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Sample records for age-adjusted charlson comorbidity

  1. Predictive value of the age-adjusted charlson comorbidity index on perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer

    PubMed Central

    Suidan, Rudy S.; Leitao, Mario M.; Zivanovic, Oliver; Gardner, Ginger J.; Long Roche, Kara C.; Sonoda, Yukio; Levine, Douglas A.; Jewell, Elizabeth L.; Brown, Carol L.; Abu-Rustum, Nadeem R.; Charlson, Mary E.; Chi, Dennis S.

    2016-01-01

    Objective To assess the ability of the Age-Adjusted Charlson Comorbidity index (ACCI) to predict perioperative complications and survival in patients undergoing primary debulking for advanced epithelial ovarian cancer (EOC). Methods Data were analyzed for all patients with stage IIIB-IV EOC who underwent primary cytoreduction from 1/2001–1/2010 at our institution. Patients were divided into 3 groups based on an ACCI of 0–1, 2–3, and ≥4. Clinical and survival outcomes were assessed and compared. Results We identified 567 patients; 199 (35%) had an ACCI of 0–1, 271 (48%) had an ACCI of 2–3, and 97 (17%) had an ACCI of ≥4. The ACCI was significantly associated with the rate of complete gross resection (0–1=44%, 2–3=32%, and ≥4=32%; p=0.02), but was not associated with the rate of minor (47% vs 47% vs 43%, p=0.84) or major (18% vs 19% vs 16%, p=0.8) complications. The ACCI was also significantly associated with progression-free (PFS) and overall survival (OS). Median PFS for patients with an ACCI of 0–1, 2–3, and ≥4 was 20.3, 16, and 15.4 months, respectively (p=0.02). Median OS for patients with an ACCI of 0–1, 2–3, and ≥4 was 65.3, 49.9, and 42.3 months, respectively (p<0.001). On multivariate analysis, the ACCI remained a significant prognostic factor for both PFS (p=0.02) and OS (p<0.001). Conclusions The ACCI was not associated with perioperative complications in patients undergoing primary cytoreduction for advanced EOC, but was a significant predictor of PFS and OS. Prospective clinical trials in ovarian cancer should consider stratifying for an age-comorbidity covariate. PMID:26037900

  2. The Charlson Comorbidity Index Can Be Used Prospectively to Identify Patients Who Will Incur High Future Costs

    PubMed Central

    Charlson, Mary; Wells, Martin T.; Ullman, Ralph; King, Fionnuala; Shmukler, Celia

    2014-01-01

    Background Reducing health care costs requires the ability to identify patients most likely to incur high costs. Our objective was to evaluate the ability of the Charlson comorbidity score to predict the individuals who would incur high costs in the subsequent year and to contrast its predictive ability with other commonly used predictors. Methods We contrasted the prior year Charlson comorbidity index, costs, Diagnostic Cost Group (DCG) and hospitalization as predictors of subsequent year costs from claims data of fund that provides comprehensive health benefits to a large union of health care workers. Total costs in the subsequent year was the principal outcome. Results Of the 181,764 predominantly Black and Latino beneficiaries, 70% were adults (mean age 45.7 years; 62% women). As the comorbidity index increased, total yearly costs increased significantly (P<.001). At lower comorbidity, the costs were similar across different chronic diseases. Using regression to predict total costs, top 5th and 10th percentile of costs, the comorbidity index, prior costs and DCG achieved almost identical explained variance in both adults and children. Conclusions and Relevance The comorbidity index predicted health costs in the subsequent year, performing as well as prior cost and DCG in identifying those in the top 5% or 10%. The comorbidity index can be used prospectively to identify patients who are likely to incur high costs. Trial Registration ClinicalTrials.gov NCT01761253 PMID:25469987

  3. Use of the Charlson Combined Comorbidity Index To Predict Postradiotherapy Quality of Life for Prostate Cancer Patients

    SciTech Connect

    Wahlgren, Thomas; Levitt, Seymour; Kowalski, Jan; Nilsson, Sten; Brandberg, Yvonne

    2011-11-15

    Purpose: To determine the impact of pretreatment comorbidity on late health-related quality of life (HRQoL) scores after patients have undergone combined radiotherapy for prostate cancer, including high-dose rate brachytherapy boost and hormonal deprivation therapy. Methods and Materials: Results from the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire survey of 158 patients 5 years or more after completion of therapy were used from consecutively accrued subjects treated with curative radiotherapy at our institution, with no signs of disease at the time of questionnaire completion. HRQoL scores were compared with the Charlson combined comorbidity index (CCI), using analysis of covariance and multivariate regression models together with pretreatment factors including tumor stage, tumor grade, pretreatment prostate-specific antigen level, neoadjuvant hormonal treatment, diabetes status, cardiovascular status, and age and Charlson score as separate variables or the composite CCI. Results: An inverse correlation between the two HRQoL domains, long-term global health (QL) and physical function (PF) scores, and the CCI score was observed, indicating an impact of comorbidity in these function areas. Selected pretreatment factors poorly explained the variation in functional HRQoL in the multivariate models; however, a statistically significant impact was found for the CCI (with QL and PF scores) and the presence of diabetes (with QL and emotional function). Cognitive function and social function were not statistically significantly predicted by any of the pretreatment factors. Conclusions: The CCI proved to be valid in this context, but it seems useful mainly in predicting long-term QL and PF scores. Of the other variables investigated, diabetes had more impact than cardiovascular morbidity on HRQoL outcomes in prostate cancer.

  4. Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients: a single-cohort perspective study.

    PubMed

    Falsetti, Lorenzo; Viticchi, Giovanna; Tarquinio, Nicola; Silvestrini, Mauro; Capeci, William; Catozzo, Vania; Fioranelli, Agnese; Buratti, Laura; Pellegrini, Francesco

    2016-09-01

    Chronic diseases are increasing worldwide. Association of two or more chronic conditions is related with poor health status and reduced life expectancy, particularly among elderly patients. Comorbidities represent a risk factor for adverse events in several critical illnesses. We aimed to evaluate if elderly patients are affected by multiple chronic pathologies, assessed by Charlson comorbidity index (CCI), showed a reduced in-hospital survival after ischemic stroke. In a 3-year period, we evaluated all the subjects admitted to our internal medicine department for ischemic stroke. Age, sex, NIHSS score and all the comorbidities were recorded. Days of hospitalization, hospital-related infections and in-hospital mortality were also assessed. For each patient, we evaluated CCI, obtaining four classes: group 1 (CCI: 2-3), group 2 (CCI: 4-5), group 3 (CCI: 6-7) and group 4 (CCI: ≥8). Survival was evaluated with Kaplan-Meier and Cox regression analyses. The complete model considered in-hospital death as the main outcome, days of hospitalization as the time variable and CCI as the main predictor, adjusting for NIHSS, sex and nosocomial infections. Patients in CCI group 3 and 4 had an increased risk of in-hospital mortality, independently of NIHSS, sex and nosocomial infections. Elderly patients with multiple comorbidities have higher risk of in-hospital death when affected by ischemic stroke. PMID:27166707

  5. Trends in the age adjusted mortality from acute ST segment elevation myocardial infarction in the United States (1988-2004) based on race, gender, infarct location and comorbidities.

    PubMed

    Movahed, Mohammed-Reza; John, Jooby; Hashemzadeh, Mehrnoosh; Jamal, M Mazen; Hashemzadeh, Mehrtash

    2009-10-15

    Treatment of acute ST-segment elevation myocardial infarction (STEMI) has dramatically changed over the past 2 decades. The goal of this study was to determine trends in the mortality of patients with acute STEMIs in the United States over a 16-year period (1988 to 2004) on the basis of gender, race, infarct location, and co-morbidities. The Nationwide Inpatient Sample database was used to analyze the age-adjusted mortality rates for STEMI from 1988 to 2004 for inpatients age >40. International Classification of Diseases, Ninth Revision, Clinical Modification codes consistent with acute STEMI were used. The Nationwide Inpatient Sample database contained a total of 1,316,216 patients who had diagnoses of acute STEMIs from 1988 to 2004. The mean age of these patients was 66.92 +/- 12.82 years. A total of 163,915 hospital deaths occurred during the study period. From 1988, the age-adjusted mortality rate decreased gradually for all acute STEMIs for the entire study period (in 1988, 406.86 per 100,000, 95% confidence interval 110.25 to 703.49; in 2004, 286.02 per 100,000, 95% confidence interval 45.21 to 526.84). Furthermore, unadjusted mortality decreased from 15% in 1988 to 10% in 2004 (p <0.01). This decrease was similar between the genders, among most ethnicities, and in patients with diabetes and those with congestive heart failure. However, women and African Americans had higher rates of acute STEMI-related mortality compared to men and Caucasians over the years studied. In conclusion, age-adjusted mortality from acute STEMIs has significantly decreased over the past 16 years, with persistent higher mortality rates in women and African Americans the study period. PMID:19801019

  6. Charlson Comorbidity Index Is an Important Prognostic Factor for Long-Term Survival Outcomes in Korean Men with Prostate Cancer after Radical Prostatectomy

    PubMed Central

    Lee, Joo Yong; Lee, Dae Hun; Cho, Nam Hoon; Rha, Koon Ho; Choi, Young Deuk; Hong, Sung Joon; Yang, Seung Choul

    2014-01-01

    Purpose To analyze overall survival (OS), prostate cancer (PCa)-specific survival (PCaSS), and non-PCaSS according to the Charlson Comorbidity Index (CCI) after radical prostatectomy (RP) for PCa. Materials and Methods Data from 336 patients who had RP for PCa between 1992 and 2005 were analyzed. Data included age, preoperative prostate-specific antigen (PSA), prostate volume, clinical stage, and pathologic stage. Pre-existing comorbidities were evaluated by the CCI, and patients were classified into two CCI score categories (0, ≥1). Results The mean age of patients was 64.31±6.12 years. The median PSA value (interquartile range, IQR) was 11.30 (7.35 and 21.02) ng/mL with a median follow-up period (IQR) of 96.0 (85.0 and 121.0) months. The mean CCI was 0.28 (0-4). Five-year OS, PCaSS, and non-PCaSS were 91.7%, 96.3%, and 95.2%, respectively. Ten-year OS, PCaSS, and non-PCaSS were 81.9%, 92.1%, and 88.9%, respectively. The CCI had a significant influence on OS (p=0.022) and non-PCaSS (p=0.008), but not on PCaSS (p=0.681), by log-rank test. In multivariate Cox regression analysis, OS was independently associated with the CCI [hazard ratio (HR)=1.907, p=0.025] and Gleason score (HR=2.656, p<0.001). PCaSS was independently associated with pathologic N stage (HR=2.857, p=0.031), pathologic T stage (HR=3.775, p=0.041), and Gleason score (HR=4.308, p=0.001). Non-PCaSS had a significant association only with the CCI (HR=2.540, p=0.009). Conclusion The CCI was independently associated with both OS and non-PCaSS after RP, but the CCI had no impact on PCaSS. The comorbidities of a patient should be considered before selecting RP as a curative modality for PCa. PMID:24532498

  7. Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study).

    PubMed

    Mamas, Mamas A; Fath-Ordoubadi, Farzin; Danzi, Gian B; Spaepen, Erik; Kwok, Chun Shing; Buchan, Iain; Peek, Niels; de Belder, Mark A; Ludman, Peter F; Paunovic, Dragica; Urban, Philip

    2015-08-01

    Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors. PMID:26037294

  8. Comparison of Elixhauser and Charlson Methods for Predicting Oral Cancer Survival

    PubMed Central

    Chang, Heng-Jui; Chen, Po-Chun; Yang, Ching-Chieh; Su, Yu-Chieh; Lee, Ching-Chih

    2016-01-01

    Abstract Cancer survival correlates not only with the features of primary malignancy but also with the degree of underlying comorbidities. Of the multiple methods used for evaluating the impact of comorbidities on survival, the Charlson and Elixhauser methods are most common. This study compared these 2 comorbidity measures for predicting survival in oral cancer patients. Using the Taiwan National Health Insurance claims data (2008–2011), we acquired data regarding patients’ characteristics, comorbidities, and survival from 3583 oral cancer patients. Comorbidity was classified according to both the Charlson comorbidity and Elixhauser comorbidity based on the International Classification of Diseases, 9th Revision. The Elixhauser comorbidity score and Charlson comorbidity score were also calculated. The prediction of survival was determined using measures of discrimination, including the Akaike information criterion and Harrell C (C-statistic). The mean age of the study cohort was 52 ± 10 years, and 94.9% of the patients were male. The median follow-up time was 30.1 months, and the 3-year overall survival was 61.6%. Elixhauser comorbidity method added higher discrimination, compared with the Charlson comorbidity method (Harrell C, 0.677 vs 0.651). Furthermore, the Elixhauser comorbidity score outperformed the Charlson comorbidity score in continuous variable (Harrell C, 0.654 vs 0.646) and category (Harrell C, 0.658 vs 0.645). The Elixhauser method is a superior comorbidity risk-adjustment model for oral cancer survival prediction. Utilization of the Elixhauser comorbidity method may be encouraged for risk adjustment in oral cancer study. PMID:26886653

  9. Impact of comorbidity on the outcome in men with advanced prostate cancer treated with docetaxel

    PubMed Central

    Zist, Andrej; Amir, Eitan; Ocana, Alberto F.; Seruga, Bostjan

    2015-01-01

    Background Men with metastatic castrate-resistant prostate cancer (mCRPC) may not receive docetaxel in everyday clinical practice due to comorbidities. Here we explore the impact of comorbidity on outcome in men with mCRPC treated with docetaxel in a population-based outcome study. Methods Men with mCRPC treated with docetaxel at the Institute of Oncology Ljubljana between 2005 and 2012 were eligible. Comorbidity was assessed by the age-adjusted Charlson comorbidity index (aa-CCI) and adult comorbidity evaluation (ACE-27) index. Hospital admissions due to the toxicity and deaths during treatment with docetaxel were used as a measure of tolerability. Association between comorbidity and overall survival (OS) was tested using the Cox proportional hazards analysis. Results Two hundred and eight men were treated with docetaxel. No, mild, moderate and severe comorbidity was present in 2%, 32%, 53% and 13% using aa-CCI and in 27%, 35%, 29% and 8% when assessed by ACE-27. A substantial dose reduction of docetaxel occurred more often in men with moderate or severe comorbidity as compared to those with no or mild comorbidity. At all comorbidity levels about one-third of men required hospitalization or died during treatment with docetaxel. In univariate analysis a higher level of comorbidity was not associated with worse OS (aa-CCI HR 0.99; [95% CI 0.87–1.13], p = 0.93; ACE-27: HR 0.96; [95% CI 0.79–1.17], p = 0.69). Conclusions Men with mCRPC, who have comorbidities may benefit from treatment with docetaxel. PMID:26834528

  10. Comorbidity in cirrhosis

    PubMed Central

    Jepsen, Peter

    2014-01-01

    Cirrhosis patients’ comorbidities are their other diseases than cirrhosis. Comorbidities are neither causes nor consequences of cirrhosis, but they can increase mortality and are therefore clinically important. They are also an important source of confounding in epidemiologic studies. Comorbidity scoring systems have been developed as tools to measure the cirrhosis patient’s total burden of comorbidity, and they are useful in the clinic and for epidemiologic studies. The recently developed CirCom score is the only comorbidity scoring system developed specifically for cirrhosis patients, and it may be preferred over the older, generic, and more complex Charlson comorbidity index. Studies of individual comorbid diseases can provide insight into the interactions between cirrhosis and other diseases and thus into the pathophysiology of cirrhosis. This article reviews the literature on comorbidity in cirrhosis. PMID:24966593

  11. Barrier Buster: Kim Charlson--Perkins School for the Blind

    ERIC Educational Resources Information Center

    Library Journal, 2005

    2005-01-01

    Kim Charlson believes everyone should live life to the fullest no matter what their handicaps. Blind since early childhood, she chose librarianship because, as a braille reader and avid user of talking books, she wanted to be "in a decision-making capacity in the library field and influence the direction of library services for people with…

  12. Impact of Age and Comorbidity on Cervical and Breast Cancer Literacy of African Americans, Latina, and Arab women

    PubMed Central

    Talley, Costellia H.; Williams, Karen Patricia

    2015-01-01

    Background Appropriate and timely screening can significantly reduce breast and cervical cancer morbidity and mortality. Racial/ethnic minorities and immigrant populations have lower screening rates and delays in follow-up after abnormal tests. Purpose In this study, we examined the relationship between age, comorbidity, breast and cervical cancer literacy in a sample of African American, Latina, and Arab women (N=371) from Detroit, Michigan. Methods Age-adjusted Charlson Comorbidity Index (ACC) was used characterize the impact of age and comorbidity has on breast and cervical cancer literacy; Breast Cancer Literacy Assessment Tool was used to assess breast cancer literacy; Cervical Cancer Literacy Assessment Tool was used to assess cervical cancer literacy. ANOVA was used to assess the relationship between ACC, breast and cervical cancer screening and group differences. Results There was a statistically significant difference between breast cancer literacy (Breast-CLAT total scores) scores (F(2,367)= 17.31, p= < 0.01). ACC had a greater impact on breast cancer literacy for African American F(2,214) =11, p = <0.01. PMID:26333609

  13. Age-adjusted Labor Force Participation Rates, 1960-2045.

    ERIC Educational Resources Information Center

    Szafran, Robert F.

    2002-01-01

    A proposed new age-adjusted measure for calculating labor force participation rate eliminates the effect of changes in the age distribution. According to the new criterion, increases in women's labor force participation from 1960-2000 would have been even greater of shifts in the age distribution had not occurred. (Contains 12 references.) (JOW)

  14. The effect of comorbidity on the use of adjuvant chemotherapy and type of regimen for curatively resected stage III colon cancer patients.

