Somatic Disorders

People with clinical depression are at nearly twice the risk for cardiac arrest as those who are not depressed, independently of their other cardiovascular risk factors, said Dr. J.P. Empana of Hôpital Paul Brousse, Villejuif, France, and associates.

There may even be a dose effect in which the risk of cardiac arrest rises as the severity of depression increases, they said.

They assessed the relationship between physician-diagnosed depression and out-of-hospital cardiac arrest using data from a large U.S. HMO. The study compared the prevalence of depression among 2,228 patients aged 40–79 years who had incident cases of cardiac arrest with 4,164 controls.

Unlike previous studies of this issue, this investigation evaluated “a large population with a wide range of demographic and clinical characteristics,” Dr. Empana and associates said (Arch. Intern. Med. 2006;166:195–200).

However, the population studied was not racially diverse; 93% of the subjects were white.

The risk for cardiac arrest was almost twice as high for people with clinical depression than for those without depression, with an odds ratio of 1.88. After the data were adjusted to account for numerous cardiovascular risk factors, the odds ratio remained elevated, at 1.43.

This association between depression and cardiac arrest was seen across all demographic subgroups. Men and women were equally affected, as were elderly people and younger adults. The risk of cardiac arrest increased with increasing severity of depression, so that people who required hospitalization for their depression within the preceding year were at highest risk.

A previous case-control study suggested that the use of tricyclic antidepressants may raise the risk of sudden cardiac death. However, that suggestion seems to be refuted in this study. Excluding the subset of 277 patients who were taking antidepressants, 82% of whom were taking tricyclics, did not alter the results, they said.

People with clinical depression are at nearly twice the risk for cardiac arrest as those who are not depressed, independently of their other cardiovascular risk factors, said Dr. J.P. Empana of Hôpital Paul Brousse, Villejuif, France, and associates.

There may even be a dose effect in which the risk of cardiac arrest rises as the severity of depression increases, they said.

They assessed the relationship between physician-diagnosed depression and out-of-hospital cardiac arrest using data from a large U.S. HMO. The study compared the prevalence of depression among 2,228 patients aged 40–79 years who had incident cases of cardiac arrest with 4,164 controls.

Unlike previous studies of this issue, this investigation evaluated “a large population with a wide range of demographic and clinical characteristics,” Dr. Empana and associates said (Arch. Intern. Med. 2006;166:195–200).

However, the population studied was not racially diverse; 93% of the subjects were white.

The risk for cardiac arrest was almost twice as high for people with clinical depression than for those without depression, with an odds ratio of 1.88. After the data were adjusted to account for numerous cardiovascular risk factors, the odds ratio remained elevated, at 1.43.

This association between depression and cardiac arrest was seen across all demographic subgroups. Men and women were equally affected, as were elderly people and younger adults. The risk of cardiac arrest increased with increasing severity of depression, so that people who required hospitalization for their depression within the preceding year were at highest risk.

A previous case-control study suggested that the use of tricyclic antidepressants may raise the risk of sudden cardiac death. However, that suggestion seems to be refuted in this study. Excluding the subset of 277 patients who were taking antidepressants, 82% of whom were taking tricyclics, did not alter the results, they said.

People with clinical depression are at nearly twice the risk for cardiac arrest as those who are not depressed, independently of their other cardiovascular risk factors, said Dr. J.P. Empana of Hôpital Paul Brousse, Villejuif, France, and associates.

There may even be a dose effect in which the risk of cardiac arrest rises as the severity of depression increases, they said.

They assessed the relationship between physician-diagnosed depression and out-of-hospital cardiac arrest using data from a large U.S. HMO. The study compared the prevalence of depression among 2,228 patients aged 40–79 years who had incident cases of cardiac arrest with 4,164 controls.

Unlike previous studies of this issue, this investigation evaluated “a large population with a wide range of demographic and clinical characteristics,” Dr. Empana and associates said (Arch. Intern. Med. 2006;166:195–200).

However, the population studied was not racially diverse; 93% of the subjects were white.

The risk for cardiac arrest was almost twice as high for people with clinical depression than for those without depression, with an odds ratio of 1.88. After the data were adjusted to account for numerous cardiovascular risk factors, the odds ratio remained elevated, at 1.43.

This association between depression and cardiac arrest was seen across all demographic subgroups. Men and women were equally affected, as were elderly people and younger adults. The risk of cardiac arrest increased with increasing severity of depression, so that people who required hospitalization for their depression within the preceding year were at highest risk.

A previous case-control study suggested that the use of tricyclic antidepressants may raise the risk of sudden cardiac death. However, that suggestion seems to be refuted in this study. Excluding the subset of 277 patients who were taking antidepressants, 82% of whom were taking tricyclics, did not alter the results, they said.

SAN FRANCISCO – Postoperative psychiatric complications in a small percentage of liver donors included three completed or attempted suicides, Dr. James F. Trotter reported in a poster at the annual meeting of the American Association for the Study of Liver Diseases.

Data on the right hepatic lobe donors came from the Adult-to-Adult Living Donor Liver Transplant Cohort Study (A2ALL), which followed donors and recipients at nine U.S. transplant centers for at least 5 days and up to nearly 6 years after the surgery.

“Suicide and severe psychiatric complications are of concern in right hepatic lobe donors. We suggest psychiatric assessment and monitoring of liver donors may be helpful to understand and prevent such tragic events,” wrote Dr. Trotter of the University of Colorado Health Sciences Center, Denver, and his associates.

More studies are needed to determine if the psychiatric complications are related to stress from the surgery or to the types of people who choose to donate, or both, he said.

The postoperative psychiatric complications, which occurred in 3% of 390 liver donors, included two completed suicides and one attempted suicide in addition to depression in two donors, substance abuse in two, and the development of worsening obsessive-compulsive disorder, insomnia, or bipolar disorder in one donor each. Detailed questionnaires were used to profile the three suicide events. The recipients of the right hepatic lobe donations in these three cases were alive and well at the time of the suicide attempts.

A 50-year-old man who donated to his niece was treated with clonazepam for bipolar disorder before and after the donation. He developed physical postoperative complications, including a middle hepatic vein thrombosis, abdominal discomfort, and fatigue. He used a shotgun to the head to kill himself 22 months after the donation.

A 35-year-old man who donated to his brother developed a pleural effusion, ileus, and mild urinary retention after the surgery. Prior to donation, he had been in counseling related to a divorce but had no psychiatric history. A fatal, self-induced drug overdose 23 months after donation was recorded as suicide by the transplant center.

A 23-year-old man who donated to his father had no physical complications. Nine months later he was hospitalized twice in a 2-month period for slashing his wrists in attempted suicides after a breakup with his significant other. He is alive and doing well today, Dr. Trotter wrote.

