(February 26, 2019) Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about serious mental illness and summarizes recently published research reports or developments.
DATAPOINT of the Month
- In 84% of states, at least some parts of inpatient psychiatric hospital stays are covered for adults through Medicaid according to the new Kaiser Health News Medicaid Behavioral Health Services Database. Services less often covered for adult Medicaid beneficiaries include intensive outpatient treatment (covered in 67% of states) and assertive community treatment (covered in 65% of states).
RESEARCH of the Month
- Higher scores on wisdom assessments linked with fewer psychotic symptoms and better cognitive performance in individuals with schizophrenia.
Wisdom, or the ability to make decisions based on experience and qualities such as insight and good judgement, can provide a window into a person’s sense of satisfaction with life and general well-being. In measuring three different types of wisdom—cognitive, reflective, and emotional—among individuals with schizophrenia and those without, researchers found people who had been diagnosed with schizophrenia obtained lower scores compared to counterparts without the disease. However, nearly one-third of participants with schizophrenia had wisdom scores within the “normal” range. This group also displayed fewer psychotic symptoms and better performance on cognitive and functional tests compared to individuals with schizophrenia who had lower wisdom scores.
The study results may help foster a meaningful shift in how the medical community addresses severe mental illness. "We have a tendency in medicine to focus attention on remediating symptoms and impairments to the exclusion of individual strengths,” says senior researcher Dr. Dilip V. Jeste, MD. “A sustained effort to assess and enhance positive traits in a person with severe mental illness, such as their levels of wisdom, happiness and resilience, might do much to improve the quality of their lives."
Van Patten, R., et al. (2019). Assessment of 3-dimmensional wisdom in schizophrenia: Associations with neuropsychological functions and physical and mental health. Schizophrenia Research.
- Adding an antidepressant medication for individuals already taking an antipsychotic medication for schizophrenia may be effective for symptom control.
Researchers conducted a study of national Medicaid data from 2001-2010 to analyze the relative efficacy of adding additional drugs, such as an antidepressant, benzodiazepine, mood stabilizer, or another antipsychotic to an individual’s treatment plan, when he or she is already being treated consistently with a single antipsychotic medication. In particular, researchers measured how each combination affected the risk of future hospitalizations, Emergency Department (ED) visits, and mortality.
Individuals who supplemented antipsychotic medication with an antidepressant were less likely to experience future hospitalization or ED visits compared to individuals who supplemented with another antipsychotic. Individuals who added a benzodiazepine were more likely to be hospitalized or visit an ED compared to those supplementing with an antipsychotic. Mood stabilizers did not produce a notable difference from antipsychotics in these categories. However, mood stabilizers were shown to increase risk of patient mortality.
Stroup, T. S., et al. (2019). Comparative effectiveness of adjunctive psychotropic medications in patients with schizophrenia. JAMA Psychiatry.
- Neuromelanin-sensitive MRI shows promise for indicating symptoms of schizophrenia in the brain
Neuromelanin is a dark pigment created within certain areas of the brain that builds up in dopamine neurons over time. As has been documented in cases of neurodegenerative diseases such as Parkinson’s, neuromelanin only decreases with the death of brain cells. Previously, neuromelanin-sensitive MRI (NM-MRI) technology had only been used to detect the loss of these brain cells in individuals with neurodegenerative diseases.
However, recent research funded by the National Institute of Mental Health (NIMH) has, for the first time, shown the capability of NM-MRI technology to also measure relative levels of dopamine in the brain. Higher NM-MRI signals suggests higher concentrations of neuromelanin, which signifies greater release of dopamine. Higher NM-MRI signals were also associated with more severe symptoms of psychosis in individuals with schizophrenia or those who are at risk of developing the disorder. Dopamine has long been linked with schizophrenia for its role in sensation and the motor system, and dysfunction may contribute to the disorder’s characteristic hallucinations.
NM-MRI technology is less invasive than other measures of dopamine function, which could make it a more viable option for repeat use among patients to observe illness progression. NM-MRI also provides higher quality images compared to other imaging technology, allowing clinicians to observe the brain in greater detail.
Cassidy, C., et al. (2019). Neuromelanin-sensitive MRI as a non-invasive proxy measure of dopamine function in the human brain. Advance online publication. Proceedings of the National Academy of Sciences of the United States.
Jessica Walthall
Research and Advocacy Associate
Treatment Advocacy Center
Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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