Heidi Splete

Primary care providers may be the first to encounter teens with depression; updated guidelines from the American Academy of Pediatrics support their efforts.

The updated information includes recommendations on collaborative care, practice preparation, establishing networks of referrals, and much more.

AlexRaths/Thinkstock

Known as the Guidelines for Adolescent Depression in Primary Care (GLAD-PC), they consist of two parts: Practice Preparation, Identification, Assessment, and Initial Management, with Dr. Zuckerbrot as the lead author, and Treatment and Ongoing Management, led by Amy H. Cheung, MD, of the University of Toronto. They were published online in Pediatrics.

“It has been over 10 years since the [last] guidelines were published and they are supposed to be updated every 5,” Dr. Zuckerbrot said in an interview. “Given the new evidence on screening, psychopharmacology, and collaborative care, the guidelines needed to be revised. The USPSTF [United States Preventive Services Task Force ] and the AAP had already supported universal adolescent depression screening, and these guidelines are finally aligned with those positions.

“Different parts of the guidelines will be the go-to for different pediatricians, depending on where they are in their delivery of mental health care,” she explained. “Some may need help with practice preparation while others may need advice on screening; others may already be prescribing and may need advice on ongoing treatment and follow-up. I think there is something for everyone.”

Implementation of the guidelines is difficult in a short visit, Dr. Zuckerbrot acknowledged. “In addition, pediatricians may not have been well trained in the management of adolescent depression during their residencies.” However, the guidelines discuss both “real teams to support the pediatricians in their efforts, as well as virtual teams when staffing is limited.

“The guidelines advise that pediatricians learn about child psychiatry primary care consultation programs in their state and make use of those free telephone consultation programs.” The guidelines also discuss strategies for collaborative or integrative care, she said.

Part I

Part I of the guidelines, “Practice Preparation, Identification, Assessment, and Initial Management,” includes several recommendations for each topic.

For practice preparation, the guidelines recommend that clinicians seek training in the assessment, diagnosis, and treatment of depression, and that they establish a network of referrals and mental health resources in their communities. This network may include not only health professionals, but also current patients and families who are managing teen depression. If available, state-wide or regional child and adolescent psychiatry consultation programs can be included.

The identification and surveillance section of the guidelines calls for screening all patients aged 12 years and older for depression each year, using a formal screening tool on paper or online. The screening could occur at an annual wellness visit or any other medical visit, such as a sports physical. A second recommendation calls for identifying patients at increased risk for depression because of factors such as personal history, family history, substance use, other psychiatric disorders, frequent somatic complaints, or trauma, and monitoring these individuals regularly for signs of depression using a formal screening tool.

The assessment and diagnosis section states that assessment should include interviews with the patients alone as well as with their families or caregivers, and should include screening teens for functional impairment.

Primary care physicians should evaluate for depression not only if an adolescent tests positive on a screening tool, but also in children who present with any emotional problem as the chief complaint, and in those in whom depression is highly suspected even if they test negative on a formal screening tool, the guidelines state.

The three recommendations for initial management of depression in the primary care setting are educating patients and families about depression; developing a treatment plan (if the primary care clinician has had appropriate training) and setting specific treatment goals in areas of functioning such as at home, with peers, and at school; and developing a safety plan that includes restricting access to weapons or other means of self-harm, according to the guidelines.

Part II

Part II of the recommendations, “Treatment and Ongoing Management,” discusses options for managing depression in the primary care setting and utilizing outside resources.

The treatment recommendations emphasize the use of integrated models, if possible. “There is a growing recognition that complex chronic conditions, such as depression, are most successfully managed with proactive, multidisciplinary, patient-centered care teams,” Dr. Cheung and her associates said.

The recommendation for cases of mild depression calls for a period of “active support and monitoring” for 6-8 weeks before reassessing if the teen shows no improvement. By contrast, for cases of moderate to severe depression or cases with evidence of substance abuse or other psychoses, the recommendation calls for potential consultation with a mental health specialist and a discussion of the roles primary and specialty care will play in treatment. The guidelines include a flow chart for PC physicians to follow.

