M. Alexander Otto

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – A survey of 178 older, mostly academic psychiatrists found that more than 6% text with patients, 20% post private information online, and 6% conduct an online search for patients.

Of those who post personal information on such social sites as Facebook, one-third do not restrict access; some are unaware of privacy settings that allow such restrictions.

Photo credit: ©DWP/Fotolia.com

About a third reported exchanging e-mails with patients as well, but only 7% get written permission first. "We found that half get verbal permission, but some never request permission [at all]. Only a small percent [have patients] sign a release form," although that’s been recommended, said senior investigator Dr. Megan Testa, a fourth-year psychiatry resident at the University Hospitals Health System in Cleveland, referring to guidelines released a few years ago by the American Medical Informatics Association Internet Working Group (J. Am. Med. Inform. Assoc. 1998;5:104-11).

The inconsistencies show that "we need a set of [electronic communication] guidelines" specific to psychiatrists, she said.

These guidelines are needed because social media can quickly blur boundaries between psychiatrists and patients, perhaps more so than with physicians in other specialties, given the interpersonal nature of the profession. "Legal issues, privacy issues, and treatment frame" issues are of particular concern, said Dr. Testa, a 2010 Group for the Advancement of Psychiatry fellow.

The 178 psychiatrists surveyed by Dr. Testa and her colleagues, also 2010 fellows, were all members of the psychiatry group. Their mean age was almost 60 years; 56% were academics, 41% in private practice, and the rest worked in other settings.

The 6% who admitted to looking up their patients online did so for a variety of reasons. Some needed to find contacts for patients who go to the emergency department and are unable to give reliable information. Others wanted to flesh out patient histories. "Sometimes," though, doctors "are curious if patients are lying," Dr. Testa said.

With doctors leaving bigger online footprints, "there is real concern [that] searches go both ways," she noted.

E-communications guidelines do exist for doctors. One set is for looking patients up online, and addresses getting consent, charting results, and sharing results with patients (Harv. Rev. Psychiatry 2010;18:103-12).

A set of social media guidelines discourages "friending" patients and freely posting personal information on sites like Facebook (J. Med. Ethics 2009;35:584-6).

Until psychiatrists come up with their own guidelines, Dr. Testa and her colleagues suggest, psychiatrists must "carefully monitor their online presences from medical school through residency and beyond to maintain a clear boundary between professional and personal identities."

HONOLULU – A survey of 178 older, mostly academic psychiatrists found that more than 6% text with patients, 20% post private information online, and 6% conduct an online search for patients.

Of those who post personal information on such social sites as Facebook, one-third do not restrict access; some are unaware of privacy settings that allow such restrictions.

Photo credit: ©DWP/Fotolia.com

About a third reported exchanging e-mails with patients as well, but only 7% get written permission first. "We found that half get verbal permission, but some never request permission [at all]. Only a small percent [have patients] sign a release form," although that’s been recommended, said senior investigator Dr. Megan Testa, a fourth-year psychiatry resident at the University Hospitals Health System in Cleveland, referring to guidelines released a few years ago by the American Medical Informatics Association Internet Working Group (J. Am. Med. Inform. Assoc. 1998;5:104-11).

The inconsistencies show that "we need a set of [electronic communication] guidelines" specific to psychiatrists, she said.

These guidelines are needed because social media can quickly blur boundaries between psychiatrists and patients, perhaps more so than with physicians in other specialties, given the interpersonal nature of the profession. "Legal issues, privacy issues, and treatment frame" issues are of particular concern, said Dr. Testa, a 2010 Group for the Advancement of Psychiatry fellow.

The 178 psychiatrists surveyed by Dr. Testa and her colleagues, also 2010 fellows, were all members of the psychiatry group. Their mean age was almost 60 years; 56% were academics, 41% in private practice, and the rest worked in other settings.

The 6% who admitted to looking up their patients online did so for a variety of reasons. Some needed to find contacts for patients who go to the emergency department and are unable to give reliable information. Others wanted to flesh out patient histories. "Sometimes," though, doctors "are curious if patients are lying," Dr. Testa said.

With doctors leaving bigger online footprints, "there is real concern [that] searches go both ways," she noted.

E-communications guidelines do exist for doctors. One set is for looking patients up online, and addresses getting consent, charting results, and sharing results with patients (Harv. Rev. Psychiatry 2010;18:103-12).

A set of social media guidelines discourages "friending" patients and freely posting personal information on sites like Facebook (J. Med. Ethics 2009;35:584-6).

Until psychiatrists come up with their own guidelines, Dr. Testa and her colleagues suggest, psychiatrists must "carefully monitor their online presences from medical school through residency and beyond to maintain a clear boundary between professional and personal identities."

