Psychiatrists Are Choosing Medications Over Traditional Psychotherapy

Many U.S. psychiatrists in today's environment are opting to break out the prescription pad and write prescriptions rather than inviting a patient to their couch for talk therapy. Some patients may like the new idea of prescribing medication rather than the more traditional therapy from their psychiatrists, especially for a quick fix, but is it just a band-aid or an actual resolution to the problem?
Lead author Dr. Ramin Mojtabai of Johns Hopkins Bloomberg School of Public Health in Baltimore, which performed the most recent study based on the new trends of psychotherapy, explained that in today's environment insurance companies are reimbursing psychiatrists at a lower rate for a 45-minute psychotherapy, than they are for three 15-minute medication visits, possibly causing the swing in the form of treatment.

Psychiatrists are in a business, and as any business they also strive to make a profit. While their primary job is to help treat patients, they must also consider the profit-and-loss factor. Because patients are responsible for whatever part of their visit insurance doesn't cover, they may opt for the therapy that best meets their budget rather than their psychological needs. The authors of the study wrote that, "Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits, and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often."

The findings of the new study, based on an annual survey performed during U.S. doctor visits, were published in a recent edition of Archives of General Psychiatry. The researchers based their analysis on 14,000 psychiatrist visits during a 10-year period and excluded psychologists visits or visits to other mental health counselors who may use talk therapy for treatment. Over 1996-1997 the study resulted in an average of 44 percent of patients that visited psychiatrists and received psychotherapy, but by 2004-2005 that number had dropped to only 29 percent.
Psychotherapy is used by trained psychotherapists as relational intervention. Psychotherapists work with a range of techniques to aid patients or clients in several areas, such as relationship building, open communication, attitude and behavior adjustments, and family struggles or group relationships, in hopes of improving the mental state of patients. Psychotherapy also known as verbal therapy, is used in hopes of aiding patients to evaluate their behaviors and thoughts and help to ease symptoms. Though there are other practitioners that may use psychotherapy to help patients, only psychotherapists may administer other medical treatments, such as psychosurgery, electroshock, and prescribe medications.

Some situations, such as those with childhood trauma or chronic depression sufferers, may benefit more from treatment through psychotherapy, than through medications. A child who is in the middle of their parents divorce may need to talk to someone outside of the family that can help them deal with their hurt, fears, and emotions. Hopefully, psychotherapists will continue to evaluate the overall situation, not be swayed by the insurance company's reimbursement percentage, and continue offering psychotherapy to those that would better benefit from the talk therapy rather than medications. Even though, based on this most recent study produced by Johns Hopkins Bloomberg School of Public Health, it seems couches used for talk therapy are being left vacant more often than in the past.

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New Genetic Clues to Schizophrenia Discovered (Part 2)

Researchers stressed that the research explained only a tiny fraction of why people might develop schizophrenia and additional work needs to look at the full spectrum of other types of genetic factors that might influence schizophrenia. Schizophrenia, like autism, tends to run in families, which is the reason to focus on genetic determinants of the disease. The paper in Nature compared the genomes of 3,300 individuals with schizophrenia against those of 3,200 individuals without the illness. "We looked at a relatively rare type of DNA change where people have a substantial portion of a chromosome either missing or extra.

These are called copy number changes," Sklar explained. The consortium found three deletions on specific chromosomes that appeared multiple times in people with schizophrenia. Two of the deletions had never been recognized before. According to Sklar that triples the number of specific DNA areas that may be responsible for the disease.

Michael O'Donovan, lead author of the Nature Genetics study and professor of psychiatric genetics at Cardiff University in the United Kingdom, acknowledged "We've been working on schizophrenia for rather more years than we care to think, and successes have not been dramatic." Other researchers have looked at what are called "whole chapters" in the genome, his team honed in on what he described as tiny spelling differences. "In addition to rare variants, we were able to convincingly show that common variants are involved in schizophrenia, but we don't know how much of a role they play compared with rare variants." According to Donovan it means that all humans have genes for schizophrenia, but those who do not have it don't have enough of the genes or possibly have not been exposed to environmental stimulus.

