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.
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.
Researchers say they have found a genetic variant that raises smokers’ risk of developing nicotine addiction and leads to increased risk of lung cancer and peripheral arterial disease.
According to the study, published April 3 in Nature, carriers of the variant are not more likely than noncarriers to start smoking but are less likely to quit smoking and face a higher risk of becoming heavy smokers and/or dependent on nicotine.
The researchers identified the variant after searching for more than 300,000 genetic markers in the DNA of 10,000-plus Icelandic smokers. The researchers estimate that the variant also explains 18% of cases of lung cancer and 10% of cases of peripheral arterial disease in smokers. The findings were replicated in populations from five European countries and New Zealand.
The National Institute on Drug Abuse supported the research.
As casualties among U.S. troops in Iraq continue to increase, the American Psychiatric Association (APA) is calling for increased funding for research of war-related mental illness.
APA says more research is needed on posttraumatic stress disorder, traumatic brain injury, and other psychiatric sequelae of war such as depression and anxiety. In a speech marking the fifth anniversary of the Iraq war, President Bush described the horrors and stresses U.S. troops have faced since 2003 in Iraq and Afghanistan.
“The traumatic events experienced by military service members highlight the immediate need for access to mental health services for our troops and their families,” said APA President Carolyn Robinowitz, MD.
To that end, APA recently joined forces with Give an Hour, a national network of clinicians who volunteer 1 hour a week to provide free mental health services to military service members and their families. APA is encouraging its members to join the network.