Damian McNamara

SAN JUAN, P.R. — Patients struggling with medication compliance for alcohol dependence may benefit from a clinical intervention combining medical management and brief counseling sessions, Helen M. Pettinati, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry.

The compliance-enhancing intervention for physicians comes from an ongoing combination drug and behavioral treatment study sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), said Dr. Pettinati, a research director at the Center for Studies of Addiction, University of Pennsylvania, Philadelphia.

During a lengthy initial session, the physician educates the patient about alcohol dependence, explains medication effects and treatment success rates, and emphasizes the importance of adherence. Follow-up is a series of 15- to 30-minute sessions that include a brief check on medical functioning and whether the patient is drinking and/or medication adherent.

The NIAAA publishes a medical management manual that includes standardized dialogues for education and counseling. The manual is available for $6 at http://www.niaaa.nih.gov/publications/combine-text.htm

“If the patient has a poor response to treatment, ask first about treatment nonadherence,” Dr. Pettinati said.

“Many times in a clinical setting someone will tell me their patient does not respond to that agent, but they haven't asked the patient if they were taking the treatment,” he noted.

“There are a lot of reasons for nonadherence—only a small percentage actually forget and need help with reminders,” Dr. Pettinati said at a symposium funded by an educational grant from Alkermes Inc. Among her disclosures was receipt of grant research support from the company.

The NIAAA study assessing the medical management approach is a phase III study of naltrexone, an injectable, long-acting medication made by Alkermes.

One aim of the study was to assess whether the 30-day form of naltrexone improves compliance. The study included 624 patients with DSM-IV-defined alcohol dependence.

At a higher dose (380 mg), long-acting naltrexone reduced heavy drinking 25% more than did placebo.

The 190-mg dose had a 17% advantage over placebo. “Reductions were seen in the placebo group as well—remember, this is an injectable placebo,” Dr. Pettinati said.

People who participated in the study were compliant—the median number of injections was six. In addition, participants attended a median of 11 out of 12 psychosocial support sessions.

SAN JUAN, P.R. — Patients struggling with medication compliance for alcohol dependence may benefit from a clinical intervention combining medical management and brief counseling sessions, Helen M. Pettinati, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry.

The compliance-enhancing intervention for physicians comes from an ongoing combination drug and behavioral treatment study sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), said Dr. Pettinati, a research director at the Center for Studies of Addiction, University of Pennsylvania, Philadelphia.

During a lengthy initial session, the physician educates the patient about alcohol dependence, explains medication effects and treatment success rates, and emphasizes the importance of adherence. Follow-up is a series of 15- to 30-minute sessions that include a brief check on medical functioning and whether the patient is drinking and/or medication adherent.

The NIAAA publishes a medical management manual that includes standardized dialogues for education and counseling. The manual is available for $6 at http://www.niaaa.nih.gov/publications/combine-text.htm

“If the patient has a poor response to treatment, ask first about treatment nonadherence,” Dr. Pettinati said.

“Many times in a clinical setting someone will tell me their patient does not respond to that agent, but they haven't asked the patient if they were taking the treatment,” he noted.

“There are a lot of reasons for nonadherence—only a small percentage actually forget and need help with reminders,” Dr. Pettinati said at a symposium funded by an educational grant from Alkermes Inc. Among her disclosures was receipt of grant research support from the company.

The NIAAA study assessing the medical management approach is a phase III study of naltrexone, an injectable, long-acting medication made by Alkermes.

One aim of the study was to assess whether the 30-day form of naltrexone improves compliance. The study included 624 patients with DSM-IV-defined alcohol dependence.

At a higher dose (380 mg), long-acting naltrexone reduced heavy drinking 25% more than did placebo.

The 190-mg dose had a 17% advantage over placebo. “Reductions were seen in the placebo group as well—remember, this is an injectable placebo,” Dr. Pettinati said.

People who participated in the study were compliant—the median number of injections was six. In addition, participants attended a median of 11 out of 12 psychosocial support sessions.

SAN JUAN, P.R. — Patients struggling with medication compliance for alcohol dependence may benefit from a clinical intervention combining medical management and brief counseling sessions, Helen M. Pettinati, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry.

The compliance-enhancing intervention for physicians comes from an ongoing combination drug and behavioral treatment study sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), said Dr. Pettinati, a research director at the Center for Studies of Addiction, University of Pennsylvania, Philadelphia.

During a lengthy initial session, the physician educates the patient about alcohol dependence, explains medication effects and treatment success rates, and emphasizes the importance of adherence. Follow-up is a series of 15- to 30-minute sessions that include a brief check on medical functioning and whether the patient is drinking and/or medication adherent.

The NIAAA publishes a medical management manual that includes standardized dialogues for education and counseling. The manual is available for $6 at http://www.niaaa.nih.gov/publications/combine-text.htm

“If the patient has a poor response to treatment, ask first about treatment nonadherence,” Dr. Pettinati said.

“Many times in a clinical setting someone will tell me their patient does not respond to that agent, but they haven't asked the patient if they were taking the treatment,” he noted.

“There are a lot of reasons for nonadherence—only a small percentage actually forget and need help with reminders,” Dr. Pettinati said at a symposium funded by an educational grant from Alkermes Inc. Among her disclosures was receipt of grant research support from the company.

The NIAAA study assessing the medical management approach is a phase III study of naltrexone, an injectable, long-acting medication made by Alkermes.

One aim of the study was to assess whether the 30-day form of naltrexone improves compliance. The study included 624 patients with DSM-IV-defined alcohol dependence.

At a higher dose (380 mg), long-acting naltrexone reduced heavy drinking 25% more than did placebo.

The 190-mg dose had a 17% advantage over placebo. “Reductions were seen in the placebo group as well—remember, this is an injectable placebo,” Dr. Pettinati said.

People who participated in the study were compliant—the median number of injections was six. In addition, participants attended a median of 11 out of 12 psychosocial support sessions.

BOCA RATON, FLA. — Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response and remission, according to a multicenter study.

Somatic symptoms of depression are getting increased attention as part of a drive to achieve asymptomatic remission, said Sidney H. Kennedy, M.D. He and his associates hypothesized that alleviation of physical symptoms of depression would improve response and remission rates.