    PubMed

    Hsieh, Mei-Chin; Thompson, Trevor; Wu, Xiao-Cheng; Styles, Timothy; O'Flarity, Mary B; Morris, Cyllene R; Chen, Vivien W

    2016-05-01

    Postsurgical chemotherapy is guideline-recommended therapy for stage III colon cancer patients. Factors associated with patients not receiving adjuvant chemotherapy were identified in numerous studies; comorbidity was recognized as an important factor besides patient's age. We assessed the association between comorbidity and the use of adjuvant chemotherapy and type of chemotherapy regimen. Stage III colon cancer patients who underwent surgical resection were obtained from ten Centers for Disease Control and Prevention (CDC)-NPCR Specialized Registries which participated in the Comparative Effectiveness Research (CER) project. Comorbidity was classified into no comorbidity recorded, Charlson, non-Charlson comorbidities, number, and severity of Charlson comorbidity. Pearson chi-square test and multivariable logistic regression were employed. Of 3180 resected stage III colon cancer patients, 64% received adjuvant chemotherapy. After adjusting for patient's demographic and tumor characteristics, there were no significant differences in receipt of chemotherapy between Charlson and non-Charlson comorbidity. However, patients who had two or more Charlson comorbidities or had moderate to severe disease were significantly less likely to have chemotherapy (ORs 0.69 [95% CI, 0.51-0.92] and 0.62 [95% CI, 0.42-0.91], respectively) when compared with those with non-Charlson comorbidity. In addition, those with moderate or severe comorbidities were more likely to receive single chemotherapy agent (P < 0.0001). Capecitabine and FOLFOX were the most common single- and multi-agent regimens regardless of type of comorbidity grouping. Both the number and severity of comorbidity were significantly associated with receipt of guideline-recommended chemotherapy and type of agent in stage III resected colon cancer patients. Better personalized care based on individual patient's condition ought to be recognized. PMID:26773804

  15. Comorbidity in chronic obstructive pulmonary disease. Related to disease severity?

    PubMed Central

    Echave-Sustaeta, Jose M; Comeche Casanova, Lorena; Cosio, Borja G; Soler-Cataluña, Juan Jose; Garcia-Lujan, Ricardo; Ribera, Xavier

    2014-01-01

    Background and objective Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients. Patients and methods In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated. Results Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage. Conclusion COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity. PMID:25429213

  16. Impact of acquired comorbidities on all-cause mortality rates among older breast cancer survivors

    PubMed Central

    Ahern, Thomas P.; Lash, Timothy L.; Thwin, Soe Soe; Silliman, Rebecca A.

    2010-01-01

    Background Breast cancer survivors with higher numbers of comorbidities at the time of primary treatment suffer higher rates of all-cause mortality than comparatively healthier survivors. The effect of time-varying comorbidity status on mortality in breast cancer survivors, however, has not been well investigated. Objective We examined longitudinal comorbidity in a cohort of women treated for primary breast cancer to determine whether accounting for comorbidities acquired after baseline assessment influenced the hazard ratio of all-cause mortality compared with an analysis using only baseline comorbidity. Methods Cox proportional hazards adjusted for age, race/ethnicity, and exercise habits were modeled using (1) only a baseline Charlson index; (2) four Charlson index values collected longitudinally and entered as time-varying covariates, with missing values addressed by carrying forward the prior observation; and (3) the four longitudinal Charlson scores entered as time-varying covariates, with missing values multiply imputed. Results The three modeling strategies yielded similar results; Model 1 HR: 1.4 per unit increase in Charlson index, 95% CI: 1.2, 1.7; Model 2 HR: 1.3, 95% CI: 1.1, 1.5 and Model 3 HR: 1.4, 95% CI: 1.2, 1.6. Conclusions Our findings indicate that a unit increase in the Charlson comorbidity index raises the hazard rate for all-cause mortality by approximately 1.4-fold in older women treated for primary breast cancer. The conclusion is essentially the same whether accounting only for baseline comorbidity or accounting for acquired comorbidity over a median follow-up period of 85 months. PMID:19106734

  17. New Morbidity and Comorbidity Scores based on the Structure of the ICD-10.

    PubMed

    Stausberg, Jürgen; Hagn, Stefan

    2015-01-01

    Measures of morbidity and comorbidity are frequently used for the control of confounding, particularly in health services research. Several proposals for those measures are defined with ICD-coded diagnoses available in hospital routine data. However, a measure that makes use of the ICD structure is missing. Objective of this work was to elaborate the power of the ICD structure for defining morbidity and comorbidity measures. Routine data from three German hospitals with inpatients discharged 2008 were used for model development; routine data from 36 German hospitals with inpatients admitted and discharged 2010 were used for model evaluation. Two different risk models were developed, one based on ICD-10 chapters, the other based on ICD-10 groups. The models were transformed into sum scores using whole-number weights. Models and scores were compared with the Charlson Index and the Elixhauser Comorbidities using the receiver operating characteristic. Dependent variable was hospital death. Logistic regression was used to derive the new models. Charlson Index and Elixhauser Comorbidities were mapped to the German ICD-10. According to the receiver operating characteristic, the quality of the measures based on the structure of the ICD-10 was superior compared with the Charlson Index and the Elixhauser Comorbidities. The best result was achieved with the measure based on ICD-10-groups with an area under curve of 0.910 (95% confidence interval = 0.907-0.913). The sum scores showed a comparable performance. The developed new measures may be used to control for confounding. PMID:26656501

  18. New Morbidity and Comorbidity Scores based on the Structure of the ICD-10

    PubMed Central

    Stausberg, Jürgen; Hagn, Stefan

    2015-01-01

    Measures of morbidity and comorbidity are frequently used for the control of confounding, particularly in health services research. Several proposals for those measures are defined with ICD-coded diagnoses available in hospital routine data. However, a measure that makes use of the ICD structure is missing. Objective of this work was to elaborate the power of the ICD structure for defining morbidity and comorbidity measures. Routine data from three German hospitals with inpatients discharged 2008 were used for model development; routine data from 36 German hospitals with inpatients admitted and discharged 2010 were used for model evaluation. Two different risk models were developed, one based on ICD-10 chapters, the other based on ICD-10 groups. The models were transformed into sum scores using whole-number weights. Models and scores were compared with the Charlson Index and the Elixhauser Comorbidities using the receiver operating characteristic. Dependent variable was hospital death. Logistic regression was used to derive the new models. Charlson Index and Elixhauser Comorbidities were mapped to the German ICD-10. According to the receiver operating characteristic, the quality of the measures based on the structure of the ICD-10 was superior compared with the Charlson Index and the Elixhauser Comorbidities. The best result was achieved with the measure based on ICD-10-groups with an area under curve of 0.910 (95% confidence interval = 0.907–0.913). The sum scores showed a comparable performance. The developed new measures may be used to control for confounding. PMID:26656501

  19. Age-Adjustment and Related Epidemiology Rates in Education and Research

    ERIC Educational Resources Information Center

    Baker, John D.; Kruckman, Laurence; George, Joyce

    2006-01-01

    A quick review of introductory textbooks reveals that while gerontology authors and instructors introduce some aspect of demography and epidemiology data, there is limited focus on age adjustment or other important epidemiology rates. The goal of this paper is to reintroduce a variety of basic epidemiology strategies such as incidence, prevalence,…

  20. Age-adjustment and related epidemiology rates in education and research.

    PubMed

    Baker, John D; Kruckman, Laurence; George, Joyce

    2006-01-01

    A quick review of introductory textbooks reveals that while gerontology authors and instructors introduce some aspect of demography and epidemiology data, there is limited focus on age adjustment or other important epidemiology rates. The goal of this paper is to reintroduce a variety of basic epidemiology strategies such as incidence, prevalence, crude, age-specific and age-adjustment rates into the gerontology classroom. Background information and formulas for each rate, as well as examples of how they can be applied are provided. A recent change, encouraged by the U.S. Department of Health and Human Services, from a 1940 to a 2000 "standard million population" for ageadjusted rates, is reviewed. Finally, a teaching module with answers is provided for use in the gerontology classroom. PMID:16873207

  1. Comorbidities and Quality of Life among Breast Cancer Survivors: A Prospective Study

    PubMed Central

    Fu, Mei R.; Axelrod, Deborah; Guth, Amber A.; Cleland, Charles M.; Ryan, Caitlin E.; Weaver, Kristen R.; Qiu, Jeanna M.; Kleinman, Robin; Scagliola, Joan; Palamar, Joseph J.; Melkus, Gail D’Eramo

    2015-01-01

    Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis. The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors’ quality of life. A prospective design was used to recruit 140 women before cancer surgery, 134 women completed the study. Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index (CCI) before and 12-month after cancer surgery. Quality of life was evaluated using Short-Form Health Survey (SF-36 v2). Descriptive statistics, chi-square tests, t-tests, Fisher’s exact test, and correlations were performed for data analysis. A total of 28 comorbidities were identified. Among the 134 patients, 73.8% had at least one of the comorbidities, 54.7% had 2–4, and only 7.4% had 5–8. Comorbidities did not change at 12 months after surgery. Numbers of comorbidities by patients’ self-report and weighted categorization of comorbidities by CCI had a similar negative correlation with overall quality of life scores as well as domains of general health, physical functioning, bodily pain, and vitality. Comorbidities, specifically hypertension, arthritis, and diabetes, were associated with poorer quality of life in multiple domains among breast cancer survivors. Future research should consider the combined influence of comorbidity and cancer on patients’ quality of life. PMID:26132751

  2. Comorbidities Affect Risk of Nonvariceal Upper Gastrointestinal Bleeding

    PubMed Central

    Crooks, Colin John; West, Joe; Card, Timothy Richard

    2013-01-01

    Background & Aims The incidence of upper gastrointestinal bleeding (GIB) has not been reduced despite the decreasing incidence of peptic ulcers, strategies to eradicate Helicobacter pylori infection, and prophylaxis against ulceration from nonsteroidal anti-inflammatory drugs. Other factors might therefore be involved in the pathogenesis of GIB. Patients with GIB have increasing nongastrointestinal comorbidity, so we investigated whether comorbidity itself increased the risk of GIB. Methods We conducted a matched case-control study using linked primary and secondary care data collected in England from April 1, 1997 through August 31, 2010. Patients older than 15 years with nonvariceal GIB (n = 16,355) were matched to 5 controls by age, sex, year, and practice (n = 81,636). All available risk factors for GIB were extracted and modeled using conditional logistic regression. Adjusted associations with nongastrointestinal comorbidity, defined using the Charlson Index, were then tested and sequential population attributable fractions calculated. Results Comorbidity had a strong graded association with GIB; the adjusted odds ratio for a single comorbidity was 1.43 (95% confidence interval [CI]: 1.35–1.52) and for multiple or severe comorbidity was 2.26 (95% CI: 2.14%–2.38%). The additional population attributable fraction for comorbidity (19.8%; 95% CI: 18.4%–21.2%) was considerably larger than that for any other measured risk factor, including aspirin or nonsteroidal anti-inflammatory drug use (3.0% and 3.1%, respectively). Conclusions Nongastrointestinal comorbidity is an independent risk factor for GIB, and contributes to a greater proportion of patients with bleeding in the population than other recognized risk factors. These findings could help in the assessment of potential causes of GIB, and also explain why the incidence of GIB remains high in an aging population. PMID:23470619

  3. Age-adjusted plasma N-terminal pro-brain natriuretic peptide level in Kawasaki disease

    PubMed Central

    Jun, Heul; Ko, Kyung Ok; Lim, Jae Woo; Yoon, Jung Min; Lee, Gyung Min

    2016-01-01

    Purpose Recent reports showed that plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) could be a useful biomarker of intravenous immunoglobulin (IVIG) unresponsiveness and coronary artery lesion (CAL) development in Kawasaki disease (KD). The levels of these peptides are critically influenced by age; hence, the normal range and upper limits for infants and children are different. We performed an age-adjusted analysis of plasma NT-proBNP level to validate its clinical use in the diagnosis of KD. Methods The data of 131 patients with KD were retrospectively analyzed. The patients were divided into 2 groups—group I (high NT-proBNP group) and group II (normal NT-proBNP group)—comprising patients with NT-proBNP concentrations higher and lower than the 95th percentile of the reference value, respectively. We compared the laboratory data, responsiveness to IVIG, and the risk of CAL in both groups. Results Group I showed significantly higher white blood cell count, absolute neutrophil count, C-reactive protein level, aspartate aminotransferase level, and troponin-I level than group II (P<0.05). The risk of CAL was also significantly higher in group I (odds ratio, 5.78; P=0.012). IVIG unresponsiveness in group I was three times that in group II (odds ratio, 3.35; P= 0.005). Conclusion Age-adjusted analysis of plasma NT-proBNP level could be helpful in predicting IVIG unresponsiveness and risk of CAL development in patients with KD. PMID:27588030

  4. Influence of Comorbid Conditions on One-Year Outcomes in Non–ST-Segment Elevation Acute Coronary Syndrome

    PubMed Central

    Sanchis, Juan; Núñez, Julio; Bodí, Vicente; Núñez, Eduardo; García-Alvarez, Ana; Bonanad, Clara; Regueiro, Ander; Bosch, Xavier; Heras, Magda; Sala, Joan; Bielsa, Oscar; Llácer, Angel

    2011-01-01

    OBJECTIVE: To investigate comorbid conditions with prognostic influence in non–ST-segment elevation acute coronary syndrome (NSTEACS). PATIENTS AND METHODS: The study group consisted of a derivation cohort of 1017 patients (admitted from October 1, 2002, through October 1, 2008) and an external validation cohort of 652 patients (admitted from February 1, 2006, through September 30, 2009). Comorbid conditions, including risk factors and components of the Charlson comorbidity index (ChCI) and coronary artery disease–specific index, were recorded. The main outcome was one-year mortality. RESULTS: During follow-up, 103 patients died. After adjusting for variables associated with NSTEACS characteristics (base model), 5 comorbid conditions predicted mortality: severe or mild renal failure (hazard ratio [HR], 2.9 and HR, 1.6, respectively), dementia (HR, 3.1), peripheral artery disease (HR, 2.0), previous heart failure (HR, 2.6), and previous myocardial infarction (HR, 1.4). A simple comorbidity index (SCI) was developed using these variables, (per point: HR, 1.6; 95% confidence interval, 1.4-1.8; P=.0001). Adding the SCI, Charlson comorbidity index, or coronary artery disease–specific index to the base model resulted in a gain of 6.58%, 5.00%, and 4.04%, respectively, in discriminative ability (P=.001), without significant differences among the 3 indices. In patients with comorbid conditions, the highest risk period was in the first weeks after NSTEACS. The strength of the association between SCI and mortality rate was similar in the external validation cohort (HR, 1.3; 95% confidence interval, 1.1-1.6; P=.001). CONCLUSION: Renal dysfunction, dementia, peripheral artery disease, previous heart failure, and previous myocardial infarction are the comorbid conditions that predict mortality in NSTEACS. A simple index using these variables proved to be as accurate as the more complex comorbidity indices for risk stratification. In-hospital management of patients with

  5. Intertumor linkage of age-adjusted incidence rate in 15 human neoplasias of both sexes.

    PubMed

    Kodama, M; Kodama, T; Murakami, M; Yokochi, T

    2000-01-01

    We report here that the application of the least square method of Gauss to the log-transformed age-adjusted incidence rate changes in time and space, as tested with either the male-female or the female-male tumor pairs for each of 15 tumor entities, has revealed the presence of intertumor linkage that was conditioning the changes of two cancer risk parameters to let them fit to the equilibrium model with close resemblance to the chemical equilibrium model. The dissimilarity of the cancer risk equilibrium model to the chemical equilibrium model--topological dissociation between the equilibrium model of centripetal force (r = -1.000) and that of centrifugal force (r = +1.000)--was discussed in the light of the concept of the oncogene activation-tumor suppressor gene inactivation. The proposed network hypothesis of human neoplasia found supporting evidence in the corresponding changes of the statistical features of human neoplasias with and without sex discrimination of cancer risk. PMID:10836207

  6. Impact of Age and Comorbidity on Non–Small-Cell Lung Cancer Treatment in Older Veterans

    PubMed Central

    Wang, Sunny; Wong, Melisa L.; Hamilton, Nathan; Davoren, J. Ben; Jahan, Thierry M.; Walter, Louise C.

    2012-01-01

    Purpose Because comorbidity affects cancer treatment outcomes, guidelines recommend considering comorbidity when making treatment decisions in older patients with lung cancer. Yet, it is unclear whether treatment is targeted to healthier older adults who might reasonably benefit. Patients and Methods Receipt of first-line guideline-recommended treatment was assessed for 20,511 veterans age ≥ 65 years with non–small-cell lung cancer (NSCLC) in the Veterans Affairs (VA) Central Cancer Registry from 2003 to 2008. Patients were stratified by age (65 to 74, 75 to 84, ≥ 85 years), Charlson comorbidity index score (0, 1 to 3, ≥ 4), and American Joint Committee on Cancer stage (I to II, IIIA to IIIB, IIIB with malignant effusion to IV). Comorbidity and patient characteristics were obtained from VA claims and registry data. Multivariate analysis identified predictors of receipt of guideline-recommended treatment. Results In all, 51% of patients with local, 35% with regional, and 27% with metastatic disease received guideline-recommended treatment. Treatment rates decreased more with advancing age than with worsening comorbidity for all stages, such that older patients with no comorbidity had lower rates than younger patients with severe comorbidity. For example, 50% of patients with local disease age 75 to 84 years with no comorbidity received surgery compared with 57% of patients age 65 to 74 years with severe comorbidity (P < .001). In multivariate analysis, age and histology remained strong negative predictors of treatment for all stages, whereas comorbidity and nonclinical factors had a minor effect. Conclusion Advancing age is a much stronger negative predictor of treatment receipt among older veterans with NSCLC than comorbidity. Individualized decisions that go beyond age and include comorbidity are needed to better target NSCLC treatments to older patients who may reasonably benefit. PMID:22454424

  7. [Comorbidities with COPD].

