The CPT code numbers that mental health professionals use for billing psychotherapy services to insurance carriers will change on January 1, 2013. In addition to the code changes, Medicare reimbursement rates will also be revised. The AMA will publish the new codes and rates later this fall.

The American Psychological Association’s Practice Central Web site outlines some of the anticipated changes, which include:

1.  Outpatient and inpatient psychotherapy codes will be replaced by a single set of codes that can be used in both settings.
2.  The new psychotherapy codes will have specified times rather than ranges:


  • 30 minutes, not 20-30 minutes

  • 45 minutes, not 45-50 minutes

  • 60 minutes, not 75-80 minutes


3.  The single psychiatric diagnostic evaluation code will be replaced by two codes: one for a diagnostic evaluation and the other for a diagnostic evaluation with medical services.


What practical steps do you need to take now in order to prepare for these changes? According to the American Psychiatric Association, the pharmacologic management code will no longer exist, so it is important for practitioners to start familiarizing themselves with the medical evaluation and management (E/M) codes for medication management. Practitioners should also review any contracts they have with insurers to make sure that the contracts don’t limit them to specific codes in the psychiatry section that may be replaced as of January 1. HIPPA requires that insurers use current CPT codes, so these companies should be updating contracts in the coming months.

For the latest information about these changes and how they may affect your practice, visit the American Psychological Association’s Practice Central Web site or call its Practitioner Helpline at 1.800.374.2723.
On October 15, PAR author Lisa Firestone, PhD, will be hosting a CE Webinar with violence expert Dr. James Gilligan on the topics of understanding and preventing violence. For more information on the Webinar, visit Dr. Firestone’s blog. To register for the Webinar, click here.
Adults with disabilities, particularly mental illness, have been found to be at an increased risk of being a victim of violence, according to a study funded by the World Health Organization’s Department of Violence and Injury Prevention and Disability. This finding, a meta-analysis of 21 studies, found that one in four people with a mental illness experience some type of violence in a given year – a much higher rate than that experienced by the general population.

The chance that a person with a mental illness will experience physical, sexual, or domestic violence was found to be 3.86-fold higher than the odds of an adult without any disabilities at all. However, violence against individuals with other disabilities was common – it was found that individuals reporting any disability were 50 percent more likely to experience physical, sexual, or intimate partner violence in the prior 12 months than those individuals without a disability, and 60 percent higher for people with intellectual impairments.

Researchers believe that their inclusion criteria probably underestimated the prevalence of violence against people with disabilities because many of the studies were based in high-income countries with lower reported rates of violence. Furthermore, there were no studies of violence against individuals with intellectual disabilities in institutional settings or studies of individuals with sensory impairments included in the analysis.

Approximately 15 percent of adults worldwide have a disability.
While every baby is different, the sleepless nights are something that most parents of infants can’t escape.

Sleepless nights don’t just equal tired parents, though. Sleep deprivation can double mom’s risk of suffering from depression and can lead to marital strife. But how should tired parents teach their babies to sleep?

While some parents believe letting their child “cry it out” will teach self-soothing behaviors, other parents believe that letting their child cry will cause their little one to feel insecure and abandoned. However, exhausted moms and dads have some new research on their side that can (hopefully) afford them a little shut eye.

A new study released in the journal Pediatrics followed 225 babies from seven months old until age 6 to compare the difference between parents who were trained in sleep intervention techniques and those who were not. The sleep intervention group was told to select either “controlled crying,” which had them respond to their infant’s cries at increasing time intervals, or  “camping out,” which asked them to sit with their child until he or she fell asleep, removing themselves earlier each night over a three-week period.

Families in the sleep training group reported improved sleep. Mothers were also less likely to experience depression and emotional problems. Furthermore, it was determined that those children in the sleep training group were not harmed by letting them cry it out. Researchers found no differences between these children and the children in the control group in matters of mental and behavioral health, sleep quality, stress, or relationship with their parents at age six. Allowing babies to cry for limited periods of time was found to help the entire family sleep better without causing psychological damage. Furthermore, an earlier study found that sleep training does work – babies learn to go to sleep easier and stay asleep longer than their counterparts.

