Noteworthy News Articles on Mental Health Topics, February 27-28, 2006

Awaiting Retrial, Yates Rejects Plea Offer
Associated Press, 2/27/2006

HOUSTON --Andrea Yates has rejected a plea offer that would have sent her to prison for 35 years for drowning her children and is expected to face a retrial in March, her attorney said Monday. Prosecutor Joe Owmby said the state would leave the offer on the table until March 10 -- 10 days before Yates' capital murder retrial is set to begin for the deaths of three of the five children in 2001. Yates has pleaded innocent by reason of insanity, as she did at her first trial. The plea offer would require her to plead guilty or no contest to murder. ''We have rejected that recommendation,'' Yates' attorney George Parnham said.
      Yates was convicted of capital murder in 2002, but the conviction was overturned because a forensic psychiatrist gave false testimony. Park Dietz had said an episode of television's ''Law & Order'' series about a woman with postpartum depression drowning her children was aired shortly before the Yates children died; the episode didn't exist.
     On Monday, State District Judge Belinda Hill granted the state's request to hire a second expert witness to evaluate Yates. Parnham opposed another evaluation. The judge also denied Parnham's claim that prosecutorial misconduct in the first trial would mean double jeopardy for Yates in the second trial. Hill found no evidence showing prosecutorial misconduct and no grounds for the double jeopardy claim.
     During the first trial, psychiatrists testified that Yates suffered from schizophrenia and postpartum depression, but expert witnesses disagreed over the severity of her illness and whether it prevented her from knowing right from wrong. A jury rejected Yates' original insanity defense and recommended life in prison for the drowning of three of her five children, ages 7, 5 and 6 months. Evidence was presented about the drowning of two others, ages 3 and 2, but Yates was not charged in their deaths.



Study Hints at Why Women Cope Better
Peter Gorner, Chicago Tribune- 2/27/2006

Female rodents handle stress much better than males, which may hint at why women seem better able to survive social isolation than men, a pioneering University of Chicago research team reported Monday. The difference in the female lab rats' responses may stem from the demands of motherhood, the researchers speculated. The idea is that mothers who can fend off stress and injury can better protect their young.
     The study used 120 rats to document the long-lasting effect that three months of isolation and one 30-minute episode of acute physical stress had on the function of the rodents' immune systems. The researchers measured what is known as the inflammatory response, the body's initial, fundamental immune reaction to bacteria, viruses and other invaders. Just two or three weeks after being subjected to isolation and the brief period of acute physical stress, male rats showed a markedly slower inflammatory response than female rats when injected with a foreign body. In fact, the response of the female rats was "staggeringly stronger," the authors wrote in their paper, which appears in a publication from the American Journal of Physiology. "The study reinforces a growing body of evidence on health disparities between men and women and may shed light on why socially isolated men are more vulnerable to disease and death than isolated women," said co-author Gretchen Hermes, referring to studies showing that men who have few personal relationships may have increased risk of heart disease.
     Senior author Martha McClintock noted that the inflammatory response "not only is at the heart of autoimmune diseases but also is involved in cancer, heart disease, infectious disease--just a whole variety of problems." "Showing the effects of social isolation on the fundamental immune process has a lot of clinical implications," she said.

Team has history of success
McClintock, a psychology professor and director of the Institute for Mind and Biology at the University of Chicago, specializes in determining how social interactions and individual beliefs regulate gene expression, affecting health and sickness. She and her colleagues are most famous for finding the first conclusive scientific evidence of human pheromones--airborne chemical signals that can't be detected with the five senses but apparently influence how we think, feel and behave.
     McClintock studies tough Norway rats, which have evolved into survivors. These common sewer rats are a particularly social species that live in large colonies of closely spaced burrows with cooperative grooming, feeding and rearing of offspring. The new study covered three months, a significant portion of the rats' life span, and showed the lasting effects of an acutely stressful event superimposed on the chronic social condition of isolation. "We stressed the animals for just 30 minutes by putting them in a plastic restraint tube that mimics the collapse of their burrow," McClintock said. "Two weeks later, we tested them and found huge sex differences in response to that very brief physical stressor." Among the males, the episode of acute stress further delayed the inflammatory response when they were exposed to a foreign substance. "But in the females, it actually compensated for the effects of isolation. It had a positive enhancing effect on the immune system," McClintock said.
     The results dovetail with studies that have found rats are more likely to give birth to female offspring than male offspring in times of stress, McClintock said, as it suggests males are less likely to survive under stressful circumstances. It is not clear why females heal more quickly than males under stress, but the authors said it may be a protection that evolved as females tried to protect their offspring. "While lactating, maternal rats become highly aggressive toward intruders and predators and are at high risk for wounding, particularly from neck bites," the report states. So it makes evolutionary sense for females to respond to an immediate stressor by enhancing their inflammatory response and healing more quickly, McClintock said.

