Gina L. Henderson

Affect Intensity Measure subscale scores can be used to help understand the complexity of emotions experienced by patients with bipolar disorder I and II, a study of 310 outpatients suggests.

Furthermore, four factors – positive affectivity, "unpeacefulness" (lack of serenity), negative reactivity, and negative intensity – allow clinicians to "explore more subtle components characterizing various aspects of emotional response" among patients with both types of bipolar, Flavie Mathieu, Ph.D., Dr. Bruno Etain, and their colleagues reported (J. Affect. Disord. 2014;157:8-13).

The Affect Intensity Measure (AIM) is a 40-item questionnaire designed to measure the extent to which patients experience emotion.

For the study, Dr. Mathieu, Dr. Etain, and their colleagues recruited patients at four university-affiliated psychiatric departments in France. All of the patients included in the study were aged 18 years or older (mean age, 42.4 years). In all, 233 of the patients met the DSM-IV criteria for bipolar disorder I, 65 met the criteria for bipolar II, and 12 for bipolar not otherwise specified, wrote Dr. Mathieu of Université Paris Diderot, Dr. Etain of Hôpital Albert Chenevier, Créteil, France, and their colleagues.

The team developed a French translation of the AIM and got it "backtranslated" by an independent translator. The patients were asked to describe their affect during euthymic periods rather than during either manic or depressive episodes. Euthymic states were confirmed based on the patients’ scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Mania Rating Scale.

No statistically significant association was found between the patients’ total AIM scores and the clinical characteristics of bipolar disorder. However, when the investigators looked at the four factors, they found significant associations between the AIM subscale scores and bipolar disorder characteristics. For example, the unpeacefulness subscale score was associated with the onset of psychotic symptoms (P = .0006) and substance misuse (P = .008). The negative intensity subscale score was associated with social phobia (P = .0005).

The investigators cited several limitations. For example, they found no correlation between the patients’ total AIM scores and MADRS scores, which suggests that "AIM total score is not necessarily influenced by depression."

Despite these limitations, the investigators said their findings "suggest that assessment of affective intensity using this self-report scale may be useful in clinical settings but also as a means of further characterizing [bipolar disorder] phenotypes in future research."

The research was funded by INSERM, Assistance Publique des Hôpitaux de Paris, Agence National pour la Recherche, and the Fondation FondaMental. The authors reported no financial conflicts.

[email protected]

Affect Intensity Measure subscale scores can be used to help understand the complexity of emotions experienced by patients with bipolar disorder I and II, a study of 310 outpatients suggests.

Furthermore, four factors – positive affectivity, "unpeacefulness" (lack of serenity), negative reactivity, and negative intensity – allow clinicians to "explore more subtle components characterizing various aspects of emotional response" among patients with both types of bipolar, Flavie Mathieu, Ph.D., Dr. Bruno Etain, and their colleagues reported (J. Affect. Disord. 2014;157:8-13).

The Affect Intensity Measure (AIM) is a 40-item questionnaire designed to measure the extent to which patients experience emotion.

For the study, Dr. Mathieu, Dr. Etain, and their colleagues recruited patients at four university-affiliated psychiatric departments in France. All of the patients included in the study were aged 18 years or older (mean age, 42.4 years). In all, 233 of the patients met the DSM-IV criteria for bipolar disorder I, 65 met the criteria for bipolar II, and 12 for bipolar not otherwise specified, wrote Dr. Mathieu of Université Paris Diderot, Dr. Etain of Hôpital Albert Chenevier, Créteil, France, and their colleagues.

The team developed a French translation of the AIM and got it "backtranslated" by an independent translator. The patients were asked to describe their affect during euthymic periods rather than during either manic or depressive episodes. Euthymic states were confirmed based on the patients’ scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Mania Rating Scale.

No statistically significant association was found between the patients’ total AIM scores and the clinical characteristics of bipolar disorder. However, when the investigators looked at the four factors, they found significant associations between the AIM subscale scores and bipolar disorder characteristics. For example, the unpeacefulness subscale score was associated with the onset of psychotic symptoms (P = .0006) and substance misuse (P = .008). The negative intensity subscale score was associated with social phobia (P = .0005).

The investigators cited several limitations. For example, they found no correlation between the patients’ total AIM scores and MADRS scores, which suggests that "AIM total score is not necessarily influenced by depression."

Despite these limitations, the investigators said their findings "suggest that assessment of affective intensity using this self-report scale may be useful in clinical settings but also as a means of further characterizing [bipolar disorder] phenotypes in future research."

The research was funded by INSERM, Assistance Publique des Hôpitaux de Paris, Agence National pour la Recherche, and the Fondation FondaMental. The authors reported no financial conflicts.

[email protected]

Affect Intensity Measure subscale scores can be used to help understand the complexity of emotions experienced by patients with bipolar disorder I and II, a study of 310 outpatients suggests.

Furthermore, four factors – positive affectivity, "unpeacefulness" (lack of serenity), negative reactivity, and negative intensity – allow clinicians to "explore more subtle components characterizing various aspects of emotional response" among patients with both types of bipolar, Flavie Mathieu, Ph.D., Dr. Bruno Etain, and their colleagues reported (J. Affect. Disord. 2014;157:8-13).

The Affect Intensity Measure (AIM) is a 40-item questionnaire designed to measure the extent to which patients experience emotion.

For the study, Dr. Mathieu, Dr. Etain, and their colleagues recruited patients at four university-affiliated psychiatric departments in France. All of the patients included in the study were aged 18 years or older (mean age, 42.4 years). In all, 233 of the patients met the DSM-IV criteria for bipolar disorder I, 65 met the criteria for bipolar II, and 12 for bipolar not otherwise specified, wrote Dr. Mathieu of Université Paris Diderot, Dr. Etain of Hôpital Albert Chenevier, Créteil, France, and their colleagues.

The team developed a French translation of the AIM and got it "backtranslated" by an independent translator. The patients were asked to describe their affect during euthymic periods rather than during either manic or depressive episodes. Euthymic states were confirmed based on the patients’ scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Mania Rating Scale.

No statistically significant association was found between the patients’ total AIM scores and the clinical characteristics of bipolar disorder. However, when the investigators looked at the four factors, they found significant associations between the AIM subscale scores and bipolar disorder characteristics. For example, the unpeacefulness subscale score was associated with the onset of psychotic symptoms (P = .0006) and substance misuse (P = .008). The negative intensity subscale score was associated with social phobia (P = .0005).

The investigators cited several limitations. For example, they found no correlation between the patients’ total AIM scores and MADRS scores, which suggests that "AIM total score is not necessarily influenced by depression."

Despite these limitations, the investigators said their findings "suggest that assessment of affective intensity using this self-report scale may be useful in clinical settings but also as a means of further characterizing [bipolar disorder] phenotypes in future research."

The research was funded by INSERM, Assistance Publique des Hôpitaux de Paris, Agence National pour la Recherche, and the Fondation FondaMental. The authors reported no financial conflicts.

[email protected]

Increased energy or motor activity is a more important symptom for diagnosing mania within bipolar disorder than are mood changes, a study of 117 hospitalized patients suggests.

Increased energy/activity has been proposed as a core symptom of manic episode in DSM-5. "The present results support the hypothesis that increased energy or activity ... represents the core feature of the manic syndrome," wrote Dr. Elie Cheniaux of the State University of Rio de Janeiro and his colleagues (J. Affect. Disord. 2014;152-4:256-61).