The guidelines suggest that PC clinicians recommend “scientifically tested and proven treatments,” such as psychotherapies, cognitive behavioral therapy (CBT) or interpersonal psychotherapy for adolescents, and/or antidepressant treatment, such as SSRIs, whenever possible and appropriate. It is important to monitor teens on antidepressants regularly to identify adverse events.

Recommendations for the ongoing management of teens with depression in the primary care setting include regular tracking of progress, reassessment if the teen shows no improvement in 6-8 weeks, and consultation with a mental health professional for those who show only partial improvement after exhausting primary care diagnostic and treatment options. Assessment of depressive symptoms is not the only thing to track. Functioning at home, school, and among peers also is important.

The final treatment recommendation is for active support of a depressed teen’s referral to mental health if necessary for best management and sharing care if possible, with an understanding of the roles of the primary and specialty clinicians, the guidelines state.

The guidelines project was funded by the Resource for Advancing Children’s Health Institute and the Bell Canada Chair in Adolescent Mood and Anxiety Disorders.

Dr. Cheung and Dr. Zuckerbrot receive book royalties. Dr Zuckerbrot works for child and adolescent psychiatry for primary care (CAP-PC), now a regional provider for Project TEACH in New York State, and she is on the steering committee as well as faculty for the REACH Institute; both of these institutions are described in the guidelines. Peter S. Jensen, MD, has received royalties from Random House, Oxford University Press, and APPI Inc. He is a part owner of a consulting company, CATCH Services LLC. He is the chief executive officer and president of a nonprofit organization, the Resource for Advancing Children’s Health Institute, but receives no compensation. The other authors indicated they have no financial relationships relevant to the guidelines.

Primary care providers may be the first to encounter teens with depression; updated guidelines from the American Academy of Pediatrics support their efforts.

The updated information includes recommendations on collaborative care, practice preparation, establishing networks of referrals, and much more.

AlexRaths/Thinkstock

Known as the Guidelines for Adolescent Depression in Primary Care (GLAD-PC), they consist of two parts: Practice Preparation, Identification, Assessment, and Initial Management, with Dr. Zuckerbrot as the lead author, and Treatment and Ongoing Management, led by Amy H. Cheung, MD, of the University of Toronto. They were published online in Pediatrics.

“It has been over 10 years since the [last] guidelines were published and they are supposed to be updated every 5,” Dr. Zuckerbrot said in an interview. “Given the new evidence on screening, psychopharmacology, and collaborative care, the guidelines needed to be revised. The USPSTF [United States Preventive Services Task Force ] and the AAP had already supported universal adolescent depression screening, and these guidelines are finally aligned with those positions.

“Different parts of the guidelines will be the go-to for different pediatricians, depending on where they are in their delivery of mental health care,” she explained. “Some may need help with practice preparation while others may need advice on screening; others may already be prescribing and may need advice on ongoing treatment and follow-up. I think there is something for everyone.”

Implementation of the guidelines is difficult in a short visit, Dr. Zuckerbrot acknowledged. “In addition, pediatricians may not have been well trained in the management of adolescent depression during their residencies.” However, the guidelines discuss both “real teams to support the pediatricians in their efforts, as well as virtual teams when staffing is limited.

“The guidelines advise that pediatricians learn about child psychiatry primary care consultation programs in their state and make use of those free telephone consultation programs.” The guidelines also discuss strategies for collaborative or integrative care, she said.

Part I

Part I of the guidelines, “Practice Preparation, Identification, Assessment, and Initial Management,” includes several recommendations for each topic.

For practice preparation, the guidelines recommend that clinicians seek training in the assessment, diagnosis, and treatment of depression, and that they establish a network of referrals and mental health resources in their communities. This network may include not only health professionals, but also current patients and families who are managing teen depression. If available, state-wide or regional child and adolescent psychiatry consultation programs can be included.

The identification and surveillance section of the guidelines calls for screening all patients aged 12 years and older for depression each year, using a formal screening tool on paper or online. The screening could occur at an annual wellness visit or any other medical visit, such as a sports physical. A second recommendation calls for identifying patients at increased risk for depression because of factors such as personal history, family history, substance use, other psychiatric disorders, frequent somatic complaints, or trauma, and monitoring these individuals regularly for signs of depression using a formal screening tool.