The studies indicate a shift in focus for finding variants that affect the risk of schizophrenia. The search for rare variants may help identify groups of patients with different genetic causes for their diseases. This could lead to treatments tailored to different biological causes which would improve treatment outcomes.

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New Genetic Clues to Schizophrenia Discovered ( Part 1)

Ancient documents identify diseases with the symptoms of schizophrenia as far back as Egypt in the second millennium before Christ, and the condition has probably followed mankind through history. The word schizophrenia is less than 100 years old and the modern identification of the disease was first done by Dr. Emile Kraepelin in 1887 as a discrete mental illness. The exact cause of schizophrenia, as with other mental disorders has eluded research for years, but researchers believe that they are moving closer to the causes and the possibility of an effective treatment for the condition.
Schizophrenia is a not a single problem but a group of serious brain disorders. It can range from mild to severe and some people with the disease may be able to function well in daily life, while others need specialized, intensive care. Schizophrenia is not the same as a split personality or multiple personalities. The word does mean "split-mind," but it refers to a disruption of the usual balance of emotions and thinking. The disease usually appears in late adolescence or early adulthood, is more common in men than women, and even with effective treatment remains a chronic condition. Approximately 1% of the population suffers from schizophrenia.
Those with schizophrenia interpret reality abnormally and usually suffer from hallucinations, delusions and disordered thinking and behavior. They will usually withdraw into their own realm marked by psychosis. Schizophrenia can appear suddenly or develop gradually over months and may be unnoticeable at first.
In independent international studies, the same rare genetic variations in patients with schizophrenia were identified. The research indicates that three rare deletions in the human genome appear to increase the risk of developing the brain condition. Dr. Pamela Sklar, corresponding author of a paper appearing in Nature and director of genetics at Harvard Medical School, Boston said "These findings give a great deal of hope, for individuals with schizophrenia and their families, loved ones, and caregivers, that we're moving towards an under standing of the cause of the disease."

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Blood Test Detects Down Syndrome (and More) with No Risk to Fetus (Part 1)

A newly developed blood DNA test given to expectant mothers can determine if an unborn baby has Down syndrome or other similar birth defects. Unlike invasive procedures such as the amniocentesis and chorionic villus sampling (CVS), the test poses no risk to the fetus.

Down syndrome occurs when a child has three, rather than two, copies of the 21st chromosome. The condition causes mild to moderate impairment of cognitive ability.Common physical traits of Down syndrome are low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the center of the palm. Down syndrome increases the risk for certain medical conditions such as congenital heart defects, respiratory and hearing problems, Alzheimer's disease, childhood leukemia, and thyroid conditions. One in every 733 babies is born with the condition and there are over 400,000 people living with Down syndrome in the United States.

Stanford University bioengineer Stephen Quake, Ph.D., of Stanford University in California led the research team in creating a way to examine small amounts of fetal DNA that circulate in the mother's blood to look for extra chromosomes that trigger Down's syndrome and other similar birth defects. “We sequence millions of molecules from each blood sample and map the DNA back to the chromosome. And then we look to see if any chromosomes are over-represented,” Quake said.

The test requires only a small blood sample from the mother, making it much safer than sticking a needle in the uterus as required by the amniocentesis, or using of CVS, which requires snipping off a small piece of the placenta for analysis. Both invasive procedures carry a risk of causing a miscarriage or birth defects.

The blood test can also be done very early in a pregnancy, as early as five weeks after conception, with results available within a couple of days. With invasive procedures, which are typically done after the 15th week of pregnancy, results can take two to three weeks.

Although Down syndrome is the most commonly occurring chromosomal condition, other dangerous chromosomal conditions exist that can also be detected by the new test. One such condition is Edward syndrome, a condition that is caused by the presence of three, as opposed to two, copies of chromosome 18 in a fetus or infant's cells. The syndrome occurs in about one in 3,000 pregnancies and approximately one in 6,000 live births and has a very low rate of survival due to heart abnormalities, kidney malformations, and other internal organ disorders.

Another condition indicated by the new test is Patau syndrome, in which a patient has an additional chromosome 13. The condition causes numerous physical and mental abnormalities, with the most predominant being heart defects, and kills more than 80 percent of children in infancy. Patau syndrome affects approximately 1 in 12,000 live births.

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