    PubMed

    Hashimoto, Shu; Gon, Yasuhiro; Mizumura, Kenji

    2016-05-01

    Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disorder and age-related disorder associated with increased prevalence of comorbid diseases such as cardiovascular diseases, and pulmonary complications such as lung cancer. We described here the clinical significance of comorbid diseases with COPD and briefly review the mechanism in the production of comorbid diseases. PMID:27254958

  8. Comorbidity and survival among women with ovarian cancer: evidence from prospective studies.

    PubMed

    Jiao, Yi-Sheng; Gong, Ting-Ting; Wang, Yong-Lai; Wu, Qi-Jun

    2015-01-01

    The relationship between comorbidity and ovarian cancer survival has been controversial so far. Therefore, we conducted a meta-analysis to summarize the existing evidence from prospective studies on this issue. Relevant studies were identified by searching the PubMed, EMBASE, and ISI Web of Science databases through the end of January 2015. Two authors independently performed the eligibility evaluation and data abstraction. Random-effects models were used to estimate summary hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival. Eight prospective studies involving 12,681 ovarian cancer cases were included in the present study. The summarized HR for presence versus absence of comorbidity was 1.20 (95% CI = 1.11-1.30, n = 8), with moderate heterogeneity (I(2) = 31.2%, P = 0.179). In addition, the summarized HR for the highest compared with the lowest category of the Charlson's comorbidity index was 1.68 (95% CI = 1.50-1.87, n = 2), without heterogeneity (I(2) = 0%, P = 0.476). Notably, a significant negative impact of comorbidity on ovarian cancer survival was observed in most subgroup analyses stratified by the study characteristics and whether there was adjustment for potential confounders. In conclusion, the findings of this meta-analysis suggest that underlying comorbidity is consistently associated with decreased survival in patients with ovarian cancer. Comorbidity should be taken into account when managing these patients. PMID:26118971

  9. Managing comorbidities in COPD

    PubMed Central

    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. PMID:25609943

  10. [Comorbidities of COPD].

    PubMed

    Brinchault, G; Diot, P; Dixmier, A; Goupil, F; Guillais, P; Gut-Gobert, C; Leroyer, C; Marchand-Adam, S; Meurice, J-C; Morel, H; Person, C; Cavaillès, A

    2015-12-01

    COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients. PMID:26585876

  11. 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

  12. A flexible data-driven comorbidity feature extraction framework.

    PubMed

    Sideris, Costas; Pourhomayoun, Mohammad; Kalantarian, Haik; Sarrafzadeh, Majid

    2016-06-01

    Disease and symptom diagnostic codes are a valuable resource for classifying and predicting patient outcomes. In this paper, we propose a novel methodology for utilizing disease diagnostic information in a predictive machine learning framework. Our methodology relies on a novel, clustering-based feature extraction framework using disease diagnostic information. To reduce the data dimensionality, we identify disease clusters using co-occurrence statistics. We optimize the number of generated clusters in the training set and then utilize these clusters as features to predict patient severity of condition and patient readmission risk. We build our clustering and feature extraction algorithm using the 2012 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP) which contains 7 million hospital discharge records and ICD-9-CM codes. The proposed framework is tested on Ronald Reagan UCLA Medical Center Electronic Health Records (EHR) from 3041 Congestive Heart Failure (CHF) patients and the UCI 130-US diabetes dataset that includes admissions from 69,980 diabetic patients. We compare our cluster-based feature set with the commonly used comorbidity frameworks including Charlson's index, Elixhauser's comorbidities and their variations. The proposed approach was shown to have significant gains between 10.7-22.1% in predictive accuracy for CHF severity of condition prediction and 4.65-5.75% in diabetes readmission prediction. PMID:27127895

  13. A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms.

    PubMed

    Newman, William C; Neal, Dan W; Hoh, Brian L

    2016-09-01

    OBJECTIVE Comorbidities have an impact on risk stratification for outcomes in analyses of large patient databases. Although the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) are the most commonly used comorbidity indexes, these have not been validated for patients with unruptured cerebral aneurysms; therefore, the authors created a comorbidity index specific to these patients. METHODS The authors extracted all records involving unruptured cerebral aneurysms treated with clipping, coiling, or both from the Nationwide Inpatient Sample (2002-2010). They assessed the effect of 37 variables on poor outcome and used the results to create a risk score for these patients. The authors used a validation data set and bootstrapping to evaluate the new index and compared it to CCI and ECI in prediction of poor outcome, mortality, length of stay, and hospital charges. RESULTS The index assigns integer values (-2 to 7) to 20 comorbidities: neurological disorder, renal insufficiency, gastrointestinal bleeding, paralysis, acute myocardial infarction, electrolyte disorder, weight loss, metastatic cancer, drug abuse, arrhythmia, coagulopathy, cerebrovascular accident, psychosis, alcoholism, perivascular disease, valvular disease, tobacco use, hypothyroidism, depression, and hypercholesterolemia. Values are summed to determine a patient's risk score. The new index was better at predicting poor outcome than CCI or ECI (area under the receiver operating characteristic curve [AUC] 0.814 [95% CI 0.798-0.830], vs 0.694 and 0.712, respectively, for the other indices), and it was also better at predicting mortality (AUC 0.775 [95% CI 0.754-0.792], vs 0.635 and 0.657, respectively, for CCI and ECI). CONCLUSIONS This new comorbidity index outperforms the CCI and ECI in predicting poor outcome, mortality, length of stay, and total charges for patients with unruptured cerebral aneurysm. Reevaluation of other patient cohorts is warranted to determine the impact of

  14. 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

  15. NATIONAL COMORBIDITY SURVEY (NCS)

    EPA Science Inventory

    The National Comorbidity Survey (NCS) was a collaborative epidemiologic investigation designed to study the prevalence and correlates of DSM III-R disorders and patterns and correlates of service utilization for these disorders. The NCS was the first survey to administer a struct...

  16. Psoriasis: new comorbidities.

    PubMed

    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

  17. [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. PMID:27221798

  18. 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,…

  19. Medical Comorbidities in Pediatric Headache.

    PubMed

    Jacobs, Howard; Singhi, Samata; Gladstein, Jack

    2016-02-01

    Comorbid conditions frequently occur in pediatric headaches and may significantly affect their management. Comorbidities that have been associated with pediatric headaches include attention-deficit or hyperactivity disorder, autism, developmental disabilities, depression, anxiety, epilepsy, obesity, infantile colic, atopic disorders, inflammatory bowel disease, and irritable bowel syndrome. The goal of this article is to review these comorbidities associated with pediatric headache, thereby empowering child neurologists to identify common triggers and tailor management strategies that address headache and its comorbidities. PMID:27017024

  20. Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need.

    PubMed

    Diaz, A; Bernardes, C M; Garvey, G; Valery, P C

    2016-03-01

    Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey. PMID:26918689

  1. Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)

    PubMed Central

    Dennison, Elaine M.; Compston, Juliet E.; Flahive, Julie; Siris, Ethel S.; Gehlbach, Stephen H.; Adachi, Jonathan D.; Boonen, Steven; Chapurlat, Roland; Díez-Pérez, Adolfo; Anderson, Frederick A.; Hooven, Frederick H.; LaCroix, Andrea Z.; Lindsay, Robert; Netelenbos, J. Coen; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Saag, Kenneth G.; Sambrook, Philip; Silverman, Stuart; Watts, Nelson B.; Greenspan, Susan L.; Premaor, Melissa; Cooper, Cyrus

    2016-01-01

    Introduction Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. Materials and methods We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. Results Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson’s disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6–3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. Conclusion Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson’s disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction. PMID:22426498

  2. Comparison of measures of comorbidity for predicting disability 12-months post-injury

    PubMed Central

    2013-01-01

    Background Understanding the factors that impact on disability is necessary to inform trauma care and enable adequate risk adjustment for benchmarking and monitoring. A key consideration is how to adjust for pre-existing conditions when assessing injury outcomes, and whether the inclusion of comorbidity is needed in addition to adjustment for age. This study compared different approaches to modelling the impact of comorbidity, collected as part of the routine hospital episode data, on disability outcomes following orthopaedic injury. Methods 12-month Glasgow Outcome Scale – Extended (GOS-E) outcomes for 13,519 survivors to discharge were drawn from the Victorian Orthopaedic Trauma Outcomes Registry, a prospective cohort study of admitted orthopaedic injury patients. ICD-10-AM comorbidity codes were mapped to four comorbidity indices. Cases with a GOS-E score of 7–8 were considered “recovered”. A split dataset approach was used with cases randomly assigned to development or test datasets. Logistic regression models were fitted with “recovery” as the outcome and the performance of the models based on each comorbidity index (adjusted for injury and age) measured using calibration (Hosmer-Lemshow (H-L) statistics and calibration curves) and discrimination (Area under the Receiver Operating Characteristic (AUC)) statistics. Results All comorbidity indices improved model fit over models with age and injuries sustained alone. None of the models demonstrated acceptable model calibration (H-L statistic p < 0.05 for all models). There was little difference between the discrimination of the indices for predicting recovery: Charlson Comorbidity Index (AUC 0.70, 95% CI: 0.68, 0.71); number of ICD-10 chapters represented (AUC 0.70, 95% CI: 0.69, 0.72); number of six frequent chronic conditions represented (AUC 0.70, 95% CI: 0.69, 0.71); and the Functional Comorbidity Index (AUC 0.69, 95% CI: 0.68, 0.71). Conclusions The presence of ICD-10 recorded comorbid

  3. What can ADHD without comorbidity teach us about comorbidity?

    PubMed

    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, gender, IQ, SES and ADHD symptoms were compared among ADHD comorbid free subjects and ADHD with internalizing and externalizing disorders. Logistic regression analyses were also carried out to investigate the relationship between comorbidity and parental psychiatric status. Age range was younger in the ADHD without comorbidity and older in ADHD+internalizing disorders. No significant difference in IQ or SES was found among ADHD comorbid and comorbid-free groups. ADHD with internalizing disorder has a significantly greater association with paternal psychiatric conditions. After matching by age, gender, IQ and SES, ADHD with externalizing disorders had significantly higher total ADHD, hyperactivity/impulsivity score and single item score of difficulty awaiting turn than ADHD without comorbidity and ADHD with internalizing disorders. Older age ranges, ADHD symptom severity and parental psychopathology may be risk factors for comorbidity. PMID:22119689

  4. Changes in Age-Adjusted Mortality Rates and Disparities for Rural Physician Shortage Areas Staffed by the National Health Service Corps: 1984-1998

    ERIC Educational Resources Information Center

    Pathman, Donald E.; Fryer, George E.; Green, Larry A.; Phillips, Robert L.

    2005-01-01

    Objective: This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality. Methods: In a descriptive study using a pre-post design with comparison groups, the…

  5. Changes in Age-Adjusted Mortality Rates and Disparities for Rural Physician Shortage Areas Staffed by the National Health Service Corps: 1984-1998

    ERIC Educational Resources Information Center

    Pathman, Donald E.; Fryer, George E.; Green, Larry A.; Phillips, Robert L.

    2005-01-01

    This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality. In a descriptive study using a pre-post design with comparison groups, the authors calculated…

  6. Association of Comorbidities With Postoperative In-Hospital Mortality

    PubMed Central

    Kork, Felix; Balzer, Felix; Krannich, Alexander; Weiss, Björn; Wernecke, Klaus-Dieter; Spies, Claudia

    2015-01-01

    Abstract The purpose of this article is to evaluate the American Society of Anesthesiologists Physical Status (ASA PS) and the Charlson comorbidity index (CCI) for the prediction of postoperative mortality. The ASA PS has been suggested to be equally good as the CCI in predicting postoperative outcome. However, these scores have never been compared in a broad surgical population. We conducted a retrospective cohort study in a German tertiary care university hospital. Predictive accuracy was compared using the area under the receiver-operating characteristic curves (AUROC). In a post hoc approach, a regression model was fitted and cross-validated to estimate the association of comorbidities and intraoperative factors with mortality. This model was used to improve prediction by recalibrating the CCI for surgical patients (sCCIs) and constructing a new surgical mortality score (SMS). The data of 182,886 patients with surgical interventions were analyzed. The CCI was superior to the ASA PS in predicting postoperative mortality (AUROCCCI 0.865 vs AUROCASAPS 0.833, P < 0.001). Predictive quality further improved after recalibration of the sCCI and construction of the new SMS (AUROCSMS 0.928 vs AUROCsCCI 0.896, P < 0.001). The SMS predicted postoperative mortality especially well in patients never admitted to an intensive care unit. The newly constructed SMS provides a good estimate of patient's risk of death after surgery. It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality. PMID:25715258

  7. Psychiatric Comorbidity and Complications.

    PubMed

    Mason, Michael J; Aplasca, Alexis; Morales-Theodore, Rosa; Zaharakis, Nikola; Linker, Julie

    2016-07-01

    This article highlights the prevalence of co-occurring disorders among adolescents and underscores the complexity and opportunities of treating these patients in a systematic, comprehensive approach. As evidenced by this review, the need exists to develop and test models of care that integrate co-occurring disorders into both psychiatric and substance abuse treatment settings. The challenge for pediatric practitioners is to provide detailed assessments linked to evidence-based treatment plans to account for the variations in adolescent development and the unique risk factor profile of each patient. The issues related to co-morbidity are vast and continue to grow with rapidly increasing research literature. PMID:27338972

  8. Migraine and its psychiatric comorbidities.

    PubMed

    Minen, Mia Tova; Begasse De Dhaem, Olivia; Kroon Van Diest, Ashley; Powers, Scott; Schwedt, Todd J; Lipton, Richard; Silbersweig, David

    2016-07-01

    Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. In this manuscript, we provide an overview of the link between migraine and several comorbid psychiatric disorders, including depression, anxiety and post-traumatic stress disorder. We present data on psychiatric risk factors for migraine chronification. We discuss the evidence, theories and methods, such as brain functional imaging, to explain the pathophysiological links between migraine and psychiatric disorders. Finally, we provide an overview of the treatment considerations for treating migraine with psychiatric comorbidities. In conclusion, a review of the literature demonstrates the wide variety of psychiatric comorbidities with migraine. However, more research is needed to elucidate the neurocircuitry underlying the association between migraine and the comorbid psychiatric conditions and to determine the most effective treatment for migraine with psychiatric comorbidity. PMID:26733600

  9. Effect of Comorbidity on Postoperative Survival Outcomes in Patients with Solid Cancers: A 6-Year Multicenter Study in Taiwan

    PubMed Central

    Chou, Wen-Chi; Chang, Pei-Hung; Lu, Chang-Hsien; Liu, Keng-Hao; Hung, Yu-Shin; Hung, Chia-Yen; Liu, Chien-Ting; Yeh, Kun-Yun; Lin, Yung-Chang; Yeh, Ta-Sen

    2016-01-01

    Purpose: Patients with comorbidities are more likely to experience treatment-related toxicities and death. Our aim was to examine the effect of comorbidity on postoperative survival outcomes in patients with solid cancers. Methods: In total, 37,288 patients who underwent potentially curative operations for solid cancers at four affiliated hospitals of the Chang Gung Memorial Hospital, between 2007 and 2012, were stratified according to the Charlson Comorbidity Index (CCI) for postoperative survival analysis. Multivariate Cox regression was used to adjust hazard ratios of survival outcomes among different CCI subgroups. Results: A significantly greater proportion of patients with comorbidities presented with poorer clinicopathological characteristics compared to those without. After cancer surgery, 26% of patients died after a median follow-up duration of 38.9 months. Overall mortality rates of patients with CCI scores of 0, 1, 2, 3, 4, and 5-8 were 22.9%, 29.5%, 38.2%, 43.2%, 50.2%, and 56.4%, respectively. After adjusting for other clinicopathological factors, patients with increasing CCI scores were associated with significantly reduced overall and noncancer-specific survival rates, while only patients with CCI scores of >2 were associated with higher cancer-specific mortality rates. Conclusions: Patients with increasing numbers of comorbidities were associated with reduced postoperative survival outcomes. Patients with multiple comorbidities were most vulnerable to both cancer- and noncancer-specific deaths in the first 6 months after cancer surgery. Our results suggest that for both the patient and clinician, it should be taken into consideration about cancer surgery when dealing with multiple comorbidities. PMID:27162545

  10. Association between Oestrogens Receptor Expressions in Breast Cancer and Comorbidities: A Cross-Sectional, Population-Based Study

    PubMed Central

    de Decker, Laure; Campone, Mario; Retornaz, Frederique; Berrut, Gilles; Kabeshova, Anastasia; Molinié, Florence; Beauchet, Olivier

    2014-01-01

    Background Breast cancer with oestrogen receptor expression is common in older women. Several factors, such as age and reproductive hormone exposure, have been associated with oestrogen receptor expression in breast cancer. However, the association between comorbidities and the oestrogen receptor expression has been poorly studied. We hypothesized that there was an association between burden comorbidity and breast cancer with oestrogen receptor expression in older women. Objective To determine whether oestrogen receptor expression in breast cancer was associated with burden comorbidity in community-dwelling women. Methods A total of 1,707 women with breast cancer registered on the list of a breast cancer registry were included. The recorded data included: age, Charlson Comorbidity Index score≥1, breast cancer characteristics (coded according to the International Classification of Diseases for Oncology), and breast cancer pathological stage (the pathological-tumour-node-metastasis, Scarff Bloom Richardson, and hormonal status of oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor). Results Breast cancer with oestrogen receptor expression was identified in 1,378 patients (80·7%). The fully-adjusted logistic regression showed that oestrogen receptor expression was associated with Charlson Comorbidity Index score≥1 (odds ratio [OR] = 1·91,95%confidence interval [CI] = [1.01–3.61], P = 0·048), progesterone receptor expression (OR = 16·64, 95%CI = [11.62–23.81], P<0·001), human epidermal growth factor receptor (OR = 0·54, 95%CI = [0.34–0.84], P = 0·007), age (OR = 1.02, 95%CI = [1.00–1.03], P = 0.008), Scarff Bloom Richardson grade II and grade III (OR = 0·21with 95%CI = [0.10–0.44] and OR = 0·06 with 95%CI = [0.03–0.12], P<0·001). Conclusion Our findings provide new data showing an independent positive association between burden comorbidity and breast

