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.

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.

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.

Click here to watch the show.