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Sample records for adult comorbidity evaluation-27

  1. Comorbidity

    MedlinePlus

    ... Adolescent Brain Comorbidity College-Age & Young Adults Criminal Justice Drugged Driving Drug Testing Drugs and the Brain ... Adolescent Brain Comorbidity College-Age & Young Adults Criminal Justice Drugged Driving Drug Testing Drugs and the Brain ...

  2. Cognitive Deficits in Adults with ADHD Go beyond Comorbidity Effects

    ERIC Educational Resources Information Center

    Silva, Katiane L.; Guimaraes-da-Silva, Paula O.; Grevet, Eugenio H.; Victor, Marcelo M.; Salgado, Carlos A. I.; Vitola, Eduardo S.; Mota, Nina R.; Fischer, Aline G.; Contini, Veronica; Picon, Felipe A.; Karam, Rafael G.; Belmonte-de-Abreu, Paulo; Rohde, Luis A.; Bau, Claiton H. D.

    2013-01-01

    Objective: This study addresses if deficits in cognitive, attention, and inhibitory control performance in adults with ADHD are better explained by the disorder itself or by comorbid conditions. Method Adult patients with ADHD ("n" = 352) and controls ("n" = 94) were evaluated in the ADHD program of a tertiary hospital. The…

  3. Psychiatric Comorbidity in Adolescents and Young Adults with Autism

    ERIC Educational Resources Information Center

    Moseley, David S.; Tonge, Bruce J.; Brereton, Avril V.; Einfeld, Stewart L.

    2011-01-01

    This article reports the findings of a study investigating rates and types of comorbid mental disorder evident in adolescents and young adults with autism. A sample of 84 young people (M = 19.5 years, SD = 4.6) with "Diagnostic and Statistical Manual of Mental Disorders," 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric…

  4. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms

    PubMed Central

    Kankaanranta, Hannu; Kauppi, Paula; Tuomisto, Leena E.; Ilmarinen, Pinja

    2016-01-01

    Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2), and cardiac and psychiatric diseases. Their role as risk factors for incident asthma and whether they affect clinical asthma are evaluated. Obesity, independently or as a part of metabolic syndrome, DM2, and depression are risk factors for incident asthma. In contrast, the effects of comorbidities on clinical asthma are less well-known and mostly studies are lacking. Cross-sectional studies in obese asthmatics suggest that they may have less well controlled asthma and worse lung function. However, no long-term clinical follow-up studies with these comorbidities and asthma were identified. These emerging comorbidities often occur in the same multimorbid adult patient and may have in common metabolic pathways and inflammatory or other alterations such as early life exposures, systemic inflammation, inflammasome, adipokines, hyperglycemia, hyperinsulinemia, lung mechanics, mitochondrial dysfunction, disturbed nitric oxide metabolism, and leukotrienes. PMID:27212806

  5. Differentiating Aging Among Adults With Down Syndrome and Comorbid Dementia or Psychopathology.

    PubMed

    Esbensen, Anna J; Johnson, Emily Boshkoff; Amaral, Joseph L; Tan, Christine M; Macks, Ryan

    2016-01-01

    Differences were examined between three groups of adults with Down syndrome in their behavioral presentation, social life/activities, health, and support needs. We compared those with comorbid dementia, with comorbid psychopathology, and with no comorbid conditions. Adults with comorbid dementia were more likely to be older, have lower functional abilities, have worse health and more health conditions, and need more support in self-care. Adults with comorbid psychopathology were more likely to exhibit more behavior problems and to be living at home with their families. Adults with no comorbidities were most likely to be involved in community employment. Differences in behavioral presentation can help facilitate clinical diagnoses in aging in Down syndrome, and implications for differential diagnosis and service supports are discussed.

  6. Psychiatric Comorbidity in Young Adults with a Clinical Diagnosis of Asperger Syndrome

    ERIC Educational Resources Information Center

    Lugnegard, Tove; Hallerback, Maria Unenge; Gillberg, Christopher

    2011-01-01

    In children with autism spectrum disorders, previous studies have shown high rates of psychiatric comorbidity. To date, studies on adults have been scarce. The aim of the present study was to investigate psychiatric comorbidity in young adults with Asperger syndrome. Participants were 26 men and 28 women (mean age 27 years) with a clinical…

  7. Comorbidity of Adult Attention Deficit and Hyperactivity Disorder in Bipolar Patients: Prevalence, Sociodemographic and Clinical Correlates

    PubMed Central

    BERKOL, Tonguç Demir; YARGIÇ, İlhan; ÖZYILDIRIM, İlker; YAZICI, Olcay

    2014-01-01

    Introduction The aims of this study were to determine the frequency of adult attention deficit and hyperactivity disorder (ADHD) comorbidity in bipolar patients and to investigate the influence of this comorbidity on the clinical characteristics of bipolar disorder (BD). Method A total of 135 patients with BD type I and II and BD not otherwise specified were included in this study. First, the Adult ADD/ADHD DSM-IV-Based Diagnostic Screening and Rating Scale (ADHD scale) was administered to all patients, and all of the patients were also interviewed for the diagnosis. Patients who were diagnosed as having ADHD comorbidity (n=23) on the basis of DSM-IV and those who were not diagnosed to have ADHD comorbidity (n=32) were compared in terms of sociodemographic and clinical correlates. Results Twenty-three of 135 patients (17%) were found to have ADHD comorbidity. In the ADHD comorbidity group, the level of education and the number of suicide attempts were higher (p=.011 and .043, respectively). Although not significant, subthreshold depressive symptoms in interepisodic periods, the lifetime history of antidepressant use and the total number of lifetime depressive episodes tended to be more frequent in bipolar disorder with ADHD comorbidity group than in the control group. Conclusion Bipolar disorder has a frequent comorbidity with ADHD, and contrary to expectations, it might be related to the depressive aspect, rather than the manic aspect, of bipolar disorder. Early diagnosis of ADHD comorbidity in bipolar patients might help to prevent serious risk factors.

  8. Alcohol and Tobacco Use Disorder Comorbidity in Young Adults and the Influence of Romantic Partner Environments

    PubMed Central

    Meacham, Meredith C.; Bailey, Jennifer A.; Hill, Karl G.; Epstein, Marina; Hawkins, J. David

    2014-01-01

    Background Although there is considerable evidence that the development of tobacco dependence (TD) and that of alcohol use disorder (AUD) are intertwined, less is known about the comorbid development of these disorders. The present study examines tobacco dependence and alcohol use disorder comorbidity in young adulthood within the context of romantic partner relationships. Methods Data were drawn from the Seattle Social Development Project, a contemporary, ethnically diverse, and gender balanced longitudinal panel including 808 participants. A typological person-centered approach was used to assign participants to four outcome groups: no disorder, tobacco dependence (TD) only, alcohol use disorder (AUD) only, and comorbid (both). Multinomial logistic regression was used to determine the association between partner general and substance-specific environments and single or dual alcohol and tobacco use disorder diagnosis in young adulthood (ages 24–33, n = 628). Previous heavy alcohol and tobacco use were controlled for, as were dispositional characteristics, gender, ethnicity, adult SES, and adult depression. Results Greater partner conflict increased the likelihood of being comorbid compared to having TD only or AUD only. Having a smoking partner increased the likelihood of being comorbid compared to having AUD only, but having a drinking partner did not significantly distinguish being comorbid from having TD only. Conclusions Findings demonstrated the utility of a comorbidity-based, person-centered approach and the influence of general and tobacco-specific, but not alcohol-specific, partner environments on comorbid alcohol and tobacco use disorders in young adulthood. PMID:23428316

  9. [Adult attention deficit/hyperactivity disorder, associated symptoms and comorbid psychiatric disorders: diagnosis and pharmacological treatment].

    PubMed

    Paslakis, G; Schredl, M; Alm, B; Sobanski, E

    2013-08-01

    Adult attention deficit/hyperactivity disorder (ADHD) is characterised by inattention and/or hyperactivity and impulsivity and is a frequent psychiatric disorder with childhood onset. In addition to core symptoms, patients often experience associated symptoms like emotional dysregulation or low self-esteem and suffer from comorbid disorders, particularly depressive episodes, substance abuse, anxiety or sleep disorders. It is recommended to include associated symptoms and comorbid psychiatric disorders in the diagnostic set-up and in the treatment plan. Comorbid psychiatric disorders should be addressed with disorder-specific therapies while associated symptoms also often improve with treatment of the ADHD core symptoms. The most impairing psychiatric disorder should be treated first. This review presents recommendations for differential diagnosis and treatment of adult ADHD with associated symptoms and comorbid psychiatric disorders with respect to internationally published guidelines, clinical trials and expert opinions.

  10. Psychiatric Comorbidity and Functioning in a Clinically Referred Population of Adults with Autism Spectrum Disorders: A Comparative Study

    ERIC Educational Resources Information Center

    Joshi, Gagan; Wozniak, Janet; Petty, Carter; Martelon, Mary Kate; Fried, Ronna; Bolfek, Anela; Kotte, Amelia; Stevens, Jonathan; Furtak, Stephannie L.; Bourgeois, Michelle; Caruso, Janet; Caron, Ashley; Biederman, Joseph

    2013-01-01

    To systematically examine the patterns of psychiatric comorbidity and functioning in clinically referred adults with autism spectrum disorders (ASD). Psychiatrically referred adults with and without ASD were compared on measures assessing for psychiatric comorbidity and psychosocial functioning. Sixty-three adults with ASD participated in the…

  11. Personality pathology comorbidity in adult females with eating disorders.

    PubMed

    De Bolle, Marleen; De Clercq, Barbara; Pham-Scottez, Alexandra; Mels, Saskia; Rolland, Jean-Pierre; Guelfi, Julien Daniel; Braet, Caroline; De Fruyt, Filip

    2011-03-01

    Personality pathology is examined in 100 female in-patients diagnosed with eating disorders. The Eating Disorder Inventory-II and the NEO-PI-R were self-administered and personality pathology was assessed using a structured interview. Clinicians additionally evaluated patients' global functioning. The results indicated sizeable personality disorder comorbidity, and two dimensions of personality pathology, for example, an internalizing and an externalizing factor, could be identified. Patients' global functioning was primarily associated with dimensions of personality pathology, but not with eating disorder symptoms. Assessment and therapeutic interventions should focus on this co-occurring pathology in order to improve patients' functioning.

  12. Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD).

    PubMed

    Sobanski, Esther

    2006-09-01

    Attention-deficit/hyperactivity disorder (ADHD) is a chronic, lifelong disorder with childhood-onset, which seriously impairs the affected adults in a variety of daily living functions like educational and occupational functioning, partnership and parenting. ADHD is associated with a high percentage of comorbid psychiatric disorders in every lifespan. In adulthood between 65-89% of all patients with ADHD suffer from one or more additional psychiatric disorders, above all mood and anxiety disorders, substance use disorders and personality disorders, which complicates the clinical picture in terms of diagnostics, treatment and outcome issues. The present overview provides information of comorbid psychiatric disorders in adults with ADHD, underlying associations and clinical implications.

  13. Recreational Substance Use Patterns and Co-Morbid Psychopathology in Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Chaplin, Eddie; Gilvarry, Catherine; Tsakanikos, Elias

    2011-01-01

    There is very limited evidence on the patterns of recreational substance use among adults with Intellectual Disabilities (ID) who have co-morbid mental health problems. In this study we collected clinical and socio-demographic information as well as data on substance use patterns for consecutive new referrals (N = 115) to specialist mental health…

  14. Gender Differences in Co-Morbid Psychopathology and Clinical Management in Adults with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Tsakanikos, Elias; Underwood, Lisa; Kravariti, Eugenia; Bouras, Nick; McCarthy, Jane

    2011-01-01

    The present study examined rates of co-morbid psychopathology and clinical management/care pathways in adult females (N = 50) and males (N = 100) with autism spectrum disorders (ASD) and intellectual disability (ID) living in community settings. We also compared a sub-sample (N = 60) with ASD to an age-, gender- and ID-matched control group (N =…

  15. New Insights into the Comorbidity between ADHD and Major Depression in Adolescent and Young Adult Females

    ERIC Educational Resources Information Center

    Biederman, Joseph; Ball, Sarah W.; Monuteaux, Michael C.; Mick, Eric; Spencer, Thomas J.; McCreary, Michelle; Cote, Michelle; Faraone, Stephen V.

    2008-01-01

    The association between attention-deficit/hyperactivity disorder (ADHD) and major depression (MD) in adolescent and young adult females is evaluated. Findings indicate that MD emerging in the context of ADHD is an impairing and severe comorbidity that needs to be considered further clinically and scientifically.

  16. Psychopathology: Differences among Adults with Intellectually Disabled, Comorbid Autism Spectrum Disorders and Epilepsy

    ERIC Educational Resources Information Center

    Smith, Kimberly R. M.; Matson, Johnny L.

    2010-01-01

    The goal of this study was to systematically examine group differences among adults with intellectual disabilities (ID), comorbid autism spectrum disorders (ASD), and epilepsy through a detailed exploration of the characteristics that these disorders present in the area of psychopathology. Previous studies indicating that individuals with ID have…

  17. Psychiatric Comorbidity and Medication Use in Adults with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Buck, Tara R.; Viskochil, Joseph; Farley, Megan; Coon, Hilary; McMahon, William M.; Morgan, Jubel; Bilder, Deborah A.

    2014-01-01

    The purpose of this study was to investigate comorbid psychiatric disorders and psychotropic medication use among adults with autism spectrum disorder (ASD) ascertained as children during a 1980's statewide Utah autism prevalence study (n = 129). Seventy-three individuals (56.6%) met criteria for a current psychiatric disorder; 89 participants…

  18. Comorbid Social Anxiety Disorder in Adults with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Maddox, Brenna B.; White, Susan W.

    2015-01-01

    Social anxiety symptoms are common among cognitively unimpaired youth with autism spectrum disorder (ASD). Few studies have investigated the co-occurrence of social anxiety disorder (SAD) in adults with ASD, although identification may aid access to effective treatments and inform our scientific efforts to parse heterogeneity. In this preliminary…

  19. Comorbidity, age and mortality among adults treated intensively for acute myeloid leukemia (AML)

    PubMed Central

    Tawfik, Bernard; Pardee, Timothy; Isom, Scott; Sliesoraitis, Sarunas; Winter, Allison; Lawrence, Julia; Powell, Bayard L.; Klepin, Heidi D.

    2015-01-01

    Introduction Our goal was to characterize comorbidities among adults receiving intensive therapy for AML, and investigate their association with outcomes. Methods We retrospectively analyzed 277 consecutive patients with newly diagnosed AML treated intensively at the Comprehensive Cancer Center of Wake Forest University from 2002–2009. Pretreatment comorbidities were identified by ICD-9 codes and chart review. Comorbidity burden (modified Charlson Comorbidity Index [CCI]) and specific conditions were analyzed individually. Outcomes were overall survival (OS), remission, and 30-day mortality. Covariates included age, gender, cytogenetic characteristics, hemoglobin, white cell count, lactate dehydrogenase, body mass index, and insurance type. Cox proportional hazards models were used to evaluate OS; logistic regression was used for remission and 30-day mortality. Results In this series, 144 patients were ≥60 years old (median age 70 years, median survival 8.7 months) and 133 were <60 years (median age 47 years, median survival 23.1 months). Older patients had a higher comorbidity burden (CCI≥1 58% versus 26%, p<0.001). Prevalent comorbid conditions differed by age (diabetes 19.2% versus 7.5%; cardiovascular disease 12.5% versus 4.5%, for older versus younger patients, respectively). The CCI was not independently associated with OS or 30-day mortality in either age group. Among older patients, diabetes was associated with higher 30-day mortality (33.3% vs. 12.0% in diabetic vs. non diabetic patients, p =0.006). Controlling for age, cytogenetic characteristics and other comorbidities, the presence of diabetes increased the odds of 30-day mortality by 4.9 (CI 1.6–15.2) times. Discussion Diabetes is adversely associated with 30-day survival in older AML patients receiving intensive therapy. PMID:26527394

  20. Occupational Outcome in Adult ADHD: Impact of Symptom Profile, Comorbid Psychiatric Problems, and Treatment--A Cross-Sectional Study of 414 Clinically Diagnosed Adult ADHD Patients

    ERIC Educational Resources Information Center

    Halmoy, Anne; Fasmer, Ole Bernt; Gillberg, Christopher; Haavik, Jan

    2009-01-01

    Objective: To determine the effects of symptom profile, comorbid psychiatric problems, and treatment on occupational outcome in adult ADHD patients. Method: Adult ADHD patients (N = 414) responded to questionnaires rating past and present symptoms of ADHD, comorbid conditions, treatment history, and work status. Results: Of the patients, 24%…

  1. Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome.

    PubMed

    Lugnegård, Tove; Hallerbäck, Maria Unenge; Gillberg, Christopher

    2011-01-01

    In children with autism spectrum disorders, previous studies have shown high rates of psychiatric comorbidity. To date, studies on adults have been scarce. The aim of the present study was to investigate psychiatric comorbidity in young adults with Asperger syndrome. Participants were 26 men and 28 women (mean age 27 years) with a clinical diagnosis of Asperger syndrome. Psychiatric comorbidity was assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders. IQ was measured using the Wechsler Adult Intelligence Scale, Third Edition. Autism spectrum diagnoses were confirmed using the DIagnostic Interview for Social and Communication Disorders. In our study group, 70% had experienced at least one episode of major depression, and 50% had suffered from recurrent depressive episodes. Anxiety disorders were seen in about 50%. Psychotic disorders and substance-induced disorders were uncommon. In conclusion, young adults with autism spectrum disorders are at high risk for mood and anxiety disorders. To identify these conditions and offer treatment, elevated vigilance is needed in clinical practice.

  2. Chronic cough in Korean adults: a literature review on common comorbidity

    PubMed Central

    Kang, Sung-Yoon; Kim, Gun-Woo; Chang, Yoon-Seok; Cho, Sang-Heon

    2016-01-01

    Chronic cough is a significant medical condition with high prevalence and a strong negative impact on the quality of life. Cough hypersensitivity is thought to underlie chronic cough, with several environmental and host factors interacting to cause neuronal sensitization and chronicity. Comorbid conditions affecting cough reflex pathways, such as upper airway diseases, asthma, and gastroesophageal reflux, play important roles in chronic cough. However, their prevalence may vary in patients living in different geographical regions or with different ethnicities. We conducted a literature review to examine common comorbidities in Korean adult patients with chronic cough, their clinical implications, and the issues that still need to be addressed in the development of clinical evidence of chronic cough in Korean adult patients. PMID:27803879

  3. Comorbidities and inhibitors in adult patients with haemophilia: issues, costs and management strategies.

    PubMed

    Berntorp, Erik; Mauser-Bunschoten, Evelien; Jiménez-Yuste, Víctor; Spears, Jeffrey B

    2015-11-01

    Along with greater life expectancy in patients with haemophilia has been an increase in associated haemophilia-related (arthropathy, osteoporosis, viral infections) and age-related (cardiovascular disease, renal disease, cancer and others) comorbidities, many of which are only just emerging as the population ages. At present, experience in managing these comorbidities is limited. As the demographic shift continues, haemophilia care centres can expect to encounter more patients with greater levels of complexity. In the absence of evidence-based information to guide the management of adult patients with haemophilia, it is important that the scientific position be reviewed on a regular basis. To this end, several topics relevant to the clinical management of adult patients with haemophilia were examined in a symposium entitled Comorbidities and inhibitors in adult patients with haemophilia: issues, costs and management strategies held on 11 February 2015 in Helsinki, Finland, in conjunction with the 8th Annual Congress of the European Association for Haemophilia and Allied Disorders. This article is a summary of that event.

  4. Comorbidity of Adult Attention Deficit and Hyperactivity Disorder in Bipolar and Unipolar Patients

    PubMed Central

    HARMANCI, Hatice; ÇAM ÇELİKEL, Feryal; ETİKAN, İlker

    2016-01-01

    Introduction The co-occurrence of attention deficit hyperactivity disorder (ADHD) in affective disorder patients is considerably high. The aims of the present study were to search for the frequency and impact of ADHD co-occurrence on the clinical features of affective disorders and to examine the relationship between the dominant affective temperaments and ADHD. Methods In total, 100 patients with bipolar disorder (BD), 100 patients with major depressive disorder (MDD), and 100 healthy controls (HC) were included. All diagnoses were assigned according to DSM-IV-TR criteria. The Adult Attention Deficit and Hyperactivity Self-Report Scale (ASRS); Wender Utah Rating Scale (WURS); and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were applied to all participants. Results The percentage of BD patients meeting the criteria for a diagnosis of current ADHD was 48% compared with the percentage of MDD patients and HCC subjects, i.e., 25% and 12%, respectively. ADHD was significantly more frequent in bipolar adults than in not only HC but also depressive patients. In the BD group, patients with a comorbid ADHD diagnosis had significantly more suicidal history than those without ADHD. The scores of the temperament traits, namely depressive, cyclothymic, irritable, and anxious, were significantly higher in subjects with ADHD in all groups, including in HC. Conclusion The most important findings of the present study were the observations that (1) the frequency of ADHD is considerably high among bipolar patients; (2) the frequency of suicide attempts is high in the bipolar patient group with comorbid ADHD; and (3) depressive, cyclothymic, irritable, and anxious temperaments are significantly associated with ADHD comorbidity in bipolar and depressive patients as well as in HC. The high comorbidity and chronic course of ADHD and its possible negative influence on the course of both disorders increase the importance of screening for adult

  5. Comorbidity and its impact in adult patients with attention-deficit/hyperactivity disorder: a primary care perspective.

    PubMed

    Babcock, Thomas; Ornstein, Craig S

    2009-05-01

    The objective of this manuscript was to review the literature relevant to the primary care practitioner concerning comorbidity and its impact on diagnosis and treatment efficacy in adults with attention-deficit/hyperactivity disorder (ADHD). A MEDLINE literature review was performed using the keywords: attention-deficit/hyperactivity disorder; psychiatric comorbidity; bipolar disorder; major depressive disorder; oppositional defiant disorder; conduct disorder; and substance use disorder. The authors assessed and summarized literature identified as relevant to primary care practitioners. Results demonstrated high rates of psychiatric comorbidity in patients with ADHD. These comorbid disorders, coupled with the differing characteristics of ADHD symptoms in adults versus children, may complicate accurate diagnosis and treatment of ADHD. Controlled clinical trials indicate that the presence of comorbidity does not substantially alter the safety and efficacy of ADHD pharmacotherapy and that treatment of ADHD can sometimes improve symptoms of the comorbid disorder. Although rates of psychiatric comorbidity are high in adults with ADHD, available data suggest that the benefits of pharmacotherapy for ADHD are not compromised by the presence of psychiatric comorbidity.

  6. The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders

    PubMed Central

    Kohane, Isaac S.; McMurry, Andrew; Weber, Griffin; MacFadden, Douglas; Rappaport, Leonard; Kunkel, Louis; Bickel, Jonathan; Wattanasin, Nich; Spence, Sarah; Murphy, Shawn; Churchill, Susanne

    2012-01-01

    Objectives Use electronic health records Autism Spectrum Disorder (ASD) to assess the comorbidity burden of ASD in children and young adults. Study Design A retrospective prevalence study was performed using a distributed query system across three general hospitals and one pediatric hospital. Over 14,000 individuals under age 35 with ASD were characterized by their co-morbidities and conversely, the prevalence of ASD within these comorbidities was measured. The comorbidity prevalence of the younger (Age<18 years) and older (Age 18–34 years) individuals with ASD was compared. Results 19.44% of ASD patients had epilepsy as compared to 2.19% in the overall hospital population (95% confidence interval for difference in percentages 13.58–14.69%), 2.43% of ASD with schizophrenia vs. 0.24% in the hospital population (95% CI 1.89–2.39%), inflammatory bowel disease (IBD) 0.83% vs. 0.54% (95% CI 0.13–0.43%), bowel disorders (without IBD) 11.74% vs. 4.5% (95% CI 5.72–6.68%), CNS/cranial anomalies 12.45% vs. 1.19% (95% CI 9.41–10.38%), diabetes mellitus type I (DM1) 0.79% vs. 0.34% (95% CI 0.3–0.6%), muscular dystrophy 0.47% vs 0.05% (95% CI 0.26–0.49%), sleep disorders 1.12% vs. 0.14% (95% CI 0.79–1.14%). Autoimmune disorders (excluding DM1 and IBD) were not significantly different at 0.67% vs. 0.68% (95% CI −0.14-0.13%). Three of the studied comorbidities increased significantly when comparing ages 0–17 vs 18–34 with p<0.001: Schizophrenia (1.43% vs. 8.76%), diabetes mellitus type I (0.67% vs. 2.08%), IBD (0.68% vs. 1.99%) whereas sleeping disorders, bowel disorders (without IBD) and epilepsy did not change significantly. Conclusions The comorbidities of ASD encompass disease states that are significantly overrepresented in ASD with respect to even the patient populations of tertiary health centers. This burden of comorbidities goes well beyond those routinely managed in developmental medicine centers and requires broad multidisciplinary management

  7. Comorbidity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders.

    PubMed

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha

    2016-10-20

    A retrospective data analysis using 2000-2008 three state Medicaid Analytic eXtract was conducted to examine the prevalence and association of comorbidities (psychiatric and non-psychiatric) with healthcare utilization and expenditures of fee-for-service enrolled adults (22-64 years) with and without autism spectrum disorders (International Classification of Diseases, Ninth Revision-clinical modification code: 299.xx). Autism spectrum disorder cases were 1:3 matched to no autism spectrum disorder controls by age, gender, and race using propensity scores. Study outcomes were all-cause healthcare utilization (outpatient office visits, inpatient hospitalizations, emergency room, and prescription drug use) and associated healthcare expenditures. Bivariate analyses (chi-square tests and t-tests), multinomial logistic regressions (healthcare utilization), and generalized linear models with gamma distribution (expenditures) were used. Adults with autism spectrum disorders (n = 1772) had significantly higher rates of psychiatric comorbidity (81%), epilepsy (22%), infections (22%), skin disorders (21%), and hearing impairments (18%). Adults with autism spectrum disorders had higher mean annual outpatient office visits (32ASD vs 8noASD) and prescription drug use claims (51ASD vs 24noASD) as well as higher mean annual outpatient office visits (US$4375ASD vs US$824noASD), emergency room (US$15,929ASD vs US$2598noASD), prescription drug use (US$6067ASD vs US$3144noASD), and total expenditures (US$13,700ASD vs US$8560noASD). The presence of a psychiatric and a non-psychiatric comorbidity among adults with autism spectrum disorders increased the annual total expenditures by US$4952 and US$5084, respectively.

  8. Borderline personality traits and adult attention-deficit hyperactivity disorder symptoms: a genetic analysis of comorbidity.

    PubMed

    Distel, Marijn A; Carlier, Angela; Middeldorp, Christel M; Derom, Catherine A; Lubke, Gitta H; Boomsma, Dorret I

    2011-12-01

    Previous research has established the comorbidity of adult Attention-Deficit Hyperactivity Disorder (ADHD) with different personality disorders including Borderline Personality Disorder (BPD). The association between adult ADHD and BPD has primarily been investigated at the phenotypic level and not yet at the genetic level. The present study investigates the genetic and environmental contributions to the association between borderline personality traits (BPT) and ADHD symptoms in a sample of 7,233 twins and siblings (aged 18-90 years) registered with the Netherlands Twin Register and the East Flanders Prospective Twin Survey (EFPTS) . Participants completed the Conners' Adult ADHD Rating Scales (CAARS-S:SV) and the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). A bivariate genetic analysis was performed to determine the extent to which genetic and environmental factors influence variation in BPT and ADHD symptoms and the covariance between them. The heritability of BPT and ADHD symptoms was estimated at 45 and 36%, respectively. The remaining variance in BPT and ADHD symptoms was explained by unique environmental influences. The phenotypic correlation between BPT and ADHD symptoms was estimated at r = 0.59, and could be explained for 49% by genetic factors and 51% by environmental factors. The genetic and environmental correlations between BPT and ADHD symptoms were 0.72 and 0.51, respectively. The shared etiology between BPT and ADHD symptoms is thus a likely cause for the comorbidity of the two disorders.

  9. Brief Report: Adults with Mild Autism Spectrum Disorders (ASD)--Scores on the Autism Spectrum Quotient (AQ) and Comorbid Psychopathology

    ERIC Educational Resources Information Center

    Ketelaars, Cees; Horwitz, Ernst; Sytema, Sjoerd; Bos, Johan; Wiersma, Durk; Minderaa, Ruud; Hartman, Catharina A.

    2008-01-01

    While knowledge about symptom presentation of adults with mild ASD, including comorbid psychopathology, is limited, referral of adults with suspected mild PDD is increasing. We report on pilot research investigating whether patients diagnosed with mild ASD (n = 15) and patients who were not diagnosed with ASD (n = 21) differed in terms of (a) AQ…

  10. Comorbidity of Personality Disorders and Adult Attention Deficit Hyperactivity Disorder (ADHD)--Review of Recent Findings.

    PubMed

    Matthies, Swantje; Philipsen, Alexandra

    2016-04-01

    Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.

  11. Mental-Physical Comorbidity in Korean Adults: Results from a Nationwide General Population Survey in Korea

    PubMed Central

    Kim, Ji-Hyun; Bae, Jae Nam; Cho, Seong-Jin; Lee, Jun-Young; Kim, Byung-Soo; Cho, Maeng Je

    2016-01-01

    Objective The aims of this study were to estimate the prevalence of mental-physical comorbidity and health-threatening risk factors in subjects with mental disorders, and the risks of mental disorders in those with physical diseases for the last 12 months in the general Korean population. Methods Korean Epidemiologic Catchment Area study replication (KECA-R) was conducted for 6,510 adults between August 2006 and April 2007. The Korean version of Composite International Diagnostic Interview 2.1 (K-CIDI) was used in the survey. Prevalence of mental and physical disorders, and risk factors for physical health were calculated, and their associations were evaluated with adjustment for age and sex. Results Subjects with any mental disorder showed significantly higher prevalence of chronic physical conditions (adjusted odds ratio, AOR=1.5 to 2.8, p<0.001) and medical risk factors including smoking, heavy drinking, overweight, and hypertension (AOR=1.5 to 4.0, p<0.001). Of those with chronic physical conditions, 21.6% had one or more comorbid mental disorder compared with 10.5% of the subjects without chronic physical disorders (AOR=2.6, p<0.001). Contrary to expectations, depressive disorders did not show significant association with hypertension and prevalence of obesity was not influenced by presence of mental disorders. Further studies should assess these findings. Conclusion This is the first identification of significant mental-physical comorbidity in the general Korean population. Clinicians and health care officials should keep in mind of its potential adverse effects on treatment outcome and aggravated disease-related socioeconomic burden. PMID:27757127

  12. Comorbidities predict worse prognosis in patients with primary myelofibrosis

    PubMed Central

    Newberry, Kate J.; Naqvi, Kiran; Nguyen, Khanh T.; Cardenas-Turanzas, Marylou; Tanaka, Maria Florencia; Pierce, Sherry; Verstovsek, Srdan

    2016-01-01

    Background Comorbidities have been shown to play an important role in prognostic assessment of several hematologic conditions; however, the role of comorbidities in primary myelofibrosis has not been studied. The aim of our study was to evaluate the prevalence and impact of comorbidities in patients with primary myelofibrosis (PMF) using the Adult Comorbidity Evaluation-27 (ACE-27). Methods In this retrospective observational cohort study, we evaluated 349 consecutive patients with a confirmed diagnosis of PMF who presented to our institution from 2000 to 2008. We evaluated the frequency and severity of comorbidities in these patients and assessed their impact on survival in a bivariable model that included the ACE-27 and Dynamic International Prognostic Scoring System (DIPSS) scores as covariates. Results Sixty-four percent of patients had at least one comorbid condition, and diseases of the cardiovascular system (63%) were most common. Comorbidities had a significant negative impact on survival (P < 0.001). Patients with severe comorbidities had twice the risk of death as those with no comorbidities. When stratified by demographic and clinical characteristics, comorbidities were significantly associated with worse survival in patients younger than 65 years (P < 0.001) and those with performance status < 1 (P < 0.001). In a multivariable model that included the ACE-27 and Dynamic-International Prognostic Scoring System scores, comorbidities retained a significant association with shorter survival (P ≤ 0.001). Conclusions Assessment of comorbid conditions in patients with PMF, particularly those who are younger and with good performance status, has important implications for overall prognosis and treatment planning. PMID:24917509

  13. Childhood history of anxiety in adults with panic disorder: association with anxiety sensitivity and comorbidity.

    PubMed

    Otto, M W; Pollack, M H; Rosenbaum, J F; Sachs, G S; Asher, R H

    1994-01-01

    Converging lines of evidence indicate a nonspecific link between childhood anxiety disorders and adult panic disorder. Anxiety sensitivity, defined as the fear of anxiety symptoms, was hypothesized to be a potential mediating variable in this link. This study examined the association among childhood history of anxiety disorders, current anxiety symptoms, and anxiety sensitivity in a sample of 100 patients with panic disorder undergoing treatment. Fifty-five percent of the patients had histories of one or more childhood anxiety disorders. Despite the heterogeneity of symptoms and treatment interventions among these patients, a childhood history of anxiety was associated with comorbid anxiety conditions, agoraphobic avoidance, and anxiety sensitivity scores. Anxiety sensitivity was itself a significant predictor of current severity of illness, but a childhood history of anxiety was not. These findings are consistent with the hypothesis that having an anxiety disorder during childhood is linked with patterns of anxiety and phobic avoidance in adulthood, including the level of anxiety sensitivity in patients with panic disorder.

  14. A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities

    PubMed Central

    Clemow, David B; Bushe, Chris; Mancini, Michele; Ossipov, Michael H; Upadhyaya, Himanshu

    2017-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that is often diagnosed during childhood, but has also increasingly been recognized to occur in adults. Importantly, up to 52% of children (including adolescents) and 87% of adults with ADHD also have a comorbid psychiatric disorder. The presence of a comorbid disorder has the potential to impact diagnosis and could affect treatment outcomes. Atomoxetine is a nonstimulant treatment for ADHD. Despite numerous published studies regarding efficacy of atomoxetine in the treatment of ADHD in patients with comorbid disorders, there is limited information about the impact of individual common comorbid disorders on the efficacy of atomoxetine for ADHD, especially with regard to adults. Moreover, a cumulative review and assessment of these studies has not been conducted. For this reason, we performed a literature review to find, identify, and cumulatively review clinical studies that examined the efficacy of atomoxetine in the treatment of patients with ADHD and comorbid psychiatric disorders. We found a total of 50 clinical studies (37 in children; 13 in adults) that examined the efficacy of atomoxetine in patients with ADHD and a comorbid disorder. The comorbidities that were studied in children or in adults included anxiety, depression, and substance use disorder. Overall, the presence of comorbidity did not adversely impact the efficacy of atomoxetine in treatment of ADHD symptoms in both patient populations. In the studies identified and assessed in this review, atomoxetine did not appear to exacerbate any of the comorbid conditions and could, therefore, be an important therapy choice for the treatment of ADHD in the presence of comorbid disorders. PMID:28223809

  15. A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities.

    PubMed

    Clemow, David B; Bushe, Chris; Mancini, Michele; Ossipov, Michael H; Upadhyaya, Himanshu

    2017-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that is often diagnosed during childhood, but has also increasingly been recognized to occur in adults. Importantly, up to 52% of children (including adolescents) and 87% of adults with ADHD also have a comorbid psychiatric disorder. The presence of a comorbid disorder has the potential to impact diagnosis and could affect treatment outcomes. Atomoxetine is a nonstimulant treatment for ADHD. Despite numerous published studies regarding efficacy of atomoxetine in the treatment of ADHD in patients with comorbid disorders, there is limited information about the impact of individual common comorbid disorders on the efficacy of atomoxetine for ADHD, especially with regard to adults. Moreover, a cumulative review and assessment of these studies has not been conducted. For this reason, we performed a literature review to find, identify, and cumulatively review clinical studies that examined the efficacy of atomoxetine in the treatment of patients with ADHD and comorbid psychiatric disorders. We found a total of 50 clinical studies (37 in children; 13 in adults) that examined the efficacy of atomoxetine in patients with ADHD and a comorbid disorder. The comorbidities that were studied in children or in adults included anxiety, depression, and substance use disorder. Overall, the presence of comorbidity did not adversely impact the efficacy of atomoxetine in treatment of ADHD symptoms in both patient populations. In the studies identified and assessed in this review, atomoxetine did not appear to exacerbate any of the comorbid conditions and could, therefore, be an important therapy choice for the treatment of ADHD in the presence of comorbid disorders.

  16. Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome.

    PubMed

    Gerasch, Sarah; Kanaan, Ahmad Seif; Jakubovski, Ewgeni; Müller-Vahl, Kirsten R

    2016-01-01

    Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4-6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics

  17. Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome

    PubMed Central

    Gerasch, Sarah; Kanaan, Ahmad Seif; Jakubovski, Ewgeni; Müller-Vahl, Kirsten R.

    2016-01-01

    Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4–6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics

  18. Effect of Lactobacillus rhamnosus GG Administration on Vancomycin-Resistant Enterococcus Colonization in Adults with Comorbidities

    PubMed Central

    Hibberd, Patricia L.; Goldin, Barry; Thorpe, Cheleste; McDermott, Laura; Snydman, David R.

    2015-01-01

    Vancomycin-resistant enterococci (VRE) are endemic in health care settings. These organisms colonize the gastrointestinal tract and can lead to infection which is associated with increased mortality. There is no treatment for VRE colonization. We conducted a randomized, double-blind, placebo-controlled clinical trial to examine the safety and efficacy of administration of the probiotic Lactobacillus rhamnosus GG (LGG) for the reduction or elimination of intestinal colonization by VRE. Colonized adults were randomized to receive LGG or placebo for 14 days. Quantitative stool cultures for LGG and VRE were collected at baseline and days 7, 14, 21, 28, and 56. Day 14 stool samples from some subjects were analyzed by quantitative PCR (qPCR) for LGG. Patients were closely monitored for adverse events. Eleven subjects, of whom 5 received LGG and 6 received placebo, were analyzed. No differences in VRE colony counts were seen at any time points between groups. No decline in colony counts was seen over time in subjects who received LGG. LGG was detected by PCR in all samples tested from subjects who received LGG but was only isolated in culture from 2 of 5 subjects in the LGG group. No treatment-related adverse events were seen. We demonstrated that LGG could be administered safely to patients with comorbidities and is recoverable in some patients' stool cultures. Concomitant administration of antibiotics may have resulted in an inability to recover viable organisms from stool samples, but LGG DNA could still be detected by qPCR. LGG administration did not affect VRE colonization in this study. (This study was registered at Clinicaltrials.gov under registration no. NCT00756262.) PMID:26014940

  19. Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction

    PubMed Central

    Pérez de los Cobos, José; Siñol, Núria; Pérez, Víctor; Trujols, Joan

    2014-01-01

    The present article reviews whether available efficacy and safety data support the pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD) in patients with concurrent substance use disorders (SUD). Arguments for and against treating adult ADHD with active SUD are discussed. Findings from 19 large open studies and controlled clinical trials show that the use of atomoxetine or extended-release methylphenidate formulations, together with psychological therapy, yield promising though inconclusive results about short term efficacy of these drugs in the treatment of adult ADHD in patients with SUD and no other severe mental disorders. However, the efficacy of these drugs is scant or lacking for treating concurrent SUD. No serious safety issues have been associated with these drugs in patients with co-morbid SUD-ADHD, given their low risk of abuse and favourable side effect and drug–drug interaction profile. The decision to treat adult ADHD in the context of active SUD depends on various factors, some directly related to SUD-ADHD co-morbidity (e.g. degree of diagnostic uncertainty for ADHD) and other factors related to the clinical expertise of the medical staff and availability of adequate resources (e.g. the means to monitor compliance with pharmacological treatment). Our recommendation is that clinical decisions be individualized and based on a careful analysis of the advantages and disadvantages of pharmacological treatment for ADHD on a case-by-case basis in the context of active SUD. PMID:23216449

  20. Psychotherapy of Adults with Comorbid Attention-Deficit/Hyperactivity Disorder and Psychoactive Substance Use Disorder

    PubMed Central

    Aviram, Ron B.; Rhum, Madeline; Levin, Frances R.

    2001-01-01

    Psychotherapy for comorbid attention-deficit/ hyperactivity disorder (ADHD) and psychoactive substance use disorder (PSUD) is described. The authors suggest that relapse prevention is an appropriate initial treatment because it is well suited to manage both substance abuse and comorbid symptomatology such as impulsivity, distractibility, and avoidance associated with ADHD. Clinical vignettes describe typical interactions between patients and their therapists, highlighting opportunities for therapists to focus on overlapping symptoms. ADHD is one of the most common comorbid diagnoses with PSUD, and it is important that efficacious psychotherapies be developed to complement psychopharmacological approaches. Clinicians should consider psychotherapy as part of a multimodal treatment approach that includes medication and perhaps family therapy. Additional contributions from clinicians who have experience conducting psychotherapy with this population are needed in order to develop effective treatments. PMID:11402081

  1. Comorbidities and Race/Ethnicity Among Adults with Stimulant Use Disorders in Residential Treatment

    PubMed Central

    Sanchez, Katherine; Chartier, Karen G.; Greer, Tracy L.; Walker, Robrina; Carmody, Thomas; Rethorst, Chad D.; Ring, Kolette M.; Dela Cruz, Adriane M.; Trivedi, Madhukar H.

    2015-01-01

    Comorbid physical and mental health problems are associated with poorer substance abuse treatment outcomes; however, little is known about these conditions among stimulant abusers at treatment entry. This study compared racial and ethnic groups on baseline measures of drug use patterns, comorbid physical and mental health disorders, quality of life, and daily functioning among cocaine and stimulant abusing/dependent patients. Baseline data from a multi-site randomized clinical trial of vigorous exercise as a treatment strategy for a diverse population of stimulant abusers (N = 290) were analyzed. Significant differences between groups were found on drug use characteristics, stimulant use disorders, and comorbid mental and physical health conditions. Findings highlight the importance of integrating health and mental health services into substance abuse treatment and could help identify potential areas for intervention to improve treatment outcomes for racial and ethnic minority groups. PMID:25580933

  2. Social Skills: Differences among Adults with Intellectual Disabilities, Co-Morbid Autism Spectrum Disorders and Epilepsy

    ERIC Educational Resources Information Center

    Smith, Kimberly R. M.; Matson, Johnny L.

    2010-01-01

    Assessing social skills is one of the most complex and challenging areas to study because behavioral repertoires vary depending on an individual's culture and context. However, researchers have conclusively demonstrated that individuals with intellectual disabilities (ID) have impaired social skills as well as those with co-morbid autism spectrum…

  3. Comorbid Symptomology in Adults with Autism Spectrum Disorder and Intellectual Disability

    ERIC Educational Resources Information Center

    Cervantes, Paige E.; Matson, Johnny L.

    2015-01-01

    Evidence-based treatment must begin with the systematic and comprehensive identification of an individual's complete clinical picture. Therefore, screening individuals with intellectual disability (ID) for comorbid disorders is imperative. Because of the frequent overlap between autism spectrum disorder (ASD) and ID, the current study explored the…

  4. Comorbidity in Adult Patients Hospitalized with Type 2 Diabetes in Northeast China: An Analysis of Hospital Discharge Data from 2002 to 2013.

    PubMed

    Chen, Hui; Zhang, Yaoyun; Wu, Di; Gong, Chunxiu; Pan, Qing; Dong, Xiao; Wu, Yonghui; Zhang, Kuan; Wang, Shiping; Lei, Jianbo; Xu, Hua

    2016-01-01

    This study aims to evaluate the comorbidity burden and patterns among adult patients hospitalized with a diagnosis of type 2 diabetes mellitus (T2DM) in Northeast China using hospital discharge data derived from the electronic medical record database between 2002 and 2013. 12.8% of 4,400,892 inpatients aged ≥18 had a diagnosis of T2DM. Sex differences in prevalence varied among those aged <50, 50-59, and ≥60. Twenty-seven diseases were determined as major comorbidities of T2DM. Essential hypertension was the most common comorbidity of T2DM (absolute cooccurrence risk, 58.4%), while T2DM was also the most popular comorbidity of essential hypertension. Peripheral and visceral atherosclerosis showed the strongest association (relative cooccurrence risk, RCoR 4.206). For five leading comorbidities among patients aged ≥40, male patients had a stronger association with disorders of lipid metabolism than female patients (RCoR 2.779 versus 2.099), and female patients had a stronger association with chronic renal failure than male patients (RCoR 2.461 versus 2.155). Leading comorbidities, except chronic renal failure, had declining associations with T2DM with increased age. Collectively, hospital discharge data can be used to estimate disease prevalence and identify comorbidities. The findings provided comprehensive information on comorbidity patterns, helping policy makers and programs in public health domains to estimate and evaluate the epidemic of chronic diseases.

  5. Comorbidity in Adult Patients Hospitalized with Type 2 Diabetes in Northeast China: An Analysis of Hospital Discharge Data from 2002 to 2013

    PubMed Central

    Zhang, Yaoyun; Wu, Di; Gong, Chunxiu; Pan, Qing; Dong, Xiao; Wu, Yonghui; Wang, Shiping

    2016-01-01

    This study aims to evaluate the comorbidity burden and patterns among adult patients hospitalized with a diagnosis of type 2 diabetes mellitus (T2DM) in Northeast China using hospital discharge data derived from the electronic medical record database between 2002 and 2013. 12.8% of 4,400,892 inpatients aged ≥18 had a diagnosis of T2DM. Sex differences in prevalence varied among those aged <50, 50–59, and ≥60. Twenty-seven diseases were determined as major comorbidities of T2DM. Essential hypertension was the most common comorbidity of T2DM (absolute cooccurrence risk, 58.4%), while T2DM was also the most popular comorbidity of essential hypertension. Peripheral and visceral atherosclerosis showed the strongest association (relative cooccurrence risk, RCoR 4.206). For five leading comorbidities among patients aged ≥40, male patients had a stronger association with disorders of lipid metabolism than female patients (RCoR 2.779 versus 2.099), and female patients had a stronger association with chronic renal failure than male patients (RCoR 2.461 versus 2.155). Leading comorbidities, except chronic renal failure, had declining associations with T2DM with increased age. Collectively, hospital discharge data can be used to estimate disease prevalence and identify comorbidities. The findings provided comprehensive information on comorbidity patterns, helping policy makers and programs in public health domains to estimate and evaluate the epidemic of chronic diseases. PMID:27847807

  6. Efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in patients with common comorbidities in children, adolescents and adults: a review.

    PubMed

    Hutchison, Shari L; Ghuman, Jaswinder K; Ghuman, Harinder S; Karpov, Irina; Schuster, James M

    2016-10-01

    Attention-deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental health disorders and is associated with higher incidence of comorbid oppositional or conduct, mood, anxiety, pervasive developmental, and substance-use disorders. Comorbid mental health conditions may alter the presence of symptoms and treatment of ADHD. Atomoxetine (ATX), a nonstimulant medication for the treatment of ADHD, may be prescribed for individuals with ADHD and comorbid conditions despite some risk for certain undesirable side effects and lower effectiveness for the treatment of ADHD than stimulants. In this paper, we review studies utilizing randomized, placebo-controlled trials (RCTs) as well as within-subject designs to determine the effectiveness of ATX in the treatment of children and adults with ADHD and comorbid conditions. The current review uses an expanded methodology beyond systematic review of randomized controlled trials in order to improve generalizability of results to real-world practice. A total of 24 articles published from 2007 to 2015 were reviewed, including 14 RCTs: n = 1348 ATX, and n = 832 placebo. The majority of studies show that ATX is effective in the treatment of ADHD symptoms for individuals with ADHD and comorbid disorders. Cohen's d effect sizes (ES) for improvement in ADHD symptoms and behaviors range from 0.47 to 2.21. The effectiveness of ATX to improve symptoms specific to comorbidity varied by type but appeared to be most effective for diminishing the presence of symptoms for those with comorbid anxiety, ES range of 0.40 to 1.51, and oppositional defiant disorder, ES range of 0.52 to 1.10. There are mixed or limited results for individuals with ADHD and comorbid substance-use disorders, autism spectrum disorders, dyslexia or reading disorder, depression, bipolar disorder, and Tourette syndrome. Results from this review suggest that ATX is effective in the treatment of some youth and adults with ADHD and comorbid disorders, and

  7. Impact of the AYA HOPE comorbidity index on assessing health care service needs and health status among adolescents and young adults with cancer

    PubMed Central

    Wu, Xiao-Cheng; Prasad, Pinki K.; Landry, Ian; Harlan, Linda C.; Parsons, Helen M.; Lynch, Charles F; Smith, Ashley Wilder; Hamilton, Ann S.; Keegan, Theresa H. M.

    2015-01-01

    Background Existing comorbidity indices were not developed for adolescent and young adults (AYA) 15–39 years of age. The aim of this study was to assess impact of comorbidities on healthcare service needs and health status among AYA cancer survivors using the newly developed AYA HOPE comorbidity index in comparison with the existing indices. Methods Data on comorbid conditions were obtained from medical records and service needs and health status were from a survey of AYA cancer survivors. Prevalence of comorbidities based on the AYA HOPE index. Charlson and NCI indices) were compared. Multivariable logistic regression was employed. Results Of the 485 patients, 14.6% had ≥2 comorbidities based on the AYA HOPE Index. Prevalence of mental illness and obesity/overweight, which were not included in existing indices, were 8.2% and 5.8%, respectively. Prevalence of cardiovascular, endocrine, gastrointestinal and neurologic conditions were higher with the AYA HOPE Index than the other two indices. Forty percent of AYA patients reported service needs, particularly for mental health services (25.2%) and support groups (17.7%). Having ≥2 comorbidities on the AYA index was associated with higher mental health service needs (OR: 2.05; 95% CI 1.10–3.82) adjusting for demographic and clinical factors. Comorbidities were associated with fair/poor self-reported health status. Conclusion The AYA HOPE Index is a more comprehensive comorbidity index for AYA cancer patients than existing indices and the number of comorbidities is associated with service needs and health status. Impact The AYA HOPE index could identify patients’ additional service needs early in therapy. PMID:26420768

  8. Social skills: differences among adults with intellectual disabilities, co-morbid autism spectrum disorders and epilepsy.

    PubMed

    Smith, Kimberly R M; Matson, Johnny L

    2010-01-01

    Assessing social skills is one of the most complex and challenging areas to study because behavioral repertoires vary depending on an individual's culture and context. However, researchers have conclusively demonstrated that individuals with intellectual disabilities (ID) have impaired social skills as well as those with co-morbid autism spectrum disorders (ASD) and epilepsy. However, it is unknown how these groups differ. Assessment of social skills was made with the Matson Evaluation of Social Skills for Individuals with Severe Retardation. One hundred participants with ID were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, significant differences were found among the four groups on the MESSIER, Wilks's Λ=.58, F(18, 257)=3.05, p<.01. The multivariate η(2) based on Wilks's Λ was .17. Significant differences were found on the Positive Verbal subscale, F(3, 96)=3.70, p<.01, η(2)=.10, Positive Non-verbal subscale, F(3, 96)=8.95, p<.01, η(2)=.22, General Positive subscale, F(3, 96)=7.30, p<.01, η(2)=.19, Negative Non-verbal subscale, F(3, 96)=5.30, p<.01, η(2)=.14, and General Negative subscale, F(3, 96)=3.16, p<.05, η(2)=.09. Based on these results, individuals with ID expressing combined co-morbid ASD and epilepsy had significantly more impaired social skills than the ID only or groups containing only a single co-morbid factor with ID (ASD or epilepsy only). Implications of these findings are discussed.

  9. Interaction Effect between Weight Perception and Comorbidities on Weight Control Behavior in Overweight and Obese Adults: Is There a Sex Difference?

    PubMed

    Hwang, Jun Hyun; Ryu, Dong Hee; Park, Soon-Woo

    2015-08-01

    We investigated the interaction effect between body weight perception and chronic disease comorbidities on body weight control behavior in overweight/obese Korean adults. We analyzed data from 9,138 overweight/obese adults ≥20 yr of age from a nationally representative cross-sectional survey. Multiple logistic regression using an interaction model was performed to estimate the effect of chronic disease comorbidities on weight control behavior regarding weight perception. Adjusted odds ratios for weight control behavior tended to increase significantly with an increasing number of comorbidities in men regardless of weight perception (P<0.05 for trend), suggesting no interaction. Unlike women who perceived their weight accurately, women who under-perceived their weight did not show significant improvements in weight control behavior even with an increasing number of comorbidities. Thus, a significant interaction between weight perception and comorbidities was found only in women (P=0.031 for interaction). The effect of the relationship between accurate weight perception and chronic disease comorbidities on weight control behavior varied by sex. Improving awareness of body image is particularly necessary for overweight and obese women to prevent complications.

  10. Assessment of Generalized Anxiety Disorder Diagnostic Criteria in the National Comorbidity Survey and Virginia Adult Twin Study of Psychiatric and Substance Use Disorders

    ERIC Educational Resources Information Center

    Kubarych, Thomas S.; Aggen, Steven H.; Hettema, John M.; Kendler, Kenneth S.; Neale, Michael C.

    2008-01-01

    The authors investigated measurement properties of the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition," generalized anxiety disorder (GAD) criteria in the National Comorbidity Survey and the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD). The two studies used different widely used…

  11. Comorbidity of Alcohol and Gambling Problems in Emerging Adults: A Bifactor Model Conceptualization

    PubMed Central

    Krieger, Heather; Neighbors, Clayton; Rinker, Dipali; Rodriguez, Lindsey; Edward, Gottheil

    2017-01-01

    Addictive disorders, such as pathological gambling and alcohol use disorders, frequently co-occur at greater than chance levels. Substantive questions stem from this comorbidity regarding the extent to which shared variance between gambling and alcohol use reflects a psychological core of addictive tendencies, and whether this differs as a function of gender. The aims of this study were to differentiate both common and unique variance in alcohol and gambling problems in a bifactor model, examine measurement invariance of this model by gender, and identify substantive correlates of the final bifactor model. Undergraduates (N = 4475) from a large northwestern university completed an online screening questionnaire which included demographics, quantity of money lost and won when gambling, the South Oaks Gambling Screen, the AUDIT, gambling motives, drinking motives, personality, and the Brief Symptom Inventory. Results suggest that the bifactor model fit the data well in the full sample. Although the data suggest configural invariance across gender, factor loadings could not be constrained to be equal between men and women. As such, general and specific factors were examined separately by gender with a more intensive subsample of females and males (n = 264). Correlations with motivational tendencies, personality traits, and mental health symptoms indicated support for the validity of the bifactor model, as well as gender-specific patterns of association. Results suggest informative distinctions between shared and unique attributes related to problematic drinking and gambling. PMID:27260007

  12. Novel Psychoactive Substances in Young Adults with and without Psychiatric Comorbidities

    PubMed Central

    Martinotti, Giovanni; Acciavatti, Tiziano; Signorelli, Maria Salvina; Bandini, Laura; Ciambrone, Paola; Aguglia, Andrea; Calò, Salvatore; Janiri, Luigi; di Giannantonio, Massimo

    2014-01-01

    Objective. Comorbidities between psychiatric diseases and consumption of traditional substances of abuse (alcohol, cannabis, opioids, and cocaine) are common. Nevertheless, there is no data regarding the use of novel psychoactive substances (NPS) in the psychiatric population. The purpose of this multicentre survey is to investigate the consumption of a wide variety of psychoactive substances in a young psychiatric sample and in a paired sample of healthy subjects. Methods. A questionnaire has been administered, in different Italian cities, to 206 psychiatric patients aged 18 to 26 years and to a sample of 2615 healthy subjects matched for sex, gender, and living status. Results. Alcohol consumption was more frequent in the healthy young population compared to age-matched subjects suffering from mental illness (79.5% versus 70.7%; P < 0.003). Conversely, cocaine and NPS use was significantly more common in the psychiatric population (cocaine 8.7% versus 4.6%; P = 0.002) (NPS 9.8% versus 3%; P < 0.001). Conclusions. The use of novel psychoactive substances in a young psychiatric population appears to be a frequent phenomenon, probably still underestimated. Therefore, careful and constant monitoring and accurate evaluations of possible clinical effects related to their use are necessary. PMID:25133182

  13. Comorbidity of Alcohol and Gambling Problems in Emerging Adults: A Bifactor Model Conceptualization.

    PubMed

    Tackett, Jennifer L; Krieger, Heather; Neighbors, Clayton; Rinker, Dipali; Rodriguez, Lindsey; Edward, Gottheil

    2017-03-01

    Addictive disorders, such as pathological gambling and alcohol use disorders, frequently co-occur at greater than chance levels. Substantive questions stem from this comorbidity regarding the extent to which shared variance between gambling and alcohol use reflects a psychological core of addictive tendencies, and whether this differs as a function of gender. The aims of this study were to differentiate both common and unique variance in alcohol and gambling problems in a bifactor model, examine measurement invariance of this model by gender, and identify substantive correlates of the final bifactor model. Undergraduates (N = 4475) from a large northwestern university completed an online screening questionnaire which included demographics, quantity of money lost and won when gambling, the South Oaks Gambling Screen, the AUDIT, gambling motives, drinking motives, personality, and the Brief Symptom Inventory. Results suggest that the bifactor model fit the data well in the full sample. Although the data suggest configural invariance across gender, factor loadings could not be constrained to be equal between men and women. As such, general and specific factors were examined separately by gender with a more intensive subsample of females and males (n = 264). Correlations with motivational tendencies, personality traits, and mental health symptoms indicated support for the validity of the bifactor model, as well as gender-specific patterns of association. Results suggest informative distinctions between shared and unique attributes related to problematic drinking and gambling.

  14. Predictive Accuracy of 29-Comorbidity Index for In-Hospital Deaths in US Adult Hospitalizations with a Diagnosis of Venous Thromboembolism

    PubMed Central

    Tsai, James; Abe, Karon; Boulet, Sheree L.; Beckman, Michele G.; Hooper, W. Craig; Grant, Althea M.

    2013-01-01

    Background Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), we evaluated the predictive accuracy of the AHRQ’s 29-comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE. Methods We assessed the case-fatality and prevalence of comorbidities among a sample of 153,518 adult hospitalizations with a diagnosis of VTE that comprised 87,605 DVTs and 65,913 PEs (with and without DVT). We estimated adjusted odds ratios and 95% confidence intervals with multivariable logistic regression models by using comorbidities as predictors and status of in-hospital death as an outcome variable. We assessed the c-statistics for the predictive accuracy of the logistic regression models. Results In 2010, approximately 41,944 in-hospital deaths (20,212 with DVT and 21,732 with PE) occurred among 770,137 hospitalizations with a diagnosis of VTE. When compared separately to hospitalizations with VTE, DVT, or PE that had no corresponding comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, peripheral vascular disorders, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss were positively and independently associated with 10%−125% increased likelihoods of in-hospital death. The c-statistic values ranged from 0.776 to 0.802. Conclusion The results of this study indicated that comorbidity was associated independently with risk of death among hospitalizations with VTE and among hospitalizations with DVT or PE. The AHRQ 29-comorbidity index provides acceptable to excellent predictive accuracy for in-hospital deaths among adult hospitalizations with VTE

  15. Association of Functional Impairments and Co-Morbid Conditions with Driving Performance among Cognitively Normal Older Adults

    PubMed Central

    Barco, Peggy P.; Babulal, Ganesh M.; Stout, Sarah H.; Johnson, Anne M.; Xiong, Chengjie; Morris, John C.; Roe, Catherine M.

    2016-01-01

    Objectives To examine the relationship between key functional impairments, co-morbid conditions and driving performance in a sample of cognitively normal older adults. Design Prospective observational study Setting The Knight Alzheimer’s Disease Research Center, Washington University at St. Louis Participants Individuals with normal cognition, 64.9 to 88.2 years old (N = 129), with a valid driver’s license, who were currently driving at least once per week, and who had participated in longitudinal studies at the Knight Alzheimer’s Disease Research Center Measurements Static visual acuity, contrast sensitivity, physical frailty measures, motor skills, total medical conditions, and the modified Washington University Road Test. Results When controlling for age, race, gender, APOE, and education the total number of medical conditions was unassociated with both road test scores (pass vs. marginal + fail) and the total driver error count. There were marginal associations of our measure of physical frailty (p = 0.06) and contrast sensitivity score (p = 0.06) with total driving error count. Conclusion Future research that focuses on older adults and driving should consider adopting measures of physical frailty and contrast sensitivity, especially in samples that may have a propensity for disease impacting visual and/or physical function (e.g. osteoarthritis, Parkinson’s, eye disorders, advanced age >80 years, etc.). PMID:28005921

  16. Behavior Problems: Differences among Intellectually Disabled Adults with Co-Morbid Autism Spectrum Disorders and Epilepsy

    ERIC Educational Resources Information Center

    Smith, Kimberly R. M.; Matson, Johnny L.

    2010-01-01

    Behavior problems such as aggression, property destruction, stereotypy, self-injurious behavior, and other disruptive behavior are commonly observed among adults with intellectual disabilities (ID), autism spectrum disorders (ASD), and epilepsy residing at state-run facilities. However, it is unknown how these populations differ on behavior…

  17. A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults

    ERIC Educational Resources Information Center

    Rybarczyk, Bruce; Stepanski, Edward; Fogg, Louis; Lopez, Martita; Barry, Paulette; Davis, Andrew

    2005-01-01

    The present study tested cognitive-behavioral therapy (CBT) for insomnia in older adults with osteoarthritis, coronary artery disease, or pulmonary disease. Ninety-two participants (mean age = 69 years) were randomly assigned to classroom CBT or stress management and wellness (SMW) training, which served as a placebo condition. Compared with SMW,…

  18. Keeping Older Adults with Vision Loss Safe: Chronic Conditions and Comorbidities that Influence Functional Mobility

    ERIC Educational Resources Information Center

    Riddering, Anne T.

    2008-01-01

    Age-related macular degeneration (AMD) is a leading cause of vision loss in Americans aged 60 and older. The loss of central vision from AMD can decrease visual acuity, contrast sensitivity, glare sensitivity, color discrimination, and the ability to adapt to changes in lighting conditions. Older adults with vision loss often have other chronic,…

  19. Untreated ADHD in Adults: Are There Sex Differences in Symptoms, Comorbidity, and Impairment?

    ERIC Educational Resources Information Center

    Rasmussen, Kirsten; Levander, Sten

    2009-01-01

    Objective: To analyze sex differences among adult, never-treated patients referred for central stimulant treatment of ADHD. Method: Data for 600 consecutive patients from northern Norway referred for evaluation by an expert team during 7 years were analyzed. General background information, diagnostic and social history, and symptom profiles were…

  20. Chromosomal microarray testing in adults with intellectual disability presenting with comorbid psychiatric disorders

    PubMed Central

    Wolfe, Kate; Strydom, André; Morrogh, Deborah; Carter, Jennifer; Cutajar, Peter; Eyeoyibo, Mo; Hassiotis, Angela; McCarthy, Jane; Mukherjee, Raja; Paschos, Dimitrios; Perumal, Nagarajan; Read, Stephen; Shankar, Rohit; Sharif, Saif; Thirulokachandran, Suchithra; Thygesen, Johan H; Patch, Christine; Ogilvie, Caroline; Flinter, Frances; McQuillin, Andrew; Bass, Nick

    2017-01-01

    Chromosomal copy-number variations (CNVs) are a class of genetic variants highly implicated in the aetiology of neurodevelopmental disorders, including intellectual disabilities (ID), schizophrenia and autism spectrum disorders (ASD). Yet the majority of adults with idiopathic ID presenting to psychiatric services have not been tested for CNVs. We undertook genome-wide chromosomal microarray analysis (CMA) of 202 adults with idiopathic ID recruited from community and in-patient ID psychiatry services across England. CNV pathogenicity was assessed using standard clinical diagnostic methods and participants underwent comprehensive medical and psychiatric phenotyping. We found an 11% yield of likely pathogenic CNVs (22/202). CNVs at recurrent loci, including the 15q11-q13 and 16p11.2-p13.11 regions were most frequently observed. We observed an increased frequency of 16p11.2 duplications compared with those reported in single-disorder cohorts. CNVs were also identified in genes known to effect neurodevelopment, namely NRXN1 and GRIN2B. Furthermore deletions at 2q13, 12q21.2-21.31 and 19q13.32, and duplications at 4p16.3, 13q32.3-33.3 and Xq24-25 were observed. Routine CMA in ID psychiatry could uncover ~11% new genetic diagnoses with potential implications for patient management. We advocate greater consideration of CMA in the assessment of adults with idiopathic ID presenting to psychiatry services. PMID:27650969

  1. Efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in patients with common comorbidities in children, adolescents and adults: a review

    PubMed Central

    Hutchison, Shari L.; Ghuman, Jaswinder K.; Ghuman, Harinder S.; Karpov, Irina; Schuster, James M.

    2016-01-01

    Attention-deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental health disorders and is associated with higher incidence of comorbid oppositional or conduct, mood, anxiety, pervasive developmental, and substance-use disorders. Comorbid mental health conditions may alter the presence of symptoms and treatment of ADHD. Atomoxetine (ATX), a nonstimulant medication for the treatment of ADHD, may be prescribed for individuals with ADHD and comorbid conditions despite some risk for certain undesirable side effects and lower effectiveness for the treatment of ADHD than stimulants. In this paper, we review studies utilizing randomized, placebo-controlled trials (RCTs) as well as within-subject designs to determine the effectiveness of ATX in the treatment of children and adults with ADHD and comorbid conditions. The current review uses an expanded methodology beyond systematic review of randomized controlled trials in order to improve generalizability of results to real-world practice. A total of 24 articles published from 2007 to 2015 were reviewed, including 14 RCTs: n = 1348 ATX, and n = 832 placebo. The majority of studies show that ATX is effective in the treatment of ADHD symptoms for individuals with ADHD and comorbid disorders. Cohen’s d effect sizes (ES) for improvement in ADHD symptoms and behaviors range from 0.47 to 2.21. The effectiveness of ATX to improve symptoms specific to comorbidity varied by type but appeared to be most effective for diminishing the presence of symptoms for those with comorbid anxiety, ES range of 0.40 to 1.51, and oppositional defiant disorder, ES range of 0.52 to 1.10. There are mixed or limited results for individuals with ADHD and comorbid substance-use disorders, autism spectrum disorders, dyslexia or reading disorder, depression, bipolar disorder, and Tourette syndrome. Results from this review suggest that ATX is effective in the treatment of some youth and adults with ADHD and comorbid disorders

  2. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities

    PubMed Central

    Bhaskar, Swapna; Hemavathy, D.; Prasad, Shankar

    2016-01-01

    Introduction: Insomnia is one of the common but neglected conditions seen in family practice with long term and serious effects on health of a patient. Family physicians have the responsibility of diagnosing and adequately treating this. This study was done to find the prevalence of chronic insomnia in adult patients visiting a family medicine outpatient department (OPD) in a hospital and to assess the risk factors and co morbidities associated with it. Materials and Methods: A cross-sectional study was done in the family medicine OPD at St. Philomena's Hospital, Bengaluru. All adult patients attending the OPD from September 1 to October 30, 2015 were enrolled in the study after obtaining written consent. Athens Insomnia Scale was used to diagnose insomnia and information regarding medical co morbidities was collected. Data was analyzed for the prevalence of insomnia and its association with co morbidities. Results: Chronic insomnia was seen in 33% of the adult population sampled. Increasing age and diabetes were significantly associated with insomnia, while other socioeconomic factors and co morbidities were not significantly associated. Twenty-seven percent of patients who had insomnia did not perceive the condition, which was statistically significant. Conclusion: Insomnia is a common sleep disorder which is many times missed by a primary care physician until/unless asked for. Since there is a higher incidence with increasing age and co morbidities such as diabetes, all patients, especially middle-aged and diabetics, should be screened for insomnia by the primary care physician with a self assessed questionnaire and counseled. PMID:28348990

  3. Metabolic co-morbidities revealed in patients with childhood-onset adult GH deficiency after cessation of GH replacement therapy for short stature.