HONOLULU – A survey of 178 older, mostly academic psychiatrists found that more than 6% text with patients, 20% post private information online, and 6% conduct an online search for patients.

Of those who post personal information on such social sites as Facebook, one-third do not restrict access; some are unaware of privacy settings that allow such restrictions.

Photo credit: ©DWP/Fotolia.com

About a third reported exchanging e-mails with patients as well, but only 7% get written permission first. "We found that half get verbal permission, but some never request permission [at all]. Only a small percent [have patients] sign a release form," although that’s been recommended, said senior investigator Dr. Megan Testa, a fourth-year psychiatry resident at the University Hospitals Health System in Cleveland, referring to guidelines released a few years ago by the American Medical Informatics Association Internet Working Group (J. Am. Med. Inform. Assoc. 1998;5:104-11).

The inconsistencies show that "we need a set of [electronic communication] guidelines" specific to psychiatrists, she said.

These guidelines are needed because social media can quickly blur boundaries between psychiatrists and patients, perhaps more so than with physicians in other specialties, given the interpersonal nature of the profession. "Legal issues, privacy issues, and treatment frame" issues are of particular concern, said Dr. Testa, a 2010 Group for the Advancement of Psychiatry fellow.

The 178 psychiatrists surveyed by Dr. Testa and her colleagues, also 2010 fellows, were all members of the psychiatry group. Their mean age was almost 60 years; 56% were academics, 41% in private practice, and the rest worked in other settings.

The 6% who admitted to looking up their patients online did so for a variety of reasons. Some needed to find contacts for patients who go to the emergency department and are unable to give reliable information. Others wanted to flesh out patient histories. "Sometimes," though, doctors "are curious if patients are lying," Dr. Testa said.

With doctors leaving bigger online footprints, "there is real concern [that] searches go both ways," she noted.

E-communications guidelines do exist for doctors. One set is for looking patients up online, and addresses getting consent, charting results, and sharing results with patients (Harv. Rev. Psychiatry 2010;18:103-12).

A set of social media guidelines discourages "friending" patients and freely posting personal information on sites like Facebook (J. Med. Ethics 2009;35:584-6).

Until psychiatrists come up with their own guidelines, Dr. Testa and her colleagues suggest, psychiatrists must "carefully monitor their online presences from medical school through residency and beyond to maintain a clear boundary between professional and personal identities."

Major Finding: A screening of outwardly healthy high school students found that 12% had borderline ECGs and 2% had abnormal ECGs. Two had cardiac disease with the potential for sudden cardiac death, and 14% were hypertensive.

Data Source: Observational cohort study of 606 students from seven high schools in Hillsborough county in Florida.

Disclosures: Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy high schoolers were screened in a Florida pilot study, it turned out that 14% had borderline or abnormal electrocardiograms, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that “there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions,” lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children's Hospital in St. Petersburg, Fla., said at the meeting.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits in preventing cardiovascular outcomes, especially sudden cardiac arrest.

“I think we need a national [study] to be able to” resolve that debate, he said, adding that he is working to secure funding for at least a statewide study in Florida.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents' consent.

Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students' reported heights and weights. Blood pressures were taken once with a Dinamap machine.

All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students' mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the remaining students were classified as “other.”

A total of 74% had normal BMIs, 14% were overweight, and 12% were obese; 41% were normotensive, 45% were prehypertensive, and 14% were hypertensive, with hypertension most common in boys.

Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

“Many of these students will go into a walk-in clinic, get their height and weight done,” a blood pressure check, and “they get signed off and cleared to participate” in sports, Dr. Dadlani commented.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – “you can really make a difference in this population” by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier age, Dr. Dadlani explained.

Major Finding: A screening of outwardly healthy high school students found that 12% had borderline ECGs and 2% had abnormal ECGs. Two had cardiac disease with the potential for sudden cardiac death, and 14% were hypertensive.

Data Source: Observational cohort study of 606 students from seven high schools in Hillsborough county in Florida.

Disclosures: Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy high schoolers were screened in a Florida pilot study, it turned out that 14% had borderline or abnormal electrocardiograms, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that “there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions,” lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children's Hospital in St. Petersburg, Fla., said at the meeting.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits in preventing cardiovascular outcomes, especially sudden cardiac arrest.

“I think we need a national [study] to be able to” resolve that debate, he said, adding that he is working to secure funding for at least a statewide study in Florida.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents' consent.

Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students' reported heights and weights. Blood pressures were taken once with a Dinamap machine.

All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students' mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the remaining students were classified as “other.”

A total of 74% had normal BMIs, 14% were overweight, and 12% were obese; 41% were normotensive, 45% were prehypertensive, and 14% were hypertensive, with hypertension most common in boys.

Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

“Many of these students will go into a walk-in clinic, get their height and weight done,” a blood pressure check, and “they get signed off and cleared to participate” in sports, Dr. Dadlani commented.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – “you can really make a difference in this population” by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier age, Dr. Dadlani explained.

Major Finding: A screening of outwardly healthy high school students found that 12% had borderline ECGs and 2% had abnormal ECGs. Two had cardiac disease with the potential for sudden cardiac death, and 14% were hypertensive.

Data Source: Observational cohort study of 606 students from seven high schools in Hillsborough county in Florida.

Disclosures: Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy high schoolers were screened in a Florida pilot study, it turned out that 14% had borderline or abnormal electrocardiograms, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that “there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions,” lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children's Hospital in St. Petersburg, Fla., said at the meeting.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits in preventing cardiovascular outcomes, especially sudden cardiac arrest.

“I think we need a national [study] to be able to” resolve that debate, he said, adding that he is working to secure funding for at least a statewide study in Florida.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents' consent.

Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students' reported heights and weights. Blood pressures were taken once with a Dinamap machine.

All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students' mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the remaining students were classified as “other.”

A total of 74% had normal BMIs, 14% were overweight, and 12% were obese; 41% were normotensive, 45% were prehypertensive, and 14% were hypertensive, with hypertension most common in boys.

Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

“Many of these students will go into a walk-in clinic, get their height and weight done,” a blood pressure check, and “they get signed off and cleared to participate” in sports, Dr. Dadlani commented.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – “you can really make a difference in this population” by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier age, Dr. Dadlani explained.

Major Finding: Seven milk-allergic children in one practice had anaphylactic reactions to Tdap vaccine; the amount of milk protein found in vaccine varied between two lots.

Data Source: A case series of seven milk-allergic children.

Disclosures: Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood had no relevant disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for reactions, according to Dr. Hugh A. Sampson.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur's Adacel) that were given between September 2007–March 2010.

“We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn't anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine,” said Dr. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

The five boys and two girls (median age, 11 years; range, 5–17 years) had prior allergic reactions to cow's milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition–enzyme linked immunosorbent assay. One vial “clearly had milk protein in it” (30 ng/mL). “The other did not,” he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As “with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions,” Dr. Sampson said at the meeting.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, “we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots” that could potentially – if given to a person who is highly milk allergic – cause a reaction, Dr. Sampson said.

The problem must be “uncommon or it would have shown up before,” and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children's Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two. Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein. “There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that's why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot,” he said. “I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein.”

Major Finding: Seven milk-allergic children in one practice had anaphylactic reactions to Tdap vaccine; the amount of milk protein found in vaccine varied between two lots.

Data Source: A case series of seven milk-allergic children.

Disclosures: Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood had no relevant disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for reactions, according to Dr. Hugh A. Sampson.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur's Adacel) that were given between September 2007–March 2010.

“We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn't anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine,” said Dr. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

The five boys and two girls (median age, 11 years; range, 5–17 years) had prior allergic reactions to cow's milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition–enzyme linked immunosorbent assay. One vial “clearly had milk protein in it” (30 ng/mL). “The other did not,” he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As “with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions,” Dr. Sampson said at the meeting.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, “we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots” that could potentially – if given to a person who is highly milk allergic – cause a reaction, Dr. Sampson said.

The problem must be “uncommon or it would have shown up before,” and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children's Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two. Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein. “There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that's why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot,” he said. “I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein.”

Major Finding: Seven milk-allergic children in one practice had anaphylactic reactions to Tdap vaccine; the amount of milk protein found in vaccine varied between two lots.

Data Source: A case series of seven milk-allergic children.

Disclosures: Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood had no relevant disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for reactions, according to Dr. Hugh A. Sampson.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur's Adacel) that were given between September 2007–March 2010.

“We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn't anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine,” said Dr. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

The five boys and two girls (median age, 11 years; range, 5–17 years) had prior allergic reactions to cow's milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition–enzyme linked immunosorbent assay. One vial “clearly had milk protein in it” (30 ng/mL). “The other did not,” he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As “with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions,” Dr. Sampson said at the meeting.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, “we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots” that could potentially – if given to a person who is highly milk allergic – cause a reaction, Dr. Sampson said.

The problem must be “uncommon or it would have shown up before,” and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children's Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two. Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein. “There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that's why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot,” he said. “I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein.”

DENVER – Physicians can't rely on what parents say regarding inhaled corticosteroid use. To know how many doses an asthmatic child is getting, it's best to have parents bring the canister into the office and check the dose counter, according to pediatrician Marina Reznik.