  11. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis

    PubMed Central

    Geersing, G J; Koek, H L; Zuithoff, Nicolaas P A; Janssen, Kristel J M; Douma, Renée A; van Delden, Johannes J M; Moons, Karel G M; Reitsma, Johannes B

    2013-01-01

    Objective To review the diagnostic accuracy of D-dimer testing in older patients (>50 years) with suspected venous thromboembolism, using conventional or age adjusted D-dimer cut-off values. Design Systematic review and bivariate random effects meta-analysis. Data sources We searched Medline and Embase for studies published before 21 June 2012 and we contacted the authors of primary studies. Study selection Primary studies that enrolled older patients with suspected venous thromboembolism in whom D-dimer testing, using both conventional (500 µg/L) and age adjusted (age×10 µg/L) cut-off values, and reference testing were performed. For patients with a non-high clinical probability, 2×2 tables were reconstructed and stratified by age category and applied D-dimer cut-off level. Results 13 cohorts including 12 497 patients with a non-high clinical probability were included in the meta-analysis. The specificity of the conventional cut-off value decreased with increasing age, from 57.6% (95% confidence interval 51.4% to 63.6%) in patients aged 51-60 years to 39.4% (33.5% to 45.6%) in those aged 61-70, 24.5% (20.0% to 29.7% in those aged 71-80, and 14.7% (11.3% to 18.6%) in those aged >80. Age adjusted cut-off values revealed higher specificities over all age categories: 62.3% (56.2% to 68.0%), 49.5% (43.2% to 55.8%), 44.2% (38.0% to 50.5%), and 35.2% (29.4% to 41.5%), respectively. Sensitivities of the age adjusted cut-off remained above 97% in all age categories. Conclusions The application of age adjusted cut-off values for D-dimer tests substantially increases specificity without modifying sensitivity, thereby improving the clinical utility of D-dimer testing in patients aged 50 or more with a non-high clinical probability. PMID:23645857

  12. Validating a Patient-Reported Comorbidity Measure with Respect to Quality of Life in End-Stage Renal Disease

    PubMed Central

    Robinski, Maxi; Strich, Franz; Mau, Wilfried; Girndt, Matthias

    2016-01-01

    Purpose Medical record-derived comorbidity measures such as the Charlson Comorbidity Index (CCI) do not predict functional limitations or quality of life (QoL) in the chronically ill. Although these shortcomings are known since the 1980s, they have been largely ignored by the international literature. Recently, QoL has received growing interest as an end-point of interventional trials in Nephrology. The aim of this study is to compare a patient-reported comorbidity measure and the CCI with respect to its validity regarding QoL. Methods The German Self-Administered Comorbidity Questionnaire (SCQ-G) was completed by 780 adult end-stage renal disease-patients recruited from 55 dialysis units throughout Germany. Acceptance was evaluated via response rates. Content validity was examined by comparing the typical comorbidity pattern in dialysis patients and the pattern retrieved from our data. Convergent validity was assessed via kappa statistics. Data was compared to the CCI. Linear associations with QoL were examined (criterion validity). Results The SCQ-G was very well accepted by dialysis patients of all ages (response rate: 99%). Content validity can be interpreted as high (corresponding comorbidity items: 73.7%). Convergent validity was rather weak (.27≤ρ≤.29) but increased when comparing only concordant items (.39≤ρ≤.43). With respect to criterion validity, the SCQ-G performed better than the CCI regarding the correlation with QoL (e.g., SF-12-physical: SCQ-G total score: ρ = -.49 vs. CCI: ρ = -.36). Conclusions The patient-reported measure proved to be more valid than the external assessment when aiming at insights on QoL. Due to the inclusion of subjective limitations, the SCQ-G is more substantial with respect to patient-centered outcomes and might be used as additional measure in clinical trials. PMID:27294867

  13. Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health

    PubMed Central

    2016-01-01

    The objective of this study was to develop a method of classifying comorbid conditions that accounts for both the severity and joint effects of the diseases. The Tromsø Study is a cohort study with a longitudinal design utilizing a survey approach with physical examinations in the Tromsø municipality from 1974 to 2008, where in total 40051 subjects participated. We used Tromsø 4 as reference population and the Norwegian Institute of Public Health (FHI) panel as validation population. Ordinal regression was used to assess the effect of comorbid disease on Self-Reported Health (SRH). The model is controlled for interaction between diseases, mental health, age, and gender. The health impact index estimated levels of SRH. The comparison of predicted and observed SRH showed no significant differences. Spearman’s correlation showed that increasing levels of comorbidity were related to lower levels of SRH (RS = -0.36, p <.001). The Charlson Comorbidity Index(CCI) was also associated with SRH (r = -.25, p <.001). When focusing on only individuals with a comorbid disease, the relation between SRH and the Health Impact Index (HII) was strengthened (r = -.42, p <.001), while the association between SRH and CCI was attenuated (r = -.14, p <.001). CCI was designed to control for comorbid conditions when survival/mortality is the outcome of interest but is inaccurate when the outcome is SRH. We conclude that HII should be used when SRH is not available, and well-being or quality of survival/life is the outcome of interest. PMID:26849044

  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. Comorbidity and Inflammatory Markers May Contribute to Predict Mortality of High-Risk Patients With Chronic Obstructive Pulmonary Disease Exacerbation

    PubMed Central

    Kim, Yu Jin; Lim, Byeongwoo; Kyung, Sun Young; Park, Jeong-woong; Jeong, Sung Hwan

    2016-01-01

    Background Acute exacerbation of chronic obstructive pulmonary disease (COPD) causes not only an accelerated disease progression, but also an increased mortality rate. The purpose of this study was to analyze the factors associated with clinical features, comorbidities and mortality in patients at high risk for acute COPD exacerbation who had been hospitalized at least once in a year. Methods The study enrolled 606 patients who had been diagnosed with and were being treated for COPD at university affiliated hospital. Among them, there were 61 patients at high risk for acute exacerbation of COPD who had been hospitalized at least once in a year. A retrospective analysis was conducted to examine the factors affecting mortality. The analysis divided the patients into non-survivor and survivor groups, and reviewed their medical records for clinical aspects, comorbidities, pulmonary function tests and blood tests. Results In the high-risk group, the number of comorbidities at diagnosis (P = 0.020) and the Charlson comorbidity index value (P = 0.018) were higher in the non-survivor group than in the survivor group. During hospitalization, the non-survivor group had a significantly higher neutrophil (%) and a significantly lower lymphocyte (%) in complete blood count. Under stable conditions, the high-sensitivity C-reactive protein (hsCRP) concentration in blood plasma and neutrophil (%) were significantly higher (P = 0.025 and P = 0.036), while the lymphocyte (%) was significantly lower (P = 0.005) in the non-survivor group. A pulmonary function test revealed no statistically significant differences between the two groups. Conclusion The number of comorbidities, neutrophil (%), lymphocyte (%) in complete blood cell (CBC) and hsCRP in blood plasma concentration among the groups at high risk for COPD exacerbation are associated with increased mortality. PMID:27298662

  16. Comorbidity as a contributor to frequent severe acute exacerbation in COPD patients

    PubMed Central

    Jeong, Suk Hyeon; Lee, Hyun; Carriere, KC; Shin, Sun Hye; Moon, Seong Mi; Jeong, Byeong-Ho; Koh, Won-Jung; Park, Hye Yun

    2016-01-01

    Background Comorbidities have a serious impact on the frequent severe acute exacerbations (AEs) in patients with COPD. Previous studies have used the Charlson comorbidity index to represent a conglomerate of comorbidities; however, the respective contribution of each coexisting disease to the frequent severe AEs remains unclear. Methods A retrospective, observational study was performed in 77 COPD patients who experienced severe AE between January 2012 and December 2014 and had at least 1-year follow-up period from the date of admission for severe AE. We explored the incidence of frequent severe AEs (≥2 severe AEs during 1-year period) in these patients and investigated COPD-related factors and comorbidities as potential risk factors of these exacerbations. Results Out of 77 patients, 61 patients (79.2%) had at least one comorbidity. During a 1-year follow-up period, 29 patients (37.7%) experienced frequent severe AEs, approximately two-thirds (n=19) of which occurred within the first 90 days after admission. Compared with patients not experiencing frequent severe AEs, these patients were more likely to have poor lung function and receive home oxygen therapy and long-term oral steroids. In multiple logistic regression analysis, coexisting asthma (adjusted odds ratio [OR] =4.02, 95% confidence interval [CI] =1.30–12.46, P=0.016), home oxygen therapy (adjusted OR =9.39, 95% CI =1.60–55.30, P=0.013), and C-reactive protein (adjusted OR =1.09, 95% CI =1.01–1.19, P=0.036) were associated with frequent severe AEs. In addition, poor lung function, as measured by forced expiratory volume in 1 second (adjusted OR =0.16, 95% CI =0.04–0.70, P=0.015), was inversely associated with early (ie, within 90 days of admission) frequent severe AEs. Conclusion Based on our study, among COPD-related comorbidities, coexisting asthma has a significant impact on the frequent severe AEs in COPD patients. PMID:27536097

  17. 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

  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. PMID:24057672

  19. Patient comorbidity predicts hospital length of stay after robot-assisted prostatectomy.

    PubMed

    Potretzke, Aaron M; Kim, Eric H; Knight, Brent A; Anderson, Barrett G; Park, Alyssa M; Sherburne Figenshau, R; Bhayani, Sam B

    2016-06-01

    We sought to examine the impact of baseline patient characteristics and perioperative outcomes on postoperative hospital length of stay (LOS), following the robot-assisted radical prostatectomy (RARP). We retrospectively reviewed consecutive patients receiving RARP at our institution by two surgeons between January 2012 and March 2014 (n = 274). Baseline patient characteristics were collected, including Charlson comorbidity index (CCI). Discharge criteria were identical for all patients and included: return of bowel function, pain controlled with oral medications, and ambulation without assistance. LOS was calculated as the number of midnights spent in the hospital following surgery. Postoperative hospital LOS was equal to 1 day for 225 patients and >1 day for 49 patients. Baseline patient and tumor characteristics, including age, race, body-mass index (BMI), pathologic stage, and Gleason score, were not significantly different. Mean operative time was shorter for patients with LOS > 1 day (155 vs. 173 min, p < 0.01) on univariate analysis. Patients with LOS > 1 day were more likely to have had a complication: 8/49 (17 %) vs. 14/225 (6 %), p < 0.01. However, multivariate logistic regression found baseline CCI > 2 as the only independent predictor of LOS > 1 day (OR = 3.2, p = 0.03), controlling for age, race, BMI, Gleason score, tumor stage, blood loss, operative time, and occurrence of complication. In our experience, baseline patient comorbidity, quantified by CCI, was the only independent predictor of hospital LOS greater than 1 day following RARP. Preoperative assessment of patient comorbidity should be used to better counsel patients on their anticipated postoperative course. PMID:27083922

  20. Screening Outcomes in Older US Women Undergoing Multiple Mammograms in Community Practice: Does Interval, Age, or Comorbidity Score Affect Tumor Characteristics or False Positive Rates?

    PubMed Central

    2013-01-01

    Background Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity. Methods From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided. Results Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0% (95% confidence interval [CI] = 46.1% to 49.9%) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0% (95% CI = 28.1% to 29.9%) of biennial screeners. Conclusion Women aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity. PMID:23385442

  1. Cardiac comorbidity in head and neck cancer patients and its influence on cancer treatment selection and mortality: a prospective cohort study.

    PubMed

    Simeoni, Roland; Breitenstein, Kerstin; Eßer, Dirk; Guntinas-Lichius, Orlando

    2016-09-01

    Comorbidity assessment and a profound cardiac examination were implemented into pre-treatment diagnostics to analyze their influence on head and neck squamous cell carcinoma (HNSCC) therapy selection and short-term mortality. Comorbidity was measured prospectively in 49 HNSCC patients using standard indices between 2012 and 2013. Cardiac examinations included electrocardiogram, echocardiography, and bicycle ergometry. Most patients had stage IV tumors (61 %), smoked (61 %), and showed alcohol abuse (57 %); 38 patients (78 %) received a multimodal therapy; 65 % had an adult comorbidity evaluation 27 index ≥2, 59 % a Charlson comorbidity index (CCI) ≥4, and 12 % a revised cardiac risk index (RCRI) ≥2. Additional cardiac examinations revealed moderate to severe cardiovascular pathologies in 32 % of the patients and led to recommendations for additional therapy in 4 patients (8 %) necessary only after cancer treatment. RCRI was associated with CCI and cardiac examinations (p = 0.009, p = 0.030). Chemotherapy, stroke history, and RCRI ≥2 were risk factors for early mortality within first 2 years after cancer therapy (p = 0.037; p = 0.012; p = 0.015). Although one-third of a strongly smoking and drinking patient cohort had relevant cardiac morbidity, extended unselected cardiac diagnostics had only low impact on HNSCC therapy selection. The risk of early mortality after HNSCC cancer treatment seems to be sufficiently reflected by the RCRI. PMID:26581475

  2. Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status

    PubMed Central

    Akinyemiju, Tomi; Jha, Megha; Moore, Justin Xavier; Pisu, Maria

    2016-01-01

    Introduction About 92% of US older adults have at least one chronic disease or medical condition and 77% have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups. Methods Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed, and Medicaid expansion status was assessed from the Center for Medicare and Medicaid Services report on State Medicaid and CHIP Income Eligibility Standards. Next, age adjusted mean number of comorbidities between expanded and non-expanded states was compared, with adjustment for socio-demographic differences. Results Expanded states had a higher proportion of adults with income of at least $50,000 per year (39.6% vs. 35.5%, p < 0.01) and a lower proportion of individuals with no health insurance coverage (15.2% vs. 20.3%, p < 0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6% vs. 26.9%, p < 001), and higher average number of comorbidities (1.62 vs. 1.52, p < 0.01) in non-expanded states compared to expanded states. Overall, the prevalence of comorbidities was higher among BRFSS participants in states that did not expand Medicaid compared with those in expanded states. Conclusion States without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions. PMID:27095325

  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. QuickStats: Age-Adjusted Suicide Rates* for Females and Males, by Method(†) - National Vital Statistics System, United States, 2000 and 2014.

    PubMed

    2016-01-01

    From 2000 to 2014, the age-adjusted suicide rate increased from 4.0 to 5.8 per 100,000 for females and from 17.7 to 20.7 for males. Suicide rates by specific method (firearm, poisoning, suffocation, or other methods) also increased, with the greatest increase seen for suicides by suffocation. During the 15-year period, the rate of suicide by suffocation more than doubled for females from 0.7 to 1.6 and increased from 3.4 to 5.6 for males. In 2014, among females, suicide by poisoning had the highest rate (1.9), and among males, suicide by firearm had the highest rate (11.4). PMID:27197046

  5. Psychiatric Comorbidities in Restless Legs Syndrome.

    PubMed

    Kallweit, Ulf; Werth, Esther; Seiz, Angela; Sefidan, Sandra; Dahmen, Norbert; Manconi, Mauro; Ehlert, Ulrike; Bassetti, Claudio L A

    2016-01-01

    Restless legs syndrome (RLS) is a neurological sleep disorder with frequent (39%) coexisting psychiatric comorbidities. Patients with any psychiatric comorbidity had fewer periodic leg movements in sleep. Psychiatric disorders should be taken into account in patients with RLS. PMID:27019065

  6. Reproductive History and Later-Life Comorbidity Trajectories: A Medicare-Linked Cohort Study From the Utah Population Database.

    PubMed

    Hanson, Heidi A; Smith, Ken R; Zimmer, Zachary

    2015-12-01

    Reproductive lives of men and women may provide significant insight into later-life morbidity and mortality. Sociological, biological, and evolutionary theories predict a relationship between reproductive history and later-life health; however, current research is lacking consensus on the direction of the relationship. Parity, early age at first birth and last birth, birth weight of offspring, having a child die as an infant, and having a preterm birth may have long-term effects on health for both men and women. In this study, the relationship between these measures of reproductive history and later-life health is examined using the Utah Population Database (a rich source of longitudinal data), and Medicare claims data from 1992-2009. Later-life health is measured using annual Charlson comorbidity index scores, a construct that summarizes most serious illnesses afflicting older individuals. Group-based trajectory modeling that accounts for nonrandom attrition due to death is used to identify the number and types of morbidity trajectories by sex and age for 52,924 individuals aged 65-84 in 1992. For females, early age at first birth, high parity, and having a preterm or high-birth-weight baby are associated with increased risks of comorbidity; later age at last birth is associated with a decreased risk of comorbidity. For males, early age at first birth and having a child with an abnormal birth weight leads to increased risk of comorbidity. The results suggest that both biological and social factors play important roles in the relationships between fertility and morbidity profiles at older ages. PMID:26527471

  7. Administrative data is as good as medical chart review for comorbidity ascertainment in patients with infections in Singapore.

