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Dr Yasmeen Rashid, Health Minister GOP, visited Institute of Psychiatry, Benazir Bhutto Hospital Rawalpindi yesterday. It was so encouraging to know that mental health care will be the top of their public health policy. Let’s hope for the best 🤞


السلام وعلیکم
آپ اور آپکے اہل خانہ کو میری طرف سے عید قربان بہت بہت مبارک ہو .
دعاگو ہوں رب کریم آپکو عید جیسی لآ تعداد خوشیاں نصیب فرماۓ.
آمیـــــــــــــن صبح بخیر
عید مبارک ۔۔۔💐💐


New US Diabetes Prevalence Data Distinguish by Disease Type

Diana Phillips
March 30, 2018
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Approximately 23 million adults in the United States are living with diabetes, and of these, nearly 6% have type 1 disease, according to new surveillance data from the Centers for Disease Control and Prevention (CDC).
Unlike previous estimates that did not distinguish between types of diabetes, the new estimates are based on data collected in the 2016 National Health Interview Survey, which included supplemental questions to help classify diabetes by disease type, report Kai McKeever Bullard, PhD, from the CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, and colleagues. The study, published March 30 in the Morbidity and Mortality Weekly Report, is the first to estimate the prevalence of diagnosed type 1 and type 2 diabetes according to self-report and current insulin use among US adults.
The ability to estimate diabetes prevalence by disease type is important, the authors stress, because it allows for more accurate monitoring of trends and targeted planning and prioritization of public health responses.
The nationally representative 2016 National Health Interview Survey sample consisted of 33,028 adults aged 18 years or older, with a final response rate of 54.3%. Of these, 3519 respondents self-reported diabetes, including 2897 with type 2 diabetes and 211 with type 1 diabetes. An additional 98 cases were classified as "other" type, such as maturity-onset diabetes of the young or latent autoimmune diabetes in adults, and 1 was classified as unknown, the authors report.
The respective prevalence rates for type 1 diabetes, type 2 diabetes, and other forms of the disease were 0.55%, 8.58%, and 0.31%.
"Based on the weighted [National Health Interview Survey] population, the estimated numbers of adults with type 1, type 2, and other diabetes types were 1.3 million, 21.0 million, and 0.8 million, respectively," the authors write. They note, however, that prevalence rates varied by age, sex, and race/ethnicity, depending on the disease type.
For type 1 diabetes, the prevalence was significantly higher among men (0.64%) than among women (0.46%; P < .05). It was also higher among non-Hispanic whites (0.67%) than among Hispanics (0.22%; P < .01). Significant differences were observed in the prevalence of type 2 diabetes among non-Hispanic blacks (11.52%), non-Hispanic Asians (6.89%), non-Hispanic whites (7.99%), and Hispanics (9.07%; P < .001).
Further, type 2 disease was most prevalent in adults 65 years and older and least prevalent in those aged from 18 to 29 years (P < .001). Prevalence decreased with higher levels of education (P < .001).
The observed variations in prevalence of type 1 and type 2 diabetes are notable from a surveillance perspective, according to the authors.
"Because the prevalence of type 2 diabetes is so much higher than that of type 1, current diabetes surveillance data that do not distinguish diabetes type are more reflective of persons with type 2 diabetes," they state. The etiology, treatment, and outcomes of the disease vary by type, however, so action planning tied to nondifferentiated surveillance data does not meet the needs of the smaller type 1 diabetes population.
Although limited by the reliance on self-reported diagnoses and insulin use, underestimation of total diabetes prevalence, and potential misclassification of diabetes type, the study provides important information for monitoring trends by disease type and creating targeted education and prevention programs, the authors explain. "Knowledge about national prevalences of type 1 and type 2 diabetes might facilitate assessment of the long-term cost-effectiveness of public health interventions and policies aimed at improving diabetes management and help to prioritize national plans for future type-specific health services," they write.
The authors have disclosed no relevant financial relationships.
Morb Mortal Wkly Rep. 2018;67:359-361. Full text
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Cite this article: New US Diabetes Prevalence Data Distinguish by Disease Type - Medscape - Mar 30, 2018.
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The US Food and Drug Administration (FDA) has cleared for marketing the first prescription mobile medical application to help treat substance use disorders (SUDs) involving alcohol, cocaine, marijuana, and stimulants, but not opioid dependence.
The reSET application, from Pear Therapeutics, should be used in conjunction with both outpatient therapy and a contingency management system, a widely used program for treating SUD that utilizes a series of incentives to reward patients for adherence to their treatment program, the FDA says.


Eid hai khuda ka ek nayam tabarok,
Eisi liye kahte hai sab EID MUBARAK




News & Perspective > Conference News
Antidepressants in Youths: No Link to Suicidal Behavior?

Nancy A. Melville
April 20, 2017
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SAN FRANCISCO – Youths treated for anxiety with antidepressants or psychotherapy show similarly increased risks for suicidal behaviors regardless of the type of treatment, new research shows.
These findings add support to evidence that antidepressant medication may not, on their own, cause suicidality but that the mental illness itself that may be the culprit.
"Youth with anxiety disorders who subsequently develop depressive symptoms as adolescents or young adults are at an increased risk of suicidal ideation or behavior, regardless if they receive treatment with an antidepressant or psychotherapy," senior author Dara Sakolsky, MD, PhD, assistant professor of psychiatry at the University of Pittsburgh and associate medical director of Services for Teens at Risk (STAR) at Western Psychiatric Institute and Clinic, in Pennsylvania, told Medscape Medical News.
Dr Sakolsy presented the study here at the Anxiety and Depression Association of America (ADAA) Conference 2017.
Black Box Warning

The findings are from the Child/Adolescent Anxiety Multi-Modal Extended Long-term Study (CAMELS), which evaluated outcomes of youths and adolescents for up to 5 years after they had undergone treatment for anxiety in the original Child/Adolescent Multi-Modal Study (CAMS). Treatment consisted of either the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft, Pfizer), cognitive-behavioral therapy (CBT), a combination of the two, or placebo.
The original study of 488 patients showed that the strongest treatment effects occurred in the patients who received combination treatment, followed by those who received CBT and those who received antidepressants, which had similar effects.
In delving into a multitude of long-term outcomes observed at 5-year follow-up, the investigators examined the relationship between anxiety treatments and subsequent suicide behaviors, outcomes particularly relevant following the issuance of a black box warning on SSRIs by the US Food and Drug Association (FDA) after some studies linked the drugs to suicidal behaviors.
The black box warning was expanded in 2007 to include the important caveat that depression was itself associated with a risk for suicide.
In the follow-up study of 319 youths, aged 7 to 17 years, who were enrolled from the previous CAMS trial, 54.9% of patients used any SSRI medication (sertraline being the most commonly used [37.6%]); 7.8% used any serotonin norepinephrine reuptake inhibitor; 12.2% used other antidepressants; and 43.9% used other medications.
Overall, 33% of patients in the CAMELS follow-up study reported any suicidal events. Of these patients, 32.7% reported suicidal ideation, described as wishing to be dead, and 8.5% reported suicidal behavior, described as preparatory acts or suicide attempts.
The risk for suicidal behaviors was significantly higher in current SSRI users compared to those who had never used SSRIs (odds ratio [OR] 2.72; P = .01) as well as in current users compared to those who had used SSRIs in the past (OR 1.93; P = .02).
There was no significant increased risk for suicidal behaviors, however, among those who used SSRIs in the past and those who had never used the drugs (P = .41).
The suicidal behavior risk relating to overall use of any antidepressant compared to no antidepressant use was also significant (OR, 2.34; P = .001). A similarly increased risk was seen with treatment with psychotherapy compared to no psychotherapy (OR, 2.50; P = .0001).
Other factors found to be associated with an increased risk for suicidal behaviors included extended time between therapy visits, depression severity, and baseline child-reported depression symptoms (P = .05).
Additional findings relating to suicidal behavior outcomes from the CAMELS study, also presented at the meeting, showed that patients who achieved remission in the original CAMS study were at reduced risk for suicidal behaviors in the long-term follow-up and had reduced depressive symptoms.
The analysis also showed that higher depressive symptoms prior to treatment was predictive of all mood outcomes. Family dysfunction and negative life events were predictors of suicidal ideation.
Growing Evidence

