Michelle B. Riba, M.D., of Ann Arbor, Michigan, was chosen president-elect of the American Psychiatric Association in balloting by APA members and will assume the APA presidency in May 2004.
The current president-elect, Marcia K. Goin, M.D., of Los Angeles will become APA president in late May at the conclusion of the 2003 APA annual meeting in San Francisco. She will succeed Paul S. Appelbaum, M.D., of Worcester, Massachusetts.
Dr. Riba, an APA vice-president since 2001, received 53 percent of the vote in a race against Fred Gottlieb, M.D., of Los Angeles. Dr. Riba is associate chair for education and academic affairs and clinical associate professor in the department of psychiatry at the University of Michigan and director of the psycho-oncology program at the university's Comprehensive Cancer Center. She was APA secretary from 1999 to 2001 and trustee-at-large from 1996 to 1999. Dr. Riba has been on the editorial board of Psychiatric Services since 2000.
In the race to succeed Dr. Riba as one of two APA vice-presidents, Pedro Ruiz, M.D., of Houston defeated Norman A. Clemens, M.D., of Cleveland, with 64 percent of the vote. Dr. Ruiz, who has been APA secretary since 2001 and a member of the editorial board of Psychiatric Services since 2001, is professor and vice-chair in the department of psychiatry and behavioral sciences at the University of Texas Medical School at Houston. Dr. Ruiz has served on more than 35 APA components since 1967. He is past-president of the American Board of Psychiatry and Neurology and of the American College of Psychiatrists.
Nada L. Stotland, M.D., M.P.H., won the race for APA secretary with 63 percent of the vote. She defeated Alfred Herzog, M.D., of Hartford, Connecticut. Dr. Stotland is professor of obstetrics and gynecology at Rush Medical College in Chicago. She was 2001-2002 speaker of the APA assembly.
Tanya R. Anderson, M.D., of Chicago won a seat on the APA board of trustees as early-career-psychiatrist trustee-at-large. She received 62 percent of the vote and defeated Charles Price, M.D., of Reno, Nevada.
The three-way race for member-in-training trustee-elect was won by Susan D. Rich, M.D., M.P.H., of Georgetown University Hospital in Washington, D.C. She received 51 percent of the vote and defeated Drew Ramsey, M.D., of New York City and William C. Wood, M.D., of Boston.
Three of the association's seven area-trustee posts were up for election this year. Donna M. Norris, M.D., of Wellesley, Massachusetts, was elected area 1 trustee with 66 percent of the vote. The race for area 4 trustee went to Sidney H. Weissman, M.D., of Chicago, who received 56 percent of the vote. Albert V. Vogel, M.D., of Albuquerque won 68 percent of the vote in the race for area 7 trustee.
Of 30,206 eligible voting members, 10,252 (34 percent) cast votes in this year's election.
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently issued a new Substance Abuse Treatment Advisory to assist medical and substance abuse treatment professionals in treating inhalant abuse. The advisory was released at a press briefing to launch the 11th National Inhalants and Poisons Prevention Week, organized by the National Inhalant Prevention Coalition (NIPC) with support from SAMHSA and the National Institute on Drug Abuse (NIDA). NIPC has developed its own draft treatment guidelines for inhalant abuse, which are currently under peer review.
The aim of SAMHSA's new advisory is to address the gap between the number of people who abuse inhalants and the number who receive treatment for this type of substance abuse. Data from SAMHSA's 2001 National Household Survey on Drug Abuse indicate that although 140,000 people in the United States are currently abusing or dependent on inhalants—more than half of them in the 12- to 17-year age group—only a small fraction of these are being treated at facilities that receive public funds. Inhalant abuse is difficult to treat, and many treatment professionals do not recognize the signs of inhalant abuse or do not know how to treat youths presenting for treatment. In addition, many facilities do not accept patients who have this form of addiction.
When the SAMHSA advisory was unveiled, Harvey Weiss, NIPC's executive director, pointed out that 800,000 youths aged 12 to 17 years used inhalants in 2001. "Inhalants are often the first substance a child will experiment with," he said. "Up until the sixth or seventh grade, inhalants are the third most popular substance of abuse, after tobacco and alcohol. There are 77,000 youngsters aged 12 to 17 in need of treatment for inhalant abuse."
