Researchers find genetic biomarker that could indicate mental illness in women

Patients' behaviors and feelings often serve as identifying factors for psychiatric disorders, which can make diagnoses difficult. Researchers at the University of California San Diego School of Medicine have discovered that the over-production of specific genes may indicate mental illness in female psychiatric patients, according to a study published in the journal EBioMedicine.

The gene XIST, which deactivates one of the two X chromosomes in cells responsible for storing genetic material, works too hard in female patients who have mental illnesses such as bipolar disorder, major depression and schizophrenia. According to the study, over-production of XIST and genes from the inactive X chromosome are common factors in patients with psychiatric disorders and rare chromosome disorders like Klinefelter syndrome and Triple X syndrome.

"There has been an utmost urgency to identify biomarkers for mental illness that could significantly impact research and drug development, said XianJin Zhou, assistant professor in the UCSD Department of Psychiatry and lead author of the study.

About half of the participants—most of whom had a family history of mental illness—had unusually higher levels of XIST and other genes related to the X chromosome. Zhou and his team said stopping the abnormal activity of the inactive X chromosome may be a new strategy for treating those with psychiatric disorders. "These results are powerful in that early diagnosis of mental illness could possibly happen with a simple blood test, leading to better interventions, therapy and treatment options," Zhou said.

Seniors get a lot of anti-anxiety drugs, sometimes in dangerous combination with narcotics; Ky. ranks third in the nation in that

When Medicare's drug program, called Part D, was put into place more than a decade ago, Congress decided to not pay for anti-anxiety medications. In 2013, when Medicare started paying for them, the program went from spending nothing for these medications to paying more than $377 million, Charles Ornstein and Ryann Grochowski Jones report for ProPublica, a nonprofit, investigative news organization.

Using anti-anxiety drugs in combination with narcotics increases the risk of overdoses, but Kentucky has many doctors who prescribe a lot of both. More than 100 Kentucky doctors each wrote at least 1,000 prescriptions for both types of drugs in 2013, according to data compiled by ProPublica.

That ranked Kentucky third in the nation, trailing only Florida and Alabama. Other southeastern states dominated the top 10. California, the nation's most populous state, ranked eighth; Tennessee was fourth and Ohio was ninth.

ProPublica has an application that lets you look up, by doctors' names, cities or ZIP codes, the number of Medicare claims they filed in 2013, the amount of money, the number of patients and the number of prescriptions for brand-name drugs.

The anti-anxiety drugs, some known as benzodiazepines, include popular tranquilizers such as Valium, Xanax and Ativan. 

Lawmakers initially chose to keep them out of Medicare Part D because they had been linked to abuse and an increased risk of falls among the elderly. Doctors kept prescribing them to Medicare enrollees, who found other ways to pay for them.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, ProPublica found. Generic versions of Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam) were among the top 32 most-prescribed medications in Medicare Part D that year.

The American Geriatrics Society "discourages the use of benzodiazepines in seniors for agitation, insomnia or delirium because they can be habit-forming and disorienting and their effects last longer in older patients." The society does say the drugs "are appropriate to treat seizure disorders, severe anxiety, withdrawal and in end-of-life care," ProPublica notes.

One geriatric psychiatrist told ProPublica that the drugs are a "very real safety concern" for the elderly, and that he and others in his field don't use them as a "first-, second-, or third- line of treatment." Some geriatric psychiatrists have voiced concerns that these drugs are now being used instead of antipsychotics, since Medicare has pushed to reduce the use of antipsychotics, particularly in nursing homes, because of their risks.

Several doctors who rank among Medicare's top prescribers of the drugs told ProPublica that any risks of anti-anxiety drugs are outweighed by their benefits. One said that the drugs worked well for his patients, many of whom were trying to kick addictions to narcotics, but struggled with anxiety and depression.

However, ProPublica also found that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, which increased the risk of misuse and overdose. That's where Kentucky ranked third.