    PubMed

    Fukuda, Izumi; Hizuka, Naomi; Yasumoto, Kumiko; Morita, Junko; Kurimoto, Makiko; Takano, Kazue

    2008-12-01

    GH therapy was approved in 2006 for treatment of adult growth hormone deficiency (GHD) in Japan. Until then, GH was used only to treat short stature in children with GHD and the treatment was stopped when the final height was reached. In the present study, we investigated metabolic co-morbidities experienced by adults with childhood-onset (CO) GHD after the cessation of GH. Forty-two patients with COGHD (M/F 22/20, age at follow up when the retrospective analysis was carried out: 18-52 yr) treated with GH in childhood were studied. We reviewed the medical records of these patients to determine the metabolic co-morbidities that developed after cessation of GH. The median age was 19 yrs (range: 14-38) at cessation of GH, and the following co-morbidities were observed: hypertriglyceridemia in 15 (41%) patients, non-alcoholic fatty liver disease (NAFLD) in 11 (29%) patients, hypercholesterolemia in 10 (26%) patients, diabetes mellitus (DM) in 4 (10%) patients, and hypertension in 1 (2.4%) patient. The median BMI when these complications became overt was 23.5 kg/m(2) for those with hypertriglyceridemia, 26.0 kg/m(2) for those with NAFLD, 20.9 kg/m(2) for those with hypercholesterolemia, and 27.2 kg/m(2 ) for those with DM. More than two co-morbidities were experienced by 32% of men and 30% of women. In conclusion, adults with COGHD after the cessation of GH have multiple metabolic co-morbidities. Lifelong GH replacement might be important for improving the overall metabolic profiles in these patients.

  4. Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial.

    PubMed

    Feldman, Jonathan M; Matte, Lynne; Interian, Alejandro; Lehrer, Paul M; Lu, Shou-En; Scheckner, Bari; Steinberg, Dara M; Oken, Tanya; Kotay, Anu; Sinha, Sumita; Shim, Chang

    2016-12-01

    Confusion between panic and asthma symptoms can result in serious self-management errors. A cognitive behavior psychophysiological therapy (CBPT) intervention was culturally adapted for Latinos consisting of CBT for panic disorder (PD), asthma education, differentiation between panic and asthma symptoms, and heart rate variability biofeedback. An RCT compared CBPT to music and relaxation therapy (MRT), which included listening to relaxing music and paced breathing at resting respiration rates. Fifty-three Latino (primarily Puerto Rican) adults with asthma and PD were randomly assigned to CBPT or MRT for 8 weekly sessions. Both groups showed improvements in PD severity, asthma control, and several other anxiety and asthma outcome measures from baseline to post-treatment and 3-month follow-up. CBPT showed an advantage over MRT for improvement in adherence to inhaled corticosteroids. Improvements in PD severity were mediated by anxiety sensitivity in CBPT and by depression in MRT, although earlier levels of these mediators did not predict subsequent improvements. Attrition was high (40%) in both groups, albeit comparable to CBT studies targeting anxiety in Latinos. Additional strategies are needed to improve retention in this high-risk population. Both CBPT and MRT may be efficacious interventions for comorbid asthma-PD, and CBPT may offer additional benefits for improving medication adherence.

  5. Comorbid Psychopathology and Stress Mediate the Relationship between Autistic Traits and Repetitive Behaviours in Adults with Autism

    ERIC Educational Resources Information Center

    García-Villamisar, D.; Rojahn, J.

    2015-01-01

    Background: Comorbid psychopathology and stress were considered possible mediators that may explain the relationship between some autistic traits and repetitive behaviours. The current study sought to examine the mediational effects of comorbid psychopathology, executive dysfunctions and stress in the relationship between some autistic traits and…

  6. Effective Methylphenidate Treatment of an Adult Aspergers Syndrome and a Comorbid ADHD: A Clinical Investigation with fMRI

    ERIC Educational Resources Information Center

    Roy, Mandy; Dillo, Wolfgang; Bessling, Svenja; Emrich, Hinderk M.; Ohlmeier, Martin D.

    2009-01-01

    Objective: Aspergers Syndrome can present as comorbid with attention-deficit/hyperactivity disorder (ADHD). Very few cases of the assessment and treatment of this comorbidity in adulthood are described in the research literature. Method: A 26-year-old patient as suffering from ADHD in combination with Aspergers Syndrome is diagnosed. Treatment is…

  7. Effect of Co-Morbid Conditions on Persistent Neuropathic Pain after Brachial Plexus Injury in Adult Patients

    PubMed Central

    Chaudakshetrin, Pongparadee; Chotisukarat, Haruthai; Mandee, Sahatsa

    2016-01-01

    Background and Purpose Neuropathic pain (NeuP) associated with traumatic brachial plexus injury (BPI) can be severe, persistent, and resistant to treatment. Moreover, comorbidity associated with NeuP may worsen the pain and quality of life. This study compared persistent NeuP after BPI between patients with and without co-morbid conditions (psychiatric dysfunction and other painful conditions) and tramadol usage as a second-line agent in combination with an antiepileptic and/or antidepressant during a 2-year follow-up. Methods The medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively. Results Of the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (p<0.001). The mean pain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (p<0.05). Conclusions Persistent pain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief. PMID:27819420

  8. Complement Component 3 Is Associated with Metabolic Comorbidities in Older HIV-Positive Adults

    PubMed Central

    Bryant, Alex K.; Fazeli, Pariya L.; Letendre, Scott L.; Ellis, Ronald J.; Potter, Michael; Burdo, Tricia H.; Singh, Kumud K.; Jeste, Dilip V.; Grant, Igor

    2016-01-01

    Abstract Our objective was to evaluate the association of plasma inflammatory biomarkers with MetS in an older population of treated HIV-infected (HIV+) as compared to age-matched HIV-negative (HIV−) adults. This was done in a retrospective observational study. Plasma concentrations of complement component 3 (C3), cystatin C, fibroblast growth factor 1, interleukin 6, oxidized LDL, soluble RAGE, soluble CD163, soluble CD14, and osteopontin were measured in 79 HIV+ participants on combination antiretroviral treatment (cART) with a suppressed HIV viral load and 47 HIV− participants with a median age of 59 (range 50 to 79). Outcomes were individual MetS components (hypertension, type II diabetes, dyslipidemia, and obesity) and MetS. Covariates were screened for inclusion in multivariable models. Odds ratios are reported per 50 mg/dl increase in C3. In the HIV+ group, higher C3 levels were associated with MetS (OR 3.19, p = 0.004), obesity (OR 2.02, p = 0.01), type II diabetes (OR 1.93, p = 0.02), and at a trend level with dyslipidemia (OR 1.87, p = 0.07) and hypertension (OR 1.66, p = 0.09). C3 levels were significantly higher in HIV+ participants with MetS compared to those without MetS (p = 0.002). C3 was higher among HIV+ patients with three or four MetS components as compared to those with one or two (p = 0.04) and those with none (p = 0.002). No associations were found between C3 and the outcomes for HIV− participants. C3 is strongly associated with both MetS and MetS components in an older HIV+ sample on cART compared to HIV− controls. C3 warrants further investigation as a marker of cardiometabolic risk among persons aging with HIV. PMID:26499082

  9. Executive functioning in hyperactive children as young adults: attention, inhibition, response perseveration, and the impact of comorbidity.

    PubMed

    Fischer, Mariellen; Barkley, Russell A; Smallish, Lori; Fletcher, Kenneth

    2005-01-01

    Tests of several executive functions (EFs) as well as direct observations of symptoms of attention deficit hyperactivity disorder (ADHD) during testing were collected at the young adult follow-up (M = 20 years) on a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The EF tasks included tests of attention, inhibition, and response perseveration. The H group was subdivided into those with and without ADHD (+ or w/o) at follow-up. The H+ADHD group made significantly more inhibition errors than the CC group on a Continuous Performance Test (CPT) and showed more ADHD symptoms while performing the CPT. The H+ADHD group also displayed more ADHD symptoms during a letter cancellation task than did both the hyperactive w/o ADHD and CC groups. Both H groups showed slower reaction times during a Card Playing Task. That subset of hyperactive probands with Conduct Disorder (CD) displayed significantly more perseverative responding on that task than did those without CD, but otherwise it did not differ on any other measures. Current level of anxiety contributed adversely to both CPT commission errors and ADHD behavior during the CPT. Comorbid depression did not contribute to any group differences on these tests. Although developmental improvements were found in both the H and the CC groups in their CPT inattention and inhibition scores since adolescence, the H groups remained distinguishable from the CC groups over this period. We conclude that formerly hyperactive children manifest greater EF deficits at follow-up in the areas of inattention, disinhibition, and slowed reaction time and greater ADHD behavior during testing, but these problems are mostly confined to those with current ADHD. Response perseveration, however, was limited to those hyperactive children with CD by follow-up, consistent with Quay's theory of these two disorders.

  10. Retrospective reports of parenting in depressed adults with and without comorbid panic disorder and social anxiety disorder.

    PubMed

    Torpey, Dana C; Olino, Thomas M; Klein, Daniel N

    2007-09-01

    Previous research has examined the role of parenting in the development of depression and anxiety disorders using retrospective reports of parenting behaviors. However, most studies have not considered comorbidity; the few that have did not differentially examine individual anxiety disorders and yielded inconsistent results. The present study compared retrospective parenting reports given by depressed individuals with no comorbid anxiety disorder, comorbid panic disorder, and comorbid social anxiety disorder. Results indicated that depressed men with panic disorder reported significantly greater maternal and nonsignificantly greater paternal protectiveness than depressed men without panic disorder but not than depressed women with and without panic disorder. No differences were found for the retrospective parenting reports given by depressed participants with or without social anxiety disorder. This work highlights the importance of examining specific anxiety disorders rather than grouping all depressed patients with any anxiety disorder together, as well as examining males and females separately when investigating the influence of parental behavior.

  11. Role of comorbidity on outcome of head and neck cancer: a population-based study in Thuringia, Germany.

    PubMed

    Göllnitz, Irene; Inhestern, Johanna; Wendt, Thomas G; Buentzel, Jens; Esser, Dirk; Böger, Daniel; Mueller, Andreas H; Piesold, Jörn-Uwe; Schultze-Mosgau, Stefan; Eigendorff, Ekkehard; Schlattmann, Peter; Guntinas-Lichius, Orlando

    2016-11-01

    To examine the impact of comorbidity on overall survival (OS) in a population-based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patient's characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity (CCI), age-adjusted CCI (ACCI), head and neck CCI (HNCCI), simplified comorbidity score (SCS), and to the Adult Comorbidity Evaluation-27 (ACE-27). Most patients were male (80%; median age: 60 years; 50% stage IV tumors). Smoking, alcohol abuse, and anemia were registered for 38%, 33%, and 23% of the patients, respectively. Predominant therapy was surgery + radiochemotherapy (30%), surgery (29%), and surgery + radiotherapy (21%). Mean CCI, ACCI, HNCCI, SCS and ACE-27 were 1.0 ± 1.5, 2.6 ± 2.1, 0.6 ± 0.8, 4.4 ± 4.2, and 0.9 ± 0.9, respectively. Median follow-up was 25.7 months. Multivariable analyses showed that higher age, higher UICC stage, no therapy, including surgery or radiotherapy, alcohol abuse, and anemia, higher comorbidity were independent risk factors for worse OS (all P < 0.05). According to the discriminatory power analysis none of the five comorbidity scores was superior to the other scores to prognosticate OS. This population-based study showed that comorbidity is frequent in German patients with head and neck cancer and is an important risk factor for poor OS. Comorbidity should be routinely assessed and taken into account in prospective clinical trials.

  12. Associations between comorbid health conditions and the use of mental health services among adults with bipolar disorder.

    PubMed

    Lee, Sungkyu; Matejkowski, Jason

    2016-01-01

    Using a nationally representative sample, this study examined to what extent the number of comorbid health conditions was associated with various mental health service utilization among people with bipolar disorder. The results of logistic regression models indicate that a greater number of comorbid medical conditions were associated with higher odds of using specialty mental health service, while they were not associated with utilization of services provided by general health care providers. The type of bipolar disorder, functional impairment, and marital status were found to be associated with the use of a specialty service, while ethnicity was the only covariate significantly related to general health care use.

  13. Real-World Executive Functions in Adults with Autism Spectrum Disorder: Profiles of Impairment and Associations with Adaptive Functioning and Co-morbid Anxiety and Depression.

    PubMed

    Wallace, Gregory L; Kenworthy, Lauren; Pugliese, Cara E; Popal, Haroon S; White, Emily I; Brodsky, Emily; Martin, Alex

    2016-03-01

    Although executive functioning (EF) difficulties are well documented among children and adolescents with autism spectrum disorder (ASD), little is known about real-world measures of EF among adults with ASD. Therefore, this study examined parent-reported real-world EF problems among 35 adults with ASD without intellectual disability and their correlations with adaptive functioning and co-morbid anxiety and depression symptomatology. A variable EF profile was found with prominent deficits occurring in flexibility and metacognition. Flexibility problems were associated with anxiety-related symptoms while metacognition difficulties were associated with depression symptoms and impaired adaptive functioning (though the metacognition-adaptive functioning relationship was moderated by ADHD symptoms). These persistent EF problems are predictors of broader functioning and therefore remain an important treatment target among adults with ASD.

  14. Real-World Executive Functions in Adults with Autism Spectrum Disorder: Profiles of Impairment and Associations with Adaptive Functioning and Co-morbid Anxiety and Depression

    PubMed Central

    Kenworthy, Lauren; Pugliese, Cara E.; Popal, Haroon S.; White, Emily I.; Brodsky, Emily; Martin, Alex

    2016-01-01

    Although executive functioning (EF) difficulties are well documented among children and adolescents with autism spectrum disorder (ASD), little is known about real-world measures of EF among adults with ASD. Therefore, this study examined parent-reported real-world EF problems among 35 adults with ASD without intellectual disability and their correlations with adaptive functioning and co-morbid anxiety and depression symptomatology. A variable EF profile was found with prominent deficits occurring in flexibility and metacognition. Flexibility problems were associated with anxiety-related symptoms while metacognition difficulties were associated with depression symptoms and impaired adaptive functioning (though the metacognition-adaptive functioning relationship was moderated by ADHD symptoms). These persistent EF problems are predictors of broader functioning and therefore remain an important treatment target among adults with ASD. PMID:26572659

  15. The Impact of Comorbid Clinical Depression on The Health-Related Quality of Life of Adults on Highly Active Antiretroviral Therapy in Maiduguri, Northeastern Nigeria

    PubMed Central

    Wakawa, Ibrahim Abdu; Said, Jidda Mohammed; Abba, Wakil Musa; Shehu, Saleh; Rabbebe, Isa Bukar; Beida, Omeiza

    2014-01-01

    Background: Globally, depression compromises the quality of life (QOL) of people suffering from it. We assessed the impact of comorbid depression on the health-related quality of life (HRQOL) of adults on highly active antiretroviral therapy (HAART) in northeastern Nigeria in this study. Materials and Methods: Three hundred and three adults on HAART were recruited for this study from the ART clinic of the University of Maiduguri Teaching Hospital in northeastern Nigeria. The depressive disorder module of the Composite international diagnostic interview (CIDI version 3.0) and the WHO quality of life instrument (WHOQOL-BREF) were used for the evaluation of depression and quality of life respectively. Results: The prevalence of depression in this study was 19.8%. The depressed respondents rated their HRQOL poorer than their nondepressed counterparts on the physical, psychological, social relationships and environmental domains as well as the global outcome, as shown by these statistically significant findings (T = 9.739, P = <0.001), (T = 8.972, P = <0.001), (T = 6.533, P = <0.001), (T = 8.913, P = <0.001), and (T = 10.018, P = <0.001), respectively. Female gender, CD4 counts <200/mm3 and diagnosis of depression were significant predictors poor QOL. Conclusion: Depression has a negative impact on the QOL of the respondents. We therefore recommend incorporation of the routine screening of this important psychiatric comorbidity into the care of this vulnerable group in order to optimize patient care. PMID:25336775

  16. Triple Comorbid Trajectories of Tobacco, Alcohol, and Marijuana Use as Predictors of Antisocial Personality Disorder and Generalized Anxiety Disorder Among Urban Adults

    PubMed Central

    Brook, Judith S.; Lee, Jung Yeon; Rubenstone, Elizabeth; Brook, David W.; Finch, Stephen J.

    2014-01-01

    Objectives. We modeled triple trajectories of tobacco, alcohol, and marijuana use from adolescence to adulthood as predictors of antisocial personality disorder (ASPD) and generalized anxiety disorder (GAD). Methods. We assessed urban African American and Puerto Rican participants (n = 816) in the Harlem Longitudinal Development Study, a psychosocial investigation, at 4 time waves (mean ages = 19, 24, 29, and 32 years). We used Mplus to obtain the 3 variable trajectories of tobacco, alcohol, and marijuana use from time 2 to time 5 and then conducted logistic regression analyses. Results. A 5-trajectory group model, ranging from the use of all 3 substances (23%) to a nonuse group (9%), best fit the data. Membership in the trajectory group that used all 3 substances was associated with an increased likelihood of both ASPD (adjusted odds ratio [AOR] = 6.83; 95% CI = 1.14, 40.74; P < .05) and GAD (AOR = 4.35; 95% CI = 1.63, 11.63; P < .001) in adulthood, as compared with the nonuse group, with control for earlier proxies of these conditions. Conclusions. Adults with comorbid tobacco, alcohol, and marijuana use should be evaluated for use of other substances and for ASPD, GAD, and other psychiatric disorders. Treatment programs should address the use of all 3 substances to decrease the likelihood of comorbid psychopathology. PMID:24922120

  17. Mental Disorders and Problem Behavior in a Community Sample of Adults with Intellectual Disability: Three-Month Prevalence and Comorbidity

    ERIC Educational Resources Information Center

    Hove, Oddbjorn; Havik, Odd E.

    2008-01-01

    The aim of this study was to investigate the prevalence of mental disorders in a Norwegian sample of adults with intellectual disability (ID) using the "Psychopathology Checklists for Adults With Intellectual Disability" (P-AID; Hove & Havik, 2008), a screening instrument adopting diagnostic criteria from the "Diagnostic…

  18. Concordance between self-reported and physician-reported chronic co-morbidity among disabled older adults.

    PubMed

    Iecovich, Esther; Biderman, Aya

    2013-09-01

    Discordance between self-reports and medical records reflects patient and provider factors that have implications for management and research. This study investigated discordance and socio-demographic factors that explain concordance. A purposive sample of 402 disabled older persons was interviewed using a structured questionnaire. The highest concordances were found for diabetes, cardiovascular accident (CVA), and cancer while the lowest were evident for arthritis, and renal and gastrointestinal conditions. Significant explanatory factors included (a) age for explaining concordance in hypertension; (b) ethnicity in explaining concordance in arthritis and cancer; (c) marital status in explaining concordance in thyroid diseases; (d) education in explaining concordance in gastrointestinal conditions; and (e) functional status in explaining concordance in respiratory, gastrointestinal, and thyroid diseases. Co-morbidity increased concordance for all health conditions and decreased concordance for hypertension. Further investigation is needed to examine the reasons for the disparities between the two sources of information.

  19. Co-occurring amphetamine use and associated medical and psychiatric comorbidity among opioid-dependent adults: results from the clinical Trials Network

    PubMed Central

    Pilowsky, Daniel J; Wu, Li-Tzy; Burchett, Bruce; Blazer, Dan G; Woody, George E; Ling, Walter

    2011-01-01

    Background In response to the rising rate of treatment admissions related to illicit use of amphetamines (eg, methamphetamine), we examined the prevalence of amphetamine use among treatment-seeking, opioid-dependent adults, explored whether amphetamine users were as likely as nonamphetamine users to enroll in opioid-dependence treatment trials, and determined whether amphetamine users manifested greater levels of medical and psychiatric comorbidity than nonusers. Methods The sample included 1257 opioid-dependent adults screened for participation in three-multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-003), which studied the effectiveness of buprenorphine for opioid detoxification under varying treatment conditions. Patients were recruited from 23 addiction treatment programs across the US. Medical and psychiatric comorbidity were examined by past-month amphetamine use (current vs former) and route of administration. Five mutually exclusive groups were examined, ie, nonusers, current amphetamine injectors, current amphetamine noninjectors, former amphetamine injectors, and former amphetamine noninjectors. Results Of the sample (n = 1257), 22.3% had a history of regular amphetamine use. Of the 280 amphetamine users, 30.3% reported injection as their primary route. Amphetamine users were more likely than nonusers to be white and use more substances. Amphetamine users were as likely as nonusers to enroll in treatment trials. Bivariate analyses indicated elevated rates of psychiatric problems (depression, anxiety, hallucinations, cognitive impairment, violence, suicidal thoughts/attempts) and medical illnesses (dermatological, hepatic, cardiovascular, respiratory, neurological, seizure, allergy conditions) among amphetamine users. After adjusting for demographic variables and lifetime use of other substances: current amphetamine users and former injectors showed an increased likelihood of having medical illnesses and

  20. Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults.

    PubMed

    Philipsen, Alexandra

    2006-09-01

    Attention-deficit/hyperactivity disorder (ADHD) in adults and borderline personality Disorder (BPD) share some similar clinical features (e. g. impulsivity, emotional dysregulation, cognitive impairment). ADHD in childhood has been reported to be highly associated with the diagnosis of BPD in adulthood and adult ADHD often co-occurs with BPD. Treatment studies revealed an efficacy of dialectical behavioral therapy (DBT) and DBT-based psychotherapy, respectively, in BPD and adult ADHD as well as neuroimaging and psychopharmacological studies showed some evidence for a potential common neurobiological dysfunction suggesting the hypothesis that ADHD and BPD may not be two distinct disorders, but represent at least in a subgroup of patients two dimensions of one disorder.

  1. Risk Factors for Tardive Dyskinesia in Adults with Intellectual Disability, Comorbid Psychopathology, and Long-Term Psychotropic Use

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Fodstad, Jill C.; Neal, Daniene; Dempsey, Timothy; Rivet, Tessa T.

    2010-01-01

    Psychotropic medications are commonly used as an adjunct treatment in large-scale residential care facilities for adults with developmental disabilities. While the benefits of medication are noted, there are very severe conditions that can result from long term medication use. Tardive dyskinesia (TD) manifests as a variety of involuntary,…

  2. Addiction in developmental perspective: influence of conduct disorder severity, subtype, and attention-deficit hyperactivity disorder on problem severity and comorbidity in adults with opioid dependence.

    PubMed

    Carpentier, Pieter-Jan; Knapen, Lieke J M; van Gogh, Mijke T; Buitelaar, Jan K; De Jong, Cornelis A J

    2012-01-01

    This retrospective cross-sectional study examines whether conduct disorder and attention deficit hyperactivity disorder are associated with problem severity and psychiatric comorbidity in 193 middle-aged, opioid-dependent patients. Conduct disorder history, attention deficit hyperactivity disorder, psychiatric comorbidity, and problem severity were assessed by structured interviews and validated instruments. A conduct disorder history was confirmed in 116 (60.1%) participants. Conduct disorder patients had significantly higher problem severity scores, more frequent comorbid substance use disorders, and more severe psychiatric comorbidity. Attention deficit hyperactivity disorder was found to increase the risk for psychiatric comorbidity. Conduct disorder persistence is a useful model for elucidating complex psychiatric comorbidity of opioid-dependent patients.

  3. Two weeks of predatory stress induces anxiety-like behavior with co-morbid depressive-like behavior in adult male mice.

    PubMed

    Burgado, Jillybeth; Harrell, Constance S; Eacret, Darrell; Reddy, Renuka; Barnum, Christopher J; Tansey, Malú G; Miller, Andrew H; Wang, Huichen; Neigh, Gretchen N

    2014-12-15

    Psychological stress can have devastating and lasting effects on a variety of behaviors, especially those associated with mental illnesses such as anxiety and depression. Animal models of chronic stress are frequently used to elucidate the mechanisms underlying the relationship between stress and mental health disorders and to develop improved treatment options. The current study expands upon a novel chronic stress paradigm for mice: predatory stress. The predatory stress model incorporates the natural predator-prey relationship that exists among rats and mice and allows for greater interaction between the animals, in turn increasing the extent of the stressful experience. In this study, we evaluated the behavioral effects of exposure to 15 days of predatory stress on an array of behavioral indices. Up to 2 weeks after the end of stress, adult male mice showed an increase of anxiety-like behaviors as measured by the open field and social interaction tests. Animals also expressed an increase in depressive-like behavior in the sucrose preference test. Notably, performance on the novel object recognition task, a memory test, improved after predatory stress. Taken as a whole, our results indicate that 15 exposures to this innovative predatory stress paradigm are sufficient to elicit robust anxiety-like behaviors with evidence of co-morbid depressive-like behavior, as well as changes in cognitive behavior in male mice.

  4. A feasibility study of a telephone-supported self-care intervention for depression among adults with a comorbid chronic physical illness in primary care

    PubMed Central

    2012-01-01

    Objective We assessed the feasibility and acceptability to patients of a telephone-supported self-care intervention for depression among adults aged 40 years or over with one of six targeted chronic physical illnesses and comorbid depressive symptoms in family practice settings. Methods An open, uncontrolled trial (feasibility study) was conducted among patients treated in Montreal family practices. Eligible patients were aged 40 years or over, had one or more of the targeted chronic physical illnesses for at least 6 months (arthritis, hypertension, diabetes, heart disease, asthma and chronic obstructive pulmonary disease) and were evaluated as having at least mild depressive symptoms (a score of ≥ 5 on the 9-item Patient Health Questionnaire, PHQ-9). Participants received a package of six self-care tools (information booklet, video, Internet programme, action plan, workbook and mood-monitoring tool) with telephone support by a lay coach for up to 6 months. Results In total, 63 eligible patients provided written consent and completed the baseline interview; 57 (90%) and 55 (87%) patients completed 2-month and 6-month follow-up interviews, respectively. The mean number of telephone calls made by coaches to participants was 10.5 (SD 4.0), and the average length of these calls was 10.6 minutes. At the 6-month follow-up, 83.6% of the participants reported that one or more of the tools were helpful. Clinically significant improvements were seen in depressive symptoms (as assessed by the PHQ-9) at 6 months, with an effect size of 0.88 (95% CI, 0.55, 1.14). Conclusion A telephone-supported self-care intervention for depression was feasible, was acceptable to patients, and was associated with a significant 6-month improvement in depressive symptoms. A randomised trial of this intervention is justified. PMID:24294301

  5. Resistant hypertension: risk factors, subclinical atherosclerosis, and comorbidities among adults-the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

    PubMed

    Lotufo, Paulo A; Pereira, Alexandre C; Vasconcellos, Paulo S; Santos, Itamar S; Mill, Jose Geraldo; Bensenor, Isabela M

    2015-01-01

    The frequency of resistant hypertension-defined as blood pressure (BP) ≥140/90 mm Hg with proven use of three antihypertensive medications, or as the use of four antihypertensive drug classes regardless of BP-is unknown in low-middle-income countries. Using data from the Brazilian Longitudinal Study of Adult Health, a cohort of 15,105 civil servants aged 35 to 74 years, the authors identified 4116 patients taking treatment for hypertension, 11% of who had resistant hypertension. These participants were more likely to be older, black, less educated, poorer, and obese. The adjusted prevalence ratios (95% confidence intervals) were diabetes, 1.44 (1.20-1.72); glomerular filtration rate (<60 mL/min/1.72 m(2) ), 1.95 (1.60-2.38); albumin-to-creatinine ratio (>300 mg/g), 2.43 (1.70-3.50); carotid-femoral pulse-wave velocity, 1.07 m/s (1.03-1.11 m/s); common carotid intima-media thickness, 2.57 mm (1.64-4.00 mm); left ventricular hypertrophy, 2.08 (1.21-3.57); and atrial fibrillation, 3.55 (2.02-6.25). Thus, the prevalence of resistant hypertension in Brazil is high and associated with subclinical markers of end-organ cardiovascular damage.

  6. Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD): an open-label prospective study of time in treatment, dose, side-effects and comorbidity.

    PubMed

    Fredriksen, Mats; Dahl, Alv A; Martinsen, Egil W; Klungsøyr, Ole; Haavik, Jan; Peleikis, Dawn E

    2014-12-01

    How to generalize from randomized placebo controlled trials of ADHD drug treatment in adults to 'real-world' clinical practice is intriguing. This open-labeled prospective observational study examined the effectiveness of long-term stimulant and non-stimulant medication in adult ADHD including dose, side-effects and comorbidity in a clinical setting. A specialized ADHD outpatient clinic gave previously non-medicated adults (n=250) with ADHD methylphenidate as first-line drug according to current guidelines. Patients who were non-tolerant or experiencing low efficacy were switched to amphetamine or atomoxetine. Primary outcomes were changes of ADHD-symptoms evaluated with the Adult ADHD Self-Report Scale (ASRS) and overall severity by the Global Assessment of Functioning (GAF). Secondary outcomes were measures of mental distress, and response on the Clinical-Global-Impressions-Improvement Scale. Data at baseline and follow-ups were compared in longitudinal mixed model analyses for time on-medication, dosage, comorbidity, and side-effects. As results, 232 patients (93%) completed examination at the 12 month endpoint, and 163 (70%) remained on medication. Compared with the patients who discontinued medication, those still on medication had greater percentage reduction in ASRS-scores (median 39%, versus 13%, P<0.001) and greater improvement of GAF (median 20% versus 4%, P<0.001) and secondary outcomes. Continued medication and higher cumulated doses showed significant associations to sustained improvement. Conversely, psychiatric comorbidity and side-effects were related to lower effectiveness and more frequent termination of medication. Taken together, one-year treatment with stimulants or atomoxetine was associated with a clinically significant reduction in ADHD symptoms and mental distress, and improvement of measured function. No serious adverse events were observed.

  7. Managing comorbidities in COPD.

    PubMed

    Hillas, Georgios; Perlikos, Fotis; Tsiligianni, Ioanna; Tzanakis, Nikolaos

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity.

  8. Prevalence and associated comorbidities of restless legs syndrome (RLS): Data from a large population-based door-to-door survey on 19176 adults in Tehran, Iran

    PubMed Central

    Rahmani, Arash; Shafieesabet, Mahdiyeh; Soori, Mahshid; Delbari, Ahmad; Motamed, Mohammad Reza; Lökk, Johan

    2017-01-01

    Background Discrepancies have been reported in the prevalence rate of restless legs syndrome (RLS) among different ethnic groups and geographic populations. Furthermore, there are disagreements on determinant factors and associated comorbidities of RLS. We aimed to estimate prevalence of RLS and investigate its associated comorbid conditions and risk factors in a large population-based door-to-door survey. Methods Following a multistage random sampling from the households lived in 22 urban districts of Tehran, Iran, 19176 participants with ≥30 years of age were recruited. Trained surveyors filled study checklist consisting of baseline characteristics, risk factors and comorbidity profile and the International RLS Study Group (IRLSSG) diagnostic criteria through face-to-face interviews. Results In total, 1580 individuals were positively screened for RLS resulting in a standardized prevalence rate of 60.0/1000. There was a gradual increase in RLS prevalence by advancing age, however, sex difference disappeared after adjustment. Parkinsonism [adjusted odds’ ratio (adj-OR) = 7.4 (95% CI: 5.3–10.4)], peripheral neuropathy [adj-OR = 3.7 (95% CI: 3.3–4.1)], subjective cognitive impairment (SCI) [adj-OR = 3.1 (95% CI: 2.7–3.4)], acting out dreams [adj-OR = 2.8 (95% CI: 2.5–3.2)], hyposmia [adj-OR = 2.5 (95% CI: 2.2–2.9)], active smoking [adj-OR = 1.5 (95% CI: 1.3–1.9)] and additional number of cardiometabolic diseases associated with higher risk of RLS [adj-OR = 1.6 (95% CI: 1.2–2.3)]. Conclusion Our findings showed that neuro-cognitive co-morbidities such as parkinsonism, peripheral neuropathy, SCI, acting out dreams and hyposmia as well as cardio-metabolic risk factors and diseases were independent determinants of RLS. It is recommended to screen individuals with either these comorbid conditions for RLS or the ones with RLS for the accompanying diseases. PMID:28212408

  9. Potentially Traumatic Event Exposure, Posttraumatic Stress Disorder, and Axis I and II Comorbidity in a Population Based Study of Norwegian Young Adults

    PubMed Central

    Amstadter, Ananda B.; Aggen, Steven H.; Knudsen, Gun Peggy; Reichborn-Kjennerud, Ted; Kendler, Kenneth S.

    2013-01-01

    Purpose Epidemiologic research on traumatic stress is limited in Norway. Prevalence and correlates of exposure to potentially traumatic events (PTEs) and Posttraumatic stress disorder (PTSD), and patterns of comorbidity with DSM-IV Axis I and II disorders were examined in an epidemiologic sample. Methods Demographics, PTEs, and resulting PTSD, and comorbid DSM-IV diagnoses were assessed in 2,794 members of the Norwegian Institute of Public Health Twin Panel. The sample was 37% male, with an average age of 28.2 years (SD=3.9). Results Approximately one-quarter of participants had lifetime PTE exposure; most PTEs were more common in men than in women. Lifetime prevalence of PTSD was 2.6%, and was significantly more common in women than men. Being female and type of PTE (both interpersonal and accidental traumatic events) were associated with increased PTSD symptoms, whereas higher education was associated with lower symptoms. PTSD was related to increased odds of most Axis I and II conditions. Conclusions PTE exposure and PTSD prevalence were lower than in the US, but comparable to other European countries. Sex differences replicated previous research. The relationship between PTSD and Borderline Personality Disorder was significantly stronger than the relationship between PTSD and any other Axis II conditions. PMID:22782308

  10. Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

    PubMed Central

    Dragioti, E; Larsson, B; Bernfort, L; Levin, LÅ; Gerdle, B

    2016-01-01

    Background and objective There is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects ≥65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7) living in southeastern Sweden. Methods Sex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP) (24.1%), regional pain medium (RP-Medium) (20.3%), regional pain heavy (RP-Heavy) (5.2%), and widespread pain (WSP) (1.7%). Results RP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all p<0.01). RP-Heavy was less likely in the 80–84 and >85 age groups compared to the 65–69 age group (both p<0.01). Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all p<0.001). An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all p<0.01). Depressive disorders were associated with all pain categories, except for LP (all p<0.05). Disorders of the central nervous system were associated with both RP-Heavy and WSP (all p<0.05). Medication for peripheral vascular disorders was associated with RP-Medium (p<0.05), and hypnotics were associated with RP-Heavy (p<0.01). Conclusion More than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain spread from LP to RP-Medium, RP-Heavy, and WSP. Effective management plans should consider these observed associations to improve functional deficiency and decrease spreading of pain-related disability in older adults. PMID:27942232

  11. Co-Morbidity of Conditions among Prisoners

    ERIC Educational Resources Information Center

    Shinkfield, Alison J.; Graffam, J.; Meneilly, Sharn

    2009-01-01

    Eighty seven adult prisoners (58 males, 29 females) completed the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and a questionnaire on current health in order to examine both the prevalence of co-morbid conditions and the relation of depression and anxiety to ill-health and prior substance use. High prevalence rates of…

  12. Real-World Executive Functions in Adults with Autism Spectrum Disorder: Profiles of Impairment and Associations with Adaptive Functioning and Co-Morbid Anxiety and Depression

    ERIC Educational Resources Information Center

    Wallace, Gregory L.; Kenworthy, Lauren; Pugliese, Cara E.; Popal, Haroon S.; White, Emily I.; Brodsky, Emily; Martin, Alex

    2016-01-01

    Although executive functioning (EF) difficulties are well documented among children and adolescents with autism spectrum disorder (ASD), little is known about real-world measures of EF among adults with ASD. Therefore, this study examined parent-reported real-world EF problems among 35 adults with ASD without intellectual disability and their…

  13. Comorbidity in rheumatoid arthritis.

    PubMed

    Turesson, Carl

    2016-01-01

    Rheumatoid arthritis (RA) is a chronic inflammatory condition, which is associated with an increased risk of comorbidity from other diseases. RA disease severity is a major predictor of development of cardiovascular disease, serious infections and malignant lymphoma. This reflects the role of chronic inflammation in the underlying pathology. Recent surveys indicate that although clinical outcomes have improved in patients with RA, mainly owing to access to more efficient pharmacotherapy, comorbidity remains a major issue in many patients. Register-based observational studies are useful sources of information on the impact of comorbidity and the efficacy and safety of antirheumatic treatment in patients with coexisting diseases. As a part of strategies to improve further the management of patients with RA, multidisciplinary collaboration for prevention and early detection of comorbidities is of major importance.

  14. Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care.

    PubMed

    Jennings, A; Hughes, C A; Kumaravel, B; Bachmann, M O; Steel, N; Capehorn, M; Cheema, K

    2014-10-01

    A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m(-2) , or 30 kg·m(-2) with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m(-2) . A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services.

  15. Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care

    PubMed Central

    Jennings, A; Hughes, C A; Kumaravel, B; Bachmann, M O; Steel, N; Capehorn, M; Cheema, K

    2014-01-01

    A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m−2, or 30 kg·m−2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m−2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services. PMID:25825858

  16. Co-morbidity of depression and anxiety in common age-related eye diseases: a population-based study of 662 adults.

    PubMed

    Eramudugolla, Ranmalee; Wood, Joanne; Anstey, Kaarin J

    2013-01-01

    This study examined the prevalence of co-morbid age-related eye disease and symptoms of depression and anxiety in late life, and the relative roles of visual function and disease in explaining symptoms of depression and anxiety. A community-based sample of 662 individuals aged over 70 years was recruited through the electoral roll. Vision was measured using a battery of tests including high and low contrast visual acuity, contrast sensitivity, motion sensitivity, stereoacuity, Useful Field of View, and visual fields. Depression and anxiety symptoms were measured using the Goldberg scales. The prevalence of self-reported eye disease [cataract, glaucoma, or age-related macular degeneration (AMD)] in the sample was 43.4%, with 7.7% reporting more than one form of ocular pathology. Of those with no eye disease, 3.7% had clinically significant depressive symptoms. This rate was 6.7% among cataract patients, 4.3% among those with glaucoma, and 10.5% for AMD. Generalized linear models adjusting for demographics, general health, treatment, and disability examined self-reported eye disease and visual function as correlates of depression and anxiety. Depressive symptoms were associated with cataract only, AMD, comorbid eye diseases and reduced low contrast visual acuity. Anxiety was significantly associated with self-reported cataract, and reduced low contrast visual acuity, motion sensitivity and contrast sensitivity. We found no evidence for elevated rates of depressive or anxiety symptoms associated with self-reported glaucoma. The results support previous findings of high rates of depression and anxiety in cataract and AMD, and in addition show that mood and anxiety are associated with objective measures of visual function independently of self-reported eye disease. The findings have implications for the assessment and treatment of mental health in the context of late-life visual impairment.

  17. Co-morbidity of depression and anxiety in common age-related eye diseases: a population-based study of 662 adults

    PubMed Central

    Eramudugolla, Ranmalee; Wood, Joanne; Anstey, Kaarin J.

    2013-01-01

    This study examined the prevalence of co-morbid age-related eye disease and symptoms of depression and anxiety in late life, and the relative roles of visual function and disease in explaining symptoms of depression and anxiety. A community-based sample of 662 individuals aged over 70 years was recruited through the electoral roll. Vision was measured using a battery of tests including high and low contrast visual acuity, contrast sensitivity, motion sensitivity, stereoacuity, Useful Field of View, and visual fields. Depression and anxiety symptoms were measured using the Goldberg scales. The prevalence of self-reported eye disease [cataract, glaucoma, or age-related macular degeneration (AMD)] in the sample was 43.4%, with 7.7% reporting more than one form of ocular pathology. Of those with no eye disease, 3.7% had clinically significant depressive symptoms. This rate was 6.7% among cataract patients, 4.3% among those with glaucoma, and 10.5% for AMD. Generalized linear models adjusting for demographics, general health, treatment, and disability examined self-reported eye disease and visual function as correlates of depression and anxiety. Depressive symptoms were associated with cataract only, AMD, comorbid eye diseases and reduced low contrast visual acuity. Anxiety was significantly associated with self-reported cataract, and reduced low contrast visual acuity, motion sensitivity and contrast sensitivity. We found no evidence for elevated rates of depressive or anxiety symptoms associated with self-reported glaucoma. The results support previous findings of high rates of depression and anxiety in cataract and AMD, and in addition show that mood and anxiety are associated with objective measures of visual function independently of self-reported eye disease. The findings have implications for the assessment and treatment of mental health in the context of late-life visual impairment. PMID:24106477

  18. Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: Results from National Epidemiological Survey on Alcohol and Related Conditions

    PubMed Central

    Blanco, Carlos; Xu, Yang; Brady, Kathleen; Pérez-Fuentes, Gabriela; Okuda, Mayumi; Wang, Shuai

    2013-01-01

    Background Despite the high rates of comorbidity of post-traumatic stress disorder (PTSD) and alcohol dependence (AD) in clinical and epidemiological samples, little is known about the prevalence, clinical presentation, course, risk factors and patterns of treatment-seeking of co-occurring PTSD-AD among the general population. Methods The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted means, frequencies and odds ratios (ORs) of sociodemographic correlates, prevalence of psychiatric disorders and rates of treatment-seeking were computed. Results: In the general population, the lifetime prevalence of PTSD only, AD only and PTSD-AD was 4.83%, 13.66% and 1.59%, respectively. Individuals with comorbid PTSD-AD were more likely than those with PTSD or AD only to have suffered childhood adversities and had higher rates of Axis I and II disorders and suicide attempts. They also met more PTSD diagnostic criteria, had earlier onset of PTSD and were more likely to use drugs and alcohol to relieve their PTSD symptoms than those with PTSD only; they also met more AD diagnostic criteria than those with AD only and had greater disability. Individuals with PTSD-AD had higher rates of treatment seeking for AD than those with AD only, but similar rates than those with PTSD only. Conclusion PTSD-AD is associated with high levels of severity across a broad range of domains even compared with individuals with PTSD or AD only, yet treatment-seeking rates are very low. There is a need to improve treatment access and outcomes for individuals with PTSD-AD. PMID:23702490

  19. [Heart failure and comorbidities].

    PubMed

    Boully, Clémence; Hanon, Olivier

    2015-03-01

    Heart failure is a frequent disease in the elderly. Its clinical presentation is less typical and the prognosis more severe than in younger subjects because heart failure occurs in patients with multiple comorbidities. A comprehensive geriatric assessment should therefore be performed to detect the vulnerabilities and manage the comorbidities. The main diseases associated with heart failure are dementia, depression, malnutrition, atrial fibrillation, coronary artery disease, orthostatic hypotension, renal failure, anemia and iron deficiency. Comorbidities worsen heart failure and makes its treatment more difficult. The identification and treatment of comorbidities improve the prognosis in terms of mortality but especially in terms of quality of life. Caution with drugs is necessary because of pharmacokinetic or pharmacodynamic changes related to aging and the comorbidities. In this context, clinical and laboratory monitoring should be increased, mostly during an acute event (acute heart failure, infection, dehydration, fall, new therapy…). Therefore, the follow-up of elderly patients with heart failure requires a multidisciplinary approach that involves close cooperation between cardiologists, geriatricians, general practitioners, nurses, and pharmacists.

  20. Comorbid anxiety and depression.

    PubMed

    Pollack, Mark H

    2005-01-01

    Anxiety and depressive disorders often occur as comorbid illnesses and share many common symptoms. Risk factors for these disorders most likely include interactions of environmental and genetic factors. The presence of comorbid anxiety and depression adversely affects clinical and treatment outcomes. Selective serotonin reuptake inhibitors are usually considered first-line treatment for patients with these disorders, although alternative antidepressants or additional therapies are often necessary. Studies suggest that benzodiazepines, anticonvulsants, and atypical antipsychotics may be effective as augmentation therapy to optimize outcome, with buspirone and beta-blockers useful in some patients as well. Cognitive-behavioral therapy is also an effective therapeutic alternative for affected patients.

  1. Comorbidity among Older American Indians: The Native Elder Care Study

    PubMed Central

    Pilkerton, Courtney S.

    2011-01-01

    Comorbidity is a growing challenge and the older adult population is most at risk of developing comorbid conditions. Comorbidity is associated with increased risk of mortality, increased hospitalizations, increased doctor visits, increased prescription medications, nursing home placement, poorer mental health, and physical disability. American Indians experience some of the highest rates of chronic conditions, but to date there have been only two published studies on the subject of comorbidity in this population. With a community-based sample of 505 American Indians aged 55 years or older, this study identified the most prevalent chronic conditions, described comorbidity, and identified socio-demographic, functional limitations, and psychosocial correlates of comorbidity. Results indicated that older American Indians experience higher rates of hypertension, diabetes, back pain, and vision loss compared to national statistics of older adults. Two-thirds of the sample experienced some degree of comorbidity according to the scale used. Older age, poorer physical functioning, more depressive symptomatology, and lower personal mastery were all correlates of higher comorbidity scores. Despite medical advances increasing life expectancy, morbidity and mortality statistics suggest that the health of older American Indians lags behind the majority population. These findings highlight the importance of supporting chronic care and management services for the older American Indian population. PMID:20532973

  2. Comorbidities and Crash Involvement among Younger and Older Drivers

    PubMed Central

    Papa, Michela; Boccardi, Virginia; Prestano, Raffaele; Angellotti, Edith; Desiderio, Manuela; Marano, Luigi; Rizzo, Maria Rosaria; Paolisso, Giuseppe

    2014-01-01

    Previous studies identified comorbidities as predictors of older driver performance and driving pattern, while the direct impact of comorbidities on road crash risk in elderly drivers is still unknown. The present study is a cross-sectional aimed at investigating the association between levels of comorbidity and crash involvement in adult and elderly drivers. 327 drivers were stratified according to age range in two groups: elderly drivers (age ≥70 years old, referred as older) and adult drivers (age <70 years old, referred as younger). Driving information was obtained through a driving questionnaire. Distance traveled was categorized into low, medium and high on the basis of kilometers driven in a year. CIRS-illness severity (IS) and CIRS-comorbidity indices (CI) in all populations were calculated. Older drivers had a significantly higher crash involvements rate (p = .045) compared with the younger group based on the number of licensed drivers. Dividing comorbidity indices into tertiles among all licensed subjects, the number of current drivers significantly decreased (p<.0001) with increasing level of comorbidity. The number of current drivers among older subjects significantly decreased with increasing comorbidity level (p = .026) while no difference among younger group was found (p = .462). Among younger drivers with increasing comorbidity level, the number of road accidents significantly increased (p = .048) and the logistic regression analysis showed that comorbidity level significantly associated with crash involvement independent of gender and driving exposure. Older subjects with high level of comorbidity are able to self-regulate driving while comorbidity burden represents a significant risk factor for crash involvements among younger drivers. PMID:24722619

  3. COPD comorbidities network.

    PubMed

    Divo, Miguel J; Casanova, Ciro; Marin, Jose M; Pinto-Plata, Victor M; de-Torres, Juan P; Zulueta, Javier J; Cabrera, Carlos; Zagaceta, Jorge; Sanchez-Salcedo, Pablo; Berto, Juan; Davila, Rebeca Baz; Alcaide, Ana B; Cote, Claudia; Celli, Bartolome R

    2015-09-01

    Multimorbidity frequently affects the ageing population and their co-existence may not occur at random. Understanding their interactions and that with clinical variables could be important for disease screening and management.In a cohort of 1969 chronic obstructive pulmonary disease (COPD) patients and 316 non-COPD controls, we applied a network-based analysis to explore the associations between multiple comorbidities. Clinical characteristics (age, degree of obstruction, walking, dyspnoea, body mass index) and 79 comorbidities were identified and their interrelationships quantified. Using network visualisation software, we represented each clinical variable and comorbidity as a node with linkages representing statistically significant associations.The resulting COPD comorbidity network had 428, 357 or 265 linkages depending on the statistical threshold used (p≤0.01, p≤0.001 or p≤0.0001). There were more nodes and links in COPD compared with controls after adjusting for age, sex and number of subjects. In COPD, a subset of nodes had a larger number of linkages representing hubs. Four sub-networks or modules were identified using an inter-linkage affinity algorithm and their display provided meaningful interactions not discernible by univariate analysis.COPD patients are affected by larger number of multiple interlinked morbidities which clustering pattern may suggest common pathobiological processes or be utilised for screening and/or therapeutic interventions.

  4. [Comorbidity in psoriasis].

    PubMed

    Gerdes, S; Mrowietz, U; Boehncke, W-H

    2016-06-01

    Psoriasis is a systemic chronic inflammatory disease associated with comorbidity. Many epidemiological studies have shown that psoriasis is associated with psoriatic arthritis as well as cardiovascular and metabolic diseases. Furthermore, obesity and psychological diseases such as depression and anxiety disorders are linked with psoriasis and play a central role in its management. The association of psoriasis and its comorbidity can be partly explained by genetic and pathophysiological mechanisms. Approximately 40 psoriasis susceptibility loci have been described with the majority linked to the innate and adaptive immune system. In some associated diseases, such as psoriatic arthritis, an overlap of their genetic susceptibility exists. Pathophysiologically the "psoriatic march" is a model that describes the development of metabolic and cardiovascular diseases due to the presence of underlying systemic inflammation. Dermatologists are the gatekeepers to treatment for patients with psoriasis. The early detection and the management of comorbidity is part of their responsibility. Concepts for the management of psoriasis and tools to screen for psoriatic comorbidity have been developed in order to support dermatologists in daily practice.

  5. Psoriasis: new comorbidities*

    PubMed Central

    Machado-Pinto, Jackson; Diniz, Michelle dos Santos; Bavoso, Nádia Couto

    2016-01-01

    Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases. PMID:26982772

  6. What Can ADHD without Comorbidity Teach Us about Comorbidity?

    ERIC Educational Resources Information Center

    Takeda, Toshinobu; Ambrosini, Paul J.; deBerardinis, Rachel; Elia, Josephine

    2012-01-01

    Neuropsychiatric comorbidity in ADHD is frequent, impairing and poorly understood. In this report, characteristics of comorbid and comorbid-free ADHD subjects are investigated in an attempt to identify differences that could potentially advance our understanding of risk factors. In a clinically-referred ADHD cohort of 449 youths (ages 6-18), age,…

  7. A randomized controlled trial reporting functional outcomes of cognitive-behavioural therapy in medication-treated adults with ADHD and comorbid psychopathology.

    PubMed

    Young, Susan; Emilsson, Brynjar; Sigurdsson, Jon Fridrik; Khondoker, Mizanur; Philipp-Wiegmann, Florence; Baldursson, Gisli; Olafsdottir, Halldora; Gudjonsson, Gisli

    2017-04-01

    Studies assessing psychological treatment of attention deficit hyperactivity disorder (ADHD) in adults are increasingly reported. However, functional outcomes are often neglected in favour of symptom outcomes. We investigated functional outcomes in 95 adults with ADHD who were already treated with medication and randomized to receive treatment as usual (TAU/MED) or psychological treatment (CBT/MED) using a cognitive-behavioural programme, R&R2ADHD, which employs both group and individual modalities. RATE-S functional outcomes associated with ADHD symptoms, social functioning, emotional control and antisocial behaviour were given at baseline, end of treatment and three-month follow-up. The Total composite score of these scales is associated with life satisfaction. In addition, independent evaluator ratings of clinicians who were blind to treatment arm were obtained on the Clinical Global Impression scale at each time point. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater functional improvement on all scales. Post-group treatment effects were maintained at follow-up with the exception of emotional control and the Total composite scales, which continued to improve. The largest treatment effect was for the RATE-S Total composite scale, associated with life satisfaction. CGI significantly correlated with all outcomes except for social functioning scale at follow-up. The study provides further evidence for the effectiveness of R&R2ADHD and demonstrates the importance of measuring functional outcomes. The key mechanism associated with improved functional outcomes is likely to be behavioural control.

  8. Comorbidity of Migraine

    PubMed Central

    BIÇAKCI, Şebnem

    2013-01-01

    Migraine is a common neurological disorder and can be severely disabling during attacks. The highest prevalence occurs between the ages of 25 and 55 years. Prior studies have found that migraine occurs together with other illnesses at a greater coincidental rate than is seen in the general population. These occurrences are called “comorbidities”. To delineate the comorbidities of migraine is important, because it can help improve treatment strategies and the understanding of the possible pathophysiology of migraine.

  9. Does Comorbidity Matter in Body Focused Repetitive Behavior Disorders?

    PubMed Central

    Grant, Jon E.; Leppink, Eric W.; Chamberlain, Samuel; Redden, Sarah A.; Curley, Erin; Odlaug, Brian L.; Keuthen, Nancy J.

    2017-01-01

    Background Trichotillomania (TTM) and skin picking disorder (SPD) have been characterized as Body Focused Repetitive Behavior Disorders (BFRBs). Because BFRBs frequently co-occur, we sought to discover the similarities and differences between having both TTM and SPD as opposed to just one. Methods 421 participants with primary TTM were evaluated regarding the comorbidity of SPD and 124 were participants with primary SPD were evaluated regarding the comorbidity of TTM. The effects of comorbid overlap on demographic and clinical measures were evaluated. Results Of the 421 participants with primary TTM, 61 (14.5%) had co-occurring SPD. Of 124 adults with primary SPD, 21 (16.9%) had comorbid TTM. Those with primary TTM and comorbid SPD had significantly more severe trichotillomania symptoms and were more likely to have major depressive disorder than those with TTM alone. Those with primary of SPD and comorbid TTM reported significantly more severe skin picking symptoms than those who only had SPD. Conclusions Individuals with co-occurring TTM and SPD may have more problematic hair pulling or skin picking symptoms. Hair pullers with comorbid SPD were more likely to have comorbid depression. Evaluating people for multiple BFRBs may be important to assess severity of symptoms and may have treatment implications. PMID:27490833

  10. Models of comorbidity for multifactorial disorders.

    PubMed Central

    Neale, M C; Kendler, K S

    1995-01-01

    We develop several formal models for comorbidity between multifactorial disorders. Based on the work of D. N. Klein and L. P. Riso, the models include (i) alternate forms, where the two disorders have the same underlying continuum of liability; (ii) random multiformity, in which affection status on one disorder abruptly increases risk for the second; (iii) extreme multiformity, where only extreme cases have an abruptly increased risk for the second disorder; (iv) three independent disorders, in which excess comorbid cases are due to a separate, third disorder; (v) correlated liabilities, where the risk factors for the two disorders correlate; and (vi) direct causal models, where the liability for one disorder is a cause of the other disorder. These models are used to make quantitative predictions about the relative proportions of pairs of relatives who are classified according to whether each relative has neither disorder, disorder A but not B, disorder B but not A, or both A and B. For illustration, we analyze data on major depression (MD) and generalized anxiety disorder (GAD) assessed in adult female MZ and DZ twins, which enable estimation of the relative impact of genetic and environmental factors. Several models are rejected--that comorbid cases are due to chance; multiformity of GAD; a third independent disorder; and GAD being a cause of MD. Of the models that fit the data, correlated liabilities, MD causes GAD, and reciprocal causation seem best. MD appears to be a source of liability for GAD. Possible extensions to the models are discussed. PMID:7573055

  11. Theory of mind in social anxiety disorder, depression, and comorbid conditions.

    PubMed

    Washburn, Dustin; Wilson, Gillian; Roes, Meighen; Rnic, Katerina; Harkness, Kate Leslie

    2016-01-01

    Social anxiety disorder is characterized by marked interpersonal impairment, particularly when presenting with comorbid major depression. However, the foundational social-cognitive skills that underlie interpersonal impairment in comorbid and non-comorbid manifestations of SAD has to date received very little empirical investigation. In a sample of 119 young adults, the current study examined differences in theory of mind (ToM), defined as the ability to decode and reason about others' mental states, across four groups: (a) non-comorbid SAD; (b) non-comorbid Lifetime MDD; (c) comorbid SAD and Lifetime MDD; and (d) healthy control. The non-comorbid SAD group was significantly less accurate at decoding mental states than the non-comorbid MDD and control groups. Further, both the comorbid and non-comorbid SAD groups made significantly more 'excessive' ToM reasoning errors than the non-comorbid MDD group, suggesting a pattern of over-mentalizing. Findings are discussed in terms of their implications for understanding the social cognitive foundations of social anxiety.

  12. Developmental Course(s) of Lifetime Cigarette Use and Panic Attack Comorbidity

    ERIC Educational Resources Information Center

    Bernstein, Amit; Zvolensky, Michael J.; Schmidt, Norman B.; Sachs-Ericcson, Natalie

    2007-01-01

    The present investigation examined the developmental course(s) of lifetime cigarette use and panic attack comorbidity. Participants included 4,409 adults, ages 15 to 54 years of age (M[Age] = 33.1, SD = 10.7, N (females) = 2,221) from the National Comorbidity Survey (NCS). The primary objective of the present investigation was to better understand…

  13. Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities.

    PubMed

    Dvir, Yael; Ford, Julian D; Hill, Michael; Frazier, Jean A

    2014-01-01

    Affect dysregulation, defined as the impaired ability to regulate or tolerate negative emotional states, has been associated with interpersonal trauma and posttraumatic stress. Affect-regulation difficulties play a role in many psychiatric conditions, including anxiety and mood disorders, and especially major depression in youth and bipolar disorder throughout the life span. Exposure to traumatic events and interpersonal trauma in childhood is associated with wide-ranging psychosocial, developmental, and medical impairments in children, adolescents, and adults, with emotional dysregulation being a core feature that may help to account for this heightened risk. In order to understand how the developmental effects of childhood maltreatment contribute to emotional dysregulation and psychiatric sequelae, we review emotional regulation and its developmental neurobiology, and examine the research evidence of associations between childhood trauma, emotional dysregulation, and psychiatric comorbidities in children, adolescents, and adults.

  14. Psoriasis: classical and emerging comorbidities*

    PubMed Central

    de Oliveira, Maria de Fátima Santos Paim; Rocha, Bruno de Oliveira; Duarte, Gleison Vieira

    2015-01-01

    Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis. PMID:25672294

  15. Psychiatric comorbidity in forensic psychiatry.

    PubMed

    Palijan, Tija Zarković; Muzinić, Lana; Radeljak, Sanja

    2009-09-01

    For the past several years a numerous studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse. The comorbid substance abuse in violent offenders was usually unrecognized and misdiagnosed. Furthermore, comorbidity in forensic psychiatry describes the co-occurrence of two or more conditions or psychiatric disorder known in the literature as dual diagnosis and defined by World Health Organization (WHO). In fact, many violent offenders have multiple psychiatric diagnoses. Recent studies have confirmed causal relationship between major psychiatric disorders and concomitant substance abuse (comorbidity) in 50-80% of forensic cases. In general, there is a high level of psychiatric comorbidity in forensic patients with prevalence of personality disorders (50-90%), mood disorders (20-60%) and psychotic disorders (15-20%) coupled with substance abuse disorders. Moreover, the high prevalence of psychiatric comorbidities could be found in mentally retarded individuals, as well as, in epileptic patients. Drugs and alcohol abuse can produce serious psychotoxic effects that may lead to extreme violent behavior and consequently to serious criminal offence such as physical assault, rape, armed robbery, attempted murder and homicide, all due to an altered brain function and generating psychotic-like symptoms. Studies have confirmed a significant statistical relevance in causal relationship between substance abuse and violent offences. In terms of forensic psychiatry, the comorbidity strongly contributes in the process of establishing psychiatric diagnosis of diminished mental capacity or insanity at the time of the offence in the course of clinical assessment and evaluation of violent offenders. Today, the primary focus of forensic psychiatry treatment services (in-patient or community) is management of the violent offenders with psychiatric comorbidity which requires a multilevel, evidence based approach to

  16. Economic and Comorbidity Burden Among Moderate‐to‐Severe Psoriasis Patients with Comorbid Psoriatic Arthritis

    PubMed Central

    Feldman, Steven R.; Shi, Lizheng; Tran, Mary Helen; Lu, Jackie

    2015-01-01

    Objective To compare the prevalence of comorbidities, health care utilization, and costs between moderate‐to‐severe psoriasis (PsO) patients with comorbid psoriatic arthritis (PsA) and matched controls. Methods Adults ages 18–64 years with concomitant diagnoses of PsO and PsA (PsO+PsA) were identified in the OptumHealth Reporting and Insights claims database between January 2007 and March 2012. Moderate‐to‐severe PsO was defined based on the use of at least one systemic or phototherapy during the 12‐month study period after the index date (randomly selected date after the first PsO diagnosis). Control patients without PsO and PsA were demographically matched 1:1 with PsO+PsA patients. Multivariate regressions were employed to examine PsO/PsA‐related comorbidities, medications, health care utilization, and costs between PsO+PsA patients and controls, adjusting for demographics, index year, insurance type, and non–PsO/PsA‐related comorbidities. Results Among 1,230 matched pairs of PsO+PsA patients and controls, PsO+PsA patients had significantly more PsO/PsA‐related comorbidities, with the top 3 most common in both groups being hypertension (35.8% versus 23.5%), hyperlipidemia (34.6% versus 28.5%), and diabetes mellitus (15.9% versus 10.0%). Compared with controls, PsO+PsA patients had a higher number of distinct prescriptions filled (incidence rate ratio 2.3, P < 0.05); were more likely to have inpatient admissions (odds ratio [OR] 1.6), emergency room visits (OR 1.3), and outpatient visits (OR 62.7) (all P < 0.05); and incurred significantly higher total, pharmacy, and medical costs (adjusted annual cost differences per patient $23,160, $17,696, and $5,077, respectively; all P < 0.01). Conclusion Compared with matched PsO‐ and PsA‐free controls, moderate‐to‐severe PsO patients with comorbid PsA had higher comorbidity and health care utilization and costs. PMID:25303478

  17. Sustained and Focused Attention Deficits in Adult ADHD

    ERIC Educational Resources Information Center

    Marchetta, Natalie D. J.; Hurks, Petra P. M.; De Sonneville, Leo M. J.; Krabbendam, Lydia; Jolles, Jelle

    2008-01-01

    Objective: To examine the specificity of deficits in focused attention and sustained attention in adults with ADHD and to evaluate the effect of comorbidity. Method: Twenty-eight adults with ADHD without comorbidity were compared with 28 ADHD outpatients with comorbidity. Two control groups were used: 68 adults referred for ADHD but with another…

  18. Genetic comorbidities in Parkinson's disease.

    PubMed

    Nalls, Mike A; Saad, Mohamad; Noyce, Alastair J; Keller, Margaux F; Schrag, Anette; Bestwick, Jonathan P; Traynor, Bryan J; Gibbs, J Raphael; Hernandez, Dena G; Cookson, Mark R; Morris, Huw R; Williams, Nigel; Gasser, Thomas; Heutink, Peter; Wood, Nick; Hardy, John; Martinez, Maria; Singleton, Andrew B

    2014-02-01

    Parkinson's disease (PD) has a number of known genetic risk factors. Clinical and epidemiological studies have suggested the existence of intermediate factors that may be associated with additional risk of PD. We construct genetic risk profiles for additional epidemiological and clinical factors using known genome-wide association studies (GWAS) loci related to these specific phenotypes to estimate genetic comorbidity in a systematic review. We identify genetic risk profiles based on GWAS variants associated with schizophrenia and Crohn's disease as significantly associated with risk of PD. Conditional analyses adjusting for SNPs near loci associated with PD and schizophrenia or PD and Crohn's disease suggest that spatially overlapping loci associated with schizophrenia and PD account for most of the shared comorbidity, while variation outside of known proximal loci shared by PD and Crohn's disease accounts for their shared genetic comorbidity. We examine brain methylation and expression signatures proximal to schizophrenia and Crohn's disease loci to infer functional changes in the brain associated with the variants contributing to genetic comorbidity. We compare our results with a systematic review of epidemiological literature, while the findings are dissimilar to a degree; marginal genetic associations corroborate the directionality of associations across genetic and epidemiological data. We show a strong genetically defined level of comorbidity between PD and Crohn's disease as well as between PD and schizophrenia, with likely functional consequences of associated variants occurring in brain.

  19. Genetic comorbidities in Parkinson's disease

    PubMed Central

    Nalls, Mike A.; Saad, Mohamad; Noyce, Alastair J.; Keller, Margaux F.; Schrag, Anette; Bestwick, Jonathan P.; Traynor, Bryan J.; Gibbs, J. Raphael; Hernandez, Dena G.; Cookson, Mark R.; Morris, Huw R.; Williams, Nigel; Gasser, Thomas; Heutink, Peter; Wood, Nick; Hardy, John; Martinez, Maria; Singleton, Andrew B.

    2014-01-01

    Parkinson's disease (PD) has a number of known genetic risk factors. Clinical and epidemiological studies have suggested the existence of intermediate factors that may be associated with additional risk of PD. We construct genetic risk profiles for additional epidemiological and clinical factors using known genome-wide association studies (GWAS) loci related to these specific phenotypes to estimate genetic comorbidity in a systematic review. We identify genetic risk profiles based on GWAS variants associated with schizophrenia and Crohn's disease as significantly associated with risk of PD. Conditional analyses adjusting for SNPs near loci associated with PD and schizophrenia or PD and Crohn's disease suggest that spatially overlapping loci associated with schizophrenia and PD account for most of the shared comorbidity, while variation outside of known proximal loci shared by PD and Crohn's disease accounts for their shared genetic comorbidity. We examine brain methylation and expression signatures proximal to schizophrenia and Crohn's disease loci to infer functional changes in the brain associated with the variants contributing to genetic comorbidity. We compare our results with a systematic review of epidemiological literature, while the findings are dissimilar to a degree; marginal genetic associations corroborate the directionality of associations across genetic and epidemiological data. We show a strong genetically defined level of comorbidity between PD and Crohn's disease as well as between PD and schizophrenia, with likely functional consequences of associated variants occurring in brain. PMID:24057672

  20. Comorbidity in the Tunisian population.

    PubMed

    Romdhane, L; Messaoud, O; Bouyacoub, Y; Kerkeni, E; Naouali, C; Cherif Ben Abdallah, L; Tiar, A; Charfeddine, C; Monastiri, K; Chabchoub, I; Hachicha, M; Tadmouri, G O; Romeo, G; Abdelhak, S

    2016-03-01

    Genetic diseases in the Tunisian population represent a real problem of public health as their spectrum encompasses more than 400 disorders. Their frequency and distribution in the country have been influenced by demographic, economic and social features especially consanguinity. In this article, we report on genetic disease association referred to as comorbidity and discuss factors influencing their expressivity. Seventy-five disease associations have been reported among Tunisian families. This comorbidity could be individual or familial. In 39 comorbid associations, consanguinity was noted. Twenty-one founder and 11 private mutations are the cause of 34 primary diseases and 13 of associated diseases. As the information dealing with this phenomenon is fragmented, we proposed to centralize it in this report in order to draw both clinicians' and researcher's attention on the occurrence of such disease associations in inbred populations as it makes genetic counseling and prenatal diagnosis challenging even when mutations are known.

  1. College-Age & Young Adults

    MedlinePlus

    ... Adolescent Brain Comorbidity College-Age & Young Adults Criminal Justice Drugged Driving Drug Testing Drugs and the Brain ... Age & Young Adults College Addiction Studies Programs Criminal Justice Drugged Driving Drug Testing Drugs and the Brain ...

  2. The Psychiatric Comorbidity Hypothesis Revisited.

    ERIC Educational Resources Information Center

    Forness, Steven R.; Kavale, Kenneth A.; Bauman, Stephanie San Miguel

    1998-01-01

    The authors of an earlier article, which argued that the social skills deficits typically found in children with learning disabilities (LD) are largely due to the comorbidity of LD with psychiatric disorders such as attention deficit hyperactivity disorder (ADHD) and depressive disorder, respond to a critique that did not find this relationship…

  3. Comorbidity of Migraine with ADHD

    ERIC Educational Resources Information Center

    Fasmer, Ole Bernt; Riise, Trond; Lund, Anders; Dilsaver, Steven C.; Hundal, Oivind; Oedegaard, Ketil J.