No matter which method parents choose, they can feel better knowing that while it may seem that their infant is stressed when he or she is crying, researchers believe that it is good stress and it will have no lasting impact on the parent-child bond.
Heavy marijuana use during adolescence has now been linked to lower IQ scores later in life, according to a study published last month by the National Academy of Sciences.

The study, which tracked 1,037 subjects from birth to age 38 years, found that those who began smoking marijuana as teenagers and used it regularly throughout adulthood scored approximately 8 points lower on an IQ test than they had at age 13 years. In comparison, the IQ scores of non-users, as well as those who started using marijuana as adults, were stable. Small to medium declines in memory, processing speed, and executive function were also seen in regular users.

“We know that there are developmental changes occurring in the teen years and up through the early 20s, and the brain may be especially vulnerable during this time,” said Dr. Madeline Meier, a researcher at Duke University and lead author of the study, in an August 27 New York Times article.

The results of this study are in direct contrast with beliefs common among adolescents that marijuana use is harmless to health. “Adolescents are initiating cannabis use at younger ages, and more adolescents are using cannabis on a daily basis,” study authors said. “Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents.”

Although the authors ruled out several alternative explanations for the neuropsychological effects (such as hard drug use, alcohol dependence, and schizophrenia), they acknowledge that their results must be interpreted within the context of the study’s limitations. “There may be some ‘third’ variable that could account for the findings,” they said. “The data cannot reveal the mechanism underlying the associations between persistent cannabis dependence and neuropsychological decline.”

What do you think? Is there a disconnect between common beliefs about marijuana use and the reality of its long-term effects on health? PAR wants to hear from you, so leave a comment and join the conversation!
One of the world’s most popular and trusted assessments of cognitive impairment is now available as a convenient app for smartphones and tablets. Like the paper-and-pencil version, the app can be used to screen for cognitive impairment, to select patients for clinical trials research in dementia treatment, or to track patients’ progress over time.

The MMSE/MMSE-2 app includes a brief instructional video that walks users through the features of the app. In addition to the original MMSE, both standard and brief versions of the MMSE-2 are available, enabling health care providers to choose the version that will suit each client. Scoring is done automatically, and patient records can be uploaded directly to an electronic medical records (EMR) system or e-mailed to appropriate personnel. Equivalent, alternate forms of the MMSE-2 decrease the possibility of practice effects that can occur over serial examinations. The app also includes norms for the MMSE and the MMSE-2, by age and education level.

The MMSE/MMSE-2 app is available to qualified health care professionals from the Apple® App StoreSM (for the iPhone® or iPad®) and from Google Play (for Android™ devices). The app is free—users pay only for administrations, which start at $1.25 each.

 
Editor’s Note: Last week, we blogged about non-medical prescription drug use (NMPDU) and a study that linked it to depression in college students. This week, we follow up with one of the study’s coauthors, Dr. Amanda Divin, from Western Illinois University. In the study, Dr. Divin found that young women were more likely to abuse painkillers than young men. We wanted to learn more.

PAR: Why might females be more likely than males to use painkillers if they were feeling hopeless, sad, depressed, or suicidal?

Dr. Divin: Well, there are lots of reasons. First, the properties of opioid painkillers are that they block pain reception in the brain but also increase release of dopamine in the brain which results in euphoria. So the pharmacological properties of painkillers make them attractive to people who may be feeling the blahs of depression or other depressive symptoms.

Second, research indicates that females have greater exposure to prescription drugs with addictive potential (e.g., opioid painkillers and anti-anxiety drugs) and are more likely to be prescribed a drug than males. If you look at the literature, and even empirical evidence, it's very common for a woman to go to a doctor complaining of symptoms, and she is given a prescription for a painkiller or sedative, whereas a male may be given different advice or treatment.

Third, women are more likely to suffer from depression. Their physiology also makes them more likely to become addicted to painkillers (females actually need a lower dose of opioids than males do to experience the same amount of painkilling effects).