Sexes differ after a brief stress
Another possibility is that males and females experience stress differently, the study said. If females perceive the restraint as more traumatic, they may react more strongly to the introduction of the foreign body and produce a stronger immune reaction. "I think probably the most striking thing are the dramatic sex differences in the enduring effects of a brief stress," McClintock said. "If I were to link the study to what's in the news right now, there are studies of differences in heart disease in men and women. We used to think they were the same disease, but now we know the nature of the inflammation is very different. "In men it's localized in the large vessels; in females it's along the smaller vessels of the heart." McClintock said she hoped the study would be an important contribution in the understanding of sex differences of disease--"but, specifically, disease as it occurs in the context of real social and psychological life."



Court Gives Meth Addicts Way Out
Ofelia Casillas, Chicago Tribune- 2/27/2006

PITTSFIELD, Ill. -- Janice Sidwell stood and proudly told a Pike County circuit judge that her children were finally home. Two rows of methamphetamine users applauded. "Congratulations," Judge Michael Roseberry told her. "Good job." Sidwell, 39, then grabbed a bag of Reese's Pieces from a candy bowl on the edge of the witness stand, a reward for her son and daughter.
     Sidwell and the children's father had been caught twice for selling and using meth. They had served prison time and lost custody of the children. And if the couple had remained in the criminal justice system, they would likely still be in prison today, in a cycle of drug abuse and incarceration that is a common path. Instead, with the help of prosecutors and a judge, they ended up in Pike County's drug court, an administrative office that has become, for all intents and purposes, a meth court, devoted to alternative responses to methamphetamine crimes.
     Like most drug courts, meth court is in some ways a kinder, gentler approach. For non-violent offenders, the court offers a chance to avoid prison time and provides a much fuller safety net, directing addicts to drug counseling, mental health treatment, even parenting classes. To address the long-lasting effects of methamphetamine and the tenacity of meth addiction, Pike County, about 270 miles southwest of Chicago, has gone a step further, with longer periods of supervision and exceptional levels of intervention. That not only helps users beat the habit, experts say, but also improves chances to reunify families such as Sidwell's.
     Sidwell entered meth court in December 2004 and has been clean since, said Barb Allensworth, Pike County's chief probation officer. This month Sidwell regained legal custody of her children. "Come hell or high water, she wanted her children back," Allensworth said.
     Though a judge typically runs drug courts, it is not an adversarial process but rather a venue for teams of probation officers, counselors and attorneys to find a common plan. How they carry out that plan, and how much individual attention is possible, can depend on where the drug court is located.
     In a Chicago drug court, where 150 people fight mostly cocaine and heroin addictions, there are no chocolates. While Pike County requires 18 sober months to graduate, a Chicago participant can graduate after six clean months, according to Cook County Drug Court Coordinator Susan Stanger. "We have such an urban setting, to hold people that long when we have a high caseload is not practical," Stanger said.
     But for all its special treatment, some offenders in rural Pike County say their drug court can be harder than prison. The intense regimen--daily drug testing, frequent counseling, proof of employment, financial plans, even a neat and up-to-date appointment book--requires a level of commitment some offenders can't handle. Those who drop out go back into the criminal court system. But for those who make it through meth court, "graduation" means a party with cake, punch, a diploma and a watch. Authorities say it also means a much greater likelihood of staying clean and out of trouble.