They assessed 205 patients undergoing open-label antidepressant treatment for 8 weeks in 47 primary care settings. Patients were being treated with venlafaxine, citalopram, fluoxetine, paroxetine, sertraline, bupropion, or mirtazapine. Mean patient age was 43 years, and 64% were female. A total of 157 patients completed the study.

At baseline, and every 2 weeks thereafter, researchers compiled an aggregate somatic score for each patient based on eight items culled from the Hamilton Depression Rating Scale (HAMD). This shorter instrument (HAMD-S) assessed gastrointestinal somatic symptoms; weight loss; early, middle, and late insomnia; general somatic symptoms; somatic anxiety; and hypochondriasis.

Two other scales—the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness—were used to measure depression severity.

Results were presented during a poster session at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

HAMD-S scores decreased from a mean of 10 at baseline to 3 at week 8, a statistically significant difference. There was a significant correlation between improvements on the HAMD-S and overall reductions in MADRS total score, response score, and remission score. Both HAMD-S and MADRS findings correlated with Clinical Global Impression Scale findings.

“The bottom line is we showed that physical symptoms responded comparably with the other symptoms,” said Dr. Kennedy, a psychiatrist with the University Health Network, Toronto.

The HAMD-S and MADRS scales, however, have not been validated as somatic subscales, Dr. Kennedy cautioned. This is a possible limitation of the study.

The study was funded by Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. — Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response and remission, according to a multicenter study.

Somatic symptoms of depression are getting increased attention as part of a drive to achieve asymptomatic remission, said Sidney H. Kennedy, M.D. He and his associates hypothesized that alleviation of physical symptoms of depression would improve response and remission rates.

They assessed 205 patients undergoing open-label antidepressant treatment for 8 weeks in 47 primary care settings. Patients were being treated with venlafaxine, citalopram, fluoxetine, paroxetine, sertraline, bupropion, or mirtazapine. Mean patient age was 43 years, and 64% were female. A total of 157 patients completed the study.

At baseline, and every 2 weeks thereafter, researchers compiled an aggregate somatic score for each patient based on eight items culled from the Hamilton Depression Rating Scale (HAMD). This shorter instrument (HAMD-S) assessed gastrointestinal somatic symptoms; weight loss; early, middle, and late insomnia; general somatic symptoms; somatic anxiety; and hypochondriasis.

Two other scales—the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness—were used to measure depression severity.

Results were presented during a poster session at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

HAMD-S scores decreased from a mean of 10 at baseline to 3 at week 8, a statistically significant difference. There was a significant correlation between improvements on the HAMD-S and overall reductions in MADRS total score, response score, and remission score. Both HAMD-S and MADRS findings correlated with Clinical Global Impression Scale findings.

“The bottom line is we showed that physical symptoms responded comparably with the other symptoms,” said Dr. Kennedy, a psychiatrist with the University Health Network, Toronto.

The HAMD-S and MADRS scales, however, have not been validated as somatic subscales, Dr. Kennedy cautioned. This is a possible limitation of the study.

The study was funded by Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. — Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response and remission, according to a multicenter study.

Somatic symptoms of depression are getting increased attention as part of a drive to achieve asymptomatic remission, said Sidney H. Kennedy, M.D. He and his associates hypothesized that alleviation of physical symptoms of depression would improve response and remission rates.

They assessed 205 patients undergoing open-label antidepressant treatment for 8 weeks in 47 primary care settings. Patients were being treated with venlafaxine, citalopram, fluoxetine, paroxetine, sertraline, bupropion, or mirtazapine. Mean patient age was 43 years, and 64% were female. A total of 157 patients completed the study.

At baseline, and every 2 weeks thereafter, researchers compiled an aggregate somatic score for each patient based on eight items culled from the Hamilton Depression Rating Scale (HAMD). This shorter instrument (HAMD-S) assessed gastrointestinal somatic symptoms; weight loss; early, middle, and late insomnia; general somatic symptoms; somatic anxiety; and hypochondriasis.

Two other scales—the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness—were used to measure depression severity.

Results were presented during a poster session at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

HAMD-S scores decreased from a mean of 10 at baseline to 3 at week 8, a statistically significant difference. There was a significant correlation between improvements on the HAMD-S and overall reductions in MADRS total score, response score, and remission score. Both HAMD-S and MADRS findings correlated with Clinical Global Impression Scale findings.

“The bottom line is we showed that physical symptoms responded comparably with the other symptoms,” said Dr. Kennedy, a psychiatrist with the University Health Network, Toronto.

The HAMD-S and MADRS scales, however, have not been validated as somatic subscales, Dr. Kennedy cautioned. This is a possible limitation of the study.

The study was funded by Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. — An abbreviated Hamilton Depression Rating Scale can quickly assess depression severity and monitor patient response to treatment in a primary care setting, according to a multicenter study.

Complete remission of symptoms is the optimal outcome with depression. However, a validated, brief, comprehensive tool to measure symptoms and remission is unavailable in both mental health and primary care settings, Sidney H. Kennedy, M.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

The full Hamilton Depression Rating Scale (HAMD) is often impractical in primary care settings because of concerns about internal consistency, reliability, and the length of time it takes to administer, Dr. Kennedy told this newspaper. Previously, he and his colleagues confirmed validity of an abbreviated seven-item version of the scale (HAMD-7) in a mood disorder clinic setting (Primary Psychiatry 2003;10:39–42).

To assess its performance in primary care settings, 47 practices across Canada enrolled 454 patients in the study. A majority, 85%, reported the HAMD-7 took 3–6 minutes to administer.

“It is a short, practical rating scale that family physicians see in the same way as [taking] a blood pressure measure. It is easy to do and repeat,” said Dr. Kennedy, psychiatrist in chief at University Health Network, Toronto.

Study participants met DSM-IV-TR criteria for a major depressive episode in the context of major depressive disorder. Patients were acutely depressed (a baseline HAMD score of 18 or greater) and required antidepressant treatment. Treatment remained open-label with flexible dosing throughout the 8-week study.

A total of 410 patients met enrollment criteria and were randomized to the HAMD or HAMD-7 group. Researchers looked for correlation between these two tools and depression symptoms measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness (CGI-I/S).

