Eli Zimmerman

AUSTIN, TEX. – Universal BRCA mutation testing for first-degree relatives of women with high-grade serous ovarian cancer could prevent significantly more cases, according to a study presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Women with high-grade serous ovarian cancer have a 20% chance of having a BRCA mutation; however, the risk is 50% for first degree relatives of someone with that mutation.

“Until we find an effective screening test for ovarian cancer, which can identify women at an early stage for which there is curative treatment, we need to maximize opportunities for prevention,” said Janice S. Kwon, MD, the gynecologic oncology fellowship program director at the University of British Columbia, Vancouver. “An obvious target group,” she added, are women “at highest risk of developing ovarian cancers, specifically those who inherit mutations in BRCA1 or BRCA2.”

First-degree relatives of ovarian cancer patients have three conceivable options if their BRCA status is unknown, and have no other risk factor for BRCA testing: To not undergo testing; to get tested and, if found to have the mutation, undergo risk-reducing surgery (bilateral salpingo-oophorectomy); or to undergo surgery without testing.

To estimate the efficiency and cost effectiveness of universal BRCA testing of female first-degree relatives of women with high-grade serous ovarian cancer, Dr. Kwon and her colleagues used the “Markov Monte Carlo” simulation model, with a time horizon of 50 years, evaluating the costs and benefits of those three strategies.

They acknowledged that testing excluded women with a personal history of breast cancer and did not include nonhormonal interventions in their analysis.

They found that the average quality-adjusted life year (QUALY) gain of universal BRCA testing was 19.20 years, compared with 18.99 years for no BRCA testing, and 18.48 years for universal surgery with no BRCA testing.

[email protected]

AUSTIN, TEX. – Universal BRCA mutation testing for first-degree relatives of women with high-grade serous ovarian cancer could prevent significantly more cases, according to a study presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Women with high-grade serous ovarian cancer have a 20% chance of having a BRCA mutation; however, the risk is 50% for first degree relatives of someone with that mutation.

“Until we find an effective screening test for ovarian cancer, which can identify women at an early stage for which there is curative treatment, we need to maximize opportunities for prevention,” said Janice S. Kwon, MD, the gynecologic oncology fellowship program director at the University of British Columbia, Vancouver. “An obvious target group,” she added, are women “at highest risk of developing ovarian cancers, specifically those who inherit mutations in BRCA1 or BRCA2.”

First-degree relatives of ovarian cancer patients have three conceivable options if their BRCA status is unknown, and have no other risk factor for BRCA testing: To not undergo testing; to get tested and, if found to have the mutation, undergo risk-reducing surgery (bilateral salpingo-oophorectomy); or to undergo surgery without testing.

To estimate the efficiency and cost effectiveness of universal BRCA testing of female first-degree relatives of women with high-grade serous ovarian cancer, Dr. Kwon and her colleagues used the “Markov Monte Carlo” simulation model, with a time horizon of 50 years, evaluating the costs and benefits of those three strategies.

They acknowledged that testing excluded women with a personal history of breast cancer and did not include nonhormonal interventions in their analysis.

They found that the average quality-adjusted life year (QUALY) gain of universal BRCA testing was 19.20 years, compared with 18.99 years for no BRCA testing, and 18.48 years for universal surgery with no BRCA testing.

[email protected]

AUSTIN, TEX. – Universal BRCA mutation testing for first-degree relatives of women with high-grade serous ovarian cancer could prevent significantly more cases, according to a study presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Women with high-grade serous ovarian cancer have a 20% chance of having a BRCA mutation; however, the risk is 50% for first degree relatives of someone with that mutation.

“Until we find an effective screening test for ovarian cancer, which can identify women at an early stage for which there is curative treatment, we need to maximize opportunities for prevention,” said Janice S. Kwon, MD, the gynecologic oncology fellowship program director at the University of British Columbia, Vancouver. “An obvious target group,” she added, are women “at highest risk of developing ovarian cancers, specifically those who inherit mutations in BRCA1 or BRCA2.”

First-degree relatives of ovarian cancer patients have three conceivable options if their BRCA status is unknown, and have no other risk factor for BRCA testing: To not undergo testing; to get tested and, if found to have the mutation, undergo risk-reducing surgery (bilateral salpingo-oophorectomy); or to undergo surgery without testing.

To estimate the efficiency and cost effectiveness of universal BRCA testing of female first-degree relatives of women with high-grade serous ovarian cancer, Dr. Kwon and her colleagues used the “Markov Monte Carlo” simulation model, with a time horizon of 50 years, evaluating the costs and benefits of those three strategies.

They acknowledged that testing excluded women with a personal history of breast cancer and did not include nonhormonal interventions in their analysis.

They found that the average quality-adjusted life year (QUALY) gain of universal BRCA testing was 19.20 years, compared with 18.99 years for no BRCA testing, and 18.48 years for universal surgery with no BRCA testing.

[email protected]

WASHINGTON – Present infections make patients more likely to develop primary Sjögren’s syndrome, according to a study presented at an International Symposium on Sjögren’s Syndrome.

“We observed a consistent association between infections and the subsequent development of primary Sjögren’s syndrome,” said Johannes Mofors of the department of medicine at the Karolinska University Hospital, Stockholm, in his presentation. “Infections of certain anatomical sites have different associations to Sjögren’s.”

With risk measurements primarily reliant on detecting the presence of MHC genes, this knowledge could be helpful in identifying at-risk patients and give physicians the chance to act before the syndrome emerges, according to Mr. Mofors.

Investigators conducted a retrospective, multicenter, controlled cohort study of 9,993 Swedish individuals from the country’s national patient registry to observe the association between infections and Sjögren’s.

Patients were an average age of 55 years, with either an SSA or SSB infection, with an average observational period of 16 years before diagnosis.

Of the patients with Sjögren’s disease, 21% reported one or more infections prior to diagnosis, compared with 12% among the control group.

When assessing patients by their type of infection, Mr. Mofors and his colleagues found the likelihood of developing Sjögren’s varied depending on which infection was present.

[email protected]

WASHINGTON – Present infections make patients more likely to develop primary Sjögren’s syndrome, according to a study presented at an International Symposium on Sjögren’s Syndrome.