The investigators evaluated the symptoms of each patient hospitalized with an acute manic episode using several instruments. All of the patients took the Mini International Neuropsychiatric Interview, a tool that allows psychiatric diagnoses to be formulated based on DSM-IV and ICD-10 criteria. Those who met the DSM-IV criteria for a manic episode were administered the 37-item Schedule for Affective Disorders and Schizophrenia (SADS)–Change Version, a scale that evaluates the presence of manic, depressive, anxiety, and psychotic symptoms. Dr. Cheniaux and his colleagues performed a Confirmatory Factor Analysis to determine which items best fit the mania dimension. Additional tools such as an Item Response Theory (IRT) Analysis were used to determine the extent to which each symptom described different levels of severity.

Most of the patients (58.1%) were female, the average age was 42.4 years, and the average age at first crisis was 24.3 years. Mania proved to be more frequent than depression in the first crisis (P less than 0.001).

The IRT analysis assigned values to each symptom, and the highest values were assigned to "increased energy" (4.05), "elated mood" (2.54), "less need for sleep" (2.07), and "increased activity" (1.98). The item "anger" got the lowest value (1.02) and "differentiates patients with mania relatively little, with similar levels across severity levels," they wrote.

Dr. Cheniaux said in an interview that he had expected a higher factorial loading with anger. "It is possible that the angriest patients refused to participate in the study, so the symptom of anger could be underrepresented in our study," he said.

Ultimately, the investigators found that patients’ increased energy was the alteration that correlated "the most with the total severity of manic symptoms."

They cited several limitations of the study. For example, patients in the sample might not be representative of bipolar patients in the general population because they were evaluated while their manic symptoms were at their peak. In addition, the investigators suggested only six manic symptoms: increased activity, less need for sleep, increased energy, elated mood, increased self-esteem, and anger. Still, the results suggest that changes in the DSM-5 in the diagnostic criteria for a bipolar diagnosis could be more extensive, they wrote.

Dr. Cheniaux reported that he had no conflicts of interest.

[email protected]

Increased energy or motor activity is a more important symptom for diagnosing mania within bipolar disorder than are mood changes, a study of 117 hospitalized patients suggests.

Increased energy/activity has been proposed as a core symptom of manic episode in DSM-5. "The present results support the hypothesis that increased energy or activity ... represents the core feature of the manic syndrome," wrote Dr. Elie Cheniaux of the State University of Rio de Janeiro and his colleagues (J. Affect. Disord. 2014;152-4:256-61).

The investigators evaluated the symptoms of each patient hospitalized with an acute manic episode using several instruments. All of the patients took the Mini International Neuropsychiatric Interview, a tool that allows psychiatric diagnoses to be formulated based on DSM-IV and ICD-10 criteria. Those who met the DSM-IV criteria for a manic episode were administered the 37-item Schedule for Affective Disorders and Schizophrenia (SADS)–Change Version, a scale that evaluates the presence of manic, depressive, anxiety, and psychotic symptoms. Dr. Cheniaux and his colleagues performed a Confirmatory Factor Analysis to determine which items best fit the mania dimension. Additional tools such as an Item Response Theory (IRT) Analysis were used to determine the extent to which each symptom described different levels of severity.

Most of the patients (58.1%) were female, the average age was 42.4 years, and the average age at first crisis was 24.3 years. Mania proved to be more frequent than depression in the first crisis (P less than 0.001).

The IRT analysis assigned values to each symptom, and the highest values were assigned to "increased energy" (4.05), "elated mood" (2.54), "less need for sleep" (2.07), and "increased activity" (1.98). The item "anger" got the lowest value (1.02) and "differentiates patients with mania relatively little, with similar levels across severity levels," they wrote.

Dr. Cheniaux said in an interview that he had expected a higher factorial loading with anger. "It is possible that the angriest patients refused to participate in the study, so the symptom of anger could be underrepresented in our study," he said.

Ultimately, the investigators found that patients’ increased energy was the alteration that correlated "the most with the total severity of manic symptoms."

They cited several limitations of the study. For example, patients in the sample might not be representative of bipolar patients in the general population because they were evaluated while their manic symptoms were at their peak. In addition, the investigators suggested only six manic symptoms: increased activity, less need for sleep, increased energy, elated mood, increased self-esteem, and anger. Still, the results suggest that changes in the DSM-5 in the diagnostic criteria for a bipolar diagnosis could be more extensive, they wrote.

Dr. Cheniaux reported that he had no conflicts of interest.

[email protected]

Increased energy or motor activity is a more important symptom for diagnosing mania within bipolar disorder than are mood changes, a study of 117 hospitalized patients suggests.

Increased energy/activity has been proposed as a core symptom of manic episode in DSM-5. "The present results support the hypothesis that increased energy or activity ... represents the core feature of the manic syndrome," wrote Dr. Elie Cheniaux of the State University of Rio de Janeiro and his colleagues (J. Affect. Disord. 2014;152-4:256-61).

The investigators evaluated the symptoms of each patient hospitalized with an acute manic episode using several instruments. All of the patients took the Mini International Neuropsychiatric Interview, a tool that allows psychiatric diagnoses to be formulated based on DSM-IV and ICD-10 criteria. Those who met the DSM-IV criteria for a manic episode were administered the 37-item Schedule for Affective Disorders and Schizophrenia (SADS)–Change Version, a scale that evaluates the presence of manic, depressive, anxiety, and psychotic symptoms. Dr. Cheniaux and his colleagues performed a Confirmatory Factor Analysis to determine which items best fit the mania dimension. Additional tools such as an Item Response Theory (IRT) Analysis were used to determine the extent to which each symptom described different levels of severity.

Most of the patients (58.1%) were female, the average age was 42.4 years, and the average age at first crisis was 24.3 years. Mania proved to be more frequent than depression in the first crisis (P less than 0.001).

The IRT analysis assigned values to each symptom, and the highest values were assigned to "increased energy" (4.05), "elated mood" (2.54), "less need for sleep" (2.07), and "increased activity" (1.98). The item "anger" got the lowest value (1.02) and "differentiates patients with mania relatively little, with similar levels across severity levels," they wrote.

Dr. Cheniaux said in an interview that he had expected a higher factorial loading with anger. "It is possible that the angriest patients refused to participate in the study, so the symptom of anger could be underrepresented in our study," he said.

Ultimately, the investigators found that patients’ increased energy was the alteration that correlated "the most with the total severity of manic symptoms."

They cited several limitations of the study. For example, patients in the sample might not be representative of bipolar patients in the general population because they were evaluated while their manic symptoms were at their peak. In addition, the investigators suggested only six manic symptoms: increased activity, less need for sleep, increased energy, elated mood, increased self-esteem, and anger. Still, the results suggest that changes in the DSM-5 in the diagnostic criteria for a bipolar diagnosis could be more extensive, they wrote.

Dr. Cheniaux reported that he had no conflicts of interest.

[email protected]

Mobile technology can be used to predict which patients with alcohol dependence are more likely to relapse and possibly prevent such relapses from occurring, results of a preliminary study of 152 adults suggest.

"This prediction algorithm may help addiction counselors take a proactive approach with these patients," wrote Ming-Yuan Chih, a doctoral candidate at the University of Wisconsin, Madison, and his colleagues. "Information and mobile communication technology offer a great opportunity to develop novel ways to deliver addiction treatment to patients."

The investigators recruited and randomized 170 patients from two residential treatment organizations – one in the northeastern United States, the other in the Midwest. The mean age of the patients was 38 years; most were white and male. Patients with either a significant developmental or cognitive impairment or a history of suicidality were excluded. More than half of the patients had abused drugs beyond alcohol in their lives, and almost half reported mental health problems (J. Subst. Abuse Treat. 2014;46:29-35).