    2012-01-01

    Objective: The purpose of this study was to investigate how often drugs used to treat migraine and ADHD are prescribed to the same patients to assess, indirectly, the comorbidity of these disorders. Method: We used data from the Norwegian prescription database for 2006, including the total Norwegian population (N = 4,640,219). Results:…

  4. Neuropsychopathological comorbidities in learning disorders

    PubMed Central

    2013-01-01

    Background Learning Disorders (LD) are complex diseases that affect about 2-10% of the school-age population. We performed neuropsychological and psychopathological evaluation, in order to investigate comorbidity in children with LD. Methods Our sample consisted of 448 patients from 7 to 16 years of age with a diagnosis of LD, divided in two subgroups: Specific Learning Disorders (SLD), including reading, writing, mathematics disorders, and Learning Disorders Not Otherwise Specified (LD NOS). Results Comorbidity with neuropsychopathologies was found in 62.2% of the total sample. In the LSD subgroup, ADHD was present in 33%, Anxiety Disorder in 28.8%, Developmental Coordination Disorder in 17.8%, Language Disorder in 11% and Mood Disorder in 9.4% of patients. In LD NOS subgroup, Language Disorder was present in 28.6%, Developmental Coordination Disorder in 27.5%, ADHD in 25.4%, Anxiety Disorder in 16.4%, Mood Disorder in 2.1% of patients. A statistically significant presence was respectively found for Language and Developmental Coordination Disorder comorbidity in LD NOS and for ADHD, mood and anxiety disorder comorbidity in SLD subgroup. Conclusions The different findings emerging in this study suggested to promote further investigations to better define the difference between SLD and LD NOS, in order to improve specific interventions to reduce the long range consequences. PMID:24330722

  5. Comorbidity Cohort (2C) study: Cardiovascular disease severity and comorbid osteoarthritis in primary care

    PubMed Central

    2012-01-01

    Background Two of the commonest chronic diseases experienced by older people in the general population are cardiovascular diseases and osteoarthritis. These conditions also commonly co-occur, which is only partly explained by age. Yet, there have been few studies investigating specific a priori hypotheses in testing the comorbid interaction between two chronic diseases and related health and healthcare outcomes. It is also unknown whether the stage or severity of the chronic disease influences the comorbidity impact. The overall plan is to investigate the interaction between cardiovascular severity groups (hypertension, ischaemic heart disease and heart failure) and osteoarthritis comorbidity, and their longitudinal impact on health and healthcare outcomes relative to either condition alone. Methods From ten general practices participating in a research network, adults aged 40 years and over were sampled to construct eight exclusive cohort groups (n = 9,676). Baseline groups were defined on the basis of computer clinical diagnostic data in a 3-year time-period (between 2006 and 2009) as: (i) without cardiovascular disease or osteoarthritis (reference group), (ii) index cardiovascular disease groups (hypertension, ischaemic heart disease and heart failure) without osteoarthritis, (iii) index osteoarthritis group without cardiovascular disease, and (vi) index cardiovascular disease groups comorbid with osteoarthritis. There were three main phases to longitudinal follow-up. The first (survey population) was to invite cohorts to complete a baseline postal health questionnaire, with 10 monthly brief interval health questionnaires, and a final 12-month follow-up questionnaire. The second phase (linkage population) was to link the collected survey data to patient clinical records with consent for the 3-year time-period before baseline, during the 12-month survey period and the 12 months after final questionnaire (total 5 years). The third phase (denominator

  6. Binge Eating Disorder and Medical Comorbidities in Bariatric Surgery Candidates

    PubMed Central

    Mitchell, James E.; King, Wendy C.; Pories, Walter; Wolfe, Bruce; Flum, David R.; Spaniolas, Konstatinos; Bessler, Mark; Devlin, Michael; Marcus, Marsha D.; Kalarchian, Melissa; Engel, Scott; Khandelwal, Saurobh; Yanovski, Susan

    2016-01-01

    Objective To determine whether binge eating disorder (BED) status is associated with medical comorbidities in obese adults scheduled for bariatric surgery. Method The study utilized Longitudinal Assessment of Bariatric Surgery-2 data obtained from 6 clinical centers around the United States. This is a well-phenotyped cohort of individuals who were evaluated within 30 days prior to their scheduled surgery using standardized protocols. In the cohort, 350 participants were classified as having BED and 1875 as not having BED (non-BED). Multivariable logistic regression was used to determine whether BED status was independently related to medical comorbidities. As an exploratory analysis, significance was based on nominal P-values (p<.05). Holm-adjusted P-values were also reported. Results After adjusting for age, sex, education and body mass index, BED status was independently associated with 4 of 15 comorbidities (i.e., impaired glucose levels (odds ratio [OR]=1.45 (95%CI: 1.12–1.87), high triglycerides (OR=1.28 (95%CI: 1.002–1.63) and urinary incontinence (OR=1.30 (95%CI: 1.02,1.66) all being more common among the BED sample, and severe walking limitations being less common in the BED sample (OR=0.53 (95%CI: 0.29–0.96)). With further adjustment for psychiatric/emotional health indicators, BED status was independently associated with 3 comorbidities (impaired glucose levels (OR=1.36 (95%CI: 1.04–1.79), cardiovascular disease (OR=0.50 (95%CI: 0.30–0.86) and severe walking limitations (OR=0.38 (95%CI: 0.19–0.77)). However, Holm’s adjusted P-values for all variables were greater than .05. Discussion The results suggest the possibility of a contribution of BED to risk of specific medical comorbidities in severely obese adults. PMID:25778499

  7. Balance Treatment Ameliorates Anxiety and Increases Self-Esteem in Children with Comorbid Anxiety and Balance Disorder

    ERIC Educational Resources Information Center

    Bart, Orit; Bar-Haim, Yair; Weizman, Einat; Levin, Moran; Sadeh, Avi; Mintz, Matti

    2009-01-01

    Comorbidity between balance and anxiety disorders in adult population is a well-studied clinical entity. Children might be particularly prone to develop balance-anxiety comorbidity, but surprisingly they are practically neglected in this field of research. The consequence is that children are treated for what seems to be the primary disorder…

  8. Migraine and Stroke: “Vascular” Comorbidity

    PubMed Central

    Guidetti, Donata; Rota, Eugenia; Morelli, Nicola; Immovilli, Paolo

    2014-01-01

    Several comorbidities are associated to migraine. Recent meta-analyses have consistently demonstrated a relationship between migraine and stroke, which is well-defined for ischemic stroke and migraine with aura (MA), even stronger in females on oral contraceptives or smokers. However, there seems to be no clear-cut association between stroke in migraineurs and the common vascular risk factors, at least in the young adult population. Migraineurs also run an increased risk of hemorrhagic stroke, while the association between migraine and cardiovascular disease remains poorly defined. Another aspect is the relationship between migraine and the presence of silent brain lesions. It has been demonstrated that there is an increased frequency of ischemic lesions in the white matter of migraineurs, especially silent infarcts in the posterior circulation territory in patients with at least 10 attacks per month. Although there is a higher prevalence of patent foramen ovale (PFO) in migraineurs, the relationship between migraine and PFO remains controversial and PFO closure is not a recommended procedure to prevent migraine. As an increased frequency of cervical artery dissections has been observed in migrainous patients, it has been hypothesized that migraine may represent a predisposing factor for cervical artery dissection. There still remains the question as to whether migraine should be considered a true “vascular disease” or if the comorbidity between migraine and cerebrovascular disease may have underlying shared risk factors or pathophysiological mechanisms. Although further studies are required to clarify this issue, current evidence supports a clinical management where MA patients should be screened for other concomitant vascular risk factors and treated accordingly. PMID:25339937

  9. Do young people with comorbid mental and alcohol disorders experience worse behavioural problems?

    PubMed

    Salom, Caroline L; Betts, Kim S; Williams, Gail M; Najman, Jackob M; Scott, James G; Alati, Rosa

    2014-10-30

    This article examines whether young individuals in the general population with comorbid alcohol use and mental health disorders experience worse internalizing and externalizing behaviour problems than those with single disorders. A large cohort of women at the Mater Misericordiae Hospital in Brisbane, Australia, was enroled during pregnancy in a longitudinal study. Mother/offspring dyads were followed over 21 years. At age 21, offspring behaviour problems were examined using the Young Adult Self Report, alcohol and mental health disorders with the Composite International Diagnostic Interview. Associations between comorbidity and behaviour problems were assessed using multinomial logistic regression, accounting for life-course factors. Twelve per cent of young adults had alcohol/mental health DSM-IV disorders with significant temporal overlap. A further 16% had alcohol disorders only and 23% mental health disorders only. The comorbid group scored significantly higher on total and externalizing behaviour problems but not internalizing behaviour problems. Stronger associations of aggression/delinquency with comorbidity were not fully accounted for by factors known to influence separate development of mental health and alcohol disorders. Young adults with comorbid alcohol/mental health disorders experience more, and more severe, behavioural problems than those with single disorder types, indicating an increased burden from comorbidity, with implications for treatment and public order.

  10. [Compulsive buying and psychiatric comorbidity].

    PubMed

    Mueller, Astrid; Mühlhans, Barbara; Silbermann, Andrea; Müller, Ulrike; Mertens, Christian; Horbach, Thomas; Mitchell, James E; de Zwaan, Martina

    2009-08-01

    Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

  11. Comorbidities in Patients with Psoriatic Arthritis

    PubMed Central

    Haddad, Amir; Zisman, Devy

    2017-01-01

    Epidemiological studies have shown that patients with psoriatic arthritis (PsA) are often affected by numerous comorbidities that carry significant morbidity and mortality. Reported comorbidities include diabetes mellitus, obesity, metabolic syndrome, cardiovascular diseases, osteoporosis, inflammatory bowel disease, autoimmune eye disease, non-alcoholic fatty liver disease, depression, and fibromyalgia. All health care providers for patients with PsA should recognize and monitor those comorbidities, as well as understand their effect on patient management to ensure an optimal clinical outcome. PMID:28178440

  12. Comorbidity of paraphilia and depression in Mexico.

    PubMed

    Haasen, Christian

    2010-01-25

    The comorbidity of paraphilia-related disorders and other psychiatric disorders is high, but the paraphilia-related disorder often remains untreated until patients seek help for the comorbid disorder. A case of a patient in Mexico with comorbid paraphilia and depressive disorder, who was effectively treated with antidepressive medication and psychotherapy, is reported. The effect of stigmatization of homosexuality on the access to care of persons with sexual disorders is discussed.

  13. Comorbidity of paraphilia and depression in Mexico

    PubMed Central

    Haasen, Christian

    2010-01-01

    The comorbidity of paraphilia-related disorders and other psychiatric disorders is high, but the paraphilia-related disorder often remains untreated until patients seek help for the comorbid disorder. A case of a patient in Mexico with comorbid paraphilia and depressive disorder, who was effectively treated with antidepressive medication and psychotherapy, is reported. The effect of stigmatization of homosexuality on the access to care of persons with sexual disorders is discussed. PMID:25478091

  14. Comorbidity and Continuity of Psychiatric Disorders in Youth After Detention

    PubMed Central

    Abram, Karen M.; Zwecker, Naomi A.; Welty, Leah J.; Hershfield, Jennifer A.; Dulcan, Mina K.; Teplin, Linda A.

    2015-01-01

    IMPORTANCE Psychiatric disorders and comorbidity are prevalent among incarcerated juveniles. To date, no large-scale study has examined the comorbidity and continuity of psychiatric disorders after youth leave detention. OBJECTIVE To determine the comorbidity and continuity of psychiatric disorders among youth 5 years after detention. DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal study of a stratified random sample of 1829 youth (1172 male and 657 female; 1005 African American, 296 non-Hispanic white, 524 Hispanic, and 4 other race/ethnicity) recruited from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois, between November 20, 1995, and June 14, 1998, and who received their time 2 follow-up interview between May 22, 2000, and April 3, 2004. MAIN OUTCOMES AND MEASURES At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-ups, the Diagnostic Interview Schedule for Children Version IV (child and young adult versions) and the Diagnostic Interview Schedule Version IV (substance use disorders and antisocial personality disorder). RESULTS Five years after detention, when participants were 14 to 24 years old, almost 27% of males and 14% of females had comorbid psychiatric disorders. Although females had significantly higher rates of comorbidity when in detention (odds ratio, 1.3; 95% CI, 1.0-1.7), males had significantly higher rates than females at follow-up (odds ratio, 2.3; 95% CI, 1.6-3.3). Substance use plus behavioral disorders was the most common comorbid profile among males, affecting 1 in 6. Participants with more disorders at baseline were more likely to have a disorder approximately 5 years after detention, even after adjusting for demographic characteristics. We found substantial continuity of disorder. However, some baseline disorders predicted alcohol and drug use disorders at follow-up. CONCLUSIONS AND RELEVANCE Although prevalence rates of comorbidity decreased in youth after detention, rates

  15. Comorbid insomnia and cognitive behavior therapy.

    PubMed

    Chand, Suma P

    2015-01-01

    Insomnia most commonly presents comorbidly in association with medical and psychiatric disorders. Comorbid insomnia, however, remains under treated in the majority of patients. Concerns about drug interactions, adverse events, and dependence as well as the assumption that treating the insomnia as a secondary presentation that will resolve when the primary condition improves are all factors that contribute to the under treatment of comorbid insomnia. This article presents the growing research evidence that highlights the benefits and importance of targeting the insomnia that presents comorbidly with medical and psychiatric conditions utilizing the nonpharmacological and effective treatment of cognitive behavior therapy.

  16. Familial Comorbidity of Bipolar Disorder and Multiple Sclerosis: Genetic Susceptibility, Coexistence or Causal Relationship?

    PubMed Central

    Kosmidis, Mary H.; Bozikas, Vasilis P.; Giannouli, Vaitsa; Karavatos, Athanasios; Fokas, Konstantinos

    2012-01-01

    Our purpose in undertaking the present study was to examine the hypotheses proposed for explaining the frequent comorbidity of bipolar disorder and multiple sclerosis. One hypothesis posits that, when there is comorbidity, MS plays a causal role in psychiatric manifestations. Another suggests that both disorders have a common underlying physiological process that increases the likelihood of their co-occurrence. We examined two adult siblings with comorbidity and their relatives, including three generations of family members with psychiatric morbidity. We found an extensive multigenerational history of bipolar disorder in this family. This history would seem to support the hypothesis of a common underlying brain process (potentially genetically-based) to explain the comorbidity of BD and MS, but cannot clarify whether this comorbidity implies a relationship between the two disorders or merely reflects parallel processes of brain deterioration. We cannot, however, rule out the possibility of a subclinical MS-related process leading to the early manifestation of BD, with MS appearing much later in time, or even a third, undetermined factor, leading to familial comorbidity. Although we have insufficient information to support either hypothesis definitively, we present the familial cases as a springboard for a discussion of dilemmas related to teasing apart MS and BD comorbidity. Further observation of the clinical course of the younger family members, who have not yet shown any neurological signs, over the next few years may elucidate the current picture further. PMID:22713400

  17. First Described Case of Group B Streptococcus Pelvic Abscess in a Patient with No Medical Comorbidities

    PubMed Central

    Dwarki, Karthik

    2016-01-01

    Background. Group B Streptococcus is an organism that commonly infects a wide range of hosts including infants in the first week of life, pregnant women, and older age adults as well as adults with underlying medical comorbidities. Case. Large pelvic abscess in a nonpregnant patient found to be caused by Group B Streptococcus was treated successfully with IR guided drainage and antibiotics. Conclusion. Though rare, GBS can still be a cause of invasive infection even in individuals who are nonpregnant and have no underlying comorbidities. Empiric antibiotic coverage for this organism should be kept in mind when treating an abscess. PMID:27529043

  18. Comorbidities Among Persons With Incident Psychiatric Condition

    PubMed Central

    Fluegge, Kyle R.

    2016-01-01

    Objective: I sought to determine how medical comorbidities co-exist with incident psychiatric condition. Method: I used data from all 11 available waves (1992-2012) of the Health and Retirement Study (HRS). I identified 4,358 index participants with self-reported incident psychiatric condition. I collected comorbidity data from participants preceding, including, and succeeding that incident wave. Comorbidities assessed included high blood pressure (HBP), diabetes mellitus, cancer, lung disease, heart disease, stroke, and arthritis. Modified Poisson regression combined with log-linked binomial regression was used to estimate relative risks (RRs) of reporting a comorbidity preceding and following the incident wave. Multiple comparison testing dictated significance of RRs with p < .007. Results: For the waves preceding the index wave, the RRs of reporting all comorbidities except HBP and cancer were significantly (p < .007) increased. For the waves following incident psychiatric condition, the risks of reporting heart disease, diabetes, and lung disease were significantly (p < .007) increased. These results were adjusted for participant age, race, gender, other comorbidities listed, and the wave in which a comorbidity was reported. Conclusion: The bidirectional association between a psychiatric condition and medical illnesses could only be statistically confirmed for lung disease, diabetes, and heart disease. It is of interest to determine how reporting a psychiatric condition may affect the sequelae of health care use and treatment outcomes for patients with either of these comorbidities or a combination of them. PMID:28008416

  19. Assessing comorbidity using claims data: an overview.

    PubMed

    Klabunde, Carrie N; Warren, Joan L; Legler, Julie M

    2002-08-01

    Comorbidity, additional disease beyond the condition under study that increases a patient's total burden of illness, is one dimension of health status. For investigators working with observational data obtained from administrative databases, comorbidity assessment may be a useful and important means of accounting for differences in patients' underlying health status. There are multiple ways of measuring comorbidity. This paper provides an overview of current approaches to and issues in assessing comorbidity using claims data, with a particular focus on established indices and the SEER-Medicare database. In addition, efforts to improve measurement of comorbidity using claims data are described, including augmentation of claims data with medical record, patient self-report, or health services utilization data; incorporation of claims data from sources other than inpatient claims; and exploration of alternative conditions, indices, or ways of grouping conditions. Finally, caveats about claims data and areas for future research in claims-based comorbidity assessment are discussed. Although the use of claims databases such as SEER-Medicare for health services and outcomes research has become increasingly common, investigators must be cognizant of the limitations of comorbidity measures derived from these data sources in capturing and controlling for differences in patient health status. The assessment of comorbidity using claims data is a complex and evolving area of investigation.

  20. Treating Comorbid Anxiety and Aggression in Children

    ERIC Educational Resources Information Center

    Levy, Karyn; Hunt, Caroline; Heriot, Sandra

    2007-01-01

    Objective: The aim of the study was to evaluate the effectiveness of an intervention that targeted both anxious and aggressive behaviors in children with anxiety disorders and comorbid aggression by parent report. Method: The effects of a cognitive-behavioral therapy intervention targeting comorbid anxiety and aggression problems were compared…

  1. Bipolar Disorder, Bipolar Depression and Comorbid Illness.

    PubMed

    Manning, J Sloan

    2015-06-01

    There is a substantial need for the early recognition and treatment of the psychiatric and medical comorbidities of bipolar disorder in primary care. If comorbid conditions are recognized and treated, serious adverse health outcomes may be averted, including substantial morbidity and mortality.

  2. Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH).

    PubMed

    Jacobi, Frank; Höfler, Michael; Siegert, Jens; Mack, Simon; Gerschler, Anja; Scholl, Lucie; Busch, Markus A; Hapke, Ulfert; Maske, Ulrike; Seiffert, Ingeburg; Gaebel, Wolfgang; Maier, Wolfgang; Wagner, Michael; Zielasek, Jürgen; Wittchen, Hans-Ulrich

    2014-09-01

    This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1-MH]). A nationally representative sample (N = 5318) of the adult (18-79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS-CIDI) to assess symptoms, syndromes and diagnoses according to DSM-IV-TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18-34: 37% versus 20% in age group 65-79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio-economic status (22%). High degree of urbanization (> 500,000 inhabitants versus < 20,000) was associated with elevated rates of psychotic (5.2% versus 2.5%) and mood disorders (13.9% versus 7.8%). The findings confirm that almost one third of the general population is affected by mental disorders and inform about subsets in the population who are particularly affected.

  3. [Affective disorders: endocrine and metabolic comorbidities].

    PubMed

    Cermolacce, M; Belzeaux, R; Adida, M; Azorin, J-M

    2014-12-01

    Links between affective and endocrine-metabolic disorders are numerous and complex. In this review, we explore most frequent endocrine-metabolic comorbidities. On the one hand, these comorbidities imply numerous iatrogenic effects from antipsychotics (metabolic side-effects) or from lithium (endocrine side-effects). On the other hand, these comorbidities are also associated with affective disorders independently from medication. We will successively examine metabolic syndrome, glycemic disturbances, obesity and thyroid disorders among patients with affective disorders. Endocrinemetabolic comorbidities can be individually encountered, but can also be associated. Therefore, they substantially impact morbidity and mortality by increasing cardiovascular risk factors. Two distinct approaches give an account of processes involved in these comorbidities: common environmental factors (iatrogenic effects, lifestyle), and/or shared physiological vulnerabilities. In conclusion, we provide a synthesis of important results and recommendations related to endocrine-metabolic comorbidities in affective disorders : heavy influence on morbidity and mortality, undertreatment of somatic diseases, importance of endocrine and metabolic side effects from main mood stabilizers, impact from sex and age on the prevalence of comorbidities, influence from previous depressive episodes in bipolar disorders, and relevance of systematic screening for subclinical (biological) disturbances.

  4. Co-Morbid Disorders in Tourette Syndrome

    PubMed Central

    Mol Debes, Nanette M. M.

    2013-01-01

    Tourette syndrome (TS) is often accompanied by other symptoms and syndromes. The two best-known co-morbidities are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD), but also other conditions like rage-attacks, depression, and sleeping disturbances are frequent in persons with TS. Both in clinical cohorts and in population-based cohorts the prevalence of co-morbidities is high. The presence of co-morbid ADHD and/or OCD has an impact on psychosocial, educational, and neuropsychological consequences of TS and it is associated with higher rates of other co-morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS is not known, but they probably all are neurotransmitter disorders. European guidelines recommend first-choice pharmacological treatment, but randomised double-blinded trials are needed. Professionals need to be aware of the close relationship between TS and co-morbidities in order to give the patients the right treatment and support. PMID:23187139

  5. Face Emotion Processing in Depressed Children and Adolescents with and without Comorbid Conduct Disorder

    ERIC Educational Resources Information Center

    Schepman, Karen; Taylor, Eric; Collishaw, Stephan; Fombonne, Eric

    2012-01-01

    Studies of adults with depression point to characteristic neurocognitive deficits, including differences in processing facial expressions. Few studies have examined face processing in juvenile depression, or taken account of other comorbid disorders. Three groups were compared: depressed children and adolescents with conduct disorder (n = 23),…

  6. Clinical Correlates of Comorbid Obsessive-Compulsive Disorder and Depression in Youth

    ERIC Educational Resources Information Center

    Canavera, Kristin E.; Ollendick, Thomas H.; Ehrenreich May, Jill T.; Pincus, Donna B.

    2010-01-01

    A burgeoning body of literature addresses the comorbidity of depression and OCD in adults. The purpose of this study was to extend this area of research to children and adolescents by examining the clinical correlates associated with co-occurring depressive disorders in a clinical sample of youth with OCD. Participants included children and…

  7. Behavioral Activation in the Treatment of Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder

    ERIC Educational Resources Information Center

    Mulick, Patrick S.; Naugle, Amy E.

    2009-01-01

    This study investigated the efficacy of 10-weeks of Behavioral Activation (BA) in the treatment of comorbid Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in four adults using a nonconcurrent multiple baseline across participants design. All participants met full "DSM-IV" criteria for both MDD and PTSD at the…

  8. Naming the Enemy: An Art Therapy Intervention for Children with Bipolar and Comorbid Disorders

    ERIC Educational Resources Information Center

    Henley, David

    2007-01-01

    Treatment and diagnosis for the pediatric form of bipolar disorder presents a clinical challenge given the differences from its adult counterpart and the various comorbid forms that complicate presentation and developmental course. This article discusses manifestations of early onset bipolar disorder and offers a method for implementing art…

  9. Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013

    PubMed Central

    Noh, Juhwan; Shin, Anna; Yeom, Hyungseon; Jang, Suk-Yong; Lee, Jung Hyun; Kim, Changsoo; Suh, Il

    2016-01-01

    Background and Objectives Joint National Committee guidelines attempt to vary treatment recommendations for patients based on considerations of their comorbidities. The aim of the present study is to estimate the age-standardized prevalence of common comorbidities among Korean hypertension patients. Subjects and Methods We analyzed the Korea National Health and Nutrition Examination Survey from 2007 to 2013. Among the 58423 participants, 30092 adults, aged ≥30 yrs who completed a health examination and interview survey, were selected. The survey procedures were used to estimate weighted prevalence and odds ratios for 8 comorbidities, including obesity, diabetes mellitus, dyslipidemia, cardiovascular disease, chronic kidney disease, and thyroid disease. Results Most chronic conditions were more prevalent in adults with hypertension than in those without hypertension. Common comorbidities were obesity (60.1%), dyslipidemia (57.6%), and impaired fasting glucose (45.1%). Hypertensive patients with two or more comorbid diseases were 42.2% and those with three or more diseases were 17.7%. The age- and sex-specific prevalence of three or more comorbid diseases among male hypertension patients was significantly higher than those patients in the 30-59 (p<0.05) age group. Conclusion Comorbidity is highly prevalent in Korean patients with hypertension. PMID:27721859

  10. Psychiatric comorbidity in women and men with eating disorders results from a large clinical database.

    PubMed

    Ulfvebrand, Sara; Birgegård, Andreas; Norring, Claes; Högdahl, Louise; von Hausswolff-Juhlin, Yvonne

    2015-12-15

    Psychiatric comorbidity is common in patients with eating disorders (ED), but prevalence estimates are heterogeneous, probably due to methodological differences between studies (population, diagnostic method, sampling procedure etc.) and a few studies include men. The aim of this study is to investigate psychiatric DSM-IV Axis I comorbidity in a large sample of adult patients, both males and females, with the whole spectrum of DSM-IV ED diagnoses. Initial presentation assessment data on 11,588 adult men and women presenting to specialist ED clinics in Sweden between 2008 and 2012 were extracted from a large clinical database. Diagnostics were based on semi-structured interviews (SCID-I) and the Structured Eating Disorder Interview (SEDI). Seventy-one percent of the patients with ED had at least one other Axis I disorder. The most common type of diagnosis was anxiety disorders (53%), where generalized anxiety disorder was the most common diagnosis. The highest levels of comorbidity were found for women with Binge Eating Disorder (BED) and men with Bulimia Nervosa (BN). Findings are consistent with previous research showing a high prevalence of psychiatric comorbidity in both men and women with ED. The small gender differences observed seem negligible compared to the general similarity in comorbidity.

  11. Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology.

    PubMed

    Spencer, Thomas J; Biederman, Joseph; Mick, Eric

    2007-01-01

    In this report, we provide an evidence-based overview of attention-deficit/hyperactivity disorder (ADHD), including diagnosis, prevalence, developmental expression of symptoms, persistence, the heterogeneity of functional outcome, impairment in afflicted adults, psychiatric comorbidity, pathophysiology, genetics, psychosocial and biologic risk factors, and neurobiology. Attention-deficit/hyperactivity disorder is an early-onset, highly prevalent neurobehavioral disorder, with genetic, environmental, and biologic etiologies, that persists into adolescence and adulthood in a sizable majority of afflicted children of both sexes. It is characterized by behavioral symptoms of inattention, hyperactivity, and impulsivity across the life cycle and is associated with considerable morbidity and disability. Comorbidity is a distinct clinical feature of both childhood and adult ADHD. Although its etiology remains unclear, emerging evidence documents its strong neurobiologic and genetic underpinnings. Despite the high diagnostic reliability and the robust evidence of the validity of ADHD, there are many underlying issues that remain to be resolved. These include establishing developmentally appropriate diagnostic criteria at older ages, further elaborating the impact of gender on symptom expression, and examining risk and protective factors in relationship to prevention or amelioration of ADHD as well as related functional impairments.

  12. Distinguishing General and Specific Personality Disorder Features and Implications for Substance Dependence Comorbidity

    PubMed Central

    Jahng, Seungmin; Trull, Timothy J.; Wood, Phillip K.; Tragesser, Sarah L.; Tomko, Rachel; Grant, Julia D.; Bucholz, Kathleen K.; Sher, Kenneth J.

    2014-01-01

    Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities. PMID:21604829

  13. Impact of Comorbid Anxiety and Depressive Disorders on Treatment Response to Cognitive Behavior Therapy for Insomnia

    PubMed Central

    Bélanger, Lynda; Harvey, Allison G.; Fortier-Brochu, Émilie; Beaulieu-Bonneau, Simon; Eidelman, Polina; Talbot, Lisa; Ivers, Hans; Hein, Kerrie; Lamy, Manon; Soehner, Adriane M.; Mérette, Chantal; Morin, Charles M.

    2016-01-01

    Objective To evaluate the impact of comorbid anxiety or depressive disorders on treatment response to cognitive behavior therapy (CBT) for insomnia, behavior therapy (BT), or cognitive therapy (CT). Method Participants were 188 adults (117 women; M age = 47.4 years) with chronic insomnia, including 45 also presenting a comorbid anxiety or mild to moderate depressive disorder. They were randomized to BT (n = 63), CT (n = 65), or CBT (n = 60). Outcome measures were the proportion of treatment responders (decrease of ≥ 8 points on the Insomnia Severity Index; ISI) and remissions (ISI score < 8) and depression and anxiety symptoms. Results Proportion of treatment responders and remitters in the CBT condition was not significantly different between the subgroups with and without comorbidity. However, the proportion of responders was lower in the comorbidity subgroup compared to those without comorbidity in both the BT (34.4% vs 81.6%; p=0.007) and CT (23.6% vs 57.6%; p=0.02) alone conditions, although remission rates and pre-post ISI change scores were not. Pre to post change scores on the depression (−10.6 vs −3.9; p<0.001) and anxiety measures (−9.2 vs −2.5; p=.01) were significantly greater in the comorbidity subgroup relative to the subgroup without comorbidity but only for those treated with the full CBT; no difference was found for those treated with either BT or CT alone. Conclusions The presence of a comorbid anxiety or mild to moderate depressive disorder did not reduce the efficacy of CBT for insomnia, but it did for its single BT and CT components when used alone. PMID:26963600

  14. Implications of Psychiatric Comorbidity Among Combat Veterans

    DTIC Science & Technology

    2013-10-01

    187-97. 30. Feinstein AR: The pre-therapeutic classification of co-morbidity in chronic disease . J Chron Dis 1970; 23: 455-68. 31. Maj M: ’Psychiatric...their medical records included an International Classification of Diseases , Ninth Revision, Clinical Modification diagnostic code between 290.00 and...during the clinical course of . . . disease " (p. 456).^° In recent years, it has been argued that the reported rates of psychiatric comorbidity have

  15. Psychiatric comorbidities of episodic and chronic migraine.

    PubMed

    Buse, Dawn C; Silberstein, Stephen D; Manack, Aubrey N; Papapetropoulos, Spyros; Lipton, Richard B

    2013-08-01

    Migraine is a prevalent disabling neurological disorder associated with a wide range of medical and psychiatric comorbidities. Population- and clinic-based studies suggest that psychiatric comorbidities, particularly mood and anxiety disorders, are more common among persons with chronic migraine than among those with episodic migraine. Additional studies suggest that psychiatric comorbidities may be a risk factor for migraine chronification (i.e., progression from episodic to chronic migraine). It is important to identify and appropriately treat comorbid psychiatric conditions in persons with migraine, as these conditions may contribute to increased migraine-related disability and impact, diminished health-related quality of life, and poor treatment outcomes. Here, we review the current literature on the rates of several psychiatric comorbidities, including depression, anxiety, and post-traumatic stress disorder, among persons with migraine in clinic- and population-based studies. We also review the link between physical, emotional, and substance abuse, psychiatric disorders, and migraine. Finally, we review the data on psychiatric risk factors for migraine chronification and explore theories and evidence underlying the comorbidity between migraine and these psychiatric disorders.

  16. Social Anxiety Disorder and Alcohol Use Disorder Comorbidity in the National Epidemiologic Survey on Alcohol and Related Conditions

    PubMed Central

    Schneier, Franklin R.; Foose, Tracy E.; Hasin, Deborah S.; Heimberg, Richard G.; Liu, Shang-Min; Grant, Bridget F.; Blanco, Carlos

    2009-01-01

    Objective To assess the prevalence and clinical impact of comorbid Social Anxiety Disorder (SAD) and Alcohol Use Disorders (AUD, i.e., alcohol abuse and alcohol dependence) in a nationally representative sample of adults in the United States. Methods Data came from a large representative sample of the United States population. Face-to-face interviews of 43,093 adults residing in households were conducted during 2001–2002. Diagnoses of mood, anxiety, alcohol and drug use disorders, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM-IV Version. Results Lifetime prevalence of comorbid AUD and SAD in the general population was 2.4%. SAD was associated with significantly increased rates of alcohol dependence (OR=2.8) and alcohol abuse (OR=1.2). Among respondents with alcohol dependence, SAD was associated with significantly more mood, anxiety, psychotic, and personality disorders. Among respondents with SAD, alcohol dependence and abuse were most strongly associated with more substance use disorders, pathological gambling, and antisocial personality disorders. SAD occurred before alcohol dependence in 79.7% of comorbid cases, but comorbidity status did not influence age of onset for either disorder. Comorbid SAD was associated with increased severity of alcohol dependence and abuse. Respondents with comorbid SAD and alcohol dependence or abuse reported low rates of treatment-seeking. Conclusions Comorbid lifetime AUD and SAD is a prevalent dual diagnosis, associated with substantial rates of additional comorbidity, but remaining largely untreated. Future research should clarify the etiology of this comorbid presentation to better identify effective means of intervention. PMID:20441690

  17. The impact of patient comorbidity on cancer stage at diagnosis

    PubMed Central

    Gurney, Jason; Sarfati, Diana; Stanley, James

    2015-01-01

    Background: It is known that cancer stage is affected by comorbidity, but the evidence regarding the magnitude and even direction of this effect is highly inconsistent and poorly understood. The aims of this study were to establish the impact of comorbidity on cancer stage at diagnosis, using both specific individual comorbid conditions and a global measure of comorbidity; and to assess whether this impact varied by cancer site, level of comorbidity burden and individual comorbidity type. Methods: We examined comorbidity among 14 096 patients with breast, colon, rectal, liver, stomach, ovarian, uterine, bladder or kidney cancer. Patients were identified from cancer registry data, and then linked to hospitalisation data to determine the presence of comorbidity in the 5 years preceding cancer diagnosis. Individual comorbid conditions were identified using ICD-10 codes, and overall burden of comorbidity attributed using a cancer-specific measure of comorbidity (C3 Index). Results: We observed that the presence of patient comorbidity (a) increases the odds of being diagnosed with distant metastases, (b) does not lead to earlier diagnosis and (c) increases the likelihood of a patient receiving no stage of disease at diagnosis. Conclusions: Patient comorbidity has a substantial impact on cancer stage at diagnosis; however, this impact varies considerably by cancer type, individual comorbid condition and overall comorbidity burden. PMID:26461060

  18. Neuroinflammation and Comorbidity of Pain and Depression

    PubMed Central

    Kavelaars, A.; Heijnen, C. J.; Dantzer, R.

    2014-01-01

    Comorbid depression and chronic pain are highly prevalent in individuals suffering from physical illness. Here, we critically examine the possibility that inflammation is the common mediator of this comorbidity, and we explore the implications of this hypothesis. Inflammation signals the brain to induce sickness responses that include increased pain and negative affect. This is a typical and adaptive response to acute inflammation. However, chronic inflammation induces a transition from these typical sickness behaviors into depression and chronic pain. Several mechanisms can account for the high comorbidity of pain and depression that stem from the precipitating inflammation in physically ill patients. These mechanisms include direct effects of cytokines on the neuronal environment or indirect effects via downregulation of G protein–coupled receptor kinase 2, activation of the tryptophan-degrading enzyme indoleamine 2,3-dioxygenase that generates neurotropic kynurenine metabolites, increased brain extracellular glutamate, and the switch of GABAergic neurotransmission from inhibition to excitation. Despite the existence of many neuroimmune candidate mechanisms for the co-occurrence of depression and chronic pain, little work has been devoted so far to critically assess their mediating role in these comorbid symptoms. Understanding neuroimmune mechanisms that underlie depression and pain comorbidity may yield effective pharmaceutical targets that can treat both conditions simultaneously beyond traditional antidepressants and analgesics. PMID:24335193

  19. Pharmacotherapy treatment of PTSD and comorbid disorders.

    PubMed

    Kozarić-Kovacić, Dragica

    2009-09-01

    Comorbity is very high in posttraumatic stress disorder (PTSD) patients. PTSD is very often complicated with depressive disorder, substance abuse, other anxiety disorders, personality disorders, psychotic features, etc. There have been few pharmacotherapy studies in this complicated field. In the past few years the literature on pharmacotherapy treatment for PTSD and comorbidity has arisen. From empirical evidence (level A) exist three sertraline studies in PTSD comorbid with: 1) anxiety, 2) depression, and 3) anxiety and depression, and one risperidone study in PTSD comorbid with psychotic symptoms. From empirical evidence (level B) exist two disulfiram, naltrexone, and their combination studies in patients with PTSD comorbid with alcohol dependence and one paroxetine or bupropion versus cognitive behavioral therapy (CBT) versus community mental health referral study in PTSD women outpatients with major depressive disorder. The results from our label trials in the Croatian war veterans with chronic PTSD comorbid with psychotic features treated with novel antipsychotics (olanzapine, risperidone, or quetiapine) are promising. In the future more rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder, especially the trials from level A.

  20. Comorbidity of Psychiatric and Personality Disorders in First Suicide Attempters

    PubMed Central

    Rao, K. Nagaraja; Kulkarni, Ranganath R.; Begum, Shamshad

    2013-01-01

    Background: Attempted suicide is a common clinical problem in a general hospital setting. It has a serious clinical and socio-economical impact too. Aims: To study the psychosocial, psychiatric, and personality profile of the first suicide attempters in a general hospital. Settings and Design: Cross-sectional, hospital-based, descriptive study. Materials and Methods: All the consecutive cases of first suicide attempt (n=100) treated in a general hospital were studied to know the clinical profile. Variables related to socio-demographic characteristics, family background, suicide characteristics, psychiatric morbidity, and comorbidity were analyzed. Risk-Rescue rating was applied to know the medical seriousness of the suicide attempt. Presumptive stressful life event scale was utilized to calculate life events score. Structured clinical interview (MINI Plus) and semi-structured clinical interview (IPDE) were used for axis-I and axis-II (personality) diagnoses. The results were analyzed using appropriate statistical measures. Results: Family history of psychiatric illnesses (31%) and suicide (11%) were noted. Insecticides and pesticides were the most common agents (71%) employed to attempt suicide. Interpersonal difficulties (46%) were the most frequent stressor. Overall medical seriousness of the suicide attempt was of moderate lethality. 93% of the suicide attempters had at least one axis-I and/or axis-II psychiatric disorder. Most common diagnostic categories were mood disorders, adjustment disorders, and substance-related disorders, with axis-I disorders (89%), personality disorders (52%), and comorbidity of psychiatric disorders (51.6%). Conclusion: Individuals who made first suicide attempt were young adults, had lower educational achievement; overall seriousness of the suicide attempt was of moderate lethality, high prevalence of psychiatric morbidity, personality disorders, and comorbidity, and had sought medical help from general practitioners. PMID:23833346

  1. [Leukotrien antagonists in the treatment of allergic rhinitis and comorbidities].

    PubMed

    Sacre Hazouri, José Antonio

    2008-01-01

    Leukotrienes comprise a family of products of the 5-lipoxigenase pathway of arachidonic acid metabolism. The cysteinil leukotrienes C4, D4 and E4 account for the biologic activity that was previously termed "slow-reacting substance of anaphylaxis". The proinflammatory effects of cysteinil leukotrienes (cys LTs) have been well described in asthma and rhinitis. The cys LTs induce broncospasm (1,000 times more potent than histamine), edema, mucus, hypersecretion, attract inflammatory cells like eosinophils, increase airway hyperreactivity, vascular leakage, and stimulate takikinins. The leukotriene synthesis can be inhibited in two different places; through inhibition of 5 lipooxigenase activating protein (FLAP) in the 5 lipooxigenase pathway, with the drug Zyleuton, or blocking the cysLT1 receptor with the drugs Montelukast, Pranlukast, Zafirlukast. The cysLTs play an important role in pathophysiology of allergic rhinitis and comorbid diseases like rhinosinusitis and nasal polyposis. Antileukotrienes are prescribed in the treatment of allergic rhinitis. Allergic rhinitis is a complex IgE inflammatory disease of the upper airways. It is the most common allergic disease ocurring in 10 to 20% of adults and up to 30% of children. It may be seasonal or perennial, intermittent or persistent. Sneezing, itching, watery rhinorrea and nasal obstruction are classic symptoms. Ocular itching, lacrimation and redness also occur frequently as almost 50% of the patients also have allergic conjunctivitis. Allergic rhinitis may be mild, moderate or severe disease. It may impair cognition, school and work performance. It affects productivity, behavior and mood changes, causes sleep disturbance and diminish the patient's quality of life. Allergic rhinitis is a common comorbid condition with asthma, sinusitis, otitis media, nasal polyposis and recurrent respiratory infections. The purpose of this rewiew article is to know the importante of leukotrienes, its receptors and the clinical

  2. Pain and depression comorbidity: a preclinical perspective

    PubMed Central

    Li, Jun-Xu

    2014-01-01

    Pain and depression are two highly prevalent and deleterious disorders with significant socioeconomic impact to society. Clinical observations have long recognized the co-existence and interactions of pain and depression. However, the underlying mechanisms of pain-depression comorbidity and their dynamic interactions remain largely unknown. Preclinical animal studies may provide critical information for the understanding of this important comorbidity. This review analyzed the current preclinical evidence of interactions between pain and depression, which generally supports the causative relationship of the two conditions. In addition, the analysis proposed to apply domain interplay concept in future model development of pain-depression comorbidity and mechanism studies. The application of spectrum-centered animal models will better the understanding of pain-depression dyad and foster the development of more effective therapeutic strategies. PMID:24797835

  3. Asperger's syndrome: diagnosis, comorbidity and therapy.

    PubMed

    Tarazi, F I; Sahli, Z T; Pleskow, J; Mousa, S A

    2015-03-01

    Asperger's syndrome (AS), a behavioral disorder that is related to autism, is associated with abnormal social functioning and repetitive behaviors but not with a decrease in intelligence or linguistic functionality. This article reviews the clinical diagnosis of AS and discusses the comorbid disorders that may be present with AS, as well as the efficacy, safety, and tolerability of pharmacotherapies given to AS patients, as reported in preclinical and clinical studies. AS may be present with several comorbid disorders including: attention deficit hyperactivity disorder, anxiety, schizophrenia, bipolar disorder, depression, and Tourette's syndrome. The difficulty in distinguishing AS from autism results in treating the comorbid disorder symptoms, rather than treating the symptoms of AS. Accordingly, there is a great need to further understand the psychobiology of AS and its association with other disorders, which should expand the pharmacological and non-pharmacological therapeutic options and improve the quality of life for AS patients.

  4. Fatigue and Comorbidities in Multiple Sclerosis

    PubMed Central

    Fiest, Kirsten M.; Fisk, John D.; Patten, Scott B.; Tremlett, Helen; Wolfson, Christina; Warren, Sharon; McKay, Kyla A.; Berrigan, Lindsay I.

    2016-01-01

    Abstract Background: Fatigue is commonly reported by people with multiple sclerosis (MS). Comorbidity is also common in MS, but its association with the presence of fatigue or fatigue changes over time is poorly understood. Methods: Nine hundred forty-nine people with definite MS were recruited from four Canadian centers. The Fatigue Impact Scale for Daily Use and a validated comorbidity questionnaire were completed at three visits over 2 years. Participants were classified into groups with no fatigue versus any fatigue. Logistic regression was used to determine the relationship between fatigue and each comorbidity at baseline, year 1, year 2, and overall. Results: The incidence of fatigue during the study was 38.8%. The prevalence of fatigue was greater in those who were older (P = .0004), had a longer time since symptom onset (P = .005), and had greater disability (P < .0001). After adjustment, depression (odds ratio [OR], 2.58; 95% confidence interval [CI], 2.03–3.27), irritable bowel syndrome (OR, 1.71; 95% CI, 1.18–2.48), migraine (OR, 1.69; 95% CI, 1.27–2.27), and anxiety (OR, 1.57; 95% CI, 1.15–2.16) were independently associated with fatigue that persisted during the study. There was also an individual-level effect of depression on worsening fatigue (OR, 1.49; 95% CI, 1.08–2.07). Conclusions: Comorbidity is associated with fatigue in MS. Depression is associated with fatigue and with increased risk of worsening fatigue over 2 years. However, other comorbid conditions commonly associated with MS are also associated with persistent fatigue, even after accounting for depression. Further investigation is required to understand the mechanisms by which comorbidities influence fatigue. PMID:27134583

  5. Demographic and clinical characteristics associated with comorbid cannabis use disorders (CUDs) in hospitalized patients with bipolar I disorder

    PubMed Central

    Weinstock, Lauren M.; Gaudiano, Brandon A.; Wenze, Susan J.; Epstein-Lubow, Gary; Miller, Ivan W.

    2015-01-01

    Background Published data suggest that cannabis use is associated with several negative consequences for individuals with bipolar disorder (BD), including new manic episode onset, psychosis, and functional disability. Yet much less is known about cannabis use disorders (CUDs) in this population, especially in more acutely symptomatic groups. Methods To evaluate correlates of CUD comorbidity in BD, a retrospective chart review was conducted for 230 adult patients with bipolar I disorder (BDI) who were admitted to a university-affiliated private psychiatric hospital. Using a computer algorithm, a hospital administrator extracted relevant demographic and clinical data from the electronic medical record for analysis. Results Thirty-six (16%) had a comorbid CUD. CUD comorbidity was significantly associated with younger age, manic/mixed episode polarity, presence of psychotic features, and comorbid nicotine dependence, alcohol use disorder (AUD), and other substance use disorders, but was associated with decreased likelihood of anxiety disorder comorbidity. With the exception of manic/mixed polarity and AUD comorbidity, results from multivariate analyses controlling for the presence of other SUDs were consistent with univariate findings. Conclusion Patients with BD and comorbid CUDs appear to be a complex population with need for enhanced clinical monitoring. Given increasing public acceptance of cannabis use, and the limited availability of evidenced-based interventions targeted toward CUDs in BD, psychoeducation and other treatment development efforts appear to be warranted. PMID:26773991

  6. Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education

    PubMed Central

    Pugh, Julia; Aggett, Justine; Goodland, Annwen; Prichard, Alison; Thomas, Nerys; Donovan, Kieron; Roberts, Gareth

    2016-01-01

    Background The incidence of chronic kidney disease (CKD) is rising and is likely to continue to do so for the foreseeable future, with the fastest growth seen among adults ≥75 years of age. Elderly patients with advanced CKD are likely to have a higher burden of comorbidity and frailty, both of which may influence their disease outcome. For these patients, treatment decisions can be complex, with the current lack of robust prognostic tools hindering the shared decision-making process. The current study aims to assess the impact of comorbidity and frailty on the outcomes of patients referred for pre-dialysis education. Methods We performed a single-centre study of patients (n = 283) referred for pre-dialysis education between 2010 and 2012. The Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS) were used to assess comorbid disease burden and frailty, respectively. Follow-up data were collected until February 2015. Results The CCI and CFS scores at the time of referral to the pre-dialysis service were independent predictors of mortality. Within the study follow-up period, 76% of patients with a high CFS score at the time of pre-dialysis education had died, with 63% of these patients not commencing dialysis before death. Conclusion A relatively simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease. PMID:26985387

  7. Comorbidity of PTSD in anxiety and depressive disorders: prevalence and shared risk factors.

    PubMed

    Spinhoven, Philip; Penninx, Brenda W; van Hemert, Albert M; de Rooij, Mark; Elzinga, Bernet M

    2014-08-01

    The present study aims to assess comorbidity of posttraumatic stress disorder (PTSD) in anxiety and depressive disorders and to determine whether childhood trauma types and other putative independent risk factors for comorbid PTSD are unique to PTSD or shared with anxiety and depressive disorders. The sample of 2402 adults aged 18-65 included healthy controls, persons with a prior history of affective disorders, and persons with a current affective disorder. These individuals were assessed at baseline (T0) and 2 (T2) and 4 years (T4) later. At each wave, DSM-IV-TR based anxiety and depressive disorder, neuroticism, extraversion, and symptom severity were assessed. Childhood trauma was measured at T0 with an interview and at T4 with a questionnaire, and PTSD was measured with a standardized interview at T4. Prevalence of 5-year recency PTSD among anxiety and depressive disorders was 9.2%, and comorbidity, in particular with major depression, was high (84.4%). Comorbidity was associated with female gender, all types of childhood trauma, neuroticism, (low) extraversion, and symptom severity. Multivariable significant risk factors (i.e., female gender and child sexual and physical abuse) were shared among anxiety and depressive disorders. Our results support a shared vulnerability model for comorbidity of anxiety and depressive disorders with PTSD. Routine assessment of PTSD in patients with anxiety and depressive disorders seems warranted.

  8. Comorbidity and Chronic Conditions in the National Social Life, Health and Aging Project (NSHAP), Wave 2

    PubMed Central

    Kotwal, Ashwin; Huisingh-Scheetz, Megan J.; Waite, Linda J.; McClintock, Martha K.; Dale, William

    2014-01-01

    Objective. The goals of this paper were: (a) to promote research using the National Social Life, Health and Aging Project (NSHAP) Wave 2 data by providing relevant background information for a broad range of chronic conditions and (b) to provide a framework for combining these chronic conditions into informative comorbidity indices. Method. The chronic conditions measured in NSHAP Wave 2 were grouped across several health domains: cardiovascular, endocrine and metabolic, cancer, lung, inflammatory and bone, neurological, and sensorimotor. Prevalences for each condition were reported as percentages and were also estimated separately by age group and gender. Additionally, 2 comorbidity indices were created: a Modified Charlson Comorbidity Index (CCI) that included conditions associated with mortality risk and the NSHAP Comorbidity Index (NCI) that included conditions from the Modified CCI as well as additional conditions related to overall health and function. Results. Hypertension, incontinence, arthritis, heart conditions, cancer, and diabetes were the most prevalent conditions. In general, prevalences of most chronic conditions increased with age. Additionally, there were several notable gender differences in chronic condition prevalence. Due to the inclusion of highly prevalent conditions, such as hypertension and incontinence, the mean comorbidity index score of the NCI was higher than that of the Modified CCI. Discussion. Wave 2 of NSHAP included a variety of measures assessing the chronic conditions that are the most prevalent in older adults. These data are a valuable resource for the study of the impact of chronic conditions on overall health and aging. PMID:25360017

  9. Comorbidities impacting on prognosis after lung transplant.

    PubMed

    Vaquero Barrios, José Manuel; Redel Montero, Javier; Santos Luna, Francisco

    2014-01-01

    The aim of this review is to give an overview of the clinical circumstances presenting before lung transplant that may have negative repercussions on the long and short-term prognosis of the transplant. Methods for screening and diagnosis of common comorbidities with negative impact on the prognosis of the transplant are proposed, both for pulmonary and extrapulmonary diseases, and measures aimed at correcting these factors are discussed. Coordination and information exchange between referral centers and transplant centers would allow these comorbidities to be detected and corrected, with the aim of minimizing the risks and improving the life expectancy of transplant receivers.

  10. Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients

    PubMed Central

    Saaresranta, Tarja; Hedner, Jan; Bonsignore, Maria R.; Riha, Renata L.; McNicholas, Walter T.; Penzel, Thomas; Anttalainen, Ulla; Kvamme, John Arthur; Pretl, Martin; Sliwinski, Pawel; Verbraecken, Johan; Grote, Ludger

    2016-01-01

    Background Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established. Methods A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness (“EDS”) and nocturnal sleep problems other than OSA (labelled as “insomnia”): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype. Results The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188–1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity. Conclusions Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS. PMID:27701416

  11. Attention deficit hyperactivity disorder and severity of substance use: the role of comorbid psychopathology.

    PubMed

    Torok, Michelle; Darke, Shane; Kaye, Sharlene

    2012-12-01

    Attention deficit hyperactivity disorder (ADHD) is a highly comorbid disorder, and, as such, there is much confusion surrounding the exact role it plays in increasing susceptibility to harmful behaviors. To date, no studies have examined the impact of adult ADHD on severity of substance use, while controlling for comorbid psychiatric disorders. Using a structured cross-sectional survey of 269 regular polysubstance users in Sydney, Australia, this study aimed to determine whether ADHD was a risk factor for more severity of substance use, and whether this effect remained when Borderline Personality Disorder (BPD) and Conduct Disorder (CD) diagnoses were controlled for. Rates of psychiatric disorders were high, with 45% meeting criteria for ADHD, 47% for BPD, and 64% for CD. While bivariate analyses showed that adult ADHD was significantly associated with all indicators of drug use severity, this effect did not remain once confounding factors were controlled. While ADHD accounted for very few differences in drug use severity, CD was found to independently predict all drug use severity indicators, including earlier onset, greater polydrug use, more frequent stimulant use, and greater risk for stimulant dependence. These results suggest that CD, rather than ADHD, is the strongest predictor of differences in patterns of drug use severity. The extensive comorbidity among this sample highlights the great potential for misattributing drug use risks to ADHD, and that it is important to account for psychiatric comorbidity to properly discern what underlying variables account for differences in harmful drug use behaviors.

  12. Screening for bipolar disorder among migraineurs: the impact of migraine–bipolar disorder comorbidity on disease characteristics

    PubMed Central

    Kivilcim, Yigit; Altintas, Merih; Domac, Fusun Mayda; Erzincan, Erkal; Gülec, Huseyin

    2017-01-01

    Purpose The aim of this study was to evaluate the prevalence of comorbid bipolar disorder (BD) among migraineurs and the impact of migraine–BD comorbidity on disease characteristics. Patients and methods A total of 120 adult patients diagnosed with migraine at a single tertiary care center were included in this cross-sectional study. Data on sociodemographic and migraine-related characteristics, family history of psychiatric diseases, comorbid psychiatric diseases, and first-episode characteristics were recorded. Mood Disorders Diagnosis and Patient Registration Form (SCIP-TURK), Mood Disorder Questionnaire (MDQ), and Hypomania Checklist-32-Revised (HCL-32-R) were applied to all patients by experienced clinicians, and clinical diagnoses were confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Migraine Disability Assessment Scale (MIDAS) was used to evaluate the headache-related disability. Study parameters were compared between migraineurs with and without comorbid BD. Results The diagnosis of comorbid BD was confirmed in 19.2% of migraineurs. A significantly higher percentage of patients with comorbid BD than those without comorbid BD had family history of BD (39.1% vs 6.2%, P<0.001), suicide attempt (30.4% vs 5.2%, P<0.001), and physical abuse (52.2% vs 26.8%, P=0.019). MIDAS scores were significantly higher (50.6 [43.2] vs 33.8 [42.7], P=0.0422) in migraineurs with comorbid BD than in those without comorbid BD. Multivariate logistic regression model revealed that a positive family history of type I BD (odds ratio [OR], 14.42; 95% confidence interval [CI], 2.94–70.73; P=0.001) and MIDAS scores >30 (OR, 3.69; 95% CI, 1.12–12.19; P=0.032) were associated with 14.42 times and 3.69 times increased likelihood of BD, respectively. Conclusion Our findings revealed comorbid BD in a remarkable percentage of migraineurs and a higher likelihood of having BD in case of a positive family history of type I BD and MIDAS scores >30. Comorbid

  13. Parkinson disease and comorbid cerebrovascular disease.

    PubMed

    Nanhoe-Mahabier, Wandana; de Laat, Karlijn F; Visser, Jasper E; Zijlmans, Jan; de Leeuw, Frank-Erik; Bloem, Bastiaan R

    2009-10-01

    Optimal management of chronic diseases not only requires tackling of the primary disease processes, but also necessitates timely recognition and treatment of comorbid conditions. In this article, we illustrate this two-pronged approach for two common age-related disorders: Parkinson disease (PD) and cerebrovascular disease (CVD). We first discuss the pathophysiological mechanisms that could provide a link between PD and CVD. Patients with PD have a series of risk factors that could promote development of CVD, but also have several protective factors. We then review the available clinical, radiological and neuropathological evidence to support an association between these two conditions. We conclude by discussing the potential implications for clinical practice, highlighting how comorbid CVD could alter the clinical presentation of PD and reviewing the possibilities for prevention and secondary prophylaxis. Additional research will be needed to fully evaluate the prevalence and clinical relevance of comorbid CVD in PD. Pending further evidence, we recommend that cerebral neuroimaging should be considered if patients with initially uncomplicated PD develop-either acutely or chronically-prominent and/or treatment-resistant gait impairment, postural instability, depression, cognitive decline, or urinary incontinence. Finding comorbid CVD in such patients could have prognostic implications, and could necessitate treatment to arrest further progression of CVD.

  14. The psychiatric comorbidities of cluster headache.

    PubMed

    Robbins, Matthew S

    2013-02-01

    Although the comorbidity of migraine has been extensively studied, the relationships between cluster headache and psychiatric disease have not been well-addressed. In this review the available literature concerning cluster headache and depression, anxiety, bipolar disorder, aggression, suicide, and their implications are discussed. Potential mechanisms, confounding variables, and unanswered questions are also addressed.

  15. Psychiatric Comorbidity in Gender Dysphoric Adolescents

    ERIC Educational Resources Information Center

    de Vries, Annelou L. C.; Doreleijers, Theo A. H.; Steensma, Thomas D.; Cohen-Kettenis, Peggy T.

    2011-01-01

    Background: This study examined psychiatric comorbidity in adolescents with a gender identity disorder (GID). We focused on its relation to gender, type of GID diagnosis and eligibility for medical interventions (puberty suppression and cross-sex hormones). Methods: To ascertain DSM-IV diagnoses, the Diagnostic Interview Schedule for Children…

  16. [Diabetic co-morbidities: prevalences in Germany].

    PubMed

    Heller, T; Blum, M; Spraul, M; Wolf, G; Müller, U A

    2014-04-01

    In some patients with diabetes mellitus (DM) chronic hyperglycemia leads to microvascular complications in retina, kidney and nerves. Concerning missing data from Germany cited prevalence in German educational books and guidelines arise from other countries. This review demonstrates the prevalence of diabetic comorbidities in Germany. The largest investigation in Germany is the Disease-Management-Programm Nordrhein with more than 450.000 surveyed DM  patients. These researches show good comparability with most analyses respective to the prevalence of diabetic comorbidities in Germany. Patients with DM2 have a mean Hba1c of 7 % and patients with DM1 of 7.9 %. In patients with DM2 the prevalence of retinopathy is 11 %, nephropathy 10 % and neuropathy 20 %. Co-morbidities are more commonin patients with long diabetes duration and high HbA1c. In patients with DM1 the prevalence of retinopathy is 25 %, of nephropathy 15 % and neuropathy 27 %. The prevalence of diabetic co-morbidities in primary care in Germany is considerably lower as mentioned in educational books or guidelines. This positive development is reasonable through a better quality of care, nationwide early detection examinations and training programmes.

  17. Psychiatric Disorders, Comorbidity, and Suicidality in Mexico

    PubMed Central

    Borges, Guilherme; Nock, Matthew K.; Medina-Mora, Maria Elena; Hwang, Irving; Kessler, Ronald C.

    2009-01-01

    Background Prior studies have reported that psychiatric disorders are among the strongest predictors of suicidal behavior (i.e., suicide ideation, plans, and attempts). However, surprisingly little is known about the independent associations between each disorder and each suicidal behavior due to a failure to account for comorbidity. Methods This study used data from a representative sample of 5,782 respondents participating in the Mexican National Comorbidity Survey (2001–2002) to examine the unique associations between psychiatric disorders and suicidality. Results A prior psychiatric disorder was present in 48.8% of those with a suicide ideation and in 65.2% of those with an attempt. Discrete-time survival models adjusting for comorbidity revealed that conduct disorder and alcohol abuse/dependence were the strongest predictors of a subsequent suicide attempt. Most disorders predicted suicidal ideation but few predicted the transition from ideation to a suicide plan or attempt. Limitations M-NCS is a household survey that excluded homeless and institutionalized people, andthe diagnostic instrument used did not include an assessment of all DSM-IV disorders which would increase the comorbidity discussed here. Conclusions These results reveal a complex pattern of associations in which diverse psychiatric disorders impact different parts of the pathway to suicide attempts. These findings will help inform clinical and public health efforts aimed at suicide prevention in Mexico and other developing countries. PMID:19926141

  18. Trajectory in obsessive-compulsive disorder comorbidities.

    PubMed

    de Mathis, Maria Alice; Diniz, Juliana B; Hounie, Ana G; Shavitt, Roseli G; Fossaluza, Victor; Ferrão, Ygor; Leckman, James F; de Bragança Pereira, Carlos; do Rosario, Maria Conceição; Miguel, Eurípedes C

    2013-07-01

    The main goal of this study is to contribute to the understanding of the trajectory of comorbid disorders associated with obsessive-compulsive disorder (OCD) according to the first manifested psychiatric disorder and its impact in the clinical course of OCD and subsequent psychiatric comorbidities. One thousand and one OCD patients were evaluated at a single time point. Standardized instruments were used to determine the current and lifetime psychiatric diagnoses (Structured Clinical Interview for DSM-IV Axis I and for impulse-control disorders) as well as to establish current obsessive-compulsive, depressive and anxiety symptom severity (Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale, Beck Depression and Anxiety Inventories and the OCD Natural History Questionnaire). To analyze the distribution of comorbidities according to age at onset Bayesian approach was used. Five hundred eight patients had the first OC symptom onset till the age of 10 years old. The first comorbidity to appear in the majority of the sample was separation anxiety disorder (17.5%, n=175), followed by ADHD (5.0%, n=50) and tic disorders (4.4%, n=44). OCD patients that presented with separation anxiety disorder as first diagnosis had higher lifetime frequency of post-traumatic stress disorder (p=0.003), higher scores in the Sexual/Religious dimension (p=0.04), Beck Anxiety (p<0.001) and Depression (p=0.005) Inventories. OCD patients that initially presented with ADHD had higher lifetime frequencies of substance abuse and dependence (p<0.001) and worsening OCD course (p=0.03). OCD patients that presented with tic disorders as first diagnosis had higher lifetime frequencies of OC spectrum disorders (p=0.03). OCD is a heterogeneous disorder and that the presence of specific comorbid diagnoses that predate the onset of OCD may influence its clinical presentation and course over the lifetime.

  19. Modafinil treatment of amphetamine abuse in adult ADHD.

    PubMed

    Mann, N; Bitsios, P

    2009-06-01

    Substance abuse is a frequent co-morbid condition of adult attention deficit hyperactivity disorder (ADHD). Treatment with conventional psychostimulants in adult ADHD with co-morbid stimulant abuse may be problematic. In this study, we report the case of a patient with adult ADHD with co-morbid amphetamine abuse who was treated successfully with the non-stimulant alertness-promoting drug modafinil. The drug resolved both the inattention/hyperactivity symptoms as well as the amphetamine abuse. Modafinil may be a suitable candidate treatment for adults with ADHD and stimulant abuse.

  20. Alcohol Use Disorders and Depression: Protective Factors in the Development of Unique Versus Comorbid Outcomes

    PubMed Central

    Mason, W. Alex; Hawkins, J. David; Kosterman, Rick; Catalano, Richard F.

    2010-01-01

    Protective factors for young adult alcohol use disorders, depression, and comorbid alcohol use disorders and depression were examined. Participants were recruited from all fifth-grade students attending 18 Seattle elementary schools. Of the 1,053 students eligible, 808 (77%) agreed to participate. Youth were surveyed when they were 10 years-old in 1985 and followed to age 21 years years in 1996 (95% retention). Protective factors were measured at age 14 years years. Young adult disorders were assessed with the Diagnostic Interview Schedule. Alcohol refusal skills, academic skills, school and family bonding, parental rewards, school rewards, and family cohesion at age 14 years years were associated with decreased risk for comorbidity at age 21 years years. PMID:21031140

  1. Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-01-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no…

  2. Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders

    PubMed Central

    Ollendick, Thomas H.; Öst, Lars-Göran; Reuterskiöld, Lena; Costa, Natalie

    2010-01-01

    The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and “other” types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician Severity Ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon. PMID:20573338

  3. Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders.

    PubMed

    Ollendick, Thomas H; Ost, Lars-Göran; Reuterskiöld, Lena; Costa, Natalie

    2010-09-01

    The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and "other" types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.

  4. Parent, Sibling and Peer Associations with Subtypes of Psychiatric and Substance Use Disorder Comorbidity in Offspring

    PubMed Central

    McCutcheon, Vivia V.; Scherrer, Jeffrey F.; Grant, Julia D.; Xian, Hong; Haber, Jon Randolph; Jacob, Theodore; Bucholz, Kathleen K

    2012-01-01

    BACKGROUND Parental substance use disorder (SUD) is associated with a range of negative offspring outcomes and psychopathology, but the clustering of these outcomes into subtypes has seldom been examined, nor have the familial and environmental contexts of these subtypes been reported. The present study examines the clustering of offspring lifetime substance use and psychiatric disorders into subtypes and characterizes them in terms of familial and non-familial influences using an offspring-of-twins design. METHOD Telephone-administered diagnostic interviews were used to collect data on psychiatric disorders and SUD from 488 twin fathers, 420 biological mothers and 831 offspring. Latent class analysis (LCA) was used to derive subtypes of lifetime comorbidity in offspring. Familial risk and environmental variables associated with each subtype (i.e. parenting, childhood physical or sexual abuse, perceived sibling and peer substance use) were identified using multinomial logistic regression. RESULTS Four classes identified by LCA were characterized as 1) unaffected, 2) alcohol abuse/dependence, 3) alcohol abuse/dependence comorbid with anxiety and depression, and 4) alcohol, cannabis abuse/dependence and nicotine dependence comorbid with conduct disorder. Inconsistent parenting, childhood physical/sexual abuse, and perceived sibling and peer substance use were significantly associated with profiles of offspring comorbidity after adjusting for familial vulnerability. Some associations were specific (i.e. perceived peer alcohol use to the AUD class), while others were general (peer smoking to all 3 comorbidity classes). CONCLUSIONS We observed distinct subtypes of psychiatric and SUD comorbidity in adolescents and young adults. Subtypes of offspring psychopathology have varied associations with parental psychopathology, family environment, and sibling and peer behaviors. PMID:22921146

  5. The Comorbidity of Diabetes Mellitus and Depression

    PubMed Central

    Katon, Wayne J.

    2009-01-01

    Several factors, including sedentary lifestyle, obesity, and an aging population, contribute to epidemic rates of type 2 diabetes mellitus. Depression frequently occurs comorbidly with diabetes although it is unrecognized and untreated in approximately two thirds of patients with both conditions. The course of depression in patients with both diabetes and depression is chronic and severe. Up to 80% of patients with diabetes and depression will experience a relapse of depressive symptoms over a 5-year period. Depression is associated with nonadherence to diabetes self-care—including following dietary restrictions, medication compliance, and blood glucose monitoring—resulting in worse overall clinical outcomes. Due to potential negative health consequences associated with comorbid diabetes and depression, both conditions should be optimally treated to maximize patient outcomes. PMID:18954592

  6. Kidney Disease and Psoriasis. A New Comorbidity?

    PubMed

    González-Parra, E; Daudén, E; Carrascosa, J M; Olveira, A; Botella, R; Bonanad, C; Rivera, R

    2016-12-01

    Psoriasis is a chronic inflammatory disease that has been associated with cardiovascular and metabolic comorbidities, particularly in young patients and patients with more severe forms of the disease. Recent studies have also linked psoriasis to kidney disease, and this would seem only logical, as the kidney is both a target of classic cardiovascular risk factors and susceptible to the toxic effects of some of the traditional drugs used to control psoriasis. In this article, we would like to draw readers' attention to this recently described comorbidity and stress the importance of early detection, as once chronic kidney disease develops, it cannot be reversed. When evaluating patients with psoriasis, particularly when they are candidates for systemic therapy, we believe it is important to order laboratory tests including glomerular filtration rate and a simple urine test to screen for albuminuria (albumin/creatinine ratio).