Dr. Leonard J. Paulozzi, a medical epidemiologist at the federal Centers for Disease Control and Prevention, co-authored an analysis showing that benzodiazepines were involved in about 30 percent of the fatal narcotic overdoses that occurred nationwide in 2010, ProPublica reports.

Law requires equal access to mental-health and drug-abuse treatment, but is not always obeyed; Ky. says it's working on issue

By Melissa Patrick
Kentucky Health News

By law, mental health benefits must be offered equally to medical and surgical benefits if the plan offers them, but this isn't always the case.

Not only does a 2008 federal law require most employer-sponsored plans to provide equal access to mental health benefits, but that parity was expanded and strengthened in 2010 by the Patient Protection and Affordable Care Act. Twenty-three states, including Kentucky since 2000, require some level of parity.

Common requirements of these laws prohibit insurers from charging higher co-payments and deductibles for mental-health services; require insurers to pay for mental-health treatment in the same scope and duration as medical treatments; ban insurers from requiring additional authorizations for mental-health services; and says they must offer an equal number of mental-health providers and approved drugs.

While insurers typically keep track of the copayment and deductible requirements, they struggle with keeping track of the compliance requirements related to actual delivery of medical services, Michael Ollove reports for Stateline.

The spokeswoman for the Kentucky Department of Insurance, Ronda Sloan, said in an e-mail that Kentucky is very diligent about parity requirements. "Kentucky insurance companies must cover mental-health treatment like other covered services," she wrote. "We review both provider networks and drug formularies for compliance and (make sure) both meet the requirements of the ACA."

A recent report by the National Alliance on Mental Illness found that this isn't always the case. Nearly one-third of those surveyed were denied authorization for mental health and substance abuse treatment, with this rate nearly twice as high for those on ACA plans.

It also found other barriers to care including the number of mental health providers in health insurance plan networks; more than half of the health plans analyzed covered less than 50 percent of anti-psychotic medications; high out-of-pocket costs for prescription drugs; high co-pays, deductible and co-insurance rates; and a lack of information about mental health coverage to consumers to help them make informed decisions in choosing their health plans.

The survey was conducted by Avalere Health and is based on a survey of 2,720 individuals with mental illness or with someone in their family with mental illness and an analysis of 84 insurance plan drug formularies in 15 states.

Sloan said that in Kentucky, "Work is being done on many fronts to increase access and progress is being made to address some of the access issues."

She said Kentucky monitors provider networks to make sure they are meeting their minimum requirements. She also said that a recent law passed by the 2015 General Assembly, which created three levels of drug and alcohol counselors with varying degrees of  certification, will have a "positive impact" on access to treatment.

Gwenda Bond, spokeswoman for the state Cabinet for Health and Family Services, said in an e-mail, "We also opened the provider network for behavioral-health services in early 2014 to a range of private providers of such services, increasing the number of options available for members, who previously could only receive treatment through the community mental health centers."

One of the main obstacles for consumers and providers is that it is not clear what criteria insurance companies and managed-care Medicaid organizations use to determine medical necessity for mental-health and substance-abuse care, and aren't transparent with this information.

"Without that information," Ollove wrotes, "it is difficult for regulators and consumers to determine whether the denial of coverage is warranted." 

Ollove also notes other problems include the federal governments delay in creating regulation guidelines, the challenges states and the federal government have had in simply implementing the ACA, let alone regulating parity and the stigma that is still associated with mental illness and addictions that make regulators not want to get involved.

Two states, New York and California, are leading the way in enforcing parity rules, Patrick Kennedy, a former Democratic congressman from Rhode Island, told Ollove, saying that they were the "only states that consistently enforce mental health parity."

Sloan took issue with that, saying, "We believe Kentucky consistently enforces the rules related to mental health and substance abuse parity." 

Kentuckians who believe they have been improperly denied mental-health and substance-abuse care should contact the Department of Insurance.