© Nick Smith/iStockphoto

Before leaving treatment, the participants in the intervention group were given smart phones with a mobile broadband connection and training on how to use the addiction-comprehensive health enhancement support, or A-CHESS system. They were expected to submit a "Weekly Check-In" to A-CHESS once every 7 days, and those numbers were sent to a secure server at the university. Seven days after each submission, the patients received a prompt to submit another Weekly Check-In. To remain in the trial, however, Weekly Check-Ins were not required. "Therefore, it is possible that substantially more than 7 days could elapse between submissions," the investigators wrote. In the end, 152 of the patients submitted 2,934 Weekly Check-In reports between April 2010 and August 2011.

The check-in survey consisted of three screens. The first asked the patients whether they had abused drugs or alcohol in the last 7 days. If the answer was yes, the patients were asked whether they wanted their A-CHESS counselor to be notified. The second screen sought to pinpoint other experiences that patients might have had in the last week. For example, one question asked whether they had had difficulty sleeping on a scale of 0-7. Another asked the patients to rate their "level of depression," and yet another asked them to rate their "drinking urges." The last screen sought to determine how patients had been spending their time over the last 7 days. They were asked to rate their Alcoholics Anonymous meeting attendance and their involvement with spiritual activities and with work and school. The intervention lasted for 8 months.

The investigators used data from screens #2 and #3 to determine each patient’s recovery progress score. This score could range from –35 to +35, and the higher scores were tied to better outcomes. In addition, the investigators used the data to construct each patient’s lapse history. Using these data, the investigators developed a model that enabled them to determine the chances of a patient lapsing within 1 week. The model was used in A-CHESS to "identify patients at high risk and then to take tailored action to reduce that risk," Mr. Chih and his colleagues wrote.

Patients with recovery progress scores of –35 to –28 had a 33% probability of lapse and a 67% probability of non-lapse. Those with recovery progress scores of +28 to +35 had a 50/50 probability of lapse and non-lapse. Those who had a good chance of relapsing within the following week automatically received a text message about the risk. The text included suggestions about steps the patient could take to avoid relapse within A-CHESS, such as planning alternative activities. The patient’s counselor also received a text message about the possible relapse and could reach out to the patient at that point. Finally, the A-CHESS study coordinator would receive a text alert. Mr. Chih noted that this model – including the alerting feature – has been implemented as part of A-CHESS.

Several limitations were cited. Because only two treatment organizations were used in this study, it is unclear whether the model is generalizable. Also, each patient’s lapse status was self-reported and might not be accurate. Still, these results serve as a "starting point for further development," the researchers wrote. "We need to find better ways to assist people with the very difficult transition from alcohol addiction to sobriety."

The National Institute on Alcohol Abuse and Alcoholism funded the study. Mr. Chih reported no conflicts of interest.

[email protected]

Mobile technology can be used to predict which patients with alcohol dependence are more likely to relapse and possibly prevent such relapses from occurring, results of a preliminary study of 152 adults suggest.

"This prediction algorithm may help addiction counselors take a proactive approach with these patients," wrote Ming-Yuan Chih, a doctoral candidate at the University of Wisconsin, Madison, and his colleagues. "Information and mobile communication technology offer a great opportunity to develop novel ways to deliver addiction treatment to patients."

The investigators recruited and randomized 170 patients from two residential treatment organizations – one in the northeastern United States, the other in the Midwest. The mean age of the patients was 38 years; most were white and male. Patients with either a significant developmental or cognitive impairment or a history of suicidality were excluded. More than half of the patients had abused drugs beyond alcohol in their lives, and almost half reported mental health problems (J. Subst. Abuse Treat. 2014;46:29-35).

© Nick Smith/iStockphoto

Before leaving treatment, the participants in the intervention group were given smart phones with a mobile broadband connection and training on how to use the addiction-comprehensive health enhancement support, or A-CHESS system. They were expected to submit a "Weekly Check-In" to A-CHESS once every 7 days, and those numbers were sent to a secure server at the university. Seven days after each submission, the patients received a prompt to submit another Weekly Check-In. To remain in the trial, however, Weekly Check-Ins were not required. "Therefore, it is possible that substantially more than 7 days could elapse between submissions," the investigators wrote. In the end, 152 of the patients submitted 2,934 Weekly Check-In reports between April 2010 and August 2011.

The check-in survey consisted of three screens. The first asked the patients whether they had abused drugs or alcohol in the last 7 days. If the answer was yes, the patients were asked whether they wanted their A-CHESS counselor to be notified. The second screen sought to pinpoint other experiences that patients might have had in the last week. For example, one question asked whether they had had difficulty sleeping on a scale of 0-7. Another asked the patients to rate their "level of depression," and yet another asked them to rate their "drinking urges." The last screen sought to determine how patients had been spending their time over the last 7 days. They were asked to rate their Alcoholics Anonymous meeting attendance and their involvement with spiritual activities and with work and school. The intervention lasted for 8 months.

The investigators used data from screens #2 and #3 to determine each patient’s recovery progress score. This score could range from –35 to +35, and the higher scores were tied to better outcomes. In addition, the investigators used the data to construct each patient’s lapse history. Using these data, the investigators developed a model that enabled them to determine the chances of a patient lapsing within 1 week. The model was used in A-CHESS to "identify patients at high risk and then to take tailored action to reduce that risk," Mr. Chih and his colleagues wrote.

Patients with recovery progress scores of –35 to –28 had a 33% probability of lapse and a 67% probability of non-lapse. Those with recovery progress scores of +28 to +35 had a 50/50 probability of lapse and non-lapse. Those who had a good chance of relapsing within the following week automatically received a text message about the risk. The text included suggestions about steps the patient could take to avoid relapse within A-CHESS, such as planning alternative activities. The patient’s counselor also received a text message about the possible relapse and could reach out to the patient at that point. Finally, the A-CHESS study coordinator would receive a text alert. Mr. Chih noted that this model – including the alerting feature – has been implemented as part of A-CHESS.

Several limitations were cited. Because only two treatment organizations were used in this study, it is unclear whether the model is generalizable. Also, each patient’s lapse status was self-reported and might not be accurate. Still, these results serve as a "starting point for further development," the researchers wrote. "We need to find better ways to assist people with the very difficult transition from alcohol addiction to sobriety."

The National Institute on Alcohol Abuse and Alcoholism funded the study. Mr. Chih reported no conflicts of interest.

[email protected]

Mobile technology can be used to predict which patients with alcohol dependence are more likely to relapse and possibly prevent such relapses from occurring, results of a preliminary study of 152 adults suggest.

"This prediction algorithm may help addiction counselors take a proactive approach with these patients," wrote Ming-Yuan Chih, a doctoral candidate at the University of Wisconsin, Madison, and his colleagues. "Information and mobile communication technology offer a great opportunity to develop novel ways to deliver addiction treatment to patients."

The investigators recruited and randomized 170 patients from two residential treatment organizations – one in the northeastern United States, the other in the Midwest. The mean age of the patients was 38 years; most were white and male. Patients with either a significant developmental or cognitive impairment or a history of suicidality were excluded. More than half of the patients had abused drugs beyond alcohol in their lives, and almost half reported mental health problems (J. Subst. Abuse Treat. 2014;46:29-35).