  7. Cardiac Imaging in Heart Failure with Comorbidities.

    PubMed

    Wong, Chiew; Chen, Sylvia; Iyngkaran, Pupalan

    2017-01-01

    Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.

  8. Self Report Co-Morbidity and Health Related Quality of Life -- A Comparison with Record Based Co-Morbidity Measures

    ERIC Educational Resources Information Center

    Voaklander, Donald C.; Kelly, Karen D.; Jones, C. Allyson; Suarez-Almazor, Maria E.

    2004-01-01

    The purpose of this project was to compare three hospital-based measures of co-morbidity to patient self-report co-morbidity and to determine the relative proportion of outcome predicted by each of the co-morbidity measures in a population of individuals receiving major joint arthroplasty. Baseline measures using the SF-36 general health…

  9. Seventy-Five Years of Comorbidity Research

    PubMed Central

    Kushner, Matt G.

    2014-01-01

    Objective: As part of the 75th anniversary edition of the Journal of Studies on Alcohol and Drugs, this article reviews research on the relationship between mental disorders and substance use disorders (“comorbidity”) from 1940—the journal’s inception—to the present. Method: First, a survey of the titles and abstracts of all articles published in the journal was used to identify those articles pertaining to comorbidity. Seminal and representative works from this set of articles and a limited selection of articles from other journals were included in the review. Results: The early psychosocial research emphasized psychoanalytic formulations of alcohol use as a defensive symptom, which informed the early experimental research on the tension-reducing properties of alcohol. The “cognitive revolution,” occurring in the 1970s, enabled an expansion of the tension-reduction theory to include a central role for mental processes (e.g., alcohol expectancies) in promoting drinking to cope with negative affectivity. The early clinical research characterized mental conditions commonly co-occurring with alcohol disorders and considered their etiological relationship to alcohol disorders. The “neo-Kraepelinian revolution” in psychiatry, which also occurred in the 1970s, infused the clinical comorbidity research with a more rigorous diagnostic technology and a range of biomedical research methodologies to study the mechanistic linkages of co-occurring disorders. Conclusions: Although a substantial quantity of scientific information on comorbidity has accumulated over the past 75 years, a standard model(s) of comorbidity has yet to congeal. Barriers and opportunities related to achieving this important goal are discussed. PMID:24565311

  10. Headache and comorbidity in children and adolescents

    PubMed Central

    2013-01-01

    Headache is one of the most common neurological symptom reported in childhood and adolescence, leading to high levels of school absences and being associated with several comorbid conditions, particularly in neurological, psychiatric and cardiovascular systems. Neurological and psychiatric disorders, that are associated with migraine, are mainly depression, anxiety disorders, epilepsy and sleep disorders, ADHD and Tourette syndrome. It also has been shown an association with atopic disease and cardiovascular disease, especially ischemic stroke and patent foramen ovale (PFO). PMID:24063537

  11. Criminal behavior and cognitive processing in male offenders with antisocial personality disorder with and without comorbid psychopathy.

    PubMed

    Riser, Rebecca E; Kosson, David S

    2013-10-01

    Antisocial personality disorder (ASPD) and psychopathy are 2 important syndromes with substantial utility in predicting antisocial behavior. Although prior studies have identified correlations between various factors and the presence of psychopathy or ASPD, most studies have focused on 1 syndrome or the other. Consequently, it is unclear whether the 2 syndromes reflect similar pathophysiologies, whether they are in fact 2 distinct syndromes, or whether the correlates of ASPD reflect its high comorbidity with psychopathy. The present study addressed this issue by examining the impact of ASPD with and without comorbid psychopathy (as assessed by the Psychopathy Checklist-Revised) on criminal offending and cognitive processing in 674 adult male inmates at a county jail in Illinois. Participants exhibited either ASPD and comorbid psychopathy, ASPD but not psychopathy, or neither ASPD nor psychopathy. Participants with and without comorbid psychopathy were characterized by more criminal behavior than controls, and inmates with ASPD and psychopathy exhibited more severe criminal behavior than those with ASPD only. In addition, inmates with ASPD and psychopathy exhibited a different pattern of cognitive task performance impairment than those with ASPD alone. Results replicate the findings of Kosson, Lorenz, and Newman (2006) and provide new evidence suggesting that men with ASPD and comorbid psychopathy are characterized by cognitive processing anomalies different from those seen in ASPD without comorbid psychopathy.

  12. Prevalence, correlates, and comorbidities of four DSM-IV specific phobia subtypes: results from the Korean Epidemiological Catchment Area study.

    PubMed

    Park, Subin; Sohn, Jee Hoon; Hong, Jin Pyo; Chang, Sung Man; Lee, Young Moon; Jeon, Hong Jin; Cho, Seong-Jin; Bae, Jae Nam; Lee, Jun Young; Son, Jung-Woo; Cho, Maeng Je

    2013-10-30

    Although several studies have detected differences in clinical features among specific phobias, there is a shortage of detailed national data on the on the DSM-IV SP subtypes, particularly in the Asian population. To examine the prevalence, demographic and other correlates, and co-morbidities of DSM-IV SP subtypes in a nationwide sample of Korean adults. We recruited 6510 participants aged 18-64 years for this study. Lay interviewers used the Composite International Diagnostic Interview to assess participants. We analyzed socio-demographics, health-related correlates and frequencies of comorbid mental disorders among participants with SP and each subtypes compared to unaffected adults. The prevalence of lifetime DSM-IV SP was 3.8%, and animal phobias were the most prevalent type of SP. Blood-injection-injury phobia was negatively associated with education, whereas situational phobia was positively associated with education. The strongest mental disorder comorbidity was associated with situational phobia; there is a higher probability of comorbid mood (OR=5.73, 95% CI=2.09-15.73), anxiety (OR=7.54, 95% CI=2.34-24.28), and somatoform disorders (OR=7.61, 95% CI=1.64-35.22) with this subtype. Blood-injection-injury phobia was highly associated with alcohol dependence (OR=9.02, 95% CI=3.54-23.02). Specific phobias are heterogeneous with respect to socio-demographic characteristics and comorbidity pattern. Implications of the usefulness of current subtype categories should continue to be investigated.

  13. Does Co-Morbid Depression Alter the Inverse Relationship between Obesity and Substance Use Disorders?

    PubMed Central

    Gearhardt, Ashley N.; Harrison, Emily L. R.; McKee, Sherry A.

    2012-01-01

    Background Substance use disorders and obesity are often inversely related to one another, hypothetically due to competition over shared neurobiological reward circuitry. However, obesity and substance use disorders share common risk factors, such as other psychiatric disorders. It is unknown whether the inverse relationship between obesity and substance use disorders continues to exist in the presence of shared risk factors. Methods For the current study, we examined the associations between major depression, alcohol and drug use disorders, and overweight/obesity status in a nationally representative sample of U.S. adults (n=40,715). Results Our findings demonstrated that adults with major depression were more likely to be obese, whereas adults with alcohol or drug use disorders were less likely to be obese. However, the inverse relationship between substance use and obesity continued to exist in adults with co-morbid depression. Adults with depression disorders co-morbid with alcohol (Relative Risk [RR]=0.63, 95%CI=0.47-0.84) or drug (RR=0.54, 95%CI=0.36-0.81) use disorders were less likely to be obese vs. normal weight. Conclusions Our findings provide support for the proposal that excess food consumption and excess drug use appear to compete over shared neurobiology even when the motivation to self-medicate with either food or substances might be elevated. PMID:22285319

  14. Comorbidity Patterns in Patients with Chronic Diseases in General Practice

    PubMed Central

    García-Olmos, Luis; Salvador, Carlos H.; Alberquilla, Ángel; Lora, David; Carmona, Montserrat; García-Sagredo, Pilar; Pascual, Mario; Muñoz, Adolfo; Monteagudo, José Luis; García-López, Fernando

    2012-01-01

    Introduction Healthcare management is oriented toward single diseases, yet multimorbidity is nevertheless the rule and there is a tendency for certain diseases to occur in clusters. This study sought to identify comorbidity patterns in patients with chronic diseases, by reference to number of comorbidities, age and sex, in a population receiving medical care from 129 general practitioners in Spain, in 2007. Methods A cross-sectional study was conducted in a health-area setting of the Madrid Autonomous Region (Comunidad Autónoma), covering a population of 198,670 individuals aged over 14 years. Multiple correspondences were analyzed to identify the clustering patterns of the conditions targeted. Results Forty-two percent (95% confidence interval [CI]: 41.8–42.2) of the registered population had at least one chronic condition. In all, 24.5% (95% CI: 24.3–24.6) of the population presented with multimorbidity. In the correspondence analysis, 98.3% of the total information was accounted for by three dimensions. The following four, age- and sex-related comorbidity patterns were identified: pattern B, showing a high comorbidity rate; pattern C, showing a low comorbidity rate; and two patterns, A and D, showing intermediate comorbidity rates. Conclusions Four comorbidity patterns could be identified which grouped diseases as follows: one showing diseases with a high comorbidity burden; one showing diseases with a low comorbidity burden; and two showing diseases with an intermediate comorbidity burden. PMID:22359665

  15. Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysis.

    PubMed

    Geiger-Brown, Jeanne M; Rogers, Valerie E; Liu, Wen; Ludeman, Emilie M; Downton, Katherine D; Diaz-Abad, Montserrat

    2015-10-01

    Cognitive behavioral therapy for insomnia (CBT-I) is effective for treatment of primary insomnia. There has been no synthesis of studies quantifying this effect on insomnia comorbid with medical and psychiatric disorders using rigorous selection criteria. The objective of this study was to quantify the effect of CBT-I in studies including patients with medical or psychiatric disorders. Studies were identified from 1985 through February 2014 using multiple databases and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I in adult patients with insomnia diagnosed using standardized criteria, who additionally had a comorbid medical or psychiatric condition. Twenty-three studies including 1379 patients met inclusion criteria. Based on weighted mean differences, CBT-I improved subjective sleep quality post-treatment, with large treatment effects for the insomnia severity index and Pittsburgh sleep quality index. Sleep diaries showed a 20 min reduction in sleep onset latency and wake after sleep onset, 17 min improvement in total sleep time, and 9% improvement in sleep efficiency post-treatment, similar to findings of meta-analyses of CBT-I in older adults. Treatment effects were durable up to 18 mo. Results of actigraphy were similar to but of smaller magnitude than subjective measures. CBT-I is an effective, durable treatment for comorbid insomnia.

  16. How do COPD comorbidities affect ICU outcomes?

    PubMed Central

    Ongel, Esra Akkutuk; Karakurt, Zuhal; Salturk, Cuneyt; Takir, Huriye Berk; Burunsuzoglu, Bunyamin; Kargin, Feyza; Ekinci, Gulbanu H; Mocin, Ozlem; Gungor, Gokay; Adiguzel, Nalan; Yilmaz, Adnan

    2014-01-01

    Background and aim Chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) frequently require admission to the intensive care unit (ICU) for application of mechanical ventilation (MV). We aimed to determine whether comorbidities and clinical variables present at ICU admission are predictive of ICU mortality. Methods A retrospective, observational cohort study was performed in a tertiary teaching hospital’s respiratory ICU using data collected between January 2008 and December 2012. Previously diagnosed COPD patients who were admitted to the ICU with ARF were included. Patients’ demographics, comorbidities, body mass index (BMI), ICU admission data, application of noninvasive and invasive MV (NIV and IMV, respectively), cause of ARF, length of ICU and hospital stay, and mortality were recorded from their files. Patients were grouped according to mortality (survival versus non-survival), and all the variables were compared between the two groups. Results During the study period, a total of 1,013 COPD patients (749 male) with a mean age (standard deviation) of 70±10 years met the inclusion criteria. Comorbidities of the non-survival group (female/male, 40/131) were significantly higher compared with the survival group (female/male, 224/618): arrhythmia (24% vs 11%), hypertension (42% vs 34%), coronary artery disease (28% vs 11%), and depression (7% vs 3%) (P<0.001, P<0.035, P<0.001, and P<0.007, respectively). Logistic regression revealed the following mortality risk factors: need of IMV, BMI <20 kg/m2, pneumonia, coronary artery disease, arrhythmia, hypertension, chronic hypoxia, and higher acute physiology and chronic health evaluation II (APACHE II) scores. The respective odds ratios, confidence intervals, and P-values for each of these were as follows: 27.7, 15.7–49.0, P<0.001; 6.6, 3.5–412.7, P<0.001; 5.1, 2.9–8.8, P<0.001; 2.9, 1.5–5.6, P<0.001; 2.7, 1.4–5.2, P<0.003; 2.6, 1.5–4.4, P<0.001; 2.2, 1.2–3.9, P<0

  17. [Comorbidity between cocaine addiction and personality disorders].

    PubMed

    Fernández-Montalvo, J; Lorea, I

    2007-01-01

    The aim of this paper was to review the current knowledge about the comorbidity between cocaine dependence and personality disorders. Results concerning a specific profile of cocaine patients are not conclusive. The prevalence rate of personality disorders in cocaine dependents is very heterogeneous (with a mean of 66% of cases), and a great variability is observed between all the studies carried out. There is a tendency for a higher proportion of cocaine dependents to be found within the cluster B category (mainly antisocial and borderline). Lastly, implications of this kind of study for future research and clinical practice are commented upon.

  18. Time spent in hospital after liver transplantation: Effects of primary liver disease and comorbidity

    PubMed Central

    Tovikkai, Chutwichai; Charman, Susan C; Praseedom, Raaj K; Gimson, Alexander E; van der Meulen, Jan

    2016-01-01

    AIM To explore the effect of primary liver disease and comorbidities on transplant length of stay (TLOS) and LOS in later admissions in the first two years after liver transplantation (LLOS). METHODS A linked United Kingdom Liver Transplant Audit - Hospital Episode Statistics database of patients who received a first adult liver transplant between 1997 and 2010 in England was analysed. Patients who died within the first two years were excluded from the primary analysis, but a sensitivity analysis was also performed including all patients. Multivariable linear regression was used to evaluate the impact of primary liver disease and comorbidities on TLOS and LLOS. RESULTS In 3772 patients, the mean (95%CI) TLOS was 24.8 (24.2 to 25.5) d, and the mean LLOS was 24.2 (22.9 to 25.5) d. Compared to patients with cancer, we found that the largest difference in TLOS was seen for acute hepatic failure group (6.1 d; 2.8 to 9.4) and the largest increase in LLOS was seen for other liver disease group (14.8 d; 8.1 to 21.5). Patients with cardiovascular disease had 8.5 d (5.7 to 11.3) longer TLOS and 6.0 d (0.2 to 11.9) longer LLOS, compare to those without. Patients with congestive cardiac failure had 7.6 d longer TLOS than those without. Other comorbidities did not significantly increase TLOS nor LLOS. CONCLUSION The time patients spent in hospital varied according to their primary liver disease and some comorbidities. Time spent in hospital of patients with cancer was relatively short compared to most other indications. Cardiovascular disease and congestive cardiac failure were the comorbidities with a strong impact on increased LOS. PMID:28058226

  19. Does Comorbid Obesity Impact Quality of Life Outcomes in Patients Undergoing Endoscopic Sinus Surgery?

    PubMed Central

    Steele, Toby O.; Mace, Jess C.; Deconde, Adam S.; Xiao, Christopher C.; Storck, Kristina A.; Gudis, David A.; Schlosser, Rodney J.; Soler, Zachary M.; Smith, Timothy L.

    2015-01-01

    Background Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS). Methods Adult patients with medically refractory CRS (n=241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5–24.9, overweight: 25.0–29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index (RSDI) and the 22-item Sinonasal Outcome Test (SNOT-22)) were evaluated compared across BMI groups and obesity subclasses. Results The prevalence of comorbid obesity was 41% (n=99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p≤0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p≥0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs. 55%, respectively) and SNOT-22 total score (29% and 40% vs. 48%, respectively). Conclusions Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without. PMID:26201473

  20. Comorbid internet addiction in male clients of inpatient addiction rehabilitation centers: psychiatric symptoms and mental comorbidity.

    PubMed

    Wölfling, Klaus; Beutel, Manfred E; Koch, Andreas; Dickenhorst, Ulrike; Müller, Kai W

    2013-11-01

    Addictive Internet use has recently been proposed to be included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Still, little is known about its nosological features, including comorbidity with other mental disorders and disorder-specific psychopathological symptoms. To investigate whether Internet addiction (IA) is an issue in patients in addiction treatment, 1826 clients were surveyed in 15 inpatient rehabilitation centers. Male patients meeting criteria for comorbid IA (n = 71) were compared with a matched control group of male patients treated for alcohol addiction without addictive Internet use (n = 58). The SCL-90-R, the Patient Health Questionnaire, and the seven-item Generalized Anxiety Disorder were used to assess associated psychiatric symptoms and further comorbid disorders. Comorbid IA was associated with higher levels of psychosocial symptoms, especially depression, obsessive-compulsive symptoms, and interpersonal sensitivity. Moreover, the patients with IA more frequently met criteria for additional mental disorders. They display higher rates of psychiatric symptoms, especially depression, and might be in need of additional therapeutic treatment. In rehabilitation centers, a regular screening for IA is recommended to identify patients with this (non-substance-related) addiction and supply them with additional disorder-specific treatment.

  1. Handling clinical comorbidity in randomized clinical trials in psychiatry.

    PubMed

    O'Hara, Ruth; Beaudreau, Sherry A; Gould, Christine E; Froehlich, Wendy; Kraemer, Helena C

    2017-03-01

    The purpose of this paper is to a) outline the importance of including patients with clinical comorbidities in Randomized Clinical Trials (RCTs) of psychiatric treatments; and b) to propose a specific approach for best handling, analyzing and interpreting the data on clinical comorbidities in terms of their impact on treatment outcomes. To do this we first define and describe clinical comorbidity and differentiate it from other forms of comorbidity. We then describe the methodological and analytical problems associated with excluding patients with clinically comorbid conditions from RCTs, including the impact on the outcomes of RCTs in psychiatry and the impact on evidence-based clinical decision-making. We then address the challenges inherent to including patients with clinical comorbidities in RCTs. Finally, we propose a methodological and analytic approach to deal with these issues in RCTs which aims to significantly improve the information yielded from RCTs in psychiatry, and thus improve clinical decision-making.

  2. Identification of disease comorbidity through hidden molecular mechanisms

    PubMed Central

    Ko, Younhee; Cho, Minah; Lee, Jin-Sung; Kim, Jaebum

    2016-01-01

    Despite multiple diseases co-occur, their underlying common molecular mechanisms remain elusive. Identification of comorbid diseases by considering the interactions between molecular components is a key to understand the underlying disease mechanisms. Here, we developed a novel approach utilizing both common disease-causing genes and underlying molecular pathways to identify comorbid diseases. Our approach enables the analysis of common pathologies shared by comorbid diseases through molecular interaction networks. We found that the integration of direct genetic sharing and indirect high-level molecular associations revealed significantly strong consistency with known comorbid diseases. In addition, neoplasm-related diseases showed high comorbidity patterns within themselves as well as with other diseases, indicating severe complications. This study demonstrated that molecular pathway information could be used to discover disease comorbidity and hidden biological mechanism to understand pathogenesis and provide new insight on disease pathology. PMID:27991583

  3. Current and new thinking in the management of comorbid insomnia.

    PubMed

    Neubauer, David N

    2009-02-01

    Insomnia occurs predominantly in conjunction with a medical or psychiatric illness. New thinking regarding the treatment of comorbid insomnia has moved the field away from practices that called for treating the comorbid condition to resolve the coexisting insomnia to one in which the insomnia is treated as a separate condition. Although 10 medications currently are approved by the US Food and Drug Administration for the treatment of insomnia, only 2, eszopiclone and zolpidem, have been evaluated for efficacy in patients with chronic comorbid insomnia. Studies suggest clear benefits in comorbid insomnia. Nonpharmacologic treatments, such as cognitive behavioral therapy, sleep hygiene, and relaxation training, have also been investigated for comorbid insomnia, with studies suggesting these approaches may be effective either alone or in conjunction with medications. While behavioral issues should be optimized, clinicians need to customize treatments for patients with comorbid insomnia based on coexisting medical and psychiatric morbidities, age, medical history, current medications, and lifestyle issues.

  4. [Health economic aspects of physical-mental comorbidity].

    PubMed

    Lehnert, T; Konnopka, A; Riedel-Heller, S; König, H-H

    2011-01-01

    Physical-mental comorbidity is often associated with worse clinical and psychosocial outcomes, reduced health-related quality of life, and increased healthcare utilization. The following article is dedicated to the health economic aspects of physical-mental comorbidity. It presents basic theoretical and methodological aspects of cost-of-illness studies and economic evaluations related to physical-mental comorbidity, which are explained and discussed for the practical example of comorbid depression in diabetes mellitus. The results show that mental comorbidity in diabetes is associated with increased healthcare costs, which can in part be attributed to an increased somatic health service use. Appropriate interventions can lower these excess costs. Economic evaluations assessing the effectiveness of interventions for depressive diabetics have shown that overall health can be improved and costs saved. However, especially in health economics, mental comorbidity in somatic diseases has not been comprehensively investigated and further research is warranted.

  5. [Comorbid psychiatric disorders and differential diagnosis of patients with autism spectrum disorder without intellectual disability].

    PubMed

    Strunz, Sandra; Dziobek, Isabel; Roepke, Stefan

    2014-06-01

    Autism spectrum conditions (ASC) without intellectual disability are often diagnosed late in life. Little is known about co-occurring psychiatric disorders and differential diagnosis of ASC in adulthood, particularly with regard to personality disorders. What kind of comorbid psychiatric disorders occur in ASC? Which are the most prevalent differential diagnoses in a sample of patients who seek autism specific clinical diagnostics? 118 adults who were referred with a presumed diagnosis of autistic disorder, were diagnosed with autism specific instruments and the prevalence of further psychiatric disorders was investigated. 59 (50%) fulfilled the criteria of ASC. 36% of the individuals with ASC fulfilled also criteria for a DSM-IV axis-I psychiatric disorder. Affective disorders (24%) and social phobia (14%) were the most prevalent comorbid disorders. The most frequent differential diagnoses were depression, social phobia, paranoid, avoidant and narcissistic personality disorder.

  6. [Psychiatric comorbidities with tobacco-related disorders].

    PubMed

    Mühlig, S; Andreas, S; Batra, A; Petersen, K U; Hoch, E; Rüther, T

    2016-01-01

    The coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.

  7. Tuberculosis Comorbidity with Communicable and Noncommunicable Diseases.

    PubMed

    Bates, Matthew; Marais, Ben J; Zumla, Alimuddin

    2015-02-06

    The 18th WHO Global Tuberculosis Annual Report indicates that there were an estimated 8.6 million incident cases of tuberculosis (TB) in 2012, which included 2.9 million women and 530,000 children. TB caused 1.3 million deaths including 320,000 human immunodeficiency virus (HIV)-infected people; three-quarters of deaths occurred in Africa and Southeast Asia. With one-third of the world's population latently infected with Mycobacterium tuberculosis (Mtb), active TB disease is primarily associated with a break down in immune surveillance. This explains the strong link between active TB disease and other communicable diseases (CDs) or noncommunicable diseases (NCDs) that exert a toll on the immune system. Comorbid NCD risk factors include diabetes, smoking, malnutrition, and chronic lung disease, all of which have increased relentlessly over the past decade in developing countries. The huge overlap between killer infections such as TB, HIV, malaria, and severe viral infections with NCDs, results in a "double burden of disease" in developing countries. The current focus on vertical disease programs fails to recognize comorbidities or to encourage joint management approaches. This review highlights major disease overlaps and discusses the rationale for better integration of tuberculosis care with services for NCDs and other infectious diseases to enhance the overall efficiency of the public health responses.

  8. Comorbidity between neurological illness and psychiatric disorders.

    PubMed

    Hesdorffer, Dale C

    2016-06-01

    Psychiatric disorders are common in many neurological disorders, including epilepsy, migraine, Alzheimer's disease, Parkinson's disease, essential tremor, and stroke. These comorbidities increase disease burden and may complicate the treatment of the combined disorders. Initial studies of the comorbidity of psychiatric and neurological disorders were cross-sectional, and time order of the associations was impossible to elucidate. More recent work has clarified time associations between psychiatric disorders and neurological disorders, particularly in epilepsy and stroke where epidemiological evidence suggests that there is a bidirectional relationship. This article takes an epidemiological approach to understanding these relationships and focuses mostly on epilepsy. Although, these relationships are understood in many neurological disorders, routine screening for psychiatric disorders in neurological disorders is infrequent, mostly due to the lack of partnerships between psychiatrists and neurologists and the paucity of neuropsychiatrists. Much more needs to be done to improve the detection and treatment of patients affected by neurological and psychiatric disorders. Understanding the scope of this overlap may inspire collaborations to improve the lives of people affected by both disorders.

  9. Adherence to Antihypertensives in Patients With Comorbid Condition

    PubMed Central

    Saadat, Zahra; Nikdoust, Farahnaz; Aerab-Sheibani, Hossein; Bahremand, Mostafa; Shobeiri, Elham; Saadat, Habibollah; Moharramzad, Yashar; Morisky, Donald E.

    2015-01-01

    Background: Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. Objectives: We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. Patients and Methods: Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. Results: The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. Conclusions: With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time. PMID:26539419

  10. [Comorbid autoimmune pathology in patients treated with disease modifying drugs].

    PubMed

    Goncharova, Z A; Sizyakina, L P; Belovolova, R A; Megeryan, V A

    2016-01-01

    Because of intensive growth of the prevalence of multiple sclerosis (MS) and other autoimmune diseases (AID) during the last years, the comorbidity of MS and AID is not a rarity. In this literature review, the development of comorbid AID in patients with MS is considered to be the probable complication of disease modifying therapy with drugs of different groups. The authors present the own data on the prevalence of comorbid autoimmune pathology in patients with MS treated with disease modifying drugs.

  11. Comorbid bipolar disorder and obsessive-compulsive disorder

    PubMed Central

    PENG, Daihui; JIANG, Kaida

    2015-01-01

    Summary Obsessive-compulsive symptoms are common in patients with bipolar disorders. This comorbid condition complicates the clinical treatment of the two disorders, so identifying these individuals is important. We discuss the comorbid occurrence of obsessive-compulsive disorder and bipolar disorder, introduce possible etiological mechanisms that could result in this common comorbid condition, discuss recent research advances in the area, and propose some clinical principles for managing such patients. PMID:26549961

  12. A case study in treating chronic comorbid obsessive-compulsive disorder and depression with behavioral activation and pharmacotherapy.

    PubMed

    Arco, Lucius

    2015-06-01

    Obsessive-compulsive disorder (OCD) is difficult to treat, and more so when comorbid with major depressive disorder (MDD). The aim of the present case study was to examine effects of behavioral activation (BA) and pharmacotherapy with an adult with chronic comorbid OCD and MDD. BA aimed at increasing approach behaviors in life activities and decreasing avoidant and inactive behaviors. After 21 months of treatment at a community mental health clinic, OCD and MDD symptoms, including compulsive checking behaviors, were no longer at clinical levels. Symptom alleviation and psychological health improved in line with increases in activities of living such as self-care, domestic, social, and studying, and decreases in medications from a regimen of mood stabilizers and anxiolytics to a sole antidepressant. The participant was satisfied with treatment procedures and outcome. The results add to growing evidence of effective BA treatments for comorbid disorders that include depression.

  13. Comorbidity and high viral load linked to clinical presentation of respiratory human bocavirus infection.

    PubMed

    Ghietto, Lucía María; Majul, Diego; Ferreyra Soaje, Patricia; Baumeister, Elsa; Avaro, Martín; Insfrán, Constanza; Mosca, Liliana; Cámara, Alicia; Moreno, Laura Beatriz; Adamo, Maria Pilar

    2015-01-01

    Human bocavirus (HBoV) is a new parvovirus associated with acute respiratory tract infection (ARTI). In order to evaluate HBoV significance as an agent of acute respiratory disease, we screened 1,135 respiratory samples from children and adults with and without symptoms during two complete calendar years. HBoV1 prevalence in patients with ARTI was 6.33 % in 2011 and 11.64 % in 2012, including neonatal and adult patients. HBoV1 was also detected in 3.77 % of asymptomatic individuals. The co-detection rate was 78.1 %. Among children, 87 % were clinically diagnosed with lower respiratory infection (no significant differences between patients with and without coinfection), and 31 % exhibited comorbidities. Pediatric patients with comorbidities were significantly older than patients without comorbidities. Patients with ARTI had either high or low viral load, while controls had only low viral load, but there were no clinical differences between patients with high or low viral load. In conclusion, we present evidence of the pathogenic potential of HBoV1 in young children with ARTI. Since patients with HBoV1-single infection are not significantly different from those with coinfection with respect to clinical features, the virus can be as pathogenic by itself as other respiratory agents are. Furthermore, an association between high HBoV1 load and disease could not be demonstrated in this study, but all asymptomatic individuals had low viral loads. Also, children with comorbidities are susceptible to HBoV1 infection at older ages than previously healthy children. Thus, the clinical presentation of infection may occur depending on both viral load and the particular interaction between the HBoV1 and the host.

  14. Comorbidities of Psoriasis - Exploring the Links by Network Approach

    PubMed Central

    Sundarrajan, Sudharsana; Arumugam, Mohanapriya

    2016-01-01

    Increasing epidemiological studies in patients with psoriasis report the frequent occurrence of one or more associated disorders. Psoriasis is associated with multiple comorbidities including autoimmune disease, neurological disorders, cardiometabolic diseases and inflammatory-bowel disease. An integrated system biology approach is utilized to decipher the molecular alliance of psoriasis with its comorbidities. An unbiased integrative network medicine methodology is adopted for the investigation of diseasome, biological process and pathways of five most common psoriasis associated comorbidities. A significant overlap was observed between genes acting in similar direction in psoriasis and its comorbidities proving the mandatory occurrence of either one of its comorbidities. The biological processes involved in inflammatory response and cell signaling formed a common basis between psoriasis and its associated comorbidities. The pathway analysis revealed the presence of few common pathways such as angiogenesis and few uncommon pathways which includes CCKR signaling map and gonadotrophin-realising hormone receptor pathway overlapping in all the comorbidities. The work shed light on few common genes and pathways that were previously overlooked. These fruitful targets may serve as a starting point for diagnosis and/or treatment of psoriasis comorbidities. The current research provides an evidence for the existence of shared component hypothesis between psoriasis and its comorbidities. PMID:26966903

  15. The challenge of comorbidity in clinical trials for multiple sclerosis

    PubMed Central

    Miller, Aaron; Sormani, Maria Pia; Thompson, Alan; Waubant, Emmanuelle; Trojano, Maria; O'Connor, Paul; Reingold, Stephen; Cohen, Jeffrey A.

    2016-01-01

    Objective: We aimed to provide recommendations for addressing comorbidity in clinical trial design and conduct in multiple sclerosis (MS). Methods: We held an international workshop, informed by a systematic review of the incidence and prevalence of comorbidity in MS and an international survey about research priorities for studying comorbidity including their relation to clinical trials in MS. Results: We recommend establishing age- and sex-specific incidence estimates for comorbidities in the MS population, including those that commonly raise concern in clinical trials of immunomodulatory agents; shifting phase III clinical trials of new therapies from explanatory to more pragmatic trials; describing comorbidity status of the enrolled population in publications reporting clinical trials; evaluating treatment response, tolerability, and safety in clinical trials according to comorbidity status; and considering comorbidity status in the design of pharmacovigilance strategies. Conclusion: Our recommendations will help address knowledge gaps regarding comorbidity that interfere with the ability to interpret safety in monitored trials and will enhance the generalizability of findings from clinical trials to “real world” settings where the MS population commonly has comorbid conditions. PMID:26888986

  16. Predicting Comorbid Conditions and Trajectories using Social Health Records.

    PubMed

    Ji, Xiang; Ae Chun, Soon; Geller, James

    2016-05-05

    Many patients suffer from comorbidity conditions, for example, obese patients often develop type-2 diabetes and hypertension. In the US, 80% of Medicare spending is for managing patients with these multiple coexisting conditions. Predicting potential comorbidity conditions for an individual patient can promote preventive care and reduce costs. Predicting possible comorbidity progression paths can provide important insights into population heath and aid with decisions in public health policies. Discovering the comorbidity relationships is complex and difficult, due to limited access to Electronic Health Records by privacy laws. In this paper, we present a collaborative comorbidity prediction method to predict likely comorbid conditions for individual patients, and a trajectory prediction graph model to reveal progression paths of comorbid conditions. Our prediction approaches utilize patient generated health reports on online social media, called Social Health Records (SHR). The experimental results based on one SHR source show that our method is able to predict future comorbid conditions for a patient with coverage values of 48% and 75% for a top-20 and a top-100 ranked list, respectively. For risk trajectory prediction, our approach is able to reveal each potential progression trajectory between any two conditions and infer the confidence of the future trajectory, given any observed condition. The predicted trajectories are validated with existing comorbidity relations from the medical literature.

  17. Validated Questionnaires heighten detection of Difficult Asthma Comorbidities.

    PubMed

    Radhakrishna, Naghmeh; Tay, Tunn Ren; Hore-Lacy, Fiona; Stirling, Robert; Hoy, R; Dabscheck, Eli; Hew, Mark

    2016-10-07

    Objective Multiple extra-pulmonary comorbidities contribute to difficult asthma, but their diagnosis can be challenging and time consuming. Previous data on comorbidity detection have focused on clinical assessment, which may miss certain conditions. We aimed to locate relevant validated screening questionnaires to identify extra-pulmonary comorbidities that contribute to difficult asthma, and evaluate their performance during a difficult asthma evaluation. Methods MEDLINE was searched to identify key extra-pulmonary comorbidities that contribute to difficult asthma. Screening questionnaires were chosen based on ease of use, presence of a cut off score, and adequate validation to help systematically identify comorbidities. In a consecutive series of 86 patients referred for systematic evaluation of difficult asthma, questionnaires were administered prior to clinical consultation. Results Six difficult asthma comorbidities and corresponding screening questionnaires were found: sinonasal disease (allergic rhinitis and chronic rhinosinusitis), vocal cord dysfunction, dysfunctional breathing, obstructive sleep apnea, anxiety and depression, and gastro-oesophageal reflux disease. When the questionnaires were added to the referring clinician's impression, the detection of all six comorbidities was significantly enhanced. The average time for questionnaire administration was approximately 40 minutes. Conclusions The use of validated screening questionnaires heightens detection of comorbidities in difficult asthma. The availability of data from a battery of questionnaires prior to consultation can save time and allow clinicians to systematically assess difficult asthma patients and to focus on areas of particular concern. Such an approach would ensure that all contributing comorbidities have been addressed before significant treatment escalation is considered.

  18. Comorbidities of Psoriasis - Exploring the Links by Network Approach.

    PubMed

    Sundarrajan, Sudharsana; Arumugam, Mohanapriya

    2016-01-01

    Increasing epidemiological studies in patients with psoriasis report the frequent occurrence of one or more associated disorders. Psoriasis is associated with multiple comorbidities including autoimmune disease, neurological disorders, cardiometabolic diseases and inflammatory-bowel disease. An integrated system biology approach is utilized to decipher the molecular alliance of psoriasis with its comorbidities. An unbiased integrative network medicine methodology is adopted for the investigation of diseasome, biological process and pathways of five most common psoriasis associated comorbidities. A significant overlap was observed between genes acting in similar direction in psoriasis and its comorbidities proving the mandatory occurrence of either one of its comorbidities. The biological processes involved in inflammatory response and cell signaling formed a common basis between psoriasis and its associated comorbidities. The pathway analysis revealed the presence of few common pathways such as angiogenesis and few uncommon pathways which includes CCKR signaling map and gonadotrophin-realising hormone receptor pathway overlapping in all the comorbidities. The work shed light on few common genes and pathways that were previously overlooked. These fruitful targets may serve as a starting point for diagnosis and/or treatment of psoriasis comorbidities. The current research provides an evidence for the existence of shared component hypothesis between psoriasis and its comorbidities.

  19. Major depression in panic disorder patients with comorbid social phobia.

    PubMed

    Reiter, S R; Otto, M W; Pollack, M H; Rosenbaum, J F

    1991-07-01

    Rates of depression among panic disorder patients are particularly elevated in patients with comorbid social phobia. However, it is unclear whether this association is specific to social phobia, or whether any comorbid anxiety disorder increases the risk of depression. We assessed 100 panic disorder patients and found a significantly higher incidence of lifetime major depression for panic patients with comorbid social phobia or generalized anxiety disorder (GAD). Panic patients with comorbid social phobia had significantly higher scores on measures of dysfunctional attitudes and lower scores on measures of assertiveness; these variables may mediate the link between social phobia and depression in this population.

  20. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life.

    PubMed

    Rodriguez-Penney, Alan T; Iudicello, Jennifer E; Riggs, Patricia K; Doyle, Katie; Ellis, Ronald J; Letendre, Scott L; Grant, Igor; Woods, Steven Paul

    2013-01-01

    This study sought to determine the synergistic effects of age and HIV infection on medical co-morbidity burden, along with its clinical correlates and impact on health-related quality of life (HRQoL) across the lifespan in HIV. Participants included 262 individuals across four groups stratified by age (≤40 and ≥50 years) and HIV serostatus. Medical co-morbidity burden was assessed using a modified version of the Charlson Co-morbidity Index (CCI). Multiple regression accounting for potentially confounding demographic, psychiatric, and medical factors revealed an interaction between age and HIV infection on the CCI, with the highest medical co-morbidity burden in the older HIV+cohort. Nearly half of the older HIV+group had at least one major medical co-morbidity, with the most prevalent being diabetes (17.8%), syndromic neurocognitive impairment (15.4%), and malignancy (12.2%). Affective distress and detectable plasma viral load were significantly associated with the CCI in the younger and older HIV-infected groups, respectively. Greater co-morbidity burden was uniquely associated with lower physical HRQoL across the lifespan. These findings highlight the prevalence and clinical impact of co-morbidities in older HIV-infected adults and underscore the importance of early detection and treatment efforts that might enhance HIV disease outcomes.

  1. Gender Dysphoria in Adults.

    PubMed

    Zucker, Kenneth J; Lawrence, Anne A; Kreukels, Baudewijntje P C

    2016-01-01

    Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.

  2. Senescence in COPD and Its Comorbidities.

    PubMed

    Barnes, Peter J

    2017-02-10

    Chronic obstructive pulmonary disease (COPD) is regarded as a disease of accelerated lung aging. This affliction shows all of the hallmarks of aging, including telomere shortening, cellular senescence, activation of PI3 kinase-mTOR signaling, impaired autophagy, mitochondrial dysfunction, stem cell exhaustion, epigenetic changes, abnormal microRNA profiles, immunosenescence, and a low-grade chronic inflammation (inflammaging). Many of these pathways are driven by chronic exogenous and endogenous oxidative stress. There is also a reduction in antiaging molecules, such as sirtuins and Klotho, which further accelerate the aging process. COPD is associated with several comorbidities (multimorbidity), such as cardiovascular and metabolic diseases, that share the same pathways of accelerated aging. Understanding these mechanisms has helped identify several novel therapeutic targets, and several drugs and dietary interventions are now in development to treat multimorbidity.

  3. Prevalence, incidence, and comorbidity of clinically diagnosed obsessive-compulsive disorder in Taiwan: a national population-based study.

    PubMed

    Huang, Li-Chung; Tsai, Kuen-Jer; Wang, Hao-Kuang; Sung, Pi-Shan; Wu, Ming-Hsiu; Hung, Kuo-Wei; Lin, Sheng-Hsiang

    2014-12-15

    Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder significant in intrusive thoughts and compensation repetitive behaviors. Few studies have reported on this condition Asia. This study estimated the prevalence, incidence and psychiatric comorbidities of OCD in Taiwan. We identified study subjects for 2000-2008 with a principal diagnosis of OCD according to the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic criteria by using National Health Research Institute database. These patients received either outpatient or inpatient care for their condition. Rates were directly age- and sex-adjusted to the 2004 Taiwan population distribution. The estimated mean annual incidence was 27.57 per 10(5) inhabitants and the one year prevalence was 65.05 per 10(5) inhabitants. Incidence and prevalence increased with age, peaking at age 18-24 years in males and at 35-44 years in females. About 53% of adults (≥18 years) and 48% of child and adolescent patients (6-17 years) had one or more comorbid psychiatric conditions. The most common comorbid diagnosis was depressive disorders for both adult and child-adolescent patients. We found a lower prevalence and incidence of clinically diagnosed OCD than that of community studies. Many Asian patients with OCD also had various psychiatric comorbidities, a clinically relevant finding.

  4. Book Review: ADHD with Comorbid Disorders: Clinical Assessment and Management.

    ERIC Educational Resources Information Center

    Kirkpatrick, Michael A.

    2001-01-01

    This article reviews "ADHD with Comorbid Disorders: Clinical Assessment and Management" by Steven R. Pliszka, Caryn L. Carlson, and James M. Swanson, a book that provides information on children displaying both attention-deficit/hyperactivity disorder and other comorbid psychiatric conditions, complex psychopharmacological interventions that may…

  5. Comorbidities in Preschool Children at Family Risk of Dyslexia

    ERIC Educational Resources Information Center

    Gooch, Debbie; Hulme, Charles; Nash, Hannah M.; Snowling, Margaret J.

    2014-01-01

    Background: Comorbidity among developmental disorders such as dyslexia, language impairment, attention deficit/hyperactivity disorder and developmental coordination disorder is common. This study explores comorbid weaknesses in preschool children at family risk of dyslexia with and without language impairment and considers the role that…

  6. Recommendations for observational studies of comorbidity in multiple sclerosis

    PubMed Central

    Miller, Aaron; Sormani, Maria Pia; Thompson, Alan; Waubant, Emmanuelle; Trojano, Maria; O'Connor, Paul; Fiest, Kirsten; Reider, Nadia; Reingold, Stephen; Cohen, Jeffrey A.

    2016-01-01

    Objective: To reach consensus about the most relevant comorbidities to study in multiple sclerosis (MS) with respect to incidence, prevalence, and effect on outcomes; review datasets that may support studies of comorbidity in MS; and identify MS outcomes that should be prioritized in such studies. Methods: We held an international workshop to meet these objectives, informed by a systematic review of the incidence and prevalence of comorbidity in MS, and an international survey regarding research priorities for comorbidity. Results: We recommend establishing age- and sex-specific incidence and prevalence estimates for 5 comorbidities (depression, anxiety, hypertension, hyperlipidemia, and diabetes); evaluating the effect of 7 comorbidities (depression, anxiety, hypertension, diabetes, hyperlipidemia, chronic lung disease, and autoimmune diseases) on disability, quality of life, brain atrophy and other imaging parameters, health care utilization, employment, and mortality, including age, sex, race/ethnicity, socioeconomic status, and disease duration as potential confounders; harmonizing study designs across jurisdictions; and conducting such studies worldwide. Ultimately, clinical trials of treating comorbidity in MS are needed. Conclusion: Our recommendations will help address knowledge gaps regarding the incidence, prevalence, and effect of comorbidity on outcomes in MS. PMID:26865523

  7. Neuroanatomical Correlates of Heterotypic Comorbidity in Externalizing Male Adolescents

    ERIC Educational Resources Information Center

    Sauder, Colin L.; Beauchaine, Theodore P.; Gatzke-Kopp, Lisa M.; Shannon, Katherine E.; Aylward, Elizabeth

    2012-01-01

    Children and adolescents with externalizing behavior disorders including attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) often present with symptoms of comorbid internalizing psychopathology. However, few studies have examined central nervous system correlates of such comorbidity. We evaluated interactions between…

  8. ADHD with Comorbid Disorders: Clinical Assessment and Management.

    ERIC Educational Resources Information Center

    Pliszka, Steven R.; Carlson, Caryn L.; Swanson, James M.

    This book is designed to help clinicians assess and treat children or adolescents with attention deficit/hyperactivity disorder who also present other disabilities. Major comorbidities are described in depth and empirically grounded guidelines are presented for evaluation and treatment. Part 1 provides an overview of issues in comorbidity,…

  9. ADHD with Comorbid Anxiety: A Review of the Current Literature

    ERIC Educational Resources Information Center

    Schatz, David Beck; Rostain, Anthony L.

    2006-01-01

    Objective/Method: ADHD is often comorbid with anxiety disorders, with rates approaching 25% in many samples. This current review's goal is to examine the literature on ADHD with comorbid anxiety from 1998 to the present. Results: Recent studies indicate that anxiety in ADHD may a) partially inhibit the impulsivity and response inhibition deficits,…

  10. Comorbid Psychiatric Disorders in Arab Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Amr, Mostafa; Raddad, Dahoud; El-Mehesh, Fatima; Bakr, Ashraf; Sallam, Khalid; Amin, Tarek

    2012-01-01

    The objective of our study is to estimate the prevalence of comorbid psychiatric disorders in a sample of children with autism spectrum disorders (ASD) recruited from three Arab countries. We also examine the relationship between comorbidity and children's cognitive functioning and gender. Children who received a diagnosis of ASD (n = 60) from a…

  11. The comorbidity of ADHD and autism spectrum disorder.

    PubMed

    Antshel, Kevin M; Zhang-James, Yanli; Faraone, Stephen V

    2013-10-01

    ADHD and autism spectrum disorder are common psychiatric comorbidities to each another. In addition, there is behavioral, biological and neuropsychological overlap between the two disorders. There are also several important differences between autism spectrum disorder and ADHD. Treatment strategies for the comorbid condition will also be reviewed. Future areas of research and clinical need will be discussed.

  12. Prevalence and patterns of comorbid cognitive impairment in low vision rehabilitation (LVR) for macular disease

    PubMed Central

    Whitson, Heather E.; Ansah, Deidra; Whitaker, Diane; Potter, Guy; Cousins, Scott W.; MacDonald, Heather; Pieper, Carl F.; Landerman, Lawrence; Steffens, David C.; Cohen, Harvey J.

    2009-01-01

    The prevalence of comorbid cognitive impairment among older adults referred to LVR for macular disease is unknown. We performed cognitive testing on 101 adults aged 65 years or older with macular disease who were referred to The Duke LVR Clinic between September 2007 and March 2008. Scores on the telephone interview for cognitive status-modified (TICS-m) ranged from 7 to 44, with 18.8% of scores below an established cutoff for cognitive impairment (≤ 27) and an additional 27.7% of scores considered marginal (28-30). On letter fluency, 46% of participants scored at least 1 × S.D. below the mean for their age, gender, race, and education level, and 18% of participants scored at least 2 × S.D. below their demographic mean. On logical memory, 26% of participants scored at least 1 × S.D. below the mean for their age group and race and 6% scored at least 2 × S.D. below their demographic mean. High prevalence of cognitive impairment, with particular difficulty in verbal fluency and verbal memory, may compromise the success of low vision rehabilitation interventions among macular disease patients. Additional work is needed to develop strategies to maximize function in older adults with this common comorbidity. PMID:19427045

  13. Vascular comorbidities in multiple sclerosis: a nationwide study from Denmark.

    PubMed

    Thormann, Anja; Magyari, Melinda; Koch-Henriksen, Nils; Laursen, Bjarne; Sørensen, Per Soelberg

    2016-12-01

    To investigate the occurrence of vascular comorbidities before and after the clinical onset of multiple sclerosis. In this combined case-control and cohort study, all Danish born citizens with onset of multiple sclerosis 1980-2005 were identified from the Danish Multiple Sclerosis Registry and randomly matched with controls regarding year of birth, gender, and municipality on January 1st in the year of multiple sclerosis (MS) onset (index date). Individual-level information on comorbidities was obtained from several independent nationwide registries and linked to the study population by unique personal identification numbers. To assess the presence of vascular comorbidities before and after MS onset, cases and controls were followed from January 1977 to the index date, and from the index date through December 2012. We used logistic regression to calculate odds ratios (ORs) and Cox regression to calculate hazard ratios (HRs). Before the index date, MS cases had a decreased probability for cerebrovascular comorbidity [OR 0.69 (95 % CI 0.48-0.99, p = 0.043)], and a numerically but not statistically significant decreased probability for cardiovascular comorbidity [OR 0.87 (95 % CI 0.71-1.07, p = 0.188)]. After the index date, MS cases had an increased risk for cerebrovascular comorbidity [HR 1.84 (95 % CI 1.69-2.00, p < 0.0005)], and for cardiovascular comorbidity [HR 1.08 (95 % CI 1.02-1.15, p = 0.013)]. The lower occurrence of cerebrovascular comorbidities in cases prior to MS onset could be due to protective immune mechanisms, while the higher occurrence of vascular comorbidities in cases after MS onset could be because of converging causal pathways of the coexisting diseases. These findings deserve to be studied closer in a broader spectrum of comorbidities in MS.

  14. Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder.

    PubMed

    Torresan, Ricardo C; Ramos-Cerqueira, Ana Teresa A; Shavitt, Roseli G; do Rosário, Maria Conceição; de Mathis, Maria Alice; Miguel, Euripedes C; Torres, Albina R

    2013-09-30

    The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18-77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and "compulsive" buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups.

  15. Mirtazapine in Comorbid Major Depression and Alcohol Dependence: An Open-Label Trial

    PubMed Central

    Cornelius, Jack R.; Douaihy, Antoine B.; Clark, Duncan B.; Chung, Tammy; Wood, D. Scott; Daley, Dennis

    2012-01-01

    Objective This was a first pilot study evaluating the acute phase (8-week) efficacy of the antidepressant medication mirtazapine for the treatment of depressive symptoms and drinking of subjects with comorbid major depressive disorder and alcohol dependence (MDD/AD). We hypothesized that mirtazapine would demonstrate within-group efficacy for the treatment of both depressive symptoms and drinking in these subjects. Methods We conducted a first open label study of the second generation antidepressant mirtazapine in 12 adult outpatient subjects with comorbid major depressive disorder/alcohol dependence. The pharmacological profile of that medication is unique among antidepressants, unrelated to tricyclics or selective serotonin reuptake inhibitors. Results Mirtazapine was well tolerated in this treatment population. Self-reported depressive symptoms decreased from 31.8 to 8.3 on the Beck Depression Inventory, a 74.0% decrease (p<0.001), and drinking decreased from 33.9 to 13.3 drinks per week, a 60.8% decrease (p<0.05). None of the subjects were employed full-time at baseline, but 9 of the 12 (75%) were employed full-time at end-of-study. Conclusions These preliminary findings suggest efficacy for mirtazapine for treating both the depressive symptoms and excessive alcohol use of comorbid major depressive disorder and alcohol dependence. Double-blind studies are warranted to further clarify the efficacy of mirtazapine in this population. PMID:23230395

  16. [Symptom variations in ADHD: importance of context, development and comorbidity].

    PubMed

    Purper-Ouakil, D; Wohl, M; Michel, G; Mouren, M C; Gorwood, P

    2004-01-01

    Attention-deficit hyperactivity (ADHD) is a common disorder in school-aged children and is associated with significant impairment in social and academic functioning. Its recognition is based on congruent information from different sources, because most ADHD children and adolescents are not completely aware of impairments caused by inattention and/or hyperactivity/impulsivity. Fluctuations in symptom expression may complicate the diagnosis: during clinical examination or tests sessions, ADHD symptoms may be less severe than usual or completely absent. This review examines variations in ADHD symptoms due to environmental context, internal state, circadian factors, development, psychiatric comorbidity and discusses their clinical relevance. Generally, ADHD symptoms are pervasive and identified in different areas of functioning. Despite their chronicity, they show a relative context-dependency. An unfamiliar environment or situation may lessen symptoms. The same happens in dual relations or in calm settings, when the child receives attention and positive reinforcement from the adult. On the contrary, the classroom situation with its high stimulation level (noise, visual distractors, large class size) is likely to reveal or accentuate instability, impulsivity and inattention. Independently from objective symptom fluctuations, the impact of ADHD symptoms, and their consequences on self-esteem may also vary with the degree of environmental mismatch. Recent research in experimental psychology also draws attention to the motivational state of ADHD children: preference for immediate gratification and delay aversion may explain why most of them show satisfactory attentional capacities in certain activities (for instance video games or TV), while showing impairment in school work or in other effortful tasks. The diagnosis of the full ADHD syndrome requires significant impact on functioning in at least two areas. Some children with "situational" ADHD are impaired either in

  17. Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study.

    PubMed

    Wittchen, H U; Fuetsch, M; Sonntag, H; Müller, N; Liebowitz, M

    2000-02-01

    Social phobia is increasingly recognized as a prevalent and socially impairing mental disorder. However, little data is available regarding the general and disease-specific impairments and disabilities associated with social phobia. Furthermore, most studies have not controlled for the confounding effects of comorbid conditions. This study investigates: (a) the generic quality of life; (b) work productivity; and, (c) various other disorder-specific social impairments in current cases with pure (n = 65), comorbid (n = 51) and subthreshold (n = 34) DSM-IV social phobia as compared to controls with no social phobia (subjects with a history of herpes infections). Social phobia cases reported a mean illness duration of 22.9 years with onset in childhood or adolescence. Current quality of life, as assessed by the SF-36, was significantly reduced in all social phobia groups, particularly in the scales measuring vitality, general health, mental health, role limitations due to emotional health, and social functioning. Comorbid cases revealed more severe reductions than pure and subthreshold social phobics. Findings from the Liebowitz self-rated disability scale indicated that: (a) social phobia affects most areas of life, but in particular education, career, and romantic relationship; (b) the presence of past and current comorbid conditions increases the frequency and severity of disease-specific impairments; and, (c) subthreshold social phobia revealed slightly lower overall impairments than comorbid social phobics. Past-week work productivity of social phobics was significantly diminished as indicated by: (a) a three-fold higher rate of unemployed cases; (b) elevated rates of work hours missed due to social phobia problems; and (c) a reduced work performance. Overall, these findings underline that social phobia in our sample of adults, whether comorbid, subthreshold, or pure was a persisting and impairing condition, resulting in considerable subjective suffering and

  18. The impact of comorbid migraine on quality of life outcomes after endoscopic sinus surgery

    PubMed Central

    DeConde, Adam S.; Mace, Jess C.; Smith, Timothy L.

    2014-01-01

    Objectives Chronic rhinosinusitis (CRS) and migraine are common entities with overlapping symptomatology yet little research exists which investigates the intersection of the two. This study seeks to investigate whether patients with CRS with and without a migraine history experience comparable quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS). Study Design Retrospective analysis of a prospective cohort Methods An adult population (n=229) with medically refractory CRS was prospectively evaluated following ESS using disease-specific QOL surveys: the Rhinosinusitis Disability Index (RSDI), the Chronic Sinusitis Survey (CSS), and the Sinonasal Outcome Test-22 (SNOT-22). History of comorbid migraine was identified (n=46) and pre- and postoperative QOL was compared to patients without migraine (n=183). Results Patients migraine and CRS were more likely to be female (p=0.023), experience allergies (p=0.024), fibromyalgia (p=0.009), depression (p=0.010), and be less likely to have nasal polyposis (p=0.003). Objective measures of disease (endoscopy and computed tomography scores) were significantly lower in patients with migraine (p=0.027 and p=0.002, respectively), yet these patients scored lower on baseline RSDI and SNOT-22 scores (p=0.025 and p=0.019, respectively). QOL in both patients with and without migraine improved significantly after ESS (p<0.003) and by comparable magnitudes (p>0.062). Conclusion Patients with comorbid migraine and CRS are more likely to have less severe evidence of disease and worse preoperative baseline QOL scores. This may imply that comorbid migraine disorder, in the setting of CRS, compels these patients to seek surgical management earlier in the disease process. Regardless, ESS provides comparable improvement for both patients with and without comorbid migraine. PMID:24431279

  19. Predicting mortality from change-over-time in the Charlson Comorbidity Index

    PubMed Central

    Fraccaro, Paolo; Kontopantelis, Evangelos; Sperrin, Matthew; Peek, Niels; Mallen, Christian; Urban, Philip; Buchan, Iain E.; Mamas, Mamas A.

    2016-01-01

    Abstract Multimorbidity is common among older people and presents a major challenge to health systems worldwide. Metrics of multimorbidity are, however, crude: focusing on measuring comorbid conditions at single time-points rather than reflecting the longitudinal and additive nature of chronic conditions. In this paper, we explore longitudinal comorbidity metrics and their value in predicting mortality. Using linked primary and secondary care data, we conducted a retrospective cohort study on adults in Salford, UK from 2005 to 2014 (n = 287,459). We measured multimorbidity with the Charlson Comorbidity Index (CCI) and quantified its changes in various time windows. We used survival models to assess the relationship between CCI changes and mortality, controlling for gender, age, baseline CCI, and time-dependent CCI. Goodness-of-fit was assessed with the Akaike Information Criterion and discrimination with the c-statistic. Overall, 15.9% patients experienced a change in CCI after 10 years, with a mortality rate of 19.8%. The model that included gender and time-dependent age, CCI, and CCI change across consecutive time windows had the best fit to the data but equivalent discrimination to the other time-dependent models. The absolute CCI score gave a constant hazard ratio (HR) of around 1.3 per unit increase, while CCI change afforded greater prognostic impact, particularly when it occurred in shorter time windows (maximum HR value for the 3-month time window, with 1.63 and 95% confidence interval 1.59–1.66). Change over time in comorbidity is an important but overlooked predictor of mortality, which should be considered in research and care quality management. PMID:27787358

  20. Comorbidities in Neurology: Is adenosine the common link?

    PubMed

    Boison, Detlev; Aronica, Eleonora

    2015-10-01

    Comorbidities in Neurology represent a major conceptual and therapeutic challenge. For example, temporal lobe epilepsy (TLE) is a syndrome comprised of epileptic seizures and comorbid symptoms including memory and psychiatric impairment, depression, and sleep dysfunction. Similarly, Alzheimer's disease (AD), Parkinson's disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are accompanied by various degrees of memory dysfunction. Patients with AD have an increased likelihood for seizures, whereas all four conditions share certain aspects of psychosis, depression, and sleep dysfunction. This remarkable overlap suggests common pathophysiological mechanisms, which include synaptic dysfunction and synaptotoxicity, as well as glial activation and astrogliosis. Astrogliosis is linked to synapse function via the tripartite synapse, but astrocytes also control the availability of gliotransmitters and adenosine. Here we will specifically focus on the 'adenosine hypothesis of comorbidities' implying that astrocyte activation, via overexpression of adenosine kinase (ADK), induces a deficiency in the homeostatic tone of adenosine. We present evidence from patient-derived samples showing astrogliosis and overexpression of ADK as common pathological hallmark of epilepsy, AD, PD, and ALS. We discuss a transgenic 'comorbidity model', in which brain-wide overexpression of ADK and resulting adenosine deficiency produces a comorbid spectrum of seizures, altered dopaminergic function, attentional impairment, and deficits in cognitive domains and sleep regulation. We conclude that dysfunction of adenosine signaling is common in neurological conditions, that adenosine dysfunction can explain co-morbid phenotypes, and that therapeutic adenosine augmentation might be effective for the treatment of comorbid symptoms in multiple neurological conditions.

  1. How I assess comorbidities before hematopoietic cell transplantation

    PubMed Central

    Sorror, Mohamed L.

    2013-01-01

    The hematopoietic cell transplantation-comorbidity index (HCT-CI) is a comorbidity tool suited for recipients of HCT. The index has been shown to sensitively capture the prevalence and magnitude of severity of various organ impairments before HCT and to provide valuable prognostic information after HCT. Many investigators have validated the discriminative power of the HCT-CI, but others have not. One concern is the consistency in comorbidity coding across different evaluators, particularly in view of the relatively recent addition of the HCT-CI to the transplant evaluation process. In this article, comorbidity scoring was tested across different evaluators, and only a fair interobserver agreement rate could be detected. To address these issues, a brief training program is proposed here, consisting of systematic methodology for data acquisition and consistent guidelines for comorbidity coding that were summarized in a Web-based calculator. In a validation patient cohort, this training program was shown to improve the interevaluator agreement on HCT-CI scores to an excellent rate with weighted κ values in the range of 0.89 to 0.97. This proposed training program will facilitate reliable assessment of comorbidities in the clinic and for research studies leading to standardization of the use of comorbidities in prediction of HCT outcomes. PMID:23355537

  2. Substance use disorders and psychiatric comorbidity in mid and later life: a review

    PubMed Central

    Wu, Li-Tzy; Blazer, Dan G

    2014-01-01

    Background Globally, adults aged 65 years or older will increase from 516 million in 2009 to an estimated 1.53 billion in 2050. Due to substance use at earlier ages that may continue into later life, and ageing-related changes in medical conditions, older substance users are at risk for substance-related consequences. Methods MEDLINE and PsychInfo databases were searched using keywords: alcohol use disorder, drug use disorder, drug misuse, substance use disorder, prescription drug abuse, and substance abuse. Using the related-articles link, additional articles were screened for inclusion. This review focused on original studies published between 2005 and 2013 to reflect recent trends in substance use disorders. Studies on psychiatric comorbidity were also reviewed to inform treatment needs for older adults with a substance use disorder. Results Among community non-institutionalized adults aged 50+ years, about 60% used alcohol, 3% used illicit drugs and 1–2% used nonmedical prescription drugs in the past year. Among adults aged 50+, about 5% of men and 1.4% of women had a past-year alcohol use disorder. Among alcohol users, about one in 14 users aged 50–64 had a past-year alcohol use disorder vs one in 30 elder users aged 65+. Among drug users aged 50+, approximately 10–12% had a drug use disorder. Similar to depressive and anxiety disorders, substance use disorders were among the common psychiatric disorders among older adults. Older drug users in methadone maintenance treatment exhibited multiple psychiatric or medical conditions. There have been increases in treatment admissions for illicit and prescription drug problems in the United States. Conclusions Substance use in late life requires surveillance and research, including tracking substance use in the racial/ethnic populations and developing effective care models to address comorbid medical and mental health problems. PMID:24163278

  3. Sub-Diagnostic Psychiatric Comorbidity in Alcoholics

    PubMed Central

    Fein, George; Di Sclafani, Victoria; Finn, Peter; Scheiner, Diane L.

    2007-01-01

    Background Psychiatric comorbidity in alcohol use disorders is clearly established, however most studies ignore data on psychiatric symptom counts that do not meet criteria for a diagnosis. We examined psychiatric symptom counts and psychological measures in the domains of anxiety, mood and externalizing pathology in 48 long-term abstinent alcoholics (LTAA) compared to 48 age/gender comparable light/non-drinking controls(NC). Methods Continuous measures of pathology (i.e., symptoms counts and psychological assessments) in each domain were compared between groups for: 1) all study participants, 2) excluding individuals with a lifetime psychiatric diagnosis in the domain, and 3) excluding individuals with a current psychiatric diagnosis in the domain. Results Psychiatric symptom counts and psychological pathology were greater in LTAA than NC. The differences between groups on these measures were not reduced by removal of individuals with lifetime or current diagnoses. Conclusions The bulk of the difference between LTAA and NC in psychiatric illness was carried by sub-diagnostic psychopathology. In comparison to the limited view provided by using only symptomatology that meets criteria for a diagnosis, the use of continuous measures of psychiatric symptomatology and psychological abnormality yields a much more accurate picture of psychiatric illness co-occurring with alcoholism. PMID:16965876

  4. Comorbidity of personality disorders with alcohol abuse.

    PubMed

    Mellos, Eleftherios; Liappas, Ioannis; Paparrigopoulos, Thomas

    2010-01-01

    There is high comorbidity of alcohol dependence with mood, anxiety, substance abuse and personality disorders. Personality disorders, in particular, are considered to be an important contributing and/or predisposing factor in the pathogenesis, clinical course and treatment outcome of alcohol dependence. According to clinical and epidemiological studies, the prevalence of personality disorders in alcoholism ranges from as low as 22-40% to as high as 58-78%. The literature has focused primarily on antisocial and borderline personality disorders; however, almost the whole spectrum of personality disorders can be encountered in alcohol dependence, such as the dependent, avoidant, paranoid and others. A number of factors, such as sampling methods, diagnostic criteria used or assessment procedures applied, may explain this wide variation. The quest of a distinct 'alcoholic personality' dates from the first half of the 20th century but failed to reveal consistent and strong substantiation. However, renewed efforts provided evidence for the importance of impulsivity/ disinhibition and neuroticism/negative affectivity in the development of alcohol dependence; the role of other personality traits such as extraversion/sociability is still unclear. These findings led to a number of typologies, some of the most popular and influential being those of Cloninger, Babor, and Lesch.

  5. Comorbid medical illness in bipolar disorder

    PubMed Central

    Forty, Liz; Ulanova, Anna; Jones, Lisa; Jones, Ian; Gordon-Smith, Katherine; Fraser, Christine; Farmer, Anne; McGuffin, Peter; Lewis, Cathryn M.; Hosang, Georgina M.; Rivera, Margarita; Craddock, Nick

    2014-01-01

    Background Individuals with a mental health disorder appear to be at increased risk of medical illness. Aims To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden. Method Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria. Results We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset. Conclusions Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role. PMID:25359927

  6. Prevalence, Risk Factors, and Comorbidities of Hidradenitis Suppurativa.

    PubMed

    Miller, Iben Marie; McAndrew, Rachel J; Hamzavi, Iltefat

    2016-01-01

    It is challenging to estimate a true prevalence of hidradenitis suppurativa (HS) because it is underdiagnosed and misdiagnosed. Prevalences have been reported from 0.00033% to 4.1%. The incidence seems to be rising. In addition to dermatologic symptoms, HS is associated with metabolic syndrome, and increased cardiovascular risk. The majority of HS patients are smokers. Additional somatic comorbidities complicating HS include autoimmune conditions, follicular syndromes, rheumatologic conditions, and malignancies. HS patients are troubled by psychological comorbidities. When treating HS patients it is imperative not only to treat the skin symptoms, but also address the screening and treatment of possible comorbidities.

  7. Comorbidities and cognitive functioning: implications for nursing research and practice.

    PubMed

    Vance, David; Larsen, Kirsten I; Eagerton, Gregory; Wright, Mary A

    2011-08-01

    Optimal cognitive functioning is necessary to successfully negotiate one's environment, yet medical conditions can interfere with brain health, thus negatively impacting cognitive functioning. Such comorbidities include hypertension, heart disease, diabetes, depression, and HIV, as well as others. The physiological properties of these comorbidities can reduce one's cognitive reserve and limit one's cognitive efficiency. This article provides an overview of a few common comorbidities known to affect cognitive functioning and addresses ways in which cognitive functioning may be ameliorated and protected or mitigated in lieu of cognitive declines in such clinical populations. Implications for nursing practice and research are posited.

