Physician Resources

Clinicians and researchers must get better at identifying Lynch syndrome because the diagnosis is so often missed, according to new AGA clinical guidelines for diagnosing and managing the disorder, published in the September issue of Gastroenterology.

Lynch syndrome, previously known as hereditary nonpolyposis colorectal cancer syndrome (HNPCC), is the most common heritable cause of colorectal cancer and also is associated with cancers of the endometrium, stomach, small intestine, pancreas, biliary tract, ovary, urinary tract, and brain. Lynch syndrome accounts for 2%-3% of all colorectal cancers in the United States, and the estimated prevalence is 1 in 440 in the general population. People with the syndrome are estimated to have a lifetime cumulative incidence of colorectal cancer approaching 80%, and affected women have an estimated 60% lifetime cumulative incidence of endometrial cancer.

The new AGA guidelines focus on identifying Lynch syndrome, both in patients without cancer who have a family history suggestive of the disorder and in all patients who develop colorectal cancer, said Dr. Joel H. Rubenstein and his associates on the clinical guidelines committee (Gastroenterology 2015 Jul. 28 [doi: 10.1053/j.gastro.2015.07.036]).

The guidelines strongly recommend that all colorectal cancers now be tested using immunohistochemistry or assessment of microsatellite instability to identify potential cases of Lynch syndrome. Given the high incidence of colorectal cancer in the United States, this recommendation in particular “may be ripe for consideration as a process measure of quality of care,” they noted.

Until now, older patients with colorectal cancer have not undergone such testing because the yield of positive results was lower than in younger patients, but now there is new appreciation that these results have a significant impact on younger family members, not just the patients themselves. From the perspective of preventing cancer in these relatives, such testing is actually cost effective, said Dr. Rubenstein of the Veterans Affairs Center for Clinical Management Research and the gastroenterology division at the University of Michigan, both in Ann Arbor, and his associates.

At present, the evidence is insufficient to recommend either of these tests above the other for identifying Lynch syndrome. The two have comparable sensitivities and specificities.

The guidelines also recommend that, in people who have no personal history of colorectal or other cancer but who have a family history that suggests Lynch syndrome, risk prediction should be performed, “rather than doing nothing.” If a first-degree relative is known to have a Lynch mutation, people should be offered germline genetic testing for that mutation. Alternatively, “if tumor tissue from an affected relative is available, the screening process should begin with testing on that tumor.”

If none of this information is available, online risk prediction models or free downloadable software incorporating such models can be used to quickly and easily estimate the probability of carrying a Lynch syndrome mutation. This approach is “imperative” to improve case finding, since it is likely that most Lynch syndrome kindreds are undiagnosed, Dr. Rubenstein and his associates said.

Such patients should be offered risk-prediction models rather than proceeding directly to germline genetic testing because of the currently high costs of genetic testing. People without cancer who have a family history suggestive of Lynch syndrome should proceed straight to germline testing if they are considered to be at high risk – for example, if they meet the highly specific Amsterdam criteria.

The AGA guidelines strongly recommend that patients identified as having Lynch syndrome undergo surveillance colonoscopy, as opposed to no surveillance. Good-quality evidence shows that this strategy decreases the overall burden of colorectal cancer and reduces disease-specific mortality. People who carry Lynch syndrome genetic mutations increase their life expectancy by 7 years if they undergo surveillance colonoscopy, and cost-effectiveness analyses indicate that the expense of such screening is lower than the expense of no screening.

The optimal screening interval for such patients has not been determined, but low-quality evidence suggests that undergoing colonoscopy every 1-2 years is the “most prudent” course and is better than doing so at longer intervals.

The guidelines also include a conditional recommendation that people found to have Lynch syndrome should be offered aspirin therapy as cancer prophylaxis. The optimal dose and frequency of aspirin use is not yet known, and there is no evidence that the treatment improves mortality, but some low-quality evidence suggests that aspirin therapy reduces the risk of colorectal and other cancers, and the risk of adverse events is quite low.

Clinicians and researchers must get better at identifying Lynch syndrome because the diagnosis is so often missed, according to new AGA clinical guidelines for diagnosing and managing the disorder, published in the September issue of Gastroenterology.

Lynch syndrome, previously known as hereditary nonpolyposis colorectal cancer syndrome (HNPCC), is the most common heritable cause of colorectal cancer and also is associated with cancers of the endometrium, stomach, small intestine, pancreas, biliary tract, ovary, urinary tract, and brain. Lynch syndrome accounts for 2%-3% of all colorectal cancers in the United States, and the estimated prevalence is 1 in 440 in the general population. People with the syndrome are estimated to have a lifetime cumulative incidence of colorectal cancer approaching 80%, and affected women have an estimated 60% lifetime cumulative incidence of endometrial cancer.

The new AGA guidelines focus on identifying Lynch syndrome, both in patients without cancer who have a family history suggestive of the disorder and in all patients who develop colorectal cancer, said Dr. Joel H. Rubenstein and his associates on the clinical guidelines committee (Gastroenterology 2015 Jul. 28 [doi: 10.1053/j.gastro.2015.07.036]).

The guidelines strongly recommend that all colorectal cancers now be tested using immunohistochemistry or assessment of microsatellite instability to identify potential cases of Lynch syndrome. Given the high incidence of colorectal cancer in the United States, this recommendation in particular “may be ripe for consideration as a process measure of quality of care,” they noted.

Until now, older patients with colorectal cancer have not undergone such testing because the yield of positive results was lower than in younger patients, but now there is new appreciation that these results have a significant impact on younger family members, not just the patients themselves. From the perspective of preventing cancer in these relatives, such testing is actually cost effective, said Dr. Rubenstein of the Veterans Affairs Center for Clinical Management Research and the gastroenterology division at the University of Michigan, both in Ann Arbor, and his associates.

At present, the evidence is insufficient to recommend either of these tests above the other for identifying Lynch syndrome. The two have comparable sensitivities and specificities.

The guidelines also recommend that, in people who have no personal history of colorectal or other cancer but who have a family history that suggests Lynch syndrome, risk prediction should be performed, “rather than doing nothing.” If a first-degree relative is known to have a Lynch mutation, people should be offered germline genetic testing for that mutation. Alternatively, “if tumor tissue from an affected relative is available, the screening process should begin with testing on that tumor.”

If none of this information is available, online risk prediction models or free downloadable software incorporating such models can be used to quickly and easily estimate the probability of carrying a Lynch syndrome mutation. This approach is “imperative” to improve case finding, since it is likely that most Lynch syndrome kindreds are undiagnosed, Dr. Rubenstein and his associates said.

Such patients should be offered risk-prediction models rather than proceeding directly to germline genetic testing because of the currently high costs of genetic testing. People without cancer who have a family history suggestive of Lynch syndrome should proceed straight to germline testing if they are considered to be at high risk – for example, if they meet the highly specific Amsterdam criteria.

The AGA guidelines strongly recommend that patients identified as having Lynch syndrome undergo surveillance colonoscopy, as opposed to no surveillance. Good-quality evidence shows that this strategy decreases the overall burden of colorectal cancer and reduces disease-specific mortality. People who carry Lynch syndrome genetic mutations increase their life expectancy by 7 years if they undergo surveillance colonoscopy, and cost-effectiveness analyses indicate that the expense of such screening is lower than the expense of no screening.