The HAMD-7 consisted of the seven items from the HAMD most often endorsed by depressed patients and most sensitive to treatment change. These items include depressed mood, guilt, work and activities, psychic anxiety, somatic anxiety, somatic general, and suicide.

Changes in HAMD and HAMD-7 scores were similar from baseline to end point. In addition, remission rates were similar between groups. For example, a total of 49% of the HAMD group achieved remission, defined as a score of 7 or less. A total of 40% achieved remission on the HAMD-7, defined as a score of 3 or less. This difference was not statistically significant.

“Our first question was: Would we see the same seven items in the family practice setting? The answer is yes, so we validated the seven-item HAMD in this setting,” said Dr. Kennedy, who is also a professor of psychiatry at University of Toronto. He and his associates also validated a cutoff score of 3 for remission using the HAMD-7 in the family practice setting.

A significant proportion of HAMD and HAMD-7 patients achieved a priori response, defined as a 50% or greater reduction in scores by study end, compared with baseline. Researchers found 74% of HAMD patients responded to treatment, as did 67% of the HAMD-7 patients, with no significant difference between groups.

There were significant changes, however, in both MADRS and CGI-I/S scores from baseline to study end within each group. For example, mean MADRS scores changed from 28 to 10 in the HAMD group and from 30 to 10 in the HAMD-7 group. Differences in depression severity between groups were not statistically significant.

The HAMD-7 scale is an important tool to gauge effectiveness of antidepressant treatment and to determine when full symptomatic remission occurs in primary care settings, according to the study authors. “We will continue looking at this,” Dr. Kennedy said.

The study was supported by funding from Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. — An abbreviated Hamilton Depression Rating Scale can quickly assess depression severity and monitor patient response to treatment in a primary care setting, according to a multicenter study.

Complete remission of symptoms is the optimal outcome with depression. However, a validated, brief, comprehensive tool to measure symptoms and remission is unavailable in both mental health and primary care settings, Sidney H. Kennedy, M.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

The full Hamilton Depression Rating Scale (HAMD) is often impractical in primary care settings because of concerns about internal consistency, reliability, and the length of time it takes to administer, Dr. Kennedy told this newspaper. Previously, he and his colleagues confirmed validity of an abbreviated seven-item version of the scale (HAMD-7) in a mood disorder clinic setting (Primary Psychiatry 2003;10:39–42).

To assess its performance in primary care settings, 47 practices across Canada enrolled 454 patients in the study. A majority, 85%, reported the HAMD-7 took 3–6 minutes to administer.

“It is a short, practical rating scale that family physicians see in the same way as [taking] a blood pressure measure. It is easy to do and repeat,” said Dr. Kennedy, psychiatrist in chief at University Health Network, Toronto.

Study participants met DSM-IV-TR criteria for a major depressive episode in the context of major depressive disorder. Patients were acutely depressed (a baseline HAMD score of 18 or greater) and required antidepressant treatment. Treatment remained open-label with flexible dosing throughout the 8-week study.

A total of 410 patients met enrollment criteria and were randomized to the HAMD or HAMD-7 group. Researchers looked for correlation between these two tools and depression symptoms measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness (CGI-I/S).

The HAMD-7 consisted of the seven items from the HAMD most often endorsed by depressed patients and most sensitive to treatment change. These items include depressed mood, guilt, work and activities, psychic anxiety, somatic anxiety, somatic general, and suicide.

Changes in HAMD and HAMD-7 scores were similar from baseline to end point. In addition, remission rates were similar between groups. For example, a total of 49% of the HAMD group achieved remission, defined as a score of 7 or less. A total of 40% achieved remission on the HAMD-7, defined as a score of 3 or less. This difference was not statistically significant.

“Our first question was: Would we see the same seven items in the family practice setting? The answer is yes, so we validated the seven-item HAMD in this setting,” said Dr. Kennedy, who is also a professor of psychiatry at University of Toronto. He and his associates also validated a cutoff score of 3 for remission using the HAMD-7 in the family practice setting.

A significant proportion of HAMD and HAMD-7 patients achieved a priori response, defined as a 50% or greater reduction in scores by study end, compared with baseline. Researchers found 74% of HAMD patients responded to treatment, as did 67% of the HAMD-7 patients, with no significant difference between groups.

There were significant changes, however, in both MADRS and CGI-I/S scores from baseline to study end within each group. For example, mean MADRS scores changed from 28 to 10 in the HAMD group and from 30 to 10 in the HAMD-7 group. Differences in depression severity between groups were not statistically significant.

The HAMD-7 scale is an important tool to gauge effectiveness of antidepressant treatment and to determine when full symptomatic remission occurs in primary care settings, according to the study authors. “We will continue looking at this,” Dr. Kennedy said.

The study was supported by funding from Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. — An abbreviated Hamilton Depression Rating Scale can quickly assess depression severity and monitor patient response to treatment in a primary care setting, according to a multicenter study.

Complete remission of symptoms is the optimal outcome with depression. However, a validated, brief, comprehensive tool to measure symptoms and remission is unavailable in both mental health and primary care settings, Sidney H. Kennedy, M.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

The full Hamilton Depression Rating Scale (HAMD) is often impractical in primary care settings because of concerns about internal consistency, reliability, and the length of time it takes to administer, Dr. Kennedy told this newspaper. Previously, he and his colleagues confirmed validity of an abbreviated seven-item version of the scale (HAMD-7) in a mood disorder clinic setting (Primary Psychiatry 2003;10:39–42).

To assess its performance in primary care settings, 47 practices across Canada enrolled 454 patients in the study. A majority, 85%, reported the HAMD-7 took 3–6 minutes to administer.

“It is a short, practical rating scale that family physicians see in the same way as [taking] a blood pressure measure. It is easy to do and repeat,” said Dr. Kennedy, psychiatrist in chief at University Health Network, Toronto.

Study participants met DSM-IV-TR criteria for a major depressive episode in the context of major depressive disorder. Patients were acutely depressed (a baseline HAMD score of 18 or greater) and required antidepressant treatment. Treatment remained open-label with flexible dosing throughout the 8-week study.

A total of 410 patients met enrollment criteria and were randomized to the HAMD or HAMD-7 group. Researchers looked for correlation between these two tools and depression symptoms measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness (CGI-I/S).

