Change Your Mind

Nearly 80% of hospitals say mentally ill patients who need to be hospitalized sometimes must wait four hours or longer to be admitted because of a shortage of psychiatric beds and mental health staff, according to a survey by the American College of Emergency Physicians, USA Today reports. By comparison, 30% of hospitals said patients not seeking mental health services had to wait four hours or more before being admitted.

For the study, ACEP officials surveyed 328 emergency medical directors. The survey also found:

About 10% of the directors said psychiatric patients wait more than one day on average;

84% of directors said ED wait times would decrease for all patients if their hospitals offered better psychiatric services;

Half of the hospitals surveyed had psychiatric units, while the rest transferred patients to other facilities; and

61% of hospitals surveyed do not have psychiatric staff caring for ED patients while they wait, but those patients do receive care for other medical problems.
The number of psychiatric beds in U.S. community hospitals has declined 12% since 2000, compared to a 4% decline in overall hospital beds, according to ACEP.

According to James Bentley of the American Hospital Association, hospitals have begun closing their psychiatric units because of low payments from government programs and health insurers, uncompensated care for uninsured patients and a shortage of psychiatrists willing to work in hospitals. Bruce Schwartz, director of psychiatry at Montefiore Medical Center, said, “For individuals in need of admission because they’re psychotic or severely depressed, it can be a very uncomfortable, scary, disorienting time” (Appleby, USA Today, 6/17).

ScienceDaily (June 17, 2008) — Concerned by the growing numbers of people using stimulant medications such as methylphenidate (MP)–either legally or illegally–to improve attention and focus, researchers used positron emission tomography (PET) imaging with the radiotracer fluorodeoxyglucose (FDG) to assess the effects of the drug on brain function in the normal human brain.

“MP is often prescribed appropriately for individuals with attention deficit hyperactivity disorder (ADHD), who are unable to focus their minds in order to perform everyday tasks,” said Nora Volkow, M.D., director of the National Institute of Drug Abuse in Bethesda, Md. “We wanted to better understand how the drug works in ‘normal, healthy’ people when they are performing a cognitive task, as well as when they are not.”

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For most of the history of psychotherapy, we’ve had to guess at how the brain really works. Until recently, researchers believed that all brain development occurred before age 5 or so. But as we learn more about Neurology through research and brain imaging we now know that the brain continues to develop throughout our lives.

Now we know that neurons – the cells of the brain – work in linked clusters or groups. When new information or input is familiar or similar to something from our past, the memory of the past event is often triggered. Game shows that play a snippet of a song rely on this aspect of brain functioning – if we know the song, our neurons will access the next several notes or words until we remember the name of the song. Repetition makes neural pathways stronger – which is why repetition helps us learn and memorize information.

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Science Daily — Alcoholics frequently smoke. Anywhere from 50 to 90 percent of individuals in North America who seek alcoholism treatment are also chronic smokers. New findings indicate that smoking may interfere with alcoholics’ neurocognitive recovery during their first six to nine months of abstinence from alcohol.

“There are several possible explanations for the concurrent use of alcohol and tobacco products,” said Timothy C. Durazzo, assistant adjunct professor in the department of radiology at the University of California San Francisco, and corresponding author for the study. “Nicotine and alcohol may enhance each other’s rewarding properties; nicotine may decrease some of alcohol’s negative effects on cognition and motor incoordination; paired use of nicotine and alcohol may produce a strong association between the two substances such that the use of one leads to cravings for the other; and there may exist a genetic vulnerability for concurrent active cigarette smoking and alcohol dependence.”

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A new study shows that alcohol may not be the only problem for repeat drunk drivers. More than half of DUI offenders also suffer from at least one mental illness in addition to a drug or alcohol-use disorder. The study found almost 60 percent of those with two or more DUI convictions reported experiencing major depression, bipolar disorder, obsessive-compulsive disorder or posttraumatic stress disorder over their lifetime.

The study consisted of people convicted of at least two DUI offenses in the past 10 years, and 40 percent had three or more DUI arrests. The majority of both men and women reported having at least one psychiatric disorder, as well as alcohol- or drug-abuse or dependence. Women had higher rates of depression than men and were more likely to suffer PTSD.

“People who deal with drug and alcohol abusers need to understand there are often other disorders that need to be dealt with as well,” said Sandra Lapham, M.D., M.P.H., principal investigator of the study. “That’s why we need to screen repeat offenders for multiple disorders. The offender should be viewed as a unique person with a unique set of issues. If they include psychiatric problems, these should be treated along with drug and alcohol issues.”

Lapham is director of the PIRE Behavioral Health Research Center of the Southwest in Albuquerque, New Mexico. She says the data suggests DUI evaluations by the courts and treatment programs should include psychiatric screening and assessments.

The study participants were part of a three-year program called Driving Under the Influence of Intoxicants Intensive Supervision Program (DISP) developed by Multnomah County Circuit Court in Portland, Oregon. The volunteer program requires intensive probation, close monitoring and built-in punishments and rewards, in exchange for reduced jail time.

“The results of this study should encourage the courts to develop a more comprehensive approach to dealing with the hard-to-treat drinking driver,” says Multnomah County Circuit Court Judge Eric J. Bloch.

“Assessing the mental health of a DUI offender will help us choose the program that will reduce the chance of a re-offense.”

The study published in the September edition of Journal of Studies on Alcohol was funded by the National Institute on Alcohol Abuse and Alcoholism.