Heidi Splete

FORT LAUDERDALE, FLA. — Sjögren's syndrome is the second most common autoimmune disorder that affects the musculoskeletal system, and yet the average time to diagnosis is 6 years, said Yvonne Sherrer, M.D., at a meeting sponsored by the Sjögren's Syndrome Foundation.

Although the cause of Sjögren's is still unknown, researchers suspect that a combination of genetic, environmental, and hormonal factors contribute to predisposition for the disease. Indeed, for every male with the syndrome, an estimated nine women are affected, underscoring the relevance of hormonal influences.

Inflammation of the exocrine glands, the common denominator of Sjögren's syndrome, most obviously affects the eyes, mouth, and vagina, said Dr. Sherrer, medical director and director of clinical research at the Centre for Rheumatology, Immunology, and Arthritis in Fort Lauderdale.

Typically, Sjögren's occurs in the context of a previously diagnosed autoimmune disorder, such as lupus, rheumatoid arthritis, or scleroderma.

The following less typical symptoms may also warrant suspecting Sjögren's syndrome:

▸Ocular. In addition to extreme dry eyes, patients may suffer from conjunctivitis, keratitis, blepharitis, ulcerations, and perforations.

▸Ears, Nose, and Throat. Tracheal dryness causes a chronic dry cough in some patients. Nosebleeds, otitis, and sinusitis can be recurring.

▸Oral. Severe dry mouth can cause swallowing problems, which may lead to malnourishment and excessive weight loss. Patients may also have accelerated caries, loss of dentition, and malfunctioning dentures.

▸Dermatologic/Vascular. Skin rashes are common, and skin eruptions and purpura may occur. Raynaud's phenomenon is a typical vascular manifestation. Vasculitis is always a concern in Sjögren's patients, but symptoms vary depending on the location of the inflammation in the body.

▸Gastrointestinal. Patients may suffer from esophageal dysmotility. In severe cases, they are at increased risk for pancreatitis, hepatitis, or atrophic gastritis.

▸Hematologic. Anemia, blood dyscrasias, and cryoglobulinemias are rare but may occur.

▸Pulmonary. Lung involvement and coronary involvement are rare but can develop due to dryness of bronchial tubes. Other potential manifestations include bronchitis, bronchitis obliterans-organized pneumonia, and interstitial fibrosis.

▸Neurologic. Neuropathies tend to be less symmetrical in Sjögren's patients, compared with other conditions. Central nervous system disorders might manifest as changes in cognitive function or as seizures.

▸Musculoskeletal. More often than not, patients with Sjögren's have arthralgia, rather than arthritis, but secondary Sjögren's patients may have concurrent arthritis or myositis.

Criteria for Primary Sjögren's Syndrome

The diagnosis of primary Sjögren's syndrome requires that patients meet at least four of the following six criteria:

1. The patient must have at least one of three ocular symptoms:

▸Dry eyes for less than 3 months.

▸Need to use artificial tears more than three times daily.

▸Sensation of a foreign body in the eye.

2. The patient must have at least one of three oral symptoms:

▸Persistent dry mouth for more than 3 months.

▸Swollen salivary glands.

▸Need to add extra liquid to the mouth in order to swallow.

3. The patient must have at least one of two ocular signs:

▸Unanesthetized Schirmer's test result of 5 mm/5 minutes or less in both eyes.

▸Positive vital dye staining.

4. The patient must have at least one of three signs of poor salivary gland function:

▸Abnormal salivary scintigraphy.

▸Abnormal parotid sialography.

▸Unstimulated salivary flow rate of 0.1 mL/minute or less.

5. Positive lip biopsy.

6. Positive anti-SSA or anti-SSB tests.

Source: “The New Sjögren's Syndrome Handbook” (New York: Oxford University Press, 2005)

FORT LAUDERDALE, FLA. — Sjögren's syndrome is the second most common autoimmune disorder that affects the musculoskeletal system, and yet the average time to diagnosis is 6 years, said Yvonne Sherrer, M.D., at a meeting sponsored by the Sjögren's Syndrome Foundation.

Although the cause of Sjögren's is still unknown, researchers suspect that a combination of genetic, environmental, and hormonal factors contribute to predisposition for the disease. Indeed, for every male with the syndrome, an estimated nine women are affected, underscoring the relevance of hormonal influences.

Inflammation of the exocrine glands, the common denominator of Sjögren's syndrome, most obviously affects the eyes, mouth, and vagina, said Dr. Sherrer, medical director and director of clinical research at the Centre for Rheumatology, Immunology, and Arthritis in Fort Lauderdale.

Typically, Sjögren's occurs in the context of a previously diagnosed autoimmune disorder, such as lupus, rheumatoid arthritis, or scleroderma.

The following less typical symptoms may also warrant suspecting Sjögren's syndrome:

▸Ocular. In addition to extreme dry eyes, patients may suffer from conjunctivitis, keratitis, blepharitis, ulcerations, and perforations.

▸Ears, Nose, and Throat. Tracheal dryness causes a chronic dry cough in some patients. Nosebleeds, otitis, and sinusitis can be recurring.

▸Oral. Severe dry mouth can cause swallowing problems, which may lead to malnourishment and excessive weight loss. Patients may also have accelerated caries, loss of dentition, and malfunctioning dentures.

▸Dermatologic/Vascular. Skin rashes are common, and skin eruptions and purpura may occur. Raynaud's phenomenon is a typical vascular manifestation. Vasculitis is always a concern in Sjögren's patients, but symptoms vary depending on the location of the inflammation in the body.

▸Gastrointestinal. Patients may suffer from esophageal dysmotility. In severe cases, they are at increased risk for pancreatitis, hepatitis, or atrophic gastritis.

▸Hematologic. Anemia, blood dyscrasias, and cryoglobulinemias are rare but may occur.

▸Pulmonary. Lung involvement and coronary involvement are rare but can develop due to dryness of bronchial tubes. Other potential manifestations include bronchitis, bronchitis obliterans-organized pneumonia, and interstitial fibrosis.

▸Neurologic. Neuropathies tend to be less symmetrical in Sjögren's patients, compared with other conditions. Central nervous system disorders might manifest as changes in cognitive function or as seizures.

▸Musculoskeletal. More often than not, patients with Sjögren's have arthralgia, rather than arthritis, but secondary Sjögren's patients may have concurrent arthritis or myositis.

Criteria for Primary Sjögren's Syndrome

The diagnosis of primary Sjögren's syndrome requires that patients meet at least four of the following six criteria:

1. The patient must have at least one of three ocular symptoms:

▸Dry eyes for less than 3 months.

▸Need to use artificial tears more than three times daily.

▸Sensation of a foreign body in the eye.

2. The patient must have at least one of three oral symptoms:

▸Persistent dry mouth for more than 3 months.

▸Swollen salivary glands.

▸Need to add extra liquid to the mouth in order to swallow.

3. The patient must have at least one of two ocular signs:

▸Unanesthetized Schirmer's test result of 5 mm/5 minutes or less in both eyes.

▸Positive vital dye staining.

4. The patient must have at least one of three signs of poor salivary gland function:

▸Abnormal salivary scintigraphy.