Besides the two donors who committed suicide, two other donors died–one from postdonation surgical complications and one in a train accident.

SAN FRANCISCO – Postoperative psychiatric complications in a small percentage of liver donors included three completed or attempted suicides, Dr. James F. Trotter reported in a poster at the annual meeting of the American Association for the Study of Liver Diseases.

Data on the right hepatic lobe donors came from the Adult-to-Adult Living Donor Liver Transplant Cohort Study (A2ALL), which followed donors and recipients at nine U.S. transplant centers for at least 5 days and up to nearly 6 years after the surgery.

“Suicide and severe psychiatric complications are of concern in right hepatic lobe donors. We suggest psychiatric assessment and monitoring of liver donors may be helpful to understand and prevent such tragic events,” wrote Dr. Trotter of the University of Colorado Health Sciences Center, Denver, and his associates.

More studies are needed to determine if the psychiatric complications are related to stress from the surgery or to the types of people who choose to donate, or both, he said.

The postoperative psychiatric complications, which occurred in 3% of 390 liver donors, included two completed suicides and one attempted suicide in addition to depression in two donors, substance abuse in two, and the development of worsening obsessive-compulsive disorder, insomnia, or bipolar disorder in one donor each. Detailed questionnaires were used to profile the three suicide events. The recipients of the right hepatic lobe donations in these three cases were alive and well at the time of the suicide attempts.

A 50-year-old man who donated to his niece was treated with clonazepam for bipolar disorder before and after the donation. He developed physical postoperative complications, including a middle hepatic vein thrombosis, abdominal discomfort, and fatigue. He used a shotgun to the head to kill himself 22 months after the donation.

A 35-year-old man who donated to his brother developed a pleural effusion, ileus, and mild urinary retention after the surgery. Prior to donation, he had been in counseling related to a divorce but had no psychiatric history. A fatal, self-induced drug overdose 23 months after donation was recorded as suicide by the transplant center.

A 23-year-old man who donated to his father had no physical complications. Nine months later he was hospitalized twice in a 2-month period for slashing his wrists in attempted suicides after a breakup with his significant other. He is alive and doing well today, Dr. Trotter wrote.

Besides the two donors who committed suicide, two other donors died–one from postdonation surgical complications and one in a train accident.

SAN FRANCISCO – Postoperative psychiatric complications in a small percentage of liver donors included three completed or attempted suicides, Dr. James F. Trotter reported in a poster at the annual meeting of the American Association for the Study of Liver Diseases.

Data on the right hepatic lobe donors came from the Adult-to-Adult Living Donor Liver Transplant Cohort Study (A2ALL), which followed donors and recipients at nine U.S. transplant centers for at least 5 days and up to nearly 6 years after the surgery.

“Suicide and severe psychiatric complications are of concern in right hepatic lobe donors. We suggest psychiatric assessment and monitoring of liver donors may be helpful to understand and prevent such tragic events,” wrote Dr. Trotter of the University of Colorado Health Sciences Center, Denver, and his associates.

More studies are needed to determine if the psychiatric complications are related to stress from the surgery or to the types of people who choose to donate, or both, he said.

The postoperative psychiatric complications, which occurred in 3% of 390 liver donors, included two completed suicides and one attempted suicide in addition to depression in two donors, substance abuse in two, and the development of worsening obsessive-compulsive disorder, insomnia, or bipolar disorder in one donor each. Detailed questionnaires were used to profile the three suicide events. The recipients of the right hepatic lobe donations in these three cases were alive and well at the time of the suicide attempts.

A 50-year-old man who donated to his niece was treated with clonazepam for bipolar disorder before and after the donation. He developed physical postoperative complications, including a middle hepatic vein thrombosis, abdominal discomfort, and fatigue. He used a shotgun to the head to kill himself 22 months after the donation.

A 35-year-old man who donated to his brother developed a pleural effusion, ileus, and mild urinary retention after the surgery. Prior to donation, he had been in counseling related to a divorce but had no psychiatric history. A fatal, self-induced drug overdose 23 months after donation was recorded as suicide by the transplant center.

A 23-year-old man who donated to his father had no physical complications. Nine months later he was hospitalized twice in a 2-month period for slashing his wrists in attempted suicides after a breakup with his significant other. He is alive and doing well today, Dr. Trotter wrote.

Besides the two donors who committed suicide, two other donors died–one from postdonation surgical complications and one in a train accident.

SAN DIEGO – Heart disease and suicide were the leading causes of death in a large study of patients with mental illness in Ohio.

Moreover, these patients died at a mean age of 48 years, which represented 32 years of potential life lost, Dr. Brian J. Miller reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“That is a strikingly high figure,” said Dr. Miller, a psychiatry resident at the Medical College of Georgia, Augusta. The findings underscore the importance of integrating the delivery of health care services to patients with serious mental illness and targeting interventions that improve their quality of life, such as monitoring blood glucose levels, taking waist circumference measurements, and looking for metabolic syndrome.

The study results “confirm findings of previous reports that patients with serious mental illness are at increased risk of death,” said Dr. Miller, who conducted the research while a medical student at Ohio State University in Columbus. “The cited literature suggests a 1.6- to 2.8-fold increased risk of premature death. We found a 3.2-fold increased risk of premature death.”

He and his associates analyzed Ohio Department of Mental Health records for 20,018 patients discharged from an Ohio public psychiatric hospital between 1998 and 2002, and matched them against Ohio Department of Health records for the same time period. They identified 608 deaths and calculated leading causes of death, medical comorbidities, age-adjusted mortality, years of potential life lost, and standardized mortality ratios.

Most patients (72%) died within 2 years of discharge from the psychiatric hospital. The leading causes of death were heart disease (21%), suicide (18%), and accidents (14%). The most prevalent medical comorbidities were obesity (24%), hypertension (22%), and diabetes mellitus (12%).

The overall standardized mortality ratio was 3.2, which corresponded to 417 excess deaths.

“What's interesting is that we found that the leading medical comorbidities–specifically, obesity, hypertension, diabetes, and COPD–are consistent with the risk factors for the observed leading [medical] causes of death: heart disease, COPD, and diabetes,” Dr. Miller said.

In the text of their poster, the investigators acknowledged that the findings may not apply to other populations with serious mental illness. “While our statistical models adjusted for age and gender differences, there are many other demographic, health, and socioeconomic factors that are difficult to adequately and accurately control,” they wrote.

The investigators said that their data came entirely from state mental health inpatient records. The study population was largely male, unmarried, and uneducated–a group for which alcohol and substance abuse were well documented.