Dr. Reznik and her colleagues at the Albert Einstein College of Medicine in the Bronx, N.Y., compared the number of puffs that parents said they gave their children vs. the number of puffs recorded on the canisters' dose counters.

They visited families' homes as part of an asthma education study, and the parents didn't know that the inhaled corticosteroid (ICS) use was being monitored.

Over the course of a month, 16 of 40 parents (40%) said that they gave their child two puffs twice a day, as prescribed; however, the counter revealed that only 2 parents (5%) actually did so. One parent (2.5%) reported having given the medication less than once a week, but in reality, four parents (10%) earned that distinction.

“Now we know what the reality is. They are not using the pump as they are supposed to,” Dr. Reznik said at the meeting.

Poor ICS adherence is nothing new, but the phenomenon hasn't been studied very much in an urban minority population, Dr. Reznik said.

The children were aged 2–9 years and were patients at a Bronx community health center. The parents' average age was 32 years, and 26 (65%) were Hispanic. In all, 12 parents (30%) had dropped out of high school.

Dr. Reznik said she thinks the problem is a lack of education. Parents have misconceptions about side effects, and don't quite understand the need for controller medications in addition to rescue medications, such as albuterol.

It's not that parents were unfamiliar with steroid inhalers. All the children had been prescribed inhalers in the past before they received a fresh one at the start of the study. Parents also knew how serious asthma can be; some of the children had been hospitalized in the past.

Even so, many parents couldn't find the inhalers during the home visits.

Dr. Reznik said she has no relevant financial disclosures.

The study was funded by the American Lung Association, the New York Community Trust, and the department of pediatrics at the Children's Hospital at Montefiore in the Bronx.

DENVER – Physicians can't rely on what parents say regarding inhaled corticosteroid use. To know how many doses an asthmatic child is getting, it's best to have parents bring the canister into the office and check the dose counter, according to pediatrician Marina Reznik.

Dr. Reznik and her colleagues at the Albert Einstein College of Medicine in the Bronx, N.Y., compared the number of puffs that parents said they gave their children vs. the number of puffs recorded on the canisters' dose counters.

They visited families' homes as part of an asthma education study, and the parents didn't know that the inhaled corticosteroid (ICS) use was being monitored.

Over the course of a month, 16 of 40 parents (40%) said that they gave their child two puffs twice a day, as prescribed; however, the counter revealed that only 2 parents (5%) actually did so. One parent (2.5%) reported having given the medication less than once a week, but in reality, four parents (10%) earned that distinction.

“Now we know what the reality is. They are not using the pump as they are supposed to,” Dr. Reznik said at the meeting.

Poor ICS adherence is nothing new, but the phenomenon hasn't been studied very much in an urban minority population, Dr. Reznik said.

The children were aged 2–9 years and were patients at a Bronx community health center. The parents' average age was 32 years, and 26 (65%) were Hispanic. In all, 12 parents (30%) had dropped out of high school.

Dr. Reznik said she thinks the problem is a lack of education. Parents have misconceptions about side effects, and don't quite understand the need for controller medications in addition to rescue medications, such as albuterol.

It's not that parents were unfamiliar with steroid inhalers. All the children had been prescribed inhalers in the past before they received a fresh one at the start of the study. Parents also knew how serious asthma can be; some of the children had been hospitalized in the past.

Even so, many parents couldn't find the inhalers during the home visits.

Dr. Reznik said she has no relevant financial disclosures.

The study was funded by the American Lung Association, the New York Community Trust, and the department of pediatrics at the Children's Hospital at Montefiore in the Bronx.

DENVER – Physicians can't rely on what parents say regarding inhaled corticosteroid use. To know how many doses an asthmatic child is getting, it's best to have parents bring the canister into the office and check the dose counter, according to pediatrician Marina Reznik.

Dr. Reznik and her colleagues at the Albert Einstein College of Medicine in the Bronx, N.Y., compared the number of puffs that parents said they gave their children vs. the number of puffs recorded on the canisters' dose counters.

They visited families' homes as part of an asthma education study, and the parents didn't know that the inhaled corticosteroid (ICS) use was being monitored.

Over the course of a month, 16 of 40 parents (40%) said that they gave their child two puffs twice a day, as prescribed; however, the counter revealed that only 2 parents (5%) actually did so. One parent (2.5%) reported having given the medication less than once a week, but in reality, four parents (10%) earned that distinction.

“Now we know what the reality is. They are not using the pump as they are supposed to,” Dr. Reznik said at the meeting.

Poor ICS adherence is nothing new, but the phenomenon hasn't been studied very much in an urban minority population, Dr. Reznik said.

The children were aged 2–9 years and were patients at a Bronx community health center. The parents' average age was 32 years, and 26 (65%) were Hispanic. In all, 12 parents (30%) had dropped out of high school.