    PubMed

    Hwang, J; Chow, A; Lye, D C; Wong, C S

    2016-07-01

    The Charlson comorbidity index (CCI) is widely used for control of confounding from comorbidities in epidemiological studies. International Classification of Diseases (ICD)-coded diagnoses from administrative hospital databases is potentially an efficient way of deriving CCI. However, no studies have evaluated its validity in infectious disease research. We aim to compare CCI derived from administrative data and medical record review in predicting mortality in patients with infections. We conducted a cross-sectional study on 199 inpatients. Correlation analyses were used to compare comorbidity scores from ICD-coded administrative databases and medical record review. Multivariable regression models were constructed and compared for discriminatory power for 30-day in-hospital mortality. Overall agreement was fair [weighted kappa 0·33, 95% confidence interval (CI) 0·23-0·43]. Kappa coefficient ranged from 0·17 (95% CI 0·01-0·36) for myocardial infarction to 0·85 (95% CI 0·59-1·00) for connective tissue disease. Administrative data-derived CCI was predictive of CCI ⩾5 from medical record review, controlling for age, gender, resident status, ward class, clinical speciality, illness severity, and infection source (C = 0·773). Using the multivariable model comprising age, gender, resident status, ward class, clinical speciality, illness severity, and infection source to predict 30-day in-hospital mortality, administrative data-derived CCI (C = 0·729) provided a similar C statistic as medical record review (C = 0·717, P = 0·8548). In conclusion, administrative data-derived CCI can be used for assessing comorbidities and confounding control in infectious disease research. PMID:26758244

  8. Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function

    PubMed Central

    2014-01-01

    Background To characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (TKA). Methods We analyzed the prospectively collected data from the Mayo Clinic Total Joint Registry for patients who underwent primary or revision TKA between 1993–2005. Using multivariable-adjusted logistic regression analyses, we examined whether medical comorbidities, depression and anxiety were associated with patient-reported subjective improvement in knee function 2- or 5-years after primary or revision TKA. Odds ratios (OR), along with 95% confidence intervals (CI) and p-value are presented. Results We studied 7,139 primary TKAs at 2- and 4,234 at 5-years; and, 1,533 revision TKAs at 2-years and 881 at 5-years. In multivariable-adjusted analyses, we found that depression was associated with significantly lower odds of 0.5 (95% confidence interval [CI]: 0.3 to 0.9; p = 0.02) of ‘much better’ knee functional status (relative to same or worse status) 2 years after primary TKA. Higher Deyo-Charlson index was significantly associated with lower odds of 0.5 (95% CI: 0.2 to 1.0; p = 0.05) of ‘much better’ knee functional status after revision TKA for every 5-point increase in score. Conclusions Depression in primary TKA and higher medical comorbidity in revision TKA cohorts were associated with suboptimal improvement in index knee function. It remains to be seen whether strategies focused at optimization of medical comorbidities and depression pre- and peri-operatively may help to improve TKA outcomes. Study limitations include non-response bias and the use of diagnostic codes, which may be associated with under-diagnosis of conditions. PMID:24725511

  9. Psychiatric comorbidity of childhood obesity.

    PubMed

    Kalarchian, Melissa A; Marcus, Marsha D

    2012-06-01

    The onset of psychiatric symptoms and disorders is relatively common in childhood, occurring among youths across the weight spectrum. However, available research suggests that certain psychiatric comorbidities are more prevalent in obese children and adolescents than in healthy weight youths. First, we review research on disordered eating, including evidence to suggest that loss of control eating is associated with weight gain and obesity in youths, as well as poor outcome in family-based treatment of paediatric obesity. Second, we highlight evidence on the relationship between depression and obesity, especially in girls. Third, we present data on attention deficit hyperactivity disorder (ADHD), particularly the symptoms of impulsivity and inattention, and childhood obesity. We also consider that some medical conditions and psychotropic medications contribute to weight gain and obesity in children and adolescents. Throughout the review, we emphasize that psychiatric comorbidity may be a cause or consequence of childhood obesity, or they may share common aetiological factors. PMID:22724645

  10. The Effects of Preexisting Medical Comorbidities on Mortality and Length of Hospital Stay in Acute Burn Injury

    PubMed Central

    Thombs, Brett D.; Singh, Vijay A.; Halonen, Jill; Diallo, Alfa; Milner, Stephen M.

    2007-01-01

    Objective: To determine whether and to what extent preexisting medical comorbidities influence mortality risk and length of hospitalization in patients with acute burn injury. Summary Background Data: The effects on mortality and length of stay of a number of important medical comorbidities have not been examined in acute burn injury. Existing studies that have investigated the effects of medical comorbidities on outcomes in acute burn injury have produced inconsistent results, chiefly due to the use of relatively small samples from single burn centers. Methods: Records of 31,338 adults who were admitted with acute burn injury to 70 burn centers from the American Burn Association National Burn Repository, were reviewed. A burn-specific list of medical comorbidities was derived from diagnoses included in the Charlson Index of Comorbidities and the Elixhauser method of comorbidity measurement. Logistic regression was used to assess the effects of preexisting medical conditions on mortality, controlling for demographic and burn injury characteristics. Ordinal least squares regression with a logarithmic transformation of the dependent variable was used to assess the relationship of comorbidities with length of stay. Results: In-hospital mortality was significantly predicted by HIV/AIDS (odds ratio [OR] = 10.2), renal disease (OR = 5.1), liver disease (OR = 4.8), metastatic cancer (OR = 4.6), pulmonary circulation disorders (OR = 2.9), congestive heart failure (OR = 2.4), obesity (OR = 2.1), non-metastatic malignancies (OR = 2.1), peripheral vascular disorders (OR = 1.8), alcohol abuse (OR = 1.8), neurological disorders (OR = 1.6), and cardiac arrhythmias (OR = 1.5). Increased length of hospital stay among survivors was significantly predicted by paralysis (90% increase), dementia (60%), peptic ulcer disease (53%), other neurological disorders (52%), HIV/AIDS (49%), renal disease (44%), a psychiatric diagnosis (42%), cerebrovascular disease (41%), cardiac arrhythmias

  11. Impact of Comorbidity and Age on Determinants Therapeutic Strategies in Advanced Pancreatic Head Cancer Patients With Obstructive Jaundices

    PubMed Central

    Chen, Yu-Guang; Pan, Hsueh-Hsing; Dai, Ming-Shen; Lin, Chin; Lu, Chieh-Sheng; Su, Sui-Lung; Chang, Ping-Ying; Huang, Tzu-Chuan; Chen, Jia-Hong; Wu, Yi-Ying; Chen, Yeu-Chin; Ho, Ching Liang

    2015-01-01

    Abstract The current retrospective study aimed to investigate the relationship between prognostic factors and overall survival (OS) in patients with advanced pancreatic head cancers who initially presented with obstructive jaundice. Furthermore, the impact of age and comorbidities on therapeutic strategies in such patients was evaluated. A total of 79 advanced pancreatic head cancer patients who were treated at our institution between January 2006 and November 2013 were reviewed. We analyzed OS risk factors including sex, age, laboratory characteristics, Eastern Cooperative Oncology Group performance status, Charlson Comorbidity Index Scores (CCIS), and therapeutic strategies using Cox proportional hazards regression models. There was no difference in the OS of patients according to the type biliary drainage procedure they underwent. Other related factors, such as better performance status, lower CCIS, and receiving chemotherapy significantly correlated with survival in multivariate analyses. There was a significant survival benefit in systemic chemotherapy compared to best supportive care (BSC) or local radiotherapy. However, no survival benefit was found in elderly patients (age >70 years) undergoing systemic therapy compared to younger patients, except in those elderly patients with CCIS ≤ 1. In advanced pancreatic head cancer patients with obstructive jaundice, systemic therapy and adequate biliary drainage were still the most effective procedures for improving OS in the general population. However, in elderly patients with relatively higher CCIS, BSC with adequate biliary drainage was palliative and no less effective than systemic/local therapies. PMID:26252308

  12. Health Is not always written in bone: using a modern comorbidity index to assess disease load in paleopathology.

    PubMed

    van Schaik, Katherine; Vinichenko, Dmitry; Rühli, Frank

    2014-06-01

    Paleopathology has revealed much about disease in the past but is usually limited to conditions with osteological manifestations; this often excludes acute soft tissue infections and causes of death for most individuals in the past and present. Our understanding of the evolution of disease is essential for contextualizing and predicting the epidemiological shifts that are happening in modern society, as high rates of infectious disease coexist alongside high rates of chronic disease in rates unlike those observed previously in human history. Moreover, many physiological states not previously classified as “disease” (obesity) have become pathologized, influencing our conception of disease and what defines health. By using the Galler Collection, a pre-antibiotic and pre-chemotherapeutic osteological series with modern autopsy records, our research quantifies disease burden of the past using the Charlson Index (CI), a modern comorbidity index of disease severity. Galler Collection remains and autopsy records were scored with the Charlson Index to correlate bone findings with soft tissue findings, and statistical analysis was performed for cumulative scores and absolute diagnosis counts, with patients stratified by sex and cause of death (pneumonia or cancer). Osteological diagnosis counts were more predictive of soft-tissue autopsy disease counts than were associated cumulative CI scores. Diagnosis counts and CI scores for osteological data were more closely related to associated soft tissue data for cancer patients than for pneumonia patients. This research indicates how interdisciplinary paleopathological analysis assists in making more reliable assessments of health and mortality in the past, with implications for trending and predicting future epidemiological shifts. PMID:24936606

  13. QuickStats: Age-Adjusted Death Rates* for Females Aged 15-44 Years, by the Five Leading Causes of Death(†) - United States, 1999 and 2014.

    PubMed

    2016-01-01

    The age-adjusted death rate for females aged 15-44 years was 5% lower in 2014 (82.1 per 100,000 population) than in 1999 (86.5). Among the five leading causes of death, the age-adjusted rates of three were lower in 2014 than in 1999: cancer (from 19.6 to 15.3, a 22% decline), heart disease (8.9 to 8.2, an 8% decline), and homicide (4.2 to 2.8, a 33% decline). The age-adjusted death rates for two of the five causes were higher in 2014 than in 1999: unintentional injuries (from 17.0 to 20.1, an 18% increase) and suicide (4.8 to 6.5, a 35% increase). Unintentional injuries replaced cancer as the leading cause of death in this demographic group. PMID:27362608

  14. QuickStats: Age-Adjusted Death Rates* for Males Aged 15-44 Years, by the Five Leading Causes of Death(†) - United States, 1999 and 2014.

    PubMed

    2016-01-01

    The age-adjusted death rate for males aged 15-44 years was 10% lower in 2014 (156.6 per 100,000 population) than in 1999 (174.1). Among the five leading causes of death, the age-adjusted rates for three were lower in 2014 than in 1999: cancer (from 17.1 to 12.8; 25% decline), heart disease (20.1 to 17.0; 15% decline), and homicide (15.7 to 13.8; 12% decline). The age-adjusted death rates for two of the five causes were higher in 2014 than in 1999: suicide (20.1 to 22.5; 12% increase), and unintentional injuries (from 48.7 to 51.0; 5% increase). PMID:27513718

  15. Comorbidity

    MedlinePlus

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  16. Comorbidities in patients with spondyloarthritis.

    PubMed

    van der Horst-Bruinsma, Irene E; Nurmohamed, Michael T; Landewé, Robert B M

    2012-08-01

    Chronic inflammatory spondyloarthritis involves axial symptoms of the spine and sacroiliac joints, or peripheral arthritis. Many patients suffer from extra-articular manifestations. With acute anterior uveitis, rapid treatment prevents synechiae. Other organs can be involved. Treatment includes exercise, nonsteroidal antiinflammatory drugs (if insufficient response, tumor necrosis factor blockers), and (with peripheral arthritis) sulfasalazine. Patients with ankylosing spondylitis have comorbidities and increased cardiovascular risk. For uveitis or inflammatory bowel disease, patients should be referred to an ophthalmologist or gastroenterologist. Cardiovascular risk may originate from atherosclerotic disease and cardiac manifestations. Epidemiological studies should be conducted before echocardiogram screening and cardiovascular risk management. PMID:23083753

  17. Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly?

    PubMed Central

    2012-01-01

    Background The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. The most widely used tool, the Charlson Comorbidity Index (CCI) is limited due to frequent missing data in medical records and administrative data. Patient self-report data has the potential to be more complete but has not been widely used. The purpose of this study was to evaluate the performance of the Self-Administered Comorbidity Questionnaire (SCQ) to predict functional capacity, quality of life (QOL) health outcomes compared to CCI medical records data. Method An SCQ-score was generated from patient interview, and the CCI score was generated by medical record review for 525 patients hospitalized for Acute Coronary Syndrome (ACS) at baseline, three months and eight months post-discharge. Linear regression models assessed the extent to which there were differences in the ability of comorbidity measures to predict functional capacity (Activity Status Index [ASI] scores) and quality of life (EuroQOL 5D [EQ5D] scores). Results The CCI (R2 = 0.245; p = 0.132) did not predict quality of life scores while the SCQ self-report method (R2 = 0.265; p < 0.0005) predicted the EQ5D scores. However, the CCI was almost as good as the SCQ for predicting the ASI scores at three and six months and performed slightly better in predicting ASI at eight-month follow up (R2 = 0.370; p < 0.0005 vs. R2 = 0.358; p < 0.0005) respectively. Only age, gender, family income and Center for Epidemiologic Studies-Depression (CESD) scores showed significant association with both measures in predicting QOL and functional capacity. Conclusions Although our model R-squares were fairly low, these results show that the self-report SCQ index is a good alternative method to predict QOL health outcomes when compared to a CCI medical record score. Both measures predicted physical functioning similarly. This suggests that patient self-reported comorbidity

  18. Obsessive-compulsive disorder and common comorbidities.

    PubMed

    Brady, Charles F

    2014-01-01

    Patients with obsessive-compulsive disorder (OCD) often have comorbid psychiatric disorders, such as depression, bipolar disorder, psychotic disorders, and eating disorders, which present challenges to the treating physician. Symptoms of OCD may have an earlier onset and be more severe in patients with comorbid illnesses than in those with OCD alone. Both cognitive-behavioral therapy (using exposure and response/ritual prevention) and medication may be needed to treat patients with OCD and comorbid mood, psychotic, or eating disorders. PMID:24502865

  19. 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. PMID:25478091

  20. 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

  1. Cardiovascular comorbidity in rheumatic diseases.

    PubMed

    Nurmohamed, Michael T; Heslinga, Maaike; Kitas, George D

    2015-12-01

    Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity. PMID:26282082

  2. Psychiatric Comorbidity in Alcohol Dependence.

    PubMed

    Fein, George

    2015-12-01

    We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than non-alcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls. PMID:26590836

  3. Comorbidity in older adults with cancer.

    PubMed

    Williams, Grant R; Mackenzie, Amy; Magnuson, Allison; Olin, Rebecca; Chapman, Andrew; Mohile, Supriya; Allore, Heather; Somerfield, Mark R; Targia, Valerie; Extermann, Martine; Cohen, Harvey Jay; Hurria, Arti; Holmes, Holly

    2016-07-01

    Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article, we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population. PMID:26725537

  4. Comorbidity in chronic obstructive pulmonary disease.

    PubMed

    Negewo, Netsanet A; McDonald, Vanessa M; Gibson, Peter G

    2015-11-01

    Patients with chronic obstructive pulmonary diseases (COPD) often experience comorbid conditions. The most common comorbidities that have been associated with COPD include cardiovascular diseases, lung cancer, metabolic disorder, osteoporosis, anxiety and depression, skeletal muscle dysfunction, cachexia, gastrointestinal diseases, and other respiratory conditions. Not only are comorbidities common but they also considerably influence disease prognosis and patients׳ health status, and are associated with poor clinical outcomes. However, perusal of literature indicates that little has been done so far to effectively assess, manage, and treat comorbidities in patients with COPD. The aim of this review is to comprehensively narrate the comorbid conditions that often coexist with COPD, along with their reported prevalence and their significant impacts in the disease management of COPD. A perspective on integrated disease management approaches for COPD is also discussed. PMID:26521102

  5. Age and Comorbid Illness Are Associated With Late Rectal Toxicity Following Dose-Escalated Radiation Therapy for Prostate Cancer

    SciTech Connect

    Hamstra, Daniel A.; Stenmark, Matt H.; Ritter, Tim; Litzenberg, Dale; Jackson, William; Johnson, Skyler; Albrecht-Unger, Liesel; Donaghy, Alex; Phelps, Laura; Blas, Kevin; Halverson, Schuyler; Marsh, Robin; Olson, Karin; Feng, Felix Y.

    2013-04-01

    Purpose: To assess the impacts of patient age and comorbid illness on rectal toxicity following external beam radiation therapy (EBRT) for prostate cancer and to assess the Qualitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) normal tissue complication probability (NTCP) model in this context. Methods and Materials: Rectal toxicity was analyzed in 718 men previously treated for prostate cancer with EBRT (≥75 Gy). Comorbid illness was scored using the Charlson Comorbidity Index (CCMI), and the NTCP was evaluated with the QUANTEC model. The influence of clinical and treatment-related parameters on rectal toxicity was assessed by Kaplan-Meier and Cox proportional hazards models. Results: The cumulative incidence of rectal toxicity grade ≥2 was 9.5% and 11.6% at 3 and 5 years and 3.3% and 3.9% at 3 and 5 years for grade ≥3 toxicity, respectively. Each year of age predicted an increasing relative risk of grade ≥2 (P<.03; hazard ratio [HR], 1.04 [95% confidence interval (CI), 1.01-1.06]) and ≥3 rectal toxicity (P<.0001; HR, 1.14 [95% CI,1.07-1.22]). Increasing CCMI predicted rectal toxicity where a history of either myocardial infarction (MI) (P<.0001; HR, 5.1 [95% CI, 1.9-13.7]) or congestive heart failure (CHF) (P<.0006; HR, 5.4 [95% CI, 0.6-47.5]) predicted grade ≥3 rectal toxicity, with lesser correlation with grade ≥2 toxicity (P<.02 for MI, and P<.09 for CHF). An age comorbidity model to predict rectal toxicity was developed and confirmed in a validation cohort. The use of anticoagulants increased toxicity independent of age and comorbidity. NTCP was prognostic for grade ≥3 (P=.015) but not grade ≥2 (P=.49) toxicity. On multivariate analysis, age, MI, CHF, and an NTCP >20% all correlated with late rectal toxicity. Conclusions: Patient age and a history of MI or CHF significantly impact rectal toxicity following EBRT for the treatment of prostate cancer, even after controlling for NTCP.