If you put all those things together, it almost seems like common sense that females are more likely to self-medicate. I do want to point out, however, there have been other studies which have found the opposite—that it’s males [who are more likely to self-medicate]. There is still a lot of research and replication that needs to be done.

PAR: Why did you decide to conduct this study? How did it affect you personally?

Dr. Divin: I'm a professor, so I work with college students every day. It’s not at all uncommon that a student will come talk to me about their problems. It’s very common that prescription drug use or depression/suicidal thoughts are among those problems. In talking with my colleague Keith Zullig [from West Virginia University], who has done a lot of research on prescription drugs, we decided this was an area that really needed to be investigated. This study personally affected me in a couple of ways: I read just about every single article that had ever been printed regarding prescription drug use—and wow, did this open my eyes to what a commonplace, everyday sort of thing NMPDU is, how easy it is to acquire prescription drugs, and just how socially acceptable it has become. Both the NMPDU and suicide literature also opened my eyes to the stress college students are under nowadays and how stress, depression, and NMPDU are all connected. I will say some of the scariest things I learned from doing this research are about the very dangerous side effects and risks that prescription drugs carry.

PAR: What advice would you give to college students using non-medical prescription drugs?

Dr. Divin: My best advice would include a few things:

(1) If you're feeling depressed, the solution isn’t going to be found in a pill bottle. NMPDU only offers a temporary solution to a very real and pervasive problem. The best thing to do is go see a professional. On most college campuses, seeing a doctor or mental health professional is free! In the final analysis, you are just temporally postponing the problem and possibly creating others in the process.

(2) Prescription drugs carry very real and dangerous side effects. Just because they were approved by the FDA doesn't mean you’re not going to have an adverse or deadly reaction.

(3) If you are currently taking several different prescription drugs non-medically, be very careful of the possible drug interactions.

(4) There is no shame in admitting you have a problem and need help.

 

This interview was conducted by Grace Gardner, a recent graduate from the University of South Florida and an editorial assistant in the Production Department at PAR.
The Centers for Disease Control and Prevention (CDC) is calling painkiller use in the U.S. a “public health epidemic.”

A new study found that non-medical drug abuse is linked to depression and suicide in college students. Keith Zullig, PhD, from West Virginia University and Amanda Divin, PhD, from Western Illinois University conducted a study analyzing non-medical drug use among college students and its relationship to symptoms of depression.

Zullig and Divin analyzed data from the 2008 American College Health Association National College Health Assessment (ACHA-NCHA). ANCHA-NCHA asked 26,000 randomly selected college students from 40 campuses in the U.S about their non-medical drug use including painkillers, stimulants, sedatives, and antidepressants, along with their overall mental health in the last year.

The study, entitled “The Association between Non-medical Prescription Drug Use, Depressive Symptoms, and Suicidality among College Students” appears in the August 2012 issue of Addictive Behaviors: An International Journal. Authors reported that 13 percent of respondents who felt hopeless, sad, depressed, or were considered suicidal were using non-medical prescription drugs. The results were especially apparent in college females who reported painkiller use. Authors suggest that these findings are the result of college students self-medicating to mask their psychological distress.

“Because prescription drugs are tested by the U.S. Food and Drug Administration and prescribed by a doctor, most people perceive them as ‘safe’ and don't see the harm in sharing with friends or family if they have a few extra pills left over,” Divin said in a news story  from Western Illinois University. “Unfortunately, all drugs potentially have dangerous side effects. As our study demonstrates, use of prescription drugs—particularly painkillers like Vicodin and Oxycontin—is related to depressive symptoms and suicidal thoughts and behaviors in college students. This is why use of such drugs need[s] to be monitored by a doctor and why mental health outreach on college campuses is particularly important.”

The U.S. Department of Education’s Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention says, “Before choosing a prevention strategy, you must start with assessment—the same as you would when addressing high-risk alcohol abuse or violence on campus.” The Center’s suggestions included surveys such as the NCHA, environmental scanning, including physical and online social networking environments, and increased faculty-student contact and mentoring.