Kentucky gets an $8.1 million federal grant to help teachers, other school personnel recognize students' mental-health needs

The Kentucky Department of Education has been awarded a five-year, $8.1 million federal grant to teach school personnel how to identify mental-health issues and get students the help they need, Brenna R. Kelly reports for Kentucky Teacher.

KDE was one of 120 state and local education agencies to get an Advancing Wellness and Resilience in Education grant last fall as part of President Obama's "Now Is The Time" initiative to decrease gun violence, increase access to mental health services and increase school safety.

It is estimated that up to one out of five children living in the U.S. experience a mental disorder in a given year, according to the National Research Council and Institute of Medicine.

Gretta Hylton of KDE’s Office of Next Generation Learners believes "that both KDE and local districts will be in a better position to get students the mental health help that they need," Kelly writes.

The grant program, Kentucky AWARE, will also create social media marketing campaigns, community events to promote mental health awareness and offer training on trauma-informed care in each of the pilot districts, to be provided by the Center on Trauma and Children at the University of Kentucky.

“More people will be able to recognize and respond appropriately to mental health issues in children,” Hylton told Kelly, “and will know how to connect those individuals with services in their hometown.”

Kentucky AWARE will be piloted in Jefferson County, Fayette County and Pulaski County schools and then move statewide. Hylton told Kelly that the three districts were chosen partly because they already have some mental-health and behavioral-intervention programs.

In addition to KDE, AWARE grants were awarded to Jefferson County, Fayette County, Bullitt County, Corbin Independent, Covington Independent and Henderson County school districts and to the Northern Kentucky Cooperative for Educational Services, Kelly reports.

School personnel, first responders, parents and anyone who interacts with youth in the pilot counties will be offered Youth Mental Health First Aid training, Kelly writes. Hylton told Kelly that she expected more than 10,000 people across the state to be trained at the end of the five-year grant.

Pain and fever reducer acetaminophen, most-used drug in U.S., is found to reduce positive emotions and reduce psychological pain

Ohio State University researchers discovered a new side effect of acetaminophen, a leading over-the-counter pain reliever: it also blunts positive emotions. Other research revealed that it helps reduce psychological pain. The drug has been used in the U.S. for more than 70 years and is best known by the brand name Tylenol.

In the Ohio study, participants took Tylenol or a placebo, then looked at very pleasant or very disturbing photos. Those in the experimental group reported weaker emotions than those in the control group. On average, those who took the placebo rated their level of emotion when viewing the photos at 6.76 on a scale of 10, while people who took the pain reliever averaged 5.85.

"Rather than just being a pain reliever, acetaminophen can be seen as an all-purpose emotion reliever," said Geoffrey Durso, the lead author of the study and a doctoral student in social psychology.

Balwin Way, an assistant psychology professor who conducted the study with Durso, said those who took Tylenol didn't seem to be aware they were reacting differently. "Most people probably aren't aware of how their emotions may be impacted when they take acetaminophen," he said.

Acetaminophen, found in more than 600 medicines, is the most common drug in the U.S., according to the Consumer Healthcare Products Association. Every week approximately 52 million American adults, 23 percent of the population, use a medicine with acetaminophen in it. Durso said researchers don't know if other pain relievers like ibuprofen and aspirin have similar effects, but they plan to study that question.

Study: Loneliness increases risk of dying more than obesity

Kentucky Health News

Loneliness increases your chance of dying, according to a study by Brigham Young University and published in the journal Perspectives on Psychological Science. It found that the subjective feeling of loneliness increases risk of death by 26 percent, social isolation increases mortality risk 29 percent and living alone, 32 percent.

"The heightened risk for mortality from a lack of social relationships is greater than that from obesity," the study report says.

“This is something that we need to take seriously for our health,” Julianne Holt-Lunstad, an author of the study, told Justin Worland of Time magazine. “This should become a public-health issue." 

