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    <recommendedItem id="20100101_19_369"
                     title="Administration Issues Mental Health Parity Rule"
                     score="0.01"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18258?impressionId=1265759474090"
                     
      &lt;p&gt;WASHINGTON  --  Under a proposed rule released by the Obama administration, patients in a group insurance plan who are being treated for mental illness or substance abuse may no longer be charged more than if they were receiving medical or surgical care.&lt;/p&gt;
&lt;p&gt;The Department of Health and Human Service (HHS), the Department of Labor, and the Internal Revenue Service issued an interim rule last week containing specific language necessary to enforce the bipartisan &lt;a href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/11169&quot; mce_href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/11169&quot; target=&quot;_blank&quot; title=&quot;Financial&amp;#8200;Bailout&amp;#8200;Carries&amp;#8200;Mental&amp;#8200;Health&amp;#8200;Parity&amp;#8200;Bill&amp;#8200;Through&amp;#8200;Congress&quot;&gt;mental health parity law passed by Congress in 2008&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;The law  --  called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act  --  states that if a group health plan covers the treatment of mental illness or drug or alcohol abuse, the limits and financial requirements for these services can be &quot;no more restrictive&quot; than those that apply to medical and surgical benefits.&lt;/p&gt;
&lt;p&gt;That means an insurance plan cannot charge higher copayments, deductibles, and out-of-pocket expenses for mental health services than for treatment of physical illnesses.&lt;/p&gt;
&lt;p&gt;Companies with fewer than 50 employees in their group insurance plans are excluded from the law.&lt;/p&gt;
&lt;p&gt;&quot;The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care,&quot; said Kathleen Sebelius, secretary of HHS.&lt;/p&gt;

&lt;p&gt;The American Psychiatric Association (APA) issued a statement applauding the regulations.&lt;/p&gt;
    &lt;p&gt;&quot;Mental health parity was a major advance for the APA and for our patients living with mental illnesses,&quot; according to the group&apos;s president, Alan F. Schatzberg, MD. &quot;The APA will continue to work hard and submit the important feedback to the administration that is necessary to make sure our patients receive the care they need.&quot;&lt;/p&gt;
    &lt;p&gt;The statement also drew attention to some shortcomings in the regulations, which did not address provider networks and formulary development.&lt;/p&gt;
    &lt;p&gt;The APA intends to submit recommendations for these and other topics during the 90-day comment period.&lt;/p&gt;
    &lt;p&gt;The American Psychological Association also welcomed the regulations.&lt;/p&gt;
    &lt;p&gt;&quot;We are delighted that under these regulations consumers are protected from insurance discrimination to the greatest extent possible,&quot; according to its executive director for professional practice, Katherine Nordal, PhD, in a prepared statement.&lt;/p&gt;
    &lt;p&gt;The rule also requires a single deductible for mental health and medical/surgical coverage. Patients who are being treated for a mental condition at the same time as somatic condition often have to pay separate deductibles which can &quot;prevent access to mental health treatment,&quot; according to the psychologists&apos; group.&lt;/p&gt;
    &lt;p&gt;&quot;It is particularly significant that the regulation will ban health plans from imposing separate deductibles or setting separate out-of-pocket caps for mental health and medical/surgical services,&quot; the statement said. &quot;This is a big win for anyone seeking mental health treatment.&quot;&lt;/p&gt;
    &lt;p&gt;The 2008 law expanded greatly on the Mental Health Parity Act of 1996, which required parity only in lifetime and annual dollar limits. In practice, crtics say, insurers got around that prohibition by charging higher copayments for mental health services and by &quot;cherry-picking&quot; services that would and would not be covered.&lt;/p&gt;
    &lt;p&gt;The 1996 law also specifically excluded coverage parity for substance abuse treatment.&lt;/p&gt;
    &lt;p&gt;The new rule will take effect April 5, 2010.

    </recommendedItem>
    <recommendedItem id="20100101_19_180"
                     title="APsaA: Connecting Online with Patients in China"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18016?impressionId=1265759474090"
                     