The assessment and diagnosis section states that assessment should include interviews with the patients alone as well as with their families or caregivers, and should include screening teens for functional impairment.

Primary care physicians should evaluate for depression not only if an adolescent tests positive on a screening tool, but also in children who present with any emotional problem as the chief complaint, and in those in whom depression is highly suspected even if they test negative on a formal screening tool, the guidelines state.

The three recommendations for initial management of depression in the primary care setting are educating patients and families about depression; developing a treatment plan (if the primary care clinician has had appropriate training) and setting specific treatment goals in areas of functioning such as at home, with peers, and at school; and developing a safety plan that includes restricting access to weapons or other means of self-harm, according to the guidelines.

Part II

Part II of the recommendations, “Treatment and Ongoing Management,” discusses options for managing depression in the primary care setting and utilizing outside resources.

The treatment recommendations emphasize the use of integrated models, if possible. “There is a growing recognition that complex chronic conditions, such as depression, are most successfully managed with proactive, multidisciplinary, patient-centered care teams,” Dr. Cheung and her associates said.

The recommendation for cases of mild depression calls for a period of “active support and monitoring” for 6-8 weeks before reassessing if the teen shows no improvement. By contrast, for cases of moderate to severe depression or cases with evidence of substance abuse or other psychoses, the recommendation calls for potential consultation with a mental health specialist and a discussion of the roles primary and specialty care will play in treatment. The guidelines include a flow chart for PC physicians to follow.

The guidelines suggest that PC clinicians recommend “scientifically tested and proven treatments,” such as psychotherapies, cognitive behavioral therapy (CBT) or interpersonal psychotherapy for adolescents, and/or antidepressant treatment, such as SSRIs, whenever possible and appropriate. It is important to monitor teens on antidepressants regularly to identify adverse events.

Recommendations for the ongoing management of teens with depression in the primary care setting include regular tracking of progress, reassessment if the teen shows no improvement in 6-8 weeks, and consultation with a mental health professional for those who show only partial improvement after exhausting primary care diagnostic and treatment options. Assessment of depressive symptoms is not the only thing to track. Functioning at home, school, and among peers also is important.

The final treatment recommendation is for active support of a depressed teen’s referral to mental health if necessary for best management and sharing care if possible, with an understanding of the roles of the primary and specialty clinicians, the guidelines state.

The guidelines project was funded by the Resource for Advancing Children’s Health Institute and the Bell Canada Chair in Adolescent Mood and Anxiety Disorders.

Dr. Cheung and Dr. Zuckerbrot receive book royalties. Dr Zuckerbrot works for child and adolescent psychiatry for primary care (CAP-PC), now a regional provider for Project TEACH in New York State, and she is on the steering committee as well as faculty for the REACH Institute; both of these institutions are described in the guidelines. Peter S. Jensen, MD, has received royalties from Random House, Oxford University Press, and APPI Inc. He is a part owner of a consulting company, CATCH Services LLC. He is the chief executive officer and president of a nonprofit organization, the Resource for Advancing Children’s Health Institute, but receives no compensation. The other authors indicated they have no financial relationships relevant to the guidelines.

Primary care providers may be the first to encounter teens with depression; updated guidelines from the American Academy of Pediatrics support their efforts.

The updated information includes recommendations on collaborative care, practice preparation, establishing networks of referrals, and much more.

AlexRaths/Thinkstock

Known as the Guidelines for Adolescent Depression in Primary Care (GLAD-PC), they consist of two parts: Practice Preparation, Identification, Assessment, and Initial Management, with Dr. Zuckerbrot as the lead author, and Treatment and Ongoing Management, led by Amy H. Cheung, MD, of the University of Toronto. They were published online in Pediatrics.

