M. Alexander Otto

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.

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.

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.

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 Dr. 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.

(c)xavier gallego morel/fotolia.com

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 annual meeting of the Pediatric Academic Societies.

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 Dr. 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.

(c)xavier gallego morel/fotolia.com

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 annual meeting of the Pediatric Academic Societies.

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 Dr. 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.

(c)xavier gallego morel/fotolia.com

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 annual meeting of the Pediatric Academic Societies.

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 – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 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," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

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.

"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 Florida-wide study.

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 rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% 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 said.

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 ages.

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

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 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," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

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.

"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 Florida-wide study.

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 rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% 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 said.

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 ages.

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

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 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," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

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.

"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 Florida-wide study.

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 rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% 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 said.

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 ages.

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

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 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," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

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.

"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 Florida-wide study.

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 rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% 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 said.

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 ages.

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

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 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," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

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.

"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 Florida-wide study.

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 rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% 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 said.

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 ages.

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

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 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," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

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.

"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 Florida-wide study.

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 rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% 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 said.

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 ages.

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

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.