APA Daily Bulletin - Day 3, 2008 - (Page 6) Tuesday The Daily BULLETIN May 6, 2008 Stotland, continued from page 1 with untreated mental illnesses did not elicit editorials calling for better mental health care. Thanks to our efforts, to the courage of public figures who have spoken about their illnesses and recoveries, and to Mental Health America, the National Alliance for Mental Illnesses, and other advocacy groups, most American people today recognize that psychiatric illnesses are real, that treatments are humane and effective, that health insurance should not be discriminatory, and that investment in research improves care. They are worried, as we are, about the psychiatric casualties from Iraq and Afghanistan. We changed public perception, and that is changing our laws. We will have a mental health parity act, and that will be just the beginning. We can shape our future. That will take education, advocacy, and sincerity. A study published just last month in the Annals of Internal Medicine revealed that 59 percent of physicians in the United States and more than 80 percent of psychiatrists, favor laws to establish national health insurance. At our October Institute in Chicago, there will be a debate: single payer versus the plan proposed by the AMA. Learn, and then tell us what you think. Reaching consensus will not be easy. But it is essential. If we take no position, we have no power to shape our future. Secondly, we will have to advocate for our position. We have to walk the halls of state capitols and testify at legislative hearings. We will have a new presidential administration next January. We need to educate the new administration about what our patients need. We have to write opinion pieces and letters to the editor, talk to reporters, and speak at our schools and in our houses of worship, where they are desperate for mental health information. Finally, and most importantly, we have to speak from our values — from our hearts. People don’t respect us as much as they used to. Some of the reasons are beyond our control. Third party payers demand we spend less time with our patients and more time fi lling out forms and begging for authorizations. But we became psychiatrists in order to help people. While others partied, we studied. While others earned, we went into debt. While others went home, we stayed at the bedside, taking responsibility for life-and-death decisions. We sit with our patients, absorbing stories of horrible trauma and heart-wrenching symptoms. When I was responsible for the care of patients in the State of Illinois Department of Mental Health, I went to see one of our hospital medical directors, Joe Parks. On the wall across from Joe’s desk, where he could see it whenever he looked up, he had hung a sign. The sign said “How will it affect the patients?” Our power to shape our future comes from that dedication. We shape our future by taking informed positions, advocating for them, and speaking from our hearts. The November elections offer us a major opportunity to shape our future. We spend more per capita on health care than any other country in the world — without producing more health. What are we doing wrong? Health care costs go up and so does the number of uninsured, who don’t seek care until their problems are catastrophic. Our emergency rooms are clogged with patients for whom there are no resources. Our jails and prisons hold more people with mental illnesses than our hospitals. We have to fill Congress and the White House with people who will do something about that. Most of the people in this country with mental illnesses do not get any treatment. They are not patients — but they are our responsibility — not ours alone, but ours. I believe that when we shape our future, we should begin with our responsibility for those who are least able to help themselves: the poor, members of minority groups, people in rural areas and inner cities. APA has brought together on our web site information about an array of creative and effective state projects that bring psychiatric care to underserved areas, including telepsychiatry, psychiatrist circuit-riders, and insurance coverage for psychiatric consultation to primary care professionals — as a resource for you as you address the underserved areas in your states. The APA has to prepare us for the psychiatry of five and 10 years from now. What will replace your cell phone, PDA, e-mail, and iPod? What new diagnostic and treatment approaches will there be? Our future is going to include some things we have doubts about, like so-called ‘pay for performance.’ There are few aspects of medical ‘performance’ that are both measurable and meaningful. But the idea of paying for performance has a strong appeal to the public. I think the APA has made the right decision under the circumstances — to sit at the table with our colleagues in other specialties and develop standards to shape the future of payfor-performance: demanding evidence-based criteria and the flexibility to adapt our care to the needs of individual patients. If we had refused to participate, others would be making the decisions that will determine our future. We became physicians because we wanted to understand and treat the whole person: body, mind, and soul. We earned our place in the house of medicine. We work every day with other mental health professionals: nurses, so- BRIEF SUMMARY. See package insert for full prescribing information. Increased Mortality in Elderly Patients with Dementia-Related Psychosis: Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Analyses of seventeen placebo controlled trials (modal duration of 10 weeks) in these patients revealed a risk of death in the drug-treated patients of between 1.6 to 1.7 times that seen in placebo-treated patients. Over the course of a typical 10 week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. GEODON (ziprasidone) is not approved for the treatment of patients with Dementia-Related Psychosis. INDICATIONS—GEODON Capsules is indicated for the treatment of schizophrenia and acute manic or mixed episodes associated with bipolar disorder with or without psychotic features. GEODON® (ziprasidone mesylate) for Injection is indicated for acute agitation in schizophrenic patients. CONTRAINDICATIONS —QT Prolongation: Because of GEODON’s dose-related prolongation of the QT interval and the known association of fatal arrhythmias with QT prolongation by some other drugs, GEODON is contraindicated in patients with a known history of QT prolongation (including congenital long QT syndrome), with recent acute myocardial infarction, or with uncompensated heart failure (see WARNINGS). Pharmacokinetic/pharmacodynamic studies between GEODON and other drugs that prolong the QT interval have not been performed. An additive effect of GEODON and other drugs that prolong the QT interval cannot be excluded. Therefore, GEODON should not be given with dofetilide, sotalol, quinidine, other Class Ia and III anti-arrhythmics, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, sparfloxacin, gatifloxacin, moxifloxacin, halofantrine, mefloquine, pentamidine, arsenic trioxide, levomethadyl acetate, dolasetron mesylate, probucol, or tacrolimus. GEODON is also contraindicated with drugs that have demonstrated QT prolongation as one of their pharmacodynamic effects and have this effect described in the full prescribing information as a contraindication or a boxed or bolded warning (see WARNINGS). GEODON is contraindicated in individuals with a known hypersensitivity to the product. WARNINGS—Increased Mortality in Elderly Patients with Dementia-Related Psychosis: Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. GEODON (ziprasidone) is not approved for the treatment of patients with dementia-related psychosis (see Boxed Warning). QT Prolongation and Risk of Sudden Death: GEODON use should be avoided in combination with other drugs that are known to prolong the QTc interval. Additionally, clinicians should be alert to the identification of other drugs that have been consistently observed to prolong the QTc interval. Such drugs should not be prescribed with GEODON. A study directly comparing the QT/QTc-prolonging effect of GEODON with several other drugs effective in the treatment of schizophrenia was conducted in patient volunteers. The mean increase in QTc from baseline for GEODON ranged from approximately 9 to 14 msec greater than for four of the comparator drugs (risperidone, olanzapine, quetiapine, and haloperidol), but was approximately 14 msec less than the prolongation observed for thioridazine. In this study, the effect of GEODON on QTc length was not augmented by the presence of a metabolic inhibitor (ketoconazole 200 mg bid). In placebo-controlled trials, GEODON increased the QTc interval compared to placebo by approximately 10 msec at the highest recommended daily dose of 160 mg. In clinical trials the electrocardiograms of 2/2988 (0.06%) GEODON patients and 1/440 (0.23%) placebo patients revealed QTc intervals exceeding the potentially clinically relevant threshold of 500 msec. In the GEODON patients, neither case suggested a role of GEODON. Some drugs that prolong the QT/QTc interval have been associated with the occurrence of torsade de pointes and with sudden unexplained death. The relationship of QT prolongation to torsade de pointes is clearest for larger increases (20 msec and greater) but it is possible that smaller QT/QTc prolongations may also increase risk, or increase it in susceptible individuals, such as those with hypokale
Table of Contents Feed for the Digital Edition of APA Daily Bulletin - Day 3, 2008 Contents Campus Violence Health Technology Frontiers in Science APA Daily Bulletin - Day 3, 2008 APA Daily Bulletin - Day 3, 2008 - Contents (Page 1) APA Daily Bulletin - Day 3, 2008 - Contents (Page 2) APA Daily Bulletin - Day 3, 2008 - Campus Violence (Page 3) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 4) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 5) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 6) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 7) APA Daily Bulletin - Day 3, 2008 - Frontiers in Science (Page 8)
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