M. Alexander Otto

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.

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.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young navy men, according to a case series from the Naval Medical Center in San Diego.

"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.

Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.

The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.

Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.

After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.

In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.

Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.

"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.

The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.

On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.

Dr. Hurst said that he has no disclosures.

DENVER – When 45 families in Brooklyn, N.Y., got weekly reminders to keep to their diets – delivered by e-mail, text message, or voice mail – they stuck with their weight-loss programs longer, according to a study at Brooklyn’s Maimonides Infants and Children’s Hospital.

The messages came once a week on Thursday afternoon, when most parents did their grocery shopping. "They wanted the reminder [then] so that when they reached for [fattening] food, they saw the message and said ‘okay, let’s keep our family on track,’ " lead investigator Rachel Friedman, Ph.D., said at the annual meeting of the Pediatric Academic Societies.

The program, Kids Weight Down, focuses on children aged 2-18 years, but also helps their families. The messages went to parents, and supplemented weekly parenting and exercise classes during the program’s maintenance phase.

Of the 45 families who got them, 37 (83%) remained in the program after 3 months, and 31 (68%) remained in the program at 1 year. Among the 45 families in the program who did not get the messages, only half remained at 3 months, and fewer than 10 were left at 1 year.

The families were demographically similar and equally motivated; Dr. Friedman and her colleagues think the messages made the difference. Families want to be healthy and want to stay in the program, but "just need an extra push. That’s what the technology is doing," she said.

They wanted to get the messages, too. "Without hesitation, they provided cell phone numbers, e-mail addresses, home phone numbers. There wasn’t one who requested to not be part of this study." Plus, "it cost us nothing; it cost them nothing," Dr. Friedman said.

She and her colleagues came up with the idea after hearing how text messages from doctors help people quit smoking and take better care of their diabetes. Kids Weight Down had a problem with attrition during the maintenance phase, so they decided to give electronic messaging a try.

The program consists of 3 months of cognitive-behavioral obesity treatment, followed by the year-long maintenance phase with weekly classes plus individualized quarterly meetings with families.

Children and their families work with psychologists, nutritionists, exercise physiologists, and endocrinologists on nutritional education, awareness of binge triggers, increases in activity, self-esteem, and other issues.

Across both groups of 45 families, children had body mass indexes above the 95th percentile for age and sex; 65% were female, and 77% were of Hispanic ethnicity. They were 8 years old on average.

Messages were short and helpful. One said, "Remember your 543210 goal this week. Memorial Day is a great time for family fun. Turn off the TV, and plan a family activity outdoors."

The numbers 543210 stand for five daily servings of fruits and vegetables; no more than 4 hours without a healthy meal or snack; three meals every day; less than 2 hours of screen time every day; 1 hour or more of exercise; and zero sugary drinks.

Dr. Friedman and her colleagues are following the families to see if their persistence translates to better lipid profiles, weight management, and other outcomes. In the meantime, messaging has been extended to additional families.

Dr. Friedman said she had no relevant financial disclosures.

DENVER – When 45 families in Brooklyn, N.Y., got weekly reminders to keep to their diets – delivered by e-mail, text message, or voice mail – they stuck with their weight-loss programs longer, according to a study at Brooklyn’s Maimonides Infants and Children’s Hospital.

The messages came once a week on Thursday afternoon, when most parents did their grocery shopping. "They wanted the reminder [then] so that when they reached for [fattening] food, they saw the message and said ‘okay, let’s keep our family on track,’ " lead investigator Rachel Friedman, Ph.D., said at the annual meeting of the Pediatric Academic Societies.

The program, Kids Weight Down, focuses on children aged 2-18 years, but also helps their families. The messages went to parents, and supplemented weekly parenting and exercise classes during the program’s maintenance phase.

Of the 45 families who got them, 37 (83%) remained in the program after 3 months, and 31 (68%) remained in the program at 1 year. Among the 45 families in the program who did not get the messages, only half remained at 3 months, and fewer than 10 were left at 1 year.

The families were demographically similar and equally motivated; Dr. Friedman and her colleagues think the messages made the difference. Families want to be healthy and want to stay in the program, but "just need an extra push. That’s what the technology is doing," she said.