“It has been over 10 years since the [last] guidelines were published and they are supposed to be updated every 5,” Dr. Zuckerbrot said in an interview. “Given the new evidence on screening, psychopharmacology, and collaborative care, the guidelines needed to be revised. The USPSTF [United States Preventive Services Task Force ] and the AAP had already supported universal adolescent depression screening, and these guidelines are finally aligned with those positions.

“Different parts of the guidelines will be the go-to for different pediatricians, depending on where they are in their delivery of mental health care,” she explained. “Some may need help with practice preparation while others may need advice on screening; others may already be prescribing and may need advice on ongoing treatment and follow-up. I think there is something for everyone.”

Implementation of the guidelines is difficult in a short visit, Dr. Zuckerbrot acknowledged. “In addition, pediatricians may not have been well trained in the management of adolescent depression during their residencies.” However, the guidelines discuss both “real teams to support the pediatricians in their efforts, as well as virtual teams when staffing is limited.

“The guidelines advise that pediatricians learn about child psychiatry primary care consultation programs in their state and make use of those free telephone consultation programs.” The guidelines also discuss strategies for collaborative or integrative care, she said.

Part I

Part I of the guidelines, “Practice Preparation, Identification, Assessment, and Initial Management,” includes several recommendations for each topic.

For practice preparation, the guidelines recommend that clinicians seek training in the assessment, diagnosis, and treatment of depression, and that they establish a network of referrals and mental health resources in their communities. This network may include not only health professionals, but also current patients and families who are managing teen depression. If available, state-wide or regional child and adolescent psychiatry consultation programs can be included.

The identification and surveillance section of the guidelines calls for screening all patients aged 12 years and older for depression each year, using a formal screening tool on paper or online. The screening could occur at an annual wellness visit or any other medical visit, such as a sports physical. A second recommendation calls for identifying patients at increased risk for depression because of factors such as personal history, family history, substance use, other psychiatric disorders, frequent somatic complaints, or trauma, and monitoring these individuals regularly for signs of depression using a formal screening tool.

The assessment and diagnosis section states that assessment should include interviews with the patients alone as well as with their families or caregivers, and should include screening teens for functional impairment.

Primary care physicians should evaluate for depression not only if an adolescent tests positive on a screening tool, but also in children who present with any emotional problem as the chief complaint, and in those in whom depression is highly suspected even if they test negative on a formal screening tool, the guidelines state.

The three recommendations for initial management of depression in the primary care setting are educating patients and families about depression; developing a treatment plan (if the primary care clinician has had appropriate training) and setting specific treatment goals in areas of functioning such as at home, with peers, and at school; and developing a safety plan that includes restricting access to weapons or other means of self-harm, according to the guidelines.

Part II

Part II of the recommendations, “Treatment and Ongoing Management,” discusses options for managing depression in the primary care setting and utilizing outside resources.

The treatment recommendations emphasize the use of integrated models, if possible. “There is a growing recognition that complex chronic conditions, such as depression, are most successfully managed with proactive, multidisciplinary, patient-centered care teams,” Dr. Cheung and her associates said.

The recommendation for cases of mild depression calls for a period of “active support and monitoring” for 6-8 weeks before reassessing if the teen shows no improvement. By contrast, for cases of moderate to severe depression or cases with evidence of substance abuse or other psychoses, the recommendation calls for potential consultation with a mental health specialist and a discussion of the roles primary and specialty care will play in treatment. The guidelines include a flow chart for PC physicians to follow.

The guidelines suggest that PC clinicians recommend “scientifically tested and proven treatments,” such as psychotherapies, cognitive behavioral therapy (CBT) or interpersonal psychotherapy for adolescents, and/or antidepressant treatment, such as SSRIs, whenever possible and appropriate. It is important to monitor teens on antidepressants regularly to identify adverse events.

Recommendations for the ongoing management of teens with depression in the primary care setting include regular tracking of progress, reassessment if the teen shows no improvement in 6-8 weeks, and consultation with a mental health professional for those who show only partial improvement after exhausting primary care diagnostic and treatment options. Assessment of depressive symptoms is not the only thing to track. Functioning at home, school, and among peers also is important.