The optimal screening interval for such patients has not been determined, but low-quality evidence suggests that undergoing colonoscopy every 1-2 years is the “most prudent” course and is better than doing so at longer intervals.

The guidelines also include a conditional recommendation that people found to have Lynch syndrome should be offered aspirin therapy as cancer prophylaxis. The optimal dose and frequency of aspirin use is not yet known, and there is no evidence that the treatment improves mortality, but some low-quality evidence suggests that aspirin therapy reduces the risk of colorectal and other cancers, and the risk of adverse events is quite low.

Clinicians and researchers must get better at identifying Lynch syndrome because the diagnosis is so often missed, according to new AGA clinical guidelines for diagnosing and managing the disorder, published in the September issue of Gastroenterology.

Lynch syndrome, previously known as hereditary nonpolyposis colorectal cancer syndrome (HNPCC), is the most common heritable cause of colorectal cancer and also is associated with cancers of the endometrium, stomach, small intestine, pancreas, biliary tract, ovary, urinary tract, and brain. Lynch syndrome accounts for 2%-3% of all colorectal cancers in the United States, and the estimated prevalence is 1 in 440 in the general population. People with the syndrome are estimated to have a lifetime cumulative incidence of colorectal cancer approaching 80%, and affected women have an estimated 60% lifetime cumulative incidence of endometrial cancer.

The new AGA guidelines focus on identifying Lynch syndrome, both in patients without cancer who have a family history suggestive of the disorder and in all patients who develop colorectal cancer, said Dr. Joel H. Rubenstein and his associates on the clinical guidelines committee (Gastroenterology 2015 Jul. 28 [doi: 10.1053/j.gastro.2015.07.036]).

The guidelines strongly recommend that all colorectal cancers now be tested using immunohistochemistry or assessment of microsatellite instability to identify potential cases of Lynch syndrome. Given the high incidence of colorectal cancer in the United States, this recommendation in particular “may be ripe for consideration as a process measure of quality of care,” they noted.

Until now, older patients with colorectal cancer have not undergone such testing because the yield of positive results was lower than in younger patients, but now there is new appreciation that these results have a significant impact on younger family members, not just the patients themselves. From the perspective of preventing cancer in these relatives, such testing is actually cost effective, said Dr. Rubenstein of the Veterans Affairs Center for Clinical Management Research and the gastroenterology division at the University of Michigan, both in Ann Arbor, and his associates.

At present, the evidence is insufficient to recommend either of these tests above the other for identifying Lynch syndrome. The two have comparable sensitivities and specificities.

The guidelines also recommend that, in people who have no personal history of colorectal or other cancer but who have a family history that suggests Lynch syndrome, risk prediction should be performed, “rather than doing nothing.” If a first-degree relative is known to have a Lynch mutation, people should be offered germline genetic testing for that mutation. Alternatively, “if tumor tissue from an affected relative is available, the screening process should begin with testing on that tumor.”

If none of this information is available, online risk prediction models or free downloadable software incorporating such models can be used to quickly and easily estimate the probability of carrying a Lynch syndrome mutation. This approach is “imperative” to improve case finding, since it is likely that most Lynch syndrome kindreds are undiagnosed, Dr. Rubenstein and his associates said.

Such patients should be offered risk-prediction models rather than proceeding directly to germline genetic testing because of the currently high costs of genetic testing. People without cancer who have a family history suggestive of Lynch syndrome should proceed straight to germline testing if they are considered to be at high risk – for example, if they meet the highly specific Amsterdam criteria.

The AGA guidelines strongly recommend that patients identified as having Lynch syndrome undergo surveillance colonoscopy, as opposed to no surveillance. Good-quality evidence shows that this strategy decreases the overall burden of colorectal cancer and reduces disease-specific mortality. People who carry Lynch syndrome genetic mutations increase their life expectancy by 7 years if they undergo surveillance colonoscopy, and cost-effectiveness analyses indicate that the expense of such screening is lower than the expense of no screening.

The optimal screening interval for such patients has not been determined, but low-quality evidence suggests that undergoing colonoscopy every 1-2 years is the “most prudent” course and is better than doing so at longer intervals.

The guidelines also include a conditional recommendation that people found to have Lynch syndrome should be offered aspirin therapy as cancer prophylaxis. The optimal dose and frequency of aspirin use is not yet known, and there is no evidence that the treatment improves mortality, but some low-quality evidence suggests that aspirin therapy reduces the risk of colorectal and other cancers, and the risk of adverse events is quite low.

The newest guidelines for testing, managing, and treating hepatitis C infections in adults are part of a “living document” – a constantly updated online resource that reflects the ever-changing world of hepatitis research.

A joint venture of the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), the document puts cutting-edge science in the hands of clinicians, Dr. Gary L. Davis wrote (Hepatology 2015 June 25 [doi:10.1002/hep.27950]). The continuously updated version may be accessed at any time at www.hcvguidelines.org.

“The pace of hepatitis C virus (HCV) drug development in recent years has accelerated dramatically,” wrote Dr. Davis, cochair for the AASLD/IDSA HCV Guidance writing group. “Such information and advice can be difficult to access readily given the diverse sources from which information is available, and the sometimes lengthy time needed for publication of original articles and scholarly perspectives. Traditional practice guidelines for more established areas of medicine and care often take years to develop and bring to publication. In the new era in hepatitis C treatment, such a process would not be nimble or timely enough to address the needs of patients with HCV infection, practitioners caring for these patients, or payers approving therapies for use.”

The online guidelines “will undergo real-time revisions as the field evolves,” Dr. Davis noted. A panel of 26 hepatologists and infectious diseases specialists and a patient advocate developed the original consensus recommendations.

The new update contains recommendations for direct antiviral drug regimens in treatment-naive patients and for all six HCV genotypes. A second section examines the recommended regimens for patients who have failed treatment with PEG-interferon and ribavirin, with or without a direct antiviral agent.

The document also gives guidance for managing patients with and without a sustained viral response and concludes with a section on treating special patient populations (decompensated cirrhosis, post-transplant HCV infections, renal impairment, and coinfection with HIV).

msullivan@frontlinemedcom.com

On Twitter @Alz_Gal

The newest guidelines for testing, managing, and treating hepatitis C infections in adults are part of a “living document” – a constantly updated online resource that reflects the ever-changing world of hepatitis research.

A joint venture of the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), the document puts cutting-edge science in the hands of clinicians, Dr. Gary L. Davis wrote (Hepatology 2015 June 25 [doi:10.1002/hep.27950]). The continuously updated version may be accessed at any time at www.hcvguidelines.org.

“The pace of hepatitis C virus (HCV) drug development in recent years has accelerated dramatically,” wrote Dr. Davis, cochair for the AASLD/IDSA HCV Guidance writing group. “Such information and advice can be difficult to access readily given the diverse sources from which information is available, and the sometimes lengthy time needed for publication of original articles and scholarly perspectives. Traditional practice guidelines for more established areas of medicine and care often take years to develop and bring to publication. In the new era in hepatitis C treatment, such a process would not be nimble or timely enough to address the needs of patients with HCV infection, practitioners caring for these patients, or payers approving therapies for use.”

The online guidelines “will undergo real-time revisions as the field evolves,” Dr. Davis noted. A panel of 26 hepatologists and infectious diseases specialists and a patient advocate developed the original consensus recommendations.