  6. Co-morbid disorders in Tourette syndrome.

    PubMed

    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

  7. Comorbidity profile in dementia with Lewy bodies versus Alzheimer’s disease: a linkage study between the Swedish Dementia Registry and the Swedish National Patient Registry

    PubMed Central

    2014-01-01

    Introduction Compared to Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) is usually associated with a more complex clinical picture and higher burden of care. Yet, few investigations have been performed on comorbidities and risk factors of DLB. Therefore, we aimed to compare clinical risk factors and comorbidity profile in DLB and AD patients using two nationwide registries. Methods This is a linkage study between the Swedish dementia registry (SveDem) and the Swedish National Patient Registry conducted on 634 subjects with DLB and 9161 individuals with AD registered during the years 2007–2012. Comorbidity profile has been coded according to the International Classification of Diseases version 10 (ICD 10) in addition to the date of each event. The main chapters of the ICD-10, the Charlson score of comorbidities and a selected number of neuropsychiatric diseases were compared between the DLB and AD groups. Comorbidity was registered before and after the dementia diagnosis. Results “Mental and behavioral disorders”, “diseases of the nervous system”, “diseases of the eye and adnexa”, diseases of the “circulatory”, “respiratory”, and “genitourinary” systems, “diseases of the skin and subcutaneous tissue” and “diseases of the musculoskeletal system and connective tissue” occurred more frequently in the DLB group after multivariate adjustment. Depression [adjusted OR = 2.12 (95%CI 1.49 to 3.03)] and migraine [adjusted OR = 3.65 (95%CI 1.48 to 9.0)] were more commonly recorded before the diagnosis of dementia in the DLB group. Following dementia diagnosis, ischemic stroke [adjusted OR = 1.89 (95%CI 1.21 to 2.96)] was more likely to happen among the DLB patients compared to the AD population. Conclusions Our study indicated a worse comorbidity profile in DLB patients with higher occurrence of depression, stroke and migraine compared with the AD group. Deeper knowledge about the underlying mechanisms of these

  8. Oncogene activation and tumor suppressor gene inactivation find their sites of expression in the changes in time and space of the age-adjusted cancer incidence rate.

    PubMed

    Kodama, M; Kodama, T; Murakami, M

    2000-01-01

    The purpose of the present investigation is to elucidate the relation between the distribution pattern of the age-adjusted incidence rate (AAIR) changes in time and space of 15 tumors of bothe sexes and the locations of centers of centripetal-(oncogene type) and centrifugal-(tumoe suppressor gene type) forces. The fitness of the observed log AAIR data sets to the oncogene type- and the tumor suppressor gene type-equilibrium models and the locations of 2 force centers were calculated by applying the least square method of Gauss to log AAIR pair data series with and without topological data manipulations, which are so designed as to let log AAIR pair data series fit to 2 variant (x, y) frameworks, the Rect-coordinates and the Para-coordinates. The 2 variant (x, y) coordinates are defined each as an (x, y) framework with its X axis crossed at a right angle to the regression line of the original log AAIR data (the Rect-coordinates) and as another framework with its X axis run in parallel with the regression line of the original log AAIR pair data series (the Para-coordinates). The fitness test of log AAIR data series to either the oncogene activation type equilibrium model (r = -1.000) or the tumor suppressor gene inactivation type (r = 1.000) was conducted for each of the male-female type pair data and the female-male type data, for each of log AAIR changes in space and log AAIR changes in time, and for each of the 3 (x, y) frameworks in a given neoplasia of both sexes. The results obtained are given as follows: 1) The positivity rates of the fitness test to the oncogene type equilibrium model and the tumor suppressor gene type model were each 63.3% and 56.7% with the log AAIR changes in space, and 73.3% and 73.3% with log AAIR changes in time, as tested in 15 human neoplasias of both sexes. 2) Evidence was presented to indicate that the clearance of oncogene activation and tumor suppressor gene inactivation is the sine qua non premise of carciniogenesis. 3) The r

  9. Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care.

    PubMed

    Morales-Espinoza, Enma Marianela; Kostov, Belchin; Salami, Daniel Cararach; Perez, Zoe Herreras; Rosalen, Anna Pereira; Molina, Jacinto Ortiz; Paz, Luis Gonzalez-de; Momblona, Josep Miquel Sotoca; Àreu, Jaume Benavent; Brito-Zerón, Pilar; Ramos-Casals, Manuel; Sisó-Almirall, Antoni

    2016-04-01

    The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case-control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P < 0.001), and greater disability (1.04 vs 0.35; P < 0.001), anxiety (43.9% vs 13.3%; P < 0.001), depression (27% vs 5.8%; P < 0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus, and number of cardiovascular events (13.1% vs 4.8%; P = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were &OV0556;3751 per year in patients with CWP vs &OV0556;1397 in controls (P < 0.001). In conclusion, the average patient with CWP has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations. PMID:26645546

  10. Complete Edentulism and Comorbid Diseases: An Update.

    PubMed

    Felton, David A

    2016-01-01

    The relationship between complete edentulism, which is the terminal outcome of a multifactorial oral disease process and other comorbid diseases, was first reported in 2009. Although the relationship between edentulism and a multitude of systemic diseases was reported, none of the publications studied could determine causality of tooth loss on the incidence of any comorbid disease. Since that publication, there has been a renewed interest in this relationship, and a plethora of new articles have been published. This article will provide an update on articles published since 2008 on the relationship between edentulism and comorbid diseases, and will include the relationship between complete edentulism and such comorbid conditions as malnutrition, obesity, cardiovascular disease, rheumatoid arthritis, pulmonary diseases (including chronic obstructive pulmonary disease), cancer, and even mortality. PMID:26371954

  11. Generalized anxiety disorder: A comorbid disease.

    PubMed

    Nutt, David; Argyropoulos, Spilos; Hood, Sean; Potokar, John

    2006-07-01

    Generalized anxiety disorder (GAD) frequently occurs comorbidly with other conditions, including depression and somatic complaints. Comorbid GAD sufferers have increased psychologic and social impairment, request additional treatment, and have an extended course and poorer outcome than those with GAD alone; therapy should alleviate both the psychic and somatic symptoms of GAD without negatively affecting the comorbid condition. The ideal treatment would provide relief from both GAD and the comorbid condition, reducing the need for polypharmacy. Physicians need suitable tools to assist them in the detection and monitoring of GAD patients-the GADI, a new, self-rating scale, may meet this requirement. Clinical data have shown that various neurobiologic irregularities (e.g., in the GABA and serotonin systems) are associated with the development of anxiety. Prescribing physicians must take into account these abnormalities when choosing a drug. Effective diagnosis and treatment should improve patients' quality of life and their prognosis for recovery. PMID:16737802

  12. Underrecognized comorbidities of chronic obstructive pulmonary disease

    PubMed Central

    Miłkowska-Dymanowska, Joanna; Białas, Adam J; Zalewska-Janowska, Anna; Górski, Paweł; Piotrowski, Wojciech J

    2015-01-01

    COPD is associated with different comorbid diseases, and their frequency increases with age. Comorbidities severely impact costs of health care, intensity of symptoms, quality of life and, most importantly, may contribute to life span shortening. Some comorbidities are well acknowledged and established in doctors’ awareness. However, both everyday practice and literature searches provide evidence of other, less recognized diseases, which are frequently associated with COPD. We call them underrecognized comorbidities, and the reason why this is so may be related to their relatively low clinical significance, inefficient literature data, or data ambiguity. In this review, we describe rhinosinusitis, skin abnormalities, eye diseases, different endocrinological disorders, and gastroesophageal reflux disease. Possible links to COPD pathogenesis have been discussed, if the data were available. PMID:26203239

  13. Predicting math outcomes: reading predictors and comorbidity.

    PubMed

    Fletcher, Jack M

    2005-01-01

    This commentary addresses issues concerning (a) the measurement of numbers, letters, and words versus cognitive processes in early screening batteries, and (b) comorbid associations of reading, math, and attention disorders. Based on reading prediction studies, assessments that include numbers should be most predictive of math outcomes. However, given the comorbid association of reading, math, and attention disorders, measures sensitive to reading and attention difficulties may be necessary in early screening batteries for math disabilities. PMID:16122061

  14. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy.

    PubMed

    Nickels, Katherine C; Zaccariello, Michael J; Hamiwka, Lorie D; Wirrell, Elaine C

    2016-08-01

    Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities. PMID:27448186

  15. Impact of Comorbidity, Race, and Marital Status in Men Referred for Prostate Biopsy with PSA >20 ng/mL: A Pilot Study in High-Risk Patients.

    PubMed

    Klaassen, Zachary; Muller, Roberto; Li, Qiang; Tatem, Alexander J; King, Sherita A; Freedland, Stephen J; Madi, Rabii; Terris, Martha K; Moses, Kelvin A

    2014-01-01

    Objective. To assess the impact of comorbidity, race, and marital status on overall survival (OS) among men presenting for prostate biopsy with PSA >20 ng/mL. Methods. Data were reviewed from 2000 to 2012 and 78 patients were included in the cohort. We analyzed predictors of OS using a Cox proportional hazards model and the association between Charlson Comorbidity Index (CCI) score and PCa diagnosis or high-grade cancer using logistic regression and multinomial regression models, respectively. Results. The median age of patients was 62.5 (IQR 57-73) years. Median CCI was 3 (IQR 2-4), 69% of patients were African American men, 56% of patients were married, and 85% of patients had a positive biopsy. CCI (HR 1.52, 95% CI 1.19, 1.94), PSA (HR 1.62, 95% CI 1.09, 2.42), and Gleason sum (HR 2.04, 95% CI 1.17, 3.56) were associated with OS. CCI was associated with Gleason sum 7 (OR 4.06, 95% CI 1.04, 15.89) and Gleason sum 8-10 (OR 4.52, 95% CI 1.16, 17.54) PCa. Conclusions. CCI is an independent predictor of high-grade disease and worse OS among men with PCa. Race and marital status were not significantly associated with survival in this cohort. Patient comorbidity is an important component of determining the optimal approach to management of prostate cancer. PMID:27355056

  16. Impact of Comorbidity, Race, and Marital Status in Men Referred for Prostate Biopsy with PSA >20 ng/mL: A Pilot Study in High-Risk Patients

    PubMed Central

    Muller, Roberto; Li, Qiang; Tatem, Alexander J.; King, Sherita A.; Freedland, Stephen J.; Madi, Rabii; Terris, Martha K.; Moses, Kelvin A.

    2014-01-01

    Objective. To assess the impact of comorbidity, race, and marital status on overall survival (OS) among men presenting for prostate biopsy with PSA >20 ng/mL. Methods. Data were reviewed from 2000 to 2012 and 78 patients were included in the cohort. We analyzed predictors of OS using a Cox proportional hazards model and the association between Charlson Comorbidity Index (CCI) score and PCa diagnosis or high-grade cancer using logistic regression and multinomial regression models, respectively. Results. The median age of patients was 62.5 (IQR 57–73) years. Median CCI was 3 (IQR 2–4), 69% of patients were African American men, 56% of patients were married, and 85% of patients had a positive biopsy. CCI (HR 1.52, 95% CI 1.19, 1.94), PSA (HR 1.62, 95% CI 1.09, 2.42), and Gleason sum (HR 2.04, 95% CI 1.17, 3.56) were associated with OS. CCI was associated with Gleason sum 7 (OR 4.06, 95% CI 1.04, 15.89) and Gleason sum 8–10 (OR 4.52, 95% CI 1.16, 17.54) PCa. Conclusions. CCI is an independent predictor of high-grade disease and worse OS among men with PCa. Race and marital status were not significantly associated with survival in this cohort. Patient comorbidity is an important component of determining the optimal approach to management of prostate cancer. PMID:27355056

  17. Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival.

    PubMed

    Breccia, Massimo; Luciano, Luigiana; Latagliata, Roberto; Castagnetti, Fausto; Ferrero, Dario; Cavazzini, Francesco; Trawinska, Malgorzata Monica; Annunziata, Mario; Stagno, Fabio; Tiribelli, Mario; Binotto, Gianni; Crisà, Elena; Musto, Pellegrino; Gozzini, Antonella; Cavalli, Laura; Montefusco, Enrico; Iurlo, Alessandra; Russo, Sabina; Cedrone, Michele; Rossi, Antonella Russo; Pregno, Patrizia; Endri, Mauro; Spadea, Antonio; Molica, Matteo; Giglio, Gianfranco; Celesti, Francesca; Sorà, Federica; Storti, Sergio; D'Addosio, Ada; Cambrin, Giovanna Rege; Isidori, Alessandro; Sica, Simona; Abruzzese, Elisabetta; Speccha, Giorgina; Rosti, Gianantonio; Alimena, Giuliana

    2014-10-01

    We applied Charlson comorbidity index (CCI) stratification on a large cohort of chronic myeloid leukemia (CML) very elderly patients (>75 years) treated with imatinib, in order to observe the impact of concomitant diseases on both compliance and outcome. One hundred and eighty-one patients were recruited by 21 Italian centers. There were 95 males and 86 females, median age 78.6 years (range 75-93.6). According to Sokal score, 106 patients were classified as intermediate risk and 55 as high risk (not available in 20 patients). According to CCI stratification, 71 patients had score 0 and 110 a score ≥ 1. Imatinib standard dose was reduced at start of therapy (200-300 mg/day) in 68 patients independently from the evaluation of baseline comorbidities, but based only on physician judgement: 43.6% of these patients had score 0 compared to 34% of patients who had score ≥ 1. Significant differences were found in terms of subsequent dose reduction (39% of patients with score 0 compared to 53% of patients with score ≥ 1) and in terms of drug discontinuation due to toxicity (35% of patients with score 0 vs 65% of patients with score ≥ 1). We did not find significant differences as regards occurrence of hematologic side effects, probably as a consequence of the initial dose reduction: 39% of patients with score 0 experienced grade 3/4 hematologic toxicity (most commonly anemia) compared to 42% of patients with score ≥ 1. Independently from the initial dose, comorbidities again did not have an impact on development of grade 3/4 non-hematologic side effects (most commonly skin rash, muscle cramps and fluid retention): 62% of patients with score 0 compared to 52.5% of patients with score ≥ 1. Notwithstanding the reduced dose and the weight of comorbidities we did not find significant differences but only a trend in terms of efficacy: 66% of patients with score 0 achieved a CCyR compared to 54% of patients with score ≥ 1. Comorbidities appeared to have an impact on

  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. Comorbidities of hidradenitis suppurativa (acne inversa)

    PubMed Central

    Fimmel, Sabine

    2010-01-01

    Comorbidities of hidradenitis suppurativa (acne inversa) were reviewed by extracting original and review publications included in MEDLINE, EMBASE and COCHRANE libraries using the terms “hidradenitis,” “Verneuil” and “acne inversa.” Follicular occlusion disorders, inflammatory bowel diseases, especially Crohn disease, spondylarthropathy, other hyperergic diseases, genetic keratin disorders associated with follicular occlusion and squamous cell carcinoma were the most common hidradenitis suppurativa comorbid diseases. A first classification of these major comorbidities and their possible genetic background reveals a list of chromosome loci and genes, which could be hidradenitis suppurativa candidates. Most of these diseases belong to the group of autoinflammatory disorders, where th17 cell cytokines seem to play a central role. PMID:21547142

  20. 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. PMID:25655905

  1. Managing comorbidities in idiopathic pulmonary fibrosis

    PubMed Central

    Fulton, Blair G; Ryerson, Christopher J

    2015-01-01

    Major risk factors for idiopathic pulmonary fibrosis (IPF) include older age and a history of smoking, which predispose to several pulmonary and extra-pulmonary diseases. IPF can be associated with additional comorbidities through other mechanisms as either a cause or a consequence of these diseases. We review the literature regarding the management of common pulmonary and extra-pulmonary comorbidities, including chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, venous thromboembolism, sleep-disordered breathing, gastroesophageal reflux disease, coronary artery disease, depression and anxiety, and deconditioning. Recent studies have provided some guidance on the management of these diseases in IPF; however, most treatment recommendations are extrapolated from studies of non-IPF patients. Additional studies are required to more accurately determine the clinical features of these comorbidities in patients with IPF and to evaluate conventional treatments and management strategies that are beneficial in non-IPF populations. PMID:26451121

  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. 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

  4. 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. PMID:24355755

  5. Single-Gene Determinants of Epilepsy Comorbidity.

    PubMed

    Noebels, Jeffrey L

    2015-11-01

    Common somatic conditions are bound to occur by chance in individuals with neurological disorders as prevalent as epilepsy, but when biological links underlying the comorbidity can be uncovered, the relationship may provide clues into the origin and mechanisms of both. The expanding list of monogenic epilepsies and their associated clinical features offer a remarkable opportunity to mine the epilepsy genome for coordinate neurodevelopmental phenotypes and examine their pathogenic mechanisms. Defined single-gene-linked epilepsy syndromes identified to date include all of the most frequently cited comorbidities, such as cognitive disorders, autism, migraine, mood disorders, late-onset dementia, and even premature lethality. Gene-linked comorbidities may be aggravated by, or independent of, seizure history. Mutations in these genes establish clear biological links between abnormal neuronal synchronization and a variety of neurobehavioral disorders, and critically substantiate the definition of epilepsy as a complex spectrum disorder. Mapping the neural circuitry of epilepsy comorbidities and understanding their single-gene risk should substantially clarify this challenging aspect of clinical epilepsy management. PMID:26525453

  6. Comorbidity in attention deficit-hyperactivity disorder.

    PubMed

    Ishii, Takashi; Takahashi, Osamu; Kawamura, Yuuichi; Ohta, Tatsuro

    2003-10-01

    Attention deficit-hyperactivity disorder (ADHD) has been noted for its high rate of comorbidity. The present study is the first report in Japan evaluating the proportion of comorbidity in ADHD cases presenting in the clinical setting, aiming at clarifying the picture of ADHD in Japan. The subjects consisted of 68 child and adolescent cases meeting criteria for ADHD (Diagnostic and Statistical Manual of Mental Disorders, 4th edn) under treatment at a child psychiatry clinic (IQ > 50, mental age >or= 4 years old). Disorders evaluated as comorbid disorders were mood disorders, anxiety disorders, elimination disorders, sleep disorders, tic disorders, oppositional defiant disorder (ODD), conduct disorder (CD), school refusal, and epilepsy. Comorbidity with mood disorders, anxiety disorders, ODD, and CD, were found to be lower than the high rates conventionally reported in North America. The lower age of the present subjects, primarily in infancy and elementary school age with few adolescent cases, and a bias towards milder cases from an outpatient clinic without inpatient facilities are believed to be factors accounting for this disparity. Furthermore, it was a notable fact that mentally delayed cases (IQ: 51-84) amounted to 34% of the cases, indicating the necessity to consider intelligence level when formulating a treatment strategy for ADHD. PMID:12950698