The HAMD-7 consisted of the seven items from the HAMD most often endorsed by depressed patients and most sensitive to treatment change. These items include depressed mood, guilt, work and activities, psychic anxiety, somatic anxiety, somatic general, and suicide.

Changes in HAMD and HAMD-7 scores were similar from baseline to end point. In addition, remission rates were similar between groups. For example, a total of 49% of the HAMD group achieved remission, defined as a score of 7 or less. A total of 40% achieved remission on the HAMD-7, defined as a score of 3 or less. This difference was not statistically significant.

“Our first question was: Would we see the same seven items in the family practice setting? The answer is yes, so we validated the seven-item HAMD in this setting,” said Dr. Kennedy, who is also a professor of psychiatry at University of Toronto. He and his associates also validated a cutoff score of 3 for remission using the HAMD-7 in the family practice setting.

A significant proportion of HAMD and HAMD-7 patients achieved a priori response, defined as a 50% or greater reduction in scores by study end, compared with baseline. Researchers found 74% of HAMD patients responded to treatment, as did 67% of the HAMD-7 patients, with no significant difference between groups.

There were significant changes, however, in both MADRS and CGI-I/S scores from baseline to study end within each group. For example, mean MADRS scores changed from 28 to 10 in the HAMD group and from 30 to 10 in the HAMD-7 group. Differences in depression severity between groups were not statistically significant.

The HAMD-7 scale is an important tool to gauge effectiveness of antidepressant treatment and to determine when full symptomatic remission occurs in primary care settings, according to the study authors. “We will continue looking at this,” Dr. Kennedy said.

The study was supported by funding from Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. – Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response, according to a multicenter, naturalistic study.

Somatic symptoms of depression are getting increased attention as part of a drive to achieve and sustain asymptomatic remission, according to Sidney H. Kennedy, M.D. He and his associates hypothesized that alleviation of the physical symptoms of depression would improve response and remission rates.

They assessed 205 patients undergoing open-label antidepressant treatment for 8 weeks in 47 primary care settings across Canada. Patients were receiving venlafaxine, citalopram, fluoxetine, paroxetine, sertraline, bupropion, or mirtazapine. Mean patient age was 43 years, and 64% were female; 157 patients completed the study.

At baseline, and every 2 weeks thereafter, researchers compiled an aggregate somatic score for each patient based on eight items culled from the Hamilton Depression Rating Scale (HAMD). This shorter instrument (HAMD-S) assessed gastrointestinal somatic symptoms; weight loss; early, middle, and late insomnia; general somatic symptoms; somatic anxiety; and hypochondriasis.

Two other scales–the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness–were used to measure depression severity.

Results were presented during a poster session at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

HAMD-S scores decreased from a mean of 10 at baseline to a mean of 3 at week 8, a statistically significant difference. There was a significant correlation between improvements on the HAMD-S and overall reductions in MADRS total score, response score, and remission score. Both HAMD-S and MADRS findings correlated with Clinical Global Impression Scale findings.

“The bottom line is we showed that physical symptoms responded comparably with the other symptoms,” said Dr. Kennedy, a psychiatrist with the University Health Network, Toronto.

The HAMD-S and MADRS scales, however, have not been validated as somatic subscales, he cautioned. This is a possible limitation of the study.

Clinicians should target somatic symptoms of depression to improve treatment outcomes, Dr. Kennedy said.

The study was supported by funding from Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. – Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response, according to a multicenter, naturalistic study.

Somatic symptoms of depression are getting increased attention as part of a drive to achieve and sustain asymptomatic remission, according to Sidney H. Kennedy, M.D. He and his associates hypothesized that alleviation of the physical symptoms of depression would improve response and remission rates.

They assessed 205 patients undergoing open-label antidepressant treatment for 8 weeks in 47 primary care settings across Canada. Patients were receiving venlafaxine, citalopram, fluoxetine, paroxetine, sertraline, bupropion, or mirtazapine. Mean patient age was 43 years, and 64% were female; 157 patients completed the study.

At baseline, and every 2 weeks thereafter, researchers compiled an aggregate somatic score for each patient based on eight items culled from the Hamilton Depression Rating Scale (HAMD). This shorter instrument (HAMD-S) assessed gastrointestinal somatic symptoms; weight loss; early, middle, and late insomnia; general somatic symptoms; somatic anxiety; and hypochondriasis.

Two other scales–the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness–were used to measure depression severity.

Results were presented during a poster session at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

HAMD-S scores decreased from a mean of 10 at baseline to a mean of 3 at week 8, a statistically significant difference. There was a significant correlation between improvements on the HAMD-S and overall reductions in MADRS total score, response score, and remission score. Both HAMD-S and MADRS findings correlated with Clinical Global Impression Scale findings.

“The bottom line is we showed that physical symptoms responded comparably with the other symptoms,” said Dr. Kennedy, a psychiatrist with the University Health Network, Toronto.

The HAMD-S and MADRS scales, however, have not been validated as somatic subscales, he cautioned. This is a possible limitation of the study.

Clinicians should target somatic symptoms of depression to improve treatment outcomes, Dr. Kennedy said.

The study was supported by funding from Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

BOCA RATON, FLA. – Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response, according to a multicenter, naturalistic study.

Somatic symptoms of depression are getting increased attention as part of a drive to achieve and sustain asymptomatic remission, according to Sidney H. Kennedy, M.D. He and his associates hypothesized that alleviation of the physical symptoms of depression would improve response and remission rates.

They assessed 205 patients undergoing open-label antidepressant treatment for 8 weeks in 47 primary care settings across Canada. Patients were receiving venlafaxine, citalopram, fluoxetine, paroxetine, sertraline, bupropion, or mirtazapine. Mean patient age was 43 years, and 64% were female; 157 patients completed the study.

At baseline, and every 2 weeks thereafter, researchers compiled an aggregate somatic score for each patient based on eight items culled from the Hamilton Depression Rating Scale (HAMD). This shorter instrument (HAMD-S) assessed gastrointestinal somatic symptoms; weight loss; early, middle, and late insomnia; general somatic symptoms; somatic anxiety; and hypochondriasis.

Two other scales–the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness–were used to measure depression severity.

Results were presented during a poster session at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

HAMD-S scores decreased from a mean of 10 at baseline to a mean of 3 at week 8, a statistically significant difference. There was a significant correlation between improvements on the HAMD-S and overall reductions in MADRS total score, response score, and remission score. Both HAMD-S and MADRS findings correlated with Clinical Global Impression Scale findings.