The new update contains recommendations for direct antiviral drug regimens in treatment-naive patients and for all six HCV genotypes. A second section examines the recommended regimens for patients who have failed treatment with PEG-interferon and ribavirin, with or without a direct antiviral agent.

The document also gives guidance for managing patients with and without a sustained viral response and concludes with a section on treating special patient populations (decompensated cirrhosis, post-transplant HCV infections, renal impairment, and coinfection with HIV).

msullivan@frontlinemedcom.com

On Twitter @Alz_Gal

The newest guidelines for testing, managing, and treating hepatitis C infections in adults are part of a “living document” – a constantly updated online resource that reflects the ever-changing world of hepatitis research.

A joint venture of the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), the document puts cutting-edge science in the hands of clinicians, Dr. Gary L. Davis wrote (Hepatology 2015 June 25 [doi:10.1002/hep.27950]). The continuously updated version may be accessed at any time at www.hcvguidelines.org.

“The pace of hepatitis C virus (HCV) drug development in recent years has accelerated dramatically,” wrote Dr. Davis, cochair for the AASLD/IDSA HCV Guidance writing group. “Such information and advice can be difficult to access readily given the diverse sources from which information is available, and the sometimes lengthy time needed for publication of original articles and scholarly perspectives. Traditional practice guidelines for more established areas of medicine and care often take years to develop and bring to publication. In the new era in hepatitis C treatment, such a process would not be nimble or timely enough to address the needs of patients with HCV infection, practitioners caring for these patients, or payers approving therapies for use.”

The online guidelines “will undergo real-time revisions as the field evolves,” Dr. Davis noted. A panel of 26 hepatologists and infectious diseases specialists and a patient advocate developed the original consensus recommendations.

The new update contains recommendations for direct antiviral drug regimens in treatment-naive patients and for all six HCV genotypes. A second section examines the recommended regimens for patients who have failed treatment with PEG-interferon and ribavirin, with or without a direct antiviral agent.

The document also gives guidance for managing patients with and without a sustained viral response and concludes with a section on treating special patient populations (decompensated cirrhosis, post-transplant HCV infections, renal impairment, and coinfection with HIV).

msullivan@frontlinemedcom.com

On Twitter @Alz_Gal

Pharmaceutical manufacturer Merck & Co. is ceasing print publication of the Merck Manuals, a popular series of reference books, but the long-running publication will continue on in all-digital format starting this month.

The company first published the original Merck Manual for doctors in 1898 and has updated the manual 18 times, most recently in 2011. The new all-digital edition, which includes separate pages on medical conditions for patients and health care providers, will be available online at no charge, and no registration is required to view the new content.

“Merck will no longer publish the Merck Manuals, at least not on paper,” explained Editor-in-Chief Robert S. Porter. “We are continually updating our content and publishing it online as soon as it is ready, so we make no distinction among ‘editions.’ Our sole distinction is audience.”

Find the newly published reference books here: http://www.merckmanuals.com/.

mbock@frontlinemedcom.com

Pharmaceutical manufacturer Merck & Co. is ceasing print publication of the Merck Manuals, a popular series of reference books, but the long-running publication will continue on in all-digital format starting this month.

The company first published the original Merck Manual for doctors in 1898 and has updated the manual 18 times, most recently in 2011. The new all-digital edition, which includes separate pages on medical conditions for patients and health care providers, will be available online at no charge, and no registration is required to view the new content.

“Merck will no longer publish the Merck Manuals, at least not on paper,” explained Editor-in-Chief Robert S. Porter. “We are continually updating our content and publishing it online as soon as it is ready, so we make no distinction among ‘editions.’ Our sole distinction is audience.”

Find the newly published reference books here: http://www.merckmanuals.com/.

mbock@frontlinemedcom.com

Pharmaceutical manufacturer Merck & Co. is ceasing print publication of the Merck Manuals, a popular series of reference books, but the long-running publication will continue on in all-digital format starting this month.

The company first published the original Merck Manual for doctors in 1898 and has updated the manual 18 times, most recently in 2011. The new all-digital edition, which includes separate pages on medical conditions for patients and health care providers, will be available online at no charge, and no registration is required to view the new content.

“Merck will no longer publish the Merck Manuals, at least not on paper,” explained Editor-in-Chief Robert S. Porter. “We are continually updating our content and publishing it online as soon as it is ready, so we make no distinction among ‘editions.’ Our sole distinction is audience.”

Find the newly published reference books here: http://www.merckmanuals.com/.

mbock@frontlinemedcom.com

The Suicide Prevention Resource Center (SPRC) has released Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments.

The Suicide Prevention Resource Center (SPRC) is the nation’s only federally-supported resource center devoted to advancing the National Strategy for Suicide Prevention. The guide includes evidence-based practices in decision support, initial interventions, and discharge planning for adults who have been identified as having some risk of suicide.

“Emergency departments are prime sites for suicide prevention activities in the U.S., but until now clinicians have not had tools to help them steer patients toward treatment options that best meet their health and safety needs,”  Pamela S. Hyde, Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA) said in a press release.

Funded by SAMHSA, the guide was based on a literature review and developed by a consensus panel of experts from emergency medicine and suicide prevention organizations, as well as individuals who have lived through suicide attempts and suicidal thoughts or feelings.

The ED Guide is endorsed by the American Academy of Emergency Medicine, American Association for Emergency Psychiatry, American Association of Suicidology, and the American Foundation for Suicide Prevention.

SAMHSA’s National Survey on Drug Use and Health indicates that 1.3 million adults aged 18 or older (0.6 percent) attempted suicide in the past year. According to the Centers for Disease Control and Prevention, more than 41,000 individuals died by suicide in 2013. Suicides are the 10th leading cause of death in the U.S.

The ED Guide addresses specific objectives articulated by the 2012 National Strategy for Suicide Prevention, namely, to promote a continuum of care, safety, and well-being for ED patients treated for suicide risk; to collaborate with other health care providers to provide rapid and appropriate follow-up treatment; and to develop standardized protocols that direct clinical responses based on individual patient risk profiles.

The Suicide Prevention Resource Center (SPRC) has released Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments.

The Suicide Prevention Resource Center (SPRC) is the nation’s only federally-supported resource center devoted to advancing the National Strategy for Suicide Prevention. The guide includes evidence-based practices in decision support, initial interventions, and discharge planning for adults who have been identified as having some risk of suicide.

“Emergency departments are prime sites for suicide prevention activities in the U.S., but until now clinicians have not had tools to help them steer patients toward treatment options that best meet their health and safety needs,”  Pamela S. Hyde, Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA) said in a press release.

Funded by SAMHSA, the guide was based on a literature review and developed by a consensus panel of experts from emergency medicine and suicide prevention organizations, as well as individuals who have lived through suicide attempts and suicidal thoughts or feelings.

The ED Guide is endorsed by the American Academy of Emergency Medicine, American Association for Emergency Psychiatry, American Association of Suicidology, and the American Foundation for Suicide Prevention.

SAMHSA’s National Survey on Drug Use and Health indicates that 1.3 million adults aged 18 or older (0.6 percent) attempted suicide in the past year. According to the Centers for Disease Control and Prevention, more than 41,000 individuals died by suicide in 2013. Suicides are the 10th leading cause of death in the U.S.