They wanted to get the messages, too. "Without hesitation, they provided cell phone numbers, e-mail addresses, home phone numbers. There wasn’t one who requested to not be part of this study." Plus, "it cost us nothing; it cost them nothing," Dr. Friedman said.

She and her colleagues came up with the idea after hearing how text messages from doctors help people quit smoking and take better care of their diabetes. Kids Weight Down had a problem with attrition during the maintenance phase, so they decided to give electronic messaging a try.

The program consists of 3 months of cognitive-behavioral obesity treatment, followed by the year-long maintenance phase with weekly classes plus individualized quarterly meetings with families.

Children and their families work with psychologists, nutritionists, exercise physiologists, and endocrinologists on nutritional education, awareness of binge triggers, increases in activity, self-esteem, and other issues.

Across both groups of 45 families, children had body mass indexes above the 95th percentile for age and sex; 65% were female, and 77% were of Hispanic ethnicity. They were 8 years old on average.

Messages were short and helpful. One said, "Remember your 543210 goal this week. Memorial Day is a great time for family fun. Turn off the TV, and plan a family activity outdoors."

The numbers 543210 stand for five daily servings of fruits and vegetables; no more than 4 hours without a healthy meal or snack; three meals every day; less than 2 hours of screen time every day; 1 hour or more of exercise; and zero sugary drinks.

Dr. Friedman and her colleagues are following the families to see if their persistence translates to better lipid profiles, weight management, and other outcomes. In the meantime, messaging has been extended to additional families.

Dr. Friedman said she had no relevant financial disclosures.

DENVER – When 45 families in Brooklyn, N.Y., got weekly reminders to keep to their diets – delivered by e-mail, text message, or voice mail – they stuck with their weight-loss programs longer, according to a study at Brooklyn’s Maimonides Infants and Children’s Hospital.

The messages came once a week on Thursday afternoon, when most parents did their grocery shopping. "They wanted the reminder [then] so that when they reached for [fattening] food, they saw the message and said ‘okay, let’s keep our family on track,’ " lead investigator Rachel Friedman, Ph.D., said at the annual meeting of the Pediatric Academic Societies.

The program, Kids Weight Down, focuses on children aged 2-18 years, but also helps their families. The messages went to parents, and supplemented weekly parenting and exercise classes during the program’s maintenance phase.

Of the 45 families who got them, 37 (83%) remained in the program after 3 months, and 31 (68%) remained in the program at 1 year. Among the 45 families in the program who did not get the messages, only half remained at 3 months, and fewer than 10 were left at 1 year.

The families were demographically similar and equally motivated; Dr. Friedman and her colleagues think the messages made the difference. Families want to be healthy and want to stay in the program, but "just need an extra push. That’s what the technology is doing," she said.

They wanted to get the messages, too. "Without hesitation, they provided cell phone numbers, e-mail addresses, home phone numbers. There wasn’t one who requested to not be part of this study." Plus, "it cost us nothing; it cost them nothing," Dr. Friedman said.

She and her colleagues came up with the idea after hearing how text messages from doctors help people quit smoking and take better care of their diabetes. Kids Weight Down had a problem with attrition during the maintenance phase, so they decided to give electronic messaging a try.

The program consists of 3 months of cognitive-behavioral obesity treatment, followed by the year-long maintenance phase with weekly classes plus individualized quarterly meetings with families.

Children and their families work with psychologists, nutritionists, exercise physiologists, and endocrinologists on nutritional education, awareness of binge triggers, increases in activity, self-esteem, and other issues.

Across both groups of 45 families, children had body mass indexes above the 95th percentile for age and sex; 65% were female, and 77% were of Hispanic ethnicity. They were 8 years old on average.

Messages were short and helpful. One said, "Remember your 543210 goal this week. Memorial Day is a great time for family fun. Turn off the TV, and plan a family activity outdoors."

The numbers 543210 stand for five daily servings of fruits and vegetables; no more than 4 hours without a healthy meal or snack; three meals every day; less than 2 hours of screen time every day; 1 hour or more of exercise; and zero sugary drinks.

Dr. Friedman and her colleagues are following the families to see if their persistence translates to better lipid profiles, weight management, and other outcomes. In the meantime, messaging has been extended to additional families.

Dr. Friedman said she had no relevant financial disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.