Friday, August 17, 2007

My Three Shrinks Podcast 30: Parity Feels Like a Bird

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So we are back from vacations and stuff. We had two podcasts we recorded before we took our relative hiatus, and this is the first of them. I plan to get the next one out over the weekend.

August 17, 2007: #30 Parity Feels Like a Bird

Topics include:
  • Mental Health Insurance Parity Legislation. 20-minute discussion about some of the current legislation (mind you this was recorded before the revisions made in early August to SB 558). Go to this link to see recent parity-related posts. This leads into a brief discussion of...
  • Mind-Body Dualism. Why are there different rules for brain stuff than for body stuff? Isn't the brain part of the body? Will we still be having this debate in yet another 2400 years?
  • Pink Floyd's Syd Barrett. Brief mention of my post last month, Shine On, You Crazy Diamond, which, in turn, points to the "Images in Psychiatry" section of the July, 2007, issue of AJP, a tribute written by Paolo Fusar-Poli. "Nobody knows where you are, How near or how far."
  • Three articles on suicide in the July 2007 AJP. The first, by Simon & Savarino, is a well-done study looking at the relationship between the initiation of depression treatment (medication or psychotherapy) and suicide attempts by looking at outpatient insurance claims of a half-million members. They found that suicide attempt rates were highest in the month before treatment initiation, and that the patterns were similar for medications and psychotherapy. See below image. Most of the people (some 90% or so) were being treated by their primary care physicians. Those with the highest risk appeared to have been referred on to therapists or psychiatrists. Regardless (and not surprisingly), the patterns were the same. As stated by David Brent in his editorial, "it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior."

  • 2nd Suicide Article by Posner et al about Classifying Suicidal Events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) is explained, in an attempt to standardize the disparate definitions currently in use across treatment trials. Click here to see examples of difficulties in defining injurious behaviors as adverse events. Click here to see the Table of C-CASA definitions and training examples.

  • 3rd Suicide Article by Gibbons et al about the Relationship Between Antidepressant Initiation and Suicide Attempts in a Large Veteran Population. This group found that SSRI antidepressants had a protective effect. "Suicide attempt rates were lower among patients who were treated with antidepressants than among those who were not..."
The last few seconds is from Astronomy Domine, from Pink Floyd's album, Pipers at the Gate of Dawn, can be purchased at iTunes.

The next podcast, or podette, will be a brief one (for us) which I will post this weekend (yes, two podcasts in as many days... we have to make up for lost time somehow) prior to our next regular podcast, which we will record on Aug 19, probably between 3-5 pm ET. If any other psychiatrist listeners can join in at that time via Skype or Talkshoe, let us know and we might include you as a guest on the show.

Find show notes with links at: The address to send us your Q&A's is there, as well.

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