The ED Guide addresses specific objectives articulated by the 2012 National Strategy for Suicide Prevention, namely, to promote a continuum of care, safety, and well-being for ED patients treated for suicide risk; to collaborate with other health care providers to provide rapid and appropriate follow-up treatment; and to develop standardized protocols that direct clinical responses based on individual patient risk profiles.

The Suicide Prevention Resource Center (SPRC) has released Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments.

The Suicide Prevention Resource Center (SPRC) is the nation’s only federally-supported resource center devoted to advancing the National Strategy for Suicide Prevention. The guide includes evidence-based practices in decision support, initial interventions, and discharge planning for adults who have been identified as having some risk of suicide.

“Emergency departments are prime sites for suicide prevention activities in the U.S., but until now clinicians have not had tools to help them steer patients toward treatment options that best meet their health and safety needs,”  Pamela S. Hyde, Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA) said in a press release.

Funded by SAMHSA, the guide was based on a literature review and developed by a consensus panel of experts from emergency medicine and suicide prevention organizations, as well as individuals who have lived through suicide attempts and suicidal thoughts or feelings.

The ED Guide is endorsed by the American Academy of Emergency Medicine, American Association for Emergency Psychiatry, American Association of Suicidology, and the American Foundation for Suicide Prevention.

SAMHSA’s National Survey on Drug Use and Health indicates that 1.3 million adults aged 18 or older (0.6 percent) attempted suicide in the past year. According to the Centers for Disease Control and Prevention, more than 41,000 individuals died by suicide in 2013. Suicides are the 10th leading cause of death in the U.S.

The ED Guide addresses specific objectives articulated by the 2012 National Strategy for Suicide Prevention, namely, to promote a continuum of care, safety, and well-being for ED patients treated for suicide risk; to collaborate with other health care providers to provide rapid and appropriate follow-up treatment; and to develop standardized protocols that direct clinical responses based on individual patient risk profiles.

For children as young as 2 years old, interventions such as behavioral therapy, flavored throat spray, a specialized pill cup, simple verbal instructions, and head-posture training were successful in improving pill swallowing abilities for more than half of the study population, according to the results of a data review published in Pediatrics.

Amee Patel, M.P.H., and her associates at the University of North Carolina at Chapel Hill, examined data from 211 articles identified in a PubMed search published between December 1986 and December 2013. Four cohort studies and one case series met the criteria for inclusion. Each of the studies concluded that pill acceptance rates were improved shortly after their intervention, with three studies reporting pill acceptance continuing for 3-6 months after the intervention.

“A major reason for the success of all the interventions is that every study recognized and specifically addressed problems with pill swallowing. As a result, there was a conscious effort to help children with their difficulties in swallowing pills,” the investigators wrote.

Read the entire article here: Pediatrics 2015 (doi: 10.1542/peds.2014-2114).

For children as young as 2 years old, interventions such as behavioral therapy, flavored throat spray, a specialized pill cup, simple verbal instructions, and head-posture training were successful in improving pill swallowing abilities for more than half of the study population, according to the results of a data review published in Pediatrics.

Amee Patel, M.P.H., and her associates at the University of North Carolina at Chapel Hill, examined data from 211 articles identified in a PubMed search published between December 1986 and December 2013. Four cohort studies and one case series met the criteria for inclusion. Each of the studies concluded that pill acceptance rates were improved shortly after their intervention, with three studies reporting pill acceptance continuing for 3-6 months after the intervention.

“A major reason for the success of all the interventions is that every study recognized and specifically addressed problems with pill swallowing. As a result, there was a conscious effort to help children with their difficulties in swallowing pills,” the investigators wrote.

Read the entire article here: Pediatrics 2015 (doi: 10.1542/peds.2014-2114).

For children as young as 2 years old, interventions such as behavioral therapy, flavored throat spray, a specialized pill cup, simple verbal instructions, and head-posture training were successful in improving pill swallowing abilities for more than half of the study population, according to the results of a data review published in Pediatrics.

Amee Patel, M.P.H., and her associates at the University of North Carolina at Chapel Hill, examined data from 211 articles identified in a PubMed search published between December 1986 and December 2013. Four cohort studies and one case series met the criteria for inclusion. Each of the studies concluded that pill acceptance rates were improved shortly after their intervention, with three studies reporting pill acceptance continuing for 3-6 months after the intervention.

“A major reason for the success of all the interventions is that every study recognized and specifically addressed problems with pill swallowing. As a result, there was a conscious effort to help children with their difficulties in swallowing pills,” the investigators wrote.

Read the entire article here: Pediatrics 2015 (doi: 10.1542/peds.2014-2114).

A new guide on the use of medications to treat patients with alcohol use disorder has been released by the Substance Abuse and Mental Health Services Administration in conjunction with National Alcohol Awareness Month.

The guide provides an overview of four Food and Drug Administration–approved drugs developed to treat alcohol use disorder: disulfiram, oral naltrexone, extended-release injectable naltrexone, and acamprosate. It also discusses how to screen, treat, and monitor patients based on their individual needs.

“Current evidence shows that medications are underused in the treatment of alcohol use disorder,” the agency said in a statement announcing the new guidance. “As the Patient Protection and Affordable Care Act (ACA) continues to be implemented, there is considerable potential for expanding use of medication-assisted treatment to treat alcohol use disorder,” they concluded.

The guide can be found online at http://store.samhsa.gov.

A new guide on the use of medications to treat patients with alcohol use disorder has been released by the Substance Abuse and Mental Health Services Administration in conjunction with National Alcohol Awareness Month.

The guide provides an overview of four Food and Drug Administration–approved drugs developed to treat alcohol use disorder: disulfiram, oral naltrexone, extended-release injectable naltrexone, and acamprosate. It also discusses how to screen, treat, and monitor patients based on their individual needs.

“Current evidence shows that medications are underused in the treatment of alcohol use disorder,” the agency said in a statement announcing the new guidance. “As the Patient Protection and Affordable Care Act (ACA) continues to be implemented, there is considerable potential for expanding use of medication-assisted treatment to treat alcohol use disorder,” they concluded.

The guide can be found online at http://store.samhsa.gov.

A new guide on the use of medications to treat patients with alcohol use disorder has been released by the Substance Abuse and Mental Health Services Administration in conjunction with National Alcohol Awareness Month.

The guide provides an overview of four Food and Drug Administration–approved drugs developed to treat alcohol use disorder: disulfiram, oral naltrexone, extended-release injectable naltrexone, and acamprosate. It also discusses how to screen, treat, and monitor patients based on their individual needs.

“Current evidence shows that medications are underused in the treatment of alcohol use disorder,” the agency said in a statement announcing the new guidance. “As the Patient Protection and Affordable Care Act (ACA) continues to be implemented, there is considerable potential for expanding use of medication-assisted treatment to treat alcohol use disorder,” they concluded.

The guide can be found online at http://store.samhsa.gov.

Citing a lack of evidence for its effectiveness, the American Academy of Pediatrics opposes school-based drug testing as a means of preventing substance abuse, although the AAP recognizes the need for school-based services for adolescents with substance use disorders, the organization announced in a statement.

