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February 12


Time for a pop quiz:

For women over 30, which of the following is most cardiac lethal? Answer below my name.

          1] Hypertension
          2] Lakphy
          3] Obesity
          4] Smoking

New Yorker cartoon: “Most opera plots could be averted by some decent therapy.”

To prepare folks for ABPN’s written exams, we will begin attaching to Sentinels PowerPoints.  We have attached one on the topic of dementias with this Sentinel and added it to the webpage. If you find some incorrect answers, please let me know. 

Each of the twelve times I have taken the ABPN Recert exam, I have signed a statement saying I will not reveal ABPN questions.  So, my PowerPoints avoids the Board’s multiple-choice questions, questions that tests recognition.  Instead, my PowerPoints require recall, which is harder, but closer to what clinicians need to do.  Studying for recall feels like less of a waste of time than studying for recognition. 

Last year, you will recall, Congress passed a law stopping the feds, Medicare, from going ahead with their plans to switch from ICD-9-CM to ICD-10-CM last October. This year, a Congressional committee has suggested that the feds have done enough preparation for the change.  So, come October 1, the long delayed [since 1992] change may happen.  Some agencies and insurance companies may switch from ICD-IV-TR to DSM-5 at the same time. 

If there is a switch to ICD-10-CM next October, there is no reason to buy anything.  Your copy of DSM-5 has both ICD-9-CM and ICD-10-CM codes.

Should it appear that training to help facilitate the ICD change will help, we expect to be able to provide training.

This month’s AJP has a study from the Netherlands on treating psychosis and mania in the postpartum period with sequential use, first of benzodiazepine, then an antipsychotic if needed, then lithium if the first two fall short, achieving 98% remission in the acute phase and 80% sustained remission.  Psychiatry is not used to “98%” and “80%.” Did they use snake oil? While DSM-5 removes “postpartum,” for those wanting to use finding of “postpartum” in the dx, it is “648.44” in ICD-9-CM and “F53” in ICD-10-CM. [This month’s AJP also has an outstanding book review by Dr. Raymond Crowel and another on Stu Yudofsky’s FATAL PAUSES.]  

Psychotherapies are essential tools in the management of adult depression, but newer psychotherapies, such as acceptance and commitment therapy and cognitive bias modification, are not more effective than existing therapies. [Current Opinion in Psychiatry, 12/22/2014.]
A new Government Accountability Office report slams the Substance Abuse and Mental Health Services Administration (SAMHSA) for doing a lackluster job in coordinating treatment for individuals with serious mental illness.  Restated, E. Fuller Torrey has been heard again, as GAO’s reflections echoes Fuller’s testimony last year.
Electroconvulsive therapy (ECT) appears to be far more effective than algorithm-based drug therapy for treatment-resistant bipolar depression [January American Journal of Psychiatry].
While the use of Botox for the treatment of depression is off-label, the findings from recent studies are so promising that Botox’s parent company, Allergan, has begun clinical trials for its use in treating major depressive disorder in women.  Why study only women?
For severe borderline syndrome, combined therapy of fluoxetine and interpersonal psychotherapy is suggested in Psychiatry Research, 02/05/2015.
Psychiatrists who are on private insurance panels declined 17% in 2009-2010 from 2005-2006, to 55% of psychiatrists.  Medicare is also at 55%. As to Medicaid, 43%. Other medical specialties are 30% higher. [JAMA Psychiatry. 2014;71(2):176-181.]

Correct answer to pop quiz: Lakphy.

Lakphy is the most lethal of the four, especially as one ages.  Smoking is only ahead of the other three in those still in their twenties. [Tufts Health & Nutrition Letter, 5 Jan 2014].  We have all seen lots of focus on treating obesity recently with meds and so forth. One wonders if the treatment of obesity doesn’t touch a pt’s lakphy, will it be effective in reducing cardiac deaths.

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