The researchers noted the difference between feelings of loneliness and the state of being socially isolated or alone and found that "both are potentially damaging."  Even those who said they were happy being alone had an increased risk of death, as did those who had many social connections, but said they were lonely. And though more conclusive data is needed,  those who felt lonely and were alone "may be at the greatest risk of death," Holt-Lunstad told Worland,

“If we just tell people to interact with more people, that might solve the social-isolation issue, but it might not solve the loneliness issue,” she told Worland. “I think we need to acknowledge that both of these components are important.”

Research shows that relationships improves health by "helping us manage stress, improving the functioning of the immune system and giving meaning to people's lives," Worland writes.

But with more Americans living alone than ever before and technology like texting and social media minimizing "flesh and blood" social connections, opportunities for loneliness and social isolation have increased.

Holt-Lunstad  told Worland that policy interventions for this issue might be difficult, but suggested that health-care providers need to begin identifying at-risk patients and communities need to re-think how neighborhoods are designed to help combat this problem.

Obamacare requires mental-health coverage to be at parity with other coverage, but 1/4 of plans don't do that, study concludes

Federal health reform "has improved access to mental health care for thousands of Kentuckians, but coverage for that care remains unequal to what people get for physical illnesses despite a federal law requiring parity and a promise that health reform would level the playing field," report Laura Ungar and Jayne O'Donnell of USA Today.

"If you need to see a cardiologist, the insurance company doesn't say you're not allowed to see the cardiologist more than a certain number of times. With behavioral health, you commonly see a limit on the visits you get," Tony Zipple, CEO of Seven Counties Services, the Louisville region's largest mental-health care provider, told Ungar, who also works for The Courier-Journal. "Behavioral health nationally is treated like a smaller part of health care."

Ungar and O'Donnell cite a study by the Johns Hopkins Bloomberg School of Public Health that found consumer information on one-fourth of plans offered under the Patient Protection and Affordable Care Act appeared to violate a federal law "designed to stop discrimination in coverage for people with mental-health or addiction problems," they write. "This makes it nearly impossible for consumers to find the best plan to cover their mental health needs, the research suggests."

Researchers found that different co-pays or deductibles for mental and physical health services, and more stringent requirements for authorizations from insurers before patients can get mental health services, may discourage people from buying such plans, said Colleen Barry, lead author of the study report, published in the journal Psychiatric Services. "She's concerned insurers have an incentive to do that because covering people who use mental health services tends to be more expensive," the story reports.

Clare Krusing, a spokeswoman for the lobby America's Health Insurance Plans, "said the rules contained some important changes affecting plan design that were only required for insurance plan years that started on or after July 1, 2014," the story reports. "Krusing added that it's unfair to say a plan doesn't offer mental health parity based only on what consumers see before buying the plans," and not the history of claims made under the plans.

Got the winter blues? Many treatments are available

(image from kidshealth.org)

For some, winter is more than just a season characterized by shorter, colder days; it is a time of year that brings on the "winter blues," Jill U. Adams reports for The Washington Post.

Officially, it's called seasonal affective disorder, or SAD, and is a type of depression. It begins during the late fall or winter of each year and disappears with the onset of spring. Common symptoms include: tiredness,even though the person is getting enough sleep; a loss of interest in usual activities; feeling sad, grumpy, moody or anxious; craving carbohydrates, eating more and gaining weight; and trouble concentrating, according to WebMD. Some even have suicidal thoughts.

SAD occurs in 1 to 2 percent of the population, with a milder version, "the winter blahs," occurring in 10 to 15 percent, Raymond Lam, a psychiatrist at the University of British Columbia in Vancouver, told the Post.

Therapy with light is the most common treatment for SAD and has proven effective, although many doctors and insurance companies still don't recognize it as effective. The disorder is also treated with medications and talk therapy, Adams notes.

Light therapy involves sitting near a very bright, broad-spectrum light for at least 30 minutes every morning, Adams reports. WebMd cautions that the fluorescent lights used in light therapy are not the same as ultraviolet lights, full-spectrum lights, tanning lamps and heat lamps, all of which should not be used for this purpose.