Although a recently published study found that students subjected to school-based drug testing reported significantly lower rates of marijuana and other illicit drug use over a 30-day period, compared with students from schools without school-based drug testing, the AAP noted that students with substance abuse problems could be more likely to skip school to avoid testing, or simply use another drug, such as alcohol. Instead, the AAP recommends that schools should focus on enrolling adolescents with substance use disorders in substance abuse prevention programs and other intervention programs and referral systems (Pediatrics 2015 [doi:10.1542/peds.2015-0054]). “Using limited resources to provide advice, counseling, and even on-site treatment of adolescents could both serve a preventive role and increase the number of adolescents who have their substance use disorders addressed and ultimately have a larger effect on reducing student drug use than drug testing alone. The two strategies have never been compared in a scientific study,” according to the AAP statement.

Citing a lack of evidence for its effectiveness, the American Academy of Pediatrics opposes school-based drug testing as a means of preventing substance abuse, although the AAP recognizes the need for school-based services for adolescents with substance use disorders, the organization announced in a statement.

Although a recently published study found that students subjected to school-based drug testing reported significantly lower rates of marijuana and other illicit drug use over a 30-day period, compared with students from schools without school-based drug testing, the AAP noted that students with substance abuse problems could be more likely to skip school to avoid testing, or simply use another drug, such as alcohol. Instead, the AAP recommends that schools should focus on enrolling adolescents with substance use disorders in substance abuse prevention programs and other intervention programs and referral systems (Pediatrics 2015 [doi:10.1542/peds.2015-0054]). “Using limited resources to provide advice, counseling, and even on-site treatment of adolescents could both serve a preventive role and increase the number of adolescents who have their substance use disorders addressed and ultimately have a larger effect on reducing student drug use than drug testing alone. The two strategies have never been compared in a scientific study,” according to the AAP statement.

Citing a lack of evidence for its effectiveness, the American Academy of Pediatrics opposes school-based drug testing as a means of preventing substance abuse, although the AAP recognizes the need for school-based services for adolescents with substance use disorders, the organization announced in a statement.

Although a recently published study found that students subjected to school-based drug testing reported significantly lower rates of marijuana and other illicit drug use over a 30-day period, compared with students from schools without school-based drug testing, the AAP noted that students with substance abuse problems could be more likely to skip school to avoid testing, or simply use another drug, such as alcohol. Instead, the AAP recommends that schools should focus on enrolling adolescents with substance use disorders in substance abuse prevention programs and other intervention programs and referral systems (Pediatrics 2015 [doi:10.1542/peds.2015-0054]). “Using limited resources to provide advice, counseling, and even on-site treatment of adolescents could both serve a preventive role and increase the number of adolescents who have their substance use disorders addressed and ultimately have a larger effect on reducing student drug use than drug testing alone. The two strategies have never been compared in a scientific study,” according to the AAP statement.

The American Academy of Orthopaedic Surgeons’ new guideline on the diagnosis and treatment of hip fractures in elderly patients targets problem areas such as postoperative delirium and pain management.

The clinical practice guideline, “Management of Hip Fractures in the Elderly,” addresses hip fractures in patients age 65 years and older and offers recommendations on issues such as the timing of surgery and the use of vitamin D.

© iStock / ThinkStockPhotos.com

The AAOS also hopes the guideline will expose gaps in the body of research literature that should be addressed in future studies. The guideline has been endorsed by the American Geriatrics Society, the U.S. Bone and Joint Initiative, the Orthopaedic Trauma Association, the American Association of Clinical Endocrinologists, and the Hip Society.

The guideline’s recommendations include:

• Regional analgesia should be used to improve preoperative pain control in patients with hip fracture.

• MRI should be the advanced imaging of choice for diagnosis of presumed hip fracture not apparent on initial radiographs.

• Hip fracture surgery should be performed within 48 hours of admission.

• An interdisciplinary care program should be utilized for patients with mild to moderate dementia who have sustained a hip fracture.

• Supplemental vitamin D and calcium should be given to patients following hip fracture surgery.

• Patients should be evaluated and treated for osteoporosis after sustaining a hip fracture.

To read the entire guideline document, click here: www.aaos.org/research/guidelines/HipFxGuideline.pdf.

The American Academy of Orthopaedic Surgeons’ new guideline on the diagnosis and treatment of hip fractures in elderly patients targets problem areas such as postoperative delirium and pain management.

The clinical practice guideline, “Management of Hip Fractures in the Elderly,” addresses hip fractures in patients age 65 years and older and offers recommendations on issues such as the timing of surgery and the use of vitamin D.

© iStock / ThinkStockPhotos.com

The AAOS also hopes the guideline will expose gaps in the body of research literature that should be addressed in future studies. The guideline has been endorsed by the American Geriatrics Society, the U.S. Bone and Joint Initiative, the Orthopaedic Trauma Association, the American Association of Clinical Endocrinologists, and the Hip Society.

The guideline’s recommendations include:

• Regional analgesia should be used to improve preoperative pain control in patients with hip fracture.

• MRI should be the advanced imaging of choice for diagnosis of presumed hip fracture not apparent on initial radiographs.

• Hip fracture surgery should be performed within 48 hours of admission.

• An interdisciplinary care program should be utilized for patients with mild to moderate dementia who have sustained a hip fracture.

• Supplemental vitamin D and calcium should be given to patients following hip fracture surgery.

• Patients should be evaluated and treated for osteoporosis after sustaining a hip fracture.

To read the entire guideline document, click here: www.aaos.org/research/guidelines/HipFxGuideline.pdf.

The American Academy of Orthopaedic Surgeons’ new guideline on the diagnosis and treatment of hip fractures in elderly patients targets problem areas such as postoperative delirium and pain management.

The clinical practice guideline, “Management of Hip Fractures in the Elderly,” addresses hip fractures in patients age 65 years and older and offers recommendations on issues such as the timing of surgery and the use of vitamin D.

© iStock / ThinkStockPhotos.com

The AAOS also hopes the guideline will expose gaps in the body of research literature that should be addressed in future studies. The guideline has been endorsed by the American Geriatrics Society, the U.S. Bone and Joint Initiative, the Orthopaedic Trauma Association, the American Association of Clinical Endocrinologists, and the Hip Society.

The guideline’s recommendations include:

• Regional analgesia should be used to improve preoperative pain control in patients with hip fracture.

• MRI should be the advanced imaging of choice for diagnosis of presumed hip fracture not apparent on initial radiographs.

• Hip fracture surgery should be performed within 48 hours of admission.

• An interdisciplinary care program should be utilized for patients with mild to moderate dementia who have sustained a hip fracture.

• Supplemental vitamin D and calcium should be given to patients following hip fracture surgery.

• Patients should be evaluated and treated for osteoporosis after sustaining a hip fracture.

To read the entire guideline document, click here: www.aaos.org/research/guidelines/HipFxGuideline.pdf.

WASHINGTON – Primary care providers are being urged by a federal agency to heighten their sensitivities to patients at risk for suicide.

Citing data that nearly half of all persons who died by suicide had seen a primary care provider within the month prior to their death, Pamela S. Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration, overseen by the U.S. Department of Health & Human Services, today announced the launch of the Suicide Safe app, a free risk-assessment tool for providers to screen patients at risk for suicide.

According to Ms. Hyde, who spoke during a SAMHSA news briefing, suicide is the leading cause of death in the United States among those aged 15-29 years, with one person dying of suicide every 13 minutes. Ms. Hyde also noted that suicide was seen to trend upward between the years 1999 and 2010 when the age-adjusted suicide rate for people aged 35-64 years increased 28%.