  8. COMORBIDITIES IN PATIENTS WITH CRYSTAL DISEASES AND HYPERURICEMIA

    PubMed Central

    Sattui, Sebastian E; Singh, Jasvinder A

    2014-01-01

    Summary Crystal arthropathies are among the most common causes of painful inflammatory arthritis. Gout, the most common example, has been associated with cardiovascular and renal disease. In the last years, evidence on these associations and those involving other comorbidities, such as the metabolic syndrome, have emerged and established the importance of asymptomatic hyperuricemia. This review article presents an update on evidence, both experimental and clinical, describing associations between hyperuricemia, gout, and several comorbidities. Causality on calcium pyrophosphate arthropathy and associated comorbidities is also briefly reviewed. PMID:24703346

  9. Diagnosis and Treatment of Insomnia Comorbid with Obstructive Sleep Apnea.

    PubMed

    Lack, Leon; Sweetman, Alexander

    2016-09-01

    Insomnia is often comorbid with obstructive sleep apnea. It reduces positive airway pressure (PAP) therapy acceptance and adherence. Comorbid patients show greater daytime impairments and poorer health outcomes. The insomnia often goes undiagnosed, undertreated, or untreated. Pharmacotherapy is not recommended for long-term treatment. Although care should be taken administering behavioral therapies to patients with elevated sleepiness, cognitive behavior therapy for insomnia (CBTi) is an effective and durable nondrug therapy that reduces symptoms and may increase the effectiveness of PAP therapy. Sleep clinics should be alert to comorbid insomnia and provide adequate diagnostic tools and clinicians with CBTi expertise.

  10. Late-life comorbid insomnia: diagnosis and treatment.

    PubMed

    McCrae, Christina S

    2009-02-01

    Changing sleep architecture in the elderly may increase their vulnerability to comorbid insomnia. Common comorbid conditions include chronic pain, depression, nocturia, and neurologic conditions such as Parkinson's and Alzheimer's disease. Diagnosing and treating comorbid insomnia in an older population poses special challenges for clinicians given the variety of coexisting medical and psychological conditions, polypharmacy, and the potential adverse effects of the most commonly used medications for insomnia in this population. Thus, the use of nonpharmacologic treatments, such as cognitive behavior therapy and relaxation techniques, is recommended before any medical approaches.

  11. Genomic Study of Cardiovascular Continuum Comorbidity

    PubMed Central

    Makeeva, O. A.; Sleptsov, A. A.; Kulish, E. V.; Barbarash, O. L.; Mazur, A. M.; Prokhorchuk, E. B.; Chekanov, N. N.; Stepanov, V. A.; Puzyrev, V. P.

    2015-01-01

    Comorbidity or a combination of several diseases in the same individual is a common and widely investigated phenomenon. However, the genetic background for non–random disease combinations is not fully understood. Modern technologies and approaches to genomic data analysis enable the investigation of the genetic profile of patients burdened with several diseases (polypathia, disease conglomerates) and its comparison with the profiles of patients with single diseases. An association study featuring three groups of patients with various combinations of cardiovascular disorders and a control group of relatively healthy individuals was conducted. Patients were selected as follows: presence of only one disease, ischemic heart disease (IHD); a combination of two diseases, IHD and arterial hypertension (AH); and a combination of several diseases, including IHD, AH, type 2 diabetes mellitus (T2DM), and hypercholesterolemia (HC). Genotyping was performed using the “My Gene” genomic service (www.i–gene.ru). An analysis of 1,400 polymorphic genetic variants and their associations with the studied phenotypes are presented. A total of 14 polymorphic variants were associated with the phenotype “IHD only,” including those in the APOB, CD226, NKX2–5, TLR2, DPP6, KLRB1, VDR, SCARB1, NEDD4L, and SREBF2 genes, and intragenic variants rs12487066, rs7807268, rs10896449, and rs944289. A total of 13 genetic markers were associated with the “IHD and AH” phenotype, including variants in the BTNL2, EGFR, CNTNAP2, SCARB1, and HNF1A genes, and intragenic polymorphisms rs801114, rs10499194, rs13207033, rs2398162, rs6501455, and rs1160312. A total of 14 genetic variants were associated with a combination of several diseases of cardiovascular continuum (CVC), including those in the TAS2R38, SEZ6L, APOA2, KLF7, CETP, ITGA4, RAD54B, LDLR, and MTAP genes, along with intragenic variants rs1333048, rs1333049, and rs6501455. One common genetic marker was identified for the

  12. Common comorbidities in women and men with epilepsy and the relationship between number of comorbidities and health plan paid costs in 2010.

    PubMed

    Wilner, A N; Sharma, B K; Soucy, A; Thompson, A; Krueger, A

    2014-03-01

    The objectives of this observational study were to determine the prevalence of the most common comorbidities in women and men with epilepsy and to demonstrate the relationship of these comorbidities to health plan paid costs. Data for 6621 members with epilepsy (52% women, 48% men) from eight commercial health plans were analyzed. The presence of comorbidities in people with epilepsy was identified by searching health insurance claims for 29 prespecified comorbidity-specific diagnosis codes. More women (50%) than men (43%) with epilepsy had one or more of the 29 comorbidities (p<0.05). The top 10 comorbidities for women and their relative prevalences were psychiatric diagnosis (16%), hypertension (12%), asthma (11%), hyperlipidemia (11%), headache (7%), diabetes (6%), urinary tract infection (5%), hypothyroidism (5%), anemia (5%), and migraine (4%). For men, the top 10 comorbidities and their relative prevalences were psychiatric diagnosis (15%), hyperlipidemia (12%), hypertension (12%), asthma (8%), diabetes (5%), headache (4%), cancer (4%), coronary artery disease (3%), anemia (3%), and gastroesophageal reflux disease (3%). Seven of the top 10 comorbidities were common to both women and men. Psychiatric diagnosis was the only comorbidity among the top five comorbidities for all age groups. The presence of one comorbidity approximately tripled the health-care cost for that member compared with the cost for members who had no comorbidities. Additional comorbidities generally further increased costs. The increase in health-care cost per member per month ($) with increase in number of comorbidities was greater for men than for women (p<0.05).

  13. Axis II comorbidity and developmental adversity in bulimia nervosa.

    PubMed

    Steiger, H; Jabalpurwala, S; Champagne, J

    1996-09-01

    Using data from 61 bulimic patients, we evaluated associations among axis II disturbances, psychopathological traits, eating symptoms, and adverse developmental experiences (e.g., childhood sexual and physical abuse). Findings showed likelihood of childhood abuse to increase markedly in function of comorbid personality pathology. In addition, comorbid borderline personality disorder was found to be a better predictor of object-relations disturbances, primitive defenses, and hostility than developmental adversity was. Although marked trait disturbances were strongly associated with borderline personality disorder (more than with severity of childhood adversity), the converse seemed true of severity of bulimic symptoms (i.e., comorbid personality disorder had no predictive effects, whereas developmental variables had inconsistent effects). Bulimic and general psychopathological symptoms, thus, seemed to have intriguingly independent determinants. We interpret these findings as showing that the observed association between developmental adversity and bulimic syndromes may, in large part, be attributable to comorbid personality pathology.

  14. Study Parses Comorbidity of Cannabis Use and Social Anxiety

    MedlinePlus

    ... Use and Social Anxiety Study Parses Comorbidity of Cannabis Use and Social Anxiety Email Facebook Twitter October ... difficulties and other cannabis-related problems. SAD and Cannabis Use Severity Further analysis suggested that people with ...

  15. Metacognitive Therapy for Comorbid Anxiety Disorders: A Case Study

    PubMed Central

    Johnson, Sverre U.; Hoffart, Asle

    2016-01-01

    We aimed to systematically evaluate a generic model of metacognitive therapy (MCT) with a highly comorbid anxiety disorder patient, that had been treated with diagnosis-specific cognitive-behavioral therapy (CBT) without significant effect. Traditionally, CBT has progressed within a disorder-specific approach, however, it has been suggested that this could be less optimal with highly comorbid patients. To address comorbidity, transdiagnostic treatment models have been emerging. This case study used an AB-design with repeated assessments during each therapy session and a 1-year follow-up assessment to evaluate the effectiveness of MCT. Following 8 sessions of MCT, significant decrease in anxiety and depression symptoms, as well as loss of diagnostic status was observed. Outcomes were preserved at 12 months follow up. The generic model of MCT seems promising as an approach to highly comorbid mixed anxiety depression patients. Further testing using more powered methodologies are needed. PMID:27746757

  16. Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder.

    PubMed

    Diamond, Diana; Levy, Kenneth N; Clarkin, John F; Fischer-Kern, Melitta; Cain, Nicole M; Doering, Stephan; Hörz, Susanne; Buchheim, Anna

    2014-10-01

    We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Attachment and mentalization were assessed on the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996). Results showed that as expected, compared with the BPD group, the NPD/BPD group was significantly more likely to be categorized as either dismissing or cannot classify on the AAI, whereas the BPD group was more likely to be classified as either preoccupied or unresolved for loss and abuse than was the NPD/BPD group. Both groups of patients scored low on mentalizing, and there were no significant differences between the groups, indicating that both NPD/BPD and BPD individuals showed deficits in this capacity. The clinical implications of the group differences in AAI classification are discussed with a focus on how understanding the attachment representations of NPD/BPD patients helps to illuminate their complex, contradictory mental states.

  17. Metabolic syndrome and childhood trauma: Also comorbidity and complication in mood disorder

    PubMed Central

    Kesebir, Sermin

    2014-01-01

    Studies for prevalence and causal relationship established that addressing comorbidities of mental illnesses with medical disease will be another revolution in psychiatry. Increasing number of evidence shows that there is a bidirectional connection between mood disorders and some medical diseases. Glucocorticoid/insulin signal mechanisms and immunoenflammatory effector systems are junction points that show pathophysiology between bipolar disorder and general medical situations susceptible to stress. A subgroup of mood disorder patients are under risk of developing obesity and diabetes. Their habits and life styles, genetic predisposition and treatment options are parameters that define this subgroup. Medical disease in adults had a significant relationship to adverse life experiences in childhood. This illustrates that adverse experiences in childhood are related to adult disease by two basic etiologic mechanisms: (1) conventional risk factors that actually are compensatory behaviors, attempts at self-help through the use of agents and foods; and (2) the effects of chronic stress. PMID:25133143

  18. Enhanced Cognitive Rehabilitation to Treat Comorbid TBI and PTSD

    DTIC Science & Technology

    2014-10-01

    AD Award Number: W81XWH-11-1-0641 TITLE: Enhanced Cognitive Rehabilitation to Treat Comorbid TBI and PTSD PRINCIPAL...DATES COVERED 15 Sep 2013 – 14 Sep 2014 4. TITLE AND SUBTITLE Enhanced Cognitive Rehabilitation to Treat Comorbid TBI and PTSD 5a. CONTRACT...therapy (CPT), an empirically supported treatment for PTSD, in which CPT is enhanced with compensatory cognitive rehabilitation principles. The

  19. Incorporating comorbidities into latent treatment pattern mining for clinical pathways.

    PubMed

    Huang, Zhengxing; Dong, Wei; Ji, Lei; He, Chunhua; Duan, Huilong

    2016-02-01

    In healthcare organizational settings, the design of a clinical pathway (CP) is challenging since patients following a particular pathway may have not only one single first-diagnosis but also several typical comorbidities, and thus it requires different disciplines involved to put together their partial knowledge about the overall pathway. Although many data mining techniques have been proposed to discover latent treatment information for CP analysis and reconstruction from a large volume of clinical data, they are specific to extract nontrivial information about the therapy and treatment of the first-diagnosis. The influence of comorbidities on adopting essential treatments is crucial for a pathway but has seldom been explored. This study proposes to extract latent treatment patterns that characterize essential treatments for both first-diagnosis and typical comorbidities from the execution data of a pathway. In particular, we propose a generative statistical model to extract underlying treatment patterns, unveil the latent associations between diagnosis labels (including both first-diagnosis and comorbidities) and treatments, and compute the contribution of comorbidities in these patterns. The proposed model extends latent Dirichlet allocation with an additional layer for diagnosis modeling. It first generates a set of latent treatment patterns from diagnosis labels, followed by sampling treatments from each pattern. We verify the effectiveness of the proposed model on a real clinical dataset containing 12,120 patient traces, which pertain to the unstable angina CP. Three treatment patterns are discovered from data, indicating latent correlations between comorbidities and treatments in the pathway. In addition, a possible medical application in terms of treatment recommendation is provided to illustrate the potential of the proposed model. Experimental results indicate that our approach can discover not only meaningful latent treatment patterns exhibiting

  20. Prazosin for Treatment With PTSD And Comorbid Alcohol Dependence

    DTIC Science & Technology

    2010-07-01

    There is a high rate of comorbidity with alcohol dependence (AD) and post traumatic stress disorder (PTSD). The rates of PTSD among individuals with...AD are at least twice as high as those in the general population. In addition, alcohol dependence is the most common comorbid condition in men with...sleep disturbance in combat veterans with PTSD and alcohol dependence . The objective of this study is to evaluate the efficacy of prazosis (16mg

  1. Management of obsessive-compulsive disorder comorbid with bipolar disorder

    PubMed Central

    Kazhungil, Firoz; Mohandas, E.

    2016-01-01

    Obsessive-compulsive disorder (OCD) is one of the most common comorbidities in bipolar disorder (BD). Clinicians often get perplexed in making treatment decisions when encountering comorbid OCD and BD as treatment of OCD by pharmacotherapy may induce or exacerbate mood instability and psychotherapeutic approaches for OCD may not be feasible in acute manic or depressive state of BD. In this study, we reviewed literature, whether existing guideline-based treatments of BD may be effective in OCD and whether newer agents will be of use for treating this comorbidity. We could find that treatment of such comorbid disorder is largely understudied. Adjuvant topiramate or olanzapine- selective serotonin reuptake inhibitor/clomipramine combination along with mood stabilizer is found to be effective for treating OCD in BD. Use of other conventional pharmacological agents and psychotherapy for treating comorbid OCD in BD lacks evidence and is limited to case reports. Our review also highlights the need for further studies regarding the treatment strategies in this highly prevalent comorbid disorder. PMID:28066002

  2. Comorbidities in Neurology: Is Adenosine the Common Link?

    PubMed Central

    Boison, Detlev; Aronica, Eleonora

    2015-01-01

    Comorbidities in Neurology represent a major conceptual and therapeutic challenge. For example, temporal lobe epilepsy (TLE) is a syndrome comprised of epileptic seizures and comorbid symptoms including memory and psychiatric impairment, depression, and sleep dysfunction. Similarly, Alzheimer’s disease (AD), Parkinson’s disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are accompanied by various degrees of memory dysfunction. Patients with AD have an increased likelihood for seizures, whereas all four conditions share certain aspects of psychosis, depression, and sleep dysfunction. This remarkable overlap suggests common pathophysiological mechanisms, which include synaptic dysfunction and synaptotoxicity, as well as glial activation and astrogliosis. Astrogliosis is linked to synapse function via the tripartite synapse, but astrocytes also control the availability of gliotransmitters and adenosine. Here we will specifically focus on the ‘adenosine hypothesis of comorbidities’ implying that astrocyte activation, via overexpression of adenosine kinase (ADK), induces a deficiency in the homeostatic tone of adenosine. We present evidence from patient-derived samples showing astrogliosis and overexpression of ADK as common pathological hallmark of epilepsy, AD, PD, and ALS. We discuss a transgenic ‘comorbidity model’, in which brain-wide overexpression of ADK and resulting adenosine deficiency produces a comorbid spectrum of seizures, altered dopaminergic function, attentional impairment, and deficits in cognitive domains and sleep regulation. We conclude that dysfunction of adenosine signaling is common in neurological conditions, that adenosine dysfunction can explain comorbid phenotypes, and that therapeutic adenosine augmentation might be effective for the treatment of comorbid symptoms in multiple neurological conditions. PMID:25979489

  3. Psychiatric Comorbidity and Acculturation Stress Among Puerto Rican Substance Abusers

    PubMed Central

    Conway, Kevin P.; Swendsen, Joel D.; Dierker, Lisa; Canino, Glorisa; Merikangas, Kathleen R.

    2007-01-01

    Background Although acculturation to the United States has been associated with an increase in substance, mood, and anxiety disorders in Latino populations, few studies have examined this concept relative to comorbidity among these syndromes. Methods This study: (1) compares the prevalence and patterns of psychiatric comorbidity among Puerto Ricans with substance use disorders living in San Juan (Puerto Rico) to those who have migrated to New Haven (Connecticut); and (2) examines the association between acculturation-related stress and the prevalence and patterns of psychiatric comorbidity among those who have migrated to New Haven. Results Lifetime levels of nearly all comorbid psychiatric disorders among respondents with substance use disorders (SUD) was generally similar across sites. However, the risk of any co-occurring psychiatric disorder was higher among SUD cases in New Haven who reported high levels of total acculturation stress and family-specific acculturation stress. These findings were generally accounted for by associations between affective disorders and high scores on these indicators of acculturation stress. Conclusions The overall prevalence and patterns of psychiatric comorbidity are remarkably similar among Puerto Rican substance abusers whether they live in San Juan or have migrated to New Haven, thereby demonstrating robustness to differences in geographic location. Nevertheless, the degree of acculturation-related family stress is positively associated with co-occurring substance and psychiatric disorders, particularly affective disorders. Intervention in family strain related to the acculturation process may diminish the development of comorbid mental disorders and assist in implementing successful treatment of substance abuse. PMID:17543714

  4. Management of obsessive-compulsive disorder comorbid with bipolar disorder.

    PubMed

    Kazhungil, Firoz; Mohandas, E

    2016-01-01

    Obsessive-compulsive disorder (OCD) is one of the most common comorbidities in bipolar disorder (BD). Clinicians often get perplexed in making treatment decisions when encountering comorbid OCD and BD as treatment of OCD by pharmacotherapy may induce or exacerbate mood instability and psychotherapeutic approaches for OCD may not be feasible in acute manic or depressive state of BD. In this study, we reviewed literature, whether existing guideline-based treatments of BD may be effective in OCD and whether newer agents will be of use for treating this comorbidity. We could find that treatment of such comorbid disorder is largely understudied. Adjuvant topiramate or olanzapine- selective serotonin reuptake inhibitor/clomipramine combination along with mood stabilizer is found to be effective for treating OCD in BD. Use of other conventional pharmacological agents and psychotherapy for treating comorbid OCD in BD lacks evidence and is limited to case reports. Our review also highlights the need for further studies regarding the treatment strategies in this highly prevalent comorbid disorder.

  5. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort.

    PubMed

    Miller, Joy; Edwards, Lisa D; Agustí, Alvar; Bakke, Per; Calverley, Peter M A; Celli, Bartolome; Coxson, Harvey O; Crim, Courtney; Lomas, David A; Miller, Bruce E; Rennard, Steve; Silverman, Edwin K; Tal-Singer, Ruth; Vestbo, Jørgen; Wouters, Emiel; Yates, Julie C; Macnee, William

    2013-09-01

    Comorbidities, are common in COPD, have been associated with poor outcomes and are thought to relate to systemic inflammation. To investigate comorbidities in relation to systemic inflammation and outcomes we recorded comorbidities in a well characterized cohort (ECLIPSE study) for 2164 clinically stable COPD subjects, 337 smokers and 245 non-smokers with normal lung function. COPD patients had a higher prevalence of osteoporosis, anxiety/panic attacks, heart trouble, heart attack, and heart failure, than smokers or nonsmokers. Heart failure (Hazard Ratio [HR] 1.9, 95% Confidence Interval [CI] 1.3-2.9), ischemic heart disease (HR 1.5, 95% CI 1.1-2.0), heart disease (HR 1.5, 95% CI 1.2-2.0), and diabetes (HR 1.7, 95% CI 1.2-2.4) had increased odds of mortality when coexistent with COPD. Multiple comorbidities had accumulative effect on mortality. COPD and cardiovascular disease was associated with poorer quality of life, higher MRC dyspnea scores, reduced 6MWD, higher BODE index scores. Osteoporosis, hypertension and diabetes were associated with higher MRC dyspnea scores and reduced 6MWD. Higher blood concentrations of fibrinogen, IL-6 and IL-8 levels occurred in those with heart disease. Comorbidity is associated with poor clinical outcomes in COPD. The comorbidities of heart disease, hypertension and diabetes are associated with increased systemic inflammation.

  6. Comorbidity and health care visit burden in working-age commercially insured patients with diabetic macular edema

    PubMed Central

    Kiss, Szilárd; Chandwani, Hitesh S; Cole, Ashley L; Patel, Vaishali D; Lunacsek, Orsolya E; Dugel, Pravin U

    2016-01-01

    Purpose To examine the comorbidity profile and update estimates of health care resource utilization for commercially insured, working-age adults with diabetic macular edema (DME) relative to a matched comparison group of diabetic adults without DME. Additional comparisons were made in the subgroup of pseudophakic patients. Patients and methods A retrospective matched-cohort study of commercially insured diabetic adults aged 18–63 years was conducted using medical and outpatient pharmacy claims (July 1, 2008–June 30, 2013). Outcomes included diabetes-related and ocular comorbidities and health care resource utilization (any health care visit days, outpatient visit days, inpatient visit days, emergency room visits, eye care-related visit days, unique medications) in the 12-month post-index period. Results All diabetes-related and ocular comorbidities were significantly more prevalent in DME cases versus non-DME controls (P<0.05). A significantly greater proportion of DME cases utilized eye care-related visits compared with non-DME controls (P<0.001). DME cases had almost twice the mean number of total health care visit days compared to non-DME controls (28.6 vs 16.9 days, P<0.001), with a minority of visit days being eye care-related (mean 5.1 vs 1.5 days, P<0.001). Similar trends were observed in pseudophakic cohorts. Conclusion This working-age DME population experienced a mean of 29 health care visit days per year. Eye care-related visit days were a minority of the overall visit burden (mean 5 days) emphasizing the trade-offs DME patients face between managing DME and their overall diabetic disease. Insights into the complex comorbidity profile and health care needs of diabetic patients with DME will better inform treatment decisions and help optimize disease management. PMID:27994438

  7. Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women

    PubMed Central

    Reisner, Sari L.; Biello, Katie B.; White Hughto, Jaclyn M.; Kuhns, Lisa; Mayer, Kenneth H.; Garofalo, Robert; Mimiaga, Matthew J.

    2016-01-01

    IMPORTANCE Transgender youth, including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse transfeminine gender identity, represent a vulnerable population at risk for negative mental health and substance use outcomes. Diagnostic clinical interviews to assess prevalence of mental health, substance dependence, and comorbid psychiatric disorders in young transgender women remain scarce. OBJECTIVE To report the prevalence of mental health, substance dependence, and comorbid psychiatric disorders assessed via clinical diagnostic interview in a high-risk community-recruited sample of young transgender women. DESIGN, SETTING, AND PARTICIPANTS Observational study reporting baseline finding from a diverse sample of 298 sexually active, young transgender women aged 16 through 29 years (mean age, 23.4 years; 49.0%black, 12.4%Latina, 25.5%white, and 13.1%other minority race/ethnicity) and enrolled in Project LifeSkills, an ongoing randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. EXPOSURE Transfeminine gender identity. MAIN OUTCOMES AND MEASURES Age- and site-adjusted prevalence and comorbidities of mental health and substance dependence disorders assessed via the Mini-International Neuropsychiatric Interview, including 1 or more diagnoses, 2 or more comorbid diagnoses, major depressive episode (current and lifetime), past 30-day suicidal risk (no/low risk vs moderate/high risk), past 6-month generalized anxiety disorder and posttraumatic stress disorder, and past 12-month alcohol dependence and nonalcohol psychoactive substance use dependence. RESULTS Of the 298 transgender women, 41.5%of participants had 1 or more mental health or substance dependence diagnoses; 1 in 5 (20.1%) had 2 or more comorbid psychiatric diagnoses. Prevalence of specific disorders was as follows: lifetime and current major

  8. Dehydration in the Older Adult.

    PubMed

    Miller, Hayley J

    2015-09-01

    Dehydration affects 20% to 30% of older adults. It has a greater negative outcome in this population than in younger adults and increases mortality, morbidity, and disability. Dehydration is often caused by water deprivation in older adults, although excess water loss may also be a cause. Traditional markers for dehydration do not take into consideration many of the physiological differences present in older adults. Clinical assessment of dehydration in older adults poses different findings, yet is not always diagnostic. Treatment of dehydration should focus on prevention and early diagnosis before it negatively effects health and gives rise to comorbidities. The current article discusses what has most thoroughly been studied; the best strategies and assessment tools for evaluation, diagnosis, and treatment of dehydration in older adults; and what needs to be researched further. [Journal of Gerontological Nursing, 41(9), 8-13.].

  9. Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches

    PubMed Central

    Coplan, Jeremy D; Aaronson, Cindy J; Panthangi, Venkatesh; Kim, Younsuk

    2015-01-01

    Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models: (1) “the avoidance model”; (2) “the intolerance of uncertainty model”; (3) “the meta-cognitive model”; (4) “the emotion dysregulation model”; and (5) “the acceptance based model”. For depression, the following theoretical models are explicated: (1) “the cognitive model”; (2) “the behavioral activation model”; and (3) “the interpersonal model”. Integration of these approaches is suggested. The treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. Serotonin reuptake inhibitors are considered first-line treatment in uncomplicated depression comorbid with a spectrum of anxiety disorders. Short-acting benzodiazepines (BZDs) are an important “bridging strategy” to address an acute anxiety component. In patients with comorbid substance abuse, avoidance of BZDs is recommended and we advise using an atypical antipsychotic in lieu of BZDs. For mixed anxiety and depression comorbid with bipolar disorder, we recommend augmentation of an antidepressant with either lamotrigine or an atypical agent. Combination and augmentation therapies in the treatment of comorbid conditions vis-à-vis monotherapy may be necessary for positive outcomes. Combination therapy with tricyclic antidepressants, gabapentin and selective serotonin/norepinephrine reuptake inhibitors (e.g., duloxetine) are

  10. Does depression and substance abuse co-morbidity affect socioeconomic status? Evidence from a prospective study of urban African Americans.

    PubMed

    Dagher, Rada K; Green, Kerry M

    2015-01-30

    Studies have established a graded association between mental health and socioeconomic status (SES). However, scarce research has examined the impact of substance use disorders (SUD) and depression comorbidity on SES. We use data from the Woodlawn Study, a longitudinal cohort study, which recruited a cohort of first graders from Chicago starting 1966-1967 (N=1242). Analyses focus on those interviewed in young adulthood and followed up through midlife. Regression analyses adjusting for childhood confounders showed that young adults with depression and SUD comorbidity had higher likelihood of having any periods of unemployment, higher likelihood of being unemployed for 3 or more months, and lower household income in midlife than those with neither disorder. Moreover, young adults with SUD without depression had higher odds of having any periods of unemployment and higher odds of being unemployed for 3 or more months than those with neither disorder. Findings point to the possibility of social selection where depression and SUD comorbidity contributes to a downward drift in SES. Clinical interventions that integrate the treatment of SUD and depression may be more effective at reducing socioeconomic disparities among minority populations.

  11. Influence of comorbid obsessive-compulsive symptoms on brain event-related potentials in Gilles de la Tourette syndrome

    PubMed Central

    Thibault, Geneviève; Felezeu, Mihaela; O’Connor, Kieron P.; Todorov, Christo; Stip, Emmanuel; Lavoie, Marc E.

    2013-01-01

    Approximately 30 to 50% of people suffering from Gilles de la Tourette Syndrome (GTS) also fulfill diagnostic criteria for obsessive-compulsive disorder (OCD). Despite this high degree of comorbidity, very few studies have addressed the question of obsessive-compulsive symptoms (OCS) in GTS patients using specific brain event-related potentials (ERP) responses. The aim of the current study was to quantify neurocognitive aspects of comorbidity, using ERPs. Fourteen adults with GTS (without OCD) were compared to a group of 12 participants with GTS and comorbid obsessive-compulsive symptoms (GTS+OCS), to a group of 15 participants with OCD and to a group of 14 control participants without neurological or psychiatric problems. The P200 and P300 components were recorded during a visual counting oddball task. Results showed intact P200 amplitude in all groups, whilst the P300 amplitude was affected differentially across groups. The P300 oddball effect was reduced in participants in both OCD and GTS+OCS groups in the anterior region. However, the P300 oddball effect was significantly larger in participants of the GTS group compared to all other groups, mostly in the parietal region. These findings suggest that adults with GTS are characterized by enhanced working memory updating processes and that the superimposition of OCS can lead to a reduction of these processes. The discrepancy between our findings and results obtained in previous studies on GTS could reflect the modulating effect of OCS on late ERP components. PMID:18280023

  12. Assessing the Influence of Different Comorbidities Indexes on the Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in a Developing Country

    PubMed Central

    Teixeira, Gustavo Machado; Bittencourt, Henrique; Rezende, Suely Meireles

    2015-01-01

    Although the application of Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) has enabled better prediction of transplant-related mortality (TRM) in allogeneic hematopoietic stem cell transplants (AHSCT), data from developing countries are scarce. This study prospectively evaluated the HCT-CI and the Adult Comorbidity Evaluation (ACE-27), in its original and in a modified version, as predictors of post-transplant complications in adults undergoing a first related or unrelated AHSCT in Brazil. Both bone marrow (BM) and peripheral blood stem cells (PBSC) as graft sources were included. We analyzed the cumulative incidence of granulocyte and platelet recovery, sinusoidal obstructive syndrome, acute and chronic graft-versus-host disease, relapse and transplant-related mortality, and rates of event-free survival and overall survival. Ninety-nine patients were assessed. Median age was 38 years (18–65 years); HCT-CI ≥ 3 accounted for only 8% of cases; hematologic malignancies comprised 75.8% of the indications for AHSCT. There was no association between the HCT-CI or the original or modified ACE-27 with TRM or any other studied outcomes after AHSCT. These results show that, in the population studied, none of the comorbidity indexes seem to be associated with AHSCT outcomes. A significantly low frequency of high-risk (HCT-CI ≥ 3) in this Brazilian population might justify these results. PMID:26394228

  13. Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome.

    PubMed

    Eapen, Valsamma; Cavanna, Andrea E; Robertson, Mary M

    2016-01-01

    Tourette syndrome (TS) is more than having motor and vocal tics, and this review will examine the varied comorbidities as well as the social impact and quality of life (QoL) in individuals with TS. The relationship between any individual and his/her environment is complex, and this is further exaggerated in the case of a person with TS. For example, tics may play a significant role in shaping the person's experiences, perceptions, and interactions with the environment. Furthermore, associated clinical features, comorbidities, and coexisting psychopathologies may compound or alter this relationship. In this regard, the common comorbidities include attention-deficit hyperactivity disorder and disruptive behaviors, obsessive compulsive disorder, and autism spectrum disorder, and coexistent problems include anxiety, depression, and low self-esteem, which can all lead to poorer psychosocial functioning and QoL. Thus, the symptoms of TS and the associated comorbid conditions may interact to result in a vicious cycle or a downward spiraling of negative experiences and poor QoL. The stigma and social maladjustment in TS and the social exclusion, bullying, and discrimination are considered to be caused in large part by misperceptions of the disorder by teachers, peers, and the wider community. Improved community and professional awareness about TS and related comorbidities and other psychopathologies as well as the provision of multidisciplinary services to meet the complex needs of this clinical population are critical. Future research to inform the risk and resilience factors for successful long-term outcomes is also warranted.

  14. Psoriasis comorbidities: complications and benefits of immunobiological treatment*

    PubMed Central

    de Carvalho, André Vicente Esteves; Romiti, Ricardo; Souza, Cacilda da Silva; Paschoal, Renato Soriani; Milman, Laura de Mattos; Meneghello, Luana Pizarro

    2016-01-01

    During the last decade, different studies have converged to evidence the high prevalence of comorbidities in subjects with psoriasis. Although a causal relation has not been fully elucidated, genetic relation, inflammatory pathways and/or common environmental factors appear to be underlying the development of psoriasis and the metabolic comorbidities. The concept of psoriasis as a systemic disease directed the attention of the scientific community in order to investigate the extent to which therapeutic interventions influence the onset and evolution of the most prevalent comorbidities in patients with psoriasis. This study presents scientific evidence of the influence of immunobiological treatments for psoriasis available in Brazil (infliximab, adalimumab, etanercept and ustekinumab) on the main comorbidities related to psoriasis. It highlights the importance of the inflammatory burden on the clinical outcome of patients, not only on disease activity, but also on the comorbidities. In this sense, systemic treatments, whether immunobiologicals or classic, can play a critical role to effectively control the inflammatory burden in psoriatic patients. PMID:28099601

  15. Comorbid anxiety and neurocognitive dysfunctions in children with ADHD.

    PubMed

    Bloemsma, J Monique; Boer, Frits; Arnold, Renée; Banaschewski, Tobias; Faraone, Stephen V; Buitelaar, Jan K; Sergeant, Joseph A; Rommelse, Nanda; Oosterlaan, Jaap

    2013-04-01

    Previous research established that children with ADHD and comorbid anxiety have a later age of ADHD onset, show less off-task and hyperactive behavior, and have more school problems than children with ADHD alone. Comorbid anxiety appears to ameliorate behavioral inhibition deficits, worsen working memory problems, and lengthen reaction times in ADHD. This study investigated the effect of comorbid anxiety on a broad range of neurocognitive functions and includes child-, parent- and teacher reports of anxiety. The sample consisted of 509 children in the age range 5-19 years, including 238 children with a diagnosis of ADHD combined subtype and 271 normal control children. Children were tested on a broad battery of neurocognitive tasks that proved highly sensitive to ADHD in previous work. Linear Structural Equation Modeling (SEM) was used to estimate the effect of comorbid anxiety on the neurocognitive functions. Child reported anxiety was associated with slower motor speed and response speed and better behavioral inhibition. Teacher reported anxiety was related to worse time production. Parent reported anxiety was not significantly associated with any of the neurocognitive functions. Compared to parent and teacher reports of anxiety, child reported comorbid anxiety shows foremost the largest associations with the neurocognitive dysfunctions observed in children with ADHD. This stresses the importance of including child self-reported anxiety assessments in clinical and research practice.

  16. Occurrence of Comorbidities before and after Soft Tissue Sarcoma Diagnosis

    PubMed Central

    van Herk-Sukel, Myrthe P. P.; Shantakumar, Sumitra; Overbeek, Lucy I. H.; van Boven, Hester; Penning-van Beest, Fernie J. A.; Herings, Ron M. C.

    2012-01-01

    Background. Data is limited on the burden of common comorbidities, such as cardiovascular disease (CVD), respiratory disease and diabetes, or comorbidities related to cancer and its treatment, such as anemia and depression, in patients with soft tissue sarcoma (STS). Patients and Methods. From the Dutch Pathology Registry linked to the PHARMO database (including data on drug use and hospitalizations), 533 patients with STS were selected during 2000–2007 and matched 1 : 10 to cancer-free controls. The occurrences of comorbidities were assessed in the 12 months before and after STS diagnosis. Results. STS patients were 2–4 times more likely to have comorbidities at diagnosis compared with cancer-free controls. The incidence of CVD, anemia, and depression after STS diagnosis differed significantly from cancer-free controls and decreased during followup from 40–124 per 1,000 person-years (py) during the first six months to 11–38 per 1,000 py more than 12 months after diagnosis. The incidence of respiratory disease and diabetes among STS patients remained stable during followup (5–21 per 1,000 py) and did not differ significantly from cancer-free controls. Conclusions. STS patients were more likely to have comorbidities before cancer diagnosis and to develop CVD, anemia, and depression after diagnosis compared to cancer-free controls. PMID:22690132

  17. Impact of age and comorbidity on survival in colorectal cancer

    PubMed Central

    van Eeghen, Elmer E.; Bakker, Sandra D.; van Bochove, Aart

    2015-01-01

    Background Patients with colorectal cancer are often excluded from clinical trials based on age or a poor performance score. However, 70% of colorectal cancer is diagnosed in patients over 65. Evaluation on the influence of age and comorbidity on survival and cause of death in a non-selected population. Methods Included were 621 consecutive patients with colorectal cancer. An extensive chart review was performed for 392 patients with colon cancer and 143 patients with rectal cancer. Analyses were performed separately for both groups. Results Median survival of colon cancer patients was 5.13 years, 131 patients (34.3%) died from tumour progression. Age and comorbidity were significant predictors for overall survival (P<0.001). Age was also a significant predictor of cause of death (P=0.001). In rectal cancer patients median survival was 4.67 years, 51 (35.7%) of patients died from tumour progression. Neither age nor comorbidity was significant predictors of survival. Age was a significant predictor of cause of death (P<0.001). Conclusions In colon cancer patient age and comorbidity predict survival. This represents possible bias or a reduced survival benefit of treatment, and is an indication that colon cancer is not the prognosis defining illness in the majority of patients. In rectal cancer patients neither age or comorbidity significantly impacted survival. PMID:26697191

  18. Unique and related predictors of major depressive disorder, posttraumatic stress disorder, and their comorbidity after Hurricane Katrina.

    PubMed

    Nillni, Yael I; Nosen, Elizabeth; Williams, Patrick A; Tracy, Melissa; Coffey, Scott F; Galea, Sandro

    2013-10-01

    The current study examined demographic and psychosocial factors that predict major depressive disorder (MDD) and comorbid MDD/posttraumatic stress disorder (MDD/PTSD) diagnostic status after Hurricane Katrina, one of the deadliest and costliest hurricanes in the history of the United States. This study expanded on the findings published in the article by Galea, Tracy, Norris, and Coffey (J Trauma Stress 21:357-368, 2008), which examined the same predictors for PTSD, to better understand related and unique predictors of MDD, PTSD, and MDD/PTSD comorbidity. A total of 810 individuals representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina were interviewed. Ongoing hurricane-related stressors, low social support, and hurricane-related financial loss were common predictors of MDD, PTSD, and MDD/PTSD, whereas educational and marital status emerged as unique predictors of MDD. Implications for postdisaster relief efforts that address the risk for both MDD and PTSD are discussed.

  19. The Effects of Age, Mental Health, and Comorbidity on the Perceived Likelihood of Hiring a Healthcare Advocate

    PubMed Central

    McKinnon, Symone A.; Holloway, Breanna M.; Santoro, Maya S.; May, April C.; Cronan, Terry A.

    2017-01-01

    Background and Purpose The projected increase in chronically ill older adults may overburden the healthcare system and compromise the receipt of quality and coordinated health care services. Healthcare advocates (HCAs) may help to alleviate the burden associated with seeking and receiving appropriate health care. We examined whether having dementia or depression, along with hypertension and arthritis, or having no comorbid medical conditions, and being an older adult, affected the perceived likelihood of hiring an HCA to navigate the health care system. Method Participants (N = 1,134), age 18 or older, read a vignette and imagined themselves as an older adult with either a mood or cognitive disorder, and comorbid medical conditions or as otherwise being physically healthy. They were then asked to complete a questionnaire assessing their perceived likelihood of hiring an HCA. Results Participants who imagined themselves as having dementia reported a greater likelihood of hiring an HCA than participants who imagined themselves as having depression (p < .001). Conclusion It is imperative that health care professionals attend to the growing and ongoing needs of older adults living with chronic conditions, and HCAs could play an important role in meeting those needs. PMID:28217035

  20. Information Processing Differences and Similarities in Adults with Dyslexia and Adults with Attention Deficit Hyperactivity Disorder during a Continuous Performance Test: A Study of Cortical Potentials

    ERIC Educational Resources Information Center

    Dhar, Monica; Been, Pieter H.; Minderaa, Ruud B.; Althaus, Monika

    2010-01-01

    Twenty male adults with ADHD, 16 dyslexic adults, 15 comorbid adults, and 16 normal controls were compared on performance and underlying brain responses, during a cued Continuous Performance Test (O-X CPT), with the aim of discovering features of information processing differentiating between the groups. The study evaluated both cue- and…

  1. The relationship of individual comorbid chronic conditions to diabetes care quality

    PubMed Central

    Magnan, Elizabeth M; Palta, Mari; Mahoney, Jane E; Pandhi, Nancy; Bolt, Daniel M; Fink, Jennifer; Greenlee, Robert T; Smith, Maureen A

    2015-01-01

    Objective Multimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions. Research design and methods This is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18–75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors. Results The 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality. Conclusions Future interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities. PMID:26217492

  2. Risk of hospitalization for hypoglycemia among older Korean people with diabetes mellitus: Interactions between treatment modalities and comorbidities.

    PubMed

    Kim, Hyun Min; Seong, Jong-Mi; Kim, Jaetaek

    2016-10-01

    The objective of this study was to carry out a large population-based study to understand the factors associated with hypoglycemia-related hospitalizations among older Korean adults with diabetes mellitus.This study analyzed data from a subset of the 2013 Health Insurance and Review and Assessment service-Adult Patient Sample. A total of 307,170 subjects, comprising 41.7% men and 58.3% women, had diabetes mellitus. Hypertension (80.8%) was the most common comorbidity, and dyslipidemia (59.0%) and ischemic heart disease (21.3%) were also prevalent. Approximately half of the patients with diabetes had >2 comorbidities, and two-thirds of the patients had >3 comorbidities. The proportion of patients taking insulin or sulfonylureas was 54.9%, and 23.2% of the patients were taking other medications. About 21.9% of the patients were treated nonpharmacologically. A total of 2867 hypoglycemia-related admission occurred, the incident rate was 9.33 per 1000 person. The risk was higher among female patients and older patients with several comorbidities, including cardiovascular disease, cerebrovascular disease, chronic liver disease, chronic kidney disease, dementia, and malignancies. Treatment modalities, including insulin and sulfonylureas, were associated with a high risk of hypoglycemia. After adjustments for age, sex, the different comorbidities, and the treatment modalities, we determined that chronic kidney disease and dementia were associated with a high risk of hypoglycemia-related hospitalization (odds ratio [OR] = 2.52 and OR = 1.93, respectively). Furthermore, patients with chronic kidney disease or dementia who were treated with sulfonylureas and insulin had very high risks of hypoglycemia, and the incident rate was 66.6 and 63.75 per 1000 person, respectively.In conclusion, the presence of comorbidities, especially chronic kidney disease and dementia, increased the risk of hypoglycemia-associated hospitalization within this population of older patients

  3. Impact of comorbidity on treatment outcome in head and neck squamous cell carcinoma - a systematic review.

    PubMed

    Bøje, Charlotte Rotbøl

    2014-01-01

    The significant association with tobacco and alcohol combined with advanced age at time of diagnosis predispose head and neck squamous cell carcinoma (HNSCC) patients to increased risk of comorbidities. The presence of comorbidity affects treatment, treatment selection and subsequent outcome. Multiple studies have demonstrated comorbidity to be a strong prognostic factor for survival, and therefore comorbidity can be a major confounder in clinical trials. This review provides a summary of the current literature on comorbidity in head and neck cancer, measurements of comorbidity, the impact of comorbidity on treatment, treatment selection, and survival. A systematic search was performed in six electronic databases. In all, 31 papers were selected for this review. A meta-analysis on the prognostic impact of comorbidity was performed including 10 studies. Furthermore, 21 studies concerning comorbidity were reviewed. Several valid indices to classify comorbidity were described in the literature, none proven to be superior over the other. The prevalence of comorbidity increased with age and the presence of comorbidity influenced treatment and treatment selection. Furthermore, comorbidity was associated with lower socio economic status and increased the risk of early retirement after treatment. The meta-analysis on comorbidity as a prognostic factor, including 22,932 patients, showed that overall survival was significantly worsened among patients with comorbidity (HR=1.38 (1.32-1.43)). Increasing comorbidity-score was associated with increased risk of death. Comorbidity is important in HNSCC and significantly impacts on overall survival. Trials concerning HNSCC should always include information on comorbidity and randomized trials should stratify patients according to comorbidity in order to avoid bias in the study.

  4. Oppositional Defiant Disorder in Adults with ADHD

    ERIC Educational Resources Information Center

    Reimherr, Frederick W.; Marchant, Barrie K.; Olsen, John L.; Wender, Paul H.; Robison, Reid J.

    2013-01-01

    Objective: Oppositional defiant disorder (ODD) is the most common comorbid condition in childhood ADHD. This trial was prospectively designed to explore ODD symptoms in ADHD adults. Method: A total of 86 patients in this placebo-controlled, double-blind trial of methylphenidate transdermal system (MTS) were categorized based on the presence of ODD…

  5. Outcomes in Adults with Asperger Syndrome

    ERIC Educational Resources Information Center

    Barnhill, Gena P.

    2007-01-01

    This article explores the current research literature on adult outcomes of individuals with Asperger syndrome (AS). Specific areas addressed are the characteristics associated with adulthood AS, including employment issues, comorbid mental and physical health conditions, neurological issues, possible problems with the legal system, mortality…

  6. Investigating asthma comorbidities: a systematic scoping review protocol

    PubMed Central

    El Ferkh, Karim; Nwaru, Bright; Griffiths, Chris; Sheikh, Aziz

    2016-01-01

    Introduction Asthma is a common long-term disorder with a number of related comorbid conditions, which may affect asthma outcomes. There is a need for greater appreciation for understanding how these comorbidities interact with asthma in order to improve asthma outcomes. Objectives To systematically identify and map out key asthma comorbidities. Methods We will systematically search the following electronic databases: MEDLINE, EMBASE, ISI Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and Google Scholar. Additional literature will be identified by searching the reference list of identified eligible studies and by searching the repositories of international conference proceedings, including ISI Conference Proceeding Citation Index, and ZETOC (British Library). Dissemination The findings from this systematic scoping review will be reported at scientific meetings and published in a peer-reviewed journal. PMID:27558899

  7. Comprehensive therapeutic approach for patients with heart failure and comorbidity.

    PubMed

    Ruiz-Laiglesia, F J; Garcés-Horna, V; Formiga, F

    2016-01-01

    The prevalence of heart failure increases with age and is accompanied by other diseases, which are encompassed within a «cardiometabolic phenotype». Their interrelation changes the evolution and treatment that each disease would have in isolation. Patients with heart failure and comorbidity are frail and complex. They require a comprehensive assessment (not just biomedical), which includes functional, cognitive, affective and psychosocial aspects. The overall treatment, which is not covered in the clinical practice guidelines, should adapt to each and every one of the comorbidities. Polypharmacy should be avoided as much as possible, due to its interactions and reduced adherence. Treatment needs to be optimised and adapted to the evolutionary phase of the disease and the specific needs of each patient. The complexity of the care process for patients with heart failure and comorbidities requires the coordination of healthcare providers and support from family and others involved in the patient's care.

  8. Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study

    PubMed Central

    Pinto, José Antonio; Ribeiro, Davi Knoll; Cavallini, Andre Freitas da Silva; Duarte, Caue; Freitas, Gabriel Santos

    2016-01-01

    Introduction Obstructive sleep apnea (OSA) is characterized by partial or complete recurrent upper airway obstruction during sleep. OSA brings many adverse consequences, such as hypertension, obesity, diabetes mellitus, cardiac and encephalic alterations, behavioral, among others, resulting in a significant source of public health care by generating a high financial and social impact. The importance of this assessment proves to be useful, because the incidence of patients with comorbidities associated with AOS has been increasing consistently and presents significant influence in natural disease history. Objective The objective of this study is to assess major comorbidities associated with obstructive sleep apnea (OSA) and prevalence in a group of patients diagnosed clinically and polysomnographically with OSA. Methods This is a retrospective study of 100 charts from patients previously diagnosed with OSA in our service between October 2010 and January 2013. Results We evaluated 100 patients with OSA (84 men and 16 women) with a mean age of 50.05 years (range 19–75 years). The prevalence of comorbidities were hypertension (39%), obesity (34%), depression (19%), gastroesophageal reflux disease (GERD) (18%), diabetes mellitus (15%), hypercholesterolemia (10%), asthma (4%), and no comorbidities (33%). Comorbidities occurred in 56.2% patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% of patients with severe OSA. Conclusion According to the current literature data and the values obtained in our paper, we can correlate through expressive values obesity with OSA and their apnea hypopnea index (AHI) values. However, despite significant prevalence of OSA with other comorbidities, our study could not render expressive significance values able to justify their correlations. PMID:27096019

  9. Compulsive Buying Behavior: Characteristics of Comorbidity with Gambling Disorder

    PubMed Central

    Granero, Roser; Fernández-Aranda, Fernando; Steward, Trevor; Mestre-Bach, Gemma; Baño, Marta; del Pino-Gutiérrez, Amparo; Moragas, Laura; Aymamí, Neus; Gómez-Peña, Mónica; Mallorquí-Bagué, Núria; Tárrega, Salomé; Menchón, José M.; Jiménez-Murcia, Susana

    2016-01-01

    Compulsive buying behavior (CBB) has begun to be recognized as a condition worthy of attention by clinicians and researchers. Studies on the commonalities between CBB and other behavioral addictions such as gambling disorder (GD) exist in the literature, but additional research is needed to assess the frequency and clinical relevance of the comorbidity of CBB and GD. The aim of the study was to estimate the point-prevalence of CBB+GD in a clinical setting. Data corresponded to n = 3221 treatment-seeking patients who met criteria for CBB or GD at a public hospital unit specialized in treating behavioral addictions. Three groups were compared: only-CBB (n = 127), only-GD (n = 3118) and comorbid CBB+GD (n = 24). Prevalence for the co-occurrence of CBB+GD was 0.75%. In the stratum of patients with GD, GD+CBB comorbidity obtained relatively low point prevalence (0.77%), while in the subsample of CBB patients the estimated prevalence of comorbid GD was relatively high (18.9%). CBB+GD comorbidity was characterized by lower prevalence of single patients, higher risk of other behavioral addictions (sex, gaming or internet), older age and age of onset. CBB+GD registered a higher proportion of women compared to only-GD (37.5 vs. 10.0%) but a higher proportion of men compared to only-CBB (62.5 vs. 24.4%). Compared to only-GD patients, the simultaneous presence of CBB+GD was associated with increased psychopathology and dysfunctional levels of harm avoidance. This study provides empirical evidence to better understand CBB, GD and their co-occurrence. Future research should help delineate the processes through which people acquire and develop this comorbidity. PMID:27199853

  10. Compulsive Buying Behavior: Characteristics of Comorbidity with Gambling Disorder.

    PubMed

    Granero, Roser; Fernández-Aranda, Fernando; Steward, Trevor; Mestre-Bach, Gemma; Baño, Marta; Del Pino-Gutiérrez, Amparo; Moragas, Laura; Aymamí, Neus; Gómez-Peña, Mónica; Mallorquí-Bagué, Núria; Tárrega, Salomé; Menchón, José M; Jiménez-Murcia, Susana

    2016-01-01

    Compulsive buying behavior (CBB) has begun to be recognized as a condition worthy of attention by clinicians and researchers. Studies on the commonalities between CBB and other behavioral addictions such as gambling disorder (GD) exist in the literature, but additional research is needed to assess the frequency and clinical relevance of the comorbidity of CBB and GD. The aim of the study was to estimate the point-prevalence of CBB+GD in a clinical setting. Data corresponded to n = 3221 treatment-seeking patients who met criteria for CBB or GD at a public hospital unit specialized in treating behavioral addictions. Three groups were compared: only-CBB (n = 127), only-GD (n = 3118) and comorbid CBB+GD (n = 24). Prevalence for the co-occurrence of CBB+GD was 0.75%. In the stratum of patients with GD, GD+CBB comorbidity obtained relatively low point prevalence (0.77%), while in the subsample of CBB patients the estimated prevalence of comorbid GD was relatively high (18.9%). CBB+GD comorbidity was characterized by lower prevalence of single patients, higher risk of other behavioral addictions (sex, gaming or internet), older age and age of onset. CBB+GD registered a higher proportion of women compared to only-GD (37.5 vs. 10.0%) but a higher proportion of men compared to only-CBB (62.5 vs. 24.4%). Compared to only-GD patients, the simultaneous presence of CBB+GD was associated with increased psychopathology and dysfunctional levels of harm avoidance. This study provides empirical evidence to better understand CBB, GD and their co-occurrence. Future research should help delineate the processes through which people acquire and develop this comorbidity.

  11. Affective comorbidity in panic disorder: is there a bipolar connection?

    PubMed

    Savino, M; Perugi, G; Simonini, E; Soriani, A; Cassano, G B; Akiskal, H S

    1993-07-01

    Although theoretical explanations for comorbidity in panic disorder (PD) abound in the literature, the complex clinical challenges of these patients have been neglected, especially where panic, obsessive-compulsive and 'soft' bipolar (e.g., hypomanic, cyclothymic and hyperthymic) conditions might co-exist. The aim of the present study has been to systematically explore the spectrum of intra-episodic and longitudinal comorbidity of 140 DSM-III-R PD patients--67.1% of whom concomitantly met the criteria for Agoraphobia--and who were consecutively admitted to the ambulatory service of the Psychiatric Clinic of the University of Pisa over a 2-year period. Comorbidity with strictly defined anxiety disorders--i.e., not explained as mere symptomatic extensions of PD--was relatively uncommon, and included Simple Phobia (10.7%), Social Phobia (6.4%), Generalized Anxiety Disorder (3.6%), and Obsessive-Compulsive Disorder (4.2%). Comorbidity with Major Depression--strictly limited to the melancholic subtype--occurred in 22.9%. Comorbidity with Bipolar Disorders included 2.1% with mania, 5% with hypomania, as well as 6.4% with cyclothymia, for a total of 13.5%; an additional 34.3% of PD patients met the criteria for hyperthymic temperament. We submit that such comorbid patterns are at the root of unwieldy clinical constructs like 'atypical depression' and 'borderline personality'. The relationship of panic disorder to other anxious-phobic and depressive states has been known for some time. Our data extend this relationship to soft bipolar disorders. Studies from other centers are needed to verify that the proposed new link is not merely due to referral bias to a tertiary university setting.

  12. Managing medical comorbidities in patients with depression to improve prognosis.

    PubMed

    Thase, Michael E

    2016-02-01

    Medical comorbidities contribute to poor antidepressant response, treatment resistance, and poor outcomes in many patients with depression. Depression can co-occur with thyroid conditions, chronic pain conditions, central nervous system disorders, and more. Inflammatory conditions such as diabetes and obesity are also associated with depression, and the connection between inflammation and depression may lead to testing that could better match patients to specific antidepressant treatment. Interventions for patients with depression and a comorbid medical condition include careful selection of antidepressant therapy as well as psychotherapy and adjunctive agents.

  13. Lithium therapy in comorbid temporal lobe epilepsy and cycloid psychosis

    PubMed Central

    Brown, Paul; Kashiviswanath, Sridhar; Huynh, Alison; Allha, Naveen; Piaggio, Ken; Sahoo, Saddichha; Gupta, Ankur

    2016-01-01

    The treatment of post-ictal psychosis has foundered on uncertainty in diagnosis of psychotic phenotypes, and equivocal efficacy of first and second generation antipsychotics. This article presents a case history of comorbid temporal lobe epilepsy and psychosis, suggests the applicability of the continental, cycloid psychosis diagnostic conceptualization to post-ictal psychoses, and demonstrates the efficacy of lithium in their treatment. Clinical studies of comorbidity of epilepsy and psychosis offer great potential as a basis for modelling brain–mind relationships, and neuropsychiatric nosology, pathophysiology and treatment. PMID:28031853

  14. Co-morbid anxiety and depression among pulmonary tuberculosis patients.

    PubMed

    Aamir, Siddiqua; Aisha

    2010-10-01

    The need to recognize and manage psychiatric co-morbidity in tuberculosis (TB) patients in primary care settings in order to improve adherence to the treatment is now well documented. Pulmonary TB patients at the District TB Control Office and TB Centre in Haripur from December 2007 to March 2008 were evalute in order to assess the frequency of anxiety and depression and continuation of treatment. Forty seven out of 65 (72%) TB patients had severe/moderate level of anxiety and depression according to Hospital Anxiety and Depression Scale (HADS). Fourteen (22%) TB patients with co-morbid anxiety and depression showed multi drug-resistance (MDR-TB).

  15. Sleep disturbances are associated with psychotic experiences: Findings from the National Comorbidity Survey Replication.

    PubMed

    Oh, Hans Y; Singh, Fiza; Koyanagi, Ai; Jameson, Nicole; Schiffman, Jason; DeVylder, Jordan

    2016-03-01

    Sleep disturbances have been linked to psychotic experiences in the general adult populations of multiple countries, but this association has yet to be confirmed in the United States using robust diagnostic measures. We analyzed a subsample (n=2304) of the National Comorbidity Survey Replication, and found that when compared with those who did not report any sleep problems, individuals with sleep disturbances lasting two weeks or longer over the past 12months were significantly more likely to report at least one psychotic experience during that same time frame. Specifically, difficulty falling asleep, waking up during the night, early morning awakenings, and feeling sleepy during the day were each associated with greater odds of reporting psychotic experiences over the past year after controlling for socio-demographic variables. However, only difficulty falling asleep and early morning awakenings were still significant after adjusting for DSM comorbid disorders. Reporting three or four types of sleep disturbances was especially predictive of psychotic experiences. Our findings underscore the importance of detecting and reducing sleep problems among individuals who report PE.

  16. Prevalence, correlates, comorbidity and severity of generalized anxiety disorder in Singapore.

    PubMed

    Lee, Siau Pheng; Sagayadevan, Vathsala; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2016-10-01

    Despite its pervasiveness and associated impairment, generalized anxiety disorder (GAD) remains a poorly recognized disorder. Furthermore, given that GAD has been relatively understudied in Asia, the current study examined the prevalence, correlates and co-morbid conditions of this disorder in a multi-ethnic population of Singapore. Data was utilized from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among the adult population (n=6616) aged 18 years and above. The Composite International Diagnostic Interview version 3.0 (CIDI v3.0) was used to assess co-morbidity as well as the life-time and 12-month prevalence of disorders. Functional impairment and treatment-seeking behavior were also assessed. The life-time (0.9%) and 12-month (0.4%) prevalence estimates in the current study were found to be lower than those reported in Western populations but comparable to the prevalence estimates found in Asian countries. The relatively lower prevalence rate of GAD in this study suggests the possible role of culture in reporting and manifestation of anxiety symptomatology. The failure of a substantial proportion of individuals to seek treatment despite self-reported impairment was also identified as an area of concern.

  17. Bipolar disorder and co-occurring cannabis use disorders: characteristics, co-morbidities and clinical correlates.

    PubMed

    Lev-Ran, Shaul; Le Foll, Bernard; McKenzie, Kwame; George, Tony P; Rehm, Jürgen

    2013-10-30

    This study examines rates of co-morbid mental disorders and indicators of the course of illness among individuals with bipolar disorder and cannabis use disorders (CUD). Data were drawn from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC Wave 1, 2001-2002), a nationally representative sample of adults living in the United States. Among individuals with lifetime prevalence of bipolar disorder (N=1905) rates of CUD in the past 12 months were 7.2%, compared to 1.2% in the general population. Logistic regression models adjusting for sociodemographic variables indicated that individuals with bipolar disorder and co-occurring CUD were at increased risk for nicotine dependence (Adjusted Odds Ratio (AOR)=3.8), alcohol (AOR=6.6) and drug (AOR=11.9) use disorders, as well as antisocial personality disorder (AOR=2.8) compared to those without CUD. Among individuals with co-occurring CUD, age of onset of bipolar disorder was significantly lower and median number of manic, hypomanic and depressive episodes per year was significantly greater compared to individuals without CUD. Co-occurring CUD is associated with significant co-morbidities and a more severe course of illness among individuals with bipolar disorder. Comprehensive evaluation of patients with bipolar disorder should include a systematic assessment of CUD.

  18. Impact of Comorbidities on Mortality in Patients with Idiopathic Pulmonary Fibrosis

    PubMed Central

    Kreuter, Michael; Ehlers-Tenenbaum, Svenja; Palmowski, Karin; Bruhwyler, Jacques; Oltmanns, Ute; Muley, Thomas; Heussel, Claus Peter; Warth, Arne; Kolb, Martin; Herth, Felix J. F.

    2016-01-01

    Introduction Comorbidities significantly influence the clinical course of idiopathic pulmonary fibrosis (IPF). However, their prognostic impact is not fully understood. We therefore aimed to determine the impact of comorbidities, as individual and as whole, on survival in IPF. Methods The database of a tertiary referral centre for interstitial lung diseases was reviewed for comorbidities, their treatments, their frequency and survival in IPF patients. Results 272 patients were identified of which 12% had no, 58% 1–3 and 30% 4–7 comorbidities, mainly cardiovascular, pulmonary and oncologic comorbidities. Median survival according to the frequency of comorbidities differed significantly with 66 months for patients without comorbidities, 48 months when 1–3 comorbidities were reported and 35 months when 4–7 comorbidities were prevalent (p = 0.004). A multivariate Cox proportional hazard analyses identified other cardiac diseases and lung cancer as significant predictors of death, gastro-oesophageal reflux disease (GERD) and diastolic dysfunction had a significant positive impact on survival. A significant impact of comorbidities associated therapies on survival was not discovered. This included the use of proton pump inhibitors at baseline, which was not associated with a survival benefit (p = 0.718). We also established a predictive tool for highly prevalent comorbidities, termed IPF comorbidome which demonstrates a new relationship of IPF and comorbidities. Conclusion Comorbidities are frequent in IPF patients. Some comorbidities, especially lung cancer, mainly influence survival in IPF, while others such as GERD may inherit a more favourable effect. Moreover, their cumulative incidence impacts survival. PMID:27023440

  19. Underdiagnosis of Attention-Deficit/Hyperactivity Disorder in Adult Patients: A Review of the Literature

    PubMed Central

    Quintero, Javier; Anand, Ernie; Casillas, Marta; Upadhyaya, Himanshu P.

    2014-01-01

    Objective: To raise awareness of attention-deficit/hyperactivity disorder (ADHD) as an underdiagnosed, undertreated, often comorbid, and debilitating condition in adults. Data Sources: PubMed was searched using combinations of keywords, including ADHD, adult, diagnosis, identify, prevalence, and comorbid, to find articles published between 1976 and 2013. Study Selection: In total, 99 articles were selected for inclusion on the basis of their relevance to the objective and importance to and representation of ADHD research, including international guidelines for adults with ADHD. Results: In a large proportion of children with ADHD, symptoms persist into adulthood. However, although adults with ADHD often experience chaotic lifestyles, with impaired educational and vocational achievement and higher risks of substance abuse and imprisonment, many remain undiagnosed and/or untreated. ADHD is usually accompanied by other psychiatric comorbidities (such as major depressive disorder, anxiety disorder, and alcohol abuse). Indeed, adults with ADHD are more likely to present to a psychiatric clinic for treatment of their comorbid disorders than for ADHD, and their ADHD symptoms are often mistaken for those of their comorbidities. Untreated ADHD in adults with psychiatric comorbidities leads to poor clinical and functional outcomes for the patient even if comorbidities are treated. Effective treatment of adults’ ADHD improves symptoms, emotional lability, and patient functioning, often leading to favorable outcomes (eg, safer driving, reduced criminality). A few medications have now been approved for use in adults with ADHD, while a multimodal approach involving psychotherapy has also shown promising results. Conclusions General psychiatrists should familiarize themselves with the symptoms of ADHD in adults in order to diagnose and manage ADHD and comorbidities appropriately in these patients. PMID:25317367

  20. Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients

    PubMed Central

    Ociskova, Marie; Prasko, Jan; Latalova, Klara; Kamaradova, Dana; Grambal, Ales

    2016-01-01

    Background Anxiety disorders are a group of various mental syndromes that have been related with generally poor treatment response. Several psychological factors may improve or hinder treatment effectiveness. Hope has a direct impact on the effectiveness of psychotherapy. Also, dissociation is a significant factor influencing treatment efficiency in this group of disorders. Development of self-stigma could decrease treatment effectiveness, as well as several temperamental and character traits. The aim of this study was to explore a relationship between selected psychological factors and treatment efficacy in anxiety disorders. Subjects and methods A total of 109 inpatients suffering from anxiety disorders with high frequency of comorbidity with depression and/or personality disorder were evaluated at the start of the treatment by the following scales: the Mini-International Neuropsychiatric Interview, the Internalized Stigma of Mental Illness scale, the Adult Dispositional Hope Scale, and the Temperament and Character Inventory – revised. The participants, who sought treatment for anxiety disorders, completed the following scales at the beginning and end of an inpatient-therapy program: Clinical Global Impression (objective and subjective) the Beck Depression Inventory – second edition, the Beck Anxiety Inventory, and the Dissociative Experiences Scale. The treatment consisted of 25 group sessions and five individual sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. There was no randomization to the type of group-therapy program. Results Greater improvement in psychopathology, assessed by relative change in objective Clinical Global Impression score, was connected with low initial dissociation level, harm avoidance, and self-stigma, and higher amounts of hope and self-directedness. Also, individuals without a comorbid personality disorder improved considerably more than comorbid patients. According to

  1. Comorbidity of Schizophrenia and Substance Abuse: Implications for Treatment.

    ERIC Educational Resources Information Center

    Mueser, Kim T.; And Others

    1992-01-01

    Reviews substance abuse disorders in schizophrenia patients, including prevalence of comorbid disorders, assessment, hypothesized mechanisms underlying abuse, and clinical effects of abuse on course of illness and cognitive functioning. Outlines principles of treatment for dual-diagnosis schizophrenia patients, noting limitations of existing…

  2. Comorbidity of Learning Disorders: Prevalence and Familial Transmission

    ERIC Educational Resources Information Center

    Landerl, Karin; Moll, Kristina

    2010-01-01

    Background: In order to fully specify the profiles of risk and protective factors of developmental disorders, a better understanding of the conditions under which they co-occur is required. So far, empirical evidence on comorbidities of specific learning disorders in arithmetic, reading and spelling is scarce. Methods: Prevalence and gender ratios…

  3. Literacy Difficulties and Psychiatric Disorders: Evidence for Comorbidity

    ERIC Educational Resources Information Center

    Carroll, Julia M.; Maughan, Barbara; Goodman, Robert; Meltzer, Howard

    2005-01-01

    Background: Literacy difficulties show high levels of comorbidity with both disruptive and emotional disorders, but questions remain over the nature and specificity of these links. Method: Relationships between specific literacy difficulties and psychiatric disorder were investigated in a large-scale national sample of children aged 9 to 15 years.…

  4. Frequency, Comorbidity, and Psychosocial Impairment of Depressive Disorders in Adolescents.

    ERIC Educational Resources Information Center

    Essau, Cecilia A.; Conradt, Judith; Petermann, Franz

    2000-01-01

    Estimated the frequency, comorbidity, and psychosocial impairment of depressive disorders from survey of 1,035 German 12- to 17-year-olds. Found that 17.9 percent met the lifetime criteria for depressive disorders, according to DSM-IV criteria; criteria were higher in females than in males. Rates for all disorders increased with age, with…

  5. Treating Obesity: Clinical Implications of Comorbid Borderline Personality Disorder.

    ERIC Educational Resources Information Center

    Sansone, Randy A.; Wiederman, Michael W.; Sansone, Lori A.

    1999-01-01

    Reviews possible links between obesity and borderline-personality disorder and discusses treatment approaches for those individuals demonstrating such comorbidity. Approaches include modification of current techniques for obesity treatment and incorporation of psychodynamic counseling specific to borderline-personality disorder. (Author/GCP)

  6. Comorbidity of Auditory Processing, Language, and Reading Disorders

    ERIC Educational Resources Information Center

    Sharma, Mridula; Purdy, Suzanne C.; Kelly, Andrea S.

    2009-01-01

    Purpose: The authors assessed comorbidity of auditory processing disorder (APD), language impairment (LI), and reading disorder (RD) in school-age children. Method: Children (N = 68) with suspected APD and nonverbal IQ standard scores of 80 or more were assessed using auditory, language, reading, attention, and memory measures. Auditory processing…

  7. Comorbidities in preschool children at family risk of dyslexia

    PubMed Central

    Gooch, Debbie; Hulme, Charles; Nash, Hannah M; Snowling, Margaret J

    2015-01-01

    Background Comorbidity among developmental disorders such as dyslexia, language impairment, attention deficit/hyperactivity disorder and developmental coordination disorder is common. This study explores comorbid weaknesses in preschool children at family risk of dyslexia with and without language impairment and considers the role that comorbidity plays in determining children’s outcomes. Method The preschool attention, executive function and motor skills of 112 children at family risk for dyslexia, 29 of whom also met criteria for language impairment, were assessed at ages 3 ½ and 4 ½. The performance of these children was compared to the performance of children with language impairment and typically developing controls. Results Weaknesses in attention, executive function and motor skills were associated with language impairment rather than family risk status. Individual differences in language and executive function are strongly related in the preschool period and preschool motor skills predicted unique variance (4%) in early reading skills over and above children’s language ability. Conclusion Comorbidity between developmental disorders can be observed in the preschool years: children with language impairment have significant and persistent weaknesses in motor skills and executive function compared to those without language impairment. Children’s early language and motor skills are predictors of children’s later reading skills. PMID:24117483

  8. Autism in Angelman Syndrome: An Exploration of Comorbidity

    ERIC Educational Resources Information Center

    Trillingsgaard, Anegen; Ostergaard, John R.