What do you think? Should colleges do more to address non-medical prescription drug abuse as part of mental health and suicide prevention programs for their students? We would love to hear from you and keep the conversation going!

Editor’s note: This week, PAR is pleased to welcome guest blogger Grace Gardner. A recent graduate of the University of South Florida with a B.A. in Mass Communication, Grace is working as an editorial assistant this summer in the production department at PAR.

 
The Sports Legacy Institute (SLI) is a non-profit organization focused on solving the concussion crisis by supporting education and research on the causes and effects of concussions and by helping to shape subsequent policy.   SLI’s mission is “to advance the study, treatment, and prevention of brain trauma in athletes and other at-risk groups.” SLI is one of PAR’s valued partners, sharing our commitment to creating connections and changing lives.

This month, SLI announced the launch of the California Concussion Coalition, and PAR was a proud sponsor of kick-off events in Los Angeles and Oakland. The goal of the coalition is “to provide student athletes in the community with the best-in-class resources available to protect them from concussions in sports.” Special guests at the August 20 kick-off event in LA included former NFL players Jim Brown, Michael Haynes, Jerry Simmons, and Shelby Jordan, as well as professional wrestler Rob Van Dam.

Concussion prevention is very important to us at PAR, and we are delighted to be working with an organization like the SLI, which supports education and research that will help protect young athletes from serious brain injury.  In terms of best-in-class resources, our concussion apps, including the award-winning CRR (for parents and coaches) and the CARE (for health care professionals), provide a simple and cost-effective way to help users quickly assess the likelihood of a concussion and take appropriate action. PAR donates 15% of the proceeds from the sale of each concussion app to support concussion research at the Children’s National Medical Center and the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, Chapel Hill.

Have you had a chance to download one of our concussion apps? If not, click on the links above or find us at the Apple® App StoreSM or Google Play. And let us know what you think—PAR wants to hear from you, so leave a comment and join the conversation!
A recent study published in the Archives of General Psychiatry found a relationship between gestational age and various psychiatric disorders in adults. The results suggest that a concrete relationship exists between a shorter gestational period and the onset of mental illness later in life.

The study analyzed data from the medical records of 1.3 million adults born in Sweden between 1973 and 1985. Researchers analyzed multiple pregnancy outcomes including gestational age at birth, birth weight, and Apgar score; they then compared this data with information about psychiatric hospitalization in adulthood and diagnoses of bipolar disorder, depressive disorder, eating disorders, and drug/alcohol dependency.

A smaller gestational weight was associated with alcohol and drug dependency in adulthood, whereas a low Apgar score suggested an association with depressive disorder. Most strikingly, people born very premature (i.e., 32 weeks gestation) were:

  • 2.5 times more likely to have a non-affective psychosis;

  • 2.9 times more likely to have a depressive disorder; and

  • 7.4 times more likely to have bipolar disorder.


Lead author Dr. Chiara Nosarti, from the Institute of Psychiatry at King’s College London, told the BBC, “I don’t think parents should be worried, but we know that preterm birth confers an increased vulnerability to a variety of psychiatric conditions and perhaps parents should be aware of this and monitor early signs of later more serious problems.”

Although Nosarti and her coauthors acknowledge that previous studies have found associations between preterm birth and the onset of psychiatric disorders in childhood as well as adult onset schizophrenia, they assert that this study is the first to find an association between preterm birth and adult onset of both depressive disorder and bipolar affective disorder.

“We found a very strong link between premature birth and a range of psychiatric disorders,” said Nosarti in a King’s College press release. “Since we considered only the most severe cases that resulted in hospitalization, it may be that in real terms this link is even stronger. However, it is important to remember that even with the increased risk, these disorders still only affect 1-6% of the population.”

What do you think? Should parents of premature infants be alerted to their children’s increased risk for mental illness later in life? PAR wants to hear from you, so leave a comment and join the conversation!

Editor’s note: This week, PAR is pleased to welcome guest blogger Grace Gardner. A recent graduate of the University of South Florida with a B.A. in Mass Communication, Grace is working as an editorial assistant this summer in the production department at PAR.