“Our offices are the key access points where we can start to identify these patients,” said Dr. Fabian Sandoval, a Washington-based researcher and clinical protocols consultant who spoke at the news briefing. “But we are not the experts, we are not the psychiatrists, so what are we going to do?”

Dr. Sandoval said the tool would support the generations of primary care providers, including advance practice nurses and physician assistants, who did not receive any formal mental or behavioral health care training, which he said was most of the “old guard” in medicine.

Based on the SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) protocols developed by Dr. Douglas Jacobs of the department of psychiatry at Harvard Medical School, Boston, and the chair of the American Psychiatric Association Practice Guidelines on Suicide, the app helps identify at-risk patients and find local facilities where patients can be referred for emergent or other treatment.

“If I am a primary care provider who doesn’t feel adequately prepared to deal with a patient in the middle of a suicidal crisis, I can use the treatment locator to find a specialized behavioral health provider within a certain radius and immediately link to that person right off the app and get that patient in for an appointment or an emergency visit,” Robert Carrol, an advanced practice registered nurse and a member of the app’s research and development team, said in an interview.

“It’s a tool that can bridge that gap of fear that often prevents providers from even opening the conversation. That’s always the first challenge, providers not wanting to ‘go there’ because they don’t want to answer a question that they won’t know how to answer or respond to.”

Starting the conversation in an open-ended way is crucial to getting a patient to speak honestly about his or her condition, Dr. Mitra Ahadpour, a primary care physician from Germantown, Md., and a clinical communications consultant with SAMHSA, said in an interview. “The open-ended question prompts in the app are very important. We have research that shows closed-ended questions turn the patient off, questions such as ‘You’re not thinking of killing yourself, are you?’ Instead, keep it very simple. Ask, ‘How are you doing today? Then take a second to see what they say.”

Even if primary care physicians are willing to ask and respond to their patients in acute danger of suicide, there is still the need to ensure that even if patients are referred to the appropriate facility, that there is enough room to accommodate them, according to Dr. Sandoval. “We’ll be able to identify more patients who are in suicidal situations than before, but now what? What do we do with this patient? That is a question we have to [address] as well.”

Incorporating the app into clinical practice should not be difficult and could even help encourage a physician to treat the patient him- or herself if the risk for suicide is found to be low, according to Dr. Ahadpour. “There are many points in the system where the app can be integrated. The PHQ-9 (patient health questionnaire that screens for depression) is included in the app, and you can have your patients fill that out ahead of time,” Dr. Ahadpour, who was not on the news briefing panel, said in an interview. “That way the clinician will already know if there is a need to take things to the second step or [assess] for a suicidal risk. If the provider feels comfortable that there is no risk for suicide, then they can treat the patient for depression, for example.” If they do not feel comfortable treating the patient, then “at least they have assessed the patient,” she added. Validated evaluation tools for other mental health conditions, including one for general anxiety disorder are also included in the app, Dr. Ahadpour said. Depression and anxiety are two major risk factors for suicidal ideation.

When asked by a reporter about how primary care physicians should bill their time for using the app, Mr. Carroll said the app included IDC-9 and ICD-10 codes.

For more information about the app, visit SAMHSA’s website.

Dr. Jacobs said the app is freely available at any smart phone app store.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Primary care providers are being urged by a federal agency to heighten their sensitivities to patients at risk for suicide.

Citing data that nearly half of all persons who died by suicide had seen a primary care provider within the month prior to their death, Pamela S. Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration, overseen by the U.S. Department of Health & Human Services, today announced the launch of the Suicide Safe app, a free risk-assessment tool for providers to screen patients at risk for suicide.

According to Ms. Hyde, who spoke during a SAMHSA news briefing, suicide is the leading cause of death in the United States among those aged 15-29 years, with one person dying of suicide every 13 minutes. Ms. Hyde also noted that suicide was seen to trend upward between the years 1999 and 2010 when the age-adjusted suicide rate for people aged 35-64 years increased 28%.

“Our offices are the key access points where we can start to identify these patients,” said Dr. Fabian Sandoval, a Washington-based researcher and clinical protocols consultant who spoke at the news briefing. “But we are not the experts, we are not the psychiatrists, so what are we going to do?”

Dr. Sandoval said the tool would support the generations of primary care providers, including advance practice nurses and physician assistants, who did not receive any formal mental or behavioral health care training, which he said was most of the “old guard” in medicine.

Based on the SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) protocols developed by Dr. Douglas Jacobs of the department of psychiatry at Harvard Medical School, Boston, and the chair of the American Psychiatric Association Practice Guidelines on Suicide, the app helps identify at-risk patients and find local facilities where patients can be referred for emergent or other treatment.

“If I am a primary care provider who doesn’t feel adequately prepared to deal with a patient in the middle of a suicidal crisis, I can use the treatment locator to find a specialized behavioral health provider within a certain radius and immediately link to that person right off the app and get that patient in for an appointment or an emergency visit,” Robert Carrol, an advanced practice registered nurse and a member of the app’s research and development team, said in an interview.

“It’s a tool that can bridge that gap of fear that often prevents providers from even opening the conversation. That’s always the first challenge, providers not wanting to ‘go there’ because they don’t want to answer a question that they won’t know how to answer or respond to.”

Starting the conversation in an open-ended way is crucial to getting a patient to speak honestly about his or her condition, Dr. Mitra Ahadpour, a primary care physician from Germantown, Md., and a clinical communications consultant with SAMHSA, said in an interview. “The open-ended question prompts in the app are very important. We have research that shows closed-ended questions turn the patient off, questions such as ‘You’re not thinking of killing yourself, are you?’ Instead, keep it very simple. Ask, ‘How are you doing today? Then take a second to see what they say.”

Even if primary care physicians are willing to ask and respond to their patients in acute danger of suicide, there is still the need to ensure that even if patients are referred to the appropriate facility, that there is enough room to accommodate them, according to Dr. Sandoval. “We’ll be able to identify more patients who are in suicidal situations than before, but now what? What do we do with this patient? That is a question we have to [address] as well.”

Incorporating the app into clinical practice should not be difficult and could even help encourage a physician to treat the patient him- or herself if the risk for suicide is found to be low, according to Dr. Ahadpour. “There are many points in the system where the app can be integrated. The PHQ-9 (patient health questionnaire that screens for depression) is included in the app, and you can have your patients fill that out ahead of time,” Dr. Ahadpour, who was not on the news briefing panel, said in an interview. “That way the clinician will already know if there is a need to take things to the second step or [assess] for a suicidal risk. If the provider feels comfortable that there is no risk for suicide, then they can treat the patient for depression, for example.” If they do not feel comfortable treating the patient, then “at least they have assessed the patient,” she added. Validated evaluation tools for other mental health conditions, including one for general anxiety disorder are also included in the app, Dr. Ahadpour said. Depression and anxiety are two major risk factors for suicidal ideation.

When asked by a reporter about how primary care physicians should bill their time for using the app, Mr. Carroll said the app included IDC-9 and ICD-10 codes.

For more information about the app, visit SAMHSA’s website.

Dr. Jacobs said the app is freely available at any smart phone app store.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Primary care providers are being urged by a federal agency to heighten their sensitivities to patients at risk for suicide.