    2004-01-01

    The aim was to explore the comorbidity between Angelman syndrome and autism spectrum disorders (ASDs). Identification of autism in children with Angelman syndrome presents a diagnostic challenge. In the present study, 16 children with Angelman syndrome, all with a 15q11-13 deletion, were examined for ASDs. Thirteen children with Angelman syndrome…

  9. Comorbidity in the context of neural network properties.

    PubMed

    Yordanova, Juliana; Kolev, Vasil; Kirov, Roumen; Rothenberger, Aribert

    2010-06-01

    Cramer et al.'s network approach reconceptualizes mental comorbidity on the basis of symptom space originating from psychometric signatures. We argue that the advantages of this approach need to be regarded in the context of the multi-level functional organization of the neural substrate, ranging from neurogenetic to psychometric. Neuroelectric oscillations are proposed as a level-integrating principle.

  10. Psychiatric Comorbidity among Children with Gender Identity Disorder

    ERIC Educational Resources Information Center

    Wallien, Madeleine S.C.; Swaab, Hanna; Cohen-Kettenis, Peggy T.

    2007-01-01

    Objective: To investigate the prevalence and type of comorbidity in children with gender identity disorder (GID). Method: The Diagnostic Interview Schedule for Children--Parent Version was used to assess psychopathology according to the DSM in two groups of children. The first group consisted of 120 Dutch children (age range 4-11 years) who were…

  11. Comorbidity and Phenomenology of Bipolar Disorder in Children with ADHD

    ERIC Educational Resources Information Center

    Serrano, Eduardo; Ezpeleta, Lourdes; Castro-Fornieles, Josefina

    2013-01-01

    Objective: To assess the comorbidity of bipolar disorder (BPD) in children with ADHD and to study the psychopathological profile of ADHD children with and without mania. Method: A total of 100 children with ADHD were assessed with a semistructured diagnostic interview and questionnaires of mania, ADHD, and general psychopathology. Results: 8% of…

  12. The Temporal Sequencing of Problem Gambling and Comorbid Disorders

    ERIC Educational Resources Information Center

    Holdsworth, Louise; Haw, John; Hing, Nerilee

    2012-01-01

    Two qualitative studies were undertaken to identify the prevalent comorbid mental disorders in treatment seeking problem gamblers and to also identify the temporal sequencing of the disorders. A forum with problem gambling counsellors and interviews with 24 mental health experts were undertaken. There was general agreement that the most commonly…

  13. Spreading of diseases through comorbidity networks across life and gender

    NASA Astrophysics Data System (ADS)

    Chmiel, Anna; Klimek, Peter; Thurner, Stefan

    2014-11-01

    The state of health of patients is typically not characterized by a single disease alone but by multiple (comorbid) medical conditions. These comorbidities may depend strongly on age and gender. We propose a specific phenomenological comorbidity network of human diseases that is based on medical claims data of the entire population of Austria. The network is constructed from a two-layer multiplex network, where in one layer the links represent the conditional probability for a comorbidity, and in the other the links contain the respective statistical significance. We show that the network undergoes dramatic structural changes across the lifetime of patients. Disease networks for children consist of a single, strongly interconnected cluster. During adolescence and adulthood further disease clusters emerge that are related to specific classes of diseases, such as circulatory, mental, or genitourinary disorders. For people over 65 these clusters start to merge, and highly connected hubs dominate the network. These hubs are related to hypertension, chronic ischemic heart diseases, and chronic obstructive pulmonary diseases. We introduce a simple diffusion model to understand the spreading of diseases on the disease network at the population level. For the first time we are able to show that patients predominantly develop diseases that are in close network proximity to disorders that they already suffer. The model explains more than 85% of the variance of all disease incidents in the population. The presented methodology could be of importance for anticipating age-dependent disease profiles for entire populations, and for design and validation of prevention strategies.

  14. Comorbidity in "DSM" Childhood Mental Disorders: A Functional Perspective

    ERIC Educational Resources Information Center

    Cipani, Ennio

    2014-01-01

    In this article, I address the issue of comorbidity and its prevalence in the prior "Diagnostic and Statistical Manual of Mental Disorders" ("DSM") classification systems. The focus on the topography or form of presenting problems as the venue for determining mental disorders is scrutinized as the possible cause. Addressing the…

  15. Psychiatric Comorbidity in Children with New Onset Epilepsy

    ERIC Educational Resources Information Center

    Jones, Jana E.; Watson, Ryann; Sheth, Raj; Caplan, Rochelle; Koehn, Monica; Seidenberg, Michael; Hermann, Bruce

    2007-01-01

    The aim of this study was to characterize the distribution, timing, and risk factors for psychiatric comorbidity in children with recent onset epilepsy. Children aged 8 to 18 years with recent onset epilepsy (less than 1 year in duration) of idiopathic etiology (n=53) and a healthy comparison group (n=50) underwent a structured psychiatric…

  16. [Comorbidities in COPD: a new challenge in clinical practice].

    PubMed

    Couillard, A; Veale, D; Muir, J-F

    2011-06-01

    Today it is a recognised fact that chronic obstructive pulmonary disease (COPD) is a real systemic disease that is respiratory-based. Recently, the focus has been on the importance of the comorbidities that are associated with COPD, such as all the cardiovascular diseases, lung cancer, diabetes, metabolic syndrome, peripheral muscular dysfunction, depression, anxiety, osteoporosis and anaemia, etc. These comorbidities constitute a new medical and therapeutic challenge with regard to COPD; their high frequency and considerable impact on the quality of life and the prognosis for survival of the patients make them a key element. The aims of this focus are to present the spectrum and prevalence of comorbidities in COPD, to obtain an objective view as to why and how these comorbidities should be systematically assessed and treated in patients, and subsequently to discuss the impact of this new data in clinical practice and in research. This recent data is another positive step in understanding the disease, optimising the diagnosis, and assessing and caring for COPD patients.

  17. Clinical features, comorbidity, and cognitive impairment in elderly bipolar patients

    PubMed Central

    Rise, Ida Vikan; Haro, Josep Maria; Gjervan, Bjørn

    2016-01-01

    Introduction Data specific to late-life bipolar disorder (BD) are limited. Current research is sparse and present guidelines are not adapted to this group of patients. Objectives We present a literature review on clinical characteristics, comorbidities, and cognitive impairment in patients with late-life BD. This review discusses common comorbidities that affect BD elders and how aging might affect cognition and treatment. Methods Eligible studies were identified in MedLine by the Medical Subject Headings terms “bipolar disorder” and “aged”. We only included original research reports published in English between 2012 and 2015. Results From 414 articles extracted, 16 studies were included in the review. Cardiovascular and respiratory conditions, type II diabetes, and endocrinological abnormalities were observed as highly prevalent. BD is associated with a high suicide risk. Bipolar elderly had an increased risk of dementia and performed worse on cognitive screening tests compared to age-matched controls across different levels of cognition. Despite high rates of medical comorbidity among bipolar elderly, a systematic under-recognition and undertreatment of cardiovascular disease have been suggested. Conclusion There was a high burden of physical comorbidities and cognitive impairment in late-life BD. Bipolar elderly might be under-recorded and undertreated in primary medical care, indicating that this group needs an adapted clinical assessment and specific clinical guidelines need to be established. PMID:27274256

  18. Temporal Sequence of Comorbid Alcohol Use Disorder and Anorexia Nervosa

    PubMed Central

    Baker, Jessica H.; Thornton, Laura M.; Strober, Michael; Brandt, Harry; Crawford, Steve; Fichter, Manfred M.; Halmi, Katherine A.; Johnson, Craig; Jones, Ian; Kaplan, Allan S.; Klump, Kelly L.; Mitchell, James E.; Treasure, Janet; Woodside, D. Blake; Berrettini, Wade H.; Kaye, Walter H.; Bulik, Cynthia M.

    2013-01-01

    Women with eating disorders have a significantly higher prevalence of substance use disorders than the general population. The goal of the current study was to assess the temporal pattern of comorbid anorexia nervosa (AN) and alcohol use disorder (AUD) and the impact this ordering has on symptomatology and associated features. Women were placed into one of three groups based on the presence or absence of comorbid AUD and the order of AN and AUD onset in those with both disorders: (1) AN Only, (2) AN First, and (3) AUD First. The groups were compared on psychological symptoms and personality characteristics often associated with AN, AUD, or both using general linear models. Twenty-one percent of women (n = 161) with AN reported a history of AUD with 115 reporting AN onset first and 35 reporting AUD onset first. Women with binge-eating and/or purging type AN were significantly more likely to have AUD. In general, differences were found only between women with AN Only and women with AN and AUD regardless of order of emergence. Women with AN and AUD had higher impulsivity scores and higher prevalence of depression and borderline personality disorder than women with AN Only. Women with AN First scored higher on traits commonly associated with AN, whereas women with comorbid AN and AUD displayed elevations in traits more commonly associated with AUD. Results do not indicate a distinct pattern of symptomatology in comorbid AN and AUD based on the temporal sequence of the disorders. PMID:23254222

  19. Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome

    PubMed Central

    Eapen, Valsamma; Cavanna, Andrea E.; Robertson, Mary M.

    2016-01-01

    Tourette syndrome (TS) is more than having motor and vocal tics, and this review will examine the varied comorbidities as well as the social impact and quality of life (QoL) in individuals with TS. The relationship between any individual and his/her environment is complex, and this is further exaggerated in the case of a person with TS. For example, tics may play a significant role in shaping the person’s experiences, perceptions, and interactions with the environment. Furthermore, associated clinical features, comorbidities, and coexisting psychopathologies may compound or alter this relationship. In this regard, the common comorbidities include attention-deficit hyperactivity disorder and disruptive behaviors, obsessive compulsive disorder, and autism spectrum disorder, and coexistent problems include anxiety, depression, and low self-esteem, which can all lead to poorer psychosocial functioning and QoL. Thus, the symptoms of TS and the associated comorbid conditions may interact to result in a vicious cycle or a downward spiraling of negative experiences and poor QoL. The stigma and social maladjustment in TS and the social exclusion, bullying, and discrimination are considered to be caused in large part by misperceptions of the disorder by teachers, peers, and the wider community. Improved community and professional awareness about TS and related comorbidities and other psychopathologies as well as the provision of multidisciplinary services to meet the complex needs of this clinical population are critical. Future research to inform the risk and resilience factors for successful long-term outcomes is also warranted. PMID:27375503

  20. Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma

    PubMed Central

    Fernández-Ruiz, Mario; Guerra-Vales, Juan-Manuel; Colina-Ruizdelgado, Francisco

    2009-01-01

    AIM: To study the outcome and prognostic factors in a series of patients with extrahepatic cholangiocarcinoma and determine the impact of comorbidity on survival. METHODS: A retrospective analysis of 68 patients with extrahepatic cholangiocarcinoma (perihilar, n = 37; distal, n = 31) seen at a single tertiary-care institution during the period 1999-2003 was performed. Data on presentation, management, and outcome were assessed by chart review. Pathologic confirmation was obtained in 37 cases (54.4%). Comorbidity was evaluated by using the Charlson comorbidity index (CCI). RESULTS: Mean age at diagnosis was 73.4 ± 11.5 years. Jaundice was the most common symptom presented (86.8%). Median CCI score was 1 (range, 0 to 4). Nineteen patients (27.9%) underwent tumor resection. Palliative biliary drainage was performed in 39 patients (57.4%), and 6 patients (8.8%) received only best supportive care. Tumor-free margin status (R0) was achieved in 15 cases (78.9% of resection group). Baseline serum carbohydrate antigen 19-9 (CA 19-9) level was revealed to be an independent predictor of surgical treatment (P = 0.026). Overall median survival was 3.1 ± 0.9 mo, with 1- and 2-year survival rates of 21% and 7%, respectively. In the univariate analysis, tumor resection, CCI score, and serum CA 19-9 levels correlated significantly with outcome. In the multivariate analysis, only resection (HR 0.10; 95% CI, 0.02-0.51, P = 0.005) and a CCI score ≥ 2 (HR 3.36; 95% CI, 1.0-10.9, P = 0.045) were found to independently predict survival. CONCLUSION: Tumor resection and comorbidity emerged as significant prognostic variables in extrahepatic cholangiocarcinoma. Comorbidity evaluation instruments should be applied in the clinical management of such patients. PMID:19908335

  1. Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment

    PubMed Central

    Vinall, Jillian; Pavlova, Maria; Asmundson, Gordon J. G.; Rasic, Nivez; Noel, Melanie

    2016-01-01

    Chronic pain during childhood and adolescence can lead to persistent pain problems and mental health disorders into adulthood. Posttraumatic stress disorders and depressive and anxiety disorders are mental health conditions that co-occur at high rates in both adolescent and adult samples, and are linked to heightened impairment and disability. Comorbid chronic pain and psychopathology has been explained by the presence of shared neurobiology and mutually maintaining cognitive-affective and behavioral factors that lead to the development and/or maintenance of both conditions. Particularly within the pediatric chronic pain population, these factors are embedded within the broader context of the parent–child relationship. In this review, we will explore the epidemiology of, and current working models explaining, these comorbidities. Particular emphasis will be made on shared neurobiological mechanisms, given that the majority of previous research to date has centered on cognitive, affective, and behavioral mechanisms. Parental contributions to co-occurring chronic pain and psychopathology in childhood and adolescence will be discussed. Moreover, we will review current treatment recommendations and future directions for both research and practice. We argue that the integration of biological and behavioral approaches will be critical to sufficiently address why these comorbidities exist and how they can best be targeted in treatment. PMID:27918444

  2. Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment.

    PubMed

    Vinall, Jillian; Pavlova, Maria; Asmundson, Gordon J G; Rasic, Nivez; Noel, Melanie

    2016-12-02

    Chronic pain during childhood and adolescence can lead to persistent pain problems and mental health disorders into adulthood. Posttraumatic stress disorders and depressive and anxiety disorders are mental health conditions that co-occur at high rates in both adolescent and adult samples, and are linked to heightened impairment and disability. Comorbid chronic pain and psychopathology has been explained by the presence of shared neurobiology and mutually maintaining cognitive-affective and behavioral factors that lead to the development and/or maintenance of both conditions. Particularly within the pediatric chronic pain population, these factors are embedded within the broader context of the parent-child relationship. In this review, we will explore the epidemiology of, and current working models explaining, these comorbidities. Particular emphasis will be made on shared neurobiological mechanisms, given that the majority of previous research to date has centered on cognitive, affective, and behavioral mechanisms. Parental contributions to co-occurring chronic pain and psychopathology in childhood and adolescence will be discussed. Moreover, we will review current treatment recommendations and future directions for both research and practice. We argue that the integration of biological and behavioral approaches will be critical to sufficiently address why these comorbidities exist and how they can best be targeted in treatment.

  3. Discriminating among ADHD alone, ADHD with a comorbid psychological disorder, and feigned ADHD in a college sample.

    PubMed

    Williamson, Kimberly D; Combs, Hannah L; Berry, David T R; Harp, Jordan P; Mason, Lisa H; Edmundson, Maryanne

    2014-01-01

    Since the early 2000s concern has increased that college students might feign ADHD in pursuit of academic accommodations and stimulant medication. In response, several studies have validated tests for use in differentiating feigned from genuine ADHD. Although results have generally been positive, relatively few publications have addressed the possible impact of the presence of psychological disorders comorbid with ADHD. Because ADHD is thought to have accompanying conditions at rates of 50% and higher, it is important to determine if the additional psychological disorders might compromise the accuracy of feigning detection measures. The present study extended the findings of Jasinski et al. (2011) to examine the efficacy of various measures in the context of feigned versus genuine ADHD with comorbid psychological disorders in undergraduate students. Two clinical groups (ADHD only and ADHD + comorbid psychological disorder) were contrasted with two non-clinical groups (normal controls answering honestly and normal participants feigning ADHD). Extending previous research to individuals with ADHD and either an anxiety or learning disorder, performance validity tests such as the Test of Memory Malingering (TOMM), the Letter Memory Test (LMT), and the Nonverbal Medical Symptom Validity Test (NV-MSVT) were effective in differentiating both ADHD groups from normal participants feigning ADHD. However, the Digit Memory Test (DMT) underperformed in this study, as did embedded validity indices from the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Woodcock Johnson Tests of Achievement-III (WJ-III).

  4. Disability and quality of life in pure and comorbid social phobia--findings from a controlled study.

    PubMed

    Wittchen, H U; Fuetsch, M; Sonntag, H; Müller, N; Liebowitz, M

    1999-06-01

    Social phobia is increasingly recognized as a prevalent and socially impairing mental disorder. However, little data is available regarding the general and disease-specific impairments and disabilities associated with social phobia. Furthermore, most studies have not controlled for the confounding effects of comorbid conditions. This study investigates: (a) the generic quality of life; (b) work productivity; and, (c) various other disorder-specific social impairments in current cases with pure (n = 65), comorbid (n = 51) and subthreshold (n = 34) DSM-IV social phobia as compared to controls with no social phobia (subjects with a history of herpes infections). Social phobia cases reported a mean illness duration of 22.9 years with onset in childhood or adolescence. Current quality of life, as assessed by the SF-36, was significantly reduced in all social phobia groups, particularly in the scales measuring vitality, general health, mental health, role limitations due to emotional health, and social functioning. Comorbid cases revealed more severe reductions than pure and subthreshold social phobics. Findings from the Liebowitz self-rated disability scale indicated that: (a) social phobia affects most areas of life, but in particular education, career, and romantic relationship; (b) the presence of past and current comorbid conditions increases the frequency of disease-specific impairments; and, (c) subthreshold social phobia revealed slightly lower overall impairments than comorbid social phobics. Past week work productivity of social phobics was significantly diminished as indicated by: (a) a three-fold higher rate of unemployed cases; (b) elevated rates of work hours missed due to social phobia problems; and, (c) a reduced work performance. Overall, these findings underline that social phobia in our sample of adults, whether comorbid, subthreshold, or pure was a persisting and impairing condition, resulting in considerable subjective suffering and negative impact

  5. Is comorbid status the best predictor of one-year mortality in patients with severe sepsis and sepsis with shock?

    PubMed

    Huddle, N; Arendts, G; Macdonald, S P J; Fatovich, D M; Brown, S G A

    2013-07-01

    Understanding longer term outcomes in critically ill patients will assist treatment decisions, allocation of scarce resources and clinical research in that population. The aim of this study was to compare a well-validated means of determining comorbidity, the Charlson Comorbidity Score, to other verified risk stratification models in predicting one-year mortality and other outcomes in emergency department patients with severe sepsis and sepsis with shock. We conducted a planned subgroup analysis of a prospective observational study, the Critical Illness and Shock Study, in adult patients with sepsis meeting study criteria for critical illness. From emergency department arrival, patients were prospectively enrolled with data collected for a minimum of one year post-enrolment. Scoring systems were derived from this data and compared using receiver-operating characteristic curves. One hundred and four patients were enrolled. The 28-day mortality was 18% and one-year mortality 40%. For predicting one-year mortality, the area under the receiver-operating characteristic curve for age-weighted Charlson Comorbidity Score (0.71, 95% confidence interval 0.61 to 0.81) was at least as good or superior to other scoring systems analysed. The intensive care unit admission rate was 45% and the median hospital length-of-stay was eight days. We conclude that in patients who present to the emergency department with severe sepsis or sepsis with shock, age-weighted Charlson Comorbidity Score is a predictor of one-year mortality that is simple to calculate and at least as accurate as other validated scoring systems.

  6. Legionnaires' Disease and Associated Comorbid Conditions as Causes of Death in the U.S., 2000–2010

    PubMed Central

    Wickramasekaran, Ranjana N.; Sorvillo, Frank

    2015-01-01

    Objective Recent U.S. outbreaks of Legionnaires' disease (LD) underscore the virulent nature of this infectious pneumonia. To date, only a paucity of literature has described the mortality burden of LD. This study updates LD mortality using U.S. multiple-cause-of-death data from 2000–2010. Methods We calculated crude and age-adjusted rates for LD mortality for age, sex, race, state, Census region, and year. We conducted Poisson regression to assess seasonal and temporal trends. We generated matched odds ratios (MORs) to describe the association between LD-related deaths and other comorbid conditions listed on the death certificates. Results We identified a total of 1,171 LD-related deaths during 2000–2010. The age-adjusted mortality rate remained relatively static from 2000 (0.038 per 100,000 population, 95% confidence interval [CI] 0.031, 0.046) to 2010 (0.040 per 100,000 population, 95% CI 0.033, 0.047). The absolute number increased from 107 to 135 deaths during this period, with adults ≥45 years of age having the highest caseload. Overall, LD mortality rates were 2.2 times higher in men than in women. White people accounted for nearly 83.3% of all LD-related deaths, but the age-adjusted mortality rates for black and white people were similar. Comorbid conditions such as leukemia (MOR=4.8, 95% CI 3.5, 6.6) and rheumatoid arthritis (MOR=5.6, 95% CI 3.3, 9.4) were associated with LD diagnosis on death certificates. Conclusion Comorbid conditions that could lead to an immunocompromised state were associated with fatal LD on U.S. death certificates. Characterization of LD mortality burden and related comorbidities has practice implications for clinical medicine and public health surveillance. PMID:25931626

  7. Adolescent substance use disorders and comorbidity.

    PubMed

    Simkin, Deborah R

    2002-04-01

    remove barriers. This technique allows youth to be less defensive and more proactive. Monti et al. [59] have demonstrated that this technique has been useful in getting youth into treatment. Primary care physicians can use instruments that will assess the possibility of both externalizing (e.g., ADHD) and internalizing (e.g., depression and anxiety) disorders. Examples of this type of instrument are the Auchenbach child behavior checklist, teacher report form, and youth self-report form, which survey symptoms for these disorders [1]. Social anxiety disorder can be detected by asking whether the prelatency child went into new situations willingly and tended to hang back or whether the child had difficulty separating from his or her parents. Other questions to ask are whether the child tended to isolate or was fearful of speaking in front of the class. Of course, any bruising or behavior that suggests exposure to adult-related sexual acts may cause concern for physical or sexual abuse and possible PTSD. However, interest in sex earlier than expected for the age of the child may also indicate the possibility of bipolar disorder. These children have many symptoms of ADHD with a high degree of irritability and may seem boastful or grandiose. They may be "daredevils" with no fear of dangerous consequences. Referral to a specialist is necessary to evaluate these children further. Because substance use at age 14 or 15 years can be predicted by academic and social behavior at ages 7 to 9 years, early detection of poor social skills and learning difficulties is essential [43]. Learning disorders can be uncovered by asking the school to do an evaluation. However, schools having economic problems may not be able to accommodate all requests. A parent may have to pay a private provider to complete this workup because insurance companies seldom pay for educational testing. Learning disorders may go undetected because many school systems opt to use a higher deviation from the full

  8. Functional Impairments in Children with ADHD: Unique Effects of Age and Comorbid Status

    ERIC Educational Resources Information Center

    Booster, Genery D.; DuPaul, George J.; Eiraldi, Ricardo; Power, Thomas J.

    2012-01-01

    Objective: Children with ADHD and comorbid disorders display poorer overall functioning compared with children with ADHD alone, though little research has examined the differential impact of externalizing versus internalizing comorbidities. Method: This study examined the impact of internalizing and externalizing comorbidities on the academic and…

  9. Culture and comorbidity in East and West berliners.

    PubMed

    Fechner, Mary J

    2010-03-01

    Following the collapse of socialism, fluctuations in cardiac mortality rates in East Germany and a West-to-East cardiac health gradient became topics of interest. Researchers suggested possible causes for these phenomena, including stress from postsocialism. I proposed that a cultural investigation of heart disease comorbid with depression could inform our understanding of the potential health effects of the postsocialist transition. I conducted ethnographic and survey research. In the study described here, I administered a depression scale (CES-D) and an ethnographically derived measure of cultural stress (Good Life Survey) to over 200 East and West Berliners with cardiovascular disease. Comparison of the groups' depression means revealed no difference. However, correlation of the Good Life Survey and the CES-D revealed unique profiles of cultural variables associated with depression in the two groups, suggesting that culture shapes depression and cardiac risk. I discuss the value of cultural studies to comorbidity research.

  10. Kleine–Levin syndrome with comorbid iron deficiency anemia

    PubMed Central

    Jain, Rajendra Singh; Kumar, Sunil; Srivastava, Trilochan; Sannegowda, Raghavendra Bakki

    2015-01-01

    Kleine–Levin syndrome (KLS) is a rare chronic sleep disorder of unknown etiopathology, which typically occurs in adolescent males. Although the severity of symptoms and disease course varies between the KLS patients, it usually resolves spontaneously, but sometime comorbid conditions may worsen the symptoms. Herein, we report a case of KLS who presented with severe episodic hypersomnia. During episodes, the patient used to sleep as long as 20 h in a day, affecting his daily living activities. All the relevant investigations including electroencephalography, magnetic resonance imaging of brain and cerebrospinal fluid analysis were normal except for severe iron deficiency anemia (IDA). In our patient, the severity of symptoms worsened due to coexistent IDA. The treatment of IDA along with modafinil decreased the severity of symptoms and shortened the hospital stay during episodes. This might be the first case report of KLS with comorbid IDA. PMID:26634130

  11. An Adolescent Boy with Comorbid Anorexia Nervosa and Hashimoto Thyroiditis

    PubMed Central

    Pehlivantürk Kızılkan, Melis; Kanbur, Nuray; Akgül, Sinem; Alikaşifoğlu, Ayfer

    2016-01-01

    Low triiodothyronine syndrome is a physiological adaptation encountered in anorexia nervosa (AN) and generally improves with sufficient weight gain. However, when a primary thyroid pathology accompanies AN, both the evaluation of thyroid hormone levels and the management of the co-morbid disease become more challenging. Hashimoto thyroiditis could complicate the management of AN by causing hyper- or hypothyroidism. AN could also negatively affect the treatment of Hashimoto thyroiditis by altering body weight and metabolic rate, as well as by causing drug non-compliance. We present the case of a 15-year-old boy with comorbid AN restrictive sub-type and Hashimoto thyroiditis. In this case report, we aimed to draw attention to the challenges that could be encountered in the diagnosis, treatment, and follow-up of patients with AN when accompanied by Hashimoto thyroiditis. PMID:26757948

  12. [The problem of comorbidity of phobic disorders in adolescents].

    PubMed

    Golovina, A G

    2007-01-01

    Age peculiarities of the comorbidity of the phobic syndrome with other psychopathological formations have been studied on the basis of clinical and follow-up examination of 314 patients, 257 male, 57 female, aged 15-17 years old, with phobic disorders diagnosed according to ICD-10 criteria. Simple phobias found in 21% of patients existed as an isolated phenomenon displaying no comorbidity. Asthenic syndrome was most frequently concomitant with phobias (293 patients); personality anomalies were found in 167 patients including 31 with personality disorders; affective syndrome was observed in 61 patients and other ones were noticeably rare. Within the structure of the acute states, phobias appear as a schizophrenic attack or reactive symptoms correlating with the basic syndrome by the time of onset, intensity and content. Age differences of the phobic and related psychopathological syndromes are revealed.

  13. Epilepsy and art: Windows into complexity and comorbidities.

    PubMed

    Schachter, Steven C

    2016-04-01

    The views of artists with epilepsy as expressed through their art provide unique opportunities to gain understanding of the experiences of living with epilepsy and related comorbidities. This paper provides a glimpse into art collected from an international group of artists with epilepsy, focusing on ictal and postictal experiences, psychiatric comorbidities, and social aspects of epilepsy. The art serves to enhance understanding among clinicians and neuroscientists of what it means to have epilepsy as well as to reduce misunderstanding and stigma among the public. It may also inspire neuroscientists to further explore the underlying neurological basis to the rich tapestries of ictal, postictal, and interictal experiences of persons with epilepsy. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

  14. The Role of Co-morbidities in Cardioprotection

    PubMed Central

    Sack, Michael; Murphy, Elizabeth

    2012-01-01

    Cardioprotective strategies such as pre and postconditioning result in a robust reduction in infarct size in young, healthy male animals. However there are data suggesting that the protection is diminished in animals with co-morbidities such as hypertension, hypercholesterolemia and diabetes. It is important to understand at a mechanistic level the reasons for these differences. The effects of sex and diseases need to be considered in design of cardioprotective interventions in animal studies and clinical trials. PMID:21821527

  15. Psychiatric comorbidity in adolescent electronic and conventional cigarette use.

    PubMed

    Leventhal, Adam M; Strong, David R; Sussman, Steve; Kirkpatrick, Matthew G; Unger, Jennifer B; Barrington-Trimis, Jessica L; Audrain-McGovern, Janet

    2016-02-01

    The popularity of electronic (e-) cigarettes has greatly increased recently, particularly in adolescents. However, the extent of psychiatric comorbidity with adolescent e-cigarette use and dual use of conventional (combustible) and e-cigarettes is unknown. This study characterized psychiatric comorbidity in adolescent conventional and e-cigarette use. Ninth grade students attending high schools in Los Angeles, CA (M age = 14) completed self-report measures of conventional/e-cigarette use, emotional disorders, substance use/problems, and transdiagnostic psychiatric phenotypes consistent with the NIMH-Research Domain Criteria Initiative. Outcomes were compared by lifetime use of: (1) neither conventional nor e-cigarettes (non-use; N = 2557, 77.3%); (2) e-cigarettes only (N = 412, 12.4%); (3) conventional cigarettes only (N = 152, 4.6%); and (4) conventional and e-cigarettes (dual use; N = 189, 5.6%). In comparison to adolescents who used conventional cigarettes only, e-cigarette only users reported lower levels of internalizing syndromes (depression, generalized anxiety, panic, social phobia, and obsessive-compulsive disorder) and transdiagnostic phenotypes (i.e., distress intolerance, anxiety sensitivity, rash action during negative affect). Depression, panic disorder, and anhedonia were higher in e-cigarette only vs. non-users. For several externalizing outcomes (mania, rash action during positive affect, alcohol drug use/abuse) and anhedonia, an ordered pattern was observed, whereby comorbidity was lowest in non-users, moderate in single product users (conventional or e-cigarette), and highest in dual users. These findings: (1) raise question of whether emotionally-healthier ('lower-risk') adolescents who are not interested in conventional cigarettes are being attracted to e-cigarettes; (2) indicate that research, intervention, and policy dedicated to adolescent tobacco-psychiatric comorbidity should distinguish conventional cigarette, e-cigarette, and dual use.

  16. Comorbidity in Dementia: Update of An Ongoing Autopsy Study

    PubMed Central

    Magaki, Shino; Yong, William H.; Khanlou, Negar; Tung, Spencer; Vinters, Harry V.

    2014-01-01

    OBJECTIVES To examine systemic and central nervous system (CNS) comorbidities of patients with dementia evaluated during general autopsy. DESIGN Retrospective cohort study. SETTING A large tertiary academic medical center in Los Angeles, California. PARTICIPANTS A cohort of 86 participants with clinically and neuropathologically diagnosed dementia who received complete autopsies and 132 participants with dementia who received partial (brain only) autopsies. MEASUREMENTS The causes of death as well as systemic and CNS comorbidities were obtained from autopsy reports and clinical information as available from the medical records. Findings were tabulated with respect to type of dementia, semiquantitative assessment of the severity of cerebral amyloid angiopathy, semiquantitative assessment of the severity of cerebrovascular disease, and evidence of ischemic damage in the brain. RESULTS Out of a total of 218 subjects with dementia, 175 (80.3%) had Alzheimer’s disease (AD) either in isolation or in combination with other lesions that might contribute to cognitive impairment, such as cerebrovascular disease and diffuse Lewy body disease (DLBD), 14 (6.4%) had frontotemporal dementia (FTD), and 7 (3.2%) had isolated DLBD. The most common cause of death among demented patients was pneumonia (57 cases, 66.3%) followed by cardiovascular disease (14 cases, 16.3%). Eighteen subjects (20.9%) had lung disease and 16 (18.6%) had evidence of old or recent myocardial infarct. Clinically undiagnosed neoplasms included colonic adenocarcinoma, metastatic pulmonary neuroendocrine carcinoma, meningioma, and Schwannoma. CONCLUSION Significant comorbidities were discovered at autopsy in patients with dementia. Understanding the causes of death and associated comorbidities in patients with various subtypes of dementia is important in the assessment of end of life care in these subjects. PMID:25039832

  17. Comorbidity between psychiatric and general medical disorders in homeless veterans.

    PubMed

    Goldstein, Gerald; Luther, James F; Haas, Gretchen L; Gordon, Adam J; Appelt, Cathleen

    2009-12-01

    Homeless veterans have numerous co-occurring medical and behavioral health problems. Identification of common patterns of comorbid conditions may help providers to determine severity of medical conditions and triage health care more effectively. In this study we identify such patterns of comorbid medical and psychiatric disorders using cluster analysis and we evaluate relationships between these patterns and sociodemographic factors. We used data from a survey of 3,595 veterans in a regional VA network who were presently or recently homeless assessing nine major medical disorder and six psychiatric disorder categories. Diagnostic ratings of presence or absence of these disorders were placed into the same cluster analysis to determine whether separable clusters emerged reflecting differing diagnostic profiles. There are recognizable patterns of comorbidity involving several psychiatric and general medical disorders, as well as disorders of both types that exist independently. Cluster membership was associated with various sociodemographic indices. Mental and general medical health problems in homeless veterans often occur in association with each other and form identifiable patterns that vary on sociodemographic factors.

  18. Psychological Co-morbidity in Children with Specific Learning Disorders

    PubMed Central

    Sahoo, Manoj K.; Biswas, Haritha; Padhy, Susanta Kumar

    2015-01-01

    Children under 19 years of age constitute over 40% of India's population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs) exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder) is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common) to depression, anxiety, suicide etc., to substance abuse (least common). Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most) given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind. PMID:25810984

  19. Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease.

    PubMed

    Corlateanu, Alexandru; Covantev, Serghei; Mathioudakis, Alexander G; Botnaru, Victor; Siafakas, Nikolaos

    2016-11-01

    The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research. This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.

  20. Temperament dimensions explain the comorbidity of psychiatric disorders.

    PubMed

    Battaglia, M; Przybeck, T R; Bellodi, L; Cloninger, C R

    1996-01-01

    The comorbidity of DSM-III-R axis I and axis II disorders presents conceptual and nosological challenges to psychiatry. In a consecutive series of 164 psychiatric outpatients and 36 healthy controls in Milan, Italy, psychopathology was measured by structured interviews for DSM-III-R disorders and temperament was measured by the Tridimensional Personality Questionnaire (TPQ). Low reward dependence (RD) distinguished cluster A personality disorders and no axis I disorders. High novelty seeking (NS) characterized cluster B personality disorders and patients with eating disorders, alcohol abuse, or substance abuse. High harm avoidance (HA) characterized all cluster C personality disorders and patients with mood or anxiety disorders. The temperament dimensions were nearly independent of one another, but patients often had multiple DSM-III-R diagnoses. The joint relations of these disorders to multiple temperament dimensions accounted for their characteristic patterns of comorbidity. These findings support the hypothesis that interactions among temperament dimensions during development influence comorbidity between axis I and axis II disorders.

  1. Comorbidities and cardiovascular risk factors in patients with psoriasis*

    PubMed Central

    Baeta, Isabela Guimarães Ribeiro; Bittencourt, Flávia Vasques; Gontijo, Bernardo; Goulart, Eugênio Marcos Andrade

    2014-01-01

    BACKGROUND Psoriasis is a chronic inflammatory disease and its pathogenesis involves an interaction between genetic, environmental, and immunological factors. Recent studies have suggested that the chronic inflammatory nature of psoriasis may predispose to an association with other inflammatory diseases, especially cardiovascular diseases and metabolic disorders. OBJECTIVES To describe the demographic, clinical, epidemiological, and laboratory characteristics of a sample of psoriasis patients; to assess the prevalence of cardiovascular comorbidities in this group of patients; and to identify the cardiovascular risk profile using the Framingham risk score. METHODS We conducted a cross-sectional study involving the assessment of 190 patients. Participants underwent history and physical examination. They also completed a specific questionnaire about epidemiological data, past medical history, and comorbidities. The cardiovascular risk profile was calculated using the Framingham risk score. RESULTS Patients' mean age was 51.5 ± 14 years, and the predominant clinical presentation was plaque psoriasis (78.4%). We found an increased prevalence of systemic hypertension, type 2 diabetes, metabolic syndrome, and obesity. Increased waist circumference was also found in addition to a considerable prevalence of depression, smoking, and regular alcohol intake. Patients' cardiovascular risk was high according to the Framingham risk score, and 47.2% of patients had moderate or high risk of fatal and non-fatal coronary events in 10 years. CONCLUSIONS Patients had high prevalence of cardiovascular comorbidities, and high cardiovascular risk according to the Framingham risk score. Further epidemiological studies are needed in Brazil for validation of our results. PMID:25184912

  2. Hyperphosphorylated tau is implicated in acquired epilepsy and neuropsychiatric comorbidities.

    PubMed

    Zheng, Ping; Shultz, Sandy R; Hovens, Chris M; Velakoulis, Dennis; Jones, Nigel C; O'Brien, Terence J

    2014-06-01

    Epilepsy is a common group of neurological diseases. Acquired epilepsy can be caused by brain insults, such as trauma, infection or tumour, and followed by a latent period from several months to years before the emergence of recurrent spontaneous seizures. More than 50% of epilepsy cases will develop chronic neurodegenerative, neurocognitive and neuropsychiatric comorbidities. It is important to understand the mechanisms by which a brain insult results in acquired epilepsy and comorbidities in order to identify targets for novel therapeutic interventions that may mitigate these outcomes. Recent studies have implicated the hyperphosphorylated tubulin-associated protein (tau) in rodent models of epilepsy and Alzheimer's disease, and in experimental and clinical studies of traumatic brain injury. This potentially represents a novel target to mitigate epilepsy and associated neurocognitive and psychiatric disorders post-brain injury. This article reviews the potential role of tau-based mechanisms in the pathophysiology of acquired epilepsy and its neurocognitive and neuropsychiatric comorbidities, and the potential to target these for novel disease-modifying treatments.

  3. Management of Colorectal Cancer in Older Adults.

    PubMed

    Hubbard, Joleen M

    2016-02-01

    Treatment for colorectal cancer should not be based on age alone. Pooled analyses from clinical trials show that fit older adults are able to tolerate treatment well with similar efficacy as younger adults. When an older adult is considered for treatment, the clinical encounter must evaluate for deficits in physical and cognitive function, and assess comorbidities, medications, and the degree of social support, all which have may affect tolerance of treatment. Based on the degree of fitness of the patient, multiple alternatives to aggressive treatment regimens and strategies exist to minimize toxicity and preserve quality of life during treatment.

  4. Improving cardiovascular health and metabolic comorbidities in patients with psoriatic arthritis

    PubMed Central

    Ogdie, Alexis; Eder, Lihi

    2016-01-01

    Numerous studies have suggested a link between psoriatic arthritis (PsA) and comorbidities, in particular cardiovascular disease and metabolic comorbidities such as diabetes. The co-existence of these comorbidities is likely the result of systemic inflammation. In order to improve the health of patients with PsA and provide optimal care, these comorbidities must be addressed. However, little is known about how to improve metabolic and cardiovascular health in patients with PsA. In this perspective, we describe the research needs in the area of improving cardiovascular disease and metabolic comorbidities among patients with PsA. PMID:27134682

  5. How Can the Comorbidity with ADHD Aid Understanding of Language and Speech Disorders?

    PubMed Central

    Tomblin, J. Bruce; Mueller, Kathyrn L

    2014-01-01

    This paper serves to provide a background for the topic of comorbidity than extends through this issue. Comorbidity is common within developmental disorders. It is shown that there are many possible reasons for comorbidity. Some of these can be viewed as artifacts as simple as chance occurrence or because of the way that the research participants were sampled. If these artifacts are eliminated, then comorbidity can be informative with respect to possible causes of the disorders that are comorbid. Several possible etiologic models are presented along with a general framework for considering levels of causality in developmental disorders. PMID:24817779

  6. Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients.

    PubMed

    Amerio, A; Tonna, M; Odone, A; Stubbs, B; Ghaemi, S N

    2016-04-01

    Psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). We updated our recent systematic review searching the electronic databases MEDLINE, Embase, and PsycINFO to investigate course of illness in BD-OCD patients. We identified a total of 13 relevant papers which found that the majority of comorbid OCD cases appeared to be related to mood episodes. OC symptoms in comorbid patients appeared more often during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes.

  7. Juvenile Fibromyalgia: Different from the Adult Chronic Pain Syndrome?

    PubMed

    Kashikar-Zuck, Susmita; King, Christopher; Ting, Tracy V; Arnold, Lesley M

    2016-04-01

    While a majority of research has focused on adult fibromyalgia (FM), recent evidence has provided insights into the presence and impact of FM in children and adolescents. Commonly referred as juvenile fibromyalgia (JFM), youths, particularly adolescent girls, present with persistent widespread pain and cardinal symptoms observed in adult FM. A majority of youth with JFM continue to experience symptoms into adulthood, which highlights the importance of early recognition and intervention. Some differences are observed between adult and juvenile-onset FM syndrome with regard to comorbidities (e.g., joint hypermobility is common in JFM). Psychological comorbidities are common but less severe in JFM. Compared to adult FM, approved pharmacological treatments for JFM are lacking, but non-pharmacologic approaches (e.g., cognitive-behavioral therapy and exercise) show promise. A number of conceptual issues still remain including (1) directly comparing similarities and differences in symptoms and (2) identifying shared and unique mechanisms underlying FM in adults and youths.

  8. Rapid Amygdala Kindling Causes Motor Seizure and Comorbidity of Anxiety- and Depression-Like Behaviors in Rats

    PubMed Central

    Chen, Shang-Der; Wang, Yu-Lin; Liang, Sheng-Fu; Shaw, Fu-Zen

    2016-01-01

    Amygdala kindling is a model of temporal lobe epilepsy (TLE) with convulsion. The rapid amygdala kindling has an advantage on quick development of motor seizures and for antiepileptic drugs screening. The rapid amygdala kindling causes epileptogenesis accompanied by an anxiolytic response in early isolation of rat pups or depressive behavior in immature rats. However, the effect of rapid amygdala kindling on comorbidity of anxiety- and depression-like behaviors is unexplored in adult rats with normal breeding. In the present study, 40 amygdala stimulations given within 2 days were applied in adult Wistar rats. Afterdischarge (AD) and seizure stage were recorded throughout the amygdala kindling. Anxiety-like behaviors were evaluated by the elevated plus maze (EPM) test and open field (OF) test, whereas depression-like behaviors were assessed by the forced swim (FS) and sucrose consumption (SC) tests. A tonic-clonic convulsion was provoked in the kindle group. Rapid amygdala kindling resulted in a significantly lower frequency entering an open area of either open arms of the EPM or the central zone of an OF, lower sucrose intake, and longer immobility of the FS test in the kindle group. Our results suggest that rapid amygdala kindling elicited severe motor seizures comorbid with anxiety- and depression-like behaviors. PMID:27445726

  9. [Evolutionary issues in attention deficit hyperactivity disorder (ADHD); from risk factors to comorbidity and social and academic impact].

    PubMed

    Quintero, Javier; Loro, Mercedes; Jiménez, Belén; García Campos, Natalia

    2011-01-01

    Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and at least one-third to one-half will continue through adolescence and adulthood. Moreover it is important the high comorbidity not only in children, but in adolescents and adults. Therefore ADHD becomes especially important when we observe it as a risk factor for the development of another psychopathology that add more complexity to the diagnosis of children and adolescents and also adults, and confers an evolutionary risk throughout the lifetime of the person who suffers from it. A correlational study with a sample of 378 patients diagnosed with ADHD in the childhood between 1988 and 2000 who had initiated treatment after been diagnosed was carried out. 88 patients were evaluated years after (2006) with ages between 18 and 33 years old. 85% of the patients in this study had had combined treatment. The data found in this study show lower comorbidity than other published studies (36.4%), as well as a lower persistence of the complete diagnosis of ADHD in the adulthood (15%). This is a treated population; the results may lead to a possible protector role of the early treatment of ADHD.

  10. Associations between Pathological Gambling and Psychiatric Comorbidity among Help-Seeking Populations in Hong Kong

    PubMed Central

    Shek, Daniel T. L.; Chan, Elda M. L.; Wong, Ryan H. Y.

    2012-01-01

    Problem gambling is complex and often comorbid with other mental health problems. Unfortunately, gambling studies on comorbid psychiatric disorders among Chinese communities are extremely limited. The objectives of this study were to (a) determine the prevalence of comorbid psychiatric disorders among treatment-seeking pathological gamblers; (b) compare the demographic profiles and clinical features of pathological gamblers with and without comorbid psychiatric disorders; (c) explore the associations between pathological gambling and psychiatric disorders and their temporal relationship. Participants (N = 201) who sought gambling counseling were examined by making Axis-I diagnoses including mood disorders, schizophrenia spectrum disorders, substance use disorders, anxiety disorders, and adjustment disorder. Results showed that 63.7% of participants had lifetime comorbid psychiatric disorder. The most common comorbid psychiatric mental disorders were mood disorders, adjustment disorder, and substance use disorders. Pathological gamblers with psychiatric comorbidities were significantly more severe in psychopathology, psychosocial functioning impairment, and gambling problems than those without the disorders. PMID:22778700

  11. Challenges with Diagnosing and Managing Sepsis in Older Adults

    PubMed Central

    Clifford, Kalin M.; Dy-Boarman, Eliza A.; Haase, Krystal K.; Maxvill, Kristen (Hesch); Pass, Steven; Alvarez, Carlos A.

    2016-01-01

    Sepsis in older adults has many challenges that affect rate of septic diagnosis, treatment, and monitoring parameters. Numerous age-related changes and comorbidities contribute to increased risk of infections in older adults, but also atypical symptomatology that delays diagnosis. Due to various pharmacokinetic/pharmacodynamic changes in the older adult, medications are absorbed, metabolized, and eliminated at different rates as compared to younger adults, which increases risk of adverse drug reactions due to use of drug therapy needed for sepsis management. This review provides information to aid in diagnosis as well as offers recommendations for monitoring and treating sepsis in the older adult population. PMID:26687340

  12. Comorbid Cognitive Impairment and Functional Trajectories in Low Vision Rehabilitation for Macular Disease

    PubMed Central

    Whitson, Heather E.; Ansah, Deidra; Sanders, Linda L; Whitaker, Diane; Potter, Guy G.; Cousins, Scott W.; Steffens, David C.; Landerman, Lawrence R.; Pieper, Carl F.; Cohen, Harvey Jay

    2011-01-01

    Background and Aims Comorbid cognitive impairment is common among visually impaired older adults. This study investigated whether baseline cognitive status predicts functional trajectories among older adults in low vision rehabilitation (LVR) for macular disease. Methods The Telephone Interview for Cognitive Status – modified (TICS-m) was administered to macular disease patients aged ≥ 65 years receiving outpatient LVR. Mixed models assessed the rate of change in instrumental activities of daily living and visual function measures over a mean follow-up of 115 days. Results Of 91 participants, 17 (18.7%) had cognitive impairment (TICS-m score ≤ 27) and 23 (25.3%) had marginal impairment (TICS-m scores 28 to 30). Controlling for age and gender, baseline cognitive status did not predict most functional outcomes. However, participants with marginal cognitive impairment experienced worse functional trajectories in ability to prepare meals (p=0.03).and activities that require distance vision (p = 0.05). Conclusion Patients with mild to moderate cognitive impairment should not be excluded from LVR, but programs should be prepared to detect and accommodate a range of cognitive ability. PMID:22526069

  13. Effect of a family history of psoriasis and age on comorbidities and quality of life in patients with moderate to severe psoriasis: Results from the ARIZONA study.

    PubMed

    López-Estebaranz, Jose Luis; Sánchez-Carazo, Jose Luis; Sulleiro, Sara

    2016-04-01

    Psoriasis is a chronic inflammatory skin disease whose clinical characteristics vary from patient to patient. We aimed to analyze how comorbidities and quality of life (QoL, as per the Dermatology Life Quality Index [DLQI]) may be affected by a family history of psoriasis and by age. The ARIZONA study was a multicenter, cross-sectional study in 1022 adult patients diagnosed with moderate to severe psoriasis at least 6 months prior to inclusion. The severity of psoriasis and the proportion of patients with comorbidities were not affected by the presence of a family history. The regression analysis revealed that the presence of a family history of psoriasis was associated with the effect on the patient's QoL (P = 0.002), regardless of disease severity. The mean DLQI total score varied significantly across age groups (5.1 ± 5.3 for the 18-30-year group, 5.7 ± 6.5 for the 31-60-year group and 3.8 ± 5.1 for the >60-year group; P = 0.001). In conclusion, the presence of a family history of psoriasis appears to disrupt QoL in patients with moderate to severe psoriasis, but it hardly affected the prevalence of comorbid conditions. The effect of age on QoL was particularly noticeable in younger patients, highlighting its negative impact. As expected, older patients appeared to be burdened with a higher number of comorbidities than their younger counterparts.

  14. Individual correlates of self-stigma in patients with anxiety disorders with and without comorbidities

    PubMed Central

    Ociskova, Marie; Prasko, Jan; Kamaradova, Dana; Grambal, Ales; Sigmundova, Zuzana

    2015-01-01

    Background A number of psychiatric patients experience stigma connected to prejudices about mental disorders. It has been shown that stigma is most harmful when it is internalized. Most of the studies were performed on individuals either with psychoses or with mood disorders, and hence, there are almost no studies with other diagnostic categories. The goals of this research were to identify factors that are significantly related to self-stigma in patients with anxiety disorders and to suggest possible models of causality for these relationships. Methods A total of 109 patients with anxiety disorders and possible comorbid depressive or personality disorders, who were admitted to the psychotherapeutic department participated in this study. All patients completed several psychodiagnostic methods, ie, the Internalized Stigma of Mental Illness Scale, Temperament and Character Inventory-Revised Version, Adult Dispositional Hope Scale, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory-Second Edition, and Clinical Global Impression (also completed by the senior psychiatrist). Results The overall level of self-stigma was positively associated with a comorbid personality disorder, more severe symptomatology, more intense symptoms of anxiety and depression, and higher levels of dissociation and harm avoidance. Self-stigma was negatively related to hope, reward dependence, persistence, self-directedness, and cooperativeness. Multiple regression analysis showed that the most significant factors connected to self-stigma are harm avoidance, the intensity of depressive symptoms, and self-directedness. Two models of causality were proposed and validated. It seems that the tendency to dissociate in stress increases the probability of development of self-stigma, and this relationship is entirely mediated by avoidance of harm. Conversely, self-directedness lowers the probability of occurrence of self-stigma, and this effect is partly mediated by hope

  15. Impulsive Aggression as a Comorbidity of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

    PubMed Central

    Amann, Birgit H.

    2016-01-01

    Abstract Objective: This article examines the characteristics of impulsive aggression (IA) as a comorbidity in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), focusing on its incidence, impact on ADHD outcomes, need for timely intervention, and limitations of current treatment practices. Methods: Relevant literature was retrieved with electronic searches in PubMed and PsycINFO using the search strategy of “ADHD OR attention deficit hyperactivity disorder” AND “impulsive aggression OR reactive aggression OR hostile aggression OR overt aggression” AND “pediatric OR childhood OR children OR pre-adolescent OR adolescent” with separate searches using review OR clinical trial as search limits. Key articles published before the 2007 Expert Consensus Report on IA were identified using citation analysis. Results: More than 50% of preadolescents with ADHD combined subtype reportedly display clinically significant aggression, with impulsive aggression being the predominant subtype. Impulsive aggression is strongly predictive of a highly unfavorable developmental trajectory characterized by the potential for persistent ADHD, increasing psychosocial burden, accumulating comorbidities, serious lifelong functional deficits across a broad range of domains, delinquency/criminality, and adult antisocial behavior. Impulsive aggression, which triggers peer rejection and a vicious cycle of escalating dysfunction, may be a key factor in unfavorable psychosocial outcomes attributed to ADHD. Because severe aggressive behavior does not remit in many children when treated with primary ADHD therapy (i.e., stimulants and behavioral therapy), a common practice is to add medication of a different class to specifically target aggressive behavior. Conclusions: Impulsive aggression in children and adolescents with ADHD is a serious clinical and public health problem. Although adjunctive therapy with an aggression-targeted agent is widely recommended when

  16. Dysfunctional breathing in children with asthma: a rare but relevant comorbidity.

    PubMed

    de Groot, Eric P; Duiverman, Eric J; Brand, Paul L P

    2013-05-01

    Hyperventilation and other clinical manifestations of dysfunctional breathing have been reported in childhood, but the prevalence is unknown. In adults, dysfunctional breathing may be a relevant comorbidity in asthma. We aimed to determine the prevalence of dysfunctional breathing in children with asthma and its impact on asthma control. We performed a cross-sectional survey in 203 asthmatic children (aged 5-18 years), using the Nijmegen Questionnaire and the paediatric Asthma Control Questionnaire. Dysfunctional breathing was found in 11 (5.3%) children; more females (eight (12.9%) out of 62) than males (three (2.1%) out 144, p=0.002). There was a dose-dependent relationship between increasing Nijmegen Questionnaire scores (increased risk of dysfunctional breathing) and poorer asthma control. Poor asthma control was more common in patients with dysfunctional breathing (10 (90.9%) out of 11 children) than in children without (65 (32.3%) out of 192 children; OR 19.3, 95% CI 3.14-430.70; p<0.0001). The median Asthma Control Questionnaire in children with dysfunctional breathing was higher (median (range) 2.00 (1.50-3.17)) than in children without (0.50 (0.17-1.17); p<0.001). The prevalence of dysfunctional breathing in children and adolescents referred to a hospital-based paediatric asthma clinic for severe or difficult-to-control asthma is 5%. The association between dysfunctional breathing and asthma control suggests that this may be a clinically relevant comorbidity in paediatric asthma.

  17. Antidepressants but not antipsychotics have antiepileptogenic effects with limited effects on comorbid depressive-like behaviour in the WAG/Rij rat model of absence epilepsy

    PubMed Central

    Citraro, Rita; Leo, Antonio; De Fazio, Pasquale; De Sarro, Giovambattista; Russo, Emilio

    2015-01-01

    Background and Purpose Two of the most relevant unmet needs in epilepsy are represented by the development of disease-modifying drugs able to affect epileptogenesis and/or the study of related neuropsychiatric comorbidities. No systematic study has investigated the effects of chronic treatment with antipsychotics or antidepressants on epileptogenesis. However, such drugs are known to influence seizure threshold. Experimental Approach We evaluated the effects of an early long-term treatment (ELTT; 17 weeks), started before seizure onset (P45), with fluoxetine (selective 5-HT-reuptake inhibitor), duloxetine (dual-acting 5-HT-noradrenaline reuptake inhibitor), haloperidol (typical antipsychotic drug), risperidone and quetiapine (atypical antipsychotic drugs) on the development of absence seizures and comorbid depressive-like behaviour in the WAG/Rij rat model. Furthermore, we studied the effects of these drugs on established absence seizures in adult (6-month-old) rats after a chronic 7 weeks treatment. Key Results ELTT with all antipsychotics did not affect the development of seizures, whereas, both ELTT haloperidol (1 mg·kg−1 day−1) and risperidone (0.5 mg·kg−1 day−1) increased immobility time in the forced swimming test and increased absence seizures only in adult rats (7 weeks treatment). In contrast, both fluoxetine (30 mg·kg−1 day−1) and duloxetine (10–30 mg·kg−1 day−1) exhibited clear antiepileptogenic effects. Duloxetine decreased and fluoxetine increased absence seizures in adult rats. Duloxetine did not affect immobility time; fluoxetine 30 mg·kg−1 day−1 reduced immobility time while at 10 mg·kg−1 day−1 an increase was observed. Conclusions and Implications In this animal model, antipsychotics had no antiepileptogenic effects and might worsen depressive-like comorbidity, while antidepressants have potential antiepileptogenic effects even though they have limited effects on comorbid depressive-like behaviour. PMID

  18. An Investigation of Comorbid Psychological Disorders, Sleep Problems, Gastrointestinal Symptoms and Epilepsy in Children and Adolescents with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Mannion, Arlene; Leader, Geraldine; Healy, Olive

    2013-01-01

    The current study investigated comorbidity in eighty-nine children and adolescents with Autism Spectrum Disorder in Ireland. Comorbidity is the presence of one or more disorders in addition to a primary disorder. The prevalence of comorbid psychological disorders, behaviours associated with comorbid psychopathology, epilepsy, gastrointestinal…

  19. Psychiatric Comorbidity in Depressed HIV-infected Individuals: Common and Clinically Consequential

    PubMed Central

    Gaynes, Bradley N.; O'Donnell, Julie; Nelson, Elise; Heine, Amy; Zinski, Anne; Edwards, Malaika; McGuinness, Teena; Riddhi, Modi A.; Montgomery, Charita; Pence, Brian W

    2015-01-01

    Objective To report on the prevalence of psychiatric comorbidity and its association with illness severity in depressed HIV patients. Methods As part of a multi-site randomized controlled trial of depression treatment for HIV patients, 304 participants meeting criteria for current Major Depressive Disorder (MDD) were assessed for other mood, anxiety and substance use disorders with the Mini-International Neuropsychiatric Interview, a structured psychiatric diagnostic interview. We also assessed baseline adherence, risk, and health measures. Results Complicated depressive illness was common. Only 18% of participants experienced MDD with no comorbid psychiatric diagnoses; 49% had comorbid dysthymia, 62% had ≥1 comorbid anxiety disorder, and 28% had a comorbid substance use disorder. Self-reported antiretroviral adherence did not differ by the presence of psychiatric comorbidity. However, psychiatric comorbidity was associated with worse physical health and functioning: compared to those with MDD alone, individuals with ≥1 comorbidity reported more HIV symptoms (5.1 vs. 4.1, p-value=0.01), and worse mental health-related quality of life on the SF-12 (29 vs. 35, p<0.01). Conclusion For HIV patients with MDD, chronic depression and psychiatric comorbidity are strikingly common, and this complexity is associated with greater HIV disease severity and worse quality of life. Appreciating this comorbidity can help clinicians better target those at risk of harder-to-treat HIV disease, and underscores the challenge of treating depression in this population. PMID:25892152

  20. Diagnosis and underdiagnosis of comorbidities in psoriasis patients - need for a multidisciplinary approach*

    PubMed Central

    Duarte, Gleison Vieira; de Oliveira, Maria de Fátima S. P.; Follador, Ivonise; Silva, Thadeu Santo; de Carvalho Filho, Edgar Marcelino

    2016-01-01

    BACKGROUND Psoriasis is an immune-mediated disease that manifests predominantly in the skin, although systemic involvement may also occur. Although associated comorbidities have long been recognized and despite several studies indicating psoriasis as an independent risk factor for cardiovascular events, little has been done in general medical practice regardind screening. In the United States, less than 50% of clinicians are aware of these recommendations. OBJECTIVE To identify the prevalence of these comorbidities in 296 patients followed up at a university dermatology clinic. METHODS Systematically investigated comorbidity frequencies were compared with general practitioners' registry frequencies. Clinical features correlated with comorbidities were also investigated. RESULTS High prevalences of systematically investigated comorbidities such as hypertension (30%) and dyslipidemia (26.5%) were documented. Conversely, data from general practitioners' records showed that 33% of dyslipidemia cases were undiagnosed and indicated possible underdiagnosis of some comorbidities. Furthermore, an association was found between: the number of comorbidities and psoriasis duration, age and high body mass index an association was found between the number of comorbidities and psoriasis duration, age, high body mass index, waist circumference or waist-to-hip ratio. (p<0.05). CONCLUSION Disease duration, age and high body mass index, waist circumference or waist-to-hip ratio are possible criteria for choosing which patients should be screened for comorbidities. Underdiagnosis of comorbidities by general practitioners highlights the need for a multidisciplinary approach in psoriasis management. PMID:28099594

  1. Comorbid Conditions and Outcomes After Percutaneous Coronary Intervention

    PubMed Central

    Singh, Mandeep; Rihal, Charanjit S.; Roger, Veronique L.; Lennon, Ryan J.; Spertus, John; Jahangir, Arshad; Holmes, David R.

    2009-01-01

    Objective To evaluate whether adding comorbid conditions to a risk model can help predict in-hospital outcome and long-term mortality after percutaneous coronary intervention (PCI). Design Retrospective chart review Setting Academic medical center. Patients 7,659 patients who had 9,032 PCIs. Interventions PCI performed at Mayo Clinic between January 1, 1999, and June 30, 2004. Main Outcome Measures The Mayo Clinic Risk Score (MCRS) and the coronary artery disease (CAD)-specific index for determination of comorbid conditions in all patients. Results The mean MCRS score was 6.5±2.9. The CAD-specific index was 0 or 1 in 46%, 2 or 3 in 30%, and 4 or higher in 23%. The rate of in-hospital major adverse cardiovascular events (MACE) increased with higher MCRS and CAD-specific index (Cochran-Armitage test, P<.001 for both models). The c-statistic for the MCRS for in-hospital MACE was 0.78; adding the CAD-specific index did not improve its discriminatory ability for in-hospital MACE (c-statistic=0.78; likelihood ratio test, P=.29). A total of 707 postdismissal deaths occurred after 7,253 successful procedures. The c-statistic for all-cause mortality was 0.69 for the MCRS model alone and 0.75 for the MCRS and CAD-specific indices together (likelihood ratio test, P<.001), indicating significant improvement in the discriminatory ability. Conclusions Addition of comorbid conditions to the MCRS adds significant prognostic information for postdismissal mortality but adds little prognostic information about in-hospital complications after PCI. Such health-status measures should be included in future risk stratification models that predict long-term mortality after PCI. PMID:17923464

  2. Impact of cardiovascular comorbidity on ovarian cancer mortality

    PubMed Central

    Shinn, Eileen H.; Lenihan, Daniel J.; Urbauer, Diana L.; Basen-Engquist, Karen M.; Valentine, Alan; Palmero, Laura; Woods, Myrshia L.; Patel, Pooja; Nick, Alpa M.; Shahzad, Mian M. K.; Stone, Rebecca L.; Golden, Antoinette; Atkinson, Emma; Lutgendorf, Susan K.; Sood, Anil K.

    2013-01-01

    BACKGROUND A retrospective cohort study utilizing prospectively collected data was conducted from August 2003 until March 2008 at M. D. Anderson Cancer Center. It is unknown whether cardiovascular comorbidity and chronic stress impact ovarian cancer outcome, which remains poor despite advances in therapy. The purpose of this study was to determine whether cardiovascular disease and markers that may be associated with stress are also associated with survival in ovarian cancer patients. METHODS Participants with newly diagnosed epithelial ovarian cancer were followed until time of death or truncation of study period (median follow-up = 4.2 years; n=271). Tumor characteristics (stage, tumor grade, histology, debulking status), demographic variables, and cardiovascular comorbidity were documented and compared to overall survival. RESULTS Of the 9 cardiovascular events tracked during follow-up, venous thrombo embolism (VTE; Hazard Ratio= 3.2; 95%CI =1.8–5.5) and pulmonary hypertension (Hazard Ratio=8.5; 95%CI=3.9– 18.7) were associated with shorter survival in multivariate analysis. In addition, high tumor grade, suboptimal cytoreduction, and baseline heart rate (Hazard Ratio=1.02; 95%CI= 1.01– 1.04) were related to decreased survival. CONCLUSION Careful management of certain cardiovascular comorbidities may extend survival in patients with ovarian cancer. Our findings suggest that increased baseline heart rate and the development of VTE and pulmonary hypertension after cancer diagnosis may be significant predictors of survival in women with ovarian cancer. IMPACT Our study emphasizes the importance of identifying and optimally treating tachycardia, VTE and pulmonary hypertension in conjunction with cancer therapy. PMID:24045927

  3. Visual height intolerance and acrophobia: clinical characteristics and comorbidity patterns.

    PubMed

    Kapfhammer, Hans-Peter; Huppert, Doreen; Grill, Eva; Fitz, Werner; Brandt, Thomas

    2015-08-01

    The purpose of this study was to estimate the general population lifetime and point prevalence of visual height intolerance and acrophobia, to define their clinical characteristics, and to determine their anxious and depressive comorbidities. A case-control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above was selected. Defined neurological conditions (migraine, Menière's disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and acrophobia were assessed. The lifetime prevalence of vHI was 28.5% (women 32.4%, men 24.5%). Initial attacks occurred predominantly (36%) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. A total of 22.5% of individuals with vHI experienced the intensity of panic attacks. The lifetime prevalence of acrophobia was 6.4% (women 8.6%, men 4.1%), and point prevalence was 2.0% (women 2.8%; men 1.1%). VHI and even more acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of previous acrophobia. VHI affects nearly a third of the general population; in more than 20% of these persons, vHI occasionally develops into panic attacks and in 6.4%, it escalates to acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.

  4. Gastrointestinal comorbidities which complicate the treatment of anorexia nervosa.

    PubMed

    Mascolo, Margherita; Geer, Bashir; Feuerstein, Joshua; Mehler, Philip S

    2017-01-01

    Patients with anorexia nervosa often voice a multitude of symptoms in regards to their gastrointestinal tract. These complaints can complicate the treatment of their eating disorder as they distract attention from the important goal of weight restoration. Moreover, the restricting of certain food groups also makes the task of weight restoration substantially more difficult, or may result in binging. Therefore a working knowledge of common gastrointestinal comorbidities, such as celiac disease, irritable bowel syndrome, inflammatory bowel disease, and gastroparesis, is useful when treating a patient who has anorexia nervosa.

  5. A comparison of two comorbidity instruments in arthritis.

    PubMed

    Gabriel, S E; Crowson, C S; O'Fallon, W M

    1999-12-01

    Comorbidity (CM) is a powerful predictor of health outcome and cost, as well as an important confounder in many epidemiologic studies. However, choosing the most appropriate CM measurement instrument is difficult because comparative data on how the available instruments perform in various disease settings are limited. We collected CM data (from the complete medical records) for two population-based prevalence cohorts with rheumatoid arthritis (RA) and osteoarthritis (OA) and a comparison cohort without arthritis (NA), using two different CM instruments: the Charlson CM index (Charl), which is based on 17 diagnoses each weighted by mortality risk, and the Index of Coexistent Diseases (ICED), which estimates the severity and frequency of 14 comorbid conditions and provides an assessment of the impairment or disability caused by each. Cox proportional hazards modeling was used to assess the impact of the two types of comorbidity scores (Charl and ICED) on survival after prevalence (index) date, adjusting for the age, sex, and disease status. There were 450, 441, and 889 individuals in the RA, OA, and NA groups, respectively, with a mean follow-up period of 10.6 years. During the follow-up, 293, 307, and 546 deaths occurred in the RA, OA, and NA groups, respectively. The mean age and percent females were: 63.3 years, 74%; 70.7 years, 74%; and 67.5 years, 75% for the RA, OA, and NA groups, respectively. Comorbidity was highest in RA, intermediate in OA, and lowest in NA by both Charl and ICED. Cox proportional hazards modeling demonstrated that both Charl and ICED were highly statistically significant predictors of mortality (P<0.0001) after adjusting for age, sex, and disease state (RA, OA, or NA) and that ICED remained highly significant as a predictor of mortality, even after adjusting for Charl. We conclude that estimating CM from medical records using ICED, an instrument that incorporates an assessment of impairment and disability, is feasible and that such as

  6. Circadian Clocks as Modulators of Metabolic Comorbidity in Psychiatric Disorders.

    PubMed

    Barandas, Rita; Landgraf, Dominic; McCarthy, Michael J; Welsh, David K

    2015-12-01

    Psychiatric disorders such as schizophrenia, bipolar disorder, and major depressive disorder are often accompanied by metabolic dysfunction symptoms, including obesity and diabetes. Since the circadian system controls important brain systems that regulate affective, cognitive, and metabolic functions, and neuropsychiatric and metabolic diseases are often correlated with disturbances of circadian rhythms, we hypothesize that dysregulation of circadian clocks plays a central role in metabolic comorbidity in psychiatric disorders. In this review paper, we highlight the role of circadian clocks in glucocorticoid, dopamine, and orexin/melanin-concentrating hormone systems and describe how a dysfunction of these clocks may contribute to the simultaneous development of psychiatric and metabolic symptoms.

