Guideline-based Occupational Care for Workers with Mental Disorders Effective in Reducing Treatment Cost

According to the National Institute of Mental Health, mental health disorders are the leading cause of disability in the United States and Canada for people 15–44 years of age. Globally, mental illness accounts for >15% of the burden of disease in developed nations. The widespread prevalence of mental health disorders—including major depressive disorder and anxiety—has been shown to have an economic affect in terms of cost of treatment. In addition, those in the workforce with mental illness often work fewer hours, are less productive, and are more likely to leave work on disability than people without a mental health disorder. Thus, an effective and cost-saving method of treating workers with mental illness has often been sought by researchers.

David J. Bruinvels, MD, PhD, and colleagues at the Departments of Public and Occupational Health at the EMGO Institute at Vrije Universiteit Medical Center in Amsterdam studied 240 police officers on sick leave due to mental health problems to evaluate the efficacy of a guideline-based treatment approach compared to referral to a mental health professional for treatment. Bruinvels and colleagues sought to determine if a guideline-based approach—a lower cost option which included counseling by an occupational physician with an emphasis on facilitating return to work—would be as efficacious as treatment by a psychiatrist or psychologist.

All of the police officers were randomized to two groups: one group received standard care, which included a referral to a psychologist for assessment and treatment, while the other group received guideline-based care from occupational physicians. Although focused on return to work, guideline-based care also provided officers in the group methods for dealing with stress and offered additional problem-solving techniques. Most patients in the study were suffering from mild, stress-related symptoms. The authors assessed period of duration to return to work and symptom recurrences at 1-year follow-up as outcome measures.

Bruinvels and colleagues found that there was no statistically significant difference in time to return to work; officers in each group were away from work for ~150 days. Among officers receiving guideline-based care whose duties were administrative, the authors found that there was a small reduction in return to work. Patients in the guideline-based care group with mild symptoms related to stress also had slightly reduced time to return to work.

However, the authors added that as guideline-based care is less costly than referral to a mental health professional and achieved similar results to usual care, it may be a beneficial treatment option, particularly for providing care to large groups of employees with minor, common mental health disorders or who are dealing with stressful environments. In addition, as many workers visit primary care physicians (PCPs) prior to referral to a mental health professional, occupational guideline-based care may help PCPs begin comparable mental health treatment earlier and reduce reduced productivity associated with disorder and the overall number of days away from work. (J Occup Environ Med. 2009;51(3):305-312). –CP

Groundbreaking and Future Addiction Genetics Research

A recent article is shoring up the current findings and consensi of the addiction genetics field, and the researchers behind the effort are making a case—using their own as well as past evidence—to set a research agenda for future research.

Ming D. Li, PhD, at the University of Virginia, and Margit Burmeister, PhD, at the University of Michigan, focused not only on the contribution of genes to vulnerability to addiction, but also discussed the possibility of implicating certain genes in specific addictions. Currently, genome-wide linkage and association studies have suggested that a group of genes is linked to increased rates of various addictions. Successfully narrowing down which genes contribute to the incidence of certain addictions could potentially lead to more successful treatments in the future.

However, it is believed—as data suggest—that genetic factors for various addictions overlap. Li and Burmeister summarize specific genomic locations on 11 chromosomes that are linked with addictions to alcohol, cannabis, heroin, nicotine, and opoids.

Focusing on certain gene clusters could be a useful component in ongoing and upcoming addictions research—specifically, the CHRNA5 cluster (which other studies have linked to the incidence of life long smoking, lung cancer, and heightened level of nicotine dependence), CHRNA3, and CHRNB4. (Nat Rev Genet. 2009;10(4):225-231). –LS

Difference in Glucose Tolerance Between Non-deficit and Deficit Schizophrenia

According to researchers at the Medical College of Georgia, there is a difference in tolerance levels for glucose among schizophrenics who have either deficit or non-deficit schizophrenia. In addition to the finding involving both subtypes, a study involving 46 schizophrenic patients and 59 healthy controls revealed that schizophrenics in general have a lower tolerance for glucose than do individuals without the disorder. 

Brian Kirkpatrick, MD, MSPH, and colleagues studied 23 patients with deficit schizophrenia—which is characterized by continual negative symptoms—who differed in their risk factors, biologic history, and treatment responses from 23 patients with non-deficit schizophrenia. In addition, 59 healthy controls were added to the study to compare the glucose tolerance level between schizophrenic individuals and those without the disorder.  The controls were matched to the demographic traits of the 46 with the disorder, including age, ethnicity, gender, socioeconomic income, and body mass index.

The study required all participants to undergo a 2-hour, two-sample, 75 g oral glucose test within 1 hour after fasting from the previous night. The baseline for the glucose concentrations was comparable throughout all groups, with 83.5 mg/dl in deficit patients, 83.0 mg/dl in non- deficit patients, and 83.8 mg/dl in controlled patients.

Cortisol levels (ie, stress hormone) also differed amongst the three groups. However, the difference was only significant between non-deficit patients and controls. Further, cortisol levels were not linked to glucose levels in multivariate analysis.
Kirkpatrick and colleagues believe that these results indicate that the deficit group has a distinctive etiopathophysiology. (Schizophr Res. 2009;107:122–127). –AC

Psychiatric dispatches is written by Amanda Cuomo, Carlos Perkins, Jr., and Lonnie Stoltzfoos.