Experts are still trying to figure out exactly why light therapy works, but some evidence suggests that not getting enough light is the main trigger for SAD, which is more common in areas where the daylight hours are shorter, Teodor Postolache, a psychiatrist at the University of Maryland School of Medicine, told the Post.

Another study found that healthy people's eyes are more sensitive to light in the wintertime, while those with SAD have less sensitivity, University of Pittsburgh psychologist Kathryn Roecklein told Adams.

Experts told Adams that it is important that SAD not be self-diagnosed and that light therapy not be experimented with. They said a person may have health conditions that mimic these same symptoms or have untreated or under-treated depression that is not seasonally influenced, and some people take medications or have conditions that make them more sensitive to light.

“If your symptoms are severe enough to interfere with daily functioning, get an assessment at a mental health clinic or by a doctor,” Lam told Adams. “There are many causes and lots of treatments.”

Paul Hokemeyer, a licensed marriage and family therapist in Manhattan, offered nutritional suggestions to help those with SAD in an article for Fox News.

He suggests that people with SAD eat foods that will increase their serotonin levels: those high in Omega-3 fatty acids and tryptophan, which he says is "linked to mood regulation, and a deficit leads to depression." Some foods high in Omega-3 are trout, salmon, and walnuts; those high in tryptophan include lean turkey, chicken, milk, eggs, nuts and bananas.

Hokemeyer also suggests that those with SAD supplement their diet with foods rich in vitamin D because studies have found a correlation between depression and low levels of vitamin D. Foods high in vitamin D are egg yolks, fortified dairy products and cereal, beef liver and cod fish oil.

And finally, he suggests those with SAD eat whole, unprocessed foods to decrease mood swings caused by the "spikes and crashes" in blood sugar levels commonly associated with eating processed foods that are high in simple sugars and white flour.

Telemedicine helps reduce waits for mental-health patients in ER and provides better health-care access in schools

Health professionals have used telemedicine to help delay Alzheimer's disease and reduce hearing loss in Appalachia, especially among children. Now the new approach is helping students access health care, and mental-health patients to get faster medical attention in emergency rooms.

AMD Global Telemedicine has been establishing telemedicine systems in schools, which allow "providers to care for students on-site with few clinicians to support it," Katie Wike writes for Health IT Outcomes. So far "the Center for Rural Health Innovation in western North Carolina used the technology to support 14 school-based programs and provide care to 4,000 students.

The health-care provider can ask the questions during the exam, and "it doesn't assume the presenter knows the questions to ask," said CRHI Executive Director Amanda Martin. This approach allows one nurse practitioner to provide care to thousands of children. Some Kentucky schools are already using the telemedicine platform, Wike reports.

Sometimes when patients seek mental-health care in emergency rooms, no psychiatric services are available. In this case, hospitals often contact and wait for a provider to arrive or send written evaluations for review, Karla Paris writes for Health IT Outcomes. Now KentuckyOne Health has a telemedicine program that gives faster response times for those requesting mental-health care. For example, patients who visit Louisville's Ss. Mary & Elizabeth Hospital for mental-health care will be able to videoconference with professionals from Our Lady of Peace Hospital. "Patients can then be referred for admission at Our Lady of Peace, another outpatient program or care center," Paris reports.

Depression should not be a taboo subject; rural Kentucky news editor details writes about her victory over it

By Tim Mandell
Institute for Rural Journalism and Community Issues

Depression is a subject people often shy away from discussing, but a large percentage of Americans suffer from, or have suffered from, serious depression. Around 50 million have become seriously depressed at some point during their lives, according to a report by the University of Kentucky Cooperative Extension Service. ­

The suicide last month of actor Robin Williams brought depression to the forefront of the national news for a few weeks, but as the national focus shifted to other stories, community journalists should continue to talk about depression, especially in rural areas where people might feel they will be ostracized if they express how they feel.