      &lt;p&gt;NEW YORK  --  As some analysts become comfortable with the notion of &quot;the chair,&quot; instead of &quot;the couch,&quot; others are welcoming yet another setting: the computer screen.&lt;/p&gt;
&lt;p&gt;Though it may be controversial among the conservative clinicians, researchers have been using a popular online video chat program known as Skype to reach faraway patients, particularly those in China.&lt;/p&gt;
&lt;p&gt;Ubaldo Leli, MD, an analyst in private practice in New York City, is vice president of the China American Psychoanalytic Alliance (CAPA), an organization that treats patients and trains mental health professionals in China.&lt;/p&gt;
&lt;p&gt;At a session at the American Psychoanalytic Association meeting here, Leli said he conducted his first Skype analysis with a Chinese patient in 2004.&lt;/p&gt;
&lt;p&gt;&quot;When I did my first Skype analysis, I had many doubts,&quot; he said. &quot;Will the analytic process develop? Will there be language differences? Cultural differences?&quot;&lt;/p&gt;
&lt;p&gt;He soon began to feel that the Skype analysis was &quot;similar to any type of analysis.&quot;&lt;/p&gt;
&lt;p&gt;He recalled one Chinese patient who was seated on his own couch in his own living room, with his computer (and hence, Leli on video chat) behind him, as in a typical analytic setting.&lt;/p&gt;
&lt;p&gt;&quot;He was talking, and then he stopped, and I asked him why he stopped,&quot; Leli recalled. &quot;He replied that he sensed a change in my breathing and thought I wanted to say something.&quot;&lt;/p&gt;
&lt;p&gt;The popular Skype software (available at skype.com) is a free download that allows users to make free voice or video calls (if both sides are equipped with Web cameras) anywhere in the world. The company also provides low-cost long distance calls between Skype users and standard local phone customers. Other programs provide many of the same features.&lt;/p&gt;
&lt;p&gt;Although Skype can create a sense of connectedness, Elise Snyder, MD, an analyst from New Haven, Conn., and president of CAPA, said it &quot;simultaneously provides intimacy and distance.&quot; Patient and analyst are in separate spaces, and are often divided by many hours  --  about 13 with Chinese patients.&lt;/p&gt;
&lt;p&gt;And it introduces issues of language and culture that are not typically present in analysis. Snyder said these are &quot;not insurmountable, but they are present.&quot;&lt;/p&gt;
&lt;p&gt;Lana Fishkin, MD, who is on the board of directors of CAPA, said from a cultural standpoint, sex is often a troublesome issue in remote sessions. While discussion of sex is a usual component of analysis in America, it&apos;s rarely mentioned among Chinese patients.&lt;/p&gt;
&lt;p&gt;During analysis, Fishkin said she&apos;s &quot;hesitant to point out that it&apos;s absent, because I&apos;m not sure what it means in Chinese culture.&quot;&lt;/p&gt;
&lt;p&gt;She also called attention to differences within the Chinese culture itself.&lt;/p&gt;
&lt;p&gt;&quot;There have been huge changes over just one generation in China that both we and they have to deal with,&quot; she said.&lt;/p&gt;
&lt;p&gt;Ralph Fishkin, DO, who is also on CAPA&apos;s board, said language issues can be tricky as well.&lt;/p&gt;
&lt;p&gt;&quot;You have to pay more attention to the word the person uses and what exactly they mean by it,&quot; he said. &quot;You have to ask yourself if you&apos;re precisely understanding their feelings.&quot;&lt;/p&gt;
&lt;p&gt;He added that the process of analysis itself is different in the context of Skype: &quot;You&apos;re in your room, they&apos;re in their room. It&apos;s like making a house call at the same time the patient is coming to your office.&quot;&lt;/p&gt;
&lt;p&gt;Some audience members at the session pointed out that there&apos;s no data on the subjective impact of the &quot;space&quot; that patient and the analyst are in. They also questioned the analyst&apos;s ability to maintain perfect eye contact with the patient, as well as the potential to pick up on other body language that would be perceived during an in-person session.&lt;/p&gt;
&lt;p&gt;Yet one of CAPA&apos;s goals is to train Chinese analysts so patients there can have one-on-one interaction.&lt;/p&gt;
&lt;p&gt;Snyder said next year&apos;s class has 100 applicants, among whom 40 or 50 will be accepted to the program.&lt;/p&gt;
&lt;p&gt;She noted that the &quot;community interested in analysis is small in China,&quot; which can create ethical dilemmas. Shanghai may have 22 million inhabitants, but psychoanalysts will be familiar with everyone in their community, including patients.&lt;/p&gt;
&lt;p&gt;&quot;It does raise ethical issues in confidentiality,&quot; she said.&lt;/p&gt;
&lt;p&gt;Psychoanalysis via Skype can also help analysts keep in touch with patients who used to come to in-person sessions but have since moved away  --  although there are no data on how many currently practice this type of remote analysis.&lt;/p&gt;
&lt;p&gt;&quot;Skype is only the beginning,&quot; Leli said. &quot;There are all sorts of new technological developments that will modify the way we think about the analytic frame.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_179"
                     title="APsaA: Do We Need the Past to Imagine the Future?"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18012?impressionId=1265759474090"
                     