Dr. Reznik said she thinks the problem is a lack of education. Parents have misconceptions about side effects, and don't quite understand the need for controller medications in addition to rescue medications, such as albuterol.

It's not that parents were unfamiliar with steroid inhalers. All the children had been prescribed inhalers in the past before they received a fresh one at the start of the study. Parents also knew how serious asthma can be; some of the children had been hospitalized in the past.

Even so, many parents couldn't find the inhalers during the home visits.

Dr. Reznik said she has no relevant financial disclosures.

The study was funded by the American Lung Association, the New York Community Trust, and the department of pediatrics at the Children's Hospital at Montefiore in the Bronx.

DENVER – Pregnant women should avoid pumping their own gasoline or painting the nursery to get it ready for the baby, among other activities, based on the results from a study at the Medical College of Wisconsin in Milwaukee.

The advice comes from Dr. Gail McCarver, a professor of pharmacology and toxicology there and the lead author on a study that found that exposure to ethylbenzene and trichloroethylene during pregnancy is associated with an increased risk of congenital heart disease (CHD).

(c) Joni Rantasalo/iStock.com

Sources of ethylbenzene, a volatile organic compound, include gasoline vapors, vehicle exhaust, tobacco smoke, varnish, adhesives, inks, insecticides, and some paints and cleaning agents.

It was two metabolites of trichloroethylene – trichloroacetic (TCA) and dichloroacetic (DCA) acids – that the researchers linked to congenital heart disease.

Trichloroethylene is found in degreasing agents, adhesives, typewriter correction fluid, dry cleaning solvents, rug cleaners, and paint and varnish removers, among other sources.

The findings, which were reported at the annual meeting of the Pediatric Academic Societies, come from meconium analysis of 135 infants with CHD and 432 control infants without CHD. Fetal exposure to ethylbenzene and the metabolites were significantly more common among infants with CHD.

"What we saw was about a fourfold increase in CHD risk among [white] infants who had fetal exposure to ethylbenzene documented in meconium" after adjustment for race and CHD family history. "We could not document the same observation in African Americans," Dr. McCarver said.

It’s a novel finding. Ethylbenzene has not been associated with CHD until now.

The presence of the trichloroethylene metabolites was associated with a twofold increase in CHD risk in white infants and an eightfold increase in black infants.

Regarding the racial differences, "I don’t think it’s implausible that different racial groups could have different risk factors. There are racial differences in the enzymes that handle these kinds of compounds," said Dr. McCarver, who is also codirector of the birth defects research center at the Medical College of Wisconsin.

The results mean that pregnant women should avoid exposure as much as possible. "What I would tell [a pregnant woman] is, don’t pump your own gasoline; don’t smoke; don’t use cleaners if you don’t have to, [especially] cleaners that have warning labels that say use a respirator," she said.

Pregnancy isn’t a good time to paint the nursery or refinish the floors, either. "Young women are doing these kinds of things even early in pregnancy" when CHD develops, Dr. McCarver said.

In general, there are four to seven CHD cases per 1,000 live births. Previously established risk factors include smoking or heavy drinking during pregnancy, family history, and white race. Infants with diabetic mothers or chromosomal abnormalities – two additional risk factors – were excluded from the study.

When the compounds were included in the statistical analysis, "maternal obesity, smoking, illicit drugs, alcohol intake, vitamin use, other solvent exposures, and the genetic variants" dropped out as significant risk factors, the researchers said.

Because smoking in particular dropped out, Dr. McCarver and her colleagues speculated that it’s the ethylbenzene in smoke that’s responsible for prior reports linking CHD and smoking.

"If you were to say to me, ‘Which is worse, ethylbenzene or smoking?’ I’d say ethylbenzene," Dr. McCarver said.

Dr. McCarver said she had no relevant financial disclosures. The study was funded by the National Institute of Environmental Health Sciences.

DENVER – Pregnant women should avoid pumping their own gasoline or painting the nursery to get it ready for the baby, among other activities, based on the results from a study at the Medical College of Wisconsin in Milwaukee.

The advice comes from Dr. Gail McCarver, a professor of pharmacology and toxicology there and the lead author on a study that found that exposure to ethylbenzene and trichloroethylene during pregnancy is associated with an increased risk of congenital heart disease (CHD).

(c) Joni Rantasalo/iStock.com

Sources of ethylbenzene, a volatile organic compound, include gasoline vapors, vehicle exhaust, tobacco smoke, varnish, adhesives, inks, insecticides, and some paints and cleaning agents.

It was two metabolites of trichloroethylene – trichloroacetic (TCA) and dichloroacetic (DCA) acids – that the researchers linked to congenital heart disease.