That’s why it’s important when journalists like Shelley Spillman, news editor of The Anderson News in Lawrenceburg, Ky., step forward and write columns detailing their own battles with depression. Spillman, who was inspired to write a column after Williams’ death and the suicide of a local man who suffered from depression, said in an interview, “This is not something we normally talk about and maybe we should. Maybe these people wouldn’t feel so alone."

"As journalists we’re part of the community too," she said. "I really enjoy people getting to know me, my real struggles in life and the things I’ve been through. It’s amazing how relating to people on a human to human level is one of the most difficult things to do. But it’s so important.”

In her column, Spillman wrote: “I, too, have suffered from the cold, metallic grip of depression. I know what it’s like to be in a room full of people and still feel alone. You’d give anything to feel the warmth of company without having to go through the mental gymnastics of plastering on a fake smile just so you don’t have to be berated with ‘are you OK?’ or ‘what’s wrong?’ It’s not their fault. Most people don’t know how to deal with people who suffer from depression. Even in our daily interactions people stop and ask ‘How are you doing?’ without sticking around long enough to hear anything other than a one-word utterance of ‘Fine.’”

“It does get better; give it time. I understand, though, that giving depression time, when a day with it can feel like carrying around the weight of a giant boulder, seems impossible, but you can. Sometimes when I think about my time with depression it seems so far away, like I’m at the fair soaring on one of those giant swings, examining bad memories of someone else’s life. I can feel black fog of depression permeating in my brain, trying to find a way back in, but I immediately recognize the intruder and sent it packing. Like I said, it’s a parasite, it’s always looking for a host to attach to.”

Spillman added, “You’ll find that you are a lot stronger than you may even realize now. You can make it out of this, and one day the clouds will part and you’ll be able to see the sun again. Let me tell you the sun feels glorious on your skin after a longtime in the dark.”

Spillman told The Rural Blog: “Readers who have called appreciate my honesty in my columns. It’s hard to put yourself out there and be that vulnerable, but I like for my columns to be honest and real. It’s a way for people to know who I am.” She said that writing a column like this is “a good way to get the ball rolling to get people talking about (depression).” She said she hopes columns like this can lead to there being more resources for people with depression, especially in small communities, and lead to depression being a subject that’s less taboo to discuss. (The Anderson News is behind a paywall but can be reached by clicking here.)

The Extension Service report details signs and types of depression, suggestions for those suffering from depression and suggestions for friends and family members of people who are depressed. Other valuable sources are available here, here, here, here and here.

Mental-health coverage now required, but access is limited; Medicaid share of all new Ky. enrollments is 85 percent

More people in Kentucky and the nation have access to mental-health care than ever, because of the Patient Protection and Affordable Care Act, but that doesn't mean the care is quick or abundant, especially for those on Medicaid, Abby Goodnough reports for The New York Times.

In the latest of a series of stories Goodnough is doing about health reform from the Louisville area, she gives a new figure for the share of Medicaid patients in the rolls of the 521,000 newly insured Kentuckians: 85 percent. When the regular enrollment period for private insurance ended this spring, the figure was 75 percent, but Medicaid enrollment is open year-round.

The reform law requires mental-health treatment to be covered by Medicaid and every private plan sold through the state's online insurance marketplace, The intent of that, Advocates told Goodnough, is to not only reduce suffering, but also to reduce other health problems and the resulting expense and lost productivity.

Kentucky recently allowed private psychologists and social workers to accept Medicaid patients, adding more than 1,000 private mental health providers to the Medicaid list, state officials told Goodnough. Previously, only "quasi-governmental agencies" were approved to treat Medicaid patients in Kentucky.

"But shortfalls in care persist," Goodnough writes, telling several stories of the successes and challenges that people on Medicaid in the Louisville area who now have mental health coverage are facing. One of the people she interviewed is Terri Hall.