      &lt;p&gt;NEW YORK  --  Imagining future events depends on much of the same cognitive and neural machinery as remembering past events, researchers said here.&lt;/p&gt;
&lt;p&gt;In several brain imaging studies, similar areas of the hippocampus were activated when patients recalled past events or imagined future ones, Daniel L. Schacter, PhD, of Harvard University, said during a plenary session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;Memory can be thought of as a tool used by the brain to allow us to generate predictions and simulations of upcoming events,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter and colleagues have conducted several studies involving the link between memory and imagining future events. They&apos;ve found that in remembering past events, patients&apos; brains don&apos;t just replay the scenario the way a computer pulls up a file.&lt;/p&gt;
&lt;p&gt;&quot;We don&apos;t need to preserve every detail,&quot; he said. &quot;We&apos;re good at preserving the gist and meaning, and that serves us pretty well.&quot;&lt;/p&gt;
&lt;p&gt;In imagining future events, those remembered details tend to be recombined into a novel event.&lt;/p&gt;
&lt;p&gt;&quot;We link bits and pieces of information from different sources,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter began wondering why humans may have this type of memory system rather than a literal one, and it led him to conduct several brain imaging studies.&lt;/p&gt;
&lt;p&gt;In their earliest work, Schacter and his colleagues were &quot;struck by the similarity we saw&quot; in the brain regions that became active when patients remembered past events or dreamed up possible future scenarios. The hippocampus was especially active.&lt;/p&gt;
&lt;p&gt;Schacter devised that the remembered details are not stored in one place, but are are reactivated during retrieval and reintegrated by the hippocampus into a coherent event.&lt;/p&gt;
&lt;p&gt;Yet the researchers noticed that a couple of regions activated selectively when patients imagined the future  --  particularly the anterior hippocampus.&lt;/p&gt;
&lt;p&gt;That region may play a role in &quot;active recombining that&apos;s critical to imagining one&apos;s future,&quot; he said.&lt;/p&gt;
&lt;p&gt;Based on their findings, the researchers formed the Constructive Episodic Simulation Hypothesis, which essentially states that imagining the future requires a system that can flexibly combine details from past events into novel scenarios.&lt;/p&gt;
&lt;p&gt;One caveat: although this theorized system is well-suited to simulate future events, it runs the risk of misrecombination that can result in memory errors, such as false recognition.&lt;/p&gt;
&lt;p&gt;Schacter questioned whether the findings &quot;tell us something new about the hippocampus, or do we already know this because the hippocampus is involved in encoding information and memory? And maybe future simulation is just piggybacking on the role of the hippocampus in encoding.&quot;&lt;/p&gt;
&lt;p&gt;Either way, he said, the process is &quot;crucial for adaptive functioning.&quot;&lt;/p&gt;
&lt;p&gt;Henry F. Smith, MD, a psychiatrist in private practice in Cambridge, Mass., said that the &quot;simulation of future events may be what the brain does when we&apos;re not perceiving the present  --  we call it daydreaming.&quot;&lt;/p&gt;
&lt;p&gt;&quot;But,&quot; he added, &quot;if the memory of the past and the simulation of the future use the same brain system, maybe that&apos;s the reason [memories] get all jumbled up.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_177"
                     title="APsaA: Top Psychoanalytic Journals Lack Rigorous Research (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18010?impressionId=1265759474090"
                     