“We observed a consistent association between infections and the subsequent development of primary Sjögren’s syndrome,” said Johannes Mofors of the department of medicine at the Karolinska University Hospital, Stockholm, in his presentation. “Infections of certain anatomical sites have different associations to Sjögren’s.”

With risk measurements primarily reliant on detecting the presence of MHC genes, this knowledge could be helpful in identifying at-risk patients and give physicians the chance to act before the syndrome emerges, according to Mr. Mofors.

Investigators conducted a retrospective, multicenter, controlled cohort study of 9,993 Swedish individuals from the country’s national patient registry to observe the association between infections and Sjögren’s.

Patients were an average age of 55 years, with either an SSA or SSB infection, with an average observational period of 16 years before diagnosis.

Of the patients with Sjögren’s disease, 21% reported one or more infections prior to diagnosis, compared with 12% among the control group.

When assessing patients by their type of infection, Mr. Mofors and his colleagues found the likelihood of developing Sjögren’s varied depending on which infection was present.

[email protected]

WASHINGTON – Present infections make patients more likely to develop primary Sjögren’s syndrome, according to a study presented at an International Symposium on Sjögren’s Syndrome.

“We observed a consistent association between infections and the subsequent development of primary Sjögren’s syndrome,” said Johannes Mofors of the department of medicine at the Karolinska University Hospital, Stockholm, in his presentation. “Infections of certain anatomical sites have different associations to Sjögren’s.”

With risk measurements primarily reliant on detecting the presence of MHC genes, this knowledge could be helpful in identifying at-risk patients and give physicians the chance to act before the syndrome emerges, according to Mr. Mofors.

Investigators conducted a retrospective, multicenter, controlled cohort study of 9,993 Swedish individuals from the country’s national patient registry to observe the association between infections and Sjögren’s.

Patients were an average age of 55 years, with either an SSA or SSB infection, with an average observational period of 16 years before diagnosis.

Of the patients with Sjögren’s disease, 21% reported one or more infections prior to diagnosis, compared with 12% among the control group.

When assessing patients by their type of infection, Mr. Mofors and his colleagues found the likelihood of developing Sjögren’s varied depending on which infection was present.

[email protected]

WASHINGTON – Over one-third of 28 outcomes identified to be important to Sjogren’s patients with dry eye are not commonly found in existing research, according to a study presented at the International Symposium on Sjogren’s Syndrome.

With dry eye found in over 85% of Sjogren’s patients, pinpointing important outcomes accurately can help researchers and physicians focus their efforts and be more cost effective when developing clinical trials, systematic reviews , practice guidelines, and evidence-based health care, according to presenter Ian J. Saldanha, MBBS, MPH, PhD, of the department of epidemiology at Johns Hopkins, Baltimore.

“When designing clinical trials, if you are trying to incorporate the views of patients, this can help more accurately depict what you should be measuring and in what time frame,“ Dr. Saldanha said to attendees. This can be important as agencies such as the Food and Drug Administration have absolved to be more committed to bringing the patient perspective to drug development, according to Dr. Saldanha.

Investigators surveyed 420 subscribers to KeratoScoop, a news source that specifically reports on dry eye, using a two-round survey process with participants ranking outcomes from 0 to 10, 0 being the least important and 10 being the most.

The majority of the patients were white American women, aged 50 years and older.

To start, Dr. Saldanha and his fellow investigators identified 109 outcomes commonly found in existing research. Of these, 28 were identified as important to survey takers.

The investigators noted that 39% of the outcomes identified were symptoms, compared with 25% for clinical testing, 14% related to quality of life, and the remainder split evenly between lab measures, safety, and others.

[email protected]

SOURCE: Saldanha I et al. International Symposium on Sjogren’s Syndrome.

WASHINGTON – Over one-third of 28 outcomes identified to be important to Sjogren’s patients with dry eye are not commonly found in existing research, according to a study presented at the International Symposium on Sjogren’s Syndrome.

With dry eye found in over 85% of Sjogren’s patients, pinpointing important outcomes accurately can help researchers and physicians focus their efforts and be more cost effective when developing clinical trials, systematic reviews , practice guidelines, and evidence-based health care, according to presenter Ian J. Saldanha, MBBS, MPH, PhD, of the department of epidemiology at Johns Hopkins, Baltimore.

“When designing clinical trials, if you are trying to incorporate the views of patients, this can help more accurately depict what you should be measuring and in what time frame,“ Dr. Saldanha said to attendees. This can be important as agencies such as the Food and Drug Administration have absolved to be more committed to bringing the patient perspective to drug development, according to Dr. Saldanha.

Investigators surveyed 420 subscribers to KeratoScoop, a news source that specifically reports on dry eye, using a two-round survey process with participants ranking outcomes from 0 to 10, 0 being the least important and 10 being the most.

The majority of the patients were white American women, aged 50 years and older.

To start, Dr. Saldanha and his fellow investigators identified 109 outcomes commonly found in existing research. Of these, 28 were identified as important to survey takers.

The investigators noted that 39% of the outcomes identified were symptoms, compared with 25% for clinical testing, 14% related to quality of life, and the remainder split evenly between lab measures, safety, and others.

[email protected]

SOURCE: Saldanha I et al. International Symposium on Sjogren’s Syndrome.

WASHINGTON – Over one-third of 28 outcomes identified to be important to Sjogren’s patients with dry eye are not commonly found in existing research, according to a study presented at the International Symposium on Sjogren’s Syndrome.

With dry eye found in over 85% of Sjogren’s patients, pinpointing important outcomes accurately can help researchers and physicians focus their efforts and be more cost effective when developing clinical trials, systematic reviews , practice guidelines, and evidence-based health care, according to presenter Ian J. Saldanha, MBBS, MPH, PhD, of the department of epidemiology at Johns Hopkins, Baltimore.

“When designing clinical trials, if you are trying to incorporate the views of patients, this can help more accurately depict what you should be measuring and in what time frame,“ Dr. Saldanha said to attendees. This can be important as agencies such as the Food and Drug Administration have absolved to be more committed to bringing the patient perspective to drug development, according to Dr. Saldanha.

Investigators surveyed 420 subscribers to KeratoScoop, a news source that specifically reports on dry eye, using a two-round survey process with participants ranking outcomes from 0 to 10, 0 being the least important and 10 being the most.

The majority of the patients were white American women, aged 50 years and older.