▸Abnormal parotid sialography.

▸Unstimulated salivary flow rate of 0.1 mL/minute or less.

5. Positive lip biopsy.

6. Positive anti-SSA or anti-SSB tests.

Source: “The New Sjögren's Syndrome Handbook” (New York: Oxford University Press, 2005)

FORT LAUDERDALE, FLA. — Sjögren's syndrome is the second most common autoimmune disorder that affects the musculoskeletal system, and yet the average time to diagnosis is 6 years, said Yvonne Sherrer, M.D., at a meeting sponsored by the Sjögren's Syndrome Foundation.

Although the cause of Sjögren's is still unknown, researchers suspect that a combination of genetic, environmental, and hormonal factors contribute to predisposition for the disease. Indeed, for every male with the syndrome, an estimated nine women are affected, underscoring the relevance of hormonal influences.

Inflammation of the exocrine glands, the common denominator of Sjögren's syndrome, most obviously affects the eyes, mouth, and vagina, said Dr. Sherrer, medical director and director of clinical research at the Centre for Rheumatology, Immunology, and Arthritis in Fort Lauderdale.

Typically, Sjögren's occurs in the context of a previously diagnosed autoimmune disorder, such as lupus, rheumatoid arthritis, or scleroderma.

The following less typical symptoms may also warrant suspecting Sjögren's syndrome:

▸Ocular. In addition to extreme dry eyes, patients may suffer from conjunctivitis, keratitis, blepharitis, ulcerations, and perforations.

▸Ears, Nose, and Throat. Tracheal dryness causes a chronic dry cough in some patients. Nosebleeds, otitis, and sinusitis can be recurring.

▸Oral. Severe dry mouth can cause swallowing problems, which may lead to malnourishment and excessive weight loss. Patients may also have accelerated caries, loss of dentition, and malfunctioning dentures.

▸Dermatologic/Vascular. Skin rashes are common, and skin eruptions and purpura may occur. Raynaud's phenomenon is a typical vascular manifestation. Vasculitis is always a concern in Sjögren's patients, but symptoms vary depending on the location of the inflammation in the body.

▸Gastrointestinal. Patients may suffer from esophageal dysmotility. In severe cases, they are at increased risk for pancreatitis, hepatitis, or atrophic gastritis.

▸Hematologic. Anemia, blood dyscrasias, and cryoglobulinemias are rare but may occur.

▸Pulmonary. Lung involvement and coronary involvement are rare but can develop due to dryness of bronchial tubes. Other potential manifestations include bronchitis, bronchitis obliterans-organized pneumonia, and interstitial fibrosis.

▸Neurologic. Neuropathies tend to be less symmetrical in Sjögren's patients, compared with other conditions. Central nervous system disorders might manifest as changes in cognitive function or as seizures.

▸Musculoskeletal. More often than not, patients with Sjögren's have arthralgia, rather than arthritis, but secondary Sjögren's patients may have concurrent arthritis or myositis.

Criteria for Primary Sjögren's Syndrome

The diagnosis of primary Sjögren's syndrome requires that patients meet at least four of the following six criteria:

1. The patient must have at least one of three ocular symptoms:

▸Dry eyes for less than 3 months.

▸Need to use artificial tears more than three times daily.

▸Sensation of a foreign body in the eye.

2. The patient must have at least one of three oral symptoms:

▸Persistent dry mouth for more than 3 months.

▸Swollen salivary glands.

▸Need to add extra liquid to the mouth in order to swallow.

3. The patient must have at least one of two ocular signs:

▸Unanesthetized Schirmer's test result of 5 mm/5 minutes or less in both eyes.

▸Positive vital dye staining.

4. The patient must have at least one of three signs of poor salivary gland function:

▸Abnormal salivary scintigraphy.

▸Abnormal parotid sialography.

▸Unstimulated salivary flow rate of 0.1 mL/minute or less.

5. Positive lip biopsy.

6. Positive anti-SSA or anti-SSB tests.

Source: “The New Sjögren's Syndrome Handbook” (New York: Oxford University Press, 2005)

A recently discovered genetic mutation that causes dysfunction in the synthesizing of serotonin might explain why some depressed patients are resistant to drug treatment, researchers say.

Xiaodong Zhang, M.D., and colleagues at Duke University, Durham, N.C., screened 87 adults with unipolar major depression, 60 adults with bipolar disorder, and 219 controls for a mutant allele known as 1463A in an enzyme that helps direct synthesis of serotonin known as human tryptophan hydroxylase 2 (hTPH2).

The gene mutation occurred in 10% of patients with major depression, compared with 1% of the controls. None of the individuals with bipolar disorder had the mutation (Neuron 2005;45:11-6).

Seven of the nine depression patients with the hTPH2 mutation had a family history of mental illness or drug and alcohol abuse, six had either attempted suicide or shown suicidal behavior, and four demonstrated generalized anxiety symptoms. In addition, seven of the patients with the mutation showed a lack of responsiveness to an SSRI, and the other two responded only to high doses.

Communication among neurons may stall if serotonin levels are low, as they often are in people with depression, anxiety, posttraumatic stress disorder, and even attention-deficit hyperactivity disorder. Additional larger studies are needed to confirm these findings and explore links between genetics and depression.

A recently discovered genetic mutation that causes dysfunction in the synthesizing of serotonin might explain why some depressed patients are resistant to drug treatment, researchers say.

Xiaodong Zhang, M.D., and colleagues at Duke University, Durham, N.C., screened 87 adults with unipolar major depression, 60 adults with bipolar disorder, and 219 controls for a mutant allele known as 1463A in an enzyme that helps direct synthesis of serotonin known as human tryptophan hydroxylase 2 (hTPH2).

The gene mutation occurred in 10% of patients with major depression, compared with 1% of the controls. None of the individuals with bipolar disorder had the mutation (Neuron 2005;45:11-6).

Seven of the nine depression patients with the hTPH2 mutation had a family history of mental illness or drug and alcohol abuse, six had either attempted suicide or shown suicidal behavior, and four demonstrated generalized anxiety symptoms. In addition, seven of the patients with the mutation showed a lack of responsiveness to an SSRI, and the other two responded only to high doses.

Communication among neurons may stall if serotonin levels are low, as they often are in people with depression, anxiety, posttraumatic stress disorder, and even attention-deficit hyperactivity disorder. Additional larger studies are needed to confirm these findings and explore links between genetics and depression.

A recently discovered genetic mutation that causes dysfunction in the synthesizing of serotonin might explain why some depressed patients are resistant to drug treatment, researchers say.

Xiaodong Zhang, M.D., and colleagues at Duke University, Durham, N.C., screened 87 adults with unipolar major depression, 60 adults with bipolar disorder, and 219 controls for a mutant allele known as 1463A in an enzyme that helps direct synthesis of serotonin known as human tryptophan hydroxylase 2 (hTPH2).

The gene mutation occurred in 10% of patients with major depression, compared with 1% of the controls. None of the individuals with bipolar disorder had the mutation (Neuron 2005;45:11-6).