Trichloroethylene is found in degreasing agents, adhesives, typewriter correction fluid, dry cleaning solvents, rug cleaners, and paint and varnish removers, among other sources.

The findings, which were reported at the annual meeting of the Pediatric Academic Societies, come from meconium analysis of 135 infants with CHD and 432 control infants without CHD. Fetal exposure to ethylbenzene and the metabolites were significantly more common among infants with CHD.

"What we saw was about a fourfold increase in CHD risk among [white] infants who had fetal exposure to ethylbenzene documented in meconium" after adjustment for race and CHD family history. "We could not document the same observation in African Americans," Dr. McCarver said.

It’s a novel finding. Ethylbenzene has not been associated with CHD until now.

The presence of the trichloroethylene metabolites was associated with a twofold increase in CHD risk in white infants and an eightfold increase in black infants.

Regarding the racial differences, "I don’t think it’s implausible that different racial groups could have different risk factors. There are racial differences in the enzymes that handle these kinds of compounds," said Dr. McCarver, who is also codirector of the birth defects research center at the Medical College of Wisconsin.

The results mean that pregnant women should avoid exposure as much as possible. "What I would tell [a pregnant woman] is, don’t pump your own gasoline; don’t smoke; don’t use cleaners if you don’t have to, [especially] cleaners that have warning labels that say use a respirator," she said.

Pregnancy isn’t a good time to paint the nursery or refinish the floors, either. "Young women are doing these kinds of things even early in pregnancy" when CHD develops, Dr. McCarver said.

In general, there are four to seven CHD cases per 1,000 live births. Previously established risk factors include smoking or heavy drinking during pregnancy, family history, and white race. Infants with diabetic mothers or chromosomal abnormalities – two additional risk factors – were excluded from the study.

When the compounds were included in the statistical analysis, "maternal obesity, smoking, illicit drugs, alcohol intake, vitamin use, other solvent exposures, and the genetic variants" dropped out as significant risk factors, the researchers said.

Because smoking in particular dropped out, Dr. McCarver and her colleagues speculated that it’s the ethylbenzene in smoke that’s responsible for prior reports linking CHD and smoking.

"If you were to say to me, ‘Which is worse, ethylbenzene or smoking?’ I’d say ethylbenzene," Dr. McCarver said.

Dr. McCarver said she had no relevant financial disclosures. The study was funded by the National Institute of Environmental Health Sciences.

DENVER – Pregnant women should avoid pumping their own gasoline or painting the nursery to get it ready for the baby, among other activities, based on the results from a study at the Medical College of Wisconsin in Milwaukee.

The advice comes from Dr. Gail McCarver, a professor of pharmacology and toxicology there and the lead author on a study that found that exposure to ethylbenzene and trichloroethylene during pregnancy is associated with an increased risk of congenital heart disease (CHD).

(c) Joni Rantasalo/iStock.com

Sources of ethylbenzene, a volatile organic compound, include gasoline vapors, vehicle exhaust, tobacco smoke, varnish, adhesives, inks, insecticides, and some paints and cleaning agents.

It was two metabolites of trichloroethylene – trichloroacetic (TCA) and dichloroacetic (DCA) acids – that the researchers linked to congenital heart disease.

Trichloroethylene is found in degreasing agents, adhesives, typewriter correction fluid, dry cleaning solvents, rug cleaners, and paint and varnish removers, among other sources.

The findings, which were reported at the annual meeting of the Pediatric Academic Societies, come from meconium analysis of 135 infants with CHD and 432 control infants without CHD. Fetal exposure to ethylbenzene and the metabolites were significantly more common among infants with CHD.

"What we saw was about a fourfold increase in CHD risk among [white] infants who had fetal exposure to ethylbenzene documented in meconium" after adjustment for race and CHD family history. "We could not document the same observation in African Americans," Dr. McCarver said.

It’s a novel finding. Ethylbenzene has not been associated with CHD until now.

The presence of the trichloroethylene metabolites was associated with a twofold increase in CHD risk in white infants and an eightfold increase in black infants.

Regarding the racial differences, "I don’t think it’s implausible that different racial groups could have different risk factors. There are racial differences in the enzymes that handle these kinds of compounds," said Dr. McCarver, who is also codirector of the birth defects research center at the Medical College of Wisconsin.

The results mean that pregnant women should avoid exposure as much as possible. "What I would tell [a pregnant woman] is, don’t pump your own gasoline; don’t smoke; don’t use cleaners if you don’t have to, [especially] cleaners that have warning labels that say use a respirator," she said.

Pregnancy isn’t a good time to paint the nursery or refinish the floors, either. "Young women are doing these kinds of things even early in pregnancy" when CHD develops, Dr. McCarver said.