The final treatment recommendation is for active support of a depressed teen’s referral to mental health if necessary for best management and sharing care if possible, with an understanding of the roles of the primary and specialty clinicians, the guidelines state.

The guidelines project was funded by the Resource for Advancing Children’s Health Institute and the Bell Canada Chair in Adolescent Mood and Anxiety Disorders.

Dr. Cheung and Dr. Zuckerbrot receive book royalties. Dr Zuckerbrot works for child and adolescent psychiatry for primary care (CAP-PC), now a regional provider for Project TEACH in New York State, and she is on the steering committee as well as faculty for the REACH Institute; both of these institutions are described in the guidelines. Peter S. Jensen, MD, has received royalties from Random House, Oxford University Press, and APPI Inc. He is a part owner of a consulting company, CATCH Services LLC. He is the chief executive officer and president of a nonprofit organization, the Resource for Advancing Children’s Health Institute, but receives no compensation. The other authors indicated they have no financial relationships relevant to the guidelines.

Interest in aesthetic procedures among skin of color patients is on the rise, Andrew F. Alexis, MD, said in a presentation at the Caribbean Dermatology Symposium.

In 2015, ethnic minority patients accounted for 25% of aesthetic procedures in the United States, up from 20% in 2010, according to data from the American Society for Aesthetic Plastic Surgery, said Dr. Alexis, chair of dermatology and director of the Skin of Color Center at Mount Sinai St. Luke’s and Mount Sinai West hospitals in New York.

Dr. Alexis shared several treatment pearls to promote successful peels in skin of color patients:

• Salicylic acid: Resist the urge to overapply and “titrate according to patient tolerability.” The endpoint of a salicylic acid peel is white precipitate, not frost; cool compresses can be used for patient comfort and for later removal of the white precipitate.
• Glycolic acid: Stick to a contact time of 2-4 minutes to avoid epidermolysis. “Completely neutralize all areas of application to avoid overpeeling.”
• Trichloroacetic acid (TCA): TCA carries a greater risk of dyspigmentation, and should be reserved for patients who have not been successfully treated with salicylic or glycolic acid; a 10%-15% concentration of TCA, applied conservatively, is recommended.

Regardless of the type of chemical, potential pitfalls of peels in patients of color include using too much product, allowing too long of an application time, and applying the chemical to an inflamed or excoriated area, Dr. Alexis said. Patients who don’t discontinue retinoids before a peel are at increased risk of developing erosions or crusting, he added.

Dr. Alexis disclosed relationships with Allergan, BioPharmX, Dermira, Galderma, Novan, Novartis, RXi, Unilever, and Valeant.

Global Academy and this news organization are owned by the same parent company.

Interest in aesthetic procedures among skin of color patients is on the rise, Andrew F. Alexis, MD, said in a presentation at the Caribbean Dermatology Symposium.

In 2015, ethnic minority patients accounted for 25% of aesthetic procedures in the United States, up from 20% in 2010, according to data from the American Society for Aesthetic Plastic Surgery, said Dr. Alexis, chair of dermatology and director of the Skin of Color Center at Mount Sinai St. Luke’s and Mount Sinai West hospitals in New York.

Dr. Alexis shared several treatment pearls to promote successful peels in skin of color patients:

• Salicylic acid: Resist the urge to overapply and “titrate according to patient tolerability.” The endpoint of a salicylic acid peel is white precipitate, not frost; cool compresses can be used for patient comfort and for later removal of the white precipitate.
• Glycolic acid: Stick to a contact time of 2-4 minutes to avoid epidermolysis. “Completely neutralize all areas of application to avoid overpeeling.”
• Trichloroacetic acid (TCA): TCA carries a greater risk of dyspigmentation, and should be reserved for patients who have not been successfully treated with salicylic or glycolic acid; a 10%-15% concentration of TCA, applied conservatively, is recommended.

Regardless of the type of chemical, potential pitfalls of peels in patients of color include using too much product, allowing too long of an application time, and applying the chemical to an inflamed or excoriated area, Dr. Alexis said. Patients who don’t discontinue retinoids before a peel are at increased risk of developing erosions or crusting, he added.