Among the recommendations in the new SAMHSA advisory is that treatment for inhalant abuse or dependence not be attempted until detoxification is complete. Detoxification can take up to a month, because inhalants can stay in the body for weeks after use. The advisory also points out that people who abuse inhalants have short attention spans and difficulty with complex thinking, which means that initial therapy sessions should not last longer than 15 or 20 minutes. In addition, treatment needs to occur over an extended period, possibly as long as two years. Relapse is common among people who abuse inhalants, so aftercare and follow-up are particularly important. In the case of young people, the advisory highlights the importance of the family's involvement in treatment. Finally, the role of education as the key to primary prevention of inhalant abuse is noted.
NIPC's draft guidelines identify four categories of inhalant abusers: transient social users between the ages of ten and 16 years who use inhalants with their friends and are unaware that they risk sudden death as a result of "huffing"; chronic social users aged 20 to 30 who have been abusing inhalants for more than five years; transient isolate users aged ten to 16 who have a short history of solo use; and chronic isolate users between the ages of 20 and 29 who have been abusing inhalants daily without companions. Individuals in this latter group usually have poor social skills, limited education, and brain damage.
The draft guidelines prepared by NIPC note that there is a disconnect between the numbers of children and adolescents who are experimenting with inhalants and what parents believe about their children's behavior. A parent attitude survey conducted by the Partnership for a Drug-Free America found that 18 percent of youths between the ages of 12 and 17 years had abused inhalants but that only 1 percent of parents believed that their child had tried this form of substance abuse.
At the press briefing, David Shurtleff, Ph.D., acting director of the division of neuroscience and behavioral research at NIDA, noted that although the 2002 Monitoring the Future survey showed the lowest inhalant abuse rates among eighth, tenth, and 12th graders in 20 years, perceived risk about the use of inhalants decreased among eighth and tenth graders. "This is a cause for concern," he said. "Previous surveys have shown that a reduced level of perceived risk about a substance often means that future surveys will show an increased use of the same substance."
Additional information about inhalant abuse and its treatment can be obtained from SAMHSA (through its Web site, www.samhsa.gov, or by calling 301-443-8956) or from NIPC (at www.inhalants.org or by calling 800-269-4237). NIPC's draft guidelines can be found on its Web site, and public comments are invited.
The board of trustees of the American Psychiatric Association (APA) has approved a task force report designating patient safety as a major programmatic priority and calls on psychiatrists and on the systems in which they work to take steps to improve patient safety. The 29-page report provides a historical context for the current initiatives in all branches of medicine to prevent medical errors and makes recommendations for psychiatry in four areas: preventable adverse medication events, seclusion and restraint, suicide, and clinical culture.
The report emphasizes that improving patient safety involves "a profound change in clinical culture" and describes errors as being as much a product of the design of systems as of individual behavior. "The culture of safety is a group responsibility implemented through individuals," states the report.
The report not only makes broad recommendations for APA to engage psychiatrists in a national effort to improve patient safety but also offers a second level of recommendations for state and local psychiatrist leaders, training directors, and individual psychiatrists to take specific actions.
The report is available on APA's Web site at www.psych.org.
Lack of community services for older Americans: Older Americans with mental illnesses remain unnecessarily segregated in nursing homes, according to a report by the Bazelon Center for Mental Health Law. Last in Line: Barriers to Community Integration of Older Adults With Mental Illnesses and Recommendations for Change notes that states have largely ignored older adults in planning community services and that financing arrangements provide incentives to place them in nursing homes even though such care is often more expensive. The report focuses on detailed data from Pennsylvania, Alabama, Illinois, Michigan and Nevada. It includes recommendations for addressing the barriers to community integration of older adults with mental illness. An executive summary is available online at www.bazelon.org.
Market update on the managed care industry: The Centers for Medicare and Medicaid Services (CMS) has issued a 45-page market update on the financial health of the managed care industry. A CMS team analyzed detailed data from major investment firms with the goal of presenting it in a clear and concise format for regulators and legislators. The report notes that profit margins for managed care companies expanded from 1.8 percent in 1999 to 4.4 percent in 2002. It predicts that 2003 will mark the third consecutive year of double-digit premium increases. Premiums are expected to increase by an average of 12 to 13 percent to stay ahead of a predicted rise in medical costs. Although trends toward more open and flexible plans may improve access for consumers, continued industry consolidation is reducing competition and driving up prices. Health Care Industry Market Update: Managed Care is available online at www.cms.gov.