In general, there are four to seven CHD cases per 1,000 live births. Previously established risk factors include smoking or heavy drinking during pregnancy, family history, and white race. Infants with diabetic mothers or chromosomal abnormalities – two additional risk factors – were excluded from the study.

When the compounds were included in the statistical analysis, "maternal obesity, smoking, illicit drugs, alcohol intake, vitamin use, other solvent exposures, and the genetic variants" dropped out as significant risk factors, the researchers said.

Because smoking in particular dropped out, Dr. McCarver and her colleagues speculated that it’s the ethylbenzene in smoke that’s responsible for prior reports linking CHD and smoking.

"If you were to say to me, ‘Which is worse, ethylbenzene or smoking?’ I’d say ethylbenzene," Dr. McCarver said.

Dr. McCarver said she had no relevant financial disclosures. The study was funded by the National Institute of Environmental Health Sciences.

HONOLULU – A statewide telepsychiatry consulting service in South Carolina shortened emergency department stays and reduced hospital admissions for more than 6,000 mental health patients. Those patients also used outpatient psychiatric services more, and their care was less expensive, said Dr. Stephanie R. Chapman at the annual meeting of the American Psychiatric Association.

Under the program, psychiatrists assess emergency department patients remotely via live video link. So far, 25 hospitals – none of which have readily available onsite psychiatric consulting services – are participating; the South Carolina Department of Mental Health plans to enroll 15 more within a year, according to Dr. Chapman, a psychiatry resident at the University of South Carolina, Columbia.

"In our state, we have so many mental health patients who are not receiving the care they need in the emergency room. A lot of facilities have no psychiatrists working in them. Someone has to drive in days later to see these patients," she said. "It’s a big problem. That is why this was initially implemented" in March 2009, she said.

When telepsychiatry is called for, a video cart is rolled into the patient’s room. At the other end of the feed is a psychiatrist in Charleston, Columbia, Aiken, or Greenville, S.C.

The patient and psychiatrist are able to see one another and talk over the link. The psychiatrist does the assessment over about 30 minutes, prepped beforehand with the patient’s history, lab results, and other findings.

Afterward, the psychiatrist might recommend hospitalization or set up an outpatient appointment through the local mental health department, Dr. Chapman said.

At present, the service is available 16 hours a day. Psychiatrists take turns manning the feed at offices in the four towns, usually in 8-hour shifts. When a shift ends in Aiken, for example, a psychiatrist in the Greenville office might pick up the feed.

To see how the program is doing, Dr. Chapman and her colleagues compared the 6,000-plus telepsychiatry patients’ outcomes with those for matched controls at hospitals not yet participating in the program.

About 8% of telepsychiatry patients were admitted, vs. 12% of control patients. With telepsychiatry, "we now have a more specialized person performing the consult" and perhaps making better calls on who needs to be hospitalized, Dr. Chapman said.

Emergency department stays averaged three days for telepsychiatry patients, but four days for controls. About 85% with severe mental illnesses in the telepsychiatry group had outpatient follow-up within 30 days, compared to 22% in the control group.

The program saves money, too. Medicaid telepsychiatry patients had median charges of $2,000; median charges were $2,800 among Medicaid patients in the control group. With other payer mixes, median charges for telepsychiatry patients were $6,800, vs. $11,000 for those in the control group.

Overall, about 80% of patients said they were satisfied with the service. About 90% of physicians said they were satisfied, too, and about three-quarters said telepsychiatry increased productivity.

In short, "the patient receives a higher quality of care, and the hospitals have reduced costs," Dr. Chapman and her colleagues concluded in their summary of the findings.

Dr. Chapman said she has no disclosures. The study was funded by the National Institute of Mental Health and the Duke Endowment.

HONOLULU – A statewide telepsychiatry consulting service in South Carolina shortened emergency department stays and reduced hospital admissions for more than 6,000 mental health patients. Those patients also used outpatient psychiatric services more, and their care was less expensive, said Dr. Stephanie R. Chapman at the annual meeting of the American Psychiatric Association.

Under the program, psychiatrists assess emergency department patients remotely via live video link. So far, 25 hospitals – none of which have readily available onsite psychiatric consulting services – are participating; the South Carolina Department of Mental Health plans to enroll 15 more within a year, according to Dr. Chapman, a psychiatry resident at the University of South Carolina, Columbia.

"In our state, we have so many mental health patients who are not receiving the care they need in the emergency room. A lot of facilities have no psychiatrists working in them. Someone has to drive in days later to see these patients," she said. "It’s a big problem. That is why this was initially implemented" in March 2009, she said.

