08 December 2011

Mental Health News

* A new study suggests strongly that co-morbidity in mental health conditions diagnosed under DSM-IV may be largely an artifact of many mental health conditions having identical or overlapping diagnostic symptoms. The study looks as DSM-IV symptoms, 439 in all for 201 conditions, and compared them to cases of multiple diagnoses. This passage from the study (corrected for an obvious clerical error) illustrates the idea:

For instance, among the symptoms of MDE [major depressive episode] we find sleep deprivation and concentration problems, while GAD (generalized anxiety disorder) comprises irritability and fatigue. It is feasible that comorbidity between MDE and GAD arises from causal chains of directly related symptoms; e.g., sleep deprivation (MDE)→fatigue (GAD)→concentration problems (MDE)→irritability (GAD).

The co-morbidity in this case may be more than a mere artifact, however. One of the leading theories of major depression posits that in many cases there is a causal link between anxiety and depression, with anxiety building up until the body's capacity to trigger normal physiological responses to anxiety eventually reached overload and causes those systems to shut down, leading to depression during which anxiety channel responses cease to function, until the anxiety response systems can recover. This theory is buttressed by the notion that some major anti-depressant drugs appear to actually be anti-anxiety drugs that are most effective in people with co-morbid anxiety and depression and treat the anxiety systems more reliably than the depression symptoms.

A core of symptoms show great overlap, while a large share of symptoms are unique to particular conditions.

Their chart is found here:

* A new study suggests that interactions between receptors for the neutransmitter chemicals serotonin (5HT) and glutamate may explain why psychedelic drugs, like LSD, and antipsychotic drugs, both of which act directly on serotonin receptors in the brain but have now been discovered to also lead to an interaction between serotonin and glutamate receptors, act differently than anti-depressant drugs that affect the same serotonin receptors in a different way. The study also suggests that it may be possible to develop psychedelic and antipsychotic drugs that act on glutamate receptors which trigger the sname serotonin receptor-glutamate receptor interaction in the opposite direction.

The interaction [that seems to explain psychosis and hallucinations] turns out to be all about G proteins, which are part of the chain of transmitter substances that convey signals within the cell, in response to neurotransmitters outside it.

* Colorado's mental health care system is still an ineffective mess, despite slight recent improvements over the last decade:

"People always say 'the system is broken. . . The system is not broken; it's just really complicated, and it's never really worked." . . .

• Three in 10 Coloradans — about 1.5 million people — need mental-health or substance-abuse treatment.

• State spending on substance-abuse treatment and prevention is one-third of the national average.

• The state needs more mental-health and substance-abuse treatment providers, but the numbers have grown, from 10,564 in 2003 to 14,217 in 2010.

• The overwhelming majority of treatment providers — 82 percent of all psychiatrists, 86 percent of all child psychiatrists and essentially all psychiatrists specializing in substance abuse — are in the Denver and Colorado Springs areas. Many rural counties, especially on the Eastern Plains, have few, if any, treatment providers.

• The most recent data, from 2007, show Colorado ranks 32nd in the nation for funding mental-health care, down a notch from its ranking of 31st in 2001. While Colorado has increased per-capita spending, from $62 in 2001 to $84 in 2007, other states have made greater increases. . . . "If you are a youth or an adult of color, it is very likely that the first time you get services will be in jail."

While many insurance carriers are offering more coverage for mental-health care. . . for those with severe mental illness, Medicaid or other public programs often offer more comprehensive treatment. . . . [M]ental-health care in Colorado was woefully underfunded and so complicated that the state barely had a mental-health system at all.

Basically, the lastest report, entitled "The Status of Behavioral Health Care in Colorado," commissioned by the Colorado Health Foundation, Caring for Colorado Foundation, the Colorado Trust and the Denver Foundation concludes that when the mentally ill were deinstitutionalized, no meaningful alternative to replace the widespread use of inpatient mental hospitals was ever established.

* Colorado's foster care system is also deeply flawed as illustrated by a case where a seven year old child's mother had her parental rights terminated for child neglect, ending up with the child in the foster care of her ex-boyfriend (who was the father of of the other son of the mother's whose parental rights were terminated, who was thus the half-brother of the child) and his new girlfriend who staved him to death while confining him to a closet in conduct that produced a report to the Colorado Department of Social Services that ignored obvious signs of abuse. Both abusive foster parents were sentenced to long prison sentences for murder. The mother of the child whose rights were terminated and the father of the child who died in foster care are suing the social workers who failed to act on the obvious signs in a suit that has been allowed to go forward.

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