Seven of the nine depression patients with the hTPH2 mutation had a family history of mental illness or drug and alcohol abuse, six had either attempted suicide or shown suicidal behavior, and four demonstrated generalized anxiety symptoms. In addition, seven of the patients with the mutation showed a lack of responsiveness to an SSRI, and the other two responded only to high doses.

Communication among neurons may stall if serotonin levels are low, as they often are in people with depression, anxiety, posttraumatic stress disorder, and even attention-deficit hyperactivity disorder. Additional larger studies are needed to confirm these findings and explore links between genetics and depression.

Depressive symptoms are not independent predictors of mortality, according to data from a national sample of 3,617 adults.

The findings of previous studies of associations between depressive symptoms and mortality have been inconsistent, and few of these studies have used population-based samples, said Susan A. Everson-Rose, Ph.D., of Rush University Medical Center, Chicago, and her colleagues (Psychosom. Med. 2004;66:823–30).

The study included noninstitutionalized adults aged 25 years and older who were participating in an ongoing, longitudinal study called Americans' Changing Lives.

A total of 542 deaths occurred during 7.5 years of follow-up. Each increase of 1 standard unit on the Center for Epidemiological Studies Depression scale (CES-D) predicted a 21% increase in death from any cause after age, race, and gender were adjusted for. However, no excess risk of mortality was associated with CES-D scores in a fully adjusted model that included demographics, education, income, behavioral risk factors, and three indicators of health status (hypertension, functional impairment, and life-threatening conditions).

The physical complaints of patients with depression often resemble symptoms of other health problems, and distinguishing between clinical depression and poor physical health can be difficult.

Patients with scores in the highest quintile on the CES-D had an 85% greater risk of death from any cause, compared with participants with the lowest CES-D scores, but no other quintiles showed an increased mortality risk, the investigators said.

Depressive symptoms were not significantly associated with mortality risk in a healthy subgroup of 2,833 adults (with 306 deaths) who reported good or excellent health at baseline. In addition, depressive symptoms were not associated with increased mortality risk in patients without functional impairments at baseline.

Although depressive symptoms were associated with greater physical impairment over time, the CES-D does not measure clinical depression, which has been studied as a possible link to mortality and cardiovascular health, the investigators noted.

Depressive symptoms are not independent predictors of mortality, according to data from a national sample of 3,617 adults.

The findings of previous studies of associations between depressive symptoms and mortality have been inconsistent, and few of these studies have used population-based samples, said Susan A. Everson-Rose, Ph.D., of Rush University Medical Center, Chicago, and her colleagues (Psychosom. Med. 2004;66:823–30).

The study included noninstitutionalized adults aged 25 years and older who were participating in an ongoing, longitudinal study called Americans' Changing Lives.

A total of 542 deaths occurred during 7.5 years of follow-up. Each increase of 1 standard unit on the Center for Epidemiological Studies Depression scale (CES-D) predicted a 21% increase in death from any cause after age, race, and gender were adjusted for. However, no excess risk of mortality was associated with CES-D scores in a fully adjusted model that included demographics, education, income, behavioral risk factors, and three indicators of health status (hypertension, functional impairment, and life-threatening conditions).

The physical complaints of patients with depression often resemble symptoms of other health problems, and distinguishing between clinical depression and poor physical health can be difficult.

Patients with scores in the highest quintile on the CES-D had an 85% greater risk of death from any cause, compared with participants with the lowest CES-D scores, but no other quintiles showed an increased mortality risk, the investigators said.

Depressive symptoms were not significantly associated with mortality risk in a healthy subgroup of 2,833 adults (with 306 deaths) who reported good or excellent health at baseline. In addition, depressive symptoms were not associated with increased mortality risk in patients without functional impairments at baseline.

Although depressive symptoms were associated with greater physical impairment over time, the CES-D does not measure clinical depression, which has been studied as a possible link to mortality and cardiovascular health, the investigators noted.

Depressive symptoms are not independent predictors of mortality, according to data from a national sample of 3,617 adults.

The findings of previous studies of associations between depressive symptoms and mortality have been inconsistent, and few of these studies have used population-based samples, said Susan A. Everson-Rose, Ph.D., of Rush University Medical Center, Chicago, and her colleagues (Psychosom. Med. 2004;66:823–30).

The study included noninstitutionalized adults aged 25 years and older who were participating in an ongoing, longitudinal study called Americans' Changing Lives.

A total of 542 deaths occurred during 7.5 years of follow-up. Each increase of 1 standard unit on the Center for Epidemiological Studies Depression scale (CES-D) predicted a 21% increase in death from any cause after age, race, and gender were adjusted for. However, no excess risk of mortality was associated with CES-D scores in a fully adjusted model that included demographics, education, income, behavioral risk factors, and three indicators of health status (hypertension, functional impairment, and life-threatening conditions).

The physical complaints of patients with depression often resemble symptoms of other health problems, and distinguishing between clinical depression and poor physical health can be difficult.

Patients with scores in the highest quintile on the CES-D had an 85% greater risk of death from any cause, compared with participants with the lowest CES-D scores, but no other quintiles showed an increased mortality risk, the investigators said.

Depressive symptoms were not significantly associated with mortality risk in a healthy subgroup of 2,833 adults (with 306 deaths) who reported good or excellent health at baseline. In addition, depressive symptoms were not associated with increased mortality risk in patients without functional impairments at baseline.

Although depressive symptoms were associated with greater physical impairment over time, the CES-D does not measure clinical depression, which has been studied as a possible link to mortality and cardiovascular health, the investigators noted.

ARLINGTON, VA. – Every company is strongly invested in its employees' ability to do their jobs, Ronald Schouten, M.D., said at the annual meeting of the Academy of Organizational and Occupational Psychiatry.

Companies with concerns about an employee's mental health will often call in a psychiatrist for a fitness-for-duty evaluation. An independent evaluation differs from a clinical evaluation in several ways, said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital in Boston.

In a clinical evaluation, the psychiatrist focuses on the diagnosis and relief of symptoms and acts as a patient advocate. An independent fitness-for-duty evaluation, however, is an objective, functional assessment conducted by a third party for the benefit of the employer, to determine whether the patient is capable of doing his or her job.

Everything a psychiatrist writes in a fitness-for-duty evaluation can be made available if the case involves a lawsuit, Dr. Schouten said. However, most employers simply want to know whether or not the person is fit for work, and what, if any, special accommodations he or she needs. A postevaluation report can generally be brief, as long as it includes the following elements:

▸ Identification of the person.

▸ An explanation of why the person was referred.

▸ Consent forms and limits of confidentiality.

▸ Job description and the job functions.

▸ Medical and psychological history that is deemed relevant.

▸ Observations related to fitness for duty.

▸ Recommendations for treatment and/or return to work.

In addition, a detailed report typically includes results from a mental status exam and other tests that were administered.

ARLINGTON, VA. – Every company is strongly invested in its employees' ability to do their jobs, Ronald Schouten, M.D., said at the annual meeting of the Academy of Organizational and Occupational Psychiatry.

Companies with concerns about an employee's mental health will often call in a psychiatrist for a fitness-for-duty evaluation. An independent evaluation differs from a clinical evaluation in several ways, said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital in Boston.