© Nick Smith/iStockphoto

Before leaving treatment, the participants in the intervention group were given smart phones with a mobile broadband connection and training on how to use the addiction-comprehensive health enhancement support, or A-CHESS system. They were expected to submit a "Weekly Check-In" to A-CHESS once every 7 days, and those numbers were sent to a secure server at the university. Seven days after each submission, the patients received a prompt to submit another Weekly Check-In. To remain in the trial, however, Weekly Check-Ins were not required. "Therefore, it is possible that substantially more than 7 days could elapse between submissions," the investigators wrote. In the end, 152 of the patients submitted 2,934 Weekly Check-In reports between April 2010 and August 2011.

The check-in survey consisted of three screens. The first asked the patients whether they had abused drugs or alcohol in the last 7 days. If the answer was yes, the patients were asked whether they wanted their A-CHESS counselor to be notified. The second screen sought to pinpoint other experiences that patients might have had in the last week. For example, one question asked whether they had had difficulty sleeping on a scale of 0-7. Another asked the patients to rate their "level of depression," and yet another asked them to rate their "drinking urges." The last screen sought to determine how patients had been spending their time over the last 7 days. They were asked to rate their Alcoholics Anonymous meeting attendance and their involvement with spiritual activities and with work and school. The intervention lasted for 8 months.

The investigators used data from screens #2 and #3 to determine each patient’s recovery progress score. This score could range from –35 to +35, and the higher scores were tied to better outcomes. In addition, the investigators used the data to construct each patient’s lapse history. Using these data, the investigators developed a model that enabled them to determine the chances of a patient lapsing within 1 week. The model was used in A-CHESS to "identify patients at high risk and then to take tailored action to reduce that risk," Mr. Chih and his colleagues wrote.

Patients with recovery progress scores of –35 to –28 had a 33% probability of lapse and a 67% probability of non-lapse. Those with recovery progress scores of +28 to +35 had a 50/50 probability of lapse and non-lapse. Those who had a good chance of relapsing within the following week automatically received a text message about the risk. The text included suggestions about steps the patient could take to avoid relapse within A-CHESS, such as planning alternative activities. The patient’s counselor also received a text message about the possible relapse and could reach out to the patient at that point. Finally, the A-CHESS study coordinator would receive a text alert. Mr. Chih noted that this model – including the alerting feature – has been implemented as part of A-CHESS.

Several limitations were cited. Because only two treatment organizations were used in this study, it is unclear whether the model is generalizable. Also, each patient’s lapse status was self-reported and might not be accurate. Still, these results serve as a "starting point for further development," the researchers wrote. "We need to find better ways to assist people with the very difficult transition from alcohol addiction to sobriety."

The National Institute on Alcohol Abuse and Alcoholism funded the study. Mr. Chih reported no conflicts of interest.

[email protected]

Patients with schizophrenia who are heavy cigarette smokers are more likely to use substances such as alcohol than are those with the disease who are non–heavy smokers. Heavy smokers also are more likely to have elevated cholesterol, a retrospective analysis of 745 patient records has found.

In light of the health risks associated with heavy smoking and elevated cholesterol, "every effort to decrease cigarette intake or stop smoking should be made for smokers with schizophrenia as part of a multifaceted treatment plan," wrote Heidi J. Wehring, Pharm.D., of the Maryland Psychiatric Research Center, Baltimore, and her colleagues.

©kutay tanir/iStockphoto.com

The investigators reviewed the records of patients who had been admitted to inpatient mental health facilities in Maryland between 2003 and 2007 with a diagnosis of schizophrenia and a history of cigarette smoking. The number of records that met the criteria totaled 745 (Schizophrenia Res. 2012;138:285-9).

Patients were identified as either heavy smokers, which means they smoked one or more packs of cigarettes per day, or non–heavy smokers, which was defined in the study as less than one pack per day at admission. Records that did not specify the extent to which patients smoked were not included in the data analysis.

Dr. Wehring and her colleagues then looked at the records to determine patients’ use of substances such as alcohol, cocaine, cannabis, heroin, lysergic acid diethylamide (LSD), phencyclidine (PCP), inhalants, and amphetamines. They also looked at other health risks, such as history of diabetes and cardiovascular disease, height and weight used to calculate body mass index, systolic and diastolic blood pressure, blood glucose, cholesterol, and triglyceride levels.

A total of 43% of the smokers were classified as heavy smokers, and 57% were non–heavy smokers. Other factors between the two groups were similar, including average age (40 for heavy smokers and 42 for non–heavy smokers), gender, and race. In addition, no significant differences were found between the two groups in triglyceride levels, glucose, systolic or diastolic blood pressure, or mean BMI.

However, Dr. Wehring found that total cholesterol was significantly higher among heavy smokers (190.7 mg/dL), compared with non–heavy smokers (178.2 mg/dL). In addition, significant differences were found between the two groups in the use of alcohol, (68% vs. 58%, P = .01); cocaine, (35% vs. 25%, P = .01); and other substances of abuse, (34% vs. 23%, P = .003). Significant differences in the use of either cannabis or heroin were not found.

"This may warrant future attention to distinguish if use and abuse patterns may differ between various substances," Dr. Wehring wrote. "However, the increased use of alcohol and cocaine in the heavy smoking sample is of note for future research and clinical intervention, as use of other substances may also add to the challenge of tobacco cessation interventions for this population."

When asked about the study results, Dr. Samuel G. Siris said in an interview that the paper is interesting. "One tricky issue is that causality is not addressed – although the casual reader may be at risk of assuming it," said Dr. Siris, professor of psychiatry at Zucker Hillside Hospital of the North Shore–Long Island Jewish Health System, Glen Oaks, N.Y.

"In other words, it is not established that more severely elevated cholesterol, for example, is the result of ‘heavy’ smoking as opposed to ‘not heavy’ smoking," Dr. Siris said. "But does this paper inadvertently tease the reader into thinking that cutting down on heavy smoking to non-heavy amounts would automatically benefit their health and/or substance use profile? Association does not necessarily imply causality."

Despite these concerns, Dr. Siris said the paper has the benefit of drawing from a large database and is a contribution to the literature.

Limitations of the study include its retrospective design and missing data points for some patients. Also, the generalizability of these findings is difficult because the participants were from an inpatient sample.

The study was funded by the National Institute of Mental Health and the Advanced Centers for Intervention and Services. Neither Dr. Wehring nor her colleagues reported having financial disclosures.

Patients with schizophrenia who are heavy cigarette smokers are more likely to use substances such as alcohol than are those with the disease who are non–heavy smokers. Heavy smokers also are more likely to have elevated cholesterol, a retrospective analysis of 745 patient records has found.

In light of the health risks associated with heavy smoking and elevated cholesterol, "every effort to decrease cigarette intake or stop smoking should be made for smokers with schizophrenia as part of a multifaceted treatment plan," wrote Heidi J. Wehring, Pharm.D., of the Maryland Psychiatric Research Center, Baltimore, and her colleagues.

©kutay tanir/iStockphoto.com

The investigators reviewed the records of patients who had been admitted to inpatient mental health facilities in Maryland between 2003 and 2007 with a diagnosis of schizophrenia and a history of cigarette smoking. The number of records that met the criteria totaled 745 (Schizophrenia Res. 2012;138:285-9).

Patients were identified as either heavy smokers, which means they smoked one or more packs of cigarettes per day, or non–heavy smokers, which was defined in the study as less than one pack per day at admission. Records that did not specify the extent to which patients smoked were not included in the data analysis.

