From the Pages of Psychiatric Times: October 2022

The experts weighed in on a wide variety of psychiatric issues for the October 2022 issue of Psychiatric Times.

In the October issue of Psychiatric TimesTM, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric issues, from research on lithium and suicide prevention to integrative medicine and nutrition for PTSD. Here are some highlights from the issue.

Federal Court Gives Green Light to Deny Coverage

Nearly every psychiatric clinician I know has experienced it: Their patient’s health plan determines—with little justification—that the needed treatment is “not medically necessary.” The clinician is then forced to spend valuable time fighting for coverage of the treatment that is validated by accepted clinical standards of care. Meanwhile, families confront their options: spending life savings, taking on burdensome debt, or going without treatment.

With more than 7.1 million American adults not receiving the mental health treatment they need because of cost, ensuring health plans cover the services patients need is essential to maintaining and increasing access to care. At the root of this issue is who makes the determinations about whether treatment is needed— and what standards should be and must be followed. Continue Reading

Exploring Integrative Medicine and Nutrition for PTSD

Evidence from a growing number of studies suggests that 38% to 40% of adults living in the United States use complementary and alternative medicine (CAM) therapies, yet only 42% have told their primary physician that they do so. Patients do not disclose their use for numerous reasons. They are not asked about it; they are concerned that their clinician will disapprove; they may not think it is necessary; and/or their clinicians are not interested in or do not know about CAM methods.

Moreover, integrative medicine (IM) appeals to groups like veterans who traditionally avoid or experience dissatisfaction with conventional treatment and are prone to posttraumatic stress disorder (PTSD). Hence, clinicians should disclose their interest and training in IM and ask patients about their health practices. Continue Reading

The Most Important Thing You Need to Know About Meta-Analyses

A busy clinician does not have time to read the vast number of randomized controlled trials (RCTs) published about different treatments. But good meta-analyses save us time by aggregating and summarizing data from relevant trials. Individual RCTs are sometimes small and suffer from methodological flaws. The results of RCTs are often influenced by sampling error. Good meta-analyses help us base decisions on larger numbers of subjects and reduce the effects of sampling error. To make the most of meta-analyses, we need to understand the most important information reported by a good meta-analysis. That information is the “prediction interval.” Although meta-analyses can focus on other topics, this article focuses on meta-analyses of treatments.

Using clear rules, a systematic review searches for studies on certain interventions for certain medical conditions. The authors of the study review the data from relevant studies to determine if helpful patterns can be found. Continue Reading

Lithium and Suicide Prevention: More Thoughts on Recent VA Study

There has been much discussion of the recently published large (519 participants) US Department of Veterans Affairs (VA)–sponsored randomized clinical trial of lithium versus placebo to prevent suicide attempts, hospitalizations to prevent suicide, and deaths after a previous attempt. The distinguished group of investigators found no advantage for lithium, and the study was actually interrupted earlier than planned because of the negative results on preliminary analysis.

The authors concluded that “simply” adding lithium to existing medication regimens is unlikely to be effective in preventing a broad range of suicide-related events. An editorial by Baldessarini and Tondo, however, proposed instead that the findings “cannot be taken as evidence that lithium lacks antisuicidal effects” due to numerous serious limitations in the study. Continue Reading

See the full October issue of Psychiatric TimesTM here. And be sure to stay up-to-date by subscribing to the Psychiatric TimesTM E-newsletter.

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