“The bottom line is we showed that physical symptoms responded comparably with the other symptoms,” said Dr. Kennedy, a psychiatrist with the University Health Network, Toronto.

The HAMD-S and MADRS scales, however, have not been validated as somatic subscales, he cautioned. This is a possible limitation of the study.

Clinicians should target somatic symptoms of depression to improve treatment outcomes, Dr. Kennedy said.

The study was supported by funding from Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.

NEW ORLEANS – Low-income smokers prescribed bupropion in primary care settings are less successful with smoking cessation than participants in controlled trials, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.

Multicenter trials indicate that sustained-release bupropion helps 44% quit at 7 weeks, compared with 19% taking a placebo (N. Engl. J. Med. 1997;337:1195–202) and 58% of cigarette smokers quit at 9 weeks, compared with 16% taking a placebo (N. Engl. J. Med. 1999;340:685–91).

But participants in those bupropion trials did not reflect the patient population in Fresno County, according to Evelyn Fang, M.D. The county has a 23% poverty rate (vs. 14% for California), a high rate of stroke and heart disease, and an increasing rate of lung cancer deaths.

Physicians at one family medicine clinic and two internal medicine clinics associated with the University of California, San Francisco, Fresno campus, screened and referred patients to Dr. Fang and her associates. The researchers enrolled 72 participants over 3 months from the University of California, San Francisco, Fresno residency-affiliated training sites.

Dr. Fang, who is no longer with the university, was a clinical instructor in medicine when the study was conducted. John Zweifler, M.D., also of the University of California, San Francisco, Fresno, presented the study at the meeting.

Participants received a free 30-day supply of bupropion with one refill. They took one pill every day for 3 days, then increased to two pills daily, and were advised to stop smoking after 7 days. The researchers surveyed participants by telephone at 30 days and 60 days. A total of 57 patients completed the follow-up and were studied further.

The mean age was 47 years and 65% were female. The group was 61% Caucasian, 19% Hispanic, 18% African American, and 2% Asian. Participants reported a median of two previous attempts to quit smoking and a median of 30 years of cigarette smoking.

A total of 17% stopped smoking at 3 months, as did 18% at 6 months.

Sustained-release bupropion may help low-income smokers in real clinical settings quit smoking, Dr. Zweifler, M.D., said, but the effect was less than half of what has been previously reported in highly controlled trials of more motivated patients.

Limitations of the study include the sample size and lack of a control group. Future studies should assess bupropion in low-income smokers with psychiatric conditions, as well as investigate cost-effective alternatives to assist patients in this population stop smoking, Dr. Zweifler said.

NEW ORLEANS – Low-income smokers prescribed bupropion in primary care settings are less successful with smoking cessation than participants in controlled trials, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.

Multicenter trials indicate that sustained-release bupropion helps 44% quit at 7 weeks, compared with 19% taking a placebo (N. Engl. J. Med. 1997;337:1195–202) and 58% of cigarette smokers quit at 9 weeks, compared with 16% taking a placebo (N. Engl. J. Med. 1999;340:685–91).

But participants in those bupropion trials did not reflect the patient population in Fresno County, according to Evelyn Fang, M.D. The county has a 23% poverty rate (vs. 14% for California), a high rate of stroke and heart disease, and an increasing rate of lung cancer deaths.

Physicians at one family medicine clinic and two internal medicine clinics associated with the University of California, San Francisco, Fresno campus, screened and referred patients to Dr. Fang and her associates. The researchers enrolled 72 participants over 3 months from the University of California, San Francisco, Fresno residency-affiliated training sites.

Dr. Fang, who is no longer with the university, was a clinical instructor in medicine when the study was conducted. John Zweifler, M.D., also of the University of California, San Francisco, Fresno, presented the study at the meeting.

Participants received a free 30-day supply of bupropion with one refill. They took one pill every day for 3 days, then increased to two pills daily, and were advised to stop smoking after 7 days. The researchers surveyed participants by telephone at 30 days and 60 days. A total of 57 patients completed the follow-up and were studied further.

The mean age was 47 years and 65% were female. The group was 61% Caucasian, 19% Hispanic, 18% African American, and 2% Asian. Participants reported a median of two previous attempts to quit smoking and a median of 30 years of cigarette smoking.

A total of 17% stopped smoking at 3 months, as did 18% at 6 months.

Sustained-release bupropion may help low-income smokers in real clinical settings quit smoking, Dr. Zweifler, M.D., said, but the effect was less than half of what has been previously reported in highly controlled trials of more motivated patients.

Limitations of the study include the sample size and lack of a control group. Future studies should assess bupropion in low-income smokers with psychiatric conditions, as well as investigate cost-effective alternatives to assist patients in this population stop smoking, Dr. Zweifler said.

NEW ORLEANS – Low-income smokers prescribed bupropion in primary care settings are less successful with smoking cessation than participants in controlled trials, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.

Multicenter trials indicate that sustained-release bupropion helps 44% quit at 7 weeks, compared with 19% taking a placebo (N. Engl. J. Med. 1997;337:1195–202) and 58% of cigarette smokers quit at 9 weeks, compared with 16% taking a placebo (N. Engl. J. Med. 1999;340:685–91).

But participants in those bupropion trials did not reflect the patient population in Fresno County, according to Evelyn Fang, M.D. The county has a 23% poverty rate (vs. 14% for California), a high rate of stroke and heart disease, and an increasing rate of lung cancer deaths.

Physicians at one family medicine clinic and two internal medicine clinics associated with the University of California, San Francisco, Fresno campus, screened and referred patients to Dr. Fang and her associates. The researchers enrolled 72 participants over 3 months from the University of California, San Francisco, Fresno residency-affiliated training sites.

Dr. Fang, who is no longer with the university, was a clinical instructor in medicine when the study was conducted. John Zweifler, M.D., also of the University of California, San Francisco, Fresno, presented the study at the meeting.

Participants received a free 30-day supply of bupropion with one refill. They took one pill every day for 3 days, then increased to two pills daily, and were advised to stop smoking after 7 days. The researchers surveyed participants by telephone at 30 days and 60 days. A total of 57 patients completed the follow-up and were studied further.