  7. Neuroplasticity Underlying the Comorbidity of Pain and Depression

    PubMed Central

    Doan, Lisa; Manders, Toby; Wang, Jing

    2015-01-01

    Acute pain induces depressed mood, and chronic pain is known to cause depression. Depression, meanwhile, can also adversely affect pain behaviors ranging from symptomology to treatment response. Pain and depression independently induce long-term plasticity in the central nervous system (CNS). Comorbid conditions, however, have distinct patterns of neural activation. We performed a review of the changes in neural circuitry and molecular signaling pathways that may underlie this complex relationship between pain and depression. We also discussed some of the current and future therapies that are based on this understanding of the CNS plasticity that occurs with pain and depression. PMID:25810926

  8. Challenging Behaviors in Adults with Intellectual Disability: The Effects of Race and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Horovitz, Max; Matson, Johnny L.; Hattier, Megan A.; Tureck, Kimberly; Bamburg, Jay W.

    2013-01-01

    Rates of challenging behaviors were assessed in 175 adults with intellectual disability (ID) or ID and a comorbid autism spectrum disorder (ASD). The relationship between ASD diagnosis, race, and challenging behaviors was assessed using the "Autism Spectrum Disorders-Behavior Problems for Adults (ASD-BPA)." Those with ASD and ID were…

  9. Scales for the Identification of Adults with Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review

    ERIC Educational Resources Information Center

    Taylor, Abigail; Deb, Shoumitro; Unwin, Gemma

    2011-01-01

    Attention deficit hyperactivity disorder (ADHD) is prevalent in the adult population. The associated co-morbidities and impairments can be relieved with treatment. Therefore, several rating scales have been developed to identify adults with ADHD who may benefit from treatment. No systematic review has yet sought to evaluate these scales in more…

  10. Young Adult Follow-Up of Hyperactive Children: Antisocial Activities and Drug Use

    ERIC Educational Resources Information Center

    Barkley, Russell A.; Fischer, Mariellen; Smallish, Lori; Fletcher, Kenneth

    2004-01-01

    Background: Hyperactive/ADHD children are believed to be a greater risk for adolescent and young adult antisocial activity and drug use/abuse, particularly that subset having comorbid conduct problems/disorder. Method: We report on the lifetime antisocial activities and illegal drug use self-reported at young adult follow-up (mean age 20-21 years;…

  11. Peripheral Inflammatory Markers Contributing to Comorbidities in Autism

    PubMed Central

    Inga Jácome, Martha Cecilia; Morales Chacòn, Lilia Maria; Vera Cuesta, Hector; Maragoto Rizo, Carlos; Whilby Santiesteban, Mabel; Ramos Hernandez, Lesyanis; Noris García, Elena; González Fraguela, Maria Elena; Fernandez Verdecia, Caridad Ivette; Vegas Hurtado, Yamilé; Siniscalco, Dario; Gonçalves, Carlos Alberto; Robinson-Agramonte, Maria de los Angeles

    2016-01-01

    This study evaluates the contribution of peripheral biomarkers to comorbidities and clinical findings in autism. Seventeen autistic children and age-matched typically developing (AMTD), between three to nine years old were evaluated. The diagnostic followed the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DMS-IV) and the Childhood Autism Rating Scale (CARS) was applied to classify the severity. Cytokine profile was evaluated in plasma using a sandwich type ELISA. Paraclinical events included electroencephalography (EEG) record. Statistical analysis was done to explore significant differences in cytokine profile between autism and AMTD groups and respect clinical and paraclinical parameters. Significant differences were found to IL-1β, IL-6, IL-17, IL-12p40, and IL-12p70 cytokines in individuals with autism compared with AMTD (p < 0.05). All autistic patients showed interictalepileptiform activity at EEG, however, only 37.5% suffered epilepsy. There was not a regional focalization of the abnormalities that were detectable with EEG in autistic patients with history of epilepsy. A higher IL-6 level was observed in patients without history of epilepsy with interictalepileptiform activity in the frontal brain region, p < 0.05. In conclusion, peripheral inflammatory markers might be useful as potential biomarkers to predict comorbidities in autism as well as reinforce and aid informed decision-making related to EEG findings in children with Autism spectrum disorders (ASD). PMID:27983615

  12. Anxiety and depression—Important psychological comorbidities of COPD

    PubMed Central

    Gray, Curt R.; Walsh, James R.; Yang, Ian A.; Rolls, Tricia A.; Ward, Donna L.

    2014-01-01

    Anxiety and depression are common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). The pathophysiology of these psychological comorbidities in COPD is complex and possibly explained by common risk factors, response to symptomatology and biochemical alterations. The presence of anxiety and/or depression in COPD patients is associated with increased mortality, exacerbation rates, length of hospital stay, and decreased quality of life and functional status. There is currently no consensus on the most appropriate approach to screening for anxiety and depression in COPD. Treatment options include psychological [relaxation, cognitive behavioural therapy (CBT), self-management] and pharmacological interventions. Although there is some evidence to support these treatments in COPD, the data are limited and mainly comprised by small studies. Pulmonary rehabilitation improves anxiety and depression, and conversely these conditions impact rehabilitation completion rates. Additional high quality studies are urgently required to optimise screening and effective treatment of anxiety and depression in patients with COPD, to enhance complex chronic disease management for these patients. PMID:25478202

  13. Peripheral Inflammatory Markers Contributing to Comorbidities in Autism.

    PubMed

    Inga Jácome, Martha Cecilia; Morales Chacòn, Lilia Maria; Vera Cuesta, Hector; Maragoto Rizo, Carlos; Whilby Santiesteban, Mabel; Ramos Hernandez, Lesyanis; Noris García, Elena; González Fraguela, Maria Elena; Fernandez Verdecia, Caridad Ivette; Vegas Hurtado, Yamilé; Siniscalco, Dario; Gonçalves, Carlos Alberto; Robinson-Agramonte, Maria de Los Angeles

    2016-12-14

    This study evaluates the contribution of peripheral biomarkers to comorbidities and clinical findings in autism. Seventeen autistic children and age-matched typically developing (AMTD), between three to nine years old were evaluated. The diagnostic followed the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DMS-IV) and the Childhood Autism Rating Scale (CARS) was applied to classify the severity. Cytokine profile was evaluated in plasma using a sandwich type ELISA. Paraclinical events included electroencephalography (EEG) record. Statistical analysis was done to explore significant differences in cytokine profile between autism and AMTD groups and respect clinical and paraclinical parameters. Significant differences were found to IL-1β, IL-6, IL-17, IL-12p40, and IL-12p70 cytokines in individuals with autism compared with AMTD (p < 0.05). All autistic patients showed interictalepileptiform activity at EEG, however, only 37.5% suffered epilepsy. There was not a regional focalization of the abnormalities that were detectable with EEG in autistic patients with history of epilepsy. A higher IL-6 level was observed in patients without history of epilepsy with interictalepileptiform activity in the frontal brain region, p < 0.05. In conclusion, peripheral inflammatory markers might be useful as potential biomarkers to predict comorbidities in autism as well as reinforce and aid informed decision-making related to EEG findings in children with Autism spectrum disorders (ASD).

  14. Comorbidities of obsessive and compulsive symptoms in Huntington disease

    PubMed Central

    Anderson, Karen E.; Gehl, Carissa R.; Marder, Karen S.; Beglinger, Leigh J.; Paulsen, Jane S.

    2011-01-01

    Although current reports document a high rate of obsessive and compulsive symptoms (O/Cs) in Huntington disease (HD), there have been no studies published that have made an attempt to identify comorbidities of O/Cs in HD. We examined O/Cs in 1,642 individuals with a diagnosis of HD. Of those endorsing significant O/Cs (27.2%), nearly one-quarter reported obtaining treatment for OCD. Individuals with HD and O/Cs were older, had poorer functioning, and a longer duration of illness than those without O/Cs. Individuals with HD and O/Cs endorsed significantly higher psychiatric comorbidities of depression, suicidal ideation, aggression, delusions and hallucinations. Participants with the most severe O/Cs had greater bradykinesia and worse performance on the Stroop task, a measure of executive function. Clinicians should be aware that patients with HD and O/Cs might have a somewhat different clinical picture from those without, and may require a specialized treatment plan. PMID:20458194

  15. Gender differences in cardiovascular disease and comorbid depression.

    PubMed Central

    Möller-Leimkühler, Anne Maria

    2007-01-01

    Although gender is increasingly perceived as a key determinant in health and illness, systematic gender studies in medicine are still lacking. For a long time, cardiovascular disease (CVD) has been seen as a “male” disease, due to men's higher absolute risk compared with women, but the relative risk in women of CVD morbidity and mortality is actually higher: Current knowledge points to important gender differences in age of onset, symptom presentation, management, and outcome, as well as traditional and psychosocial risk factors. Compared with men, CVD risk in women is increased to a greater extent by some traditional factors (eg, diabetes, hypertension, hypercholesterolemia, obesity,) and socioeconomic and psychosocial factors also seem to have a higher impact on CVD in women. With respect la differences in CVD management, a gender bias in favor of men has to be taken into account, in spite of greater age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression has been shown to be an independent risk factor and consequence of CVD; however, concerning gender differences, The results have been inconsistent. Current evidence suggests that depression causes a greater increase in CVD incidence in women, and that female CVD patients experience higher levels of depression than men. Gensier aspects should be more intensively considered, both in further research on gender differences in comorbid depresion, and in cardiac treatment and rehabilitation, with the goal of making secondary prevention more effective. PMID:17506227

  16. Heterogeneity of executive functions among comorbid neurodevelopmental disorders.

    PubMed

    Dajani, Dina R; Llabre, Maria M; Nebel, Mary Beth; Mostofsky, Stewart H; Uddin, Lucina Q

    2016-11-09

    Executive functions (EFs) are used to set goals, plan for the future, inhibit maladaptive responses, and change behavior flexibly. Although some studies point to specific EF profiles in autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) - prevalent and often highly comorbid neurodevelopmental disorders - others have not differentiated them. The objective of the current study was to identify distinct profiles of EF across typically developing (TD) children and children with ASD and ADHD. We employed a latent profile analysis using indicators of EF (e.g., working memory, inhibition, and flexibility) in a mixed group of 8-13 year-olds including TD children (n = 128), children with ASD without ADHD (n = 30), children with ADHD (n = 93), and children with comorbid ASD and ADHD (n = 66). Three EF classes emerged: "above average," "average," and "impaired." EF classes did not reproduce diagnostic categories, suggesting that differences in EF abilities are present within the ASD and ADHD groups. Further, greater EF dysfunction predicted more severe socioemotional problems, such as anxiety/depression. These results highlight the heterogeneity of current diagnostic groups and identify an "impaired" EF group, consisting of children with both ASD and ADHD, which could specifically be targeted for EF intervention.

  17. Heterogeneity of executive functions among comorbid neurodevelopmental disorders

    PubMed Central

    Dajani, Dina R.; Llabre, Maria M.; Nebel, Mary Beth; Mostofsky, Stewart H.; Uddin, Lucina Q.

    2016-01-01

    Executive functions (EFs) are used to set goals, plan for the future, inhibit maladaptive responses, and change behavior flexibly. Although some studies point to specific EF profiles in autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) — prevalent and often highly comorbid neurodevelopmental disorders — others have not differentiated them. The objective of the current study was to identify distinct profiles of EF across typically developing (TD) children and children with ASD and ADHD. We employed a latent profile analysis using indicators of EF (e.g., working memory, inhibition, and flexibility) in a mixed group of 8–13 year-olds including TD children (n = 128), children with ASD without ADHD (n = 30), children with ADHD (n = 93), and children with comorbid ASD and ADHD (n = 66). Three EF classes emerged: “above average,” “average,” and “impaired.” EF classes did not reproduce diagnostic categories, suggesting that differences in EF abilities are present within the ASD and ADHD groups. Further, greater EF dysfunction predicted more severe socioemotional problems, such as anxiety/depression. These results highlight the heterogeneity of current diagnostic groups and identify an “impaired” EF group, consisting of children with both ASD and ADHD, which could specifically be targeted for EF intervention. PMID:27827406

  18. Genomic structural variations for cardiovascular and metabolic comorbidity

    PubMed Central

    Nazarenko, Maria S.; Sleptcov, Aleksei A.; Lebedev, Igor N.; Skryabin, Nikolay A.; Markov, Anton V.; Golubenko, Maria V.; Koroleva, Iuliia A.; Kazancev, Anton N.; Barbarash, Olga L.; Puzyrev, Valery P.

    2017-01-01

    The objective of this study was to identify genes targeted by both copy number and copy-neutral changes in the right coronary arteries in the area of advanced atherosclerotic plaques and intact internal mammary arteries derived from the same individuals with comorbid coronary artery disease and metabolic syndrome. The artery samples from 10 patients were screened for genomic imbalances using array comparative genomic hybridization. Ninety high-confidence, identical copy number variations (CNVs) were detected. We also identified eight copy-neutral changes (cn-LOHs) > 1.5 Mb in paired arterial samples in 4 of 10 individuals. The frequencies of the two gains located in the 10q24.31 (ERLIN1) and 12q24.11 (UNG, ACACB) genomic regions were evaluated in 33 paired arteries and blood samples. Two patients contained the gain in 10q24.31 (ERLIN1) and one patient contained the gain in 12q24.11 (UNG, ACACB) that affected only the blood DNA. An additional two patients harboured these CNVs in both the arteries and blood. In conclusion, we discovered and confirmed a gain of the 10q24.31 (ERLIN1) and 12q24.11 (UNG, ACACB) genomic regions in patients with coronary artery disease and metabolic comorbidity. Analysis of DNA extracted from blood indicated a possible somatic origin for these CNVs. PMID:28120895

  19. Cystic fibrosis lung disease in adult patients.

    PubMed

    Vender, Robert L

    2008-04-01

    As the longevity of all patients with cystic fibrosis (CF) continues to increase (median 2005 survival=36.8 years), more adult patients will be receiving their medical care from nonpediatric adult-care providers. Cystic fibrosis remains a fatal disease, with more than 80% of patients dying after the age of 18 years, and most deaths resulting from pulmonary disease. The changing epidemiology requires adult-care providers to become knowledgeable and competent in the clinical management of adults with CF. Physicians must understand the influence of specific genotype on phenotypic disease presentation and severity, the pathogenic factors determining lung disease onset and progression, the impact of comorbid disease factors such as CF-related diabetes and malnutrition upon lung disease severity, and the currently approved or standard accepted therapies used for chronic management of CF lung disease. This knowledge is critical to help alleviate morbidity and improve mortality for the rapidly expanding population of adults with CF.

  20. Prazosin for Treatment of Patients with PTSD and Comorbid Alcohol Dependence

    DTIC Science & Technology

    2014-12-01

    Prazosin for Treatment of Patients with PTSD and Comorbid Alcohol Dependence PRINCIPAL INVESTIGATOR...of Patients with PTSD and Comorbid Alcohol Dependence 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-08-2-0075 5c. PROGRAM ELEMENT NUMBER 6...comorbidity with alcohol dependence (AD) and post traumatic stress disorder (PTSD). The rates of TSD among individuals with AD are at least twice

  1. Rapid cycling as a feature of bipolar disorder and comorbid migraine

    PubMed Central

    Gordon-Smith, K.; Forty, L.; Chan, C.; Knott, S.; Jones, I.; Craddock, N.; Jones, L.A.

    2015-01-01

    Background Previous research has suggested the clinical profile of individuals with bipolar disorder (BD) differs according to the presence or absence of comorbid migraine. We aimed to determine the clinical characteristics that differentiate individuals with BD with and without comorbid migraine in a large, representative, clinically well-characterised UK sample. Methods The lifetime clinical characteristics of 1488 individuals with BD (BPI n=1120, BPII n=368) with and without comorbid migraine were compared (n=375 vs. n=1113 respectively). Results Individuals with BD and comorbid migraine had a distinctive set of lifetime clinical characteristics. A multivariate model showed that consistent with previous studies those with comorbid migraine were significantly more likely to be female (OR=2.099, p=0.005) and have comorbid panic attacks (OR=1.842, p=0.004). A novel finding was that even after controlling for other differences, the individuals with BD and comorbid migraine were more likely to have a rapid cycling illness course (OR=1.888, p=0.002). Limitations Presence of migraine was assessed using self report measures. Cross-sectional study design limits investigations of bidirectional associations between migraine and bipolar disorder. Conclusions Comorbid migraine in BD may represent a more homogenous subtype of BD with an unstable rapid cycling course. Identifying individuals with BD and comorbid migraine may be of use in a clinical setting and this subgroup could be the focus of future aetiological studies. PMID:25661398

  2. Major comorbid disease processes associated with increased incidence of acute kidney injury.

    PubMed

    Farooqi, Salwa; Dickhout, Jeffrey G

    2016-03-06

    Acute kidney injury (AKI) is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodeficiency virus (HIV) acquired immune deficiency syndrome (AIDS). This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including: Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.

  3. A bivariate mann-whitney approach for unraveling genetic variants and interactions contributing to comorbidity.

    PubMed

    Wen, Yalu; Schaid, Daniel J; Lu, Qing

    2013-04-01

    Although comorbidity among complex diseases (e.g., drug dependence syndromes) is well documented, genetic variants contributing to the comorbidity are still largely unknown. The discovery of genetic variants and their interactions contributing to comorbidity will likely shed light on underlying pathophysiological and etiological processes, and promote effective treatments for comorbid conditions. For this reason, studies to discover genetic variants that foster the development of comorbidity represent high-priority research projects, as manifested in the behavioral genetics studies now underway. The yield from these studies can be enhanced by adopting novel statistical approaches, with the capacity of considering multiple genetic variants and possible interactions. For this purpose, we propose a bivariate Mann-Whitney (BMW) approach to unravel genetic variants and interactions contributing to comorbidity, as well as those unique to each comorbid condition. Through simulations, we found BMW outperformed two commonly adopted approaches in a variety of underlying disease and comorbidity models. We further applied BMW to datasets from the Study of Addiction: Genetics and Environment, investigating the contribution of 184 known nicotine dependence (ND) and alcohol dependence (AD) single nucleotide polymorphisms (SNPs) to the comorbidity of ND and AD. The analysis revealed a candidate SNP from CHRNA5, rs16969968, associated with both ND and AD, and replicated the findings in an independent dataset with a P-value of 1.06 × 10(-03) .

  4. Major comorbid disease processes associated with increased incidence of acute kidney injury

    PubMed Central

    Farooqi, Salwa; Dickhout, Jeffrey G

    2016-01-01

    Acute kidney injury (AKI) is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodeficiency virus (HIV) acquired immune deficiency syndrome (AIDS). This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including: Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI. PMID:26981437

  5. Managing Comorbid Illness in Obstructive Sleep Apnea: What Can We Learn from Other Diseases?

    PubMed

    Conwell, Walter D; Tsai, Sheila C

    2016-09-01

    Obstructive sleep apnea (OSA) is associated with numerous comorbid medical conditions. Symptoms of OSA may mimic those of comorbid conditions. The presence of OSA may worsen outcomes from the primary condition. Conversely, OSA treatment may benefit both sleep symptomatology and comorbid illness. Because of potential significant benefit, it is important to screen for sleep apnea symptoms, to have a low threshold to perform diagnostic testing, to treat OSA if present, and to closely monitor symptoms. OSA management does not necessarily replace, but rather, should be performed in conjunction with primary therapy for comorbid conditions.

  6. Posttraumatic Stress Disorder in Adults: Impact, Comorbidity, Risk Factors, and Treatment

    PubMed Central

    Sareen, Jitender

    2014-01-01

    During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World Trade Center, have led to a greater public interest in the risk and protective factors for PTSD. In this In Review paper, I discuss some of the important advances in PTSD. The paper provides a concise review of the evolution of PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, impact of PTSD in the community, an overview of the established risk factors for developing PTSD, and assessment and treatment. Throughout the paper, controversies and clinical implications are discussed. PMID:25565692

  7. [Bacterial parotitis in an immunocompromised patient in adult ICU].

    PubMed

    Vassal, O; Bernet, C; Wallet, F; Friggeri, A; Piriou, V

    2013-09-01

    Bacterial parotitis is a common childhood disease with a favorable outcome. Staphylococcus aureus is the most frequently involved pathogen. Clinical presentation in adult patients can be misleading, Onset occurs in patients with multiple comorbidities, making diagnosis difficult--particularly in ICU. Different pathogens are found in adults with worse outcomes observed. We report here the case of a critically ill patient and discuss diagnosis and management of bacterial parotitis.

  8. Treatment options for osteoarthritis: considerations for older adults.

    PubMed

    Seed, Sheila M; Dunican, Kaelen C; Lynch, Ann M

    2011-02-01

    Osteoarthritis (OA) is the most common form of arthritis and the leading cause of disability among older adults in the United States. Treatment options such as acetaminophen and nonsteroidal anti-inflammatory drugs are the most widely used agents to manage mild-to-moderate pain. Treatment with tramadol or opioids is usually reserved for severe pain associated with OA. These agents do not come without risk, especially for older adults. Patient-specific parameters and comorbid conditions must be considered when evaluating treatment options for older adults. This article reviews pharmacological and nonpharmacological approaches to the management of OA in older adults.

  9. Excessive Body Weight in Older Adults.

    PubMed

    Porter Starr, Kathryn N; Bales, Connie W

    2015-08-01

    The health challenges prompted by obesity in the older adult population are poorly recognized and understudied. A defined treatment of geriatric obesity is difficult to establish, as it must take into account biological heterogeneity, age-related comorbidities, and functional limitations (sarcopenia/dynapenia). This retrospective article highlights the current understanding of the optimal body mass index (BMI) in later life, addressing appropriate recommendations based on BMI category, age, and health history. The findings of randomized control trials of weight loss/maintenance interventions help one to move closer to evidence-based and appropriately individualized recommendations for body weight management in older adults.

  10. Gender Differences in Anxiety Disorders: Prevalence, Course of Illness, Comorbidity and Burden of Illness

    PubMed Central

    McLean, Carmen P.; Asnaani, Anu; Litz, Brett T.; Hofmann, Stefan G.

    2011-01-01

    Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N = 20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men. PMID:21439576

  11. CHARACTERISTICS OF BORDERLINE PERSONALITY DISORDER IN A COMMUNITY SAMPLE: COMORBIDITY, TREATMENT UTILIZATION, AND GENERAL FUNCTIONING

    PubMed Central

    Tomko, Rachel L.; Trull, Timothy J.; Wood, Phillip K.; Sher, Kenneth J.

    2013-01-01

    This study provides estimates of the prevalence and demographic features of borderline personality disorder (BPD) in a community sample as well as BPD comorbidity rates with Axis I and II disorders. In addition, the authors provide data on general functioning and treatment seeking among individuals with BPD. Data from 34,481 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. Results suggest that 2.7% of adults in the United States meet diagnostic criteria for BPD, with slightly higher rates of the disorder in females, people in lower income brackets, people younger than 30, and individuals who are separated or divorced. Racial/ethnic differences were evident, with Native Americans (5.0%) and Blacks (3.5%) having significantly higher rates of the disorder, on average, and Asians having significantly lower rates (1.2%). Individuals with a BPD diagnosis were likely to have co-occurring lifetime mood disorders, anxiety disorders, substance use disorders, and other personality disorders. Specifically, 84.8% of individuals with BPD also had a lifetime anxiety disorder, 82.7% had a lifetime mood disorder/episode, and 78.2% were diagnosed with a lifetime substance use disorder. Individuals with BPD showed significant impairment in functioning and were highly likely to seek therapy or receive medication for mental health concerns. PMID:25248122

  12. Key Comorbid Conditions that Are Predictive of Survival among Hemodialysis Patients

    PubMed Central

    Bragg-Gresham, Jennifer; Gillespie, Brenda W.; Tentori, Francesca; Pisoni, Ronald L.; Tighiouart, Hocine; Levey, Andrew S.; Port, Friedrich K.

    2009-01-01

    Background and objectives: Abstracting information about comorbid illnesses from the medical record can be time-consuming, particularly when a large number of conditions are under consideration. We sought to determine which conditions are most prognostic and whether comorbidity continues to contribute to a survival model once laboratory and clinical parameters have been accounted for. Design, setting, participants, & measurements: Comorbidity data were abstracted from the medical records of Dialysis Outcomes and Practice Pattern Study (DOPPS) I, II, and III participants using a standardized questionnaire. Models that were composed of different combinations of comorbid conditions and case-mix factors were compared for explained variance (R2) and discrimination (c statistic). Results: Seventeen comorbid conditions account for 96% of the total explained variance that would result if 45 comorbidities that were expected to be predictive of survival were added to a demographics-adjusted survival model. These conditions together had more discriminatory power (c statistic 0.67) than age alone (0.63) or serum albumin (0.60) and were equivalent to a combination of routine laboratory and clinical parameters (0.67). The strength of association of the individual comorbidities lessened when laboratory/clinical parameters were added, but all remained significant. The total R2 of a model adjusted for demographics and laboratory/clinical parameters increased from 0.13 to 0.17 upon addition of comorbidity. Conclusions: A relatively small list of comorbid conditions provides equivalent discrimination and explained variance for survival as a more extensive characterization of comorbidity. Comorbidity adds to the survival model a modest amount of independent prognostic information that cannot be substituted by clinical/laboratory parameters. PMID:19808231

  13. Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial.

    PubMed

    Tryggestad, Jeanie B; Willi, Steven M

    2015-03-01

    With the rise in childhood obesity, type 2 diabetes mellitus (T2DM) has been recognized to occur in adolescents with increasing frequency. Although much is known about T2DM in adults, few studies have examined the treatment and complications of T2DM in youth. The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study was designed to evaluate the efficacy of various treatments and provided a unique opportunity to study the disease progression and appearance of complications in a pediatric cohort with recent onset of the disease. In the TODAY study, hypertension was present in 11.6% of the population at baseline and increased to 33.8% by the end of the study. Prevalence of high-risk LDL-cholesterol rose from 4.5% at baseline to 10.7% at the end of the study. Microalbuminuria was found in 6.3% of the cohort at baseline and increased to 16.6%. Retinopathy was not assessed upon entry into TODAY, but was present in 13.9% of the TODAY cohort at the end of the study. Experience to date indicates that these complications and comorbidities are similar to those seen in adults, but occur on an accelerated timeline. The early manifestation of diabetes complications in youth-onset T2DM suggests that this group will be burdened with the tangible consequences of cardiovascular disease, nephropathy, and retinopathy in the third and fourth decades of life. It is hoped that through an early, aggressive approach to treatment and prevention, we may be able to curb the onset and progression of these potentially devastating outcomes.

  14. Family history and psychiatric comorbidity in persons with kleptomania.

    PubMed

    Grant, Jon E

    2003-01-01

    The current study was constructed to examine the family history and psychiatric comorbidity of a group of persons with kleptomania. Thirty-one subjects with DSM-IV kleptomania were administered the Structured Clinical Interview for DSM-IV (SCID) and the Minnesota Impulse Disorders Inventory (MIDI). The Family History Research Diagnostic Criteria (FH-RDC) were used to collect information about psychiatric disorders in first-degree relatives. Subjects with kleptomania were more likely than comparison subjects to have any lifetime impulse-control disorder (chi2=12.569; df=1; P<.001) and to have a first-degree relative with an alcohol use disorder (chi2=6.994; df=1; P=.008) or any psychiatric disorder (chi2=12.056; df=1; P=.001). Persons with kleptomania appear to have a higher lifetime prevalence of impulse-control disorders and are more likely to have first-degree relatives with alcohol problems than are comparison subjects.

  15. A Taxonomy of medical comorbidity for veterans who are homeless.

    PubMed

    Goldstein, Gerald; Luther, James F; Jacoby, Aaron M; Haas, Gretchen L; Gordon, Adam J

    2008-08-01

    Homeless veterans have numerous medical and behavioral health problems. Grouping homeless people based on comorbidity patterns may assist in determining severity of illness and triaging health care more effectively. We sought to determine if a finite number of profiles could be identified related to demographic characteristics, living situation, length of homelessness, and referral areas using interview data from 2,733 veterans who were presently or recently homeless. We considered 12 disorders: eye problems, hypertension, cardiovascular problems, COPD/emphysema, tuberculosis, gastrointestinal problems, hepatic disease, neurologic disorders, orthopedic problems, skin problems, and trauma. Ratings were evaluated using cluster analysis. Comparison statistics were used to compare intercluster differences in demographics, homeless situation, and referral recommendations. A four-cluster solution is proposed: generalized illness, hepatic disease, lung disease, and neurologic disorder. Medical health problems are common and heterogeneous in homeless individuals. Classifications of these problems may be useful in planning treatment and predicting outcome.

  16. The effect of obesity surgery on obesity comorbidity.

    PubMed

    Bouldin, Marshall J; Ross, Leigh Ann; Sumrall, Caryl D; Loustalot, Fleetwood V; Low, Annette K; Land, Kelly K

    2006-04-01

    Obesity is epidemic in the modern world. It is becoming increasingly clear that obesity is a major cause of cardiovascular disease, diabetes, and renal disease, as well as a host of other comorbidities. There are at present no generally effective long-term medical therapies for obesity. Surgical therapy for morbid obesity is not only effective in producing long-term weight loss but is also effective in ameliorating or resolving several of the most significant complications of obesity, including diabetes, hypertension, dyslipidemia, sleep apnea, gastroesophageal reflux disease, degenerative joint disease, venous stasis, pseudotumor cerebri, nonalcoholic steatohepatitis, urinary incontinence, fertility problems, and others. The degree of benefit and the rates of morbidity and mortality of the various surgical procedures vary according to the procedure.

  17. COMORBID MOOD, PSYCHOSIS, AND MARIJUANA ABUSE DISORDERS: A THEORECTICAL REVIEW

    PubMed Central

    Wilson, Natascha; Cadet, Jean Lud

    2009-01-01

    There is a need to bridge the gap between the fields of addiction psychiatry and general psychiatry in order to effectively treat co-morbid substance abuse and psychiatric disorders. This alarming epidemic transcends communities and severely impacts healthcare worldwide yielding poor treatment outcomes and prognoses for afflicted patients. Because substance abuse can acerbate and/or trigger psychosis and mood disorders, it is important to keep these issues in the forefront when evaluating patients. In order to address some of the complications stemming from not enough interactions between various groups of practitioners, this review addresses the neurobehavioral effects of cannabis use and their impact on patients who suffer from psychotic or affective disorders. The hope is that this paper will serve as a spring board for further discussions among practitioners who treat these patients. Greater interactions between caretakers are bound to impact the care of our patients in a very positive way. PMID:20155601

  18. Infinite Continuous Feature Model for Psychiatric Comorbidity Analysis.

    PubMed

    Valera, Isabel; Ruiz, Francisco J R; Olmos, Pablo M; Blanco, Carlos; Perez-Cruz, Fernando

    2016-02-01

    We aim at finding the comorbidity patterns of substance abuse, mood and personality disorders using the diagnoses from the National Epidemiologic Survey on Alcohol and Related Conditions database. To this end, we propose a novel Bayesian nonparametric latent feature model for categorical observations, based on the Indian buffet process, in which the latent variables can take values between 0 and 1. The proposed model has several interesting features for modeling psychiatric disorders. First, the latent features might be off, which allows distinguishing between the subjects who suffer a condition and those who do not. Second, the active latent features take positive values, which allows modeling the extent to which the patient has that condition. We also develop a new Markov chain Monte Carlo inference algorithm for our model that makes use of a nested expectation propagation procedure.

  19. [Depression and addiction comorbidity: towards a common molecular target?].

    PubMed

    Arango-Lievano, Margarita; Kaplitt, Michael G

    2015-05-01

    The comorbidity of depression and cocaine addiction suggests shared mechanisms and anatomical pathways. Specifically, the limbic structures, such as the nucleus accumbens (NAc), play a crucial role in both disorders. P11 (S100A10) is a promising target for manipulating depression and addiction in mice. We summarized the recent genetic and viral strategies used to determine how the titration of p11 levels within the NAc affects hedonic behavior and cocaine reward learning in mice. In particular, p11 in the ChAT+ cells or DRD1+ MSN of the NAc, controls depressive-like behavior or cocaine reward, respectively. Treatments to counter maladaptation of p11 levels in the NAc could provide novel therapeutic opportunities for depression and cocaine addiction in humans.

  20. RD, ADHD, and their comorbidity from a dual route perspective.

    PubMed

    de Jong, Christien G W; Licht, Robert; Sergeant, Joseph A; Oosterlaan, Jaap

    2012-01-01

    In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.

  1. [Evidence-based psychotherapy: addiction and personality disorders as comorbidities].

    PubMed

    Kienast, T; Roediger, E; Kensche, M; Foerster, J; Daig, I; Heinz, A

    2009-09-01

    A large number of studies have shown that various psychotherapeutic methods have a positive effect on the course of addiction and personality disorders when they are treated separately. Co-morbid occurrence of both disorders is common but a chronologically separated treatment often leads to renewed occurrence of the symptoms of the initially treated disorder. Failures of abstinence motivation, severe drug craving and the activation of dysfunctional behavior patterns frequently lead to renewed consumption of addictive substances and thus endanger the further course of treatment. So far, evidence of effectiveness exists only for dialectic behavior therapy and dual focus schema therapy. This article summarizes the current state of knowledge and introduces both methods by highlighting the core therapeutic strategies.

  2. Substance Use Disorders, Comorbidity, and Arrest among Indigenous Adolescents*

    PubMed Central

    Hartshorn, Kelley J. Sittner; Whitbeck, Les B.; Prentice, Patricia

    2011-01-01

    Indigenous adolescents are overrepresented at multiple stages of the justice system, but we know very little about the role that mental health, particularly substance use disorder, plays in Indigenous pathways to arrest. This study examined the association between substance use disorder, its comorbidity with other disorders, and arrest using a longitudinal sample of Indigenous youth from the Northern Midwest and Canada. Of the 16% of youth who reported at least one arrest at Wave 5, half met criteria for substance abuse/dependence, and slightly more for conduct disorder. Substance abuse/dependence and conduct disorder were each associated with an increased risk of arrest, although co-occurring disorders were not. The reciprocal effects of arrest and mental disorder are discussed. PMID:26759503

  3. [Psycho-organic comorbidity of climacteric: acknowledgement of denial].

    PubMed

    Souza y Machorro, Mario

    2002-03-01

    Considering psychiatric co-morbidity of menopause within the context of a new historical and psychosocial view of woman and femininity, the recommendations of current scientific literature focused to its attention, treatment and prevention, become different from the traditional sociomedical observations. In order to reach a new more effective assistance, prevailing prejudices must be overcame to achieve an adequate updating before being really effective. That is, to be suitable to the psychosocial needs of those who suffer a physiological condition. The change in the social role of women (which requires a genuine community acceptance) is not consolidated to new favorable attitudes which is required in the general thinking in our country, in order to offer better therapeutic alternatives to women's problems and its complications. Such situation is reflected even the medical and psychological handling of cases, where women are the main protagonists. This paper offers a brief discussion of this issue and some recommendations for diffusion purposes.

  4. Clinical Decision Support Systems for Comorbidity: Architecture, Algorithms, and Applications

    PubMed Central

    Fan, Aihua; Tang, Yu

    2017-01-01

    In this paper, we present the design of a clinical decision support system (CDSS) for monitoring comorbid conditions. Specifically, we address the architecture of a CDSS by characterizing it from three layers and discuss the algorithms in each layer. Also we address the applications of CDSSs in a few real scenarios and analyze the accuracy of a CDSS in consideration of the potential conflicts when using multiple clinical practice guidelines concurrently. Finally, we compare the system performance in our design with that in the other design schemes. Our study shows that our proposed design can achieve a clinical decision in a shorter time than the other designs, while ensuring a high level of system accuracy. PMID:28373881

  5. Alternative comorbidity adjustors for the Medicare inpatient psychiatric facility PPS.

    PubMed

    Drozd, Edward M; Maier, Jan; Hales, Jan F; Thomas, Frederick G

    2008-01-01

    The inpatient psychiatric facility prospective payment system (IPF-PPS), provides per diem payments for psychiatric hospitals and units, including 17 comorbid condition payment adjustors that cover 11 percent of patients. This study identifies an alternative set of 16 adjustors identifying three times as many high-cost patients and evaluates the improved predictive power in log per diem cost regression models. A model using the IPF-PPS adjustors achieved 8.8 percent of the feasible improvement from a no-adjustor baseline, while the alternative adjustors achieved 22.1 percent of the feasible improvement. The current adjustors may therefore be too restrictive, resulting in systematic over- or underpayment for many patients.

  6. Personality traits and psychiatric comorbidities in alcohol dependence

    PubMed Central

    Donadon, M.F.; Osório, F.L.

    2015-01-01

    Non-adaptive personality traits may constitute risk factors for development of psychiatric disorders such as depression and anxiety. We aim to evaluate associations and the predictive value of personality traits among alcohol-dependent individuals, with or without psychiatric comorbidities. The convenience sample comprised two groups of males over 18 years of age: one with subjects who had an alcohol dependence diagnosis (AG, n=110), and a control group without abuse and/or alcohol dependence diagnosis (CG, n=110). The groups were assessed by means of the Structured Clinical Interview DSM-IV (SCID-IV). AG participants were recruited among outpatients from the university hospital, whereas CG participants were recruited from a primary healthcare program. Data collection was done individually with self-assessment instruments. Parametric statistics were performed, and a significance level of P=0.05 was adopted. A positive correlation was observed between openness and the length of time that alcohol has been consumed, as were significant and negative correlations between conscientiousness and both the length of time alcohol has been consumed and the number of doses. For alcoholics, extraversion emerged as a protective factor against depression development (P=0.008) and tobacco abuse (P=0.007), whereas openness worked as a protective factor against anxiety (P=0.02). The findings point to specific deficits presented by alcoholics in relation to personality traits with or without psychiatric comorbidities and to the understanding that therapeutic approaches should favor procedures and/or preventive measures that allow more refined awareness about the disorder. PMID:26628399

  7. Psychiatric Comorbidity in Long-Term Abstinent Alcoholics

    PubMed Central

    Di Sclafani, Victoria; Finn, Peter; Fein, George

    2007-01-01

    BACKGROUND A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholics (LTAA; mean abstinence = 6.3 years; n = 52) compared to age and gender-comparable non-alcoholic controls (NC; n = 48). We asked the following questions: 1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable to NC) and 2) can ongoing abstinence be maintained in the face of a current psychiatric disorder? METHODS Lifetime and current (prior 12-months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS). RESULTS Over 85% of LTAA had a lifetime psychiatric diagnosis, compared to 50% of NC. LTAA had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. LTAA also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse. CONCLUSIONS Our results suggest that: 1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, 2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and 3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared to pre-abstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying

  8. Tics and psychiatric comorbidity in children and adolescents.

    PubMed

    Gadow, Kenneth D; Nolan, Edith E; Sprafkin, Joyce; Schwartz, Joseph

    2002-05-01

    This study examined comorbid psychiatric symptoms in a large, community-based sample of children and adolescents. The study sample comprised a total of 3006 school children: 413 preschool (3 to 5 years; 237 males, 176 females; mean age 4 years 2 months, SD 8 months), 1520 elementary school (5 to 12 years; 787 males, 733 females; mean age 8 years 2 months, SD 1 year 11 months), and 1073 secondary school children (12 to 18 years; 573 males, 500 females; mean age 14 years 4 months, SD 1 year 10 months), all of whom were attending regular education programs. Children were evaluated with a teacher-completed DSM-IV-referenced rating scale. The sample was divided into four groups: attention-deficit-hyperactivity disorder with tics (ADHD+tics), ADHD without tics (ADHD), tics without ADHD (T), and a comparison group i.e. neither ADHD nor tics (Non). The percentage of children with tic behaviors varied with age: preschool children (22.3%), elementary school children (7.8%), and adolescents (3.4%). Tic behaviors were more common in males than females, regardless of comorbid ADHD symptoms. For many psychiatric symptoms, screening prevalence rates were highest for the ADHD groups (ADHD+tics>ADHD>T>Non). However, obsessive-compulsive and simple and social phobia symptoms were more common in the groups with tic behavior. Findings for a community-based sample show many similarities with studies of clinically referred samples suggesting that teacher-completed ratings of DSM-IV symptoms may be a useful methodology for investigating the phenomenology of tic disorders.

  9. Profiling leucocyte subsets in tuberculosis-diabetes co-morbidity.

    PubMed

    Kumar, Nathella Pavan; Moideen, Kadar; Dhakshinraj, Sharmila D; Banurekha, Vaithilingam V; Nair, Dina; Dolla, Chandrakumar; Kumaran, Paul; Babu, Subash

    2015-10-01

    The immune system plays an important role in the pathogenesis of pulmonary tuberculosis-type 2 diabetes mellitus (PTB-DM) co-morbidity. However, the phenotypic profile of leucocyte subsets at homeostasis in individuals with active or latent tuberculosis (LTB) with coincident diabetes is not known. To characterize the influence of diabetes on leucocyte phenotypes in PTB or LTB, we examined the frequency (Fo ) of leucocyte subsets in individuals with TB with (PTB-DM) or without (PTB) diabetes; individuals with latent TB with (LTB-DM) or without (LTB) diabetes and non-TB-infected individuals with (NTB-DM) or without (NTB) diabetes. Coincident DM is characterized by significantly lower Fo of effector memory CD4(+) T cells in LTB individuals. In contrast, DM is characterized by significantly lower Fo of effector memory CD8(+) T cells and significantly higher Fo of central memory CD8(+) T cells in PTB individuals. Coincident DM resulted in significantly higher Fo of classical memory B cells in PTB and significantly higher Fo of activated memory and atypical B cells in LTB individuals. Coincident DM resulted in significantly lower Fo of classical and intermediate monocytes in PTB, LTB and NTB individuals. Finally, DM resulted in significantly lower Fo of myeloid and plasmacytoid dendritic cells in PTB, LTB and NTB individuals. Our data reveal that coincident diabetes alters the cellular subset distribution of T cells, B cells, dendritic cells and monocytes in both individuals with active TB and those with latent TB, thus potentially impacting the pathogenesis of this co-morbid condition.

  10. Comorbidity and Pattern of Substance Use in Hospitalized Psychiatric Patients

    PubMed Central

    Sepehrmanesh, Zahra; Ahmadvand, Afshin; Moraveji, Alireza

    2014-01-01

    Background: Substance use in patients with psychiatric disorder is an every-day seen. Detection of this comorbidity can significantly affect the treatment of these disorders, as well as substance use. Objectives: This study has been conducted to determine the prevalence and pattern of substance use in hospitalized psychiatric patients. Patients and Methods: In this cross-sectional study, 210 hospitalized psychiatric patients were selected by simple randomization from all records of hospitalized patients. The instrument of gathering data was a demographic checklist including age, gender, marital status, education, type of disorder and substance abuse and duration of psychiatric disorder. Data were analyzed by SPSS version 16 using Fisher exact and Chi square tests. Results: The mean age of patients was 37.9 years. Most of the patients were male, married and unemployed. The Prevalence of substance use was 36.7%. The most prevalent pattern of substance use was opium, opioid, methamphetamines and other substances (poly substance). The prevalence of substance use in patients with mood disorders was more than the other disorders and the most prevalent substance use in these patients was opium and opioid. Poly substance use was the most prevalent pattern of use (80 %) in psychotic and mood disorders due to substance. Significant difference was seen between genders, marital status, occupation, duration of illness and frequency of substance use (P < 0.05 ), however no significant difference was seen between educational levels, age and substance use. Conclusions: The patients with mood disorders had the highest comorbidity with substance use and concurrent use of poly substance was the most prevalent pattern of use in these patients. Therefore, successful treatment of psychiatric disorders and substance use needs multimodal and more serious interventions. Regarding to the pattern of poly substance use in these patients, careful screening should be performed at admission

  11. The 'co-morbidity roundabout': a framework to guide assessment and intervention strategies and engineer change among people with co-morbid problems.

    PubMed

    Kay-Lambkin, Frances J; Baker, Amanda L; Lewin, Terry J

    2004-12-01

    This paper describes the nature and consequences of co-morbidity, as applied to co-occurring mental health and alcohol/other drug (AOD) use problems. The 'co-morbidity roundabout' is introduced as a useful metaphor for conceptualizing the current experiences of people with co-occurring mental health and AOD use problems. In order to successfully negotiate the 'roundabout', the 'drivers' (people with co-morbid mental health and AOD use problems) must consider a range of internal and external conditions (knowledge about services, support from family, friends, health providers, motivation to change, etc.), account for their vehicle's characteristics (other conditions and demands, including social/legal/financial issues), keep their travel itinerary in mind (plans for change including treatment) and navigate through the many detours and dead-ends that they may confront (eligibility for services, accessibility of treatments, etc.). Co-morbidity is a major contributing factor in 'drivers' failing to successfully negotiate, or even becoming 'stuck' on, the 'roundabout'. A summary of relevant treatment research is also presented, including descriptions of brief interventions and more intensive treatment approaches. Finally, the 'co-morbidity roundabout' metaphor is expanded to assist clinicians to translate the findings from this treatment research into clinical practice. Further suggestions are made for improved navigation through and exit from the 'roundabout', including recommendations for the use of a stepped-care approach to the assessment and treatment of clients with co-morbid mental health and AOD use problems.

  12. Comorbid Depressive Disorders in Anxiety-Disordered Youth: Demographic, Clinical, and Family Characteristics

    ERIC Educational Resources Information Center

    O'Neil, Kelly A.; Podell, Jennifer L.; Benjamin, Courtney L.; Kendall, Philip C.

    2010-01-01

    Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxiety disorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and…

  13. Atomoxetine Treatment for Pediatric Patients with Attention-Deficit/Hyperactivity Disorder with Comorbid Anxiety Disorder

    ERIC Educational Resources Information Center

    Geller, Daniel; Donnelly, Craig; Lopez, Frank; Rubin, Richard; Newcorn, Jeffrey; Sutton, Virginia; Bakken, Rosalie; Paczkowski, Martin; Kelsey, Douglas; Sumner, Calvin

    2007-01-01

    Objective: Research suggests 25% to 35% of children with attention-deficit/hyperactivity disorder (ADHD) have comorbid anxiety disorders. This double-blind study compared atomoxetine with placebo for treating pediatric ADHD with comorbid anxiety, as measured by the ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored…

  14. Health Co-Morbidities in Ageing Persons with Down Syndrome and Alzheimer's Dementia

    ERIC Educational Resources Information Center

    McCarron, M.; Gill, M.; McCallion, P.; Begley, C.

    2005-01-01

    Consideration of the relationship between physical and mental health co-morbidities in ageing persons with Down syndrome (DS) and Alzheimer's dementia (AD) is of clinical importance both from a care and resource perspective. To investigate and measure health co-morbidities in ageing persons with Down syndrome with and without AD. Recorded physical…

  15. How Can Comorbidity with Attention-Deficit/Hyperactivity Disorder Aid Understanding of Language and Speech Disorders?

    ERIC Educational Resources Information Center

    Tomblin, J. Bruce; Mueller, Kathyrn L.

    2012-01-01

    This article provides a background for the topic of comorbidity of attention-deficit/hyperactivity disorder and spoken and written language and speech disorders that extends through this issue of "Topics in Language Disorders." Comorbidity is common within developmental disorders and may be explained by many possible reasons. Some of these can be…

  16. Test of Alternative Hypotheses Explaining the Comorbidity between Attention-Deficit/Hyperactivity Disorder and Conduct Disorder

    ERIC Educational Resources Information Center

    Rhee, Soo Hyun; Willcutt, Erik G.; Hartman, Christie A.; Pennington, Bruce F.; DeFries, John C.

    2008-01-01

    There is significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD). The conclusions of studies that examined the causes of comorbidity between ADHD and CD conflict, with some researchers finding support for the three independent disorders model and others finding support for the correlated risk…

  17. [How I treat....psoriasis comorbidities by adalimumab (Humira) anti-TNFalpha].

    PubMed

    Piérard-Franchimont, C; Henry, F; Szepetiuk, G; Piérard, G E

    2010-10-01

    Psoriasis is primarily a chronic inflammatory skin disease burdened by some comorbidities including psoriatic alopecia, arthropathies, Crohn's disease, the metabolic syndrome and some cardiovascular involvement. During the past years, several biologicals corresponding to monoclonal antibodies were offered to treat psoriasis refractory to other potent conventional treatments. We review the effects of biologicals, in particular adalimumab (Humira), on psoriatic comorbidities.

  18. Differentiating Interpersonal Correlates of Depressive Symptoms and Social Anxiety in Adolescence: Implications for Models of Comorbidity

    ERIC Educational Resources Information Center

    Starr, Lisa R.; Davila, Joanne

    2008-01-01

    Research on psychosocial correlates of depression and social anxiety often has not accounted for their comorbidity. Differentiating correlates of depression and social anxiety may inform the development of comorbidity models. Building on research linking both disorders to interpersonal dysfunction, this study examined interpersonal correlates of…

  19. Untangling Psychiatric Comorbidity in Young Children Who Experienced Single, Repeated, or Hurricane Katrina Traumatic Events

    ERIC Educational Resources Information Center

    Scheeringa, Michael S.

    2015-01-01

    Background: In individuals with posttraumatic stress disorder (PTSD), 70-90 % have at least one comorbid non-PTSD disorder. Objective: This study tested several hypotheses to untangle comorbidity issues. Following McMillen et al. ("Compr Psychiatry" 43(6):478-485, 2002), we hypothesized that few non-PTSD disorders would arise following…

  20. Family Correlates of Comorbid Anxiety Disorders in Children with Attention Deficit/Hyperactivity Disorder

    ERIC Educational Resources Information Center

    Pfiffner, Linda J.; McBurnett, Keith

    2006-01-01

    This study evaluated parental anxiety and parenting practices associated with comorbid Anxiety Disorders among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 143) were diagnosed using DSM criteria. Parents and children completed measures of parenting practices. Comorbid anxiety in children was significantly…

  1. Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Pediatric Obsessive-Compulsive Disorder

    ERIC Educational Resources Information Center

    Storch, Eric A.; Merlo, Lisa J.; Larson, Michael J.; Geffken, Gary R.; Lehmkuh, Heather D.; Jacob, Marni L.; Murphy, Tanya K.; Goodman, Wayne K.

    2008-01-01

    A chronic psychiatric condition among children and adolescents of concern is obsessive-compulsive disorder, which involves comorbid conditions. The impact of a range of comorbid illnesses on cognitive-behavioral therapy response and remission rates was conducted, with results revealing a negative impact on treatment response.

  2. Patterns and Impact of Comorbidity and Multimorbidity among Community-Resident American Indian Elders

    ERIC Educational Resources Information Center

    John, Robert; Kerby, Dave S.; Hennessy, Catherine Hagan

    2003-01-01

    Purpose: The purpose of this study is to suggest a new approach to identifying patterns of comorbidity and multimorbidity. Design and Methods: A random sample of 1,039 rural community-resident American Indian elders aged 60 years and older was surveyed. Comorbidity was investigated with four standard approaches, and with cluster analysis. Results:…

  3. Comorbidity of ADHD and Substance Use Disorder (SUD): A Neuroimaging Perspective

    ERIC Educational Resources Information Center

    Frodl, Thomas

    2010-01-01

    Introduction: ADHD has a high comorbidity with substance use disorders (SUD). Both diseases have profound social, psychological, and economic consequences and are therefore highly relevant for health systems. The high comorbidity indicates some shared underlying neurobiological substrates. Knowing these substrates may increase the understanding of…

  4. Does Comorbid Social Anxiety Disorder Impact the Clinical Presentation of Principal Major Depressive Disorder?

    PubMed Central

    Dalrymple, Kristy L.; Zimmerman, Mark

    2008-01-01

    Background Although previous research has examined comorbidity in principal Social Anxiety Disorder (SAD), few studies have examined the disorders for which those with comorbid SAD seek treatment. Further, studies have shown that depressive disorders often are associated with SAD, but few have examined the clinical characteristics of patients with this particular comorbidity. Method The current study examined the prevalence of various principal Axis I disorders in 577 individuals diagnosed with comorbid SAD. Results Consistent with previous research, Major Depressive Disorder (MDD) was the most frequent principal diagnosis in patients with comorbid SAD. Those with principal MDD and comorbid SAD (MDD-SAD) were compared to those with MDD without SAD (MDD) on demographic and clinical characteristics. Patients with MDD-SAD versus those with MDD were more severe in terms of social functioning, duration of depressive episode, suicidal ideation, time out of work, presence of current alcohol abuse/dependence, and age of onset of MDD. Social functioning, duration of episode, suicidal ideation, and age of onset of MDD remained significant even after controlling for additional comorbid disorders. Conclusions Findings suggest the need for future research to determine how treatments could be adapted for this commonly occurring comorbidity. PMID:17188365

  5. Validity of the Autism Spectrum Disorder-Comorbid for Children (ASD-CC)

    ERIC Educational Resources Information Center

    Matson, Johnny L.; LoVullo, Santino V.; Rivet, Tessa T.; Boisjoli, Jessica A.

    2009-01-01

    A limited number of studies currently exist focusing on comorbid psychopathology of children with autism spectrum disorders (ASDs). Due to the heterogeneity of ASD symptoms, communication deficits, and impairments in intellectual functioning, assessing symptoms of psychopathology is complicated. The "Autism Spectrum Disorders-Comorbidity for…

  6. A Clinical Study of Phenomenology and Comorbidity of Paediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Gupta, Pavan Kumar; T., Sivakumar; Agarwal, Vivek; Sitholey, Prabhat

    2012-01-01

    Background: Considerable controversy exists regarding clinical presentation, diagnosis, and comorbidities especially with Attention Deficit Hyperactivity Disorder (ADHD), in paediatric Bipolar Disorder (BPD). Aims and objectives: To describe phenomenology and comorbidities of paediatric BPD. Method: 78 Subjects (6-16 years) attending child and…

  7. Comorbidity of Anxiety-Depression among Australian University Students: Implications for Student Counsellors

    ERIC Educational Resources Information Center

    Bitsika, Vicki; Sharpley, Christopher F.

    2012-01-01

    The incidence, factor structure and scale item differences in anxiety-depression comorbidity were investigated in a sample of Australian university students defined according to the presence of anxiety and/or depression. The incidence of anxiety-depression comorbidity was over 32%, about four times that for anxiety or depression alone.…

  8. Common comorbidities seen in adolescents with attention-deficit/hyperactivity disorder.

    PubMed

    Young, Joel

    2008-08-01

    This article provides an overview of key research on significant comorbidities that occur among adolescents with attention-deficit/hyperactivity disorder, including disruptive behaviors. Such comorbidities include oppositional defiant disorder and conduct disorder, as well as depressive disorders, anxiety disorders, personality disorders, suicidality, eating disorders, sleep disorders, learning disabilities, Internet "addiction," tic disorders, new-onset pediatric epilepsy, and celiac disease.

  9. Interpersonal Psychotherapy-Adolescent Skills Training: Anxiety Outcomes and Impact of Comorbidity

    ERIC Educational Resources Information Center

    Young, Jami F.; Makover, Heather B.; Cohen, Joseph R.; Mufson, Laura; Gallop, Robert J.; Benas, Jessica S.

    2012-01-01

    Given the frequent comorbidity of anxiety and depression, it is important to study the effects of depression interventions on anxiety and the impact of comorbid anxiety on depression outcomes. This article reports on pooled anxiety and depression data from two randomized trials of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a…

  10. Transdiagnostic Treatment of Bipolar Disorder and Comorbid Anxiety with the Unified Protocol: A Clinical Replication Series

    ERIC Educational Resources Information Center

    Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.

    2012-01-01

    Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. More than 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxiety disorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes.…

  11. Calibrating for Comorbidity: Clinical Decision-Making in Youth Depression and Anxiety

    ERIC Educational Resources Information Center

    Chu, Brian C.; Merson, Rachel A.; Zandberg, Laurie J.; Areizaga, Margaret

    2012-01-01

    Comorbidity in clinical youth populations is more the rule than the exception, yet few established guidelines exist to help practicing clinicians manage complex diagnostic profiles. The current paper reviews efforts within the treatment development literature to handle comorbidity in depressed and anxious children and adolescents, including…

  12. Families of Individuals with Intellectual Disability and Comorbid Mental Health Problems

    ERIC Educational Resources Information Center

    Esbensen, Anna J.

    2011-01-01

    This review focuses on the families of individuals dually diagnosed with intellectual disability (ID) and comorbid mental health problems. The review examines the impact of caring for individuals with ID and comorbid mental health problems on family well-being, the impact of the family on these individuals, and intervention and support needs of…

  13. Cardiac Reactivity and Stimulant Use in Adolescents with Autism Spectrum Disorders with Comorbid ADHD Versus ADHD

    ERIC Educational Resources Information Center

    Bink, M.; Popma, A.; Bongers, I. L.; van Boxtel, G. J. M.; Denissen, A.; van Nieuwenhuizen, Ch.

    2015-01-01

    A large number of youngsters with autism spectrum disorders (ASD) display comorbid attention deficit/hyperactivity disorder (ADHD) symptoms. However, previous studies are not conclusive whether psychophysiological correlates, like cardiac reactivity, are different for ASD with comorbid ADHD (ASD+) compared to ADHD. Therefore, the current study…

  14. Comorbidities in Chronic Pediatric Peritoneal Dialysis Patients: A Report of the International Pediatric Peritoneal Dialysis Network

    PubMed Central

    Neu, Alicia M.; Sander, Anja; Borzych-Dużałka, Dagmara; Watson, Alan R.; Vallés, Patricia G.; Ha, Il Soo; Patel, Hiren; Askenazi, David; Balasz-Chmielewska, Irena; Lauronen, Jouni; Groothoff, Jaap W.; Feber, Janusz; Schaefer, Franz; Warady, Bradley A.

    2012-01-01

    ♦ Background, Objectives, and Methods: Hospitalization and mortality rates in pediatric dialysis patients remain unacceptably high. Although studies have associated the presence of comorbidities with an increased risk for death in a relatively small number of pediatric dialysis patients, no large-scale study had set out to describe the comorbidities seen in pediatric dialysis patients or to evaluate the impact of those comorbidities on outcomes beyond the newborn period. In the present study, we evaluated the prevalence of comorbidities in a large international cohort of pediatric chronic peritoneal dialysis (CPD) patients from the International Pediatric Peritoneal Dialysis Network registry and began to assess potential associations between those comorbidities and hospitalization rates and mortality. ♦ Results: Information on comorbidities was available for 1830 patients 0 - 19 years of age at dialysis initiation. Median age at dialysis initiation was 9.1 years [interquartile range (IQR): 10.9], median follow-up for calculation of hospitalization rates was 15.2 months (range: 0.2 - 80.9 months), and total follow-up time in the registry was 2095 patient-years. At least 1 comorbidity had been reported for 602 of the patients (32.9%), with 283 (15.5%) having cognitive impairment; 230 (12.6%), motor impairment; 167 (9.1%), cardiac abnormality; 76 (4.2%), pulmonary abnormality; 212 (11.6%), ocular abnormality; and 101 (5.5%), hearing impairment. Of the 150 patients (8.2%) that had a defined syndrome, 85% had at least 1 nonrenal comorbidity, and 64% had multiple comorbidities. The presence of at least 1 comorbidity was associated with a higher hospitalization rate [hospital days per 100 observation days: 1.7 (IQR: 5.8) vs 1.2 (IQR: 3.9), p = 0.001] and decreased patient survival (4-year survival rate: 73% vs 90%, p < 0.0001). ♦ Conclusions: Nearly one third of pediatric CPD patients in a large international cohort had at least 1 comorbidity, and multiple

  15. Comorbidity Analysis According to Sex and Age in Hypertension Patients in China

    PubMed Central

    Liu, Jiaqi; Ma, James; Wang, Jiaojiao; Zeng, Daniel Dajun; Song, Hongbin; Wang, Ligui; Cao, Zhidong

    2016-01-01

    Background: Hypertension, an important risk factor for the health of human being, is often accompanied by various comorbidities. However, the incidence patterns of those comorbidities have not been widely studied. Aim: Applying big-data techniques on a large collection of electronic medical records, we investigated sex-specific and age-specific detection rates of some important comorbidities of hypertension, and sketched their relationships to reveal the risk for hypertension patients. Methods: We collected a total of 6,371,963 hypertension-related medical records from 106 hospitals in 72 cities throughout China. Those records were reported to a National Center for Disease Control in China between 2011 and 2013. Based on the comprehensive and geographically distributed data set, we identified the top 20 comorbidities of hypertension, and disclosed the sex-specific and age-specific patterns of those comorbidities. A comorbidities network was constructed based on the frequency of co-occurrence relationships among those comorbidities. Results: The top four comorbidities of hypertension were coronary heart disease, diabetes, hyperlipemia, and arteriosclerosis, whose detection rates were 21.71% (21.49% for men vs 21.95% for women), 16.00% (16.24% vs 15.74%), 13.81% (13.86% vs 13.76%), and 12.66% (12.25% vs 13.08%), respectively. The age-specific detection rates of comorbidities showed five unique patterns and also indicated that nephropathy, uremia, and anemia were significant risks for patients under 39 years of age. On the other hand, coronary heart disease, diabetes, arteriosclerosis, hyperlipemia, and cerebral infarction were more likely to occur in older patients. The comorbidity network that we constructed indicated that the top 20 comorbidities of hypertension had strong co-occurrence correlations. Conclusions: Hypertension patients can be aware of their risks of comorbidities based on our sex-specific results, age-specific patterns, and the comorbidity network

  16. Adolescent Substance Use and Comorbid Psychopathology: Emotion Regulation Deficits as a Transdiagnostic Risk Factor

    PubMed Central

    Lejuez, Carl W.

    2015-01-01

    Rates of substance use and comorbid psychopathology peak during adolescence, highlighting the need to identify transdiagnostic risk processes that cut across conditions and elucidate early embedded risk factors for comorbidity across development. The current review highlights emotion regulation deficits as a core transdiagnostic risk factor underlying the development of substance use, addiction, and comorbid psychopathology in adolescence. We present the dual systems model of neurological development to highlight adolescence as a critical period of increased risk for emotion regulation difficulties, corresponding risk behaviors, and psychopathology. We describe malfunction in the neurobiological regulation system underlying the relationship between emotion regulation and risk for addiction and comorbidity. We pull from two established developmental theories including both the externalizing pathway and the internalizing pathway to substance use disorders, which together highlight how early embedded risk in the form of emotion regulation deficits can explain mechanisms underlying the development of addiction and comorbid psychiatric disorders. PMID:26889402

  17. Fourth revolution in psychiatry – Addressing comorbidity with chronic physical disorders

    PubMed Central

    Gautam, Shiv

    2010-01-01

    The moral treatment of mental patients, Electro Convulsive therapy (ECT), and Psychotropic medications constitute the first, second, and third revolution in psychiatry, respectively. Addressing comorbidities of mental illnesses with chronic physical illnesses will be the fourth revolution in psychiatry. Mind and body are inseparable; there is a bidirectional relationship between psyche and soma, each influencing the other. Plausible biochemical explanations are appearing at an astonishing rate. Psychiatric comorbidity with many chronic physical disorders has remained neglected. Such comorbidity with cardiac, respiratory, Gastrointestinal, endocrinal, and neurological disorders, trauma, and other conditions like HIV and so on, needs to be addressed too. Evidence base of prevalence and causal relationship of psychiatric comorbidities in these disorders has been highlighted and strategies to meet the challenge of comorbidity have been indicated. PMID:21180405

  18. Comorbidities of Attention Deficit Hyperactivity Disorder: Pregnancy Risk Factors and Parent Mental Health.

    PubMed

    Silva, Desiree; Houghton, Stephen; Hagemann, Erika; Bower, Carol

    2015-08-01

    Our study examined the risk of maternal smoking and alcohol consumption in pregnancy associated with child comorbidity in a community sample of children diagnosed with attention deficit hyperactivity disorder (ADHD). We used a cross sectional community retrospective questionnaire of 321 children diagnosed with ADHD. Our results suggest that maternal smoking increased the risk of oppositional defiant behavior (ODB) in children with ADHD twofold (OR 2.27; CI 1.29-4.11). Maternal alcohol consumption increased the risk although not significantly for ADHD child comorbid ODB, anxiety disorder and depression. Parent mental health significantly impacted on child comorbidity. Our study suggests that smoking in pregnancy is associated with comorbid ODB, independent of parent mental health, family history of ADHD and socioeconomic factors. Parent mental health is independently associated with comorbid ODB, anxiety disorder and depression.

  19. Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment.

    PubMed

    DuPaul, George J; Gormley, Matthew J; Laracy, Seth D

    2013-01-01

    Attention-deficit/hyperactivity disorder (ADHD) and learning disability (LD) can co-occur for a significant minority of children with each disorder. A total of 17 studies (2001-2011) examining ADHD-LD comorbidity were reviewed, revealing a higher mean comorbidity rate (45.1%) than has been obtained previously. Higher comorbidity may be the result of including students with writing disorders, not just reading and/or math disabilities. Proposed DSM-5 criteria for both disorders will likely affect comorbidity rates; however, it is unclear whether such rates will increase or decrease. Regardless of the specific impact of DSM revisions, academic skill and/or performance deficits should be assessed for students with ADHD as part of screening, comprehensive evaluation, and treatment monitoring. Comprehensive intervention services for students with comorbid ADHD and LD will require empirically supported treatment strategies that address both disorders and that are implemented across school and home settings.

  20. Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates

    PubMed Central

    Balanzá-Martínez, Vicent; Crespo-Facorro, Benedicto; González-Pinto, Ana; Vieta, Eduard

    2015-01-01

    Bipolar disorder (BD) and alcohol use disorders (AUDs) are usually comorbid, and both have been associated with significant neurocognitive impairment. Patients with the BD-AUD comorbidity (dual diagnosis) may have more severe neurocognitive deficits than those with a single diagnosis, but there is paucity of research in this area. To explore this hypothesis more thoroughly, we carried out a systematic literature review through January 2015. Eight studies have examined the effect of AUDs on the neurocognitive functioning of BD patients. Most studies found that BD patients with current or past history of comorbid AUDs show more severe impairments, especially in verbal memory and executive cognition, than their non-dual counterparts. Greater neurocognitive dysfunction is another facet of this severe comorbid presentation. Implications for clinical practice and research are discussed. Specifically, the application of holistic approaches, such as clinical staging and systems biology, may open new avenues of discoveries related to the BD-AUD comorbidity. PMID:25904869

  1. A Developmental Psychopathology Perspective on ADHD and Comorbid Conditions: The Role of Emotion Regulation.

    PubMed

    Steinberg, Elizabeth A; Drabick, Deborah A G

    2015-12-01

    Research investigating attention-deficit/hyperactivity disorder (ADHD) and co-occurring disorders such as oppositional defiant disorder, conduct disorder, anxiety, and depression has surged in popularity; however, the developmental relations between ADHD and these comorbid conditions remain poorly understood. The current paper uses a developmental psychopathology perspective to examine conditions commonly comorbid with ADHD during late childhood through adolescence. First, we present evidence for ADHD and comorbid disorders. Next, we discuss emotion regulation and its associations with ADHD. The role of parenting behaviors in the development and maintenance of emotion regulation difficulties and comorbid disorders among children with ADHD is explored. An illustrative example of emotion regulation and parenting over the course of development is provided to demonstrate bidirectional relations among these constructs. We then present an integrated conceptual model of emotion regulation as a shared risk process that may lead to different comorbid conditions among children with ADHD. Implications and directions for future research are presented.