Patients died at a mean age of 48 years, which represented 32 years of potential life lost. DR. MILLER

SAN DIEGO – Heart disease and suicide were the leading causes of death in a large study of patients with mental illness in Ohio.

Moreover, these patients died at a mean age of 48 years, which represented 32 years of potential life lost, Dr. Brian J. Miller reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“That is a strikingly high figure,” said Dr. Miller, a psychiatry resident at the Medical College of Georgia, Augusta. The findings underscore the importance of integrating the delivery of health care services to patients with serious mental illness and targeting interventions that improve their quality of life, such as monitoring blood glucose levels, taking waist circumference measurements, and looking for metabolic syndrome.

The study results “confirm findings of previous reports that patients with serious mental illness are at increased risk of death,” said Dr. Miller, who conducted the research while a medical student at Ohio State University in Columbus. “The cited literature suggests a 1.6- to 2.8-fold increased risk of premature death. We found a 3.2-fold increased risk of premature death.”

He and his associates analyzed Ohio Department of Mental Health records for 20,018 patients discharged from an Ohio public psychiatric hospital between 1998 and 2002, and matched them against Ohio Department of Health records for the same time period. They identified 608 deaths and calculated leading causes of death, medical comorbidities, age-adjusted mortality, years of potential life lost, and standardized mortality ratios.

Most patients (72%) died within 2 years of discharge from the psychiatric hospital. The leading causes of death were heart disease (21%), suicide (18%), and accidents (14%). The most prevalent medical comorbidities were obesity (24%), hypertension (22%), and diabetes mellitus (12%).

The overall standardized mortality ratio was 3.2, which corresponded to 417 excess deaths.

“What's interesting is that we found that the leading medical comorbidities–specifically, obesity, hypertension, diabetes, and COPD–are consistent with the risk factors for the observed leading [medical] causes of death: heart disease, COPD, and diabetes,” Dr. Miller said.

In the text of their poster, the investigators acknowledged that the findings may not apply to other populations with serious mental illness. “While our statistical models adjusted for age and gender differences, there are many other demographic, health, and socioeconomic factors that are difficult to adequately and accurately control,” they wrote.

The investigators said that their data came entirely from state mental health inpatient records. The study population was largely male, unmarried, and uneducated–a group for which alcohol and substance abuse were well documented.

Patients died at a mean age of 48 years, which represented 32 years of potential life lost. DR. MILLER

SAN DIEGO – Heart disease and suicide were the leading causes of death in a large study of patients with mental illness in Ohio.

Moreover, these patients died at a mean age of 48 years, which represented 32 years of potential life lost, Dr. Brian J. Miller reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“That is a strikingly high figure,” said Dr. Miller, a psychiatry resident at the Medical College of Georgia, Augusta. The findings underscore the importance of integrating the delivery of health care services to patients with serious mental illness and targeting interventions that improve their quality of life, such as monitoring blood glucose levels, taking waist circumference measurements, and looking for metabolic syndrome.

The study results “confirm findings of previous reports that patients with serious mental illness are at increased risk of death,” said Dr. Miller, who conducted the research while a medical student at Ohio State University in Columbus. “The cited literature suggests a 1.6- to 2.8-fold increased risk of premature death. We found a 3.2-fold increased risk of premature death.”

He and his associates analyzed Ohio Department of Mental Health records for 20,018 patients discharged from an Ohio public psychiatric hospital between 1998 and 2002, and matched them against Ohio Department of Health records for the same time period. They identified 608 deaths and calculated leading causes of death, medical comorbidities, age-adjusted mortality, years of potential life lost, and standardized mortality ratios.

Most patients (72%) died within 2 years of discharge from the psychiatric hospital. The leading causes of death were heart disease (21%), suicide (18%), and accidents (14%). The most prevalent medical comorbidities were obesity (24%), hypertension (22%), and diabetes mellitus (12%).

The overall standardized mortality ratio was 3.2, which corresponded to 417 excess deaths.

“What's interesting is that we found that the leading medical comorbidities–specifically, obesity, hypertension, diabetes, and COPD–are consistent with the risk factors for the observed leading [medical] causes of death: heart disease, COPD, and diabetes,” Dr. Miller said.

In the text of their poster, the investigators acknowledged that the findings may not apply to other populations with serious mental illness. “While our statistical models adjusted for age and gender differences, there are many other demographic, health, and socioeconomic factors that are difficult to adequately and accurately control,” they wrote.

The investigators said that their data came entirely from state mental health inpatient records. The study population was largely male, unmarried, and uneducated–a group for which alcohol and substance abuse were well documented.

Patients died at a mean age of 48 years, which represented 32 years of potential life lost. DR. MILLER

SANTA ANA PUEBLO, N.M. – A hepatitis C virus clinic in Minnesota helped alcoholic patients become eligible for antiviral therapy by integrating alcohol screening and a behavioral intervention into medical care.

Nearly half (47%) of 47 new patients flagged for “severe alcohol use” reduced their drinking after physicians warned that it could make them ineligible for antiviral treatment, according to a poster presented by Dr. Eric W. Dieperink at the annual meeting of the Academy of Psychosomatic Medicine.

Some relapsed after this initial brief intervention, but nearly two-thirds (62%) subsequently reduced their alcohol use by participating in an on-site program with a psychiatric clinical nurse-specialist. And 17 patients (36%) achieved long-term abstinence and were offered antiviral therapy.

“There was a big effect of just having the [clinic staff] address alcohol use at the initial visit,” Dr. Dieperink, a psychiatrist at the University of Minnesota, said in an interview at the meeting. “It's a cost-effective way to help people start treatment.”

Standard practice is to refer patients to a substance abuse program and tell them to “come back in 6 months when you are sober,” Dr. Dieperink said. He and his colleagues reasoned that people facing medical consequences would be more likely to respond to an alcohol intervention than would a general population. They decided, therefore, to engage patients medically and psychiatrically at the clinic.

Gastroenterologists at the Veterans Affairs Medical Center in Minneapolis invited psychiatrists into the clinic about 6 years ago, Dr. Dieperink said, citing concerns about depression as a side effect of interferon treatment. Over time, the collaboration took on other psychiatric disorders in an ongoing attempt to address barriers to treatment.

“Alcohol is considered a barrier to treatment for hepatitis C and also hastens the fibrosis related to liver disease. So there were two reasons to address it,” Dr. Dieperink said.

The intervention began with all patients being screened for psychiatric problems at their initial clinic visit. Instruments included the Alcohol Use Disorders Identification Test-C (AUDIT-C), which the psychiatric clinical nurse-specialist reviewed. The nurse-specialist subsequently met with patients who scored above 4 on the AUDIT-C or were referred by staff members for alcohol problems.