  7. 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

  8. 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…

  9. Gender Differences in ADHD Subtype Comorbidity

    ERIC Educational Resources Information Center

    Levy, Florence; Hay, David A.; Bennett, Kellie S.; McStephen, Michael

    2005-01-01

    Objective: To examine gender differences in attention-deficit/hyperactivity disorder ("ADHD") symptom comorbidity with "oppositional defiant disorder", "conduct disorder", "separation anxiety disorder", "generalized anxiety disorder", speech therapy, and remedial reading in children. Method: From 1994 to 1995, data from a large sample (N = 4,371)…

  10. 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…

  11. Recognizing obesity and comorbidities in sparse data.

    PubMed

    Uzuner, Ozlem

    2009-01-01

    In order to survey, facilitate, and evaluate studies of medical language processing on clinical narratives, i2b2 (Informatics for Integrating Biology to the Bedside) organized its second challenge and workshop. This challenge focused on automatically extracting information on obesity and fifteen of its most common comorbidities from patient discharge summaries. For each patient, obesity and any of the comorbidities could be Present, Absent, or Questionable (i.e., possible) in the patient, or Unmentioned in the discharge summary of the patient. i2b2 provided data for, and invited the development of, automated systems that can classify obesity and its comorbidities into these four classes based on individual discharge summaries. This article refers to obesity and comorbidities as diseases. It refers to the categories Present, Absent, Questionable, and Unmentioned as classes. The task of classifying obesity and its comorbidities is called the Obesity Challenge. The data released by i2b2 was annotated for textual judgments reflecting the explicitly reported information on diseases, and intuitive judgments reflecting medical professionals' reading of the information presented in discharge summaries. There were very few examples of some disease classes in the data. The Obesity Challenge paid particular attention to the performance of systems on these less well-represented classes. A total of 30 teams participated in the Obesity Challenge. Each team was allowed to submit two sets of up to three system runs for evaluation, resulting in a total of 136 submissions. The submissions represented a combination of rule-based and machine learning approaches. Evaluation of system runs shows that the best predictions of textual judgments come from systems that filter the potentially noisy portions of the narratives, project dictionaries of disease names onto the remaining text, apply negation extraction, and process the text through rules. Information on disease-related concepts

  12. Critical issues in the evaluation of comorbidity of psychiatric disorders.

    PubMed

    Wittchen, H U

    1996-06-01

    Comorbidity has become an increasingly popular theme in psychiatry and clinical psychology, although its heuristic value was recognised long ago. Frequently used in research and practice, no definition of comorbidity is uniformly accepted and it has no comprehensive and coherent theoretical framework. These factors have led to substantial variation in the magnitude of comorbidity across studies. The variability in the definition, assessment and design of comorbidity studies has led to an increasingly complex and confusing picture about the potential value of this concept. The full exploration of mechanisms of comorbidity requires an interdisciplinary approach to investigating nosology, assessment, and underlying models of comorbidity, as well as experimental study designs beyond the scope of clinical and epidemiological studies. A more precise specification of comorbidity patterns might help identify common biochemical and cognitive markers relevant in the aetiology of specific mental disorders as well as comorbid conditions. Critical issues that might help us understand and explain the variability of findings are described. PMID:8864144

  13. Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel

    PubMed Central

    Mysliwiec, Vincent; McGraw, Leigh; Pierce, Roslyn; Smith, Patrick; Trapp, Brandon; Roth, Bernard J.

    2013-01-01

    Study Objectives: Describe the prevalence of sleep disorders in military personnel referred for polysomnography and identify relationships between demographic characteristics, comorbid diagnoses, and specific sleep disorders. Design: Retrospective cross-sectional study. Setting: Military medical treatment facility. Participants: Active duty military personnel with diagnostic polysomnogram in 2010. Measurements: Primary sleep disorder rendered by review of polysomnogram and medical record by a board certified sleep medicine physician. Demographic characteristics and conditions of posttraumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), anxiety, depression, and pain syndromes determined by medical record review. Results: Primary sleep diagnoses (n = 725) included: mild obstructive sleep apnea (OSA), 207 (27.2%); insomnia, 188 (24.7%); moderate-to-severe OSA, 183 (24.0 %); and paradoxical insomnia,39 (5.1%); behaviorally induced insufficient sleep syndrome, 68 (8.9%) and snoring, 40 (5.3%) comprised our control group. Short sleep duration (< 5 h) was reported by 41.8%. Overall 85.2% had deployed, with 58.1% having one or more comorbid diagnoses. Characteristics associated with moderate-to-severe OSA were age (adjusted odds ratio [OR], 1.03 [95% confidence interval {CI}, 1.0–1.05], sex (male) (adjusted OR, 19.97 [95% CI, 2.66–150.05], anxiety (adjusted OR, 0.58 [95% CI, 0.34–0.99]), and body mass index, BMI (adjusted OR 1.19 [95% CI, 1.13–1.25]; for insomnia, characteristics included PTSD (adjusted OR, 2.12 [95% CI, 1.31–3.44]), pain syndromes (adjusted OR, 1.48 [95%CI, 1.01–2.12]), sex (female) (adjusted OR, 0.22 [95% CI, 0.12–0.41]) and lower BMI (adjusted OR, 0.91 [95% CI, 0.87, 0.95]). Conclusions: Service-related illnesses are prevalent in military personnel who undergo polysomnography with significant associations between PTSD, pain syndromes, and insomnia. Despite having sleep disorders, almost half reported short sleep duration

  14. 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…

  15. Evidence of functional declining and global comorbidity measured at baseline proved to be the strongest predictors for long-term death in elderly community residents aged 85 years: a 5-year follow-up evaluation, the OCTABAIX study

    PubMed Central

    Formiga, Francesc; Ferrer, Assumpta; Padros, Gloria; Montero, Abelardo; Gimenez-Argente, Carme; Corbella, Xavier

    2016-01-01

    Objective To investigate the predictive value of functional impairment, chronic conditions, and laboratory biomarkers of aging for predicting 5-year mortality in the elderly aged 85 years. Methods Predictive value for mortality of different geriatric assessments carried out during the OCTABAIX study was evaluated after 5 years of follow-up in 328 subjects aged 85 years. Measurements included assessment of functional status comorbidity, along with laboratory tests on vitamin D, cholesterol, CD4/CD8 ratio, hemoglobin, and serum thyrotropin. Results Overall, the mortality rate after 5 years of follow-up was 42.07%. Bivariate analysis showed that patients who survived were predominantly female (P=0.02), and they showed a significantly better baseline functional status for both basic (P<0.001) and instrumental (P<0.001) activities of daily living (Barthel and Lawton index), better cognitive performance (Spanish version of the Mini-Mental State Examination) (P<0.001), lower comorbidity conditions (Charlson) (P<0.001), lower nutritional risk (Mini Nutritional Assessment) (P<0.001), lower risk of falls (Tinetti gait scale) (P<0.001), less percentage of heart failure (P=0.03) and chronic obstructive pulmonary disease (P=0.03), and took less chronic prescription drugs (P=0.002) than nonsurvivors. Multivariate Cox regression analysis identified a decreased score in the Lawton index (hazard ratio 0.86, 95% confidence interval: 0.78–0.91) and higher comorbidity conditions (hazard ratio 1.20, 95% confidence interval: 1.08–1.33) as independent predictors of mortality at 5 years in the studied population. Conclusion The ability to perform instrumental activities of daily living and the global comorbidity assessed at baseline were the predictors of death, identified in our 85-year-old community-dwelling subjects after 5 years of follow-up. PMID:27143867

  16. 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…

  17. [Comorbidity in obsessive-compulsive disorder].

    PubMed

    Raffray, Tifenn; Pelissolo, Antoine

    2007-01-15

    It has been identified for a long time that obsessive-compulsive disorder (OCD) coexists with other psychiatric disorders: in over 50 percent of the OCD, patients meet the criteria for at least one axis I disorder (depression, anxiety disorders, eating disorders, impulse control disorders). Depressive disorders are the most commonly co-occurring difficulties and associated with significantly higher level of impairment and distress. Eating disorders and impulse control disorders are common comorbidity in OCD. These disorders as eating disorders, body dysmorphic disorder, trichotillomania, pathological gambling, share similarities in etiology, comorbidity, clinical features and treatment. Actually the notion of a spectrum of obsessive-compulsive related disorders is suggested by numerous studies. PMID:17432000

  18. 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

  19. Comorbidity of ADHD and incontinence in children.

    PubMed

    von Gontard, Alexander; Equit, Monika

    2015-02-01

    ADHD and incontinence are common childhood disorders which co-occur at much higher rates than expected by chance. The aim of this review was to provide an overview both of the comorbidity of nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI) in children with ADHD; and, vice versa, of the co-occurrence of ADHD in children with NE, DUI and FI. Most clinical studies have focussed on the association of ADHD and NE. Population-based studies have shown that children with DUI have an even greater risk for ADHD than those with NE. While children with FI have the highest overall comorbidity rates of psychological disorders, these are heterogeneous with a wide range of internalising and externalising disorders--not necessarily of ADHD. Genetic studies indicate that ADHD and NE, DUI and FI do not share the same genetic basis. The comorbidity is conferred by non-genetic factors. Possible aetiological and pathogenetic links between ADHD and incontinence are provided by neurophysiological, imaging and pharmacological studies. The co-occurrence has clinical implications: children with ADHD and NE, DUI and FI are more difficult to treat, show lower compliance and have less favourable treatment outcomes for incontinence. Therefore, both groups of disorders have to be assessed and treated specifically. PMID:24980793

  20. Risk Factors and Comorbidities for Onychomycosis

    PubMed Central

    Tosti, Antonella

    2015-01-01

    A number of comorbidities and risk factors complicate the successful management of onychomycosis. Underlying conditions and patient characteristics, such as tinea pedis, age, and obesity, contribute to risk, whereas comorbidities, such as diabetes and psoriasis, can increase susceptibility to the disease. There are limited data on treatment effectiveness in these patients. Here, the authors review post hoc analyses of efinaconazole topical solution, 10%, in mild-to-moderate onychomycosis and present new data in terms of age and obesity. The only post hoc analysis to report significant differences so far is gender, where female patients do much better; however, the reasons are unclear. The authors report significant differences in terms of efficacy in obese patients who do not respond as well as those with normal body mass index (P=0.05) and in patients who have their co-existing tinea pedis treated compared to those in whom co-existing tinea pedis was not treated (P=0.025). Although there is a trend to reduced efficacy in older patients and those with co-existing diabetes, differences were not significant. More research is needed in onychomycosis patients with these important risk factors and comorbidities to fully evaluate the treatment challengse and possible solutions. PMID:26705439

  1. Management of psychiatric and neurological comorbidities in epilepsy.

    PubMed

    Kanner, Andres M

    2016-02-01

    The treatment of epileptic seizure disorders is not restricted to the achievement of seizure-freedom, but must also include the management of comorbid medical, neurological, psychiatric and cognitive comorbidities. Psychiatric and neurological comorbidities are relatively common and often co-exist in people with epilepsy (PWE). For example, depression and anxiety disorders are the most common psychiatric comorbidities in PWE, and they are particularly common in PWE who also have a neurological comorbidity, such as migraine, stroke, traumatic brain injury or dementia. Moreover, psychiatric and neurological comorbodities often have a more severe impact on the quality of life in patients with treatment-resistant focal epilepsy than do the actual seizures. Epilepsy and psychiatric and neurological comorbidities have a complex relationship, which has a direct bearing on the management of both seizures and the comorbidities: the comorbidities have to be factored into the selection of antiepileptic drugs, and the susceptibility to seizures has to be considered when choosing the drugs to treat comorbidities. The aim of this Review is to highlight the complex relationship between epilepsy and common psychiatric and neurological comorbidities, and provide an overview of how treatment strategies for epilepsy can positively and negatively affect these comorbidities and vice versa. PMID:26782334

  2. Patterns of Comorbidity of Suicide Attempters: An Update.

    PubMed

    Blasco-Fontecilla, Hilario; Rodrigo-Yanguas, Maria; Giner, Lucas; Lobato-Rodriguez, Maria Jose; de Leon, Jose

    2016-10-01

    Between 10 and 20 million people attempt suicide every year worldwide, and suicide attempts represent a major economic burden. Suicide attempters suffer from high rates of comorbidity, and comorbidity is the rule in suicide re-attempters. Comorbidity complicates treatment and prognosis and causes a more protracted course. In the present narrative review, we included these patterns of comorbidity: intra-Axis I disorders, intra-Axis II disorders, Axis I with Axis II disorders, and psychiatric with physical illnesses. We also briefly reviewed the patterns of comorbidity in suicide re-attempters. We concluded that comorbidity at different levels appears to be the rule in suicide attempters, particularly in those who re-attempt. However, several issues deserve further research regarding the patterns of comorbidity in suicide attempters. PMID:27595859

  3. Lamotrigine positively affects the development of psychiatric comorbidity in epileptic animals, while psychiatric comorbidity aggravates seizures.

    PubMed

    Russo, Emilio; Chimirri, Serafina; Aiello, Rossana; De Fazio, Salvatore; Leo, Antonio; Rispoli, Vincenzo; Marra, Rosario; Labate, Angelo; De Fazio, Pasquale; Citraro, Rita; De Sarro, Giovambattista

    2013-08-01

    Several clinical and preclinical studies have focused on the relationship between epilepsy and psychological disturbances. Although behavior in some experimental models of epilepsy has been studied, only few of them can be considered as models of epilepsy and mood disorder comorbidity. Since several models of epilepsy or psychiatric disorders are already available, we wondered whether a mixture of the two could experimentally represent a valid alternative to study such comorbidity. Here, we present a possible experimental protocol to study drug effects and physiopathogenesis of psychiatric comorbidity in epileptic animals. Pentylentetrazol-kindled animals were subjected to the chronic mild stress (CMS) procedure; furthermore, we tested the effects of chronic lamotrigine treatment on the development of comorbidity. We found that epileptic-depressed animals showed more pronounced behavioral alterations in comparison to other mice groups, indicating that kindled animals develop more pronounced CMS-induced behavioral alterations than nonepileptic mice; lamotrigine was able to prevent the development of comorbidities such as anxiety, depression-like behavior, and memory impairment. PMID:23773980

  4. Bad news itself or just the messenger? The high mortality of Fusobacterium spp. infections is related to disseminated malignancy and other comorbidities

    PubMed Central

    Johannesen, Katrine; Dessau, Ram; Heltberg, Ole; Bodtger, Uffe

    2016-01-01

    Background Fusobacterium species are pleomorphic, obligate anaerobic gram-negative bacilli. They are difficult to culture and grow slowly. If antibiotic treatment is initiated prior to blood cultures, the bacteria might evade detection. This is a comprehensive report on mortality in non-bacteraemia fusobacterial infection. Methods Data were collected retrospectively in adults having a positive culture with Fusobacterium spp. admitted during 2000–2012 at the medical department. Data on culture specimens, number of cultures, admission and culture dates, patient age, gender, clinical disease, Charlson's index of co-morbidity, CRP level and survival were obtained. For comparison, we traced 60 consecutive, similarly obtained cultures from 2009 to 2010 containing Staphylococcus aureus. Results Within a 12-year period, we identified 28 patients with a positive culture of Fusobacterium spp. in a medical ward serving a population of 220,000. Only a minority (39%) had a positive blood culture, and 54% had focus in respiratory tract or pleura. Overall 6-month mortality was 32%, and unrelated to subspecies, treatment or anatomic location but significantly related to age >60 years, admission for severe, acute illness, and comorbidity, especially metastatic malignancy. Comparison between infection with Fusobacterium spp. and S. aureus showed that Fusobacterium spp. infections were predominantly community acquired, while S. aureus were both community and hospital acquired. Overall mortality for both bacterial infections increased significantly with age and current malignant disease. S. aureus–infected patients carried a significantly higher mortality. Conclusion Our data support that Fusobacterium spp. infection is a marker for significant, chronic disease rather than carrying a poor prognosis per se. PMID:27171316

  5. 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

  6. [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. PMID:17898818

  7. 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

  8. Comorbid psychiatric disorders in substance dependence patients: A control study

    PubMed Central

    Shantna, K.; Chaudhury, S.; Verma, A. N.; Singh, A. R.

    2009-01-01

    Background: The purpose of this study was to investigate the comorbidity of mental disorders among a random sample of substance dependence patients from a psychiatric inpatients department and the general population. Materials and Methods: Comprehensive data was collected from inpatients with substance abuse/dependence and comorbidity of mental disorders at the Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS) and from normal controls from the general population during the period January 2007 to May 2007. Results: The results show that the most prevalent comorbid disorders in substance dependence patients and substance abusers were depressive disorders. Conclusions: The majority of substance dependence patients suffered from comorbid mental disorders. Comorbidity needs to be taken into account when analyzing the relationship between substance dependence and depression and in planning treatment strategies for comorbid conditions. PMID:21180482

  9. 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. PMID:26898322

  10. 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

  11. Comorbid depression and anxiety effects on pregnancy and neonatal outcome.

    PubMed

    Field, Tiffany; Diego, Miguel; Hernandez-Reif, Maria; Figueiredo, Barbara; Deeds, Osvelia; Ascencio, Angela; Schanberg, Saul; Kuhn, Cynthia

    2010-02-01

    The effects of comorbid depression and anxiety were compared to the effects of depression alone and anxiety alone on pregnancy mood states and biochemistry and on neonatal outcomes in a large multi-ethnic sample. At the prenatal period the comorbid and depressed groups had higher scores than the other groups on the depression measure. But, the comorbid group had higher anxiety, anger and daily hassles scores than the other groups, and they had lower dopamine levels. As compared to the non-depressed group, they also reported more sleep disturbances and relationship problems. The comorbid group also experienced a greater incidence of prematurity than the depressed, the high anxiety and the non-depressed groups. Although the comorbid and anxiety groups were lower birthweight than the non-depressed and depressed groups, the comorbid group did not differ from the depressed and anxiety groups on birth length. The neonates of the comorbid and depressed groups had higher cortisol and norepinephrine and lower dopamine and serotonin levels than the neonates of the anxiety and non-depressed groups as well as greater relative right frontal EEG. These data suggest that for some measures comorbidity of depression and anxiety is the worst condition (e.g., incidence of prematurity), while for others, comorbidity is no more impactful than depression alone. PMID:19945170

  12. 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

  13. [Integrated approach to comorbidity in patients with psoriasis.Working Group on Psoriasis-associated Comorbidities].