  2. External Validation of Comorbid Patterns of Anxiety Disorders in Children and Adolescents

    PubMed Central

    Franco, Ximena; Saavedra, Lissette; Silverman, Wendy K

    2009-01-01

    To evaluate the external validity of comorbid patterns of anxiety disorders among youth who presented to an anxiety disorders clinic, comorbid cases were compared to “pure” anxiety disorder cases. Children and adolescents (N = 329; mean age = 10.04 years) and parents were administered structured interviews and four groups were formed, Pure Anxiety, Anxiety + Anxiety, Anxiety + Externalizing, and Anxiety + Depressive, and compared along 4 external validation criteria: sociodemographics, clinical phenomenology, psychosocial, and family factors. All comorbid groups were more severe than the pure anxiety group on clinical phenomenology and psychosocial factors. The Anxiety + Depressive Disorders group was most severe on all criteria except sociodemographics. Results provide evidence for the external validity of comorbid diagnostic presentations among anxiety disorders, as there was differential meaningfulness in the diagnostic presentation of a pure anxiety disorder versus anxiety disorder comorbid with other disorders. Assessment and future research implications are discussed. PMID:17095184

  3. Weight Management in Older Adults

    PubMed Central

    Gill, Lydia E.; Bartels, Stephen J.; Batsis, John A.

    2017-01-01

    As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality is lost), the increase risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults, the dangers and benefits of weight loss in this population, and provides an overview of the new Medicare Obesity Benefit. In addition we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice. PMID:26627496

  4. Diabetes Self-Care and the Older Adult

    PubMed Central

    Weinger, Katie; Beverly, Elizabeth A.; Smaldone, Arlene

    2014-01-01

    The prevalence of diabetes is highest in older adults, a population that is increasing. Diabetes self-care is complex with important recommendations for nutrition, physical activity, checking glucose levels, and taking medication. Older adults with diabetes have unique issues which impact self-care. As people age, their health status, support systems, physical and mental abilities, and nutritional requirements change. Furthermore, comorbidities, complications, and polypharmacy complicate diabetes self-care. Depression is also more common among the elderly and may lead to deterioration in self-care behaviors. Because of concerns about cognitive deficits and multiple comorbidities, adults older than 65 years are often excluded from research trials. Thus, little clinical evidence is available and the most appropriate treatment approaches and how to best support older patients’ self-care efforts are unclear. This review summarizes the current literature, research findings, and expert and consensus recommendations with their rationales. PMID:24510969

  5. Geriatric Syndromes in Older HIV-Infected Adults

    PubMed Central

    Greene, Meredith; Covinsky, Kenneth E.; Valcour, Victor; Miao, Yinghui; Madamba, Joy; Lampiris, Harry; Cenzer, Irena Stijacic; Martin, Jeffrey; Deeks, Steven G.

    2015-01-01

    Background Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. Limited data exists on these conditions in older HIV-infected adults and no studies have comprehensively examined these conditions. Methods Geriatric syndromes including falls, urinary incontinence, functional impairment, frailty, sensory impairment, depression and cognitive impairment were measured in a cross-sectional study of HIV-infected adults age 50 and older who had an undetectable viral load on antiretroviral therapy (ART). We examined both HIV and non-HIV related predictors of geriatric syndromes including sociodemographics, number of co-morbidities and non-antiretroviral medications, and HIV specific variables in multivariate analyses. Results We studied 155 participants with a median age of 57 (IQR 54-62); (94%) were men. Pre-frailty (56%), difficulty with instrumental activities of daily living (46%), and cognitive impairment (47%) were the most frequent geriatric syndromes. Lower CD4 nadir (IRR 1.16, 95% CI 1.06-1.26), non-white race (IRR 1.38, 95% CI 1.10-1.74), and increasing number of comorbidities (IRR 1.09, 95%CI 1.03-1.15) were associated with increased risk of having more geriatric syndromes. Conclusions Geriatric syndromes are common in older HIV infected adults. Treatment of comorbidities and early initiation of ART may help to prevent development of these age related complications. Clinical care of older HIV-infected adults should consider incorporation of geriatric principles. PMID:26009828

  6. Psychiatric Comorbidity and Cognitive Profile in Children with Narcolepsy with or without Association to the H1N1 Influenza Vaccination

    PubMed Central

    Szakács, Attila; Hallböök, Tove; Tideman, Pontus; Darin, Niklas; Wentz, Elisabet

    2015-01-01

    Objectives: To evaluate psychiatric comorbidity and the cognitive profile in children and adolescents with narcolepsy in western Sweden and the relationship of these problems to H1N1 vaccination. Patients: Thirty-eight patients were included in the study. Design: We performed a population-based, cross-sectional study to investigate psychiatric comorbidity using a test battery of semistructured interviews generating Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnoses, including the Development and Well-Being Assessment and the attention deficit hyperactivity disorder rating scale. The Autism Spectrum Screening Questionnaire and the Positive and Negative Syndrome Scale were used to screen for autistic traits and psychotic symptoms, respectively. The cognitive assessments were made by a clinical psychologist using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, the Wechsler Intelligence Scale for Children, Fourth Edition, or the Wechsler Adult Intelligence Scale, Fourth Edition. Measurements and Results: In the post-H1N1 vaccination (PHV) narcolepsy group (n = 31), 43% of patients had psychiatric comorbidity, 29% had attention deficit hyperactivity disorder (ADHD) inattentive type, 20% had major depression, 10% had general anxiety disorder, 7% had oppositional defiant disorder (ODD), 3% had pervasive developmental disorder not otherwise specified (i.e., atypical autism), and 3% had eating disorder not otherwise specified (anorectic type). In the non–post-H1N1 vaccination (nPHV) narcolepsy group, one of seven patients had ADHD, inattentive type and ODD. The most frequent psychiatric symptom was temper tantrums, which occurred in 94% of the patients in the PHV group and 71% of the patients in the nPHV narcolepsy group. The cognitive assessment profile was similar in both groups and showed normal results for mean full-scale IQ and perceptual speed but decreased verbal comprehension and working memory. Patients with

  7. [Analgesic abuse and psychiatric comorbidity in headache patients].

    PubMed

    Radat, F; Irachabal, S; Swendsen, J; Henry, P

    2002-01-01

    Headache patients frequently overuse analgesic medications: 20% of the patients from headache centers is concerned by this problem, which has been estimated to occur in four percent of the community migrainers. Frequent use of various types of headache medication may paradoxically cause an increase in headache attack frequency as well as their chronicisation due to potentially complex mechanisms of sensitization. Patients will enter into a self- perpetuating cycle of daily headaches and use of symptomatic medications which can lead to addiction and to social and occupational impairement. Indeed, many patients will experience pharmacological tolerance and dependence but also by some kind of craving. International Headache Society qualify these patients as abusers referring mostly to the amount of substance ingested. Hence patients are labelled analgesic abusers . However, as many of these analgesic medications contained psychotropic substances (i.e. caffeine, codeine.), these patients may fulfill DSM IV criteria of dependance. Nevertheless, the dependance criteria should be adapted to chronic pain patients. Indeed, if pharmacological dependence and tolerance criteria are easy to apply in such patients, it is not the case for the criteria a great deal of time spent to obtain substances, to use substances or to recover from substances effects . As analgesic medications are legally obtained from medical practitioners, drug seeking behaviours are mostly: obtaining medications from multiple providers, repeating episodes of prescription loss and multiplying requests for early refills. Moreover the detrimental effects of analgesic abuse on psychosocial functioning is likely to be related to pain rather than to medication overuse. Finally the best indicator of addictive behaviors in such patients, is the loss of control over the use of analgesic medication despite the adverse consequences over pain. Comorbidity with addiction to other substances has never been specifically

  8. Influence of comorbidities in idiopathic normal pressure hydrocephalus — research and clinical care. A report of the ISHCSF task force on comorbidities in INPH

    PubMed Central

    2013-01-01

    Idiopathic normal pressure hydrocephalus (INPH) is a syndrome of ventriculomegaly, gait impairment, cognitive decline and incontinence that occurs in an elderly population prone to many types of comorbidities. Identification of the comorbidities is thus an important part of the clinical management of INPH patients. In 2011, a task force was appointed by the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF) with the objective to compile an evidence-based expert analysis of what we know and what we need to know regarding comorbidities in INPH. This article is the final report of the task force. The expert panel conducted a comprehensive review of the literature. After weighing the evidence, the various proposals were discussed and the final document was approved by all the task force members and represents a consensus of expert opinions. Recommendations regarding the following topics are given: I. Musculoskeletal conditions; II. Urinary problems; III. Vascular disease including risk factors, Binswanger disease, and white matter hyperintensities; IV. Mild cognitive impairment and Alzheimer disease including biopsies; V. Other dementias (frontotemporal dementia, Lewy body, Parkinson); VI. Psychiatric and behavioral disorders; VII. Brain imaging; VIII. How to investigate and quantify. The task force concluded that comorbidity can be an important predictor of prognosis and post-operative outcome in INPH. Reported differences in outcomes among various INPH cohorts may be partly explained by variation in the rate and types of comorbidities at different hydrocephalus centers. Identification of comorbidities should thus be a central part of the clinical management of INPH where a detailed history, physical examination, and targeted investigations are the basis for diagnosis and grading. Future INPH research should focus on the contribution of comorbidity to overall morbidity, mortality and long-term outcomes. PMID:23758953

  9. Adult Dyslexia and Attention Deficit Disorder in Finland--Project DyAdd: WAIS-III Cognitive Profiles

    ERIC Educational Resources Information Center

    Laasonen, Marja; Leppamaki, Sami; Tani, Pekka; Hokkanen, Laura

    2009-01-01

    The project Adult Dyslexia and Attention Deficit Disorder in Finland (Project DyAdd) compares adults (n = 119, 18-55 years) with dyslexia, attention-deficit/hyperactivity disorder (ADHD), dyslexia together with ADHD (comorbid), and healthy controls with neuropsychological, psychophysical, and biological methods. The focus of this article is on the…

  10. Comparison of Younger and Older Adults' Acceptability of Treatment for Generalized Anxiety Disorder Co-Occurring with Parkinson's Disease

    ERIC Educational Resources Information Center

    Lundervold, Duane A.; Ament, Patrick A.; Holt, Peter S.; Hunt, Lauren S.

    2013-01-01

    Acceptability ratings of medication or Behavioral Relaxation Training (BRT), for general anxiety disorder (GAD) co-occurring with Parkinson's Disease (PD) were obtained from younger ("n" = 79) and older ("n" = 54) adults. Participants read a case description of an older adult with PD and comorbid GAD followed by a description…

  11. Effect of comorbid tics on a clinically meaningful response to 8-week open-label trial of fluoxetine in obsessive compulsive disorder.

    PubMed

    Husted, David S; Shapira, Nathan A; Murphy, Tanya K; Mann, Giselle D; Ward, Herbert E; Goodman, Wayne K

    2007-01-01

    Currently, there are limited published data evaluating the effects of tics on serotonin reuptake inhibitor (SRI) monotherapy responses in treating obsessive-compulsive disorder (OCD). One retrospective case-controlled analysis of OCD patients treated with SRI monotherapy showed lesser improvement in OCD symptoms in patients with tics than those without. However, more recently there were preliminary reports of OCD subjects treated with SRI monotherapy which did not demonstrate poorer response in subjects with tics or Tourette's Syndrome (TS). The specific aim of this study was to investigate whether the presence of comorbid chronic tics affected "clinically meaningful improvement" [McDougle, C.J., Goodman, W.K., Leckman, J.F., Barr, L.C., Heninger, G.R., Price, L.H., 1993. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. Journal of Clinical Psychopharmacology 13, 354-358] of OCD in an 8-week open-label trial of fluoxetine monotherapy. Seventy-four adult subjects (13 patients with comorbid chronic tics and 61 patients without tics) with a primary DSM-IV OCD diagnosis were treated with up to 40mg fluoxetine for 8 weeks and had at least one post-baseline evaluation. The results indicate that there was a significant response by time in both fluoxetine-with-tic subjects and fluoxetine-without-tic subjects. Additionally, there were 3 (23.0%) OCD subjects with tics who had clinically meaningful improvement versus 16 (26.2%) OCD subjects without tics that demonstrated similar levels of improvement. These findings indicate that OCD patients with or without chronic tic disorders did not have a differential response to an 8-week open-label trial of fluoxetine. Limitations include the relatively low number of tic subjects and the open-label nature of the study. Additional data are needed on how comorbid tics may affect SRI treatment response in OCD.

  12. What is the impact of different spirometric criteria on the prevalence of spirometrically defined COPD and its comorbidities? Results from the population-based KORA study

    PubMed Central

    Karrasch, Stefan; Brüske, Irene; Smith, Maia P; Thorand, Barbara; Huth, Cornelia; Ladwig, Karl-Heinz; Kronenberg, Florian; Heinrich, Joachim; Holle, Rolf; Peters, Annette; Schulz, Holger

    2016-01-01

    Background There is an ongoing debate about the appropriate spirometric criterion for airway obstruction to detect COPD. Furthermore, the association of different criteria with comorbidity prevalence and inflammatory biomarkers in advanced age is unclear. Materials and methods Spirometry was performed in a population-based study (n=2,256) covering an age range of 41–90 years. COPD was spirometrically determined either by a fixed ratio (FR) of <0.7 for forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) or by FEV1/FVC below the lower limit of normal (LLN). Comorbidity prevalences and circulating biomarker levels (C-reactive protein [CRP], interleukin [IL]-6) were compared between subjects with or without COPD by the two criteria using logistic and multiple regression models, adjusting for sex and age. Results The prevalence of spirometrically defined COPD by FR increased with age from 10% in subjects aged <65 years to 26% in subjects aged ≥75 years. For LLN-defined COPD, it remained below 10% for all age groups. Overall, COPD diagnosis was not associated with specific comorbidities, except for a lower prevalence of obesity in both FR- and LLN-defined cases. Both CRP and IL-6 tended to be higher in cases by both criteria. Conclusion In a population-based cohort of adults up to the age of 90 years, the prevalence of spirometrically defined COPD was higher for the FR criterion than for the LLN criterion. This difference increased with age. Neither prevalences of common comorbidities nor levels of the biomarkers, CRP or IL-6, were conclusively associated with the selection of the COPD criterion. Results have to be considered in light of the predominantly mild cases of airway obstruction in the examined study population. PMID:27574413

  13. The Effect of Comorbid AD/HD and Learning Disabilities on Parent-Reported Behavioral and Academic Outcomes of Children

    ERIC Educational Resources Information Center

    Smith, Thomas J.; Adams, Gail

    2006-01-01

    Data from the 2001 National Household Education Survey were examined to estimate the prevalence of comorbid AD/HD and LD among school-aged children in the United States and assess how this comorbidity was associated with selected parent-reported behavioral and academic outcomes. The observed prevalence of comorbidity coincided with estimates in…

  14. Chronic Comorbidities Contribute to the Burden and Costs of Persistent Asthma

    PubMed Central

    Linna, Miika; Jantunen, Juha; Martikainen, Jaana E.; Haahtela, Tari; Pelkonen, Anna; Mäkelä, Mika

    2015-01-01

    Background. We aimed to study the prevalence of chronic comorbidities in asthma patients and the costs of health care use associated with asthma with comorbidities. Material and Methods. We analysed the prevalence of the four most common chronic diseases in asthma patients in 2008–2014 in Finland. Prevalence of coronary artery disease, diabetes and dyslipidaemia, hypertension, epilepsy, inflammatory bowel disease, rheumatic diseases, and severe psychiatric disease was studied by register of the Social Insurance Institution of Finland. The costs of health care services were collected from the registries maintained by the National Institute for Health and Welfare (THL). Results. Prevalence of asthma was 4.6% in 2014. Diabetes was among the four most common comorbidities in all the age groups. The other common comorbidities were hypertension (≥46 years; 12.9–37.6%), severe psychiatric disorders (age groups of 16–59 years; 1.4–3.5%), and ischaemic heart disease (≥60 years; 10–25%). In patients with both asthma and diabetes, the costs of hospitalization were approximately 169% compared with patients with asthma alone. Conclusions. Prevalence of asthma increases by tenfold when aging. The comorbidity diversity and rate are age-dependent. Prevalence of diabetes as comorbidity in asthma has increased. Costs of hospitalizations in asthma approximately double with chronic comorbidities. PMID:26783384

  15. Comorbid Personality Disorders in Obsessive-Compulsive Disorder and Its Symptom Dimensions.

    PubMed

    Bulli, Francesco; Melli, Gabriele; Cavalletti, Veronica; Stopani, Eleonora; Carraresi, Claudia

    2016-06-01

    The current paper was aimed at: (1) investigating the comorbidity between obsessive-compulsive disorder (OCD) and personality disorders (PDs) using an OCD sample and clinician-administered structured interviews; (2) exploring the associations of different cluster comorbid PDs with the specific symptom dimensions of OCD; (3) analyzing the variables which could play a significant role in the probability of having at least one comorbid PD, controlling for confounding variables. The SCID-II and Y-BOCS, together with a series of self-report measures of OCD, depression and anxiety symptoms were administered to a clinical sample of 159 patients with a primary diagnosis of OCD. 20.8 % of the participants suffered from at least one comorbid PD; the most common was obsessive-compulsive PD (9.4 %), followed by narcissistic PD (6.3 %). In OCD patients with comorbid cluster C PDs, the percentage of responsibility for harm, injury, or bad luck symptoms was significantly greater than other OCD symptom dimensions (p < .005). Logistic regression found some evidence supporting the association between severity of OCD symptoms and comorbid PDs. PDs are prevalent among Italian people with OCD and should be routinely assessed, as comorbidity may affect help-seeking behaviour and response to treatment.

  16. A meta-analysis of the influence of comorbidity on treatment outcome in the anxiety disorders.

    PubMed

    Olatunji, Bunmi O; Cisler, Josh M; Tolin, David F

    2010-08-01

    Although psychiatric comorbidity is common among patients with anxiety disorders, its impact on treatment outcome remains unclear. The present study used meta-analytic techniques to examine the relationship between diagnostic comorbidity and treatment outcome for patients with anxiety disorders. One hundred forty-eight anxiety-disordered treatment samples (combined N=3534) were examined for post-treatment effects from the PsychINFO database. Samples consisted of those exposed to both active (CBT, dynamic therapy, drug treatment, CBT+drug treatment, mindfulness) and inactive treatments (placebo/attention control, wait-list). All treatments were associated with significant improvement at post-treatment, and active treatments were associated with greater effects than were inactive treatments. However, overall comorbidity was generally unrelated to effect size at post-treatment or at follow-up. A significant negative relationship between overall comorbidity and treatment outcome was found for mixed or "neurotic" anxiety samples when examining associations between comorbidity and specific diagnoses. Conversely, there was a significant positive relationship between overall comorbidity and treatment outcome for panic disorder and/or agoraphobia and PTSD or sexual abuse survivors. These findings suggest that while diagnostic comorbidity may not impact the effects of specific anxiety disorder treatments, it appears to differentially impact outcome for specific anxiety disorder diagnoses.

  17. The chronic obstructive pulmonary disease comorbidity spectrum in Japan differs from that in western countries.

    PubMed

    Takahashi, Saeko; Betsuyaku, Tomoko

    2015-11-01

    Patients with Chronic Obstructive Pulmonary Disease (COPD) frequently suffer from various comorbidities, such as cardiovascular disease, osteoporosis, depression, malnutrition, metabolic syndrome, diabetes, and lung cancer. These comorbidities have a significant impact on disease severity and survival. In fact, guidelines from both the Global Initiative for Chronic Obstructive Lung Disease and the Japanese Respiratory Society recommend that physicians take comorbidities into account when they evaluate COPD severity. These guidelines also emphasize the importance of managing comorbidities alongside airway obstruction in COPD. The mechanisms by which the many COPD-related comorbidities develop are still unclear. Aging and smoking are well-established as major factors. However, systemic inflammation may also contribute to the disease process. Having developed from the classical theory to differentiate COPD patients into "pink puffers" and "blue bloaters", COPD is now generally considered as a heterogeneous condition. On this point, we have noticed that the characteristics of Japanese COPD patients tend to differ from those of Westerners. Specifically, Japanese patients tend to be older, to have lower body mass index, to suffer from emphysema-dominant lung disease, and to experience exacerbations less frequently. The comorbidity spectrum of Japanese COPD patients also seems to differ from that of Westerners. For instance, in Japanese patients, cardiovascular disease and metabolic syndrome are less prevalent, whereas osteoporosis and malnutrition are more frequent. In order to treat Japanese COPD patients optimally, we must pay particular attention to their unique demographics and comorbidity spectrum, which contrast with those of Western COPD patients.

  18. Neuroinflammation and comorbidities are frequently ignored factors in CNS pathology

    PubMed Central

    Sandu, Raluca Elena; Buga, Ana Maria; Uzoni, Adriana; Petcu, Eugen Bogdan; Popa-Wagner, Aurel

    2015-01-01

    Virtually all drug interventions that have been successful pre-clinically in experimental stroke have failed to prove their efficacy in a clinical setting. This could be partly explained by the complexity and heterogeneity of human diseases as well as the associated co-morbidities which may render neuroprotective drugs less efficacious in clinical practice. One aspect of crucial importance in the physiopathology of stroke which is not completely understood is neuroinflammation. At the present time, it is becoming evident that subtle, but continuous neuroinflammation can provide the ground for disorders such as cerebral small vessel disease. Moreover, advanced aging and a number of highly prevalent risk factors such as obesity, hypertension, diabetes and atherosclerosis could act as “silent contributors” promoting a chronic proinflammatory state. This could aggravate the outcome of various pathological entities and can contribute to a number of subsequent post-stroke complications such as dementia, depression and neurodegeneration creating a pathological vicious cycle. Moreover, recent data suggests that the inflammatory process might be closely linked with multiple neurodegenerative pathways related to depression. In addition, pro-inflammatory cytokines could play a central role in the pathophysiology of both depression and dementia. PMID:26604877

  19. [Comorbid antisocial and borderline personality disorders: mentalization-based treatment].

    PubMed

    Bateman, Anthony; Fonagy, Peter

    2010-01-01

    Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change.

  20. Nosology and epidemiology of addictive disorders and their comorbidity.

    PubMed

    Bucholz, K K

    1999-06-01

    Diagnostic classification systems have developed to the point at which the DSM-IV and ICD-10 are nearly identical, so that researchers and clinicians in different parts of the world have a common language for substance-dependence diagnoses. Despite the differences in nosology, the demographic correlates of alcohol and drug dependence are strikingly similar. Lifetime and 12-month prevalences are generally higher in men than in women, whites compared with nonwhites, younger compared with older cohorts, those with lower income levels and lower educational attainment, and those who have not been stably married (including those who have cohabited). NCS data indicated differences in risk factors for stages of drug use, arguing for separation of these in future analyses. Alcoholics are more likely to have another psychiatric disorder compared with their nonalcoholic counterparts, and ASPD, mania, and other drug dependence rank among those disorders most strongly associated with alcohol and drug dependence. Analyses from the NCS examining temporal ordering of diagnoses have focused attention on anxiety disorders in the cause of alcohol dependence. Depression, although not so strongly associated with substance dependence as clinical studies had led researchers to believe, nonetheless seems to be of etiologic interest as well, according to the NCS analyses. The cross-sectional results of the NLAES data on comorbidity between depression and alcohol and drug dependence have uncovered important new associations between gender, age, and depression and may yield further etiologic insights when age-of-onset data are taken into account.

  1. [Autism spectrum disorders - epidemiology, symptoms, comorbidity and diagnosis].

    PubMed

    Rybakowski, Filip; Bialek, Anna; Chojnicka, Izabela; Dziechciarz, Piotr; Horvath, Andrea; Janas-Kozik, Malgorzata; Jeziorek, Anetta; Pisula, Ewa; Piwowarczyk, Anna; Slopien, Agnieszka; Sykut-Cegielska, Jolanta; Szajewska, Hanna; Szczaluba, Krzysztof; Szymanska, Krystyna; Urbanek, Ksymena; Waligórska, Anna; Wojciechowska, Aneta; Wroniszewski, Michal; Dunajska, Anna

    2014-01-01

    In the new classification of American Psychiatric Association - DSM-5 - a category of autistic spectrum disorders (ASD) was introduced, which replaced autistic disorder, Asperger syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. ASD are defined by two basic psychopathological dimensions: communication disturbances and stereotyped behaviors, and the diagnosis is complemented with the assessment of language development and intellectual level. In successive epidemiological studies conducted in 21 century the prevalence of ASD has been rising, and currently is estimated at 1% in general population. The lifetime psychiatric comorbidity is observed in majority of patients. The most common coexisting diagnoses comprise disorders ofanxiety-affective spectrum, and in about 1/3 of patients attention deficit/ hyperactivity disorders could be diagnosed. Prodromal symptoms of ASD may emerge before 12 months of life, however reliability of diagnosis at such an early age is poor. Several screening instruments, based on the parental and/or healthcare professional assessments may be helpful in ASD detection. However, structured interviews and observation schedules remain the gold standard of diagnosis.

  2. Suicidal ideation in Huntington disease: The role of comorbidity

    PubMed Central

    Wetzel, Heather H.; Gehl, Carissa R.; Dellefave, Lisa; Schiffman, Judith F.; Shannon, Kathleen M.; Paulsen, Jane S.

    2013-01-01

    Huntington disease (HD) is a neurodegenerative condition characterized by cognitive impairments, motor abnormalities, and psychiatric disturbance. An increased risk for suicide has been documented. The majority of HD research has focused on cognitive and motor features of HD; the implications of psychiatric manifestations have received less consideration. Recent studies have sought to identify the stages of HD in which patients are at increased risk to experience suicidal ideation, though no study has examined possible risk factors for suicidality. The current study examines the presence of psychiatric comorbidity and its involvement in suicidal ideation. Suicidal ideation was examined in 1,941 HD patients enrolled in the Huntington Study Group. Of those, 19% (N = 369) reported suicidal ideation. Logistic regression analyses indicated that depression/anxiety and aggression/irritability are significant predictors of suicidal ideation (p < 0.01). In a subsample with the greatest suicidal ideation, alcohol and drug abuse were also predictive. Findings suggest that suicide in HD may be more distinct as compared to suicide in the general population. It is recommended that all individuals with HD (specifically those with features of depression, aggression, substance abuse) have routine suicide assessment; further research is needed to understand the high rate of suicide in HD. PMID:21605914

  3. Association of Lifestyle-Related Comorbidities With Periodontitis

    PubMed Central

    Lee, Jae-Hong; Lee, Jung-Seok; Park, Jin-Young; Choi, Jung-Kyu; Kim, Dong-Wook; Kim, Young-Taek; Choi, Seong-Ho

    2015-01-01

    Abstract The aim of this study was to determine the association of periodontitis with lifestyle-related comorbidities (LCs) using data in the Korean National Health Insurance Cohort Database from 2002 to 2013. This was a retrospective study involving a large national cohort with patient samples (representing 2% of the total Korean population) stratified on the basis of sociodemographic information. Using this precisely extracted database, the correlations between LCs (cerebral infarction, angina pectoris, myocardial infarction, hypertension, diabetes mellitus, rheumatoid arthritis, erectile dysfunction, osteoporosis, and obesity) and periodontitis were investigated while adjusting for confounding bias. Univariate and multiple logistic regression analyses were used to evaluate differences in variable factors. Among a total of 1,025,340 samples, 321,103 (31.3%) cases were diagnosed with periodontitis. Statistically significant associations were found between all LCs except myocardial infarction and periodontitis (P < 0.005). Periodontitis is significantly and positively correlated with LCs (except for myocardial infarction) after adjusting for confounding bias. In particular, lifestyle-related diseases, erectile dysfunction, and osteoporosis seem to be intimately related to periodontitis. PMID:26376407

  4. Factitious disorder comorbid with bipolar I disorder. A case report.

    PubMed

    Del Casale, Antonio; Ferracuti, Stefano; Rapinesi, Chiara; Serata, Daniele; Simonetti, Alessio; Caloro, Matteo; Roma, Paolo; Savoja, Valeria; Kotzalidis, Georgios D; Sani, Gabriele; Tatarelli, Roberto; Girardi, Paolo

    2012-06-10

    We describe a case of factitious disorder with physical and psychological symptoms comorbid with bipolar I disorder in a 37-year-old woman. Since the onset of bipolar disorder, which occurred at the age of 31, she increasingly complained of physical symptoms, compulsively seeking medical and surgical interventions. She has been hospitalised several times and her Munchausen-type factitious disorder recently appeared to be developing into Munchausen by proxy, involving her 11-year-old daughter. The patient adhered poorly to stabilising and antipsychotic drug treatment and did not improve through the years. We here analyse her mood phases, which were always associated with changes in the quality of factitious symptoms, according to whether the disorder was in its depressive phase (somatic complaints and suicidal ideation prevail), or in its manic or mixed phase (medical intervention-seeking and manipulation of clinicians to obtain surgical interventions). We also briefly discuss some important forensic issues to consider in similar cases, mainly stemming from the psychotic aspects of these two co-occurring disorders. Clinicians should be aware of some patients' ability to produce signs and symptoms of physical and/or psychological illness and consult psychiatrists before giving consent to invasive diagnostic procedures or surgery.

  5. [Glucose-lowering therapy in patients with cardiac comorbidities].

    PubMed

    Meier, Juris J

    2015-04-01

    The risk for cardiovascular events, congestive heart failure and cardiac arrhythmia is significantly increased in patients with diabetes. Although poor glycaemic control has been associated with an increased cardiovascular event rate, aggressive glucose-lowering strategies have failed to improve cardiovascular endpoints or mortality. Therefore, treatment-associated adverse effects, especially hypoglycaemia and weight gain, must be carefully outbalanced against the potential benefits of better glycaemic control. Furthermore, certain drug-specific aspects must be considered: Pioglitazone is contraindicated in patients with heart failure, and DPP-4 inhibitors have recently been associated with an increased heart failure rate. Heart rate may increase during treatment with GLP-1 analogues. Only with metformin a reduction in cardiovascular endpoint has been demonstrated in patients with diabetes. Insulin and sulphonylureas have yielded neutral results in the available endpoint trials. Endpoint studies with GLP-1 analogues or SGLT-2 inhibitors have not yet been completed. These various drug-specific actions in the cardiovascular system need to be born in mind for the choice of the optimal glucose-lowering strategy in patients with cardiac comorbidities.

  6. Obesity, insulin resistance and comorbidities – Mechanisms of association

    PubMed Central

    Castro, Ana Valeria B.; Kolka, Cathryn M.; Kim, Stella P.; Bergman, Richard N.

    2015-01-01

    Overall excess of fat, usually defined by the body mass index, is associated with metabolic (e.g. glucose intolerance, type 2 diabetes mellitus (T2DM), dyslipidemia) and non-metabolic disorders (e.g. neoplasias, polycystic ovary syndrome, non-alcoholic fat liver disease, glomerulopathy, bone fragility etc.). However, more than its total amount, the distribution of adipose tissue throughout the body is a better predictor of the risk to the development of those disorders. Fat accumulation in the abdominal area and in non-adipose tissue (ectopic fat), for example, is associated with increased risk to develop metabolic and non-metabolic derangements. On the other hand, observations suggest that individuals who present peripheral adiposity, characterized by large hip and thigh circumferences, have better glucose tolerance, reduced incidence of T2DM and of metabolic syndrome. Insulin resistance (IR) is one of the main culprits in the association between obesity, particularly visceral, and metabolic as well as non-metabolic diseases. In this review we will highlight the current pathophysiological and molecular mechanisms possibly involved in the link between increased VAT, ectopic fat, IR and comorbidities. We will also provide some insights in the identification of these abnormalities. PMID:25211442

  7. Pregnancy-Onset Panic Disorder: Incidence, Comorbidity and Associated Factors

    PubMed Central

    GÜLER, Özkan; KAYA, Veli; GEZGİNÇ, Kazım; KAYHAN, Fatih; ÇİÇEK, Erdinç; SÖNMEZ, Önder; UĞUZ, Faruk

    2015-01-01

    Introduction The present study aimed to investigate the incidence rate of pregnancy-onset panic disorder (POPD) among Turkish pregnant women using a diagnostic interview. Additionally, we examined whether the independent socio-demographic or clinical risk factors were associated with the risk of panic disorder in these women. Methods The study sample comprised 1475 consecutive pregnant women who presented to the obstetric outpatient clinics of two research centers. The rate of POPD in these participants was 1.3% (Group 1, n=20). The 20 women with POPD were compared with 250 pregnant women without pregnancy-onset depression or anxiety (Group 2; controls). Panic disorder and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV. Comorbid Axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders. Results The incidence rate of panic disorder was 1.3% (n=20). In group 1, 55% (n=11) of the women with POPD had an additional mood or anxiety disorder. In addition, the prevalence rate of any cluster C personality disorder, including avoidant, passive-aggressive and obsessive-compulsive personality disorders, were significantly greater in the group 1 women with POPD than the control pregnant women without a panic disorder (group 2). Conclusion The women with POPD were more likely than the controls to have a cluster C Axis II disorder and a history of a pre-existing anxiety or mood disorder.

  8. A Neurobiological Basis for Substance Abuse Comorbidity in Schizophrenia

    PubMed Central

    Chambers, R. Andrew; Krystal, John H.; Self, David W.

    2010-01-01

    It is commonly held that substance use comorbidity in schizophrenia represents self-medication, an attempt by patients to alleviate adverse positive and negative symptoms, cognitive impairment, or medication side effects. However, recent advances suggest that increased vulnerability to addictive behavior may reflect the impact of the neuropathology of schizophrenia on the neural circuitry mediating drug reward and reinforcement. We hypothesize that abnormalities in the hippocampal formation and frontal cortex facilitate the positive reinforcing effects of drug reward and reduce inhibitory control over drug-seeking behavior. In this model, disturbances in drug reward are mediated, in part, by dysregulated neural integration of dopamine and glutamate signaling in the nucleus accumbens resulting form frontal cortical and hippocampal dysfunction. Altered integration of these signals would produce neural and motivational changes similar to long-term substance abuse but without the necessity of prior drug exposure. Thus, schizophrenic patients may have a predilection for addictive behavior as a primary disease symptom in parallel to, and in many cases independent from, their other symptoms. PMID:11526998

  9. Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis

    PubMed Central

    Zhang, Tingting; Tremlett, Helen; Leung, Stella; Zhu, Feng; Kingwell, Elaine; Fisk, John D.; Bhan, Virender; Campbell, Trudy L.; Stadnyk, Karen; Yu, B. Nancy

    2016-01-01

    Objective: Comorbidities are common in multiple sclerosis (MS) and adversely affect health outcomes. However, the effect of comorbidity on treatment decisions in MS remains unknown. We aimed to examine the effects of comorbidity on initiation of injectable disease-modifying therapies (DMTs) and on the choice of the initial DMT in MS. Methods: We conducted a retrospective observational analysis using population-based health administrative and linked clinical databases in 3 Canadian provinces. MS cases were defined as any individual with ≥3 diagnostic codes for MS. Cohort entry (index date) was the first recorded demyelinating disease-related claim. The outcomes included choice of initial first-line DMTs and time to initiating a DMT. Logistic and Cox regression models were used to examine the association between comorbidity status and study outcomes, adjusting for sex, age, year of index date, and socioeconomic status. Meta-analysis was used to estimate overall effects across the 3 provinces. Results: We identified 10,698 persons with incident MS, half of whom had ≥1 comorbidities. As the total number of comorbidities increased, the likelihood of initiating a DMT decreased. Comorbid anxiety and ischemic heart disease were associated with reduced initiation of a DMT. However, patients with depression were 13% more likely to initiate a DMT compared to those without depression at the index date (adjusted hazard ratio 1.13; 95% confidence interval 1.00–1.27). Conclusions: Comorbidities are associated with treatment decisions regarding DMTs in MS. A better understanding of the effects of comorbidity on effectiveness and safety of DMTs is needed. PMID:26944268

  10. Effect of Comorbidities on Outcomes of Neurorehabilitation Interventions in Multiple Sclerosis

    PubMed Central

    Fakolade, Afolasade; Bisson, Etienne J.; Pétrin, Julie; Lamarre, Julie

    2016-01-01

    Background: Interest in comorbidities has increased in the past few years, but the effect of comorbidities on outcomes of multiple sclerosis (MS) neurorehabilitation interventions is unclear. The aim of this review was to identify and summarize the existing evidence regarding the effect of comorbidities on outcomes of neurorehabilitation interventions targeting people with MS. Methods: Five databases (Embase, MEDLINE through Ovid, PubMed Central, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) were searched using index terms and keywords relating to MS and a wide range of rehabilitation interventions. Studies screened were limited to English-language randomized controlled trials. Information related to included and excluded comorbidities and how they were reported and described was extracted from the included studies. Results: Fifty-four neurorehabilitation randomized controlled trials were included and were grouped into categories: robotics/technology-enhanced (n = 7), task-oriented training/neurorehabilitation principles (n = 7), electrical stimulation (n = 12), temperature regulation (n = 6), magnetic field therapy (n = 5), vibration (n = 9), and miscellaneous (n = 8). Although the issue of comorbidity was considered in 40 studies, it was limited to excluding individuals from participating in the trials. Only two studies reported on comorbidity, but neither examined the possible mediating or moderating effect of comorbidities on intervention outcomes. Conclusions: This review documents important knowledge gaps about the effect of comorbidity on neurorehabilitation outcomes and identifies a critical need for future studies to address this issue. Without this information, we limit our understanding of the mechanisms of comorbidity and its effects on relevant clinical and research outcomes specific to neurorehabilitation. PMID:27999522

  11. Identifying comorbid depression and disruptive behavior disorders: comparison of two approaches used in adolescent studies.

    PubMed

    Vander Stoep, Ann; Adrian, Molly C; Rhew, Isaac C; McCauley, Elizabeth; Herting, Jerald R; Kraemer, Helena C

    2012-07-01

    Interest in commonly co-occurring depression and disruptive behavior disorders in children has yielded a small body of research that estimates the prevalence of this comorbid condition and compares children with the comorbid condition and children with depression or disruptive behavior disorders alone with respect to antecedents and outcomes. Prior studies have used one of two different approaches to measure comorbid disorders: (1) meeting criteria for two DSM or ICD diagnoses or (2) scoring .5 SD above the mean or higher on two dimensional scales. This study compares two snapshots of comorbidity taken simultaneously in the same sample with each of the measurement approaches. The Developmental Pathways Project administered structured diagnostic interviews as well as dimensional scales to a community-based sample of 521 11-12 year olds to assess depression and disruptive behavior disorders. Clinical caseness indicators of children identified as "comorbid" by each method were examined concurrently and 3-years later. Cross-classification of adolescents via the two approaches revealed low agreement. When other indicators of caseness, including functional impairment, need for services, and clinical elevations on other symptom scales were examined, adolescents identified as comorbid via dimensional scales only were similar to those who were identified as comorbid via DSM-IV diagnostic criteria. Findings suggest that when relying solely on DSM diagnostic criteria for comorbid depression and disruptive behavior disorders, many adolescents with significant impairment will be overlooked. Findings also suggest that lower dimensional scale thresholds can be set when comorbid conditions, rather than single forms of psychopathology, are being identified.

  12. Polymyositis - adult

    MedlinePlus

    ... rash is a sign of a similar condition, dermatomyositis . Common symptoms include: Muscle weakness in the shoulders ... in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. ...

  13. Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations

    PubMed Central

    Flory, Janine D.; Yehuda, Rachel

    2015-01-01

    Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD). The current paper examines evidence for two explanations of this comorbidity. First, that the comorbidity reflects overlapping symptoms in the two disorders. Second, that the co-occurrence of PTSD and MDD is not an artifact, but represents a trauma-related phenotype, possibly a subtype of PTSD. Support for the latter explanation is inferred from literature that examines risk and biological correlates of PTSD and MDD, including molecular processes. Treatment implications of the comorbidity are considered. PMID:26246789

  14. Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder.

    PubMed

    Brunner, Patrick M; Silverberg, Jonathan I; Guttman-Yassky, Emma; Paller, Amy S; Kabashima, Kenji; Amagai, Masayuki; Luger, Thomas A; Deleuran, Mette; Werfel, Thomas; Eyerich, Kilian; Stingl, Georg

    2017-01-01

    Atopic dermatitis comorbidities extend well beyond the march to allergic conditions (food allergy, asthma, allergic rhinitis, allergic conjunctivitis, and eosinophilic esophagitis), suggesting both cutaneous and systemic immune activation. In reviewing atopic dermatitis comorbidities, Councilors of the International Eczema Council found a strong pattern of immune activation in peripheral blood and the propensity to both skin and systemic infections. Associations with cardiovascular, neuropsychiatric, and malignant diseases were increasingly reported, but confirmation of their link with atopic dermatitis requires longitudinal studies. Given the possibility of atopic dermatitis-related systemic immune activation, future investigations of new interventions should concurrently examine the impact on these comorbidities.

  15. Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations.

    PubMed

    Flory, Janine D; Yehuda, Rachel

    2015-06-01

    Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD). The current paper examines evidence for two explanations of this comorbidity. First, that the comorbidity reflects overlapping symptoms in the two disorders. Second, that the co-occurrence of PTSD and MDD is not an artifact, but represents a trauma-related phenotype, possibly a subtype of PTSD. Support for the latter explanation is inferred from literature that examines risk and biological correlates of PTSD and MDD, including molecular processes. Treatment implications of the comorbidity are considered.

  16. Comorbid Diabetes and Depression in African Americans: Implications for the Health Care Provider.

    PubMed

    Chlebowy, Diane Orr; Coty, Mary-Beth; Fu, Liyan; Hines-Martin, Vicki

    2017-03-09

    Health care providers (HCPs) face many obstacles as they undertake efforts to meet the challenges of caring for African American patients with comorbid diabetes and depression. This review article discusses the incidence of comorbid diabetes and depression in African Americans, cultural factors affecting diabetes self-management, and clinical practice implications for the HCP. The role of patient-centered care, engagement, and best-practice strategies are discussed to provide the HCP with guidelines regarding the minimal standards that support improved health care outcomes for African Americans with comorbid diabetes and depression.

  17. The Measured Effect Magnitude of Co-Morbidities on Burn injury Mortality

    PubMed Central

    Knowlin, Laquanda; Stanford, Lindsay; Moore, Danier; Cairns, Bruce; Charles, Anthony

    2016-01-01

    Introduction The ability to better prognosticate burn injury outcome is challenging and historically, most center use the Baux or revised Baux score to help prognosticate burn outcome, however, the weighted contribution of comorbidity on burn mortality has traditionally not been accounted for nor adequately studied. We therefore sought to determine the effect of comorbidities, using the Charlson comorbidity index (CCI) on burn mortality. Methods The purpose of this study was to determine the effect of comorbidities on burn injury mortality as determined by the LA50 (lethal TBSA burn at which 50% of the cohort will succumb from the burn injury) in a retrospective analysis of patients admitted to a regional burn center from 2002–2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA (total body surface area), length of hospital stay, and pre-existing comorbidities. Bivariate analysis was performed and logistic regression modeling using significant variables was utilized to estimate odds of death. Results 7640 patients were included in this study. Overall survival rate was 96%. 40% of our burn cohort had at least one comorbidity. There was a linear increase in the likelihood of death with an increase in CCI. The logistic regression model for mortality outcomes identified four statistically significant variables: age, TBSA, inhalational injury and the presence of comorbidities (OR = 1.59 for each 1 point increase in CCI; 95% CI 1.44–1.77). The unadjusted LA50 was 53% for the entire cohort. Partial adjustment multivariate regression controlling for burn mechanism and inhalation injury only, produced a slight reduction in LA50 for the 0–18 and 19–64 age categories to 76% and 48%, respectively, but a significant decrease occurred in the ≥ 65 years age group with a reduced LA50 to 20% (p<0.001). After full adjustment for all significant covariates, including comorbidities, the independent magnitude of

  18. Oxytocin for Male Subjects with Autism Spectrum Disorder and Comorbid Intellectual Disabilities: A Randomized Pilot Study

    PubMed Central

    Munesue, Toshio; Nakamura, Hiroyuki; Kikuchi, Mitsuru; Miura, Yui; Takeuchi, Noriyuki; Anme, Tokie; Nanba, Eiji; Adachi, Kaori; Tsubouchi, Kiyotaka; Sai, Yoshimichi; Miyamoto, Ken-ichi; Horike, Shin-ichi; Yokoyama, Shigeru; Nakatani, Hideo; Niida, Yo; Kosaka, Hirotaka; Minabe, Yoshio; Higashida, Haruhiro

    2016-01-01

    Approximately half of autism spectrum disorder (ASD) individuals suffer from comorbid intellectual disabilities (IDs). Oxytocin (OXT) receptors are highly expressed in temporal lobe structures and are likely to play a modulatory role in excitatory/inhibitory balance, at least based on animal model findings. Thus, it is feasible that in the highly representative group of Kanner-type ASD subjects, OXT could have a beneficial effect on social communication and social interaction. The aim of this pilot study is to investigate the feasibility and adverse events, such as epilepsy, of the long-term administration of intranasal OXT for adolescent and adult ASD subjects with ID because such patients frequently have seizures. We also addressed the question on how to scale the OXT effects to the core symptoms of social deficits because of the relative difficulty in obtaining objective measurements. Twenty-nine males (aged 15–40 years old) participated in a randomized, double-blind, and placebo-controlled crossover study (each for 8 weeks) with OXT (16 IU/day). Except for seizures experienced by one participant, other serious adverse events did not occur. The primary and secondary outcomes measured using the Childhood Autism Rating Scale and several standard scales, respectively, revealed no difference between the OXT and placebo groups. Instead, in an exploratory analysis, the social interactions observed in the play sessions or in daily life were significantly more frequent in the initial half period in the OXT-first arm of the crossover trial. There were also significant correlations between the plasma OXT concentration and subscale scores for irritability on the Aberrant Behavior Checklist. In conclusion, this pilot study demonstrates that long-term administration of intranasal OXT is tolerable in a representative cohort of ASD individuals with ID and suggests that future multicenter trials of OXT are warranted and should include measurements of reciprocal social

  19. Asperger syndrome in India: findings from a case-series with respect to clinical profile and comorbidity.

    PubMed

    Sreedaran, Priya; Ashok, M V

    2015-01-01

    Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders.

  20. Asperger Syndrome in India: Findings from a Case-Series with Respect to Clinical Profile and Comorbidity

    PubMed Central

    Sreedaran, Priya; Ashok, M. V.

    2015-01-01

    Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders. PMID:25969609

  1. Norepinephrine Regulates Condylar Bone Loss via Comorbid Factors.

    PubMed

    Jiao, K; Niu, L; Xu, X; Liu, Y; Li, X; Tay, F R; Wang, M

    2015-06-01

    Degenerative changes of condylar subchondral bone occur frequently in temporomandibular disorders. Although psychologic stresses and occlusal abnormalities have been implicated in temporomandibular disorder, it is not known if these risks represent synergistic comorbid factors that are involved in condylar subchondral bone degradation that is regulated by the sympathetic nervous system. In the present study, chronic immobilization stress (CIS), chemical sympathectomy, and unilateral anterior crossbite (UAC) were sequentially applied in a murine model. Norepinephrine contents in the subjects' serum and condylar subchondral bone were detected by ELISA; bone and cartilage remodeling parameters and related gene expression in the subchondral bone were examined. Subchondral bone loss and increased subchondral bone norepinephrine level were observed in the CIS and UAC groups. These groups exhibited decreased bone mineral density, volume fraction, and bone formation rate; decreased expressions of osterix, collagen I, and osteocalcin; but increased trabecular separation, osteoclast number and surface, and RANKL expression. Combined CIS + UAC produced more severe subchondral bone loss, higher bone norepinephrine level, and decreased chondrocyte density and cartilage thickness when compared to CIS or UAC alone. Sympathectomy simultaneously prevented subchondral bone loss and decreased bone norepinephrine level in all experimental subgroups when compared to the vehicle-treated counterparts. Norepinephrine also decreased mRNA expression of osterix, collagen I, and osteocalcin by mesenchymal stem cells at 7 and 14 d of stimulation and increased the expression of RANKL and RANKL/OPG ratio by mesenchymal stem cells at 2 h. In conclusion, CIS and UAC synergistically promote condylar subchondral bone loss and cartilage degradation; such processes are partially regulated by norepinephrine within subchondral bone.

  2. Frequency of obesity and comorbidities in medical students

    PubMed Central

    Mehmood, Yasir; Al-Swailmi, Farhan Khashim; Al-Enazi, Shehab Ahmed

    2016-01-01

    Objectives: To determine the frequency of obesity disorders and their co-morbidities in medical students. Methods: This cross-sectional study was conducted in Faculty of Medicine, Northern Border University, Ar’ar, Saudi Arabia. All medical students who consented to participate were included in the study. Their relevant information was recorded on a structured proforma. Weight and height of the participants were measured using calibrated manual weighing scale and Body mass index (BMI) was calculated. The obtained results were interpreted according to classification of body weight disorders. The participants who turned out to be over-weight and obese were further assessed for hypertension, diabetes mellitus and gallstones. The collected data was analyzed using the Statistical Package for Social Science (SPSS) version 20. Results: A total of 405 students participated in study, age range was 19-25 years. Male were 169 (41.7%) and female students were 236(58.3%). Family history of obesity was present in 34.3%. Out of 405 students, 126 were having BMI between 25 and 45.6, among them 34(8.4%) students were obese and 88 (21.7%) were overweight. Sixty two (15.3%) among them were male and 64 (15.8%) female. Fourteen (11.1%) were hypertensive and 9(7.1%) were having gall stones. Conclusion: The frequency of obesity among medical students was 8.4%. Increasing frequency of obesity associated with unhealthy life style needs to be controlled at national level to raise a healthy generation and to reduce burden on health economy. PMID:28083058

  3. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention.

    PubMed

    Rankin, Jean; Matthews, Lynsay; Cobley, Stephen; Han, Ahreum; Sanders, Ross; Wiltshire, Huw D; Baker, Julien S

    2016-01-01

    Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is

  4. The Family of Sensorimotor Gating Disorders: Comorbidities or Diagnostic Overlaps?

    PubMed Central

    GEYER, MARK A.

    2009-01-01

    Prepulse inhibition (PPI) of startle is an operational measure of the pre-attentive filtering process known as sensorimotor gating. Originally identified in patients with schizophrenia, PPI deficits have been observed in multiple but not all psychiatric disorders. Thus, as with most signs and symptoms of psychiatric disorders, deficits in PPI cut across diagnostic categories. It remains unclear whether the diversity of disorders exhibiting deficient PPI bespeaks diagnostic overlaps or comorbidities. Given the recent focus on treatments for cognitive deficits of schizophrenia independently of treating psychosis, the relationship of PPI deficits to cognitive deficits becomes of interest. Although PPI cannot be considered to be a cognitive process per se, abnormalities in pre-attentive information processing may be predictive of or lead to complex cognitive deficits. Animal models of PPI deficits produced by dopamine agonists reliably predict existing antipsychotics. Nevertheless, since neither PPI nor cognitive deficits in schizophrenia are ameliorated by standard antipsychotics, current research is exploring the predictive value of non-dopaminergic PPI models in identifying treatments for gating disturbances independently of their relevance to specific disorders. Both PPI and cognitive deficits in schizophrenia patients are not reversed by first generation antipsychotics but may be attenuated by clozapine. Similarly, effects of glutamate antagonists on symptoms in patients and PPI in animals appear to be reduced by clozapine. Hence, treatment-induced reversals of deficits in PPI produced by glutamate antagonists may provide animal, and human, models to aid in the discovery of treatments of cognitive deficits in patients already treated with existing antipsychotics. PMID:17197371

  5. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention

    PubMed Central

    Rankin, Jean; Matthews, Lynsay; Cobley, Stephen; Han, Ahreum; Sanders, Ross; Wiltshire, Huw D; Baker, Julien S

    2016-01-01

    Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is

  6. [Neuro-psychiatric comorbidity among children and adolescents who suffer from epilepsy].

    PubMed

    Doron, Yariv; Epstein, Orna; Heyman, Eli; Lahat, Eli

    2013-01-01

    Epilepsy is quite a common disorder in the child and adolescent population, and it has been studied for many years. Recently, a better understanding has been achieved regarding the comorbidities in epilepsy, including: major depression, anxiety, learning disabilities, etc.. The comorbidities are extensive and affect many aspects in the life of the patient, and his family members, including: psychological development, learning abilities, independence, etc.. Several mechanisms take part in these comorbidities, starting in the cell and ending with a broadened psychological effect. A better understanding of these mechanisms may assist the physicians in diagnosing their patients and tailoring a wide-approach treatment plan, thereby improving the patient's clinical status and his quality of life (and that of his family). The objective of this article is to describe some of the common comorbidities that are present in epilepsy, and outline the multi-disciplinary approach in treating the epileptic child and his/her family.

  7. A Prospective Study of Psychiatric Comorbidity and Recidivism Among Repeat DUI Offenders.

    PubMed

    Nelson, Sarah E; Belkin, Katerina; LaPlante, Debi A; Bosworth, Leslie; Shaffer, Howard J

    2015-04-13

    Psychiatric comorbidity has emerged as a key element distinguishing DUI offenders from others, and, in some cases, distinguishing repeat offenders from first-time offenders. This paper utilizes a prospective design to determine whether the comorbid disorders identified among repeat DUI offenders can predict recidivism. Seven hundred forty-three repeat DUI offenders were recruited from a two-week inpatient treatment program at which they received a standardized mental health assessment and followed across five years post-treatment to track DUI offense, motor vehicle-related offenses, and general criminal offenses. Psychiatric comorbidity, though it did not predict DUI recidivism specifically, predicted criminal re-offense more generally. In addition, there was a specific relationship between lifetime attention deficit disorder and repeated motor vehicle-related offenses. These findings suggest that for many repeat offenders, DUI is one outlet in a constellation of criminal behavior, and that psychiatric comorbidity increases vulnerability for criminal re-offense.

  8. Lifetime Prevalence, Age of Risk, and Etiology of Comorbid Psychiatric Disorders in Tourette Syndrome

    PubMed Central

    Hirschtritt, Matthew E.; Lee, Paul C.; Pauls, David L.; Dion, Yves; Grados, Marco A.; Illmann, Cornelia; King, Robert A.; Sandor, Paul; McMahon, William M.; Lyon, Gholson J.; Cath, Danielle C.; Kurlan, Roger; Robertson, Mary M.; Osiecki, Lisa; Scharf, Jeremiah M.; Mathews, Carol A.

    2015-01-01

    Importance Tourette syndrome (TS) is characterized by high rates of psychiatric comorbidity; however, few studies have fully characterized these comorbidities. Furthermore, most studies have included relatively few participants (<200), and none has examined the ages of highest risk for each TS-associated comorbidity or their etiologic relationship to TS. Objective To characterize the lifetime prevalence, clinical associations, ages of highest risk, and etiology of psychiatric comorbidity among individuals with TS. Design, Setting, and Participants Cross-sectional structured diagnostic interviews conducted between April 1, 1992, and December 31, 2008, of participants with TS (n = 1374) and TS-unaffected family members (n = 1142). Main Outcomes and Measures Lifetime prevalence of comorbid DSM-IV-TR disorders, their heritabilities, ages of maximal risk, and associations with symptom severity, age at onset, and parental psychiatric history. Results The lifetime prevalence of any psychiatric comorbidity among individuals with TS was 85.7%; 57.7% of the population had 2 or more psychiatric disorders. The mean (SD) number of lifetime comorbid diagnoses was 2.1 (1.6); the mean number was 0.9 (1.3) when obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) were excluded, and 72.1% of the individuals met the criteria for OCD or ADHD. Other disorders, including mood, anxiety, and disruptive behavior, each occurred in approximately 30% of the participants. The age of greatest risk for the onset of most comorbid psychiatric disorders was between 4 and 10 years, with the exception of eating and substance use disorders, which began in adolescence (interquartile range, 15–19 years for both). Tourette syndrome was associated with increased risk of anxiety (odds ratio [OR], 1.4; 95% CI, 1.0–1.9; P = .04) and decreased risk of substance use disorders (OR, 0.6; 95% CI, 0.3–0.9; P = .02) independent from comorbid OCD and ADHD; however, high rates

  9. Transdiagnostic Treatment of Bipolar Disorder and Comorbid Anxiety with the Unified Protocol: A Clinical Replication Series

    PubMed Central

    Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.

    2013-01-01

    Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. Over 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxiety disorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes. Effectively treating comorbid anxiety in individuals with BD has been recognized as one of the biggest unmet needs in the field of bipolar disorder. Recently, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was developed to be applicable to the full range of anxiety and mood disorders, based upon converging evidence from genetics, cognitive and affective neuroscience, and behavioral research suggesting common, core emotion-related pathology. Here, we present a preliminary evaluation of the efficacy of the UP for the treatment of BD with comorbid anxiety, in a clinical replication series consisting of three cases. PMID:22822175

  10. A Prospective Study of Psychiatric Comorbidity and Recidivism Among Repeat DUI Offenders

    PubMed Central

    Nelson, Sarah E.; Belkin, Katerina; LaPlante, Debi A.; Bosworth, Leslie; Shaffer, Howard J.

    2015-01-01

    Psychiatric comorbidity has emerged as a key element distinguishing DUI offenders from others, and, in some cases, distinguishing repeat offenders from first-time offenders. This paper utilizes a prospective design to determine whether the comorbid disorders identified among repeat DUI offenders can predict recidivism. Seven hundred forty-three repeat DUI offenders were recruited from a two-week inpatient treatment program at which they received a standardized mental health assessment and followed across five years post-treatment to track DUI offense, motor vehicle-related offenses, and general criminal offenses. Psychiatric comorbidity, though it did not predict DUI recidivism specifically, predicted criminal re-offense more generally. In addition, there was a specific relationship between lifetime attention deficit disorder and repeated motor vehicle-related offenses. These findings suggest that for many repeat offenders, DUI is one outlet in a constellation of criminal behavior, and that psychiatric comorbidity increases vulnerability for criminal re-offense. PMID:26539339

  11. Genetic similarity between cancers and comorbid Mendelian diseases identifies candidate driver genes

    PubMed Central

    Melamed, Rachel D.; Emmett, Kevin J.; Madubata, Chioma; Rzhetsky, Andrey; Rabadan, Raul

    2015-01-01

    Despite large-scale cancer genomics studies, key somatic mutations driving cancer, and their functional roles, remain elusive. Here we propose that analysis of comorbidities of Mendelian diseases with cancers provides a novel, systematic way to discover new cancer genes. If germline genetic variation in Mendelian loci predisposes bearers to common cancers, the same loci may harbor cancer-associated somatic variation. Compilations of clinical records spanning over 100 million patients provide an unprecedented opportunity to assess clinical associations between Mendelian diseases and cancers. We systematically compare these comorbidities against recurrent somatic mutations from more than five thousand patients across many cancers. Using multiple measures of genetic similarity, we show that a Mendelian disease and comorbid cancer indeed have genetic alterations of significant functional similarity. This result provides a basis to identify candidate drivers in cancers including melanoma and glioblastoma. Some Mendelian diseases demonstrate “pan-cancer” comorbidity and shared genetics across cancers. PMID:25926297

  12. Difficulties in the diagnosis of heart failure in patients with comorbidities.

    PubMed

    Trullàs, J C; Casado, J; Morales-Rull, J L

    2016-01-01

    Heart failure (HF) patients present frequently comorbidities and the diagnosis of HF in this setting is a challenge. The symptoms and signs of HF may be atypical and can be simulated or disguised by co-morbidities such as respiratory disease and/or obesity. For this reasons, confirmation of the diagnosis always requires further tests. Natriuretic peptides accurately exclude cardiac dysfunction as a cause of symptoms, but the optimal cut-off levels for ruling out and ruling in HF diagnosis are influenced by different co-morbidities. Echocardiography should be performed in all patients to confirm the diagnosis of HF, except in those cases with low clinical probability and a concentration of brain natriuretic peptides below the exclusion cut-off. This review aims to provide a practical clinical approach for the diagnosis of HF in patients with comorbidity, focusing in older patients and patients with chronic obstructive pulmonary disease and/or obesity.

  13. Stress modulation of drug self-administration: implications for addiction comorbidity with post-traumatic stress disorder.

    PubMed

    Logrip, Marian L; Zorrilla, Eric P; Koob, George F

    2012-02-01

    Drug abuse and dependence present significant health burdens for our society, affecting roughly 10% of the population. Stress likely contributes to the development and persistence of drug use; for example, rates of substance dependence are elevated among individuals diagnosed with post-traumatic stress disorder (PTSD). Thus, understanding the interaction between stress and drug use, and associated neuroadaptations, is key for developing therapies to combat substance use disorders. For this purpose, many rodent models of the effects of stress exposure on substance use have been developed; the models can be classified according to three categories of stress exposure: developmental, adult nonsocial, and adult social. The present review addresses preclinical findings on the effect of each type of trauma on responses to and self-administration of drugs of abuse by focusing on a key exemplar for each category. In addition, the potential efficacy of targeting neuropeptide systems that have been implicated in stress responses and stress system neuroadaptation in order to treat comorbid PTSD and substance abuse will be discussed. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

  14. Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia.

    PubMed

    Nguyen, Ruby H N; Ecklund, Ali M; Maclehose, Richard F; Veasley, Christin; Harlow, Bernard L

    2012-01-01

    Many women with vulvodynia also suffer from other chronic co-morbid pain conditions. Alone, these pain conditions are associated with feeling invalidated by others and feeling socially isolated. It is unclear, however, how the presence of additional pain co-morbidities are associated with the psychosocial wellbeing of women with vulvodynia. We used data from a survey administered by the National Vulvodynia Association. Women reported clinician-diagnosed vulvodynia, presence of co-morbid pain, and how often they felt that they felt no one believed their pain existed (invalidated) and isolated. Analyses determined prevalence of feeling invalidated or isolated, and the difference in prevalence when co-morbidities existed. Forty-five percent of these 1847 women with vulvodynia reported having at least one of the following five chronic pain conditions, chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, or irritable bowel syndrome. Adjusted baseline prevalence among all women of feeling invalidated was 9% and of feeling isolated was 14%. Having a co-morbid condition with vulvodynia, as well as having an increasing number of co-morbid conditions with vulvodynia, was significantly associated with the presence of feeling both invalidated and isolated. Chronic fatigue syndrome was the co-morbidity most strongly associated with feelings invalidation and isolation. One or more co-morbid pain conditions in addition to vulvodynia were significantly associated with psychosocial wellbeing. However, the temporality of the association could not be elucidated and therefore we cannot conclude that these pain conditions cause poor psychosocial wellbeing. Despite this, future studies should explore the utility of promoting validation of women's pain conditions and reducing social isolation for women with chronic pain.

  15. Comorbid Analysis of Genes Associated with Autism Spectrum Disorders Reveals Differential Evolutionary Constraints

    PubMed Central

    David, Maude M.; Enard, David; Ozturk, Alp; Daniels, Jena; Jung, Jae-Yoon; Diaz-Beltran, Leticia; Wall, Dennis. P.

    2016-01-01

    The burden of comorbidity in Autism Spectrum Disorder (ASD) is substantial. The symptoms of autism overlap with many other human conditions, reflecting common molecular pathologies suggesting that cross-disorder analysis will help prioritize autism gene candidates. Genes in the intersection between autism and related conditions may represent nonspecific indicators of dysregulation while genes unique to autism may play a more causal role. Thorough literature review allowed us to extract 125 ICD-9 codes comorbid to ASD that we mapped to 30 specific human disorders. In the present work, we performed an automated extraction of genes associated with ASD and its comorbid disorders, and found 1031 genes involved in ASD, among which 262 are involved in ASD only, with the remaining 779 involved in ASD and at least one comorbid disorder. A pathway analysis revealed 13 pathways not involved in any other comorbid disorders and therefore unique to ASD, all associated with basal cellular functions. These pathways differ from the pathways associated with both ASD and its comorbid conditions, with the latter being more specific to neural function. To determine whether the sequence of these genes have been subjected to differential evolutionary constraints, we studied long term constraints by looking into Genomic Evolutionary Rate Profiling, and showed that genes involved in several comorbid disorders seem to have undergone more purifying selection than the genes involved in ASD only. This result was corroborated by a higher dN/dS ratio for genes unique to ASD as compare to those that are shared between ASD and its comorbid disorders. Short-term evolutionary constraints showed the same trend as the pN/pS ratio indicates that genes unique to ASD were under significantly less evolutionary constraint than the genes associated with all other disorders. PMID:27414027

  16. Identifying comorbid depression and disruptive behavior disorders: Comparison of two approaches used in adolescent studies

    PubMed Central

    Stoep, Ann Vander; Adrian, Molly C.; Rhew, Isaac C.; McCauley, Elizabeth; Herting, Jerald R.; Kraemer, Helena C.

    2013-01-01

    Interest in commonly co-occurring depression and disruptive behavior disorders in children has yielded a small body of research that estimates the prevalence of this comorbid condition and compares children with the comorbid condition and children with depression or disruptive behavior disorders alone with respect to antecedents and outcomes. Prior studies have used one of two different approaches to measure comorbid disorders: 1) meeting criteria for two DSM or ICD diagnoses or 2) scoring .5 SD above the mean or higher on two dimensional scales. This study compares two snapshots of comorbidity taken simultaneously in the same sample with each of the measurement approaches. The Developmental Pathways Project administered structured diagnostic interviews as well as dimensional scales to a community-based sample of 521 11-12 year olds to assess depression and disruptive behavior disorders. Clinical caseness indicators of children identified as “comorbid” by each method were examined concurrently and 3-years later. Cross-classification of adolescents via the two approaches revealed low agreement. When other indicators of caseness, including functional impairment, need for services, and clinical elevations on other symptom scales were examined, adolescents identified as comorbid via dimensional scales only were similar to those who were identified as comorbid via DSM-IV diagnostic criteria. Findings suggest that when relying solely on DSM diagnostic criteria for comorbid depression and disruptive behavior disorders, many adolescents with significant impairment will be overlooked. Findings also suggest that lower dimensional scale thresholds can be set when comorbid conditions, rather than single forms of psychopathology, are being identified. PMID:22575333

  17. [Possible side effects of drugs in elderly patients with chronic obstructive pulmonary disease and comorbidity].

    PubMed

    Malykhin, F T; Baturin, V A

    2016-01-01

    the papers gives data on the positive effects and adverse reactions of drugs used to treat chronic obstructive pulmonary disease (COPD) and its comorbidity, first of all cardiovascular disease. The authors present alternative points of views based on both the data available in the literature and their findings. they propose to modify pharmacotherapy for COPD in the presence of comorbidity in patients of old age groups.

  18. Prazosin for Treatment of Patients with PTSD and Comorbid Alcohol Dependence

    DTIC Science & Technology

    2011-07-01

    08-2-0075 TITLE: Prazosin for Treatment of Patients With PTSD and Comorbid Alcohol Dependence PRINCIPAL INVESTIGATOR: Ismene...page. Subject terms on next page. 6 Prazosin for Treatment of Patients With PTSD and Comorbid Alcohol Dependence Ismene Petrakis Yale University New...PTSD. There is evidence of common neurobiological mechanisms that underlie both AD and PTSD. Prazosin is an alpha-! adrenergic •ceptor antagonist

  19. Simultaneous bilateral hip fractures following a simple fall in an elderly patient without predilecting comorbidities

    PubMed Central

    van der Zeeuw, Frederique T.; Weeda, Víola B.; Vrouenraets, Bart C.

    2016-01-01

    Simultaneous bilateral hip fractures are rare, mostly being caused by violent forces or in patients with bone metabolism disorders. We present the case of an elderly patient who sustained simultaneous bilateral hip fractures following a simple fall without having any known predilecting comorbidities other than advanced age. Only four cases have been described of elderly patients without comorbidity with simultaneous bilateral hip fractures following low-energy traumas. This rare