocates warn.
The Association of Directors of Geriatric Academic Programs (ADGAP) says there are:
• 3.9 geriatric psychiatrists for every 10,000 Americans age ?85
• 1.1 geriatric psychiatrist for every 10,000 persons age >75.
Last year, nearly 1,600 board-certified geriatric psychiatrists practiced in the United States—far fewer than the 5,000 ADGAP estimates are needed to treat a population at high risk for Alzheimer’s disease, depression, and other late-life psychiatric disorders.
In an extensive report on health care availability for older patients, the Institute of Medicine notes that geriatric specialists require extra years of education and training but earn significantly less than generalists or other specialists. Also, low Medicare payments for mental health treatment and annual scheduled cuts in Medicare physician payments discourage psychiatrists from entering geriatric medicine, the report notes.
“Unless changes are made now, older Americans will face long waits, decreased choice, and suboptimal care,” said AAGP President-Elect Charles F. Reynolds, III, MD.
To view the Institute of Medicine report, click here.
Taking aim at what it calls inconsistencies in psychiatric treatment for children, a coalition of mental health advocacy organizations has created a “Bill of Rights for Children with Mental Health Disorders and their Families.”
“This Bill of Rights represents the standard of what families living with mental illnesses should expect from treatment,” said AACAP President Robert Hendren, DO. “Children do better when they receive consistent, tailored treatment. Few children receive any treatment and fewer still receive the sustained quality care they need.”
Psychostimulant treatment for childhood attention-deficit/hyperactivity disorder (ADHD) does not increase risk for substance abuse in adulthood, findings from two National Institutes of Health-funded studies suggest:
• In a prospective longitudinal study conducted at New York University, men who began stimulant treatment for ADHD at ages 6 to 8 and a comparison group of men without ADHD showed similar rates of substance abuse (27% vs. 29%, respectively). Men who began psychostimulants at ages 9 to 12 had a higher substance abuse rate (44%) than the other two groups, possibly because of co-occurring antisocial personality disorder.
Nonetheless, “Young people with ADHD need to be screened for substance abuse,” says National Institute on Drug Abuse Director Nora Volkow, MD. “Treatment needs to go beyond standard ADHD strategies towards integrated treatments that target both ADHD and substance abuse as soon as symptoms emerge.”
Investigators in both trials acknowledge the studies’ limitations, including:
• small samples (<300 men with childhood ADHD in both studies combined)
• non-randomized study designs
• and exclusively male, predominantly Caucasian study populations.
The studies appear in the March and April online issues of the American Journal of Psychiatry.