Citing data that nearly half of all persons who died by suicide had seen a primary care provider within the month prior to their death, Pamela S. Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration, overseen by the U.S. Department of Health & Human Services, today announced the launch of the Suicide Safe app, a free risk-assessment tool for providers to screen patients at risk for suicide.

According to Ms. Hyde, who spoke during a SAMHSA news briefing, suicide is the leading cause of death in the United States among those aged 15-29 years, with one person dying of suicide every 13 minutes. Ms. Hyde also noted that suicide was seen to trend upward between the years 1999 and 2010 when the age-adjusted suicide rate for people aged 35-64 years increased 28%.

“Our offices are the key access points where we can start to identify these patients,” said Dr. Fabian Sandoval, a Washington-based researcher and clinical protocols consultant who spoke at the news briefing. “But we are not the experts, we are not the psychiatrists, so what are we going to do?”

Dr. Sandoval said the tool would support the generations of primary care providers, including advance practice nurses and physician assistants, who did not receive any formal mental or behavioral health care training, which he said was most of the “old guard” in medicine.

Based on the SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) protocols developed by Dr. Douglas Jacobs of the department of psychiatry at Harvard Medical School, Boston, and the chair of the American Psychiatric Association Practice Guidelines on Suicide, the app helps identify at-risk patients and find local facilities where patients can be referred for emergent or other treatment.

“If I am a primary care provider who doesn’t feel adequately prepared to deal with a patient in the middle of a suicidal crisis, I can use the treatment locator to find a specialized behavioral health provider within a certain radius and immediately link to that person right off the app and get that patient in for an appointment or an emergency visit,” Robert Carrol, an advanced practice registered nurse and a member of the app’s research and development team, said in an interview.

“It’s a tool that can bridge that gap of fear that often prevents providers from even opening the conversation. That’s always the first challenge, providers not wanting to ‘go there’ because they don’t want to answer a question that they won’t know how to answer or respond to.”

Starting the conversation in an open-ended way is crucial to getting a patient to speak honestly about his or her condition, Dr. Mitra Ahadpour, a primary care physician from Germantown, Md., and a clinical communications consultant with SAMHSA, said in an interview. “The open-ended question prompts in the app are very important. We have research that shows closed-ended questions turn the patient off, questions such as ‘You’re not thinking of killing yourself, are you?’ Instead, keep it very simple. Ask, ‘How are you doing today? Then take a second to see what they say.”

Even if primary care physicians are willing to ask and respond to their patients in acute danger of suicide, there is still the need to ensure that even if patients are referred to the appropriate facility, that there is enough room to accommodate them, according to Dr. Sandoval. “We’ll be able to identify more patients who are in suicidal situations than before, but now what? What do we do with this patient? That is a question we have to [address] as well.”

Incorporating the app into clinical practice should not be difficult and could even help encourage a physician to treat the patient him- or herself if the risk for suicide is found to be low, according to Dr. Ahadpour. “There are many points in the system where the app can be integrated. The PHQ-9 (patient health questionnaire that screens for depression) is included in the app, and you can have your patients fill that out ahead of time,” Dr. Ahadpour, who was not on the news briefing panel, said in an interview. “That way the clinician will already know if there is a need to take things to the second step or [assess] for a suicidal risk. If the provider feels comfortable that there is no risk for suicide, then they can treat the patient for depression, for example.” If they do not feel comfortable treating the patient, then “at least they have assessed the patient,” she added. Validated evaluation tools for other mental health conditions, including one for general anxiety disorder are also included in the app, Dr. Ahadpour said. Depression and anxiety are two major risk factors for suicidal ideation.

When asked by a reporter about how primary care physicians should bill their time for using the app, Mr. Carroll said the app included IDC-9 and ICD-10 codes.

For more information about the app, visit SAMHSA’s website.

Dr. Jacobs said the app is freely available at any smart phone app store.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

HUNTINGTON BEACH, CALIF. – In the opinion of Dr. John M. Oldham, clinicians who deem the alternative personality disorder model of the DSM-5 as too confusing are misguided.

“If you’re going to compare DSM-5 alternative personality disorder model with the DSM-IV model, you have to do a fair comparison,” Dr. Oldham told attendees at the annual meeting of the American College of Psychiatrists. ”In fact, we reduced the number of items that you have to measure by 43%.”

So when people describe the DSM-5’s personality disorders criteria as more complicated, he continued, “what they really mean is, ‘it’s more complicated than what I do,’ not that it’s more complicated than [the] DSM-IV.”

Along with Dr. Andrew E. Skodol, Dr. Oldham cochaired a work group of experts convened by the American Psychiatric Association to update diagnostic criteria related to personality and personality disorders for the DSM-5. “We took our work and our charge seriously,” recalled Dr. Oldham, senior vice president and chief of staff at the Menninger Clinic, Houston. “It was not easy. We had many challenges. A great deal of research has been done in the factor analytic research psychology world around things like the five-factor model of personality. Such terms are not always terribly familiar in clinical medicine, so there was a problem with the lack of familiarity. Then there were vested interests different groups had that were influential in some ways.”

Ultimately, the alternative personality disorder model was placed in section III of the DSM-5. The model enables clinicians “to individually portray the dimensions of the patient’s pathology in a thorough and broad way,” Dr. Oldham explained. “We emphasize impairment in functioning. That’s an important new requirement. So you have to determine, by using the level of functioning scale, whether the person does or doesn’t have moderate or greater impairment. If you have a patient with mild impairment, you can describe what you’re concerned about, but you’re not putting that patient into a diagnostic box of pathology. There is a dimensional scope that enables you to capture many types of patients.”

An empirical study of 337 clinicians demonstrated that in 14 of 18 comparisons, respondents deemed the DSM-5 pathological personality traits as more clinical useful, compared with the DSM-IV, with respect to ease of use, communication of clinical information to other professionals, communication of clinical information to patients, comprehensiveness in describing pathology, and treatment planning (J. Abnorm. Psychol. 2013;122:836-41). “In fact, this was a preference to the new model, which was unfamiliar, compared to the model that these clinicians had been using for 20 years,” Dr. Oldham said.

The study also found that the new DSM-5 personality disorder model was more strongly related to clinical decision making in areas of global functioning, risk assessment, recommended treatment type and intensity, and prognosis.

According to unpublished data from the DSM-5 field trials conducted in the United States and Canada, more than 80% of clinicians in academic and routine clinical practice fields found the new personality disorder criteria “moderately” to “extremely” useful, compared with the DSM-IV. In fact, the respondents rated the new criteria as more useful than other changes to the DSM-5, including those related to bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, and other conditions.

In addition, a test-retest reliability study conducted at 11 academic medical centers found that the new model for borderline personality disorder had a good test-retest reliability (.054), in the same ballpark as that for bipolar I disorder (0.56) and schizophrenia (.50) (Am. J. Psychiatry 2013;170:43-58). “This surprised a lot of people,” Dr. Oldham said.

About 1 year after the DSM-5’s release, Medscape Psychiatry surveyed almost 3,000 clinicians about their impressions of the new guidelines. Of the 2,828 respondents, nearly one-third (28%) were psychiatrists, 22% were psychologists, 13% were family medicine clinicians, and the rest were from other medical fields. The researchers found that 39% of survey respondents were considering the dimensional approaches offered in the new personality disorder criteria of the DSM-5.

“That’s not bad,” Dr. Oldham said.

He reported having no relevant financial conflicts.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

HUNTINGTON BEACH, CALIF. – In the opinion of Dr. John M. Oldham, clinicians who deem the alternative personality disorder model of the DSM-5 as too confusing are misguided.

“If you’re going to compare DSM-5 alternative personality disorder model with the DSM-IV model, you have to do a fair comparison,” Dr. Oldham told attendees at the annual meeting of the American College of Psychiatrists. ”In fact, we reduced the number of items that you have to measure by 43%.”

So when people describe the DSM-5’s personality disorders criteria as more complicated, he continued, “what they really mean is, ‘it’s more complicated than what I do,’ not that it’s more complicated than [the] DSM-IV.”

Along with Dr. Andrew E. Skodol, Dr. Oldham cochaired a work group of experts convened by the American Psychiatric Association to update diagnostic criteria related to personality and personality disorders for the DSM-5. “We took our work and our charge seriously,” recalled Dr. Oldham, senior vice president and chief of staff at the Menninger Clinic, Houston. “It was not easy. We had many challenges. A great deal of research has been done in the factor analytic research psychology world around things like the five-factor model of personality. Such terms are not always terribly familiar in clinical medicine, so there was a problem with the lack of familiarity. Then there were vested interests different groups had that were influential in some ways.”

Ultimately, the alternative personality disorder model was placed in section III of the DSM-5. The model enables clinicians “to individually portray the dimensions of the patient’s pathology in a thorough and broad way,” Dr. Oldham explained. “We emphasize impairment in functioning. That’s an important new requirement. So you have to determine, by using the level of functioning scale, whether the person does or doesn’t have moderate or greater impairment. If you have a patient with mild impairment, you can describe what you’re concerned about, but you’re not putting that patient into a diagnostic box of pathology. There is a dimensional scope that enables you to capture many types of patients.”

An empirical study of 337 clinicians demonstrated that in 14 of 18 comparisons, respondents deemed the DSM-5 pathological personality traits as more clinical useful, compared with the DSM-IV, with respect to ease of use, communication of clinical information to other professionals, communication of clinical information to patients, comprehensiveness in describing pathology, and treatment planning (J. Abnorm. Psychol. 2013;122:836-41). “In fact, this was a preference to the new model, which was unfamiliar, compared to the model that these clinicians had been using for 20 years,” Dr. Oldham said.

The study also found that the new DSM-5 personality disorder model was more strongly related to clinical decision making in areas of global functioning, risk assessment, recommended treatment type and intensity, and prognosis.

According to unpublished data from the DSM-5 field trials conducted in the United States and Canada, more than 80% of clinicians in academic and routine clinical practice fields found the new personality disorder criteria “moderately” to “extremely” useful, compared with the DSM-IV. In fact, the respondents rated the new criteria as more useful than other changes to the DSM-5, including those related to bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, and other conditions.

In addition, a test-retest reliability study conducted at 11 academic medical centers found that the new model for borderline personality disorder had a good test-retest reliability (.054), in the same ballpark as that for bipolar I disorder (0.56) and schizophrenia (.50) (Am. J. Psychiatry 2013;170:43-58). “This surprised a lot of people,” Dr. Oldham said.

About 1 year after the DSM-5’s release, Medscape Psychiatry surveyed almost 3,000 clinicians about their impressions of the new guidelines. Of the 2,828 respondents, nearly one-third (28%) were psychiatrists, 22% were psychologists, 13% were family medicine clinicians, and the rest were from other medical fields. The researchers found that 39% of survey respondents were considering the dimensional approaches offered in the new personality disorder criteria of the DSM-5.

“That’s not bad,” Dr. Oldham said.

He reported having no relevant financial conflicts.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

HUNTINGTON BEACH, CALIF. – In the opinion of Dr. John M. Oldham, clinicians who deem the alternative personality disorder model of the DSM-5 as too confusing are misguided.

“If you’re going to compare DSM-5 alternative personality disorder model with the DSM-IV model, you have to do a fair comparison,” Dr. Oldham told attendees at the annual meeting of the American College of Psychiatrists. ”In fact, we reduced the number of items that you have to measure by 43%.”

So when people describe the DSM-5’s personality disorders criteria as more complicated, he continued, “what they really mean is, ‘it’s more complicated than what I do,’ not that it’s more complicated than [the] DSM-IV.”

Along with Dr. Andrew E. Skodol, Dr. Oldham cochaired a work group of experts convened by the American Psychiatric Association to update diagnostic criteria related to personality and personality disorders for the DSM-5. “We took our work and our charge seriously,” recalled Dr. Oldham, senior vice president and chief of staff at the Menninger Clinic, Houston. “It was not easy. We had many challenges. A great deal of research has been done in the factor analytic research psychology world around things like the five-factor model of personality. Such terms are not always terribly familiar in clinical medicine, so there was a problem with the lack of familiarity. Then there were vested interests different groups had that were influential in some ways.”

Ultimately, the alternative personality disorder model was placed in section III of the DSM-5. The model enables clinicians “to individually portray the dimensions of the patient’s pathology in a thorough and broad way,” Dr. Oldham explained. “We emphasize impairment in functioning. That’s an important new requirement. So you have to determine, by using the level of functioning scale, whether the person does or doesn’t have moderate or greater impairment. If you have a patient with mild impairment, you can describe what you’re concerned about, but you’re not putting that patient into a diagnostic box of pathology. There is a dimensional scope that enables you to capture many types of patients.”

An empirical study of 337 clinicians demonstrated that in 14 of 18 comparisons, respondents deemed the DSM-5 pathological personality traits as more clinical useful, compared with the DSM-IV, with respect to ease of use, communication of clinical information to other professionals, communication of clinical information to patients, comprehensiveness in describing pathology, and treatment planning (J. Abnorm. Psychol. 2013;122:836-41). “In fact, this was a preference to the new model, which was unfamiliar, compared to the model that these clinicians had been using for 20 years,” Dr. Oldham said.

The study also found that the new DSM-5 personality disorder model was more strongly related to clinical decision making in areas of global functioning, risk assessment, recommended treatment type and intensity, and prognosis.

According to unpublished data from the DSM-5 field trials conducted in the United States and Canada, more than 80% of clinicians in academic and routine clinical practice fields found the new personality disorder criteria “moderately” to “extremely” useful, compared with the DSM-IV. In fact, the respondents rated the new criteria as more useful than other changes to the DSM-5, including those related to bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, and other conditions.

In addition, a test-retest reliability study conducted at 11 academic medical centers found that the new model for borderline personality disorder had a good test-retest reliability (.054), in the same ballpark as that for bipolar I disorder (0.56) and schizophrenia (.50) (Am. J. Psychiatry 2013;170:43-58). “This surprised a lot of people,” Dr. Oldham said.

About 1 year after the DSM-5’s release, Medscape Psychiatry surveyed almost 3,000 clinicians about their impressions of the new guidelines. Of the 2,828 respondents, nearly one-third (28%) were psychiatrists, 22% were psychologists, 13% were family medicine clinicians, and the rest were from other medical fields. The researchers found that 39% of survey respondents were considering the dimensional approaches offered in the new personality disorder criteria of the DSM-5.

“That’s not bad,” Dr. Oldham said.

He reported having no relevant financial conflicts.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk