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Clinical Ps
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News
www.clinicalpsychiatrynews.com
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The Leading Independent Newspaper for the Psychiatrist—Since 1973
M
AY
2006
Trauma Takes TollOn Young Refugees
BY SHARON WORCESTER
Southeast Bureau
M
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— Posttrau-matic stress disorder symptomsare emerging as a common andoften unrecognized result oftheimmigration experience, Dr. Eu-genio M. Rothe reported at theannual meeting ofthe AmericanSociety for Adolescent Psychiatry.In his work treating young refugees, he has found that manyexperience posttraumatic stressdisorder (PTSD; see box, page 37.)For example, the refugees con-fined in the early 1990s to thecamps at the U.S. Naval StationGuantanamo Bay, Cuba, had toendure the indignities ofcampconfinement, after being inter-cepted at sea and before eventu-ally being admitted to the UnitedStates. During their sea journeys,they experienced trauma that of-ten included witnessing deathand corpses offamily members being devoured by sharks. At one point, the camps con-tained 32,000 refugees in a 42-square-mile area, where peoplelived in tents with up to 14 people,often strangers. The accumula-tion oftraumatic events such asthese takes its toll, said Dr. Rothe,director ofthe child and adoles-cent psychiatry clinic at the Uni-versity ofMiami. He describedseveral studies focusing on PTSDin children and adolescents.In a study ofthe first 301refugees from these camps whowere aged 3-19 years and whosought, or were referred for, psy-chiatric services, 84% of preschool-age girls and 91% of preschool-age boys scored in the“very severe” range on the Post-traumatic Stress Disorder Reac-tion Index. Most ofthe school-ageand adolescent children (thoughfewer than in the preschoolgroup) also scored in this range. A second study assessed cog-nitive-related PTSD symptomsin a subpopulation ofrefugeeswho first traveled to the Cayman
BY ALICIA AULT
Associate Editor, Practice Trends
I
n a not unexpected but defi-nitely unwelcome move, theCenters for Medicare and Medic-aid Services has announced thatit will cut physician pay by 4.6%for 2007.The federal health programsaid the scheduled decrease inphysician fees is based partly onthe fact that spending for physi-cians’ services rose by 8.5% in2005, with 7.5% ofthat rise dueto growth in the volume and in-tensity ofphysician services.But physician organizations blame the hit on the sustainablegrowth rate (SGR). IfMedicarespending on physicians increasesmore than the SGR, CMS mustcut physician fees; lower spend-ing means higher rates for physi-cians. But errors made in setting the SGR in 1998 and 1999 haveled to annual proposed cutbacksand yearly congressional bailouts.Last year, for instance, medicalorganizations successfully lob- bied Congress to block a pro-posed 4.4% cut for 2006, but be-cause legislators did not increasefees, payments essentially werefrozen at the 2005 rate.
Transdermal methylphenidate approved.
New Patch for KidsMay Broaden UseOf ADHD Therapy
CMS to Cut PhysicianPay by 4.6% in 2007
BY ROBERT FINN
San Francisco Bureau
T
he Food and Drug Ad-ministration’s approval of a transdermal methyl-phenidate patch for the treat-ment ofattention-deficit hyper-activity disorder in childrencould broaden use ofthe drug for patients who need it.“Some patients may have diffi-culty swallowing the tablets, andpatients may prefer to use thepatch,” Dr. Joseph Biederman,professor ofpsychiatry at Har-vard Medical School, Boston, saidin an interview. “So it’s a technol-ogy that may allow physicians toexpand the repertoire ofchoices.”Dr. Thomas Laughren, direc-tor ofthe FDA’s division ofpsy-chiatric products in Rockville,Md., agreed. During a meeting of the FDA’s PsychopharmacologicDrugs Advisory Panel in De-cember, the agency heard fromseveral advisers and others that a“substantial fraction” ofchildrenhave difficulty taking pills, Dr.Laughren said during a mediateleconference sponsored by theFDA. “They felt that this would be an important addition to theavailable treatments for ADHD.”Dr. Richard Gorman said in aninterview that he also thinks thatanother dosage form will openuse ofthe drug for patients whohave had difficulty withmethylphenidate in the past.
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Dr. Eugenio M. Rothe, director of the University of Miami’s childand adolescent psychiatry clinic, has treated many refugees.
Reel Life
‘Grizzly Man’ shows director Werner Herzog’s enduring attraction to danger.
PAGE 16
BorderlinePersonality
Twenty-week cognitive-behavioral program shows promise.
PAGE 36
Alzheimer’sDisease
Researchers are hot onthe trail ofselectivenicotinic agonists.
PAGE 64
See
Refugees
page 37
INSIDE
See
ADHD Patch
page 38See
CMS
page 78
Top 10 Diagnoses by Psychiatrists in 2005
SchizophreniaOther adjustment reactionsParanoid schizophreniaMajor depressive disorder,recurrent episodeDysthymic disorderAttention-deficit disorderBipolar I disorderAnxiety statesDepressive disorderMajor depressive disorder,single episode
Note: Based on projected nationwide data from a monthly survey ofabout 162 psychiatrists.Source: Verispan
11.5%10.8%10.6%7.6%6.5%4.8%4.7%3.3%2.6%2.5%
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