Dr. Wehring and her colleagues then looked at the records to determine patients’ use of substances such as alcohol, cocaine, cannabis, heroin, lysergic acid diethylamide (LSD), phencyclidine (PCP), inhalants, and amphetamines. They also looked at other health risks, such as history of diabetes and cardiovascular disease, height and weight used to calculate body mass index, systolic and diastolic blood pressure, blood glucose, cholesterol, and triglyceride levels.

A total of 43% of the smokers were classified as heavy smokers, and 57% were non–heavy smokers. Other factors between the two groups were similar, including average age (40 for heavy smokers and 42 for non–heavy smokers), gender, and race. In addition, no significant differences were found between the two groups in triglyceride levels, glucose, systolic or diastolic blood pressure, or mean BMI.

However, Dr. Wehring found that total cholesterol was significantly higher among heavy smokers (190.7 mg/dL), compared with non–heavy smokers (178.2 mg/dL). In addition, significant differences were found between the two groups in the use of alcohol, (68% vs. 58%, P = .01); cocaine, (35% vs. 25%, P = .01); and other substances of abuse, (34% vs. 23%, P = .003). Significant differences in the use of either cannabis or heroin were not found.

"This may warrant future attention to distinguish if use and abuse patterns may differ between various substances," Dr. Wehring wrote. "However, the increased use of alcohol and cocaine in the heavy smoking sample is of note for future research and clinical intervention, as use of other substances may also add to the challenge of tobacco cessation interventions for this population."

When asked about the study results, Dr. Samuel G. Siris said in an interview that the paper is interesting. "One tricky issue is that causality is not addressed – although the casual reader may be at risk of assuming it," said Dr. Siris, professor of psychiatry at Zucker Hillside Hospital of the North Shore–Long Island Jewish Health System, Glen Oaks, N.Y.

"In other words, it is not established that more severely elevated cholesterol, for example, is the result of ‘heavy’ smoking as opposed to ‘not heavy’ smoking," Dr. Siris said. "But does this paper inadvertently tease the reader into thinking that cutting down on heavy smoking to non-heavy amounts would automatically benefit their health and/or substance use profile? Association does not necessarily imply causality."

Despite these concerns, Dr. Siris said the paper has the benefit of drawing from a large database and is a contribution to the literature.

Limitations of the study include its retrospective design and missing data points for some patients. Also, the generalizability of these findings is difficult because the participants were from an inpatient sample.

The study was funded by the National Institute of Mental Health and the Advanced Centers for Intervention and Services. Neither Dr. Wehring nor her colleagues reported having financial disclosures.

Patients with schizophrenia who are heavy cigarette smokers are more likely to use substances such as alcohol than are those with the disease who are non–heavy smokers. Heavy smokers also are more likely to have elevated cholesterol, a retrospective analysis of 745 patient records has found.

In light of the health risks associated with heavy smoking and elevated cholesterol, "every effort to decrease cigarette intake or stop smoking should be made for smokers with schizophrenia as part of a multifaceted treatment plan," wrote Heidi J. Wehring, Pharm.D., of the Maryland Psychiatric Research Center, Baltimore, and her colleagues.

©kutay tanir/iStockphoto.com

The investigators reviewed the records of patients who had been admitted to inpatient mental health facilities in Maryland between 2003 and 2007 with a diagnosis of schizophrenia and a history of cigarette smoking. The number of records that met the criteria totaled 745 (Schizophrenia Res. 2012;138:285-9).

Patients were identified as either heavy smokers, which means they smoked one or more packs of cigarettes per day, or non–heavy smokers, which was defined in the study as less than one pack per day at admission. Records that did not specify the extent to which patients smoked were not included in the data analysis.

Dr. Wehring and her colleagues then looked at the records to determine patients’ use of substances such as alcohol, cocaine, cannabis, heroin, lysergic acid diethylamide (LSD), phencyclidine (PCP), inhalants, and amphetamines. They also looked at other health risks, such as history of diabetes and cardiovascular disease, height and weight used to calculate body mass index, systolic and diastolic blood pressure, blood glucose, cholesterol, and triglyceride levels.

A total of 43% of the smokers were classified as heavy smokers, and 57% were non–heavy smokers. Other factors between the two groups were similar, including average age (40 for heavy smokers and 42 for non–heavy smokers), gender, and race. In addition, no significant differences were found between the two groups in triglyceride levels, glucose, systolic or diastolic blood pressure, or mean BMI.

However, Dr. Wehring found that total cholesterol was significantly higher among heavy smokers (190.7 mg/dL), compared with non–heavy smokers (178.2 mg/dL). In addition, significant differences were found between the two groups in the use of alcohol, (68% vs. 58%, P = .01); cocaine, (35% vs. 25%, P = .01); and other substances of abuse, (34% vs. 23%, P = .003). Significant differences in the use of either cannabis or heroin were not found.

"This may warrant future attention to distinguish if use and abuse patterns may differ between various substances," Dr. Wehring wrote. "However, the increased use of alcohol and cocaine in the heavy smoking sample is of note for future research and clinical intervention, as use of other substances may also add to the challenge of tobacco cessation interventions for this population."

When asked about the study results, Dr. Samuel G. Siris said in an interview that the paper is interesting. "One tricky issue is that causality is not addressed – although the casual reader may be at risk of assuming it," said Dr. Siris, professor of psychiatry at Zucker Hillside Hospital of the North Shore–Long Island Jewish Health System, Glen Oaks, N.Y.

"In other words, it is not established that more severely elevated cholesterol, for example, is the result of ‘heavy’ smoking as opposed to ‘not heavy’ smoking," Dr. Siris said. "But does this paper inadvertently tease the reader into thinking that cutting down on heavy smoking to non-heavy amounts would automatically benefit their health and/or substance use profile? Association does not necessarily imply causality."

Despite these concerns, Dr. Siris said the paper has the benefit of drawing from a large database and is a contribution to the literature.

Limitations of the study include its retrospective design and missing data points for some patients. Also, the generalizability of these findings is difficult because the participants were from an inpatient sample.

The study was funded by the National Institute of Mental Health and the Advanced Centers for Intervention and Services. Neither Dr. Wehring nor her colleagues reported having financial disclosures.

The odds of depression are significantly elevated for older, obese women and significantly decreased for older overweight men, a study of almost 8,000 adults found.

The results of the study also held in a longitudinal analysis of the same cohort 5 years later.

The findings suggest that more research is needed to determine whether weight loss in older women might lead to a drop in either the prevalence or symptoms of depression, according to Dr. Beate W. Wild of the Medical University Hospital, Heidelberg, Germany, and her colleagues.

The results came from the baseline measurement and second follow-up of the ESTHER study, a cohort study of older adults conducted in Saarland, Germany. Patients were recruited by their primary care physicians during a biannual check-up and completed a self-administered questionnaire that asked about height and weight. One item on the questionnaire asked about past or present occurrence of depression (J. Psychosom. Res. 2012;72:376-82).

In the second follow-up, about 5 years after the initial analysis, patients aged 53-80 years completed another questionnaire that asked again about height and weight. This time, they also were asked to complete the 15-item Geriatric Depression Scale (GDS-15).

Those who were underweight at baseline at the 5-year follow-up were excluded from the sample. In all, 7,808 patients completed the items about height and weight and at least 12 of the GDS-15 items. The participants’ self-reported height and weight were used to calculate their body mass index (BMI), which was categorized into normal weight, overweight, obesity class I, obesity class II, and obesity class III based on criteria from the National Heart, Lung, and Blood Institute.