To start, Dr. Saldanha and his fellow investigators identified 109 outcomes commonly found in existing research. Of these, 28 were identified as important to survey takers.

The investigators noted that 39% of the outcomes identified were symptoms, compared with 25% for clinical testing, 14% related to quality of life, and the remainder split evenly between lab measures, safety, and others.

[email protected]

SOURCE: Saldanha I et al. International Symposium on Sjogren’s Syndrome.

WASHINGTON – Therapy targeting early maladaptive schemas can reduce the severity of PTSD symptoms and improve the quality of life for patients, according to data presented at the annual conference of the Anxiety and Depression Association of America.

Change in early maladaptive schemas correlated with a 13%-20% variation in PTSD symptom severity among patients tested, which points to the efficacy of incorporating schema-based interventions in trauma-focused therapies, said Karina T. Loyo, of Marquette University, Milwaukee.

Early maladaptive schemas, broad worldviews that develop in childhood, can lead to unhealthy, pervasive expectations in adulthood that directly inhibit PTSD treatment, according to Ms. Loyo. “We can see with how early maladaptive schemas developed early on can influence how an individual interprets a traumatic event,” she said.

To test whether early maladaptive schemas can predict symptom reduction and life improvement beyond trauma-related cognitions, Ms. Loyo and her colleagues gave 120 PTSD patients an early maladaptive schemas questionnaire, a quality of life questionnaire, as well as the Posttraumatic Cognitions Inventory.

Using a regression model, investigators found the Posttraumatic Cognitions Inventory and schema questionnaire predicted quality of life fairly accurately. This was especially true of the schema questionnaire, which predicted 20% more variance in quality of life scores, Ms. Loyo said.

“This suggests that schema-focused therapy [SFT] is related to PTSD symptom severity reduction,” Ms. Loyo said. “This has clinical implications as far as how we integrate schema-based interventions in trauma-focused areas.”

These schema-based treatments can be used to change a patient’s thoughts on their disorder, as well as gather information. For example, a patient exhibiting the early maladaptive schema of mistrust from abuse might be suspicious of others based on childhood experiences of being used or taken advantage of by others. This can lead to alienation from others, which in turn, would affect the patient’s quality of life after their traumatic experience.

Using SFT, clinicians can talk through and identify the possible intentions of those in the patient’s life to reinforce the notion that the people in their life might be both imperfect yet trustworthy, Ms. Loyo said.

SFT can also be used to address childhood trauma that caused a patient’s development of early maladaptive schemas. This kind of work can build trust between the clinician and the patient – and make subsequent treatments more effective.

Unlike a typical trauma narrative, SFT focuses on increasing awareness of patients’ emotions before the trauma occurred and how they felt while addressing the moment the trauma occurred. In addition, SFT uses a slightly different form of imagery scripting in an effort to acknowledge patients’ pain and direct them in a more constructive direction to channel those emotions into rebuilding values such as trust.

Ms. Loyo reported no financial disclosures.

[email protected]

SOURCE: Loyo KT et al. ADAA 2018.

WASHINGTON – Therapy targeting early maladaptive schemas can reduce the severity of PTSD symptoms and improve the quality of life for patients, according to data presented at the annual conference of the Anxiety and Depression Association of America.

Change in early maladaptive schemas correlated with a 13%-20% variation in PTSD symptom severity among patients tested, which points to the efficacy of incorporating schema-based interventions in trauma-focused therapies, said Karina T. Loyo, of Marquette University, Milwaukee.

Early maladaptive schemas, broad worldviews that develop in childhood, can lead to unhealthy, pervasive expectations in adulthood that directly inhibit PTSD treatment, according to Ms. Loyo. “We can see with how early maladaptive schemas developed early on can influence how an individual interprets a traumatic event,” she said.

To test whether early maladaptive schemas can predict symptom reduction and life improvement beyond trauma-related cognitions, Ms. Loyo and her colleagues gave 120 PTSD patients an early maladaptive schemas questionnaire, a quality of life questionnaire, as well as the Posttraumatic Cognitions Inventory.

Using a regression model, investigators found the Posttraumatic Cognitions Inventory and schema questionnaire predicted quality of life fairly accurately. This was especially true of the schema questionnaire, which predicted 20% more variance in quality of life scores, Ms. Loyo said.

“This suggests that schema-focused therapy [SFT] is related to PTSD symptom severity reduction,” Ms. Loyo said. “This has clinical implications as far as how we integrate schema-based interventions in trauma-focused areas.”

These schema-based treatments can be used to change a patient’s thoughts on their disorder, as well as gather information. For example, a patient exhibiting the early maladaptive schema of mistrust from abuse might be suspicious of others based on childhood experiences of being used or taken advantage of by others. This can lead to alienation from others, which in turn, would affect the patient’s quality of life after their traumatic experience.

Using SFT, clinicians can talk through and identify the possible intentions of those in the patient’s life to reinforce the notion that the people in their life might be both imperfect yet trustworthy, Ms. Loyo said.

SFT can also be used to address childhood trauma that caused a patient’s development of early maladaptive schemas. This kind of work can build trust between the clinician and the patient – and make subsequent treatments more effective.

Unlike a typical trauma narrative, SFT focuses on increasing awareness of patients’ emotions before the trauma occurred and how they felt while addressing the moment the trauma occurred. In addition, SFT uses a slightly different form of imagery scripting in an effort to acknowledge patients’ pain and direct them in a more constructive direction to channel those emotions into rebuilding values such as trust.

Ms. Loyo reported no financial disclosures.

[email protected]

SOURCE: Loyo KT et al. ADAA 2018.

WASHINGTON – Therapy targeting early maladaptive schemas can reduce the severity of PTSD symptoms and improve the quality of life for patients, according to data presented at the annual conference of the Anxiety and Depression Association of America.

Change in early maladaptive schemas correlated with a 13%-20% variation in PTSD symptom severity among patients tested, which points to the efficacy of incorporating schema-based interventions in trauma-focused therapies, said Karina T. Loyo, of Marquette University, Milwaukee.

Early maladaptive schemas, broad worldviews that develop in childhood, can lead to unhealthy, pervasive expectations in adulthood that directly inhibit PTSD treatment, according to Ms. Loyo. “We can see with how early maladaptive schemas developed early on can influence how an individual interprets a traumatic event,” she said.