When telepsychiatry is called for, a video cart is rolled into the patient’s room. At the other end of the feed is a psychiatrist in Charleston, Columbia, Aiken, or Greenville, S.C.

The patient and psychiatrist are able to see one another and talk over the link. The psychiatrist does the assessment over about 30 minutes, prepped beforehand with the patient’s history, lab results, and other findings.

Afterward, the psychiatrist might recommend hospitalization or set up an outpatient appointment through the local mental health department, Dr. Chapman said.

At present, the service is available 16 hours a day. Psychiatrists take turns manning the feed at offices in the four towns, usually in 8-hour shifts. When a shift ends in Aiken, for example, a psychiatrist in the Greenville office might pick up the feed.

To see how the program is doing, Dr. Chapman and her colleagues compared the 6,000-plus telepsychiatry patients’ outcomes with those for matched controls at hospitals not yet participating in the program.

About 8% of telepsychiatry patients were admitted, vs. 12% of control patients. With telepsychiatry, "we now have a more specialized person performing the consult" and perhaps making better calls on who needs to be hospitalized, Dr. Chapman said.

Emergency department stays averaged three days for telepsychiatry patients, but four days for controls. About 85% with severe mental illnesses in the telepsychiatry group had outpatient follow-up within 30 days, compared to 22% in the control group.

The program saves money, too. Medicaid telepsychiatry patients had median charges of $2,000; median charges were $2,800 among Medicaid patients in the control group. With other payer mixes, median charges for telepsychiatry patients were $6,800, vs. $11,000 for those in the control group.

Overall, about 80% of patients said they were satisfied with the service. About 90% of physicians said they were satisfied, too, and about three-quarters said telepsychiatry increased productivity.

In short, "the patient receives a higher quality of care, and the hospitals have reduced costs," Dr. Chapman and her colleagues concluded in their summary of the findings.

Dr. Chapman said she has no disclosures. The study was funded by the National Institute of Mental Health and the Duke Endowment.

HONOLULU – A statewide telepsychiatry consulting service in South Carolina shortened emergency department stays and reduced hospital admissions for more than 6,000 mental health patients. Those patients also used outpatient psychiatric services more, and their care was less expensive, said Dr. Stephanie R. Chapman at the annual meeting of the American Psychiatric Association.

Under the program, psychiatrists assess emergency department patients remotely via live video link. So far, 25 hospitals – none of which have readily available onsite psychiatric consulting services – are participating; the South Carolina Department of Mental Health plans to enroll 15 more within a year, according to Dr. Chapman, a psychiatry resident at the University of South Carolina, Columbia.

"In our state, we have so many mental health patients who are not receiving the care they need in the emergency room. A lot of facilities have no psychiatrists working in them. Someone has to drive in days later to see these patients," she said. "It’s a big problem. That is why this was initially implemented" in March 2009, she said.

When telepsychiatry is called for, a video cart is rolled into the patient’s room. At the other end of the feed is a psychiatrist in Charleston, Columbia, Aiken, or Greenville, S.C.

The patient and psychiatrist are able to see one another and talk over the link. The psychiatrist does the assessment over about 30 minutes, prepped beforehand with the patient’s history, lab results, and other findings.

Afterward, the psychiatrist might recommend hospitalization or set up an outpatient appointment through the local mental health department, Dr. Chapman said.

At present, the service is available 16 hours a day. Psychiatrists take turns manning the feed at offices in the four towns, usually in 8-hour shifts. When a shift ends in Aiken, for example, a psychiatrist in the Greenville office might pick up the feed.

To see how the program is doing, Dr. Chapman and her colleagues compared the 6,000-plus telepsychiatry patients’ outcomes with those for matched controls at hospitals not yet participating in the program.

About 8% of telepsychiatry patients were admitted, vs. 12% of control patients. With telepsychiatry, "we now have a more specialized person performing the consult" and perhaps making better calls on who needs to be hospitalized, Dr. Chapman said.

Emergency department stays averaged three days for telepsychiatry patients, but four days for controls. About 85% with severe mental illnesses in the telepsychiatry group had outpatient follow-up within 30 days, compared to 22% in the control group.

The program saves money, too. Medicaid telepsychiatry patients had median charges of $2,000; median charges were $2,800 among Medicaid patients in the control group. With other payer mixes, median charges for telepsychiatry patients were $6,800, vs. $11,000 for those in the control group.

Overall, about 80% of patients said they were satisfied with the service. About 90% of physicians said they were satisfied, too, and about three-quarters said telepsychiatry increased productivity.

In short, "the patient receives a higher quality of care, and the hospitals have reduced costs," Dr. Chapman and her colleagues concluded in their summary of the findings.

Dr. Chapman said she has no disclosures. The study was funded by the National Institute of Mental Health and the Duke Endowment.