     Methamphetamine is a highly addictive nerve stimulant sold in pill, powder or solid form that can be smoked, injected, snorted or swallowed. Meth can be made by anyone, just about anywhere, and one user said she could once turn $100 in supplies into $1,000 in profit. The high from smoking meth can last a day, compared with cocaine's 30-minute high, according to the National Institute of Drug Abuse. Afterward, meth stays in the body many times longer than cocaine.
     Pike County officials say their drug court was the first in Illinois to specialize in methamphetamine, beginning in 2003, focusing on the long recovery period and high rate of relapse. More meth courts might be on the way. "We are trying to monitor Cook County cases to see if we have to do that," Chicago Police Lt. Robert Stasch said. "If it's necessary that we have a dedicated court, I don't doubt that is something that would be forthcoming."
     It's up to the judge and prosecutors to determine whether to defer criminal proceedings and send a meth offender to drug court. There are roughly 1,600 drug courts in the U.S. and 24 in Illinois, according to the National and Illinois Associations of Drug Court Professionals.
     On a recent afternoon in Pike County, Judge Roseberry's team reviewed in his chambers the cases of the 18 current drug court participants. Outside, the participants lined up for their mandatory drug tests or talked with one another about the vagaries of recovery: weight gain, lost friends and less cash, now that they don't sell meth. Later that afternoon, Roseberry called them up one by one. One woman, after a few denials, admitted she had been drinking on New Year's Eve; Roseberry thanked her for self-reporting and sent her to jail for a day. A man who had passed a recovery milestone got a certificate and a hug from a court official. Offenders in the gallery greeted some reports with applause. Some successes were rewarded with free gas or dinner. "I've come to be a very huggy person now," Allensworth said. That treatment ethos leads to some unusual efforts by court officers, who have helped offenders find work or places to live, donated furniture or a used car and even lent money for a graduation gown.
     Beyond the salaries of the judge and other public officials, who all have other duties in the criminal system, meth court costs Pike County taxpayers nothing, Allensworth said. The court spends about $3,000 per client per year, officials said, for appointment books, counseling, drug testing, graduation and, occasionally, housing or gas money. But that money is raised through probation fees and donations. And recently meth court officials held their first "trivia night," a community fundraiser that generated several thousand dollars.
     Since the start of Pike County's meth court, Roseberry counts five graduates, none of whom has relapsed. There have been about a dozen dropouts. That's a tiny dent in the meth problem, officials acknowledge, but they hope that a few successes here will mean a much larger reduction in repeat arrests. "We can't arrest our way out of this one," said Illinois State Police Sgt. Bruce Liebe. "No matter how many labs we take, it has to be a combination of treatment to break this cycle." And experts say a few thousand dollars spent on drug court is cheap, compared with the $20,000 to $50,000 per year that it costs to keep a convict in prison.
     Sidwell's children--Angel, 9, and Damien, 2--moved back in with her last summer on a conditional basis, though the state retained legal custody. Sidwell had started smoking pot at age 15 and using meth at 23. That's how she met the children's father, Rick Cantwell, 33, a sawmill laborer. They went to prison at the same time in 2001 and again in 2004. They also started drug court together. Cantwell did not succeed as quickly as Sidwell, testing positive for drugs several months into the program. Instead of prison, Roseberry gave him a chance to attend rehab. The couple plan to marry after they graduate from drug court in the fall. For now, they are trying to catch up on the moments with their children that they missed because of meth.
     On a recent evening, Damien raced trucks in the living room. Cantwell helped Angel solve math problems. "I never used to do this when I was using drugs," Cantwell said. Sidwell lamented lost time with Damien. "We missed him crawling. We missed him walking," she said. "We missed everything." Sidwell said all she and Cantwell need are their kids. "Drug court saved our family," Sidwell said as she looked at her children. "Mommy's never going to leave you guys again."