In a clinical evaluation, the psychiatrist focuses on the diagnosis and relief of symptoms and acts as a patient advocate. An independent fitness-for-duty evaluation, however, is an objective, functional assessment conducted by a third party for the benefit of the employer, to determine whether the patient is capable of doing his or her job.

Everything a psychiatrist writes in a fitness-for-duty evaluation can be made available if the case involves a lawsuit, Dr. Schouten said. However, most employers simply want to know whether or not the person is fit for work, and what, if any, special accommodations he or she needs. A postevaluation report can generally be brief, as long as it includes the following elements:

▸ Identification of the person.

▸ An explanation of why the person was referred.

▸ Consent forms and limits of confidentiality.

▸ Job description and the job functions.

▸ Medical and psychological history that is deemed relevant.

▸ Observations related to fitness for duty.

▸ Recommendations for treatment and/or return to work.

In addition, a detailed report typically includes results from a mental status exam and other tests that were administered.

ARLINGTON, VA. – Every company is strongly invested in its employees' ability to do their jobs, Ronald Schouten, M.D., said at the annual meeting of the Academy of Organizational and Occupational Psychiatry.

Companies with concerns about an employee's mental health will often call in a psychiatrist for a fitness-for-duty evaluation. An independent evaluation differs from a clinical evaluation in several ways, said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital in Boston.

In a clinical evaluation, the psychiatrist focuses on the diagnosis and relief of symptoms and acts as a patient advocate. An independent fitness-for-duty evaluation, however, is an objective, functional assessment conducted by a third party for the benefit of the employer, to determine whether the patient is capable of doing his or her job.

Everything a psychiatrist writes in a fitness-for-duty evaluation can be made available if the case involves a lawsuit, Dr. Schouten said. However, most employers simply want to know whether or not the person is fit for work, and what, if any, special accommodations he or she needs. A postevaluation report can generally be brief, as long as it includes the following elements:

▸ Identification of the person.

▸ An explanation of why the person was referred.

▸ Consent forms and limits of confidentiality.

▸ Job description and the job functions.

▸ Medical and psychological history that is deemed relevant.

▸ Observations related to fitness for duty.

▸ Recommendations for treatment and/or return to work.

In addition, a detailed report typically includes results from a mental status exam and other tests that were administered.

WASHINGTON – A team approach to managing opioid dependence with buprenorphine kept 32 of 37 patients (86%) on buprenorphine therapy at 4 months' follow-up, Daniel Alford, M.D., reported in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The patients, who were aged 18–52 years, began treatment over a 6-month period. Most were male (62%) and white (92%). The treatment protocol included an average of two in-person contacts and 15 phone contacts from a nurse care manager during the first 2 weeks, followed by one to four contacts per week. Follow-up visits included random urine samples, pill counts, and observations of dosing.

The team approach featured extensive interaction between patients and nurse care managers, with physician assessments and consultations.

The nurse care manager made the initial assessment of each patient's substance use, medical and psychiatric history, and social support system by telephone, Dr. Alford said.

Physicians reviewed and further assessed the patients before enrolling them in the study and prescribing buprenorphine.

The physicians also performed physical exams at enrollment and 4 months after the start of treatment.

The nurse care manager also obtained initial lab tests, educated the patients about buprenorphine, and reviewed patient responsibilities.

The nurse case manager devised an induction schedule based on physician guidelines, and was in frequent contact with the patients until they reached their stable maintenance doses.

Patients had access to the nurse care managers by cell phone, Dr. Alford said at the conference, which was also sponsored by Brown Medical School.

After 4 months, only 13% of opioid urine tests were positive, compared with 100% at baseline, said Dr. Alford, who is with Boston Medical Center.

Ninety-two percent of the patients had social support for their treatment, and 56% were attending counseling sessions or mutual self-help meetings, he reported.

A majority of the patients (59%) had a medical comorbidity at baseline, but 68% had no usual source of primary care. Further, 54% reported psychiatric comorbidity, but only 20% had received psychiatric care prior to the study.

WASHINGTON – A team approach to managing opioid dependence with buprenorphine kept 32 of 37 patients (86%) on buprenorphine therapy at 4 months' follow-up, Daniel Alford, M.D., reported in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The patients, who were aged 18–52 years, began treatment over a 6-month period. Most were male (62%) and white (92%). The treatment protocol included an average of two in-person contacts and 15 phone contacts from a nurse care manager during the first 2 weeks, followed by one to four contacts per week. Follow-up visits included random urine samples, pill counts, and observations of dosing.

The team approach featured extensive interaction between patients and nurse care managers, with physician assessments and consultations.

The nurse care manager made the initial assessment of each patient's substance use, medical and psychiatric history, and social support system by telephone, Dr. Alford said.

Physicians reviewed and further assessed the patients before enrolling them in the study and prescribing buprenorphine.

The physicians also performed physical exams at enrollment and 4 months after the start of treatment.

The nurse care manager also obtained initial lab tests, educated the patients about buprenorphine, and reviewed patient responsibilities.

The nurse case manager devised an induction schedule based on physician guidelines, and was in frequent contact with the patients until they reached their stable maintenance doses.

Patients had access to the nurse care managers by cell phone, Dr. Alford said at the conference, which was also sponsored by Brown Medical School.

After 4 months, only 13% of opioid urine tests were positive, compared with 100% at baseline, said Dr. Alford, who is with Boston Medical Center.

Ninety-two percent of the patients had social support for their treatment, and 56% were attending counseling sessions or mutual self-help meetings, he reported.

A majority of the patients (59%) had a medical comorbidity at baseline, but 68% had no usual source of primary care. Further, 54% reported psychiatric comorbidity, but only 20% had received psychiatric care prior to the study.

WASHINGTON – A team approach to managing opioid dependence with buprenorphine kept 32 of 37 patients (86%) on buprenorphine therapy at 4 months' follow-up, Daniel Alford, M.D., reported in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The patients, who were aged 18–52 years, began treatment over a 6-month period. Most were male (62%) and white (92%). The treatment protocol included an average of two in-person contacts and 15 phone contacts from a nurse care manager during the first 2 weeks, followed by one to four contacts per week. Follow-up visits included random urine samples, pill counts, and observations of dosing.

The team approach featured extensive interaction between patients and nurse care managers, with physician assessments and consultations.

The nurse care manager made the initial assessment of each patient's substance use, medical and psychiatric history, and social support system by telephone, Dr. Alford said.

Physicians reviewed and further assessed the patients before enrolling them in the study and prescribing buprenorphine.

The physicians also performed physical exams at enrollment and 4 months after the start of treatment.

The nurse care manager also obtained initial lab tests, educated the patients about buprenorphine, and reviewed patient responsibilities.

The nurse case manager devised an induction schedule based on physician guidelines, and was in frequent contact with the patients until they reached their stable maintenance doses.

Patients had access to the nurse care managers by cell phone, Dr. Alford said at the conference, which was also sponsored by Brown Medical School.

After 4 months, only 13% of opioid urine tests were positive, compared with 100% at baseline, said Dr. Alford, who is with Boston Medical Center.