To test whether early maladaptive schemas can predict symptom reduction and life improvement beyond trauma-related cognitions, Ms. Loyo and her colleagues gave 120 PTSD patients an early maladaptive schemas questionnaire, a quality of life questionnaire, as well as the Posttraumatic Cognitions Inventory.

Using a regression model, investigators found the Posttraumatic Cognitions Inventory and schema questionnaire predicted quality of life fairly accurately. This was especially true of the schema questionnaire, which predicted 20% more variance in quality of life scores, Ms. Loyo said.

“This suggests that schema-focused therapy [SFT] is related to PTSD symptom severity reduction,” Ms. Loyo said. “This has clinical implications as far as how we integrate schema-based interventions in trauma-focused areas.”

These schema-based treatments can be used to change a patient’s thoughts on their disorder, as well as gather information. For example, a patient exhibiting the early maladaptive schema of mistrust from abuse might be suspicious of others based on childhood experiences of being used or taken advantage of by others. This can lead to alienation from others, which in turn, would affect the patient’s quality of life after their traumatic experience.

Using SFT, clinicians can talk through and identify the possible intentions of those in the patient’s life to reinforce the notion that the people in their life might be both imperfect yet trustworthy, Ms. Loyo said.

SFT can also be used to address childhood trauma that caused a patient’s development of early maladaptive schemas. This kind of work can build trust between the clinician and the patient – and make subsequent treatments more effective.

Unlike a typical trauma narrative, SFT focuses on increasing awareness of patients’ emotions before the trauma occurred and how they felt while addressing the moment the trauma occurred. In addition, SFT uses a slightly different form of imagery scripting in an effort to acknowledge patients’ pain and direct them in a more constructive direction to channel those emotions into rebuilding values such as trust.

Ms. Loyo reported no financial disclosures.

[email protected]

SOURCE: Loyo KT et al. ADAA 2018.

WASHINGTON – Successfully treating patients who have treatment-resistant depression (TRD) means leaving acute intervention behind and adopting more chronic remediation techniques, Scott T. Aaronson, MD, said at the annual conference of the Anxiety and Depression Association of America.

“We need to change the paradigm; most of the research is looking at a 6- to 12-week outcome measure,” said Dr. Aaronson, director of the clinical research program at Sheppard Pratt Health System, Baltimore. “These are folks who have been depressed for most of their adult lives, and we don’t tend to take a longer-term perspective when looking at this.”

Treatment-resistant depression, Dr. Aaronson said, can be conceptualized as two levels. The first is failure of two agents or treatments, and the second is a failure of four or more agents – including electroconvulsive therapy. In light of those levels, Dr. Aaronson suggests approaching depression as one would cancer, with different stages of failure determining payment for more expensive treatments.

Courtesy Dr. Scott T. Aaronson

Before planning how best to handle treatment-resistant depression, it is important for psychiatrists to understand its complexity, and address the issues associated with current psychiatric diagnoses, Dr. Aaronson said.

Diagnoses now are based purely on phenomenological analysis rather than biological analysis, he said. “Basically, it’s a room full of people getting together to decide what the diagnostic criteria are,” Dr. Aaronson said. “It’s eminence-based medicine, not evidence-based medicine.”

This approach creates a large gray area in which diagnoses can fall, making it more difficult to distinguish between bipolar and unipolar depression, as well as tough to distinguish psychotic and nonpsychotic illnesses.

If a patient displayed mood instability, for example, but not enough to fit the criteria of bipolar disorder, this scenario would present a dilemma for psychiatrists unable to diagnose the patient as bipolar and unconvinced that it would help to treat the patient as only being depressed, according to an example from Dr. Aaronson.

[email protected]

WASHINGTON – Successfully treating patients who have treatment-resistant depression (TRD) means leaving acute intervention behind and adopting more chronic remediation techniques, Scott T. Aaronson, MD, said at the annual conference of the Anxiety and Depression Association of America.

“We need to change the paradigm; most of the research is looking at a 6- to 12-week outcome measure,” said Dr. Aaronson, director of the clinical research program at Sheppard Pratt Health System, Baltimore. “These are folks who have been depressed for most of their adult lives, and we don’t tend to take a longer-term perspective when looking at this.”

Treatment-resistant depression, Dr. Aaronson said, can be conceptualized as two levels. The first is failure of two agents or treatments, and the second is a failure of four or more agents – including electroconvulsive therapy. In light of those levels, Dr. Aaronson suggests approaching depression as one would cancer, with different stages of failure determining payment for more expensive treatments.

Courtesy Dr. Scott T. Aaronson

Before planning how best to handle treatment-resistant depression, it is important for psychiatrists to understand its complexity, and address the issues associated with current psychiatric diagnoses, Dr. Aaronson said.

Diagnoses now are based purely on phenomenological analysis rather than biological analysis, he said. “Basically, it’s a room full of people getting together to decide what the diagnostic criteria are,” Dr. Aaronson said. “It’s eminence-based medicine, not evidence-based medicine.”

This approach creates a large gray area in which diagnoses can fall, making it more difficult to distinguish between bipolar and unipolar depression, as well as tough to distinguish psychotic and nonpsychotic illnesses.

If a patient displayed mood instability, for example, but not enough to fit the criteria of bipolar disorder, this scenario would present a dilemma for psychiatrists unable to diagnose the patient as bipolar and unconvinced that it would help to treat the patient as only being depressed, according to an example from Dr. Aaronson.

[email protected]

WASHINGTON – Successfully treating patients who have treatment-resistant depression (TRD) means leaving acute intervention behind and adopting more chronic remediation techniques, Scott T. Aaronson, MD, said at the annual conference of the Anxiety and Depression Association of America.

“We need to change the paradigm; most of the research is looking at a 6- to 12-week outcome measure,” said Dr. Aaronson, director of the clinical research program at Sheppard Pratt Health System, Baltimore. “These are folks who have been depressed for most of their adult lives, and we don’t tend to take a longer-term perspective when looking at this.”

Treatment-resistant depression, Dr. Aaronson said, can be conceptualized as two levels. The first is failure of two agents or treatments, and the second is a failure of four or more agents – including electroconvulsive therapy. In light of those levels, Dr. Aaronson suggests approaching depression as one would cancer, with different stages of failure determining payment for more expensive treatments.