The mean age was 47 years and 65% were female. The group was 61% Caucasian, 19% Hispanic, 18% African American, and 2% Asian. Participants reported a median of two previous attempts to quit smoking and a median of 30 years of cigarette smoking.

A total of 17% stopped smoking at 3 months, as did 18% at 6 months.

Sustained-release bupropion may help low-income smokers in real clinical settings quit smoking, Dr. Zweifler, M.D., said, but the effect was less than half of what has been previously reported in highly controlled trials of more motivated patients.

Limitations of the study include the sample size and lack of a control group. Future studies should assess bupropion in low-income smokers with psychiatric conditions, as well as investigate cost-effective alternatives to assist patients in this population stop smoking, Dr. Zweifler said.

BOCA RATON, FLA. – Vestibular rehabilitation and balance retraining reduced vertigo and falls in a study of 100 community-dwelling elderly patients with disequilibrium of aging.

The intervention also improved gait and overall quality of life in the study conducted at the Atlanta Ear Clinic between July 2004 and March 2005. The study included 57 women, and the mean age was 79 years.

“We see a lot of elderly people in our population, and vertigo is a common cause of falls,” Gaye W. Cronin, an occupational therapist at the clinic, said during a poster session at the annual meeting of the American Head and Neck Society.

At baseline, participants had a medical examination, an audiogram, and an assessment of fall risk, balance, gait, positional vertigo, and oculomotor function. The intervention consisted of balance and vestibular rehabilitation, oculomotor exercises, and repositioning or redistribution exercises for benign paroxysmal positional vertigo (BPPV).

The intervention “would be pretty easy to follow by other physicians,” Ms. Cronin told this newspaper.

Vestibular rehabilitation and balance retraining involve movement and exercise intended to decrease or eliminate dizziness or vertigo, improve balance function and safety, improve visual motor control, increase activity levels, and reduce falls or risk of falls. The program is indicated for people with vertigo or imbalance conditions that do not spontaneously resolve within 3–4 weeks, she said.

Ms. Cronin and her associate, Ronald Leif Steenerson, M.D., followed the patients in person or via telephone for 6 months. There was an 80% reduction in the number of falls. “We saw a significant reduction in falls, from 56 falls before the intervention to 11 falls afterward,” she said.

The intervention normalized BPPV for 82 of the initial 91 patients (90%) who presented with the condition. Gait was normalized for 55% of the patients. A total of 71% had normalized balance tests, and 54% no longer needed a device to assist with mobility.

The researchers also measured quality of life on a 0 to 10 scale. Scores improved from an average 3.5 at baseline to 7 after the intervention.

More information on vestibular rehabilitation and balance retraining is available at www.atlantaearclinic.com

BOCA RATON, FLA. – Vestibular rehabilitation and balance retraining reduced vertigo and falls in a study of 100 community-dwelling elderly patients with disequilibrium of aging.

The intervention also improved gait and overall quality of life in the study conducted at the Atlanta Ear Clinic between July 2004 and March 2005. The study included 57 women, and the mean age was 79 years.

“We see a lot of elderly people in our population, and vertigo is a common cause of falls,” Gaye W. Cronin, an occupational therapist at the clinic, said during a poster session at the annual meeting of the American Head and Neck Society.

At baseline, participants had a medical examination, an audiogram, and an assessment of fall risk, balance, gait, positional vertigo, and oculomotor function. The intervention consisted of balance and vestibular rehabilitation, oculomotor exercises, and repositioning or redistribution exercises for benign paroxysmal positional vertigo (BPPV).

The intervention “would be pretty easy to follow by other physicians,” Ms. Cronin told this newspaper.

Vestibular rehabilitation and balance retraining involve movement and exercise intended to decrease or eliminate dizziness or vertigo, improve balance function and safety, improve visual motor control, increase activity levels, and reduce falls or risk of falls. The program is indicated for people with vertigo or imbalance conditions that do not spontaneously resolve within 3–4 weeks, she said.

Ms. Cronin and her associate, Ronald Leif Steenerson, M.D., followed the patients in person or via telephone for 6 months. There was an 80% reduction in the number of falls. “We saw a significant reduction in falls, from 56 falls before the intervention to 11 falls afterward,” she said.

The intervention normalized BPPV for 82 of the initial 91 patients (90%) who presented with the condition. Gait was normalized for 55% of the patients. A total of 71% had normalized balance tests, and 54% no longer needed a device to assist with mobility.

The researchers also measured quality of life on a 0 to 10 scale. Scores improved from an average 3.5 at baseline to 7 after the intervention.

More information on vestibular rehabilitation and balance retraining is available at www.atlantaearclinic.com

BOCA RATON, FLA. – Vestibular rehabilitation and balance retraining reduced vertigo and falls in a study of 100 community-dwelling elderly patients with disequilibrium of aging.

The intervention also improved gait and overall quality of life in the study conducted at the Atlanta Ear Clinic between July 2004 and March 2005. The study included 57 women, and the mean age was 79 years.

“We see a lot of elderly people in our population, and vertigo is a common cause of falls,” Gaye W. Cronin, an occupational therapist at the clinic, said during a poster session at the annual meeting of the American Head and Neck Society.

At baseline, participants had a medical examination, an audiogram, and an assessment of fall risk, balance, gait, positional vertigo, and oculomotor function. The intervention consisted of balance and vestibular rehabilitation, oculomotor exercises, and repositioning or redistribution exercises for benign paroxysmal positional vertigo (BPPV).

The intervention “would be pretty easy to follow by other physicians,” Ms. Cronin told this newspaper.

Vestibular rehabilitation and balance retraining involve movement and exercise intended to decrease or eliminate dizziness or vertigo, improve balance function and safety, improve visual motor control, increase activity levels, and reduce falls or risk of falls. The program is indicated for people with vertigo or imbalance conditions that do not spontaneously resolve within 3–4 weeks, she said.

Ms. Cronin and her associate, Ronald Leif Steenerson, M.D., followed the patients in person or via telephone for 6 months. There was an 80% reduction in the number of falls. “We saw a significant reduction in falls, from 56 falls before the intervention to 11 falls afterward,” she said.

