Folks,
Raymond L. Crowel, Psy.D., has been chosen to be the next Chief, of Behavioral Health and Crisis Services (BHCS) in the Department of Health and Human Services (HHS), expected to begin 13July2009. He replaces David Jones who took a position in Baltimore last February. To quote Ike Leggett, “Dr. Crowel’s impressive credentials and experience will be an asset to our Behavioral Health and Crisis Services.” Crowel, 54, received a B.A. in Psychology, with Distinction, from the University of Michigan and a Psy.D. in Clinical Psychology from Rutgers.
Dr. Lee Heller sent the following: “I have a comment on your mailing from May 21 with regard to archiving emails. My response is that absolutely a copy of all emails received or sent should be made part of the chart. This is the same as phone calls. A record should be made of all phone calls. The rationale for this is that you are receiving and/or giving medical information. As such, it is part of your decision making process and treatment of the patient. It should be made a part of the permanent medical record. This should be the case even if the information does not seem medical or releva nt at the time.”
From AJP this month, each time a new antipsychotic arrives, there is usually a hint by its promoters that it “may” address deficit signs of schizophrenia. A study comparing haloperidol (1 to 4 mg/day, olanzapine (5 to 20 mg/day, quetiapine (200 to 750 mg/day ), and ziprasidone (40 to 160 mg/day ), found treatment with antipsychotic medication is associated with moderate improvement in the cognitive test performance of patients who have schizophreniform disorder or who are in their first episode of schizophrenia. The magnitude of improvement does not differ between treatment with haloperidol and treatment with
second-generation antipsychotics. Moreover, cognitive improvement is weakly related to symptom change.
A second item from AJP, in a comparison of paliperidone extended-release, 9 or 12 mg/day, and quetiapine, 600 or 800 mg/day in pts who ha d relapse with schizophrenia, paliperidone produced more reduction in the PANSS, and showed improvement quicker.
In a study of autism spectrum disorders, citalopram was no more effective than placebo at reducing repetitive behaviors in children — a finding that, some say, calls into question the currently widespread practice of prescribing SSRIs in this patient population in the absence of scientific evidence.
A study published June 3 in JAMA found that a group cognitive behavioral program that teaches coping and problem-solving skills to these high-risk teens can reduce their risk of developing depression. The success rate of the prevention program varied greatly, depending on the mental health status of the teenagers' parents at the time they began intervention. Restated, the program was muc h more effective than standard care if the teens' parents were without depression
when the intervention began."
US regulators may warn patients taking tamoxifen, not to use certain types of antidepressants that are involved with the CYP2D6 because they may block the tumor-fighting drug's effectiveness. While the announcement was not specific as to which antidepressants, if the focus is 2D6, then I would assume the worry is with bupropion, clomipramine, duloxetine, fluoxetine, paroxetine, and sertraline.
A study that compared paroxetine and low-dose risperidone in the treatment of panic attacks found equal efficaciousness and tolerability.
This month’s Cleveland Clinic Heart Advisor surprised me: “Optimal blood pressure in most individuals older that 80 years old should be above 140 mm Hg.” “Most” does not include those with coronary artery disease. How to increase BP safely was not explicated. Nor was it clear what is the ideal systolic, but I assume the article would like for us to keep these older folks close to 140. For our elderly pts with BP of 110/65, are we to advise stopping exercise and adding salt to their food? Maybe a follow-up will clarify.
The County is eager to see more private practitioners able to prescribe buprenorphine. On June 27, there is the 8 hour certification seminar on prescribing buprenorphine. Info at:
For your Rolodex; Info on mental health services in Prince George’s County: 301 985 3890.
Roger |
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