Courtesy Dr. Scott T. Aaronson

Before planning how best to handle treatment-resistant depression, it is important for psychiatrists to understand its complexity, and address the issues associated with current psychiatric diagnoses, Dr. Aaronson said.

Diagnoses now are based purely on phenomenological analysis rather than biological analysis, he said. “Basically, it’s a room full of people getting together to decide what the diagnostic criteria are,” Dr. Aaronson said. “It’s eminence-based medicine, not evidence-based medicine.”

This approach creates a large gray area in which diagnoses can fall, making it more difficult to distinguish between bipolar and unipolar depression, as well as tough to distinguish psychotic and nonpsychotic illnesses.

If a patient displayed mood instability, for example, but not enough to fit the criteria of bipolar disorder, this scenario would present a dilemma for psychiatrists unable to diagnose the patient as bipolar and unconvinced that it would help to treat the patient as only being depressed, according to an example from Dr. Aaronson.

[email protected]

WASHINGTON – Using schema therapy as an adjunct for substance use disorder might help fill the gaps in traditional cognitive-behavioral therapy, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Schema therapy, developed for treatment-resistant diagnoses, allows clinicians to challenge cognitive distortions and negative coping styles that develop during childhood or adolescence. As an extension of the cognitive-behavioral therapy (CBT) model of Aaron T. Beck, MD, schema therapy can target substance use disorder (SUD) psychiatric comorbidities like PTSD and antisocial personality disorder – which are present in more than 50% of SUD patients, said presenter Katharine D. Wojcik, of the University of British Columbia, Vancouver.

“The combination of a dual diagnosis makes the traditional 12-step addiction therapy less effective,” said Ms. Wojcik, a doctoral candidate at the university. “Additionally, traditional treatment approaches have been found to be ineffective against comorbid mental health and substance use disorders.”

To investigate the effects of schema therapy, Ms. Wojcik collected data on more than 100 residents of a treatment program for patients with addictions and mental illness. The patients took the Young Schema Questionnaire 3 so the investigators could assess the presence and extent of early maladaptive schemas. The patients, mostly white females, participated in the schema therapy protocol for 30 days.

Medication management, a 12-step program, individual sessions, and a CBT intervention – including prolonged exposure, behavior activation, and schema therapy – were incorporated to target their multiple diagnoses, Ms. Wojcik said.

In the initial assessments, the investigators found that self-sacrifice, unrelenting standards, and insufficient self-control were the most common schema among the subject group, with notably elevated levels of disconnection, rejection, overvigilance, and inhibition.

After the assessments, patients and clinicians sat down to discuss the schema clinicians found present. If patients bought into the report, they began self-monitoring through daily activities such as journaling.

Ms. Wojcik and her colleagues said those self-monitoring practices will help change patients’ schema. But such practices were not the only tool in the program aimed at sparking these changes, patients worked with clinicians on cognitive strategies as well. Addressing core beliefs, schema bias, schema activation formulation, and schema rules and assumptions were a few of the strategies implemented by clinicians.

“We also work on schema challenging, which means [when] in session with a client, as a clinician you are able to say: ‘I wonder if this schema is coming up for you right now,’ or ‘Are you noticing any schemas as we’re talking about this?’ ” Ms. Wojcik said. “Since there is such a high comorbidity, a lot of times it does come down to these experiences that they’ve had that tie into trauma history.”

After the end of their stay, patients were given a reassessment and then shown the results to see how they had progressed. The reassessment did show some subtle changes, but the short length of the program hindered any patients from seeing complete deescalation of their schema, Ms. Wojcik said.

She discussed the case of a 30-year-old woman with diagnoses of SUD, PTSD, and bipolar disorder – and an extensive treatment history. Therapists found that the combination of traditional and CBT helped significantly with the patient’s elevated abandonment schema.

“We were able to have her close her eyes and walk through not only what it was like when that schema developed, but also have her talk about what were the things that went unmet in that situation that caused this to happen,” Ms. Wojcik said. “She successfully completed her treatment with us, noticed a lot of her schema had decreased in elevation, and expressed pride that she had done this.”

Ms. Wojcik and her colleagues reported no relevant financial disclosures.

[email protected]

SOURCE: Wojcik KD et al. ADAA 2018, Abstract 173C.

WASHINGTON – Using schema therapy as an adjunct for substance use disorder might help fill the gaps in traditional cognitive-behavioral therapy, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Schema therapy, developed for treatment-resistant diagnoses, allows clinicians to challenge cognitive distortions and negative coping styles that develop during childhood or adolescence. As an extension of the cognitive-behavioral therapy (CBT) model of Aaron T. Beck, MD, schema therapy can target substance use disorder (SUD) psychiatric comorbidities like PTSD and antisocial personality disorder – which are present in more than 50% of SUD patients, said presenter Katharine D. Wojcik, of the University of British Columbia, Vancouver.

“The combination of a dual diagnosis makes the traditional 12-step addiction therapy less effective,” said Ms. Wojcik, a doctoral candidate at the university. “Additionally, traditional treatment approaches have been found to be ineffective against comorbid mental health and substance use disorders.”

To investigate the effects of schema therapy, Ms. Wojcik collected data on more than 100 residents of a treatment program for patients with addictions and mental illness. The patients took the Young Schema Questionnaire 3 so the investigators could assess the presence and extent of early maladaptive schemas. The patients, mostly white females, participated in the schema therapy protocol for 30 days.

Medication management, a 12-step program, individual sessions, and a CBT intervention – including prolonged exposure, behavior activation, and schema therapy – were incorporated to target their multiple diagnoses, Ms. Wojcik said.

In the initial assessments, the investigators found that self-sacrifice, unrelenting standards, and insufficient self-control were the most common schema among the subject group, with notably elevated levels of disconnection, rejection, overvigilance, and inhibition.

After the assessments, patients and clinicians sat down to discuss the schema clinicians found present. If patients bought into the report, they began self-monitoring through daily activities such as journaling.

Ms. Wojcik and her colleagues said those self-monitoring practices will help change patients’ schema. But such practices were not the only tool in the program aimed at sparking these changes, patients worked with clinicians on cognitive strategies as well. Addressing core beliefs, schema bias, schema activation formulation, and schema rules and assumptions were a few of the strategies implemented by clinicians.

