Psychiatric Times Vol 16 No 3

This is the first in a series of articles summarizing research presented at the 1998 American College of Neuropsychopharmacology Annual Meeting.

Migration - Poetry of the Times

Lately, things have not been going well for some of the nation's largest health plans. Lawsuits have managed care organizations around the country worried that their cost-cutting measures may end up penalizing them with liabilities in the hundreds of millions of dollars.

Efforts are underway to persuade the Health Care Financing Administration (HCFA) to expand Medicare coverage for positron emission tomography, popularly known as PET scanning. At present, the government only reimburses charges for PET scans in connection with the diagnosis of lung cancer.

Concerned about increasing medical costs, Congress began to tinker with physicians' fees under Medicare with the Omnibus Budget Reconciliation Act of 1989. The result, the Resource-Based Relative Value Scale (RBRVS), altered our fees in the Medicare system.

Daniel F. Kripke, M.D. has studied the relationship between biological rhythms and depression since the early 1970s. He states that seasonal responses in many mammals are controlled by the photoperiod. Therefore, it seemed that depression might be analogous to winter responses and that light might be an effective treatment.

Despite the development of better-tolerated antidepressants and more effective applications of nondrug modalities like cognitive-behavioral therapy, depressive disorders are often chronic or recurrent. The researchers point out that there has been relatively little evaluation of chronic depression, with most studies addressing short-term treatment of acute episodes.

Given that passion, opinion, opportunism and inertia have shaped much of managed care's evolution, there is an increasing need for the systematic gathering and rational application of facts. Outcome evaluations and insights into what facilitates and what impedes efficient and effective care are now avidly sought, not only for improving care delivery and treatment effectiveness but also for regulatory functions and commercial promotion.

Insomnia, the subjective sense of having inadequate quantity or quality of sleep, occurs in 20% to 35% of the general population. Not surprisingly, many insomniacs describe a variety of difficulties in their personal and professional lives.

In recent years, melatonin has been touted in the media as a "hot sleeping pill, natural and cheap" and as the drug that "may help ease insomnia, combat jet lag...and extend life." Trials are finally being conducted. Across the United States, some 30 medical centers are studying melatonin as a potential treatment for sleep disturbances.