Using logistic regression analysis, the investigators found that the odds of being depressive were significantly higher for women who were in obesity class II. In an additional analysis that did not control for chronic diseases, the researchers found that the odds of being depressive also were significantly increased for women who were in obesity class III. However, they found a significant, inverse association between depression symptoms in men and overweight.

"That is, overweight men had a lower chance of being depressive than normal weight men," the investigators wrote.

Dr. Wild and her colleagues found a similar pattern in the longitudinal analysis. Women who were in obesity classes II and III at baseline had significantly higher odds for being depressive 5 years later than did women who were at normal weight at baseline (class II: OR, 1.67; class III: OR, 2.93). Men who were overweight had lower odds of being depressive than did normal weight men (, 0.69).

The researchers speculated that the results in men might be explained by the finding that overweight is the most frequent weight condition in older men.

"Thus, overweight in elderly men appears to be the norm and could, therefore, have been considered (and lived) as the healthier condition by these men."

Women, however, "tend to be more troubled by obesity than men," they wrote. This could be tied to the finding in the Midlife in the United States study in which women in obesity class II were three times more likely to report weight discrimination, compared with males in the same obesity class (Int. J. Obesity 2005;29:1011-29).

The investigators reported several limitations. For example, the height and weight of the patients were self-reported. In addition, some studies have suggested that BMI alone might not be an adequate measure for obesity among older adults. Also, scores on the GDS-15 are not comparable to depression diagnoses that are based on structured clinical interviews.

Nevertheless, the findings suggest that more research is needed to determine whether weight loss in older women might lead to a drop in either the prevalence or symptoms of depression, they wrote.

Dr. Wild and her colleagues declared no conflicts of interest.

The odds of depression are significantly elevated for older, obese women and significantly decreased for older overweight men, a study of almost 8,000 adults found.

The results of the study also held in a longitudinal analysis of the same cohort 5 years later.

The findings suggest that more research is needed to determine whether weight loss in older women might lead to a drop in either the prevalence or symptoms of depression, according to Dr. Beate W. Wild of the Medical University Hospital, Heidelberg, Germany, and her colleagues.

The results came from the baseline measurement and second follow-up of the ESTHER study, a cohort study of older adults conducted in Saarland, Germany. Patients were recruited by their primary care physicians during a biannual check-up and completed a self-administered questionnaire that asked about height and weight. One item on the questionnaire asked about past or present occurrence of depression (J. Psychosom. Res. 2012;72:376-82).

In the second follow-up, about 5 years after the initial analysis, patients aged 53-80 years completed another questionnaire that asked again about height and weight. This time, they also were asked to complete the 15-item Geriatric Depression Scale (GDS-15).

Those who were underweight at baseline at the 5-year follow-up were excluded from the sample. In all, 7,808 patients completed the items about height and weight and at least 12 of the GDS-15 items. The participants’ self-reported height and weight were used to calculate their body mass index (BMI), which was categorized into normal weight, overweight, obesity class I, obesity class II, and obesity class III based on criteria from the National Heart, Lung, and Blood Institute.

Using logistic regression analysis, the investigators found that the odds of being depressive were significantly higher for women who were in obesity class II. In an additional analysis that did not control for chronic diseases, the researchers found that the odds of being depressive also were significantly increased for women who were in obesity class III. However, they found a significant, inverse association between depression symptoms in men and overweight.

"That is, overweight men had a lower chance of being depressive than normal weight men," the investigators wrote.

Dr. Wild and her colleagues found a similar pattern in the longitudinal analysis. Women who were in obesity classes II and III at baseline had significantly higher odds for being depressive 5 years later than did women who were at normal weight at baseline (class II: OR, 1.67; class III: OR, 2.93). Men who were overweight had lower odds of being depressive than did normal weight men (, 0.69).

The researchers speculated that the results in men might be explained by the finding that overweight is the most frequent weight condition in older men.

"Thus, overweight in elderly men appears to be the norm and could, therefore, have been considered (and lived) as the healthier condition by these men."

Women, however, "tend to be more troubled by obesity than men," they wrote. This could be tied to the finding in the Midlife in the United States study in which women in obesity class II were three times more likely to report weight discrimination, compared with males in the same obesity class (Int. J. Obesity 2005;29:1011-29).

The investigators reported several limitations. For example, the height and weight of the patients were self-reported. In addition, some studies have suggested that BMI alone might not be an adequate measure for obesity among older adults. Also, scores on the GDS-15 are not comparable to depression diagnoses that are based on structured clinical interviews.

Nevertheless, the findings suggest that more research is needed to determine whether weight loss in older women might lead to a drop in either the prevalence or symptoms of depression, they wrote.

Dr. Wild and her colleagues declared no conflicts of interest.

The odds of depression are significantly elevated for older, obese women and significantly decreased for older overweight men, a study of almost 8,000 adults found.

The results of the study also held in a longitudinal analysis of the same cohort 5 years later.

The findings suggest that more research is needed to determine whether weight loss in older women might lead to a drop in either the prevalence or symptoms of depression, according to Dr. Beate W. Wild of the Medical University Hospital, Heidelberg, Germany, and her colleagues.

The results came from the baseline measurement and second follow-up of the ESTHER study, a cohort study of older adults conducted in Saarland, Germany. Patients were recruited by their primary care physicians during a biannual check-up and completed a self-administered questionnaire that asked about height and weight. One item on the questionnaire asked about past or present occurrence of depression (J. Psychosom. Res. 2012;72:376-82).

In the second follow-up, about 5 years after the initial analysis, patients aged 53-80 years completed another questionnaire that asked again about height and weight. This time, they also were asked to complete the 15-item Geriatric Depression Scale (GDS-15).

Those who were underweight at baseline at the 5-year follow-up were excluded from the sample. In all, 7,808 patients completed the items about height and weight and at least 12 of the GDS-15 items. The participants’ self-reported height and weight were used to calculate their body mass index (BMI), which was categorized into normal weight, overweight, obesity class I, obesity class II, and obesity class III based on criteria from the National Heart, Lung, and Blood Institute.

Using logistic regression analysis, the investigators found that the odds of being depressive were significantly higher for women who were in obesity class II. In an additional analysis that did not control for chronic diseases, the researchers found that the odds of being depressive also were significantly increased for women who were in obesity class III. However, they found a significant, inverse association between depression symptoms in men and overweight.

"That is, overweight men had a lower chance of being depressive than normal weight men," the investigators wrote.

Dr. Wild and her colleagues found a similar pattern in the longitudinal analysis. Women who were in obesity classes II and III at baseline had significantly higher odds for being depressive 5 years later than did women who were at normal weight at baseline (class II: OR, 1.67; class III: OR, 2.93). Men who were overweight had lower odds of being depressive than did normal weight men (, 0.69).

The researchers speculated that the results in men might be explained by the finding that overweight is the most frequent weight condition in older men.

"Thus, overweight in elderly men appears to be the norm and could, therefore, have been considered (and lived) as the healthier condition by these men."

Women, however, "tend to be more troubled by obesity than men," they wrote. This could be tied to the finding in the Midlife in the United States study in which women in obesity class II were three times more likely to report weight discrimination, compared with males in the same obesity class (Int. J. Obesity 2005;29:1011-29).

The investigators reported several limitations. For example, the height and weight of the patients were self-reported. In addition, some studies have suggested that BMI alone might not be an adequate measure for obesity among older adults. Also, scores on the GDS-15 are not comparable to depression diagnoses that are based on structured clinical interviews.

Nevertheless, the findings suggest that more research is needed to determine whether weight loss in older women might lead to a drop in either the prevalence or symptoms of depression, they wrote.