    PubMed

    Daudén, E; Castañeda, S; Suárez, C; García-Campayo, J; Blasco, A J; Aguilar, M D; Ferrándiz, C; Puig, L; Sánchez-Carazo, J L

    2012-01-01

    The relationship between psoriasis and associated diseases has drawn particular interest in recent years. To provide appropriate management of psoriasis from an early stage, it is necessary to include prompt diagnosis of concomitant disease and to prevent and treat any comorbidity found. Such an integrated approach also serves to ensure that the drugs used to treat associated diseases do not interfere with the management of psoriasis, and vice versa. This clinical practice guideline on the management of comorbidity in psoriasis has been drawn up to help dermatologists to achieve an integrated approach to this inflammatory disease. The guide focuses primarily on the diseases most often found in patients with psoriasis, which include psoriatic arthritis, cardiovascular disease, nonalcoholic fatty liver disease, inflammatory bowel disease, lymphoma, skin cancer, anxiety, and depression. Cardiovascular disease is approached through the study of its major risk factors (obesity, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome). Other cardiovascular risk factors related to lifestyle, such as smoking and alcohol consumption, are also discussed. The overall aim of this guide is to provide the dermatologist with a precise, easy to-use tool for systematizing the diagnosis of comorbidity in these patients and to facilitate decisions regarding referral and treatment once associated diseases have been found. The specific objectives are as follows: a) to review the most common diseases associated with psoriasis, including the prevalence of each one and its importance to the dermatologist; b) to provide guidelines for the physical examination, diagnostic tests, and clinical criteria on which to base a preliminary diagnosis; c) to establish criteria for the appropriate referral of patients with suspected comorbidity; d) to provide information on how therapies for psoriasis may modify the course of associated diseases, and e) to provide information concerning

  14. PTSD substance abuse comorbidity and treatment utilization.

    PubMed

    Brown, P J; Recupero, P R; Stout, R

    1995-01-01

    The present study investigates the prevalence of posttraumatic stress disorder (PTSD) among a sample of treatment-seeking substance abusers and examines the relationship between PTSD comorbidity and rates of inpatient substance abuse treatment. Eighty-four patients (48 male and 36 female) admitted for detoxification at a private hospital were administered self-report measures of lifetime stressor events, PTSD symptomatology, and prior treatment history. Approximately one quarter of the sample was found to present with significant PTSD symptomatology. Women were more likely than men to have been physically and sexually abused, and women reported experiencing a greater number of traumatic events. Consequently, more women than men were classified as having possible PTSD. With respect to inpatient substance abuse treatment admission rates, the PTSD group reported a greater number of hospitalizations than their non-PTSD counterparts. Implications of these findings for routine trauma screening and more effective treatment for substance abusers with concomitant PTSD are highlighted. PMID:7484319

  15. Childhood Maltreatment, Emotional Dysregulation, and Psychiatric Comorbidities

    PubMed Central

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

    2014-01-01

    Affect dysregulation, defined as the impaired ability to regulate and/or tolerate negative emotional states, and has been associated with interpersonal trauma and post-traumatic stress. Affect regulation difficulties also play a role in many other psychiatric conditions, including anxiety disorders and mood disorders, specifically major depression in youth and bipolar disorder throughout the life span. Exposure to traumatic events and interpersonal trauma in childhood is associated with a wide range of 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 traumatization, emotional dysregulation, and psychiatric co-morbidities in children, adolescents and adults. PMID:24704784

  16. 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. PMID:24704784

  17. Narcolepsy with cataplexy and comorbid immunopathological diseases.

    PubMed

    Martínez-Orozco, Francisco J; Vicario, José L; Villalibre-Valderrey, Isabel; De Andrés, Clara; Fernández-Arquero, Miguel; Peraita-Adrados, Rosa

    2014-08-01

    Evidence suggests that autoimmune diseases tend to co-occur so that patients with an autoimmune disorder are at higher risk of a second autoimmune disease. The association between allergic and autoimmune diseases is also of considerable interest. There are no reports on the association between sporadic or familial narcolepsy with cataplexy and other non-neurological immune-mediated diseases. This study reported on the comorbid immunopathological diseases associated with narcolepsy. One-hundred and fifty six narcoleptic patients with a mean age at diagnosis of 39.1 ± 17.8 years (range, 6-70 years) were assessed using the clinical history, physical and neurological examinations, sleep questionnaires, neuroimaging and human leucocyte antigen typing. Diagnosis was confirmed by polysomnography followed by a multiple sleep latency test or by measuring hypocretin-1 levels. Patients with immunopathological diseases were matched for gender and age at the onset of narcoleptic symptoms with narcoleptic patients without immunopathological diseases. Twenty-six patients (16.6%; 50% women; one familial, 25 sporadic) had one or more immunopathological diseases associated: autoimmune diseases, such as idiopathic thrombocytopenic purpura, multiple sclerosis, systemic lupus erythematosus, psoriasis, Crohn's disease, ulcerative colitis, autoimmune thyroid disease, Peyronie's disease and idiopathic recurrent facial palsy; other immunopathological diseases, like atopic dermatitis, allergic asthma and allergic rhinitis. Although not significant, the age at diagnosis of narcolepsy was 9.3 years earlier in patients with narcolepsy + immunopathological diseases. The results demonstrate that the prevalence of comorbid immunopathological diseases is high in narcolepsy, and cataplexy is significantly more severe in patients with narcolepsy + immunopathological diseases. PMID:24645699

  18. Comorbidity and Risk Behaviors among Drug Users Not in Treatment.

    ERIC Educational Resources Information Center

    Johnson, Mark E.; Brems, Christiane; Wells, Rebecca S.; Theno, Shelley A.; Fisher, Dennis G.

    2003-01-01

    In a sample of 700 drug users, 64% evidenced comorbidity (i.e., coexisting substance use and psychiatric disorders). Robust relationships between the presence of comorbidity and increased levels of risk behavior, such as needle sharing and trading sex for money, were revealed. (Contains 44 references and 2 tables.) (Author)

  19. 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

  20. 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…

  1. 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…

  2. 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…

  3. How to build personalized multi-omics comorbidity profiles

    PubMed Central

    Moni, Mohammad Ali; Liò, Pietro

    2015-01-01

    Multiple diseases (acute or chronic events) occur together in a patient, which refers to the disease comorbidities, because of the multi ways associations among diseases. Due to shared genetic, molecular, environmental, and lifestyle-based risk factors, many diseases are comorbid in the same patient. Methods for integrating multiple types of omics data play an important role to identify integrative biomarkers for stratification of patients into groups with different clinical outcomes. Moreover, integrated omics and clinical information may potentially improve prediction accuracy of disease comorbidities. However, there is a lack of effective and efficient bioinformatics and statistical software for true integrative data analysis. With the availability of the wide spread huge omics, phenotype and ontology information, it is becoming more and more practical to help doctors in clinical diagnostics and comorbidity prediction by providing appropriate software tool. We developed an R software POGO to compute novel estimators of the disease comorbidity risks and patient stratification. Starting from an initial diagnosis, omics and clinical data of a patient the software identifies the association risk of disease comorbidities. The input of this software is the initial diagnosis of a patient and the output provides evidence of disease comorbidities. The functions of POGO offer flexibility for diagnostic applications to predict disease comorbidities, and can be easily integrated to high–throughput and clinical data analysis pipelines. POGO is compliant with the Bioconductor standard and it is freely available at www.cl.cam.ac.uk/~mam211/POGO/. PMID:26157799

  4. 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,…

  5. How to build personalized multi-omics comorbidity profiles.

    PubMed

    Moni, Mohammad Ali; Liò, Pietro

    2015-01-01

    Multiple diseases (acute or chronic events) occur together in a patient, which refers to the disease comorbidities, because of the multi ways associations among diseases. Due to shared genetic, molecular, environmental, and lifestyle-based risk factors, many diseases are comorbid in the same patient. Methods for integrating multiple types of omics data play an important role to identify integrative biomarkers for stratification of patients into groups with different clinical outcomes. Moreover, integrated omics and clinical information may potentially improve prediction accuracy of disease comorbidities. However, there is a lack of effective and efficient bioinformatics and statistical software for true integrative data analysis. With the availability of the wide spread huge omics, phenotype and ontology information, it is becoming more and more practical to help doctors in clinical diagnostics and comorbidity prediction by providing appropriate software tool. We developed an R software POGO to compute novel estimators of the disease comorbidity risks and patient stratification. Starting from an initial diagnosis, omics and clinical data of a patient the software identifies the association risk of disease comorbidities. The input of this software is the initial diagnosis of a patient and the output provides evidence of disease comorbidities. The functions of POGO offer flexibility for diagnostic applications to predict disease comorbidities, and can be easily integrated to high-throughput and clinical data analysis pipelines. POGO is compliant with the Bioconductor standard and it is freely available at www.cl.cam.ac.uk/~mam211/POGO/. PMID:26157799

  6. 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,…

  7. Management of Noncardiac Comorbidities in Chronic Heart Failure.

    PubMed

    Chong, Vun Heng; Singh, Jagdeep; Parry, Helen; Saunders, Jocelyn; Chowdhury, Farhad; Mancini, Donna M; Lang, Chim C

    2015-10-01

    Prevalence of heart failure is increasing, especially in the elderly population. Noncardiac comorbidities complicate heart failure care and are increasingly common in elderly patients with reduced or preserved ejection fraction heart failure, owing to prolongation of patient's lives by advances in chronic heart failure (CHF) management. Common comorbidities include respiratory disease, renal dysfunction, anemia, arthritis, obesity, diabetes mellitus, cognitive dysfunction, and depression. These conditions contribute to the progression of the disease and may alter the response to treatment, partly as polypharmacy is inevitable in these patients. Cardiologists and other physicians caring for patients with CHF need to be vigilant to comorbid conditions that complicate the care of these patients. There is now more guidance on management of noncardiac comorbidities in heart failure, and this article contains a comprehensive review of the most recent updates on management of noncardiac comorbidities in CHF. PMID:26108139

  8. The changing prevalence of comorbidity across the age spectrum.

    PubMed

    Piccirillo, Jay F; Vlahiotis, Anna; Barrett, Laurel B; Flood, Kellie L; Spitznagel, Edward L; Steyerberg, Ewout W

    2008-08-01

    The purpose of the research was to demonstrate that comorbid health conditions disproportionately affect elderly cancer patients. Descriptive analyses and stacked area charts were used to examine the prevalence and severity of comorbid ailments by age of 27,506 newly diagnosed patients treated at one of eight cancer centers between 1998 and 2003. Hypertension was the most common ailment in all patients, diabetes was the second most prevalent ailment in middle-aged patients, and previous solid tumor(s) were the second most prevalent ailment in patients aged 74 and older. Although the prevalence and severity of comorbid ailments including dementia and congestive heart failure increased with age, some comorbidities such as HIV/AIDS and obesity decreased. Advances in cancer interventions have increased survivorship, but the impact of the changing prevalence and severity of comorbidities at different ages has implications for targeted research into targeted clinical and psychosocial interventions. PMID:18375141

  9. Curative-Intent Aggressive Treatment Improves Survival in Elderly Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma and High Comorbidity Index

    PubMed Central

    Chen, Jin-Hua; Yen, Yu-Chun; Yang, Hsuan-Chia; Liu, Shing-Hwa; Yuan, Sheng-Po; Wu, Li-Li; Lee, Fei-Peng; Lin, Kuan-Chou; Lai, Ming-Tang; Wu, Chia-Che; Chen, Tsung-Ming; Chang, Chia-Lun; Chow, Jyh-Ming; Ding, Yi-Fang; Wu, Szu-Yuan

    2016-01-01

    Abstract For locally advanced head and neck squamous cell carcinoma (HNSCC), therapeutic decisions depend on comorbidity or age. We estimated the treatment outcomes of patients with different Charlson comorbidity index (CCI) scores and ages to determine whether aggressive treatment improves survival. Data from the Taiwan National Health Insurance and cancer registry databases were analyzed, and we included >20-year-old patients with American Joint Committee on Cancer (AJCC) stage III or IV HNSCC (International Classification of Diseases, Ninth Revision, Clinical Modification codes 140.0–148.9) undergoing surgery, chemotherapy (CT), radiotherapy (RT), concurrent chemoradiotherapy (CCRT), sequential CT and RT, or surgery with adjuvant treatment. The exclusion criteria were a past cancer history, distant metastasis, AJCC stage I or II, missing sex data, an age < 20 years, nasopharyngeal cancer, in situ carcinoma, sarcoma, and HNSCC recurrence. The index date was the date of first HNSCC diagnosis, and comorbidities were scored using the CCI. The enrolled patients were categorized into Group 1 (curative-intent aggressive treatments) and Group 2 (best supportive care or palliative treatments). We enrolled 21,174 stage III or IV HNSCC patients without distant metastasis (median follow-up, 3.25 years). Groups 1 and 2 comprised 18,584 and 2232 patients, respectively. After adjustment for age, sex, and clinical stage, adjusted hazard ratios (95% confidence intervals) of overall death in Group 1 were 0.33 (0.31–0.35), 0.34 (0.31–0.36), and 0.37 (0.28–0.49), and those of all-cause death among patients undergoing curative surgical aggressive treatments were 1.13 (0.82–1.55), 0.67 (0.62–0.73), and 0.49 (0.46–0.53) for CCI scores of ≥10, 5 to 9, and <5, respectively. Aggressive treatments improve survival in elderly (≥65 years) and critically ill HNSCC patients. Curative nonsurgical aggressive treatments including definitive RT or CCRT might be suitable for

  10. Marginal costing methods highlight the contributing cost of comorbid conditions in Medicare patients: a quasi-experimental case–control study of ischemic stroke costs

    PubMed Central

    2013-01-01

    Background Cost of illness studies are needed to provide estimates for input into cost-effectiveness studies and as information drivers to resource allocation. However, these studies often do not differentiate costs associated with the disease of interest and costs of co-morbidities. The goal of this study was to identify the 1-year cost of ischemic stroke compared to the annual cost of care for a comparable non-stroke group of South Carolina (SC) Medicare beneficiaries resulting in a marginal cost estimate. Methods SC data for 2004 and 2005 were used to estimate the mean 12 month cost of stroke for 2,976 Medicare beneficiaries hospitalized for Ischemic Stroke in 2004. Using nearest neighbor propensity score matching, a control group of non-stroke beneficiaries were matched on age, gender, race, risk factors, and Charlson comorbidity index and their costs were calculated. Marginal cost attributable to ischemic stroke was calculated as the difference between these two adjusted cost estimates. Results The total cost estimated for SC stroke patients for 1 year (2004) was $81.3 million. The cost for the matched comparison group without stroke was $54.4 million. Thus, the 2004 marginal costs to Medicare due to Ischemic stroke in SC are estimated to be $26.9 million. Conclusions Accurate estimates of cost of care for conditions, such as stroke, that are common in older patients with a high rate of comorbid conditions require the use of a marginal costing approach. Over estimation of cost of care for stroke may lead to prediction of larger savings than realizable from important stroke treatment and prevention programs, which may damage the credibility of program advocates, and jeopardize long term funding support. Additionally, correct cost estimates are needed as inputs for valid cost-effectiveness studies. Thus, it is important to use marginal costing for stroke, especially with the increasing public focus on evidence-based economic decision making to be expected with

  11. Prevalence of Comorbidities in Asthma and Nonasthma Patients

    PubMed Central

    Su, Xinming; Ren, Yuan; Li, Menglu; Zhao, Xuan; Kong, Lingfei; Kang, Jian

    2016-01-01

    Abstract This study compares the prevalence rates of comorbidities between asthma and nonasthma control patients reported in the literature. Literature was searched in several electronic databases. After the selection of studies by following précised eligibility criteria, meta-analyses of odds ratios were carried out with subgroup and sensitivity analyses. Eleven studies studying 117,548 asthma patients compared with 443,948 non-asthma controls were included in the meta-analysis. The prevalence of cardiovascular comorbidities (odds ratio (OR): [95% CI] 1.90 [1.70, 2.14]; P < 0.00001), cerebrovascular comorbidities (OR 1.44 [1.29, 1.60]; P < 0.00001), obesity (OR 1.51 [1.14, 2.01]; P < 0.00001), hypertension (OR 1.66 [1.47, 1.88]; P < 0.00001, diabetes (OR 1.25 [1.08, 1.44]; P < 0.00001), other metabolic and endocrine comorbidities (OR 1.60 [1.40, 1.83]; P < 0.00001), psychiatric and neurological comorbidities (OR 1.62 [1.44, 1.82]; P < 0.00001), gut and urinary comorbidities (OR 1.91 [1.47, 2.49]; P < 0.00001),), cancer (OR 1.17 [1.10, 1.25]; P < 0.00001), and respiratory comorbidities (OR 5.60 [4.22, 7.44]; P < 0.00001) were significantly higher in the asthma patients in comparison with nonasthma controls. Asthma is associated with significantly higher comorbidities including cardio-/cerebrovascular diseases, obesity, hypertension, diabetes, psychiatric and neurological comorbidities, gut and urinary conditions, cancer, and respiratory problems other than asthma. Respiratory comorbidities are found 5 times more prevalent in asthma than in non-asthma patients. PMID:27258489

  12. Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review.

    PubMed

    Raghu, Ganesh; Amatto, Valeria C; Behr, Jürgen; Stowasser, Susanne

    2015-10-01

    Idiopathic pulmonary fibrosis (IPF) is associated with a fatal prognosis and manifests in