Hall suffers from depression and anxiety that "often consumed her," Goodnough writes. Since she got Medicaid coverage, she is now getting therapy for the first time, but she "just wished she could go more often." She tells Goonough that she has had to wait up to seven weeks between appointments at Seven Counties Services. This is a common story among the people Goodnough interviewed.

Another challenge to mental-health access is that many private therapists, like some of their physician counterparts, refuse to accept Medicaid. Medicaid pays, on average, about 66 percent of what Medicare does, and some therapists say "the paperwork takes too much time and the poor — who often experience more violence and trauma than those who are better off — are too challenging to treat," Goodnough reports.

In addition to low reimbursement, private providers struggle when they take on Medicaid patients because they have to wait to be approved by the managed care companies that provide benefits to Medicaid recipients, Goodnough writes.

With nearly one in five Americans having a diagnosable mental illness, according to the Department of Health and Human Services, but most getting no treatment, Goodnough writes, the new health law offers "a big opportunity for mental health providers to reach more people of all income levels," especially the poor in states that have expanded Medicaid.

Teens sensitive to light or noise after a concussion are more likely to suffer anxiety or depression, UK study finds

Teens who are sensitive to light or noise after a concussion may also have increased emotional symptoms, such as anxiety or depression, according to a study at the University of Kentucky.

“While most people recover from a concussion within a week, a number of factors affect their recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes,” co-author Lisa M. Koehl said in a news release. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school.”

The study followed 37 athletes, ages 12 to 17, who had persisting symptoms for an average of 37 days following a concussion. They were checked for post-concussion changes in physical, emotional and cognitive symptoms. The study determined that there were no differences in the severity of concussions in the group, and that a family history of psychiatric problems did not affect post-concussion emotional symptoms.

But it did find that teens who are sensitive to light or noise after a concussion may also be more likely to have emotional symptoms, including irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions.

Of the 37 athletes studied, 22 had emotional symptoms, and of this group, five (23 percent) were sensitive to light while three (14 percent) were sensitive to noise. Of the 15 athletes with no emotional symptoms, only two (13 percent) were sensitive to light and no teens were sensitive to noise, according to the release.

"Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability," said co-author Dan Han. "While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion."

The researchers presented their findings at the American Academy of Neurology's Sports Concussion Conference in Chicago in July. Click here for more information about concussions.

Daytime mental-health programs shrink, citing problems with managed-care Medicaid; pastoral counselors to be licensed

Access to daytime mental-health care "is on a steep decline in Kentucky, leaving what some fear is a gap in care that isolates the mentally ill at home or drives them out into the streets, hospitals or jail," Mike Wynn of The Courier-Journal's Frankfort Bureau reports. The Kentucky Association of Regional Programs, the lobby for community mental-health centers, "reports that 33 of the roughly 50 programs offered across the state have closed in the past 18 months while four others have reduced their hours by half," affecting an estimated 1,000 people.

The state Department for Behavioral Health, Developmental and Intellectual Disabilities says these community mental-health centers should embrace "a shift away from using day programs," Wynn writes, but mental-health advocates "say the centers have struggled to get enough coverage authorized under Kentucky's Medicaid managed-care system to keep the services operating. That has forced programs to close before new services are available to replace them, they argue."

The advocates say that among companies that manage care in Kentucky under Medicaid, Coventry Cares and its subsidiary MHNet "are by far the worst about denying coverage or reducing hours for therapeutic day programs. Coventry and MHNet are owned by insurance provider Aetna," which "says complaints are off target and that it is committed to providing patients with high-quality care. MHNet has approved two-thirds of the requests it received for therapeutic rehabilitation since January 2013, Aetna said in a statement."