The results are consistent with randomized controlled trials conducted since the FDA black box warning that support the theory that treatment-seeking for anxiety or depression is associated with greater risk for suicidal behaviors than SSRI use. Nevertheless, concerns linger in the public, particularly among parents.
"Parents often ask about the long-term consequences of treating anxious youth with an SSRI," Dr Sakolsky said.
"The CAMELS data are reassuring in this regard. They show that appropriate, time-limited use of SSRIs for treatment of anxiety disorders does not increase risk of suicidal thoughts or behavior in the long term."
The black box warning itself helped generate evidence of the benefits vs risk of antidepressant use by demonstrating changes in behavior patterns after the significant decline in prescriptions that followed the FDA warning, Dr Sakolsky said.
One study, for example, showed that after rates of suicide among youths aged 10 to 19 years had declined during a 20-year period, those rates increased abruptly in 2003-2004, an increase that corresponded with the FDA warning, widespread media coverage, and a subsequent drop in SSRI prescriptions.
Another study showed a significant increase in poisonings from psychotropic drugs that corresponded with the drop in antidepressant prescribing after the FDA warnings.
"For that study, psychotropic poisoning was used as a proxy for suicide attempt, because they found it was one of the most reliable measures in their database for describing suicide. So if anything, the study is probably underreporting suicide attempts," Dr Sakolsky said.
She pointed to another study that showed suicide attempts in the 3 months before and after initiation of treatment soared just before treatment and subsided by month 6 to rates below that for the 3 months prior to treatment. Similar patterns were seen for antidepressant therapy and psychotherapy.
"What these large pharmacological epidemiological studies show us is that suicide attempts often initiate rather than follow treatment with SSRIs or therapy, and greater SSRI use is associated with lower rates of suicide attempt and completed suicide," she said.
The CAMS and CAMELS studies were funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.
Anxiety and Depression Association of America (ADAA) Conference 2017. Presented April 7, 2015.