Beyond Rivalry, a Hidden World of Sibling Violence
Katy Butler, New York Times- 2/28/2006

From infancy until he reached the threshold of manhood, the beatings Daniel W. Smith received at his older brother's hands were qualitatively different from routine sibling rivalry. Rarely did he and his brother just shove each other in the back of the family car over who was crowding whom, or wrestle over a toy firetruck. Instead, Mr. Smith said in an interview, his brother, Sean, would grip him in a headlock or stranglehold and punch him repeatedly. "Fighting back just made it worse, so I'd just take it and wait for it to be over," said Mr. Smith, who was 18 months younger than his brother. "What was I going to do? Where was I going to go? I was 10 years old."
      To speak only of helplessness and intimidation, however, is to oversimplify a complex bond. "We played kickball with neighborhood kids, and we'd go off exploring in the woods together as if he were any other friend," said Mr. Smith, who is now 34 and a writing instructor at San Francisco State University. (Sean died of a heart attack three years ago.) "But there was always tension," he said, "because at any moment things could go sour."
     Siblings have been trading blows since God first played favorites with Cain and Abel. Nearly murderous sibling fights — over possessions, privacy, pecking orders and parental love — are woven through biblical stories, folktales, fiction and family legends. In Genesis, Joseph's jealous older brothers strip him of his coat of many colors and throw him into a pit in the wilderness. Brutal brother-on-brother violence dominates an opening section of John Steinbeck's "East of Eden," and in Annie Proulx's short story "Brokeback Mountain," the cowboy Ennis del Mar describes an older brother who "slugged me silly ever' day."
     This casual, intimate violence can be as mild as a shoving match and as savage as an attack with a baseball bat. It is so common that it is almost invisible. Parents often ignore it as long as nobody gets killed; researchers rarely study it; and many psychotherapists consider its softer forms a normal part of growing up. But there is growing evidence that in a minority of cases, sibling warfare becomes a form of repeated, inescapable and emotionally damaging abuse, as was the case for Mr. Smith.
     In a study published last year in the journal Child Maltreatment, a group of sociologists found that 35 percent of children had been "hit or attacked" by a sibling in the previous year. The study was based on phone interviews with a representative national sample of 2,030 children or those who take care of them. Although some of the attacks may have been fleeting and harmless, more than a third were troubling on their face.
     According to a preliminary analysis of unpublished data from the study, 14 percent of the children were repeatedly attacked by a sibling; 4.55 percent were hit hard enough to sustain injuries like bruises, cuts, chipped teeth and an occasional broken bone; and 2 percent were hit by brothers or sisters wielding rocks, toys, broom handles, shovels and even knives. Children ages 2 to 9 who were repeatedly attacked were twice as likely as others their age to show severe symptoms of trauma, anxiety and depression, like sleeplessness, crying spells, thoughts of suicide and fears of the dark, further unpublished data from the same study suggest.
     "There are very serious forms of, and reactions to, sibling victimization," said David Finkelhor, a sociologist at the Family Research Laboratory at the University of New Hampshire, the study's lead author, who suggests it is often minimized. "If I were to hit my wife, no one would have trouble seeing that as an assault or a criminal act," Dr. Finkelhor said. "When a child does the same thing to a sibling, the exact same act will be construed as a squabble, a fight or an altercation." The sibling attacks in Dr. Finkelhor's study were equally frequent among children of all races and socioeconomic groups; they were most frequent on children 6 to 12, slightly more frequent on boys than on girls, and tapered off gradually as children entered adolescence.
     As violent as sibling conflicts are among humans, they are seldom fatal, as they can be among birds and a smattering of other animals. Siblicide is common among birds of prey, including tawny eagles, brown pelicans and kittiwakes. A Pacific Ocean seabird known as the blue-footed booby pecks at its siblings and pushes them out of the nest to die of starvation while the parents stand idly by. A baby black-crowned night heron in Minnesota was twice observed swallowing the entire head of a younger nestmate until it went limp and looked close to death. Embryonic sand tiger sharks eat one another while they're still in the womb. Piglets are born with a special set of temporary "needle teeth" to attack their littermates in the struggle for the mother's prodigal frontal teats; the runts kicked back to the hind teat sometimes starve on its thin milk. On the Serengeti Plain of Tanzania, spotted hyena pups, who are usually born in pairs, bite and shake each other almost from the moment they leave the womb. When the mother's milk is thin, the struggles often end with the death of one pup from wounds or malnutrition — especially, curiously enough, if the pups are the same sex.
     Baby animals, researchers theorize, fight mainly to establish dominance and to compete for scarce food. Human children, on the other hand, fight not only over who got the bigger bowl of ice cream but also over who decides what game to play, who controls the remote, who is supposed to do the dishes, who started it and who is loved most.
     Few experts agree on how extensive sibling abuse is, or where sibling conflict ends and abuse begins. It is rarely studied: only two major national studies, a handful of academic papers and a few specialized books have looked at it in the last quarter-century. And it is as easy to over-dramatize as it is to underestimate.
     In 1980, when the sociologist Murray Straus of the University of New Hampshire published "Behind Closed Doors," a groundbreaking national study of family violence, he concluded that the sibling relationship was the most violent of human bonds. Judged strictly by counting blows, he was right: Dr. Straus and his colleagues found that 74 percent of a representative sample of children had pushed or shoved a sibling within the year and 42 percent had kicked, bitten or punched a brother or sister. (Only 3 percent of parents had attacked a child that violently, and only 3 percent of husbands had physically attacked their wives.)