A cornerstone of the program was having gastroenterologists discuss alcohol each time they saw the patients. “At every visit, the hepatology folks continued to address alcohol,” Dr. Dieperink said. “That was the synergism–constantly attending to the alcohol use at every visit–which we think made a big difference.”

He described the approach as matter of fact. Physicians would compare the patients' drinking with standards and norms for their age groups, recommend they cut back, and offer to arrange follow-up with the nurse.

The poster described the 47 veterans as 51 years old on average. Of the 47 patients, 32 were diagnosed with alcohol dependence and 15 with alcohol abuse. Most (82%) were hepatitis C genotype 1. Nearly two-thirds had stage II or higher liver fibrosis. The mean score on the AUDIT-C was 6.5. In addition, 24 patients (51%) self-reported use of cannabis, cocaine, or methamphetamine during the previous 6 months.

The patients had consumed alcohol on average 17.3 of the 30 days before they came to the clinic, consuming a mean of 9.5 drinks per day. After the initial brief intervention, the average number of drinking days per month fell to 10.6 and the average number of drinks consumed per day declined to 5.5.

Ten patients refused referral to the nurse-specialist. Among those who participated in the follow-up program, the average number of drinking days fell to 8.8 after 3–18 months and the number of drinks per day to 3.8 after 5–22 months.

Of 37 patients who participated in the follow-up program with the clinical nurse-specialist and/or a mental health practitioner, only 3 were excluded from antiviral therapy because of continued alcohol use. Seventeen were offered retroviral therapy, and 13 started treatment.

The investigators said the treatment rate, 28% of patients with serious alcohol use, compared favorably with the 21% treatment rate reported for consecutive hepatitis C patients in Veterans Affairs clinics nationwide.

SANTA ANA PUEBLO, N.M. – A hepatitis C virus clinic in Minnesota helped alcoholic patients become eligible for antiviral therapy by integrating alcohol screening and a behavioral intervention into medical care.

Nearly half (47%) of 47 new patients flagged for “severe alcohol use” reduced their drinking after physicians warned that it could make them ineligible for antiviral treatment, according to a poster presented by Dr. Eric W. Dieperink at the annual meeting of the Academy of Psychosomatic Medicine.

Some relapsed after this initial brief intervention, but nearly two-thirds (62%) subsequently reduced their alcohol use by participating in an on-site program with a psychiatric clinical nurse-specialist. And 17 patients (36%) achieved long-term abstinence and were offered antiviral therapy.

“There was a big effect of just having the [clinic staff] address alcohol use at the initial visit,” Dr. Dieperink, a psychiatrist at the University of Minnesota, said in an interview at the meeting. “It's a cost-effective way to help people start treatment.”

Standard practice is to refer patients to a substance abuse program and tell them to “come back in 6 months when you are sober,” Dr. Dieperink said. He and his colleagues reasoned that people facing medical consequences would be more likely to respond to an alcohol intervention than would a general population. They decided, therefore, to engage patients medically and psychiatrically at the clinic.

Gastroenterologists at the Veterans Affairs Medical Center in Minneapolis invited psychiatrists into the clinic about 6 years ago, Dr. Dieperink said, citing concerns about depression as a side effect of interferon treatment. Over time, the collaboration took on other psychiatric disorders in an ongoing attempt to address barriers to treatment.

“Alcohol is considered a barrier to treatment for hepatitis C and also hastens the fibrosis related to liver disease. So there were two reasons to address it,” Dr. Dieperink said.

The intervention began with all patients being screened for psychiatric problems at their initial clinic visit. Instruments included the Alcohol Use Disorders Identification Test-C (AUDIT-C), which the psychiatric clinical nurse-specialist reviewed. The nurse-specialist subsequently met with patients who scored above 4 on the AUDIT-C or were referred by staff members for alcohol problems.

A cornerstone of the program was having gastroenterologists discuss alcohol each time they saw the patients. “At every visit, the hepatology folks continued to address alcohol,” Dr. Dieperink said. “That was the synergism–constantly attending to the alcohol use at every visit–which we think made a big difference.”

He described the approach as matter of fact. Physicians would compare the patients' drinking with standards and norms for their age groups, recommend they cut back, and offer to arrange follow-up with the nurse.

The poster described the 47 veterans as 51 years old on average. Of the 47 patients, 32 were diagnosed with alcohol dependence and 15 with alcohol abuse. Most (82%) were hepatitis C genotype 1. Nearly two-thirds had stage II or higher liver fibrosis. The mean score on the AUDIT-C was 6.5. In addition, 24 patients (51%) self-reported use of cannabis, cocaine, or methamphetamine during the previous 6 months.

The patients had consumed alcohol on average 17.3 of the 30 days before they came to the clinic, consuming a mean of 9.5 drinks per day. After the initial brief intervention, the average number of drinking days per month fell to 10.6 and the average number of drinks consumed per day declined to 5.5.

Ten patients refused referral to the nurse-specialist. Among those who participated in the follow-up program, the average number of drinking days fell to 8.8 after 3–18 months and the number of drinks per day to 3.8 after 5–22 months.

Of 37 patients who participated in the follow-up program with the clinical nurse-specialist and/or a mental health practitioner, only 3 were excluded from antiviral therapy because of continued alcohol use. Seventeen were offered retroviral therapy, and 13 started treatment.

The investigators said the treatment rate, 28% of patients with serious alcohol use, compared favorably with the 21% treatment rate reported for consecutive hepatitis C patients in Veterans Affairs clinics nationwide.

SANTA ANA PUEBLO, N.M. – A hepatitis C virus clinic in Minnesota helped alcoholic patients become eligible for antiviral therapy by integrating alcohol screening and a behavioral intervention into medical care.

Nearly half (47%) of 47 new patients flagged for “severe alcohol use” reduced their drinking after physicians warned that it could make them ineligible for antiviral treatment, according to a poster presented by Dr. Eric W. Dieperink at the annual meeting of the Academy of Psychosomatic Medicine.

Some relapsed after this initial brief intervention, but nearly two-thirds (62%) subsequently reduced their alcohol use by participating in an on-site program with a psychiatric clinical nurse-specialist. And 17 patients (36%) achieved long-term abstinence and were offered antiviral therapy.

“There was a big effect of just having the [clinic staff] address alcohol use at the initial visit,” Dr. Dieperink, a psychiatrist at the University of Minnesota, said in an interview at the meeting. “It's a cost-effective way to help people start treatment.”

Standard practice is to refer patients to a substance abuse program and tell them to “come back in 6 months when you are sober,” Dr. Dieperink said. He and his colleagues reasoned that people facing medical consequences would be more likely to respond to an alcohol intervention than would a general population. They decided, therefore, to engage patients medically and psychiatrically at the clinic.