“We also work on schema challenging, which means [when] in session with a client, as a clinician you are able to say: ‘I wonder if this schema is coming up for you right now,’ or ‘Are you noticing any schemas as we’re talking about this?’ ” Ms. Wojcik said. “Since there is such a high comorbidity, a lot of times it does come down to these experiences that they’ve had that tie into trauma history.”

After the end of their stay, patients were given a reassessment and then shown the results to see how they had progressed. The reassessment did show some subtle changes, but the short length of the program hindered any patients from seeing complete deescalation of their schema, Ms. Wojcik said.

She discussed the case of a 30-year-old woman with diagnoses of SUD, PTSD, and bipolar disorder – and an extensive treatment history. Therapists found that the combination of traditional and CBT helped significantly with the patient’s elevated abandonment schema.

“We were able to have her close her eyes and walk through not only what it was like when that schema developed, but also have her talk about what were the things that went unmet in that situation that caused this to happen,” Ms. Wojcik said. “She successfully completed her treatment with us, noticed a lot of her schema had decreased in elevation, and expressed pride that she had done this.”

Ms. Wojcik and her colleagues reported no relevant financial disclosures.

[email protected]

SOURCE: Wojcik KD et al. ADAA 2018, Abstract 173C.

WASHINGTON – Using schema therapy as an adjunct for substance use disorder might help fill the gaps in traditional cognitive-behavioral therapy, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Schema therapy, developed for treatment-resistant diagnoses, allows clinicians to challenge cognitive distortions and negative coping styles that develop during childhood or adolescence. As an extension of the cognitive-behavioral therapy (CBT) model of Aaron T. Beck, MD, schema therapy can target substance use disorder (SUD) psychiatric comorbidities like PTSD and antisocial personality disorder – which are present in more than 50% of SUD patients, said presenter Katharine D. Wojcik, of the University of British Columbia, Vancouver.

“The combination of a dual diagnosis makes the traditional 12-step addiction therapy less effective,” said Ms. Wojcik, a doctoral candidate at the university. “Additionally, traditional treatment approaches have been found to be ineffective against comorbid mental health and substance use disorders.”

To investigate the effects of schema therapy, Ms. Wojcik collected data on more than 100 residents of a treatment program for patients with addictions and mental illness. The patients took the Young Schema Questionnaire 3 so the investigators could assess the presence and extent of early maladaptive schemas. The patients, mostly white females, participated in the schema therapy protocol for 30 days.

Medication management, a 12-step program, individual sessions, and a CBT intervention – including prolonged exposure, behavior activation, and schema therapy – were incorporated to target their multiple diagnoses, Ms. Wojcik said.

In the initial assessments, the investigators found that self-sacrifice, unrelenting standards, and insufficient self-control were the most common schema among the subject group, with notably elevated levels of disconnection, rejection, overvigilance, and inhibition.

After the assessments, patients and clinicians sat down to discuss the schema clinicians found present. If patients bought into the report, they began self-monitoring through daily activities such as journaling.

Ms. Wojcik and her colleagues said those self-monitoring practices will help change patients’ schema. But such practices were not the only tool in the program aimed at sparking these changes, patients worked with clinicians on cognitive strategies as well. Addressing core beliefs, schema bias, schema activation formulation, and schema rules and assumptions were a few of the strategies implemented by clinicians.

“We also work on schema challenging, which means [when] in session with a client, as a clinician you are able to say: ‘I wonder if this schema is coming up for you right now,’ or ‘Are you noticing any schemas as we’re talking about this?’ ” Ms. Wojcik said. “Since there is such a high comorbidity, a lot of times it does come down to these experiences that they’ve had that tie into trauma history.”

After the end of their stay, patients were given a reassessment and then shown the results to see how they had progressed. The reassessment did show some subtle changes, but the short length of the program hindered any patients from seeing complete deescalation of their schema, Ms. Wojcik said.

She discussed the case of a 30-year-old woman with diagnoses of SUD, PTSD, and bipolar disorder – and an extensive treatment history. Therapists found that the combination of traditional and CBT helped significantly with the patient’s elevated abandonment schema.

“We were able to have her close her eyes and walk through not only what it was like when that schema developed, but also have her talk about what were the things that went unmet in that situation that caused this to happen,” Ms. Wojcik said. “She successfully completed her treatment with us, noticed a lot of her schema had decreased in elevation, and expressed pride that she had done this.”

Ms. Wojcik and her colleagues reported no relevant financial disclosures.

[email protected]

SOURCE: Wojcik KD et al. ADAA 2018, Abstract 173C.

A breakdown of marijuana use across industries encourages employers to be aware of, and possibly reevaluate, their current workplace safety policies, according to a report from the Centers for Disease Control and Prevention.

As legal recreational marijuana use continues to expand across the United States, marijuana has been shown to inhibit certain motor skills, which has made it crucial for employers to have a better understanding how best to approach safety training, according to the study published in the Morbidity and Mortality Weekly Report.

“We have been looking at some of the behavioral risk factors associated with marijuana legalization and were interested in the data broken down by industry and occupation, which could help employers make decisions on any kind of safety and drug use policies in the workplace,” lead author Roberta Smith, RN, occupational health program manager at the Colorado Department of Public Health and Environment, said in a interview. “This doesn’t necessarily imply any impairment on the job, but these data will reinforce current policies and encourage employers to go back and see how their work places operate and make sure their employees are good to staff.”

To examine current marijuana use by working adults and the industries and occupations in which they are employed, the Colorado Department of Public Health and Environment analyzed data from the state’s Behavioral Risk Factor Surveillance System regarding current marijuana use (at least 1 day during the preceding 30 days) among 10,169 persons who had responded to the current marijuana use question.

Participants were over the age of 21 years old and were either employed at the time of the survey or had been unemployed for less than a year.

In the overall population, 14.6% reported using marijuana, with higher prevalence in men (17.2%) and those 18-25 years old (29.6%).

By industry, accommodation and food service workers reported the highest rate of use at 30.1%, followed by those in the arts, entertainment, and recreation industry with 28.3%.

[email protected]

SOURCE: Smith R et al. MMWR. 2018 Apr 13;67(14):409-13.

