News Briefs: July, 2011

“Marital functioning” suffers more when women can’t sleep than when men can’t, according to research presented in June at the annual convention of the Associated Professional Sleep Societies (APSS). “We found that wives’ sleep problems affect her own and her spouse’s marital functioning the next day,” said Wendy Troxel, assistant professor of psychiatry at the University of Pittsburgh School of Medicine. In contrast, husbands’ sleep did not affect their own or their wife’s report of next day’s marital interactions. Study subjects suffered from a variety of sleep disorders including “sleep latency” and “wakefulness after onset of sleep” but otherwise had no relevant medical or psychiatric problem. The APSS meeting was held in Minneapolis, June 11-15, 2011. For more, see tinyurl.com/pf0511a.

The American Psychiatric Association’s annual convention in Honolulu, May 14-18, gave rise to a pair of mini-controversies. First, some Association members expressed concern in the weeks before the meeting that fallout from the destroyed Fukushima nuclear plant in Japan might cross the Pacific and pose a hazard. Reassurances from Hawaiian health authorities seemed to quell those concerns. Second, a small number of psychiatrists announced a boycott of the convention in protest of the selection of Desmond Tutu as keynote speaker. At issue is Tutu’s comparison of Israel with Apartheid-era South Africa. Psychiatrist Ronnie Stangler told the Honolulu Star-Advertiser (May 12) that she and her dissenting colleagues are opposed to Bishop Tutu's call in 2010 for an “academic, artistic, social and political boycott of Israel.” Next year’s convention will be held in Philadelphia, May 5-9.

“Coercive paraphilia” (a.k.a. rape) will not make it into the DSM-V as a mental health disorder. The issue has been raised each time the DSM has been revised over the last couple of decades, but so far the task force in charge of revisions has resisted. In an opinion piece in Psychiatric Times (May 12), Allen Frances, professor emeritus at the Duke University School of Medicine, said: “Rapists need to receive longer prison sentences, not psychiatric hospitalizations that are constitutionally questionable.”

Clinicians sometimes confuse “highly educated” with “high functioning,” warns Jennifer Sewell, VP of clinical and counseling services at Ceridian. “With some contracts where we deal with highly education populations like engineers, providers sometimes have the idea that these people are always in control of themselves. Preconceived notions impact the assessment...We tell them they have to be extra vigilant about at-risk situations like suicide, child abuse, domestic abuse, and elder abuse.” (Sewell is quoted extensively in the “Managed Care” article beginning on page 1.)

Baby Boomers are less happy at work than their younger colleagues, according to research by Deloitte. Surveying employees at 350 large companies, the consulting giant finds that 32% of Boomers feel a “lack of trust in leadership.” In Human Resource Executive, an online publication, Deloitte’s Jeff Schwartz explains that the recession and sluggish recovery have hardened employers’ attitudes toward employees, creating a mindset that "People should feel lucky they at least have jobs." Older workers resent this attitude the most. For more, see tinyurl.com/pf0511f.

Cocaine is down, but opiates are up. A report released in June by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that hospital admits for cocaine abuse dropped between 1999 and 2009, while admits for opiates--especially prescription opiates--increased. Overall, the top substances on the rehab hit parade are: 1) alcohol (42% of admits); 2) opiates (21%); 3) marijuana (18%); 4) cocaine (9%); 5) amphetamines/methamphetamines (6%). For more, see tinyurl.com/pf0511g.

As predicted, the parity law appears to be creating some blowback. A Kaiser Foundation report cited in the May/June issue of Psychotherapy Networker says some employers--especially smaller employers--have dropped their behavioral health coverage since the new parity law took effect last year. This was the biggest loophole in the law: Employers are bound to observe parity between physical and mental health coverage--but only if they offer mental health coverage in the first place. If they drop it, then parity doesn’t apply. Kaiser says that among employers with more than 50 employees that previously offered some form of mental health coverage, 9% have dropped it. Smaller companies, those with 50-200 workers, are more likely than the larger ones to have made this move. Another key issue is medical necessity: Nothing in the parity law addresses the level of treatment required for any diagnosis. So insurers can evade parity entirely by getting more aggressive in their assessment of medical necessity. Some clinicians are complaining that this is beginning to happen.