Gastroenterologists at the Veterans Affairs Medical Center in Minneapolis invited psychiatrists into the clinic about 6 years ago, Dr. Dieperink said, citing concerns about depression as a side effect of interferon treatment. Over time, the collaboration took on other psychiatric disorders in an ongoing attempt to address barriers to treatment.

“Alcohol is considered a barrier to treatment for hepatitis C and also hastens the fibrosis related to liver disease. So there were two reasons to address it,” Dr. Dieperink said.

The intervention began with all patients being screened for psychiatric problems at their initial clinic visit. Instruments included the Alcohol Use Disorders Identification Test-C (AUDIT-C), which the psychiatric clinical nurse-specialist reviewed. The nurse-specialist subsequently met with patients who scored above 4 on the AUDIT-C or were referred by staff members for alcohol problems.

A cornerstone of the program was having gastroenterologists discuss alcohol each time they saw the patients. “At every visit, the hepatology folks continued to address alcohol,” Dr. Dieperink said. “That was the synergism–constantly attending to the alcohol use at every visit–which we think made a big difference.”

He described the approach as matter of fact. Physicians would compare the patients' drinking with standards and norms for their age groups, recommend they cut back, and offer to arrange follow-up with the nurse.

The poster described the 47 veterans as 51 years old on average. Of the 47 patients, 32 were diagnosed with alcohol dependence and 15 with alcohol abuse. Most (82%) were hepatitis C genotype 1. Nearly two-thirds had stage II or higher liver fibrosis. The mean score on the AUDIT-C was 6.5. In addition, 24 patients (51%) self-reported use of cannabis, cocaine, or methamphetamine during the previous 6 months.

The patients had consumed alcohol on average 17.3 of the 30 days before they came to the clinic, consuming a mean of 9.5 drinks per day. After the initial brief intervention, the average number of drinking days per month fell to 10.6 and the average number of drinks consumed per day declined to 5.5.

Ten patients refused referral to the nurse-specialist. Among those who participated in the follow-up program, the average number of drinking days fell to 8.8 after 3–18 months and the number of drinks per day to 3.8 after 5–22 months.

Of 37 patients who participated in the follow-up program with the clinical nurse-specialist and/or a mental health practitioner, only 3 were excluded from antiviral therapy because of continued alcohol use. Seventeen were offered retroviral therapy, and 13 started treatment.

The investigators said the treatment rate, 28% of patients with serious alcohol use, compared favorably with the 21% treatment rate reported for consecutive hepatitis C patients in Veterans Affairs clinics nationwide.

SEATTLE – Anxiety disorders are associated with a wide range of physical health problems, even after adjustment for other common mental disorders such as depression, Dr. Jitender Sareen said in a poster presentation at the annual conference of the Anxiety Disorders Association of America.

“There has long been an interest in understanding how depression affects physical health,” said Dr. Sareen of the department of psychiatry at the University of Manitoba, Winnipeg. “However, there have only been a few studies which have examined the relationship between anxiety disorders and medical conditions.”

The researchers used data derived from the U.S. National Comorbidity Survey, a national representative sample of 5,877 individuals aged 15–54 years, to examine the relationship between anxiety disorders and a wide range of medical conditions. They used the Composite International Diagnostic Interview to make DSM-III-R mental disorder diagnoses, and assessed participants' general physical conditions on the basis of self-report. Multiple logistic regression was used to analyze the relationship between a past-year anxiety disorder diagnosis and past-year chronic physical illness.

Anxiety disorders diagnosed among the survey participants during the previous year included posttraumatic stress disorder, panic attacks, agoraphobia, generalized anxiety disorder, and social phobia.

The investigators looked at disability and functional impairment, and then controlled for factors such as depression, alcohol use, and pain. But even after they adjusted for common mood and substance abuse disorders, pain, and sociodemographics, anxiety disorders remained associated with a high level of disability and greater role impairment.

Among the anxiety disorders, posttraumatic stress disorder was linked to the widest range of physical conditions, with the most prevalent being any type of metabolic or autoimmune condition. Neurologic conditions, including epilepsy, multiple sclerosis, and stroke, were also highly prevalent. Other associated disorders included vascular conditions, respiratory illnesses, gastrointestinal disease, bone or joint disorders, and diseases like cancer and AIDS.

Subjects reporting a diagnosis of panic attacks and agoraphobia were also highly likely to have a comorbid medical condition, especially a vascular disease or a bone or joint disorder. Dr. Sareen and his colleagues found that generalized anxiety disorder and social or simple phobias were also associated with physical illnesses, but the prevalence was lower.

There is a strong and unique association between anxiety disorders and physical disorders, the researchers concluded, and the presence of an anxiety disorder among patients with physical disorders may confer a greater level of disability.

“We have found that anxiety disorders are related to physical health, much in the same way that depression is,” he said.

SEATTLE – Anxiety disorders are associated with a wide range of physical health problems, even after adjustment for other common mental disorders such as depression, Dr. Jitender Sareen said in a poster presentation at the annual conference of the Anxiety Disorders Association of America.

“There has long been an interest in understanding how depression affects physical health,” said Dr. Sareen of the department of psychiatry at the University of Manitoba, Winnipeg. “However, there have only been a few studies which have examined the relationship between anxiety disorders and medical conditions.”

The researchers used data derived from the U.S. National Comorbidity Survey, a national representative sample of 5,877 individuals aged 15–54 years, to examine the relationship between anxiety disorders and a wide range of medical conditions. They used the Composite International Diagnostic Interview to make DSM-III-R mental disorder diagnoses, and assessed participants' general physical conditions on the basis of self-report. Multiple logistic regression was used to analyze the relationship between a past-year anxiety disorder diagnosis and past-year chronic physical illness.

Anxiety disorders diagnosed among the survey participants during the previous year included posttraumatic stress disorder, panic attacks, agoraphobia, generalized anxiety disorder, and social phobia.

The investigators looked at disability and functional impairment, and then controlled for factors such as depression, alcohol use, and pain. But even after they adjusted for common mood and substance abuse disorders, pain, and sociodemographics, anxiety disorders remained associated with a high level of disability and greater role impairment.

Among the anxiety disorders, posttraumatic stress disorder was linked to the widest range of physical conditions, with the most prevalent being any type of metabolic or autoimmune condition. Neurologic conditions, including epilepsy, multiple sclerosis, and stroke, were also highly prevalent. Other associated disorders included vascular conditions, respiratory illnesses, gastrointestinal disease, bone or joint disorders, and diseases like cancer and AIDS.