Dr. Wild and her colleagues declared no conflicts of interest.

PHILADELPHIA – Dr. Dilip V. Jeste fell in love with psychiatry while growing up in a remote village in India. "Becoming an APA member seemed like a dream," Dr. Jeste told a packed hotel ballroom May 6 during the opening session of the annual meeting of the American Psychiatric Association.

Today, Dr. Jeste is not only a member of the American Psychiatric Association but the group’s president-elect. He said the focus of his 1-year term will be on unity.

"The APA is a big tent," said Dr. Jeste, the Estelle and Edgar Levi Chair in Aging at the University of California, San Diego. He wants to make the organization broader, more international, and younger. "We need a concerted effort to [increase] diversity at all levels."

The APA exists to fight mental illness and to make sure that patients get the best possible care, he said.

"We can’t do this by ourselves," said Dr. Jeste, emphasizing the need to coordinate with other organizations, such as the American Medical Association and the National Alliance on Mental Illness.

He also stressed the importance of focusing on enhancing resilience and promoting wellness across the lifespan. "Older people are not a drain on society, but a resource," said Dr. Jeste, pointing out that the number of people in the United States aged 65 years and older is expected to double by 2030.

Dr. Jeste also serves as distinguished professor of psychiatry and neurosciences and the director of the Sam and Rose Stein Institute for Research on Aging at the university, and as editor-in-chief of the American Journal of Geriatric Psychiatry.

Earlier in the session, Dr. John M. Oldham, the current APA president, said that the workforce issues facing psychiatry are a huge concern. The latest figures from the National Resident Matching Program showed that fewer medical students chose psychiatry for the sixth year in a row. Yet, the shortage of psychiatrists continues in the United States and internationally.

"Medical students say the road to happiness" can be found in four specialties – anesthesiology, dermatology, ophthalmology, and radiology – but "students who want to go into psychiatry want to connect with patients," said Dr. Oldham, chief of staff at the Menninger Clinic, Houston.

The theme of his term – integrated care – stresses the need for psychiatry to be part of all health care discussions. "As medical homes come online, psychiatry must be at the table," he said.

PHILADELPHIA – Dr. Dilip V. Jeste fell in love with psychiatry while growing up in a remote village in India. "Becoming an APA member seemed like a dream," Dr. Jeste told a packed hotel ballroom May 6 during the opening session of the annual meeting of the American Psychiatric Association.

Today, Dr. Jeste is not only a member of the American Psychiatric Association but the group’s president-elect. He said the focus of his 1-year term will be on unity.

"The APA is a big tent," said Dr. Jeste, the Estelle and Edgar Levi Chair in Aging at the University of California, San Diego. He wants to make the organization broader, more international, and younger. "We need a concerted effort to [increase] diversity at all levels."

The APA exists to fight mental illness and to make sure that patients get the best possible care, he said.

"We can’t do this by ourselves," said Dr. Jeste, emphasizing the need to coordinate with other organizations, such as the American Medical Association and the National Alliance on Mental Illness.

He also stressed the importance of focusing on enhancing resilience and promoting wellness across the lifespan. "Older people are not a drain on society, but a resource," said Dr. Jeste, pointing out that the number of people in the United States aged 65 years and older is expected to double by 2030.

Dr. Jeste also serves as distinguished professor of psychiatry and neurosciences and the director of the Sam and Rose Stein Institute for Research on Aging at the university, and as editor-in-chief of the American Journal of Geriatric Psychiatry.

Earlier in the session, Dr. John M. Oldham, the current APA president, said that the workforce issues facing psychiatry are a huge concern. The latest figures from the National Resident Matching Program showed that fewer medical students chose psychiatry for the sixth year in a row. Yet, the shortage of psychiatrists continues in the United States and internationally.

"Medical students say the road to happiness" can be found in four specialties – anesthesiology, dermatology, ophthalmology, and radiology – but "students who want to go into psychiatry want to connect with patients," said Dr. Oldham, chief of staff at the Menninger Clinic, Houston.

The theme of his term – integrated care – stresses the need for psychiatry to be part of all health care discussions. "As medical homes come online, psychiatry must be at the table," he said.

PHILADELPHIA – Dr. Dilip V. Jeste fell in love with psychiatry while growing up in a remote village in India. "Becoming an APA member seemed like a dream," Dr. Jeste told a packed hotel ballroom May 6 during the opening session of the annual meeting of the American Psychiatric Association.

Today, Dr. Jeste is not only a member of the American Psychiatric Association but the group’s president-elect. He said the focus of his 1-year term will be on unity.

"The APA is a big tent," said Dr. Jeste, the Estelle and Edgar Levi Chair in Aging at the University of California, San Diego. He wants to make the organization broader, more international, and younger. "We need a concerted effort to [increase] diversity at all levels."

The APA exists to fight mental illness and to make sure that patients get the best possible care, he said.

"We can’t do this by ourselves," said Dr. Jeste, emphasizing the need to coordinate with other organizations, such as the American Medical Association and the National Alliance on Mental Illness.

He also stressed the importance of focusing on enhancing resilience and promoting wellness across the lifespan. "Older people are not a drain on society, but a resource," said Dr. Jeste, pointing out that the number of people in the United States aged 65 years and older is expected to double by 2030.

Dr. Jeste also serves as distinguished professor of psychiatry and neurosciences and the director of the Sam and Rose Stein Institute for Research on Aging at the university, and as editor-in-chief of the American Journal of Geriatric Psychiatry.

Earlier in the session, Dr. John M. Oldham, the current APA president, said that the workforce issues facing psychiatry are a huge concern. The latest figures from the National Resident Matching Program showed that fewer medical students chose psychiatry for the sixth year in a row. Yet, the shortage of psychiatrists continues in the United States and internationally.

"Medical students say the road to happiness" can be found in four specialties – anesthesiology, dermatology, ophthalmology, and radiology – but "students who want to go into psychiatry want to connect with patients," said Dr. Oldham, chief of staff at the Menninger Clinic, Houston.

The theme of his term – integrated care – stresses the need for psychiatry to be part of all health care discussions. "As medical homes come online, psychiatry must be at the table," he said.

Posttraumatic stress disorder is associated with a doubling of the number of hospitalizations and more than twice the use of mental health resources for urban primary care patients, according to a cross-sectional study published in the journal Medical Care.

Using electronic medical records (EMR) data from primary care settings, Dr. Anand Kartha of the clinical addiction research and education (CARE) unit at Boston Medical Center, and his colleagues found that 80% of the 592 patients studied had one or more trauma exposures, and 22% had current PTSD.

In addition, the researchers found that subjects with PTSD had more hospitalizations, hospital nights, and mental health visits. However, those patients did not have additional outpatient or emergency department visits (Medical Care 2008;46:388-93).

The relationship between trauma/PTSD has been cited in studies before among victims of combat and sexual assault, Dr. Kartha and his colleagues reported. But few studies have been conducted in “urban, disenfranchised community populations like our subjects.

“Furthermore, to our knowledge, no other study has addressed the serious methodological concerns of prior studies in this population–either lack of diagnostic instrument for PTSD or self-reported utilization,” the researchers wrote.

“These are patients who are medically hospitalized. As a result, the PTSD is not really on our radar,” Dr. Kartha, a hospitalist also affiliated with the Veterans Affairs Boston Healthcare System, said in an interview.

To determine the prevalence of traumatic exposure in this population, the researchers interviewed primary care outpatients of a university-affiliated hospital. The patients were aged 18–65 years.