     John V. Caffaro, a clinical psychologist and family therapist in private practice in the San Diego suburb Del Mar, defines sibling abuse as a pattern of repeated violence and intimidation. In an interview, Dr. Caffaro, a co-author of "Sibling Abuse Trauma," said abuse was most often determined by a combination of disengaged upbringing by parents, testosterone and family demographics. It occurs most often in large families composed entirely of closely spaced boys, and least frequently among pairs of sisters, he said. "A kid can hit a sibling once and it can look pretty bad, but that's not what we consider abuse," he said. "We're looking for a repeated pattern and when that happens, somebody — a parent — has got to be out to lunch."
     Abuse occurs most frequently, he said, when a parent is emotionally absent as a result of divorce, long working hours, extensive business travel, alcoholism, preoccupation with his or her own problems or other factors. "One or both parents aren't really around much to do their jobs. It's almost a given," Dr. Caffaro said, adding that "peripheral" fathers are particularly problematic. "Things are chaotic, boundaries are blurred, and supervision is minimal," he said, noting that those families do not always look chaotic from the outside. "Sometimes the father is just basically extensively out of town for business and Mom is not a good limit-setter," he said. In other cases, he added, parents escalate conflicts by playing favorites, ignoring obvious victimization, intervening only to shut the kids up or blaming older children without understanding how younger children helped provoke them.
     Dr. Caffaro said that in his experience sibling violence could rarely be attributed simply to an extraordinarily aggressive or psychotic child. In nearly 15 years of working with more than a hundred families and adult survivors of sibling abuse, he said he could remember only a handful of such cases, one involving a girl repeatedly beaten up by a brother with schizophrenia. Although some children have poor impulse control, he said, violence only becomes repeated abuse when parents fail to nip it in the bud.
     Several adults, contacted through a classified advertisement posted online on Craigslist and through a Web site for survivors of sibling abuse, said that their parents had ignored their siblings' intimidation. "My parents tended to lessen the significance of the abuse, telling me that my brother loved me, really, and that he really was a nice person," wrote Kasun J., 21, an Australian university student, in a posting on the Web site he started under the pen name Mandragora. Kasun J., who did not want to be further identified for fear of family repercussions, said in an interview that he still kept his distance from an older brother who once threw a clock and a set of nail clippers at his head.
     Daniel Smith said that his parents rarely intervened when he and his brother fought, figuring that "boys will be boys." When he was in sixth grade, he said, a school counselor, concerned about a violent short story he had written, asked him about possible abuse at home, and he felt relieved and hopeful. But as soon as he told her that it was his brother, not his parents, who was hitting him, the counselor dropped the subject. "I remember thinking that she was sort of a fraud," Mr. Smith said.
     Other people interviewed said they were still haunted by memories of older brothers — and an occasional sister — who dumped them out of bassinets, hit them with mop handles, sat on their chests until they feared suffocation, punched them in the mouth or stabbed them in the hands with a nutpick or compass point. Several said they were second-born children, and they theorized that their abusive siblings had resented being displaced. None wanted to be further identified out of concerns about family privacy.
     Many people said the effects of the early abuse had lingered into adulthood. Mr. Smith, for instance, said that he still fights a tendency to avoid confrontations, especially with aggressive people who remind him of his brother. Another man, an academic in his 50's who did not want to be further identified out of privacy concerns, ascribed what he called his "constant wariness" to his physical intimidation in childhood by an older sister. "I have a high need for solitude when I work," said the professor, who added that the unwelcome shoving and wrestling started when he was a toddler and was one of the defining influences of his early emotional life. "I'm attentive to noise," he said. "If somebody's around, a lot of my brain immediately turns to: Who is it? What's up? Are they going to bother me or sabotage me in some way?"
     Several people said that the abuse continued until they reached early adolescence and became strong enough to defend themselves. In Mr. Smith's family, however, the fights became even more violent when he reached his late teens, because he took up tae kwon do, began lifting weights and eventually struck back. One afternoon in the family kitchen when he was 19, in the course of a routine argument, his brother half-heartedly slapped him. This time, for the first time, it was Daniel who got his brother in a crushing headlock, and Daniel who pressed a forearm against his brother's nose until it bled. Knowing he could hold the position forever, Mr. Smith let his brother up. When Sean tried to restart the fighting, Mr. Smith, much to his surprise, burst into long, jagged sobs. "I remember feeling like I should have been triumphant and I did feel some of that, but I also felt scared and confused," he said. "It was a rite of passage for me. I'd accomplished something and become my own person."
     The brothers never fought again, never spoke about the violence and were not close for most of their lives. Sean Smith went on to a difficult adult life, and had only recently freed himself from addiction to alcohol and methamphetamines when he died three years ago, Daniel Smith said. Only then, he said, did he realize the unspoken depth and complexity of their connection. When asked whether he had forgiven his brother, Mr. Smith hesitated. "Once he died, I realized that we had a pretty strong bond that I didn't understand or even knew existed," he said. "I can tell you I outcried everybody else at the funeral."