Subjects reporting a diagnosis of panic attacks and agoraphobia were also highly likely to have a comorbid medical condition, especially a vascular disease or a bone or joint disorder. Dr. Sareen and his colleagues found that generalized anxiety disorder and social or simple phobias were also associated with physical illnesses, but the prevalence was lower.

There is a strong and unique association between anxiety disorders and physical disorders, the researchers concluded, and the presence of an anxiety disorder among patients with physical disorders may confer a greater level of disability.

“We have found that anxiety disorders are related to physical health, much in the same way that depression is,” he said.

SEATTLE – Anxiety disorders are associated with a wide range of physical health problems, even after adjustment for other common mental disorders such as depression, Dr. Jitender Sareen said in a poster presentation at the annual conference of the Anxiety Disorders Association of America.

“There has long been an interest in understanding how depression affects physical health,” said Dr. Sareen of the department of psychiatry at the University of Manitoba, Winnipeg. “However, there have only been a few studies which have examined the relationship between anxiety disorders and medical conditions.”

The researchers used data derived from the U.S. National Comorbidity Survey, a national representative sample of 5,877 individuals aged 15–54 years, to examine the relationship between anxiety disorders and a wide range of medical conditions. They used the Composite International Diagnostic Interview to make DSM-III-R mental disorder diagnoses, and assessed participants' general physical conditions on the basis of self-report. Multiple logistic regression was used to analyze the relationship between a past-year anxiety disorder diagnosis and past-year chronic physical illness.

Anxiety disorders diagnosed among the survey participants during the previous year included posttraumatic stress disorder, panic attacks, agoraphobia, generalized anxiety disorder, and social phobia.

The investigators looked at disability and functional impairment, and then controlled for factors such as depression, alcohol use, and pain. But even after they adjusted for common mood and substance abuse disorders, pain, and sociodemographics, anxiety disorders remained associated with a high level of disability and greater role impairment.

Among the anxiety disorders, posttraumatic stress disorder was linked to the widest range of physical conditions, with the most prevalent being any type of metabolic or autoimmune condition. Neurologic conditions, including epilepsy, multiple sclerosis, and stroke, were also highly prevalent. Other associated disorders included vascular conditions, respiratory illnesses, gastrointestinal disease, bone or joint disorders, and diseases like cancer and AIDS.

Subjects reporting a diagnosis of panic attacks and agoraphobia were also highly likely to have a comorbid medical condition, especially a vascular disease or a bone or joint disorder. Dr. Sareen and his colleagues found that generalized anxiety disorder and social or simple phobias were also associated with physical illnesses, but the prevalence was lower.

There is a strong and unique association between anxiety disorders and physical disorders, the researchers concluded, and the presence of an anxiety disorder among patients with physical disorders may confer a greater level of disability.

“We have found that anxiety disorders are related to physical health, much in the same way that depression is,” he said.

MONTREAL – Non-GI symptoms can help distinguish irritable bowel syndrome from inflammatory bowel disease, Dr. Noel B. Hershfield said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the 200 patients with IBD, he said.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD. More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Of the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to gastrointestinal pain, compared with 179 IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” Dr. Hershfield said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms that are associated with organic bowel disease. “People with IBD often have tremendous weight loss. … They can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” he said.

IBS patients, on the other hand, don't present with weight loss, anemia, and bleeding, Dr. Hershfield added.

MONTREAL – Non-GI symptoms can help distinguish irritable bowel syndrome from inflammatory bowel disease, Dr. Noel B. Hershfield said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the 200 patients with IBD, he said.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD. More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Of the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to gastrointestinal pain, compared with 179 IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” Dr. Hershfield said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms that are associated with organic bowel disease. “People with IBD often have tremendous weight loss. … They can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” he said.

IBS patients, on the other hand, don't present with weight loss, anemia, and bleeding, Dr. Hershfield added.

MONTREAL – Non-GI symptoms can help distinguish irritable bowel syndrome from inflammatory bowel disease, Dr. Noel B. Hershfield said at the 13th World Congress of Gastroenterology.

Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.

He reached these conclusions based on his survey of 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.

Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the 200 patients with IBD, he said.

Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD. More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).

Of the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to gastrointestinal pain, compared with 179 IBD patients (Can. J. Gastroenterol. 2005;19:231–4).

“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” Dr. Hershfield said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel.”

Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms that are associated with organic bowel disease. “People with IBD often have tremendous weight loss. … They can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” he said.

IBS patients, on the other hand, don't present with weight loss, anemia, and bleeding, Dr. Hershfield added.

DALLAS – A quick, six-question survey can diagnose anxiety in patients who've had a myocardial infarction and identify those who need treatment with an anxiolytic.

“The Brief Symptom Inventory [BSI] is performed similarly to the State Anxiety Instrument [SAI]. The brief symptom inventory is a valid instrument for quickly diagnosing anxiety and identifying patients who need anxiolytic therapy,” Mohannad Abu Ruz said at the annual scientific sessions of the American Heart Association.

“It's important to treat anxiety during the first 72 hours following a myocardial infarction, but few patients get their anxiety level measured following an infarction,” said Mr. Abu Ruz, a nursing-PhD candidate at the University of Kentucky in Lexington.

“There is a belief that the diagnostic instruments are time consuming and burdensome to patients, and many physicians rely on physiologic indicators of anxiety such as blood pressure and heart rate.”

The study involved 536 patients admitted for an acute MI at any of five participating hospitals in the United States and Australia. MIs were confirmed by ECG and cardiac enzymes.

Within 72 hours of admission, all patients were assessed for their anxiety level using the SAI, the standard diagnostic tool for anxiety, and by the BSI, which can be administered in 2–5 minutes.

Questions on the BSI all use simple language and are structured to ask about the patient's mental state at the time of the interview–for example, “Are you nervous at this time?”

Answers are measured on a 0–4 scale, with 0 meaning no anxiety and 4 meaning a high level of anxiety. The ideal is an answer of 0 for all six questions. For this study, a patient who scored 2 or more points on the BSI was considered anxious enough to need treatment.

A total of 261 were diagnosed as anxious using the SAI, and 262 were diagnosed as anxious by the BSI, producing a correlation coefficient of 0.7–a good level of correlation between the two measures, Mr. Abu Ruz said.

Further confirmation of the validity of BSI was based on the mean number of in-hospital complications experienced by the patients diagnosed as anxious or not anxious.

Using diagnoses based on the SAI, patients who were anxious had an average of 1.3 complications during hospitalization, compared with 0.8 complications per patient among those who were not anxious. Identical complication rates were seen when patients were categorized by the BSI, Mr. Abu Ruz reported.

DALLAS – A quick, six-question survey can diagnose anxiety in patients who've had a myocardial infarction and identify those who need treatment with an anxiolytic.

