Archive for March, 2008

Mental Health Insurance

The House recently passed a bill requiring insurance companies to provide mental health insurance parity, banning them from limiting mental health coverage. The insurance industry is up-in-arms and the mind-body debate continues raging:

Sarah Kershaw of the New York Times reports:

In the United States over the last five years, research studies examining the link between physical brain abnormalities and disorders like severe depression and schizophrenia have begun to make a strong case that the disorders are not scary tales of minds gone mad but manifestations of actual, and often fatal, problems in brain circuitry. These disorders affect behavior and mood, and they look different from Parkinson’s disease or multiple sclerosis in brain imaging. Still, a growing number of studies — and many more are under way — are making the biological connection, redefining the concept of mental illness as brain illness.

However…

Critics of parity say that anything that would not turn up in an autopsy, as in depression or agoraphobia, cannot be equated with physical illness, either in the pages of a medical text or on an insurance claim. These critics also say that because the mental abnormality research is so new, it should still be considered theory rather than an established basis for equal payment and treatment. “Schizophrenia and depression refer to behavior, not to cellular abnormalities,” said Jeffrey A. Schaler, a psychologist and an assistant professor of justice, law and society at American University in Washington. “So what constitutes medicine? Is it what anybody says is medicine? Is it acupuncture? Is it homeopathy?”

The bill, if passed, will be a 3.8billion dollar tax burden and mean a substantial (but unpredictable) raise in insurance premiums. Insurance companies argue that they shouldn’t be expected to pay for diseases that you can’t scientifically test for. Bush says he’ll veto the bill if it comes before him as the house passed it.

The “bare minimum” coverage that we currently require insurance companies to offer isn’t terribly inclusive. The House is attempting to considerably raise the bar. If the House really represents the will of the American people then I wonder why we’re on board. Is it that we really think mental disorders (or at least some mental disorders) should be treated like diseases or is it that we’re simply on the universal, more inclusive health care bandwagon?

I certainly hope it is the former. People who think schizophrenia is solely behavioral like Mr. Schaler (above) must not have ever visited a mental ward. Some mental illnesses are indubitably biological. It’s high time we formally recognized the body’s affect on the mind.

I do, however, hear the opposition’s point. We’re a long way from completely unifying the two. For the time being there’s a fine line between mental diseases (biologically rooted) and mental disorders (societally or behaviorally rooted). It isn’t outrageous to suggest that the psychiatric community should differentiate between the two before we force our broken insurance system to standardly cover all mental health. Some things, like most phobias for instance, you can live with. Other things, like schizophrenia or bipolar disorder, you cannot.

I think the bill is a step in the right direction, just not the right step. What do you think? Leave a comment.

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I’m Back

Spring Break is over and The Neurotic is back up and running. Expect a post tomorrow.

Cheers,

Jeff

Bat Phones

This may have nothing to do with neuroscience but… don’t take your hearing for granted.

bat_phones.jpg

Pretty Pictures

Beautiful Images:

(link)

Thanks Mind Hacks.

Bipolar Disorder and Mania

Psychiatrists have long been befuddled by the therapeutic effects of Lithium and the biological basis of bipolar disorder. Neuroscientifically Challenged has a recent post on the “mystery of mania” outlining some recent research on the topic.

BPD involves a spectrum of symptoms, and sorting out the mechanisms behind its occurrence has been expectedly complicated. No single gene has been identified as being responsible for BPD, and its complexity has prohibited scientists from being able to recreate the disorder reliably in animals for study. Recently, however, a group of scientists from the National Institutes of Health (NIH) has identified a gene that seems to be related to manic states in mice.

The scientists knocked the gene out (rendered it inoperable) and found…

The KO mice exhibited behavior that was consistent with mania. This was measured with a battery of tests, which showed the mice to be more aggressive, more active, and less inhibited. They were also overly sensitive to amphetamine administration, and their hyperactivity was mitigated by the administration of lithium, a mood stabilizer and common treatment for BPD.

Spectrum disorders, like schizophrenia, bipolar disorder, and autism, have long baffled the scientific community despite abundant funding and exhaustive research efforts. The discovery of a potential gene for bipolar disorder is notable because it’s a candle in a dark room.

Bipolar Disorder Lecture

Via Dr Shock:

Dr. Kay Redfield Jamison, psychiatry professor at Johns Hopkins University School of Medicine, lived every day with the mania and severe depression that she had studied for years. She talks openly of the challenges she faced with the treatment and disclosure of her mental illness.

Her description of the disorder and the effect of her medication is wonderfully poetic.

Bipolar disorder is incredibly damaging to those who suffer from it. Manic episodes leave a tumultuous aftermath. Depressive episodes result in two times more suicides than depression alone. Lithium, the standard treatment for bipolar disorder, is widely considered one of our most successful psychotropic medications. The narrow dose response window and various side effects (blunted affect, etc) are overwhelmingly outweighed by its clinical potency.

Lithium, a mere salt, and the recent hubbub about SSRIs are quite an interesting contrast.

Disconnection Anxiety

Dr Shock wrote a recent post in reaction to Engadget’s article about a study by Solutions Research Group. They’ve “discovered” a new anxiety disorder: disconnection anxiety.

Disconnect Anxiety refers to various feelings of disorientation and nervousness experienced when a person is deprived of Internet or wireless access for a period of time.

Overall, our research finds that 27% of the population exhibit significantly elevated levels of anxiety when disconnected. In terms of profile, 41% of this group are 12-24, 50% are 25-49 and 9% are over the age of 50.

Dr Shock scoffingly responds:

Medicalizing adaptation to new developments again. I won’t be surprised if they come up with cognitive behavioral therapy for disconnection anxiety.

I wouldn’t be surprised either. However, unlike Endgadget and Dr Shock, I’m not so critical. People only seek out therapy if they feel their disorder is causing them significant distress. Why would they bother spending hours in therapy if it didn’t affect their lives in a significant way? If a treatment for a generalized disconnection disorder is in demand… why not offer it?

Engadget jokes therapy should be a hefty dose of sunshine. I don’t see why not. Just like internet addiction and video game addiction before it, it would be reasonable to include disconnection anxiety in the next version of the DSM.

The information era ushered in a wave of change for our youthful generations. I’m fairly certain I was addicted to mmorpgs in my adolescence. As time trudges forever forward we need diagnostic criteria that adapt to changing stressors and environments. If people are willing to undergo therapy for their internet addiction, video game addiction, or disconnection anxiety, then we should certainly offer it to them.