A breakdown of marijuana use across industries encourages employers to be aware of, and possibly reevaluate, their current workplace safety policies, according to a report from the Centers for Disease Control and Prevention.

As legal recreational marijuana use continues to expand across the United States, marijuana has been shown to inhibit certain motor skills, which has made it crucial for employers to have a better understanding how best to approach safety training, according to the study published in the Morbidity and Mortality Weekly Report.

“We have been looking at some of the behavioral risk factors associated with marijuana legalization and were interested in the data broken down by industry and occupation, which could help employers make decisions on any kind of safety and drug use policies in the workplace,” lead author Roberta Smith, RN, occupational health program manager at the Colorado Department of Public Health and Environment, said in a interview. “This doesn’t necessarily imply any impairment on the job, but these data will reinforce current policies and encourage employers to go back and see how their work places operate and make sure their employees are good to staff.”

To examine current marijuana use by working adults and the industries and occupations in which they are employed, the Colorado Department of Public Health and Environment analyzed data from the state’s Behavioral Risk Factor Surveillance System regarding current marijuana use (at least 1 day during the preceding 30 days) among 10,169 persons who had responded to the current marijuana use question.

Participants were over the age of 21 years old and were either employed at the time of the survey or had been unemployed for less than a year.

In the overall population, 14.6% reported using marijuana, with higher prevalence in men (17.2%) and those 18-25 years old (29.6%).

By industry, accommodation and food service workers reported the highest rate of use at 30.1%, followed by those in the arts, entertainment, and recreation industry with 28.3%.

[email protected]

SOURCE: Smith R et al. MMWR. 2018 Apr 13;67(14):409-13.

A breakdown of marijuana use across industries encourages employers to be aware of, and possibly reevaluate, their current workplace safety policies, according to a report from the Centers for Disease Control and Prevention.

As legal recreational marijuana use continues to expand across the United States, marijuana has been shown to inhibit certain motor skills, which has made it crucial for employers to have a better understanding how best to approach safety training, according to the study published in the Morbidity and Mortality Weekly Report.

“We have been looking at some of the behavioral risk factors associated with marijuana legalization and were interested in the data broken down by industry and occupation, which could help employers make decisions on any kind of safety and drug use policies in the workplace,” lead author Roberta Smith, RN, occupational health program manager at the Colorado Department of Public Health and Environment, said in a interview. “This doesn’t necessarily imply any impairment on the job, but these data will reinforce current policies and encourage employers to go back and see how their work places operate and make sure their employees are good to staff.”

To examine current marijuana use by working adults and the industries and occupations in which they are employed, the Colorado Department of Public Health and Environment analyzed data from the state’s Behavioral Risk Factor Surveillance System regarding current marijuana use (at least 1 day during the preceding 30 days) among 10,169 persons who had responded to the current marijuana use question.

Participants were over the age of 21 years old and were either employed at the time of the survey or had been unemployed for less than a year.

In the overall population, 14.6% reported using marijuana, with higher prevalence in men (17.2%) and those 18-25 years old (29.6%).

By industry, accommodation and food service workers reported the highest rate of use at 30.1%, followed by those in the arts, entertainment, and recreation industry with 28.3%.

[email protected]

SOURCE: Smith R et al. MMWR. 2018 Apr 13;67(14):409-13.

WASHINGTON – Trauma-Informed Parenting Skills for Resource Parents, a new intervention program, might be an answer to addressing trauma symptoms in foster homes, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Rates of trauma exposure range from 80% to 93% in child welfare populations. In light of those statistics, foster parents are left to deal with the effects of traumatic stress symptoms without proper preparation or tools. Trauma-Informed Parenting Skills for Resource Parents targets different aspects of the way in which trauma can affect both the foster child and other members of the family.

[email protected]

WASHINGTON – Trauma-Informed Parenting Skills for Resource Parents, a new intervention program, might be an answer to addressing trauma symptoms in foster homes, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Rates of trauma exposure range from 80% to 93% in child welfare populations. In light of those statistics, foster parents are left to deal with the effects of traumatic stress symptoms without proper preparation or tools. Trauma-Informed Parenting Skills for Resource Parents targets different aspects of the way in which trauma can affect both the foster child and other members of the family.

[email protected]

WASHINGTON – Trauma-Informed Parenting Skills for Resource Parents, a new intervention program, might be an answer to addressing trauma symptoms in foster homes, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Rates of trauma exposure range from 80% to 93% in child welfare populations. In light of those statistics, foster parents are left to deal with the effects of traumatic stress symptoms without proper preparation or tools. Trauma-Informed Parenting Skills for Resource Parents targets different aspects of the way in which trauma can affect both the foster child and other members of the family.

[email protected]

Difficult patient interactions are a major contributing factor behind hospitalist burnout, but clinicians should know there are options.

Faye Reiff-Pasarew, MD, director of the humanism in medicine program at Mount Sinai Hospital in New York, and a presenter at the Tuesday education session “Challenging Patients, Challenging Stories: A Medical Humanities Approach to Provider Burnout,” says a broader perspective can help.

“We don’t spend a lot of time talking about what we can do in the moment to deal with these situations,” she said. “We need to help clinicians maintain their ability to continue to practice and provide excellent care.”

Dr. Reiff-Pasarew and her colleague Joshua Allen-Dicker, MD, MPH, FHM, of Beth Israel Deaconess Medical Center in Boston, will explain how the intersection of humanities and medicine can help make treating challenging patients more manageable.

“The practice of medicine is enriched by having a broader perspective on what can be useful and drawing on the wisdom of other disciplines,” Dr. Reiff-Pasarew explained. “The biomedical model can be very narrow and does not always take into account the larger aspects of people’s humanity.”

Session leaders say attendees will learn tactics that they will be able to take with them and immediately implement in their own practice.

“Medical humanities is an interdisciplinary approach drawing from the arts and social sciences to broaden our understanding of health and illness outside of the purely biomedical model,” Dr. Reiff-Pasarew said. “We are going to use different examples, from narrative medicine or graphic medicine, to show clinicians how to be more emotionally connected and give them tools to develop empathy for their patient’s perspective, even when it may manifest in very challenging ways.”

The session will begin by outlining the issues of burnout in medicine, followed by strategies for clinicians to better handle patients during an interaction. The instructors will also explain how hospitalists can better manage their – and their patients’ –emotions that may arise during a patient encounter. Attendees will learn how they can keep their emotions in check and not be overly reactive, said Dr. Reiff-Pasarew.