Dr. Alexis disclosed relationships with Allergan, BioPharmX, Dermira, Galderma, Novan, Novartis, RXi, Unilever, and Valeant.

Global Academy and this news organization are owned by the same parent company.

Interest in aesthetic procedures among skin of color patients is on the rise, Andrew F. Alexis, MD, said in a presentation at the Caribbean Dermatology Symposium.

In 2015, ethnic minority patients accounted for 25% of aesthetic procedures in the United States, up from 20% in 2010, according to data from the American Society for Aesthetic Plastic Surgery, said Dr. Alexis, chair of dermatology and director of the Skin of Color Center at Mount Sinai St. Luke’s and Mount Sinai West hospitals in New York.

Dr. Alexis shared several treatment pearls to promote successful peels in skin of color patients:

• Salicylic acid: Resist the urge to overapply and “titrate according to patient tolerability.” The endpoint of a salicylic acid peel is white precipitate, not frost; cool compresses can be used for patient comfort and for later removal of the white precipitate.
• Glycolic acid: Stick to a contact time of 2-4 minutes to avoid epidermolysis. “Completely neutralize all areas of application to avoid overpeeling.”
• Trichloroacetic acid (TCA): TCA carries a greater risk of dyspigmentation, and should be reserved for patients who have not been successfully treated with salicylic or glycolic acid; a 10%-15% concentration of TCA, applied conservatively, is recommended.

Regardless of the type of chemical, potential pitfalls of peels in patients of color include using too much product, allowing too long of an application time, and applying the chemical to an inflamed or excoriated area, Dr. Alexis said. Patients who don’t discontinue retinoids before a peel are at increased risk of developing erosions or crusting, he added.

Dr. Alexis disclosed relationships with Allergan, BioPharmX, Dermira, Galderma, Novan, Novartis, RXi, Unilever, and Valeant.

Global Academy and this news organization are owned by the same parent company.

More teenagers are sending and receiving sexts than in previous years, based on data from a meta-analysis of 39 studies including 110,380 individuals younger than 18 years.

Published rates of sexting in teens range from 1% to 60%, wrote Sheri Madigan, PhD, of the University of Calgary, Alberta, Canada, and her colleagues. “However, the true public health importance of youth sexting is unclear at present because the field is handicapped by inconsistent information regarding its prevalence.”

Denise Fulton/Frontline Medical News

SOURCE: Madigan S et al. JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5314.

More teenagers are sending and receiving sexts than in previous years, based on data from a meta-analysis of 39 studies including 110,380 individuals younger than 18 years.

Published rates of sexting in teens range from 1% to 60%, wrote Sheri Madigan, PhD, of the University of Calgary, Alberta, Canada, and her colleagues. “However, the true public health importance of youth sexting is unclear at present because the field is handicapped by inconsistent information regarding its prevalence.”

Denise Fulton/Frontline Medical News

SOURCE: Madigan S et al. JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5314.

More teenagers are sending and receiving sexts than in previous years, based on data from a meta-analysis of 39 studies including 110,380 individuals younger than 18 years.

Published rates of sexting in teens range from 1% to 60%, wrote Sheri Madigan, PhD, of the University of Calgary, Alberta, Canada, and her colleagues. “However, the true public health importance of youth sexting is unclear at present because the field is handicapped by inconsistent information regarding its prevalence.”

Denise Fulton/Frontline Medical News

SOURCE: Madigan S et al. JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5314.

Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.

“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.

Dmitrii Kotin/Thinkstock.com

The guidelines are based on the ASCRS Practice Parameters for the Management of Hemorrhoids published in 2011. The 2018 update was published in the Diseases of the Colon & Rectum.

The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.

AGA offers information for your patients about hemorrhoids at http://www.gastro.org/patient-care/conditions-diseases/hemorrhoids.

SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.

Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.

“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.

Dmitrii Kotin/Thinkstock.com

The guidelines are based on the ASCRS Practice Parameters for the Management of Hemorrhoids published in 2011. The 2018 update was published in the Diseases of the Colon & Rectum.

The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.