Early Intervention Program Tackles Anxiety in Primary Care

Nancy A. Melville
April 18, 2017
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SAN FRANCISCO – A behavioral therapy program for the treatment of anxiety in primary care yields benefits to a large patient population who often receive suboptimal treatment – if any at all.
"We know anxiety disorders are much more likely to show up in a primary care setting long before they end up in a specialty mental health setting, and usually that delay can be several years. So, it's an important opportunity to try to treat these anxiety patients right at the primary care level," Craig N. Sawchuk, PhD, of the Mayo Clinic, in Rochester, Minnesota, told delegates attending the Anxiety and Depression Association of America (ADAA) Conference 2017.
The Mayo Clinic's Integrated Behavioral Health psychotherapy program, which is embedded in the system's primary care settings, focuses on providing short-term, evidence-based cognitive-behavioral therapy (CBT) in one to 10 sessions.
One aspect of the program that makes it unique is the detailed tracking of evidence-based interventions and patient outcomes on a session-by-session basis.
Dr Sawchuk described data from June 2014 through February 2017 on five primary care clinics in Rochester, Minnesota.
Of the 928 patients diagnosed with primary anxiety in the sample, 562 received one or more CBT sessions. Treatments included cognitive interventions (85%), exposure therapy (67%), behavioral activation (50%), motivational engagement (45%), skill building (44%), and relaxation (24%).
Patients attended an average of 3.65 sessions over 13.67 weeks. Significant improvements were found from the initial visit to the final session (for all, P < .001) in scores on the Generalized Anxiety Disorder–7 (GAD-7) and the Patient Health Questionnaire–9 (PHQ-9). For the entire sample, the rate of response on the GAD-7 was 35%, and the rate of remission was 23%.
Significant Commitment Required
The tracking data were further stratified according to type of anxiety disorder. In a sample of 298 patients treated specifically for generalized anxiety disorder (GAD), the most common treatment offered was cognitive intervention (90%), followed by exposure therapy (64%) and skill building (47%). Those patients attended an average of 3.24 sessions. Changes on the GAD-7 and PHQ-9 were both significant (all P < .001); 37% of patients achieved response on the GAD-7, and 24% achieved remission.
For those treated for panic disorder (n = 35), the majority received exposure therapy (87%), followed by cognitive (71%), motivational (42%), and relaxation (13%) interventions. The patients attended an average of 3.08 sessions. Significant improvements were seen in scores on the GAD-7 (P < .007) and the PHQ-9 (P < .009); 31% achieved response on the GAD-7, and 13% achieved remission.
Among 43 patients with obsessive-compulsive disorder, interventions included exposure therapy (80%), cognitive therapy (74%), and skill building (37%). The average number of sessions was 5.46. Significant improvements were found on the GAD-7 (P < .001) but not the PHQ-9. GAD-7 response and remission rates were 33% and 22%, respectively.
For patients with posttraumatic stress disorder (PTSD) (n = 26), cognitive therapy was the most common intervention (80%), followed by exposure therapy (70%) and behavioral activation (60%). Patients with PTSD attended the highest average number of sessions (6.10). Changes in scores on the GAD-7 (P < .007) and PHQ-9 (P < .04) were both significant; 23% of patients achieved response on the GAD-7, and 13% achieved remission.
In comparing the results with the Coordinated Anxiety Learning and Management (CALM) trial from 2010, the rates of response and remission for patients with specific anxiety disorders in the Mayo Clinic's sample were lower.
Unlike the findings from the CALM study, the Mayo study's findings are not representative of a highly structured, controlled research study. Instead, they reflect routine practice, which has very little, if any, selection or exclusion criteria, Dr Sawchuk said.
"Routine practice studies such as ours may also result in shorter courses of care than research-funded studies," he told Medscape Medical News.
The improvements are an important indicator of progress that can be made with the inclusion of mental health services in primary care. A critical aspect of that provision is training in evidence-based practices, Dr Sawchuk noted.
The Mayo Clinic conducts weekly psychotherapy case consultations with all primary care psychotherapy providers and monthly psychotherapy training seminars on specific evidence-based approaches, which helps to prevent the tendency for providers to drift back to therapy practices that may not be effective.
"These [efforts] require a significant investment on the part of the institution to allow for protected time for skill development," Dr Sawchuk said.
Serious Lack of Evidence-Based Care
The payoff is an emphasis on evidence-based care, which, particularly for anxiety disorders, is sorely lacking, not just in primary care but among mental health providers in general, he said.
"We know that the interventions known to be least effective for anxiety, such as distraction and, to some degree, relaxation, are in fact used the most frequently, while strategies known to be the most effective – exposure-based interventions ― are used the least, so there is a tremendous quality control issue."
With panic disorder, for example, evidence strongly favors the benefits of exposure therapy, which involves gradual but repeated confrontation of the triggers of the patient's fears.
"Our mantra is to get those patients to exposure therapy as soon as possible," Dr Sawchuk noted.
Research suggests that the use of exposure therapy among providers is low. This may be due to the fact that some providers are not trained in exposure therapy or that providers have fears or misconceptions about the approach, Dr Sawchuk said.
"[Misconceptions] can include that exposure therapy can be harmful, or feel it's not good to make patients upset," he said.
In addition, exposure therapy may require more time and effort than is typically available in primary care practices.
"Some patients may need a bit more help with the groundwork of preparing themselves to do exposures, [such as] motivational engagement exercises.
"However, this is the best treatment we can offer, and therefore, it's our duty to make sure that consumers are made aware of and have access to such treatments."
Praise for Mayo Program
In previous research, Risa B. Weisberg, PhD, and colleagues reported findings that underscore the low utilization of exposure therapy in primary care.
"We found that while a third of patients were receiving psychotherapy, only 13% were getting cognitive techniques, and only 5% received exposure therapy," Dr Weisberg told Medscape Medical News. Dr Weisbert is assistant chief of psychology at the VA Boston Healthcare System and is professor of psychiatry at the Boston University School of Medicine.
She echoed the problem that some practitioners are not comfortable providing exposure therapy.
"Many therapists avoid engaging their patients in exposure, as this treatment technique inherently involves encouraging your patient to become distressed and uncomfortable – which is distressing and uncomfortable to many providers," said Dr Weisberg, who is not involved in the Mayo Clinic program.
Consequently, many turn to the easier option of writing a prescription, as was demonstrated in a study from 2007 by Dr Weisberg's team.
"We found that nearly half of primary care patients with anxiety disorders weren't receiving any treatment; 21% were receiving only pharmacotherapy; 24.5% were receiving both medications and psychotherapy of some sort; and 7% were getting only psychotherapy. So, overall, pharmacotherapy was more common than psychotherapy," she said.
Dr Weisberg underscored the value of the Mayo Clinic's program in addressing many of these shortcomings.
"The wonderful thing about what Mayo Clinic is currently doing is that they are providing in-depth training and continued support to their primary care behavioral providers on how to best treat anxiety," she said.
"Many healthcare systems assume that professionals hired into clinical positions will know which treatments are most effective and how to implement them.
"Mayo Clinic isn't making this assumption – they are providing this training."
The authors and Dr Weisberg have disclosed no relevant financial relationships.
Anxiety and Depression Association of America (ADAA) Conference 2017. Presented April 7, 2017.




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