“The Brief Symptom Inventory [BSI] is performed similarly to the State Anxiety Instrument [SAI]. The brief symptom inventory is a valid instrument for quickly diagnosing anxiety and identifying patients who need anxiolytic therapy,” Mohannad Abu Ruz said at the annual scientific sessions of the American Heart Association.

“It's important to treat anxiety during the first 72 hours following a myocardial infarction, but few patients get their anxiety level measured following an infarction,” said Mr. Abu Ruz, a nursing-PhD candidate at the University of Kentucky in Lexington.

“There is a belief that the diagnostic instruments are time consuming and burdensome to patients, and many physicians rely on physiologic indicators of anxiety such as blood pressure and heart rate.”

The study involved 536 patients admitted for an acute MI at any of five participating hospitals in the United States and Australia. MIs were confirmed by ECG and cardiac enzymes.

Within 72 hours of admission, all patients were assessed for their anxiety level using the SAI, the standard diagnostic tool for anxiety, and by the BSI, which can be administered in 2–5 minutes.

Questions on the BSI all use simple language and are structured to ask about the patient's mental state at the time of the interview–for example, “Are you nervous at this time?”

Answers are measured on a 0–4 scale, with 0 meaning no anxiety and 4 meaning a high level of anxiety. The ideal is an answer of 0 for all six questions. For this study, a patient who scored 2 or more points on the BSI was considered anxious enough to need treatment.

A total of 261 were diagnosed as anxious using the SAI, and 262 were diagnosed as anxious by the BSI, producing a correlation coefficient of 0.7–a good level of correlation between the two measures, Mr. Abu Ruz said.

Further confirmation of the validity of BSI was based on the mean number of in-hospital complications experienced by the patients diagnosed as anxious or not anxious.

Using diagnoses based on the SAI, patients who were anxious had an average of 1.3 complications during hospitalization, compared with 0.8 complications per patient among those who were not anxious. Identical complication rates were seen when patients were categorized by the BSI, Mr. Abu Ruz reported.

DALLAS – A quick, six-question survey can diagnose anxiety in patients who've had a myocardial infarction and identify those who need treatment with an anxiolytic.

“The Brief Symptom Inventory [BSI] is performed similarly to the State Anxiety Instrument [SAI]. The brief symptom inventory is a valid instrument for quickly diagnosing anxiety and identifying patients who need anxiolytic therapy,” Mohannad Abu Ruz said at the annual scientific sessions of the American Heart Association.

“It's important to treat anxiety during the first 72 hours following a myocardial infarction, but few patients get their anxiety level measured following an infarction,” said Mr. Abu Ruz, a nursing-PhD candidate at the University of Kentucky in Lexington.

“There is a belief that the diagnostic instruments are time consuming and burdensome to patients, and many physicians rely on physiologic indicators of anxiety such as blood pressure and heart rate.”

The study involved 536 patients admitted for an acute MI at any of five participating hospitals in the United States and Australia. MIs were confirmed by ECG and cardiac enzymes.

Within 72 hours of admission, all patients were assessed for their anxiety level using the SAI, the standard diagnostic tool for anxiety, and by the BSI, which can be administered in 2–5 minutes.

Questions on the BSI all use simple language and are structured to ask about the patient's mental state at the time of the interview–for example, “Are you nervous at this time?”

Answers are measured on a 0–4 scale, with 0 meaning no anxiety and 4 meaning a high level of anxiety. The ideal is an answer of 0 for all six questions. For this study, a patient who scored 2 or more points on the BSI was considered anxious enough to need treatment.

A total of 261 were diagnosed as anxious using the SAI, and 262 were diagnosed as anxious by the BSI, producing a correlation coefficient of 0.7–a good level of correlation between the two measures, Mr. Abu Ruz said.

Further confirmation of the validity of BSI was based on the mean number of in-hospital complications experienced by the patients diagnosed as anxious or not anxious.

Using diagnoses based on the SAI, patients who were anxious had an average of 1.3 complications during hospitalization, compared with 0.8 complications per patient among those who were not anxious. Identical complication rates were seen when patients were categorized by the BSI, Mr. Abu Ruz reported.

MONTREAL – Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Dr. Douglas A. Drossman said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach.”

In a study of 211 patients with moderate and severe functional bowel disorder, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory). Poor coping responses, such as catastrophizing, were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that, compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms and reported having a significantly poorer quality of life.

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said. It is possible that comorbid psychosocial factors may affect perception of physical experiences, or that stress can lower the pain threshold and produce other GI symptoms.

Poor coping responses were more common in patients with severe functional bowel disorder. DR. DROSSMAN

MONTREAL – Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Dr. Douglas A. Drossman said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach.”

In a study of 211 patients with moderate and severe functional bowel disorder, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory). Poor coping responses, such as catastrophizing, were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that, compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms and reported having a significantly poorer quality of life.

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said. It is possible that comorbid psychosocial factors may affect perception of physical experiences, or that stress can lower the pain threshold and produce other GI symptoms.

Poor coping responses were more common in patients with severe functional bowel disorder. DR. DROSSMAN

MONTREAL – Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Dr. Douglas A. Drossman said at the 13th World Congress of Gastroenterology.

Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach.”

In a study of 211 patients with moderate and severe functional bowel disorder, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 versus 9.3 on the Beck Depression Inventory). Poor coping responses, such as catastrophizing, were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 versus 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).

The study also showed that, compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms and reported having a significantly poorer quality of life.

“There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms.

The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said. It is possible that comorbid psychosocial factors may affect perception of physical experiences, or that stress can lower the pain threshold and produce other GI symptoms.

Poor coping responses were more common in patients with severe functional bowel disorder. DR. DROSSMAN

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL – A total of 35% of those with polycystic ovary syndrome also had depression in a case-control study of 206 women.

“We recommend that women with PCOS should be routinely screened and adequately treated for depression,” study investigator Elizabeth M. Hollinrake said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Among women with PCOS, the odds ratio was 5.11 for newly diagnosed depression and 4.23 for depression overall (newly diagnosed and previously diagnosed depression), compared with controls who did not have polycystic ovary syndrome, said Ms. Hollinrake, a third-year medical student at the University of Iowa in Iowa City.

In an interview, the study's lead author, Dr. Anuja Dokras, noted that the results also show for the first time that depression in PCOS patients is significantly associated with both high body mass index (BMI) and insulin resistance.

“Between 50% and 70% of women who are treated for depression recover completely, so this is an important target population that we should be both screening and treating,” added Dr. Dokras, who is with the University of Iowa Hospitals and Clinics, Iowa City.