Fifty-nine percent of the patients were black, 19% were white, 8% were Hispanic, and 14% were other. Half of the patients reported an annual income of above $20,000; the others said they made less than $20,000 per year.

Standard validated questionnaires were used for the eligible patients to assess levels of stress, Dr. Jane Liebschutz, one of the researchers, said in an interview. The Composite International Diagnostic Interview was used to determine trauma exposure and to make PTSD diagnoses.

Researchers reviewed each EMR to determine the number of non-mental health outpatient, emergency department, and mental health outpatient visits.

Subjects with trauma exposure were more likely to be male and unmarried. Twenty percent of the participants reported having been sexually molested. Eighteen percent of the patients reported drug and/or alcohol dependence within the previous 6 months, and 45% reported having major and/or other depression.

“Depression really stands out,” said Dr. Kartha, who also serves as an assistant professor of medicine at Boston University. “Of those [130] who had PTSD, about 70% had depression. That's a reflection of the burden of mental illness.”

The study shows that PTSD can contribute greatly to the use of medical services in civilian settings, and that PTSD is underrecognized and undertreated, said Dr. Liebschutz, an associate professor of medicine and social and behavior sciences at Boston University who also is affiliated with the CARE unit at Boston Medical Center.

“PTSD may be on the causal pathway between trauma experiences and negative health consequences,” Dr. Liebschutz, said in a statement.

“These findings are relevant in light of the PTSD prevalence not only in our returning veterans, but in areas of urban poor,” she said.

Future studies are needed to prospectively determine the mechanisms of how PTSD might contribute to use of medical services and whether this additional use is appropriate.

Posttraumatic stress disorder is associated with a doubling of the number of hospitalizations and more than twice the use of mental health resources for urban primary care patients, according to a cross-sectional study published in the journal Medical Care.

Using electronic medical records (EMR) data from primary care settings, Dr. Anand Kartha of the clinical addiction research and education (CARE) unit at Boston Medical Center, and his colleagues found that 80% of the 592 patients studied had one or more trauma exposures, and 22% had current PTSD.

In addition, the researchers found that subjects with PTSD had more hospitalizations, hospital nights, and mental health visits. However, those patients did not have additional outpatient or emergency department visits (Medical Care 2008;46:388-93).

The relationship between trauma/PTSD has been cited in studies before among victims of combat and sexual assault, Dr. Kartha and his colleagues reported. But few studies have been conducted in “urban, disenfranchised community populations like our subjects.

“Furthermore, to our knowledge, no other study has addressed the serious methodological concerns of prior studies in this population–either lack of diagnostic instrument for PTSD or self-reported utilization,” the researchers wrote.

“These are patients who are medically hospitalized. As a result, the PTSD is not really on our radar,” Dr. Kartha, a hospitalist also affiliated with the Veterans Affairs Boston Healthcare System, said in an interview.

To determine the prevalence of traumatic exposure in this population, the researchers interviewed primary care outpatients of a university-affiliated hospital. The patients were aged 18–65 years.

Fifty-nine percent of the patients were black, 19% were white, 8% were Hispanic, and 14% were other. Half of the patients reported an annual income of above $20,000; the others said they made less than $20,000 per year.

Standard validated questionnaires were used for the eligible patients to assess levels of stress, Dr. Jane Liebschutz, one of the researchers, said in an interview. The Composite International Diagnostic Interview was used to determine trauma exposure and to make PTSD diagnoses.

Researchers reviewed each EMR to determine the number of non-mental health outpatient, emergency department, and mental health outpatient visits.

Subjects with trauma exposure were more likely to be male and unmarried. Twenty percent of the participants reported having been sexually molested. Eighteen percent of the patients reported drug and/or alcohol dependence within the previous 6 months, and 45% reported having major and/or other depression.

“Depression really stands out,” said Dr. Kartha, who also serves as an assistant professor of medicine at Boston University. “Of those [130] who had PTSD, about 70% had depression. That's a reflection of the burden of mental illness.”

The study shows that PTSD can contribute greatly to the use of medical services in civilian settings, and that PTSD is underrecognized and undertreated, said Dr. Liebschutz, an associate professor of medicine and social and behavior sciences at Boston University who also is affiliated with the CARE unit at Boston Medical Center.

“PTSD may be on the causal pathway between trauma experiences and negative health consequences,” Dr. Liebschutz, said in a statement.

“These findings are relevant in light of the PTSD prevalence not only in our returning veterans, but in areas of urban poor,” she said.

Future studies are needed to prospectively determine the mechanisms of how PTSD might contribute to use of medical services and whether this additional use is appropriate.

Posttraumatic stress disorder is associated with a doubling of the number of hospitalizations and more than twice the use of mental health resources for urban primary care patients, according to a cross-sectional study published in the journal Medical Care.

Using electronic medical records (EMR) data from primary care settings, Dr. Anand Kartha of the clinical addiction research and education (CARE) unit at Boston Medical Center, and his colleagues found that 80% of the 592 patients studied had one or more trauma exposures, and 22% had current PTSD.

In addition, the researchers found that subjects with PTSD had more hospitalizations, hospital nights, and mental health visits. However, those patients did not have additional outpatient or emergency department visits (Medical Care 2008;46:388-93).

The relationship between trauma/PTSD has been cited in studies before among victims of combat and sexual assault, Dr. Kartha and his colleagues reported. But few studies have been conducted in “urban, disenfranchised community populations like our subjects.

“Furthermore, to our knowledge, no other study has addressed the serious methodological concerns of prior studies in this population–either lack of diagnostic instrument for PTSD or self-reported utilization,” the researchers wrote.

“These are patients who are medically hospitalized. As a result, the PTSD is not really on our radar,” Dr. Kartha, a hospitalist also affiliated with the Veterans Affairs Boston Healthcare System, said in an interview.

To determine the prevalence of traumatic exposure in this population, the researchers interviewed primary care outpatients of a university-affiliated hospital. The patients were aged 18–65 years.

Fifty-nine percent of the patients were black, 19% were white, 8% were Hispanic, and 14% were other. Half of the patients reported an annual income of above $20,000; the others said they made less than $20,000 per year.

Standard validated questionnaires were used for the eligible patients to assess levels of stress, Dr. Jane Liebschutz, one of the researchers, said in an interview. The Composite International Diagnostic Interview was used to determine trauma exposure and to make PTSD diagnoses.

Researchers reviewed each EMR to determine the number of non-mental health outpatient, emergency department, and mental health outpatient visits.

Subjects with trauma exposure were more likely to be male and unmarried. Twenty percent of the participants reported having been sexually molested. Eighteen percent of the patients reported drug and/or alcohol dependence within the previous 6 months, and 45% reported having major and/or other depression.

“Depression really stands out,” said Dr. Kartha, who also serves as an assistant professor of medicine at Boston University. “Of those [130] who had PTSD, about 70% had depression. That's a reflection of the burden of mental illness.”

The study shows that PTSD can contribute greatly to the use of medical services in civilian settings, and that PTSD is underrecognized and undertreated, said Dr. Liebschutz, an associate professor of medicine and social and behavior sciences at Boston University who also is affiliated with the CARE unit at Boston Medical Center.

“PTSD may be on the causal pathway between trauma experiences and negative health consequences,” Dr. Liebschutz, said in a statement.

“These findings are relevant in light of the PTSD prevalence not only in our returning veterans, but in areas of urban poor,” she said.

Future studies are needed to prospectively determine the mechanisms of how PTSD might contribute to use of medical services and whether this additional use is appropriate.