What Parents Should Look For
Parents can ask several questions to differentiate healthy sibling conflict from damaging abuse, said Vernon Wiehe, a professor at the College of Social Work at the University of Kentucky and author of "What Parents Need to Know About Sibling Abuse." "The most important question is, is one child. constantly a victim of the other?" Dr. Wiehe said. "Does that child need help? How often and how long has the behavior occurred? Is there a pattern? And is the behavior age-appropriate?" A 5-year-old hitting a 3-year-old over a toy is one thing, Dr. Wiehe said. A 14-year-old hauling off and slugging a 10-year-old for borrowing his tennis racket is something else again.
     When one child is always the loser, the aggression keeps escalating and parents do not intervene effectively, the safety of the victimized child should become a therapist's primary concern, said Dr. John V. Caffaro, a clinical psychologist and family therapist in private practice in the San Diego suburb of Del Mar. "You don't spend your time teaching parenting skills in that case," he said. "If the family is not going to take it seriously, it might mean getting law enforcement or social service agencies involved" He continued: "It might mean putting locks on the victimized child's bedroom door. If the children are sharing a bedroom and it's become a terrorist camp for one child, you might alter that arrangement." Dr. Caffaro sometimes recruits a grandmother or grandfather to move into the home for a couple of months to provide additional supervision, he said.
     Parents should also create clear and consistent rules about the privacy of bedrooms and individual possessions, said Dr. James C. Dobson, a clinical psychologist best known as the politically and socially conservative religious activist and host of an internationally broadcast radio advice program, "Focus on the Family." "Children are very sensitive to questions of fairness, " said Dr. Dobson, who earned his doctorate in child development at the University of Southern California. "You don't let the older one pick on or harass the younger one, and you don't let the younger one break the toys or disrupt things when the older one has friends over. You cannot allow obvious injustice to occur."