Steve Shannon, executive director of the centers' lobbying group, "said that even mild reductions — such as approving services for three days a week rather than five — can wreak havoc on a program's financial viability," Wynn writes. "He also argues that centers may have stopped requesting services once they realized that MHNet would not approve them." (Read more)

Meanwhile, Kentucky has become the sixth state to license pastoral counselors under a new law that will also allow them to be paid for their services. The sponsor of Senate Bill 61, Sen. Alice Forgy Kerr of Lexington, told Jack Brammer of the Lexington Herald-Leader that the counselors must have a master of pastoral counseling degree, in addition to the same qualifications as other licensed counselors, and must also pass a written examination. (Read more)

July is Minority Mental Health Month; experts discuss mental-health complications among African Americans

By Melissa Landon
Kentucky Health News

July is Minority Mental Health Month. KET's Renee Shaw interviewed Sycarah Fisher, associate professor in the College of Education at the University of Kentucky, and Shambra Mulder, an assistant professor in the School of Education at Kentucky State University, about challenges and differences professionals face in providing care for African Americans with mental health conditions. The show is available online and airing on KET's secondary channels.

"Getting the right diagnosis and treatment for mental health issues are difficult tasks, and can be even more challenging for ethnic and racial minority groups," Shaw said at the beginning of the interview on her weekly show, "Connections."

Fisher said mental illness is particularly stigmatized in African American communities and other ethnic or racial groups, perhaps because some "feel like getting help, especially from medical professionals, makes [them] weak, and [they're] expected to be strong and be able to take care of [themselves]."

Mulder agreed, adding that "The church and spirituality play a big role in the African American community," so those who seek medical help might be seen as lacking the faith to be healed. It may also have to do with the lack of minorities working in the field, she said. Research shows that African-Americans are more inclined to seek or stay in therapy if they have a minority therapist.

Fisher discussed ways more minorities might be recruited to the field. She called that "a very, very big task," noting that it can be uncomfortable to be the only African American in a program. Even the students who do make it into Ph.D. programs have more difficulty graduating, she said. Many programs are seeking grants to bring in minority psychologists.

Mulder added that if people haven't seen or heard of many black psychologists, they might think it's really difficult or might not think they couldn't do it. Shaw clarified that they weren't saying a doctor must be black to understand a black patient, it's just that mental health is a sensitive issue that people are sometimes uncomfortable discussing.

Fisher said it's important for people, especially African Americans, to talk about their disorders and treatments and how it is helping so that others will feel comfortable seeking medical attention that they need. Mulder said that even taking medication can be stigmatized.

Adding to the problem is that racial and ethnic minorities are more often misdiagnosed. Fisher "A lot of measures that are used to identify different types of behavior disorders aren't normed on African American samples," Fisher said. "We're taking and giving measures to African-American individuals, but yet when we're comparing them to different cultural groups."

Mulder agreed, adding that some people may not want to be forthcoming about their symptoms. If they will not accurately explain what they're dealing with, it's difficult to make the correct diagnosis. Shaw pointed out that this and other factors can lead to delayed treatment, which can have serious consequences. Fisher said, "The earlier you intervene, the better your outcomes are going to be. . . . The longer you wait, the more severe the problem behaviors are going to get."

The experts also discussed diagnosis of children. Shaw asked how professionals perceive the difference between a child who has a mental health issues and a child who is being abused or something similar. Fisher said environmental factors must be addressed, and Mulder said, "The behavior might be age appropriate, but the environment might not be age-appropriate," such as asking kindergartners to sit for a long time.

Shaw said people may wonder what schools can do to help. Fisher said a school psychologist's job is to make sure the student can function in the school environment. They may not have enough time to talk with the students and provide all the help they need, so they can "rally the troops" and "connect our services with the services they're receiving in the community."

Mulder noted that although it's important for school psychologists to make sure students are diagnosed so they can get the help they need, doctors are supposed to notice the early symptoms in young children. Later on, teachers may notice something is amiss but usually only if it is externalized behavior. Parental input is also important although they often don't have sufficient knowledge of what symptoms would be. Schools are moving to a more preventative approach, Fisher said. Teachers will report things that disrupt the classroom and miss the internalized behaviors.

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