Ninety-two percent of the patients had social support for their treatment, and 56% were attending counseling sessions or mutual self-help meetings, he reported.

A majority of the patients (59%) had a medical comorbidity at baseline, but 68% had no usual source of primary care. Further, 54% reported psychiatric comorbidity, but only 20% had received psychiatric care prior to the study.

WASHINGTON – Elderly women reported more pain than men, and black women reported more pain that limited their activity, compared with white women, in two studies totaling 3,800 patients, said Jana M. Mossey, Ph.D., at the annual meeting of the Gerontological Society of America.

She examined two large quality of life studies for the prevalence and nature of pain complaints in minority elders in the community and in institutions. Overall, 60% of the patients had been diagnosed with degenerative joint pain, 47% had been diagnosed with low back pain, and 39% had been diagnosed with chronic pain.

No significant differences surfaced in the prevalence of pain between black males and white males (57% vs. 55%), reported Dr. Mossey, professor of epidemiology and biostatistics at Drexel University School of Public Health, Philadelphia.

About 57% of minority elders reported pain–22% reported pain that did not limit their activities and 35% reported pain that did. The subjects included 600 community-dwelling adults older than 70 years in Philadelphia (300 African Americans and 300 non-Hispanic whites) and 3,200 chronic pain patients in rural Georgia (760 African Americans and 2,440 non-Hispanic whites).

Those who reported pain, regardless of ethnicity, were 10 times more likely to have poor physical function and three times more likely to use health services and to spend time sick in bed. However, community-dwelling minority elders who reported pain were more likely to be female, to have poorer physical and emotional function, and to have more medical problems.

WASHINGTON – Elderly women reported more pain than men, and black women reported more pain that limited their activity, compared with white women, in two studies totaling 3,800 patients, said Jana M. Mossey, Ph.D., at the annual meeting of the Gerontological Society of America.

She examined two large quality of life studies for the prevalence and nature of pain complaints in minority elders in the community and in institutions. Overall, 60% of the patients had been diagnosed with degenerative joint pain, 47% had been diagnosed with low back pain, and 39% had been diagnosed with chronic pain.

No significant differences surfaced in the prevalence of pain between black males and white males (57% vs. 55%), reported Dr. Mossey, professor of epidemiology and biostatistics at Drexel University School of Public Health, Philadelphia.

About 57% of minority elders reported pain–22% reported pain that did not limit their activities and 35% reported pain that did. The subjects included 600 community-dwelling adults older than 70 years in Philadelphia (300 African Americans and 300 non-Hispanic whites) and 3,200 chronic pain patients in rural Georgia (760 African Americans and 2,440 non-Hispanic whites).

Those who reported pain, regardless of ethnicity, were 10 times more likely to have poor physical function and three times more likely to use health services and to spend time sick in bed. However, community-dwelling minority elders who reported pain were more likely to be female, to have poorer physical and emotional function, and to have more medical problems.

WASHINGTON – Elderly women reported more pain than men, and black women reported more pain that limited their activity, compared with white women, in two studies totaling 3,800 patients, said Jana M. Mossey, Ph.D., at the annual meeting of the Gerontological Society of America.

She examined two large quality of life studies for the prevalence and nature of pain complaints in minority elders in the community and in institutions. Overall, 60% of the patients had been diagnosed with degenerative joint pain, 47% had been diagnosed with low back pain, and 39% had been diagnosed with chronic pain.

No significant differences surfaced in the prevalence of pain between black males and white males (57% vs. 55%), reported Dr. Mossey, professor of epidemiology and biostatistics at Drexel University School of Public Health, Philadelphia.

About 57% of minority elders reported pain–22% reported pain that did not limit their activities and 35% reported pain that did. The subjects included 600 community-dwelling adults older than 70 years in Philadelphia (300 African Americans and 300 non-Hispanic whites) and 3,200 chronic pain patients in rural Georgia (760 African Americans and 2,440 non-Hispanic whites).

Those who reported pain, regardless of ethnicity, were 10 times more likely to have poor physical function and three times more likely to use health services and to spend time sick in bed. However, community-dwelling minority elders who reported pain were more likely to be female, to have poorer physical and emotional function, and to have more medical problems.

WASHINGTON – Only 2.5% of adults aged 65 years and older use outpatient mental health services, compared with 7.1% of adults aged 18–64 years, Bradley E. Karlin said at the annual meeting of the Gerontological Society of America.

Based on data from the 2001 National Survey on Drug Use and Health, older Americans continue to underuse mental health services, despite their need for them, said Mr. Karlin, a doctoral candidate in clinical psychology at Texas A&M University, College Station.

“One of the most disconcerting findings in the mental health literature is the underuse of mental health services by the older population,” he noted.

Mr. Karlin and his coauthor, Michael Duffy, Ph.D., of Texas A&M University, conducted a logistic regression analysis to identify factors relating to unmet mental health needs and use of outpatient treatment. Older adults identified fewer mental health problems than did younger adults in the survey and had lower rates of serious mental illness. However, only 9% of older adults with serious mental illness and 10% with mental health syndromes used outpatient mental health services.

“Virtually nothing is known about predictors of mental health care in the elderly population. We don't know who the health seekers are,” Mr. Karlin said. A greater understanding of the role of mental health in aging in the general population may increase the use of outpatient services, and older adults who hear about a friend's positive experience may be more likely to try outpatient care themselves, he added.

Overall, no differences appeared in the extent to which mental health treatment improves ability to manage daily activities, suggesting that older adults who do use outpatient mental health services derive at least as much benefit as younger adults, Dr. Karlin noted.

WASHINGTON – Only 2.5% of adults aged 65 years and older use outpatient mental health services, compared with 7.1% of adults aged 18–64 years, Bradley E. Karlin said at the annual meeting of the Gerontological Society of America.

Based on data from the 2001 National Survey on Drug Use and Health, older Americans continue to underuse mental health services, despite their need for them, said Mr. Karlin, a doctoral candidate in clinical psychology at Texas A&M University, College Station.

“One of the most disconcerting findings in the mental health literature is the underuse of mental health services by the older population,” he noted.

Mr. Karlin and his coauthor, Michael Duffy, Ph.D., of Texas A&M University, conducted a logistic regression analysis to identify factors relating to unmet mental health needs and use of outpatient treatment. Older adults identified fewer mental health problems than did younger adults in the survey and had lower rates of serious mental illness. However, only 9% of older adults with serious mental illness and 10% with mental health syndromes used outpatient mental health services.

“Virtually nothing is known about predictors of mental health care in the elderly population. We don't know who the health seekers are,” Mr. Karlin said. A greater understanding of the role of mental health in aging in the general population may increase the use of outpatient services, and older adults who hear about a friend's positive experience may be more likely to try outpatient care themselves, he added.

Overall, no differences appeared in the extent to which mental health treatment improves ability to manage daily activities, suggesting that older adults who do use outpatient mental health services derive at least as much benefit as younger adults, Dr. Karlin noted.

WASHINGTON – Only 2.5% of adults aged 65 years and older use outpatient mental health services, compared with 7.1% of adults aged 18–64 years, Bradley E. Karlin said at the annual meeting of the Gerontological Society of America.