The study, which earned a first-place award among the General Program Prize Papers presented at the meeting, compared 103 women who had PCOS with 103 controls. Women with PCOS diagnosed by the Rotterdam criteria were recruited from a reproductive endocrinology clinic; women without PCOS who attend the gynecology clinic for an annual exam were used as controls.

Dr. Dokras and Ms. Hollinrake used the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire to diagnose major depressive disorder and other depressive syndromes.

The Beck Depression Inventory was used to score the severity of depression. Chi-square and t-testing were used to compare differences between women with PCOS and controls, and PCOS women with and without depression.

In the PCOS group, 35% (36 women) were classified as depressed, compared with 10.7% (11 women) of those in the control group, which represents a statistically significant difference. Of these 47 women with depression, 22 were already on antidepressants when they entered the clinic.

When these 22 women were not considered, the rate of newly diagnosed depression was 21% in the group with polycystic ovary syndrome and 3% in the control group.

Women with PCOS had a significantly higher mean BMI than did controls (34.9 versus 25.4), as did the subset of PCOS women who were depressed compared with those who had screened negative.

“Although increased BMI among the depressed women is in keeping with the literature, ours is the first study to show this correlation in depressed women with PCOS,” Dr. Dokras said.

Among the women with PCOS, 11% of those with depression also had diabetes, compared with none of the women without depression; the depressed women also had significantly higher glucose, insulin, and QUICKI scores.

“Importantly, women with PCOS have higher androgen levels, so one would have expected that if that was the basis, we would find some correlation with depression. On the contrary, these data showed no association with androgens … only with BMI and insulin resistance,” Dr. Dokras said.

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL – A total of 35% of those with polycystic ovary syndrome also had depression in a case-control study of 206 women.

“We recommend that women with PCOS should be routinely screened and adequately treated for depression,” study investigator Elizabeth M. Hollinrake said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Among women with PCOS, the odds ratio was 5.11 for newly diagnosed depression and 4.23 for depression overall (newly diagnosed and previously diagnosed depression), compared with controls who did not have polycystic ovary syndrome, said Ms. Hollinrake, a third-year medical student at the University of Iowa in Iowa City.

In an interview, the study's lead author, Dr. Anuja Dokras, noted that the results also show for the first time that depression in PCOS patients is significantly associated with both high body mass index (BMI) and insulin resistance.

“Between 50% and 70% of women who are treated for depression recover completely, so this is an important target population that we should be both screening and treating,” added Dr. Dokras, who is with the University of Iowa Hospitals and Clinics, Iowa City.

The study, which earned a first-place award among the General Program Prize Papers presented at the meeting, compared 103 women who had PCOS with 103 controls. Women with PCOS diagnosed by the Rotterdam criteria were recruited from a reproductive endocrinology clinic; women without PCOS who attend the gynecology clinic for an annual exam were used as controls.

Dr. Dokras and Ms. Hollinrake used the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire to diagnose major depressive disorder and other depressive syndromes.

The Beck Depression Inventory was used to score the severity of depression. Chi-square and t-testing were used to compare differences between women with PCOS and controls, and PCOS women with and without depression.

In the PCOS group, 35% (36 women) were classified as depressed, compared with 10.7% (11 women) of those in the control group, which represents a statistically significant difference. Of these 47 women with depression, 22 were already on antidepressants when they entered the clinic.

When these 22 women were not considered, the rate of newly diagnosed depression was 21% in the group with polycystic ovary syndrome and 3% in the control group.

Women with PCOS had a significantly higher mean BMI than did controls (34.9 versus 25.4), as did the subset of PCOS women who were depressed compared with those who had screened negative.

“Although increased BMI among the depressed women is in keeping with the literature, ours is the first study to show this correlation in depressed women with PCOS,” Dr. Dokras said.

Among the women with PCOS, 11% of those with depression also had diabetes, compared with none of the women without depression; the depressed women also had significantly higher glucose, insulin, and QUICKI scores.

“Importantly, women with PCOS have higher androgen levels, so one would have expected that if that was the basis, we would find some correlation with depression. On the contrary, these data showed no association with androgens … only with BMI and insulin resistance,” Dr. Dokras said.

Kate Johnson of the Montreal Bureau contributed to this report.

MONTREAL – A total of 35% of those with polycystic ovary syndrome also had depression in a case-control study of 206 women.

“We recommend that women with PCOS should be routinely screened and adequately treated for depression,” study investigator Elizabeth M. Hollinrake said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Among women with PCOS, the odds ratio was 5.11 for newly diagnosed depression and 4.23 for depression overall (newly diagnosed and previously diagnosed depression), compared with controls who did not have polycystic ovary syndrome, said Ms. Hollinrake, a third-year medical student at the University of Iowa in Iowa City.

In an interview, the study's lead author, Dr. Anuja Dokras, noted that the results also show for the first time that depression in PCOS patients is significantly associated with both high body mass index (BMI) and insulin resistance.

“Between 50% and 70% of women who are treated for depression recover completely, so this is an important target population that we should be both screening and treating,” added Dr. Dokras, who is with the University of Iowa Hospitals and Clinics, Iowa City.

The study, which earned a first-place award among the General Program Prize Papers presented at the meeting, compared 103 women who had PCOS with 103 controls. Women with PCOS diagnosed by the Rotterdam criteria were recruited from a reproductive endocrinology clinic; women without PCOS who attend the gynecology clinic for an annual exam were used as controls.

Dr. Dokras and Ms. Hollinrake used the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire to diagnose major depressive disorder and other depressive syndromes.

The Beck Depression Inventory was used to score the severity of depression. Chi-square and t-testing were used to compare differences between women with PCOS and controls, and PCOS women with and without depression.

In the PCOS group, 35% (36 women) were classified as depressed, compared with 10.7% (11 women) of those in the control group, which represents a statistically significant difference. Of these 47 women with depression, 22 were already on antidepressants when they entered the clinic.

When these 22 women were not considered, the rate of newly diagnosed depression was 21% in the group with polycystic ovary syndrome and 3% in the control group.

Women with PCOS had a significantly higher mean BMI than did controls (34.9 versus 25.4), as did the subset of PCOS women who were depressed compared with those who had screened negative.

“Although increased BMI among the depressed women is in keeping with the literature, ours is the first study to show this correlation in depressed women with PCOS,” Dr. Dokras said.

Among the women with PCOS, 11% of those with depression also had diabetes, compared with none of the women without depression; the depressed women also had significantly higher glucose, insulin, and QUICKI scores.

“Importantly, women with PCOS have higher androgen levels, so one would have expected that if that was the basis, we would find some correlation with depression. On the contrary, these data showed no association with androgens … only with BMI and insulin resistance,” Dr. Dokras said.