AGA offers information for your patients about hemorrhoids at http://www.gastro.org/patient-care/conditions-diseases/hemorrhoids.

SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.

Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.

“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.

Dmitrii Kotin/Thinkstock.com

The guidelines are based on the ASCRS Practice Parameters for the Management of Hemorrhoids published in 2011. The 2018 update was published in the Diseases of the Colon & Rectum.

The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.

AGA offers information for your patients about hemorrhoids at http://www.gastro.org/patient-care/conditions-diseases/hemorrhoids.

SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.

Adding meropenem to colistin had no effect on clinical success in cases of severe Acinetobacter baumannii infections, based on data from 406 patients.

In a study published online in The Lancet Infectious Diseases, Mical Paul, MD, of Rambam Health Care Campus, Haifa, Israel, and colleagues randomized 198 patients to colistin alone and 208 to colistin plus meropenem (Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099[18]30099-9).

The demographics were similar between the groups and approximately 77% of patients in each group were infected with A. baumannii.

monkeybusinessimages/Thinkstock

SOURCE: Paul M et al. Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099(18)30099-9.

Adding meropenem to colistin had no effect on clinical success in cases of severe Acinetobacter baumannii infections, based on data from 406 patients.

In a study published online in The Lancet Infectious Diseases, Mical Paul, MD, of Rambam Health Care Campus, Haifa, Israel, and colleagues randomized 198 patients to colistin alone and 208 to colistin plus meropenem (Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099[18]30099-9).

The demographics were similar between the groups and approximately 77% of patients in each group were infected with A. baumannii.

monkeybusinessimages/Thinkstock

SOURCE: Paul M et al. Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099(18)30099-9.

Adding meropenem to colistin had no effect on clinical success in cases of severe Acinetobacter baumannii infections, based on data from 406 patients.

In a study published online in The Lancet Infectious Diseases, Mical Paul, MD, of Rambam Health Care Campus, Haifa, Israel, and colleagues randomized 198 patients to colistin alone and 208 to colistin plus meropenem (Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099[18]30099-9).

The demographics were similar between the groups and approximately 77% of patients in each group were infected with A. baumannii.

monkeybusinessimages/Thinkstock

SOURCE: Paul M et al. Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099(18)30099-9.

Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.

“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.

Dmitrii Kotin/Thinkstock.com

[email protected]

SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.

Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.

“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.

Dmitrii Kotin/Thinkstock.com

[email protected]

SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.

Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.

“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.

Dmitrii Kotin/Thinkstock.com

[email protected]

SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.

Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.

“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.

In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.

The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”

After 9 months, the social recovery group averaged 8 more hours of structured activity compared with the control group in an intent-to-treat analysis. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.

“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.

The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.

The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.

The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.

SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.

Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.

“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.

In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.

The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”

After 9 months, the social recovery group averaged 8 more hours of structured activity compared with the control group in an intent-to-treat analysis. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.

“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.

The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.

The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.

The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.

SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.

Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.

“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.

In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.

The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”

After 9 months, the social recovery group averaged 8 more hours of structured activity compared with the control group in an intent-to-treat analysis. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.

“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.

The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.

The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.

The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.

SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.

Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.

The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).

In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.

The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.

A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.

The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.

SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.

Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.

The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).

In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.

The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.

A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.

The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.

SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.

Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.

The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).

In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.

The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.

A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.

The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.

SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.

Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).

Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.

In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.

Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).

Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.

The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”

The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.

The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.

SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.

Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).

Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.

In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.

Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).

Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.

The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”

The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.

The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.

SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.

Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).

Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.

In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.

Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).

Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.

The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”

The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.

The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.

SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.

Screening asymptomatic women for ovarian cancer does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.

The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.

The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.

The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.

Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.

The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.

The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.

The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.

The task force members had no financial conflicts to disclose.

SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.

Screening asymptomatic women for ovarian cancer does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.

The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.

The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.

The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.

Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.

The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.

The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.

The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.

The task force members had no financial conflicts to disclose.

SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.

Screening asymptomatic women for ovarian cancer does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.

The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.

The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.

The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.

Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.

The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.

The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.

The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.

The task force members had no financial conflicts to disclose.

SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.