After Iraq, Many Soldiers Seek Counseling
Associated Press, 2/28/2006

CHICAGO -- More than a third of U.S. soldiers received psychological counseling soon after returning from Iraq, according to a Pentagon study that could add fodder to a budget battle in Congress over veterans' health care. The researchers did not find the results surprising, because the military has a new mental health screening program for returning soldiers and is encouraging them to get help early to prevent serious problems later, said study co-author Dr. Charles Hoge, a colonel at the Walter Reed Army Institute of Research.
      Because of the new screening program, the findings cannot be compared to those from previous wars, Hoge said. ''There are psychological consequences of war and we want to address those up front,'' Hoge said. ''The hope is we won't have as high rates of mental health consequences as we've seen in prior wars.''
     Thirty-five percent of Iraq veterans received mental health care during their first year home, according to the study. In addition, 12 percent of the more than 222,000 returning Army soldiers and Marines in the study were diagnosed with a mental problem. Nineteen percent of those back from Iraq reported mental health concerns, compared with 11 percent of those back from Afghanistan and 8.5 percent of those returning from other places, such as Bosnia. The study appears in Wednesday's Journal of the American Medical Association.
     Veterans' advocates said the study supports their call for increased spending on mental health care for Iraq veterans. President Bush's budget plan includes a 6 percent increase in spending for the Department of Veterans Affairs. But some in Congress say that is not enough because the increase hinges on more than $1 billion in cuts in other VA spending and the approval of new fees and co-payments for some veterans. ''This budget would ultimately shortchange veterans who need mental health services,'' said Ralph Ibson, a vice president of the National Mental Health Association. ''This study can and should be a wake-up call in terms of veterans' mental health needs.''
     Medical authorities first accepted post-traumatic stress disorder as a psychiatric condition in 1980 at the urging of Vietnam veterans. A previous study by Hoge and his colleagues found 15 percent to 17 percent of soldiers returning from Iraq showed signs of the disorder, and many were reluctant to seek help because of the stigma attached to mental illness.
     Shortly after starting the ground war in Iraq in 2003, the Pentagon began requiring returning service members to complete a three-page survey that is used to decide who needs further help. Among other things, the veterans are asked whether they have had nightmares, whether they are constantly on guard or easily startled, and whether they feel numb or detached from others. ''In prior wars, mental health issues weren't studied until years, sometimes decades, after the soldiers came back,'' Hoge said. ''For this war, we're doing it differently. Research is influencing policy and we're adjusting policies as the data come in.''
     On the Net: JAMA: http://jama.ama-assn.org


Regulators Approve Patch to Treat Depression
Associated Press, 2/28/2006

WASHINGTON -- Federal regulators approved the first antidepressant skin patch on Tuesday, providing a different way to administer a drug already used by Parkinson's disease patients. The Food and Drug Administration approved the selegiline transdermal patch, agency spokeswoman Susan Cruzan said. The drug belongs to a class of medicines that is rarely a first or even second choice to treat depression. It will be marketed as Emsam, said Somerset Pharmaceuticals Inc., which developed the drug, and Bristol-Myers Squib Co., which will market it.
      The FDA will require the drug to bear a so-called ''black-box'' warning of the risks of suicidal thoughts and behaviors in children and adolescents treated with antidepressants. The drug is meant for use only by adults. The drug's label also will carry a long list of foods, drinks and other drugs that patients must avoid while using the Emsam patch. The warnings are typical of the class of drugs to which it belongs.
     Selegiline, approved in pill form by the FDA in 1989 to help treat Parkinson's disease, is a monoamine oxidase inhibitor, or MAOI. Typically, doctors prescribe MAOIs only if patients don't respond to other antidepressants, including selective serotonin reuptake inhibitors like Prozac, Zoloft and Paxil. Although health officials say MAOIs are safe when used correctly, the drugs can cause dangerous interactions, including sudden and severe rises in blood pressure that can lead to a stroke, when patients consume food or drinks that contain a substance called tyramine -- found in draft beer, red wine, fava beans, salamis, aged cheeses, soy sauce and other products. Bristol-Myers and Somerset said Emsam patients, when using the six-milligram or lowest strength patch, shouldn't have to watch their diets. However, those using the larger nine- or 12-milligram versions of the once-a-day patch must do so. Somerset Pharmaceuticals is a joint venture between Watson Pharmaceuticals Inc. and Mylan Laboratories Inc.
     On the Net: Food and Drug Administration: http://www.fda.gov