Based on data from the 2001 National Survey on Drug Use and Health, older Americans continue to underuse mental health services, despite their need for them, said Mr. Karlin, a doctoral candidate in clinical psychology at Texas A&M University, College Station.

“One of the most disconcerting findings in the mental health literature is the underuse of mental health services by the older population,” he noted.

Mr. Karlin and his coauthor, Michael Duffy, Ph.D., of Texas A&M University, conducted a logistic regression analysis to identify factors relating to unmet mental health needs and use of outpatient treatment. Older adults identified fewer mental health problems than did younger adults in the survey and had lower rates of serious mental illness. However, only 9% of older adults with serious mental illness and 10% with mental health syndromes used outpatient mental health services.

“Virtually nothing is known about predictors of mental health care in the elderly population. We don't know who the health seekers are,” Mr. Karlin said. A greater understanding of the role of mental health in aging in the general population may increase the use of outpatient services, and older adults who hear about a friend's positive experience may be more likely to try outpatient care themselves, he added.

Overall, no differences appeared in the extent to which mental health treatment improves ability to manage daily activities, suggesting that older adults who do use outpatient mental health services derive at least as much benefit as younger adults, Dr. Karlin noted.

Pituitary Volume Steady in Bipolar

No differences were found in pituitary gland volume between 16 bipolar children and 21 healthy controls, said Hua Hsuan Chen of the University of Texas, San Antonio, and colleagues.

Studies of bipolar adults have shown a reduced pituitary volume compared with healthy controls, so the researchers examined young patients to determine whether these differences were present early in the disease (Depress. Anxiety 2004;20:182–6). MRI scans showed an unadjusted mean volume of 0.73 mL among the bipolar children (mean age, 15 years) and 0.69 mL among the control children. This similarity suggests that ongoing hypothalamus and pituitary dysfunction might contribute to the volume differences over time.

Continuum of Eating Disorders Seen

Subclinical eating disorders were diagnosed in 7% of 259 female students aged 17–20 years, reported Paolo Cotrufo, Ph.D., of the University of Naples, Caserta, Italy, and associates.

The investigators sought to characterize less severe forms of eating disorders. The girls completed a sociodemographic questionnaire, the General Health Questionnaire, and the Eating Disorder Inventory 2 (ED2). The ED2 consists of 11 subscales, including drive for thinness, bulimia, and body dissatisfaction. Two psychologists interviewed the 49 girls who scored at least 14 on the drive for thinness scale. Each girl completed the ED2 Symptom Checklist, which measures eating attitudes, compensatory strategies, and menstrual regularity (J. Adolesc. 2005;28:147–54).

Two girls met the criteria for full-blown bulimia nervosa, nine met partial criteria for bulimia, one met partial criteria for binge-eating disorder, 15 met the criteria for subclinical anorexia, and three met the criteria for subclinical bulimia. The other 19 were false-positive cases. The higher prevalence of subclinical anorexia vs. full and partial bulimia suggests that eating disorders might begin with the psychopathology of anorexia and evolve toward bulimia.

Hostility Drives Smoking Initiation

An interaction between depressive symptoms and hostility was strongly associated with initiation of smoking in middle school students, reported Jie Wu Weiss, Ph.D., and colleagues at the University of Southern California, Alhambra.

Adolescents who have difficulty controlling their anger often use smoking as a coping mechanism, the researchers noted. An ethnically diverse sample of 1,699 students completed 160-item surveys in both the sixth and seventh grades (J. Adolesc. 2005;28:49–62).

Overall, 141 children (8.3%) said they had smoked at least once by sixth grade. Compared with never smokers, those who had smoked scored significantly higher on baseline depressive symptoms, hostility, and socioeconomic status. An additional 141 of the original never-smokers reported smoking at least once by seventh grade, and higher depression and hostility scores at baseline were significantly associated with smoking initiation.

Deficits Don't Predict Teen Problems

Children aged 3–36 months who were diagnosed with minor developmental deficits did not show significantly more emotional or behavioral problems in adolescence compared with typical control children, said Daniel Hardoff, M.D., of Bnai Zion Medical Center, Haifa, Israel, and his colleagues.

In a study of 116 children, the most common diagnoses were mild motor impairment (32 children) and language abnormalities (27 children). After 12–16 years, parents completed the Child Behavior Checklist and their now-adolescents completed the Youth Self-Report. All the scores were within the nonpathologic range (J. Adolesc. Health 2005;36:70–1). The only significant difference was in self-perception of internalizing emotional problems, with males scoring higher than females.

Self-Cutting Linked to Risky Sex

Self-cutting was significantly associated with risky sexual behaviors in a study of 293 adolescents aged 13–18 years who were not psychotic, reported Larry K. Brown, Ph.D., and his associates at Brown University in Providence, R.I.

The researchers examined the characteristics of self-cutters as part of a larger longitudinal study and found that self-cutting was significantly associated with being female, white, sexually abused, and impulsive; HIV prevention self-efficacy was not predictive of self-cutting (Psychiatr. Serv. 2005;56:216–8). Although sexually active adolescents who were self-cutters were less likely than noncutters to have had sex within the past month, the self-cutters were also significantly less likely to consistently use condoms. Prior studies also have associated self-cutting with increased risk for HIV because self-cutters might share cutting implements.

Pituitary Volume Steady in Bipolar

No differences were found in pituitary gland volume between 16 bipolar children and 21 healthy controls, said Hua Hsuan Chen of the University of Texas, San Antonio, and colleagues.

Studies of bipolar adults have shown a reduced pituitary volume compared with healthy controls, so the researchers examined young patients to determine whether these differences were present early in the disease (Depress. Anxiety 2004;20:182–6). MRI scans showed an unadjusted mean volume of 0.73 mL among the bipolar children (mean age, 15 years) and 0.69 mL among the control children. This similarity suggests that ongoing hypothalamus and pituitary dysfunction might contribute to the volume differences over time.

Continuum of Eating Disorders Seen

Subclinical eating disorders were diagnosed in 7% of 259 female students aged 17–20 years, reported Paolo Cotrufo, Ph.D., of the University of Naples, Caserta, Italy, and associates.

The investigators sought to characterize less severe forms of eating disorders. The girls completed a sociodemographic questionnaire, the General Health Questionnaire, and the Eating Disorder Inventory 2 (ED2). The ED2 consists of 11 subscales, including drive for thinness, bulimia, and body dissatisfaction. Two psychologists interviewed the 49 girls who scored at least 14 on the drive for thinness scale. Each girl completed the ED2 Symptom Checklist, which measures eating attitudes, compensatory strategies, and menstrual regularity (J. Adolesc. 2005;28:147–54).

Two girls met the criteria for full-blown bulimia nervosa, nine met partial criteria for bulimia, one met partial criteria for binge-eating disorder, 15 met the criteria for subclinical anorexia, and three met the criteria for subclinical bulimia. The other 19 were false-positive cases. The higher prevalence of subclinical anorexia vs. full and partial bulimia suggests that eating disorders might begin with the psychopathology of anorexia and evolve toward bulimia.