The intervention normalized BPPV for 82 of the initial 91 patients (90%) who presented with the condition. Gait was normalized for 55% of the patients. A total of 71% had normalized balance tests, and 54% no longer needed a device to assist with mobility.

The researchers also measured quality of life on a 0 to 10 scale. Scores improved from an average 3.5 at baseline to 7 after the intervention.

More information on vestibular rehabilitation and balance retraining is available at www.atlantaearclinic.com

NEW ORLEANS — Nearly all family physician faculty members believe intrauterine devices are safe and effective, and more than half reported insertion of one or more in the previous year, according to survey findings presented at the annual conference of the Society of Teachers of Family Medicine.

An estimated 10%–13% of women worldwide use an intrauterine device (IUD) versus less than 1% of women in the United States. Lower use in this country might be related to a lack of residency training or misconceptions about the devices. “It could be a fear of infection or liability concerns,” said Smita Arora, M.D.

Dr. Arora surveyed a random sample of 500 clinical family medicine residency faculty selected from the Society of Teachers of Family Medicine membership list. There were 221 responses, for a 44% response rate. The mean age of respondents was 44 years and 56% were male. She used an IUD survey tool adapted from the work of Nancy Stanwood, M.D. (Obstet. Gynecol. 2002;99:275–80).

More than 92% of respondents said that they believe IUDs are a safe, effective, and cost-effective means of contraception, said Dr. Arora, associate director of residency and director of obstetric and women's health at Sacred Heart Hospital in Allentown, Pa. The survey was part of work she did at a previous position.

A total of 53% of physicians said they had inserted an IUD in the previous year. “I was very surprised at this result,” Dr. Arora said. Of these physicians, 59% reported insertion of only 1–4 devices; 90% inserted copper IUDs, and 10% inserted levonorgestrel IUDs. A total of 18% said they had never inserted an IUD.

“So we have this large population of family [medicine] faculty who are open to using IUDs. So why is the rate so low?” Dr. Arora asked. “We need less restrictive and more evidence-based criteria for use of IUDs, which would be a more woman-friendly approach to contraception.”

A majority of respondents, 74%, said they believe patients are receptive to learning about IUDs. Twenty percent believe IUDs are abortifacients and 6% think the devices lead to lawsuits.

Respondents said they would not consider use of an IUD in a patient with history of pelvic inflammatory disease (71%), nulliparity (53%), or sexually transmitted disease (52%).

When asked what they believe are the three most effective methods of contraception, 28% said tubal ligation, 21% said vasectomy, and 15% said a copper IUD. Dr. Arora said, “They may have responded with IUD because this was an IUD study. I'm not sure that 15% would really say IUD otherwise.”

NEW ORLEANS — Nearly all family physician faculty members believe intrauterine devices are safe and effective, and more than half reported insertion of one or more in the previous year, according to survey findings presented at the annual conference of the Society of Teachers of Family Medicine.

An estimated 10%–13% of women worldwide use an intrauterine device (IUD) versus less than 1% of women in the United States. Lower use in this country might be related to a lack of residency training or misconceptions about the devices. “It could be a fear of infection or liability concerns,” said Smita Arora, M.D.

Dr. Arora surveyed a random sample of 500 clinical family medicine residency faculty selected from the Society of Teachers of Family Medicine membership list. There were 221 responses, for a 44% response rate. The mean age of respondents was 44 years and 56% were male. She used an IUD survey tool adapted from the work of Nancy Stanwood, M.D. (Obstet. Gynecol. 2002;99:275–80).

More than 92% of respondents said that they believe IUDs are a safe, effective, and cost-effective means of contraception, said Dr. Arora, associate director of residency and director of obstetric and women's health at Sacred Heart Hospital in Allentown, Pa. The survey was part of work she did at a previous position.

A total of 53% of physicians said they had inserted an IUD in the previous year. “I was very surprised at this result,” Dr. Arora said. Of these physicians, 59% reported insertion of only 1–4 devices; 90% inserted copper IUDs, and 10% inserted levonorgestrel IUDs. A total of 18% said they had never inserted an IUD.

“So we have this large population of family [medicine] faculty who are open to using IUDs. So why is the rate so low?” Dr. Arora asked. “We need less restrictive and more evidence-based criteria for use of IUDs, which would be a more woman-friendly approach to contraception.”

A majority of respondents, 74%, said they believe patients are receptive to learning about IUDs. Twenty percent believe IUDs are abortifacients and 6% think the devices lead to lawsuits.

Respondents said they would not consider use of an IUD in a patient with history of pelvic inflammatory disease (71%), nulliparity (53%), or sexually transmitted disease (52%).

When asked what they believe are the three most effective methods of contraception, 28% said tubal ligation, 21% said vasectomy, and 15% said a copper IUD. Dr. Arora said, “They may have responded with IUD because this was an IUD study. I'm not sure that 15% would really say IUD otherwise.”

NEW ORLEANS — Nearly all family physician faculty members believe intrauterine devices are safe and effective, and more than half reported insertion of one or more in the previous year, according to survey findings presented at the annual conference of the Society of Teachers of Family Medicine.

An estimated 10%–13% of women worldwide use an intrauterine device (IUD) versus less than 1% of women in the United States. Lower use in this country might be related to a lack of residency training or misconceptions about the devices. “It could be a fear of infection or liability concerns,” said Smita Arora, M.D.

Dr. Arora surveyed a random sample of 500 clinical family medicine residency faculty selected from the Society of Teachers of Family Medicine membership list. There were 221 responses, for a 44% response rate. The mean age of respondents was 44 years and 56% were male. She used an IUD survey tool adapted from the work of Nancy Stanwood, M.D. (Obstet. Gynecol. 2002;99:275–80).

More than 92% of respondents said that they believe IUDs are a safe, effective, and cost-effective means of contraception, said Dr. Arora, associate director of residency and director of obstetric and women's health at Sacred Heart Hospital in Allentown, Pa. The survey was part of work she did at a previous position.

A total of 53% of physicians said they had inserted an IUD in the previous year. “I was very surprised at this result,” Dr. Arora said. Of these physicians, 59% reported insertion of only 1–4 devices; 90% inserted copper IUDs, and 10% inserted levonorgestrel IUDs. A total of 18% said they had never inserted an IUD.