      &lt;p&gt;NEW YORK  --  The top three psychoanalytic journals are short on original research on psychoanalysis, researchers said.&lt;/p&gt;
&lt;p&gt;Combined, the journals produced fewer than 10 original research articles annually over a seven-year period, Jane G. Tillman, PhD, of the Austen Riggs Center in Stockbridge, Mass., and colleagues reported in a poster session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s not very many in a scientific field,&quot; Tillman said.&lt;/p&gt;
&lt;p&gt;Calls for rigorous psychoanalytic research studies have become more common in the past decade, as an increasing number of analysts have committed to demonstrating the validity and efficacy of what they do.&lt;/p&gt;
&lt;p&gt;But the debate also goes to the heart of the discipline itself.&lt;/p&gt;
&lt;p&gt;Critics argue that because psychoanalysis attempts to explain everything, it&apos;s not falsifiable and can&apos;t state a null hypothesis; thus it&apos;s not a proper science.&lt;/p&gt;
&lt;p&gt;While some analysts say psychoanalysis is an hermeneutic discipline because of its reliance on the interpretation of texts, others argue that it is indeed a science and must demonstrate validity and efficacy via a solid methodology.&lt;/p&gt;
&lt;p&gt;To shed light on the debate, the researchers investigated whether there were significant differences in the number of research articles published in the three major psychoanalytic journals: the &lt;em&gt;International Journal of Psychoanalysis&lt;/em&gt;, the &lt;em&gt;Journal of the American Psychoanalytic Association&lt;/em&gt;, and &lt;em&gt;Psychoanalytic Psychology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;They also looked at the characteristics of research samples in the studies, as well as the predominant methodologies.&lt;/p&gt;
&lt;p&gt;Between 2001 and 2008, they found 76 original research articles, which yielded a mean of 9.5 total articles per year  --  only about three in each journal.&lt;/p&gt;
&lt;p&gt;There were no significant differences in the number of research articles published each year by all three journals.&lt;/p&gt;
&lt;p&gt;About 40% of studies used interviews for their data collection.&lt;/p&gt;
&lt;p&gt;The researchers said their survey &quot;raises questions about the status of psychoanalytic research&quot; in these journals.&lt;/p&gt;
&lt;p&gt;Tillman said the absence of serious methodological and research education at many psychoanalytic training institutes may play a role in the lack of research.&lt;/p&gt;
&lt;p&gt;&quot;It really cuts down on the interest,&quot; she said. Yet she also acknowledged that it&apos;s &quot;hard to reduce the complexity of psychoanalysis into well-defined variables.&quot;&lt;/p&gt;
&lt;p&gt;The researchers questioned whether the major psychoanalytic journals receive more submissions of research articles than they print but reject them because of poor quality or poor fit with the aims of the journal.&lt;/p&gt;
&lt;p&gt;Or perhaps psychoanalytic researchers tend to publish in journals that are not identified as specifically psychoanalytic in order to broaden their readership, they suggested.&lt;/p&gt;
&lt;p&gt;Tillman said further research is necessary to find out. Also, based on the high percentage of interviews used in data collection, developing &quot;clear methodologies for working with the interview data&quot; may help increase the rigor of studies.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_176"
                     title="APsaA: Away from the Couch and into the Community"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18009?impressionId=1265759474090"
                     
      &lt;p&gt;NEW YORK  --  Psychoanalysts should get out of their offices and engage their community more frequently, researchers said here.&lt;/p&gt;
&lt;p&gt;Harold Kudler, MD, of the VA in Durham, N.C., reported on four initiatives in his home state that got analysts involved in their communities at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;It all comes down to the idea that psychoanalysts need to get more involved in their communities, and by doing so, we make people more aware of what we do,&quot; Kudler said during a poster session.&lt;/p&gt;
&lt;p&gt;He noted that analysts are often portrayed as &quot;introspective denizens of their own quiet offices.&quot; But when they engage the larger community, both are enriched, he added.&lt;/p&gt;
&lt;p&gt;The impetus toward community involvement came when Kudler learned that only 45% of eligible patients seek treatment at VA hospitals. He wanted to branch out and raise awareness of the services his agency offered.&lt;/p&gt;
&lt;p&gt;The researchers&apos; first initiative was a concert to raise funds for a psychoanalytic preschool, the Lucy Daniels Center for Early Childhood. Kudler said the fundraiser sparked new levels of volunteerism within the center and generated &quot;a new base of support to build on for years to come.&quot;&lt;/p&gt;
&lt;p&gt;For the other three initiatives, the researchers reached out with the help of the North Carolina Psychoanalytic Foundation, focusing on children&apos;s and veterans&apos; issues.&lt;/p&gt;
&lt;p&gt;One project was a day-long program on bullying in a Durham, N.C., inner-city school, which Kudler said inspired involvement and sponsorship from across the community.&lt;/p&gt;
&lt;p&gt;The foundation also partnered with North Carolina state officials to create a training program for local providers regarding military issues. These included military culture, deployment stress, common effects on the veteran and on the family, recommended interventions, and appropriate resources.&lt;/p&gt;
&lt;p&gt;Finally, the organization appointed one member to serve as an adviser to a national multimedia children&apos;s program regarding military deployment issues.&lt;/p&gt;
&lt;p&gt;Kudler said he and his colleagues and the foundation are looking for other venues to integrate with their community. He said they are consulting with businesses, religious groups, and other organizations involved in community support.&lt;/p&gt;
&lt;p&gt;He emphasized that the &quot;psychoanalytic community is a vital part of the greater community. Their mutual health and their futures naturally intertwine.&quot;&lt;/p&gt;

    </recommendedItem>
</recommendedContent>