Assembly Members Tackle Wide-Ranging Agenda

have APA explore whether to develop criteria for the diagnosis of bipolar disorder in children that would be included in the next edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM). The authors noted a substantial increase in the last few years of articles and presentations on the diagnosis and treatment of bipolar disorder in children, but indicated that only one sentence in DSM-IV refers to this disorder in children, since the latest edition appeared before much of the recent research was presented. The DSM “should reflect the current understanding of this disorder,” the paper states.

continue to support federal legislation to establish an open clinical-trials registry for new medications that would include studies whose findings were negative as well as positive. The Assembly also urged APA to promote awareness of such a registry, should it be established, at all of its scientific meetings and continuing medical education sessions and to publish both negative and positive study findings in APA journals.

urge APA to work to terminate Medicaid's Institution for Mental Diseases (IMD) exclusion, which bars hospitals, nursing facilities, and other institutions from eligibility to receive Medicaid reimbursement if they have more than 16 beds. When Congress approved this exclusion when Medicaid was enacted in 1965, it signaled the federal government's intention to leave the burden of paying for long-term psychiatric care in these facilities with the states. The exclusion applies to indigent adults aged 21 to 65. Ending this exclusion should provide psychiatric patients with “their fair share of health care dollars,” said Jeffrey Geller, M.D., one of the paper's authors. Concern was expressed, however, over the possibility that eliminating the exclusion could threaten a funding source for general hospitals that treat psychiatric inpatients and have 16 or fewer beds. Others maintained that this could halt a nationwide closure of psychiatric beds because more facilities would be eligible for reimbursement through Medicaid, thus increasing access to the mental health care system.

amend APA's position statement on same-sex unions to add a phrase indicating that APA not only “supports the legal recognition of same-sex unions and their associated legal rights, benefits, and responsibilities” but also “opposes restrictions to those same rights, benefits, and responsibilities.”

add additional incentives for psychiatry residency programs to get all of their trainees to join APA and thus qualify for the 100% Club. It wants the Board of Trustees to change the $100 annual contribution the program receives toward buying APPI books to one that provides programs with“ one major APPI textbook for each year the program qualifies” for the 100% Club. These programs would also receive a free online subscription to the APA continuing medical education journal Focus.

approve minor technical revisions to several APA position statements related to HIV/AIDS, including those on confidentiality in outpatient psychiatric services, HIV in adolescents, and HIV infection in pregnant women. The changes were to add updated statistical data, clinical information, current treatment protocols, or text references.

endorse a new position statement on the psychiatric implications of comorbid HIV and hepatitis C infections. The statement was developed by the Committee on AIDS to respond to the mental health implications of the growing public health problem posed by this type of coinfection and its treatment. About 25 percent of HIV-infected Americans have comorbid hepatitis C infection. The statement describes the dimensions of the neuropsychiatric aspects of the problem and of its treatment. Among the statement's recommendations are that patients be treated for mood disorders prior to initiating treatment for hepatitis C and that psychiatrists should closely monitor changes in neuropsychiatric functioning in patients with this coinfection. This monitoring includes drug-drug interactions and interactions of antiretroviral treatments with substances of abuse.

ask the Board of Trustees to decide whether APA should meet with the New York Academy of Medicine to discuss joining its group Doctors Against Handgun Injury. This is a coalition of a dozen national medical societies whose mission is to “enhance awareness of the link between handguns and suicide and to increase clinical and public health programs” focused on this issue. The paper noted that since mental health issues are intimately bound up in suicide decisions, APA has considerable expertise to contribute in this area.

encourage the medical director and Board of Trustees to continue their lobbying efforts to have the Virginia legislature change a state law prohibiting employers from offering health insurance to the domestic partners of their employees. Virginia is the only state to have codified such a ban. The issue became critical to APA when it moved its headquarters from Washington, D.C., to Arlington, Va., in late 2002. At that time APA learned that it was no longer permitted to offer the benefit, which had been available to staff for more than a decade.