“So we have this large population of family [medicine] faculty who are open to using IUDs. So why is the rate so low?” Dr. Arora asked. “We need less restrictive and more evidence-based criteria for use of IUDs, which would be a more woman-friendly approach to contraception.”

A majority of respondents, 74%, said they believe patients are receptive to learning about IUDs. Twenty percent believe IUDs are abortifacients and 6% think the devices lead to lawsuits.

Respondents said they would not consider use of an IUD in a patient with history of pelvic inflammatory disease (71%), nulliparity (53%), or sexually transmitted disease (52%).

When asked what they believe are the three most effective methods of contraception, 28% said tubal ligation, 21% said vasectomy, and 15% said a copper IUD. Dr. Arora said, “They may have responded with IUD because this was an IUD study. I'm not sure that 15% would really say IUD otherwise.”

NEW ORLEANS — A substantial number of people in the U.S. Hispanic community self-medicate with oral antibiotics, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.

Many countries in Latin America dispense antibiotics without a prescription, and individuals from these countries have cultural norms for self-medication, said Arch G. Mainous III, Ph.D.

The researchers interviewed 219 self-identified Hispanics, and 45% indicated they had purchased nonprescribed antibiotics outside the United States at some time; 16% had imported them. “Those results were striking,” said Dr. Mainous, professor of family medicine at the Medical University of South Carolina, Charleston. “Another striking feature was that 19% had acquired antibiotics not prescribed for the person in the United States; 93% [of them] said they got them in stores.”

Latin America has a high level of antibiotic resistance, Dr. Mainous said. U.S. interventions on resistance have decreased antibiotic use, but they focus on prescribing. To correct inappropriate acquisition and use, patient education materials should not only be available in Spanish, but also should be culturally sensitive, he suggested.

The findings of the study, Dr. Mainous said, “point to a large unrecognized reservoir of nonprescribed antibiotics likely used for inappropriate self-medication. We know from other studies that people in countries where antibiotics are available tend to take subtherapeutic doses.”

All participants were 18 years and older and were recruited from one of two clinics in Charleston. The majority (75%) were born in Mexico; 41% said they had been in the United States fewer than 4 years; and 90% did not have medical insurance. The common cold, ear infections, cough, and sore throat were the primary illnesses for which respondents took nonprescribed antibiotics.

Of interviewed individuals, 64% said they acquired antibiotics without a prescription because it was preferable to a physician visit. “Only 7% said there was a language barrier, so most did not want to spend the money or go to a doctor.”

This phenomenon is not limited to Hispanics, Dr. Mainous pointed out. “People in the Philippines, Taiwan, and Bangladesh will also buy subtherapeutic doses for self-medication.”

NEW ORLEANS — A substantial number of people in the U.S. Hispanic community self-medicate with oral antibiotics, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.

Many countries in Latin America dispense antibiotics without a prescription, and individuals from these countries have cultural norms for self-medication, said Arch G. Mainous III, Ph.D.

The researchers interviewed 219 self-identified Hispanics, and 45% indicated they had purchased nonprescribed antibiotics outside the United States at some time; 16% had imported them. “Those results were striking,” said Dr. Mainous, professor of family medicine at the Medical University of South Carolina, Charleston. “Another striking feature was that 19% had acquired antibiotics not prescribed for the person in the United States; 93% [of them] said they got them in stores.”

Latin America has a high level of antibiotic resistance, Dr. Mainous said. U.S. interventions on resistance have decreased antibiotic use, but they focus on prescribing. To correct inappropriate acquisition and use, patient education materials should not only be available in Spanish, but also should be culturally sensitive, he suggested.

The findings of the study, Dr. Mainous said, “point to a large unrecognized reservoir of nonprescribed antibiotics likely used for inappropriate self-medication. We know from other studies that people in countries where antibiotics are available tend to take subtherapeutic doses.”

All participants were 18 years and older and were recruited from one of two clinics in Charleston. The majority (75%) were born in Mexico; 41% said they had been in the United States fewer than 4 years; and 90% did not have medical insurance. The common cold, ear infections, cough, and sore throat were the primary illnesses for which respondents took nonprescribed antibiotics.

Of interviewed individuals, 64% said they acquired antibiotics without a prescription because it was preferable to a physician visit. “Only 7% said there was a language barrier, so most did not want to spend the money or go to a doctor.”

This phenomenon is not limited to Hispanics, Dr. Mainous pointed out. “People in the Philippines, Taiwan, and Bangladesh will also buy subtherapeutic doses for self-medication.”

NEW ORLEANS — A substantial number of people in the U.S. Hispanic community self-medicate with oral antibiotics, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.

Many countries in Latin America dispense antibiotics without a prescription, and individuals from these countries have cultural norms for self-medication, said Arch G. Mainous III, Ph.D.

The researchers interviewed 219 self-identified Hispanics, and 45% indicated they had purchased nonprescribed antibiotics outside the United States at some time; 16% had imported them. “Those results were striking,” said Dr. Mainous, professor of family medicine at the Medical University of South Carolina, Charleston. “Another striking feature was that 19% had acquired antibiotics not prescribed for the person in the United States; 93% [of them] said they got them in stores.”

Latin America has a high level of antibiotic resistance, Dr. Mainous said. U.S. interventions on resistance have decreased antibiotic use, but they focus on prescribing. To correct inappropriate acquisition and use, patient education materials should not only be available in Spanish, but also should be culturally sensitive, he suggested.

The findings of the study, Dr. Mainous said, “point to a large unrecognized reservoir of nonprescribed antibiotics likely used for inappropriate self-medication. We know from other studies that people in countries where antibiotics are available tend to take subtherapeutic doses.”

All participants were 18 years and older and were recruited from one of two clinics in Charleston. The majority (75%) were born in Mexico; 41% said they had been in the United States fewer than 4 years; and 90% did not have medical insurance. The common cold, ear infections, cough, and sore throat were the primary illnesses for which respondents took nonprescribed antibiotics.

Of interviewed individuals, 64% said they acquired antibiotics without a prescription because it was preferable to a physician visit. “Only 7% said there was a language barrier, so most did not want to spend the money or go to a doctor.”

This phenomenon is not limited to Hispanics, Dr. Mainous pointed out. “People in the Philippines, Taiwan, and Bangladesh will also buy subtherapeutic doses for self-medication.”