Finally, hospitalists will learn how best to deal with any frustrations following a session with a difficult patient.

“There can be a lot of residual stress as a result of these experiences, and many do not have a great outlet,” said Dr. Reiff-Pasarew. “We are going to do some group brainstorming about coping mechanisms, focusing particularly on creative expression.”

Challenging Patients, Challenging Stories: A Medical Humanities Approach to Provider Burnout
Tuesday, 11 a.m.-12:30 p.m.
Grand Ballroom 4-6

Difficult patient interactions are a major contributing factor behind hospitalist burnout, but clinicians should know there are options.

Faye Reiff-Pasarew, MD, director of the humanism in medicine program at Mount Sinai Hospital in New York, and a presenter at the Tuesday education session “Challenging Patients, Challenging Stories: A Medical Humanities Approach to Provider Burnout,” says a broader perspective can help.

“We don’t spend a lot of time talking about what we can do in the moment to deal with these situations,” she said. “We need to help clinicians maintain their ability to continue to practice and provide excellent care.”

Dr. Reiff-Pasarew and her colleague Joshua Allen-Dicker, MD, MPH, FHM, of Beth Israel Deaconess Medical Center in Boston, will explain how the intersection of humanities and medicine can help make treating challenging patients more manageable.

“The practice of medicine is enriched by having a broader perspective on what can be useful and drawing on the wisdom of other disciplines,” Dr. Reiff-Pasarew explained. “The biomedical model can be very narrow and does not always take into account the larger aspects of people’s humanity.”

Session leaders say attendees will learn tactics that they will be able to take with them and immediately implement in their own practice.

“Medical humanities is an interdisciplinary approach drawing from the arts and social sciences to broaden our understanding of health and illness outside of the purely biomedical model,” Dr. Reiff-Pasarew said. “We are going to use different examples, from narrative medicine or graphic medicine, to show clinicians how to be more emotionally connected and give them tools to develop empathy for their patient’s perspective, even when it may manifest in very challenging ways.”

The session will begin by outlining the issues of burnout in medicine, followed by strategies for clinicians to better handle patients during an interaction. The instructors will also explain how hospitalists can better manage their – and their patients’ –emotions that may arise during a patient encounter. Attendees will learn how they can keep their emotions in check and not be overly reactive, said Dr. Reiff-Pasarew.

Finally, hospitalists will learn how best to deal with any frustrations following a session with a difficult patient.

“There can be a lot of residual stress as a result of these experiences, and many do not have a great outlet,” said Dr. Reiff-Pasarew. “We are going to do some group brainstorming about coping mechanisms, focusing particularly on creative expression.”

Challenging Patients, Challenging Stories: A Medical Humanities Approach to Provider Burnout
Tuesday, 11 a.m.-12:30 p.m.
Grand Ballroom 4-6

Difficult patient interactions are a major contributing factor behind hospitalist burnout, but clinicians should know there are options.

Faye Reiff-Pasarew, MD, director of the humanism in medicine program at Mount Sinai Hospital in New York, and a presenter at the Tuesday education session “Challenging Patients, Challenging Stories: A Medical Humanities Approach to Provider Burnout,” says a broader perspective can help.

“We don’t spend a lot of time talking about what we can do in the moment to deal with these situations,” she said. “We need to help clinicians maintain their ability to continue to practice and provide excellent care.”

Dr. Reiff-Pasarew and her colleague Joshua Allen-Dicker, MD, MPH, FHM, of Beth Israel Deaconess Medical Center in Boston, will explain how the intersection of humanities and medicine can help make treating challenging patients more manageable.

“The practice of medicine is enriched by having a broader perspective on what can be useful and drawing on the wisdom of other disciplines,” Dr. Reiff-Pasarew explained. “The biomedical model can be very narrow and does not always take into account the larger aspects of people’s humanity.”

Session leaders say attendees will learn tactics that they will be able to take with them and immediately implement in their own practice.

“Medical humanities is an interdisciplinary approach drawing from the arts and social sciences to broaden our understanding of health and illness outside of the purely biomedical model,” Dr. Reiff-Pasarew said. “We are going to use different examples, from narrative medicine or graphic medicine, to show clinicians how to be more emotionally connected and give them tools to develop empathy for their patient’s perspective, even when it may manifest in very challenging ways.”

The session will begin by outlining the issues of burnout in medicine, followed by strategies for clinicians to better handle patients during an interaction. The instructors will also explain how hospitalists can better manage their – and their patients’ –emotions that may arise during a patient encounter. Attendees will learn how they can keep their emotions in check and not be overly reactive, said Dr. Reiff-Pasarew.

Finally, hospitalists will learn how best to deal with any frustrations following a session with a difficult patient.

“There can be a lot of residual stress as a result of these experiences, and many do not have a great outlet,” said Dr. Reiff-Pasarew. “We are going to do some group brainstorming about coping mechanisms, focusing particularly on creative expression.”

Challenging Patients, Challenging Stories: A Medical Humanities Approach to Provider Burnout
Tuesday, 11 a.m.-12:30 p.m.
Grand Ballroom 4-6

Here are 4 articles in the April issue of Journal of Clinical Outcomes Management. 

1. Young Adult HIV Patients May Be At Increased Risk of Hypertension

2. Written Exposure Therapy Rivals Cognitive Processing Therapy For PTSD

3. Large Database Analysis Suggests Safety of Bariatric Surgery in Seniors

4. Who Fares Best After Successful ECT?

Here are 4 articles in the April issue of Journal of Clinical Outcomes Management. 

1. Young Adult HIV Patients May Be At Increased Risk of Hypertension

2. Written Exposure Therapy Rivals Cognitive Processing Therapy For PTSD

3. Large Database Analysis Suggests Safety of Bariatric Surgery in Seniors

4. Who Fares Best After Successful ECT?

Here are 4 articles in the April issue of Journal of Clinical Outcomes Management. 

1. Young Adult HIV Patients May Be At Increased Risk of Hypertension

2. Written Exposure Therapy Rivals Cognitive Processing Therapy For PTSD

3. Large Database Analysis Suggests Safety of Bariatric Surgery in Seniors

4. Who Fares Best After Successful ECT?