Hostility Drives Smoking Initiation

An interaction between depressive symptoms and hostility was strongly associated with initiation of smoking in middle school students, reported Jie Wu Weiss, Ph.D., and colleagues at the University of Southern California, Alhambra.

Adolescents who have difficulty controlling their anger often use smoking as a coping mechanism, the researchers noted. An ethnically diverse sample of 1,699 students completed 160-item surveys in both the sixth and seventh grades (J. Adolesc. 2005;28:49–62).

Overall, 141 children (8.3%) said they had smoked at least once by sixth grade. Compared with never smokers, those who had smoked scored significantly higher on baseline depressive symptoms, hostility, and socioeconomic status. An additional 141 of the original never-smokers reported smoking at least once by seventh grade, and higher depression and hostility scores at baseline were significantly associated with smoking initiation.

Deficits Don't Predict Teen Problems

Children aged 3–36 months who were diagnosed with minor developmental deficits did not show significantly more emotional or behavioral problems in adolescence compared with typical control children, said Daniel Hardoff, M.D., of Bnai Zion Medical Center, Haifa, Israel, and his colleagues.

In a study of 116 children, the most common diagnoses were mild motor impairment (32 children) and language abnormalities (27 children). After 12–16 years, parents completed the Child Behavior Checklist and their now-adolescents completed the Youth Self-Report. All the scores were within the nonpathologic range (J. Adolesc. Health 2005;36:70–1). The only significant difference was in self-perception of internalizing emotional problems, with males scoring higher than females.

Self-Cutting Linked to Risky Sex

Self-cutting was significantly associated with risky sexual behaviors in a study of 293 adolescents aged 13–18 years who were not psychotic, reported Larry K. Brown, Ph.D., and his associates at Brown University in Providence, R.I.

The researchers examined the characteristics of self-cutters as part of a larger longitudinal study and found that self-cutting was significantly associated with being female, white, sexually abused, and impulsive; HIV prevention self-efficacy was not predictive of self-cutting (Psychiatr. Serv. 2005;56:216–8). Although sexually active adolescents who were self-cutters were less likely than noncutters to have had sex within the past month, the self-cutters were also significantly less likely to consistently use condoms. Prior studies also have associated self-cutting with increased risk for HIV because self-cutters might share cutting implements.

Pituitary Volume Steady in Bipolar

No differences were found in pituitary gland volume between 16 bipolar children and 21 healthy controls, said Hua Hsuan Chen of the University of Texas, San Antonio, and colleagues.

Studies of bipolar adults have shown a reduced pituitary volume compared with healthy controls, so the researchers examined young patients to determine whether these differences were present early in the disease (Depress. Anxiety 2004;20:182–6). MRI scans showed an unadjusted mean volume of 0.73 mL among the bipolar children (mean age, 15 years) and 0.69 mL among the control children. This similarity suggests that ongoing hypothalamus and pituitary dysfunction might contribute to the volume differences over time.

Continuum of Eating Disorders Seen

Subclinical eating disorders were diagnosed in 7% of 259 female students aged 17–20 years, reported Paolo Cotrufo, Ph.D., of the University of Naples, Caserta, Italy, and associates.

The investigators sought to characterize less severe forms of eating disorders. The girls completed a sociodemographic questionnaire, the General Health Questionnaire, and the Eating Disorder Inventory 2 (ED2). The ED2 consists of 11 subscales, including drive for thinness, bulimia, and body dissatisfaction. Two psychologists interviewed the 49 girls who scored at least 14 on the drive for thinness scale. Each girl completed the ED2 Symptom Checklist, which measures eating attitudes, compensatory strategies, and menstrual regularity (J. Adolesc. 2005;28:147–54).

Two girls met the criteria for full-blown bulimia nervosa, nine met partial criteria for bulimia, one met partial criteria for binge-eating disorder, 15 met the criteria for subclinical anorexia, and three met the criteria for subclinical bulimia. The other 19 were false-positive cases. The higher prevalence of subclinical anorexia vs. full and partial bulimia suggests that eating disorders might begin with the psychopathology of anorexia and evolve toward bulimia.

Hostility Drives Smoking Initiation

An interaction between depressive symptoms and hostility was strongly associated with initiation of smoking in middle school students, reported Jie Wu Weiss, Ph.D., and colleagues at the University of Southern California, Alhambra.

Adolescents who have difficulty controlling their anger often use smoking as a coping mechanism, the researchers noted. An ethnically diverse sample of 1,699 students completed 160-item surveys in both the sixth and seventh grades (J. Adolesc. 2005;28:49–62).

Overall, 141 children (8.3%) said they had smoked at least once by sixth grade. Compared with never smokers, those who had smoked scored significantly higher on baseline depressive symptoms, hostility, and socioeconomic status. An additional 141 of the original never-smokers reported smoking at least once by seventh grade, and higher depression and hostility scores at baseline were significantly associated with smoking initiation.

Deficits Don't Predict Teen Problems

Children aged 3–36 months who were diagnosed with minor developmental deficits did not show significantly more emotional or behavioral problems in adolescence compared with typical control children, said Daniel Hardoff, M.D., of Bnai Zion Medical Center, Haifa, Israel, and his colleagues.

In a study of 116 children, the most common diagnoses were mild motor impairment (32 children) and language abnormalities (27 children). After 12–16 years, parents completed the Child Behavior Checklist and their now-adolescents completed the Youth Self-Report. All the scores were within the nonpathologic range (J. Adolesc. Health 2005;36:70–1). The only significant difference was in self-perception of internalizing emotional problems, with males scoring higher than females.

Self-Cutting Linked to Risky Sex

Self-cutting was significantly associated with risky sexual behaviors in a study of 293 adolescents aged 13–18 years who were not psychotic, reported Larry K. Brown, Ph.D., and his associates at Brown University in Providence, R.I.

The researchers examined the characteristics of self-cutters as part of a larger longitudinal study and found that self-cutting was significantly associated with being female, white, sexually abused, and impulsive; HIV prevention self-efficacy was not predictive of self-cutting (Psychiatr. Serv. 2005;56:216–8). Although sexually active adolescents who were self-cutters were less likely than noncutters to have had sex within the past month, the self-cutters were also significantly less likely to consistently use condoms. Prior studies also have associated self-cutting with increased risk for HIV because self-cutters might share cutting implements.

WASHINGTON – A majority of parents in rural Kansas think children should know about problem drinkers in the family, reported Kimber Richter, Ph.D.

Approximately 45% of alcoholism is genetic, and knowledge of family history might help children make better choices about alcohol consumption, said Dr. Richter at the annual conference of the Association for Medical Education and Research in Substance Abuse.

Dr. Richter and a group of medical students in a rural preceptorship program designed a survey to better understand parent-child communication regarding a family history of alcohol problems. They surveyed 24 sets of parents aged 18 years or older living in rural Kansas who had children between the ages of 10 and 20 years.

In response to a two-page questionnaire, 100% of the parents said that they had talked to their children about alcohol, and 100% agreed that a family history of alcohol problems increased children's risk. Most (96%) said they believed that families with a positive history of alcohol problems should inform their children. Of the 83% of parents who reported a family history of problems, 57% said they had informed children in the family about this history. Overall, 63% had family rules concerning drinking, with punishments for breaking the rules. The children were not interviewed about their alcohol use, but they averaged 15 years old, the average age of first alcohol use in Kansas, Dr. Richter noted at the conference, also sponsored by Brown Medical School.

WASHINGTON – A majority of parents in rural Kansas think children should know about problem drinkers in the family, reported Kimber Richter, Ph.D.

Approximately 45% of alcoholism is genetic, and knowledge of family history might help children make better choices about alcohol consumption, said Dr. Richter at the annual conference of the Association for Medical Education and Research in Substance Abuse.

Dr. Richter and a group of medical students in a rural preceptorship program designed a survey to better understand parent-child communication regarding a family history of alcohol problems. They surveyed 24 sets of parents aged 18 years or older living in rural Kansas who had children between the ages of 10 and 20 years.

In response to a two-page questionnaire, 100% of the parents said that they had talked to their children about alcohol, and 100% agreed that a family history of alcohol problems increased children's risk. Most (96%) said they believed that families with a positive history of alcohol problems should inform their children. Of the 83% of parents who reported a family history of problems, 57% said they had informed children in the family about this history. Overall, 63% had family rules concerning drinking, with punishments for breaking the rules. The children were not interviewed about their alcohol use, but they averaged 15 years old, the average age of first alcohol use in Kansas, Dr. Richter noted at the conference, also sponsored by Brown Medical School.

WASHINGTON – A majority of parents in rural Kansas think children should know about problem drinkers in the family, reported Kimber Richter, Ph.D.

Approximately 45% of alcoholism is genetic, and knowledge of family history might help children make better choices about alcohol consumption, said Dr. Richter at the annual conference of the Association for Medical Education and Research in Substance Abuse.

Dr. Richter and a group of medical students in a rural preceptorship program designed a survey to better understand parent-child communication regarding a family history of alcohol problems. They surveyed 24 sets of parents aged 18 years or older living in rural Kansas who had children between the ages of 10 and 20 years.

In response to a two-page questionnaire, 100% of the parents said that they had talked to their children about alcohol, and 100% agreed that a family history of alcohol problems increased children's risk. Most (96%) said they believed that families with a positive history of alcohol problems should inform their children. Of the 83% of parents who reported a family history of problems, 57% said they had informed children in the family about this history. Overall, 63% had family rules concerning drinking, with punishments for breaking the rules. The children were not interviewed about their alcohol use, but they averaged 15 years old, the average age of first alcohol use in Kansas, Dr. Richter noted at the conference, also sponsored by Brown Medical School.

The assessment of children with autism spectrum disorders is going high tech.

The Developmental, Dimensional and Diagnostic Interview, known as 3di, is a computerized program that analyzes autistic symptoms in clinical and normal populations, said David Skuse, M.D., of University College London and his colleagues.

Current standardized interviews, including the National Institute of Mental Health Diagnostic Interview Schedule for Children, fail to measure autistic symptoms, the researchers noted.

Although nothing substitutes for a careful interview by someone who knows the child well, the 3di is a hybrid of structured and semistructured interview methods (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:548–58).

The program is meant primarily to evaluate autistic traits in children with normal-range abilities, but it includes features to assess children with moderate or severe mental retardation as well, the researchers said.

In terms of concurrent validity, the 3di was nearly perfect in determining whether children had any autism diagnosis: Among 60 cases and 60 comparison children (mean age 11 years), the 3di diagnosed only one comparison patient with generalized autism disorder.

In a second approach to concurrent validity involving 60 symptomatic children who were referred to psychiatric services, 27 had clinician-diagnosed autism spectrum disorders. Based on how well the children met the International Statistical Classification of Diseases, the 3di program diagnosed 29 of the children with a significant autistic disorder. In addition, the 3di's positive predictive power was 0.93 and negative predictive power was 0.91 in a discriminant validity study of the program's ability to distinguish autism spectrum disorders from nonautistic conditions.

Dr. Skuse is a stockholder in IXDX Ltd., which owns the rights to the interview software and to the dissemination of the technology.

The assessment of children with autism spectrum disorders is going high tech.

The Developmental, Dimensional and Diagnostic Interview, known as 3di, is a computerized program that analyzes autistic symptoms in clinical and normal populations, said David Skuse, M.D., of University College London and his colleagues.

Current standardized interviews, including the National Institute of Mental Health Diagnostic Interview Schedule for Children, fail to measure autistic symptoms, the researchers noted.

Although nothing substitutes for a careful interview by someone who knows the child well, the 3di is a hybrid of structured and semistructured interview methods (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:548–58).

The program is meant primarily to evaluate autistic traits in children with normal-range abilities, but it includes features to assess children with moderate or severe mental retardation as well, the researchers said.

In terms of concurrent validity, the 3di was nearly perfect in determining whether children had any autism diagnosis: Among 60 cases and 60 comparison children (mean age 11 years), the 3di diagnosed only one comparison patient with generalized autism disorder.

In a second approach to concurrent validity involving 60 symptomatic children who were referred to psychiatric services, 27 had clinician-diagnosed autism spectrum disorders. Based on how well the children met the International Statistical Classification of Diseases, the 3di program diagnosed 29 of the children with a significant autistic disorder. In addition, the 3di's positive predictive power was 0.93 and negative predictive power was 0.91 in a discriminant validity study of the program's ability to distinguish autism spectrum disorders from nonautistic conditions.

Dr. Skuse is a stockholder in IXDX Ltd., which owns the rights to the interview software and to the dissemination of the technology.

The assessment of children with autism spectrum disorders is going high tech.

The Developmental, Dimensional and Diagnostic Interview, known as 3di, is a computerized program that analyzes autistic symptoms in clinical and normal populations, said David Skuse, M.D., of University College London and his colleagues.

Current standardized interviews, including the National Institute of Mental Health Diagnostic Interview Schedule for Children, fail to measure autistic symptoms, the researchers noted.

Although nothing substitutes for a careful interview by someone who knows the child well, the 3di is a hybrid of structured and semistructured interview methods (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:548–58).

The program is meant primarily to evaluate autistic traits in children with normal-range abilities, but it includes features to assess children with moderate or severe mental retardation as well, the researchers said.

In terms of concurrent validity, the 3di was nearly perfect in determining whether children had any autism diagnosis: Among 60 cases and 60 comparison children (mean age 11 years), the 3di diagnosed only one comparison patient with generalized autism disorder.

In a second approach to concurrent validity involving 60 symptomatic children who were referred to psychiatric services, 27 had clinician-diagnosed autism spectrum disorders. Based on how well the children met the International Statistical Classification of Diseases, the 3di program diagnosed 29 of the children with a significant autistic disorder. In addition, the 3di's positive predictive power was 0.93 and negative predictive power was 0.91 in a discriminant validity study of the program's ability to distinguish autism spectrum disorders from nonautistic conditions.

Dr. Skuse is a stockholder in IXDX Ltd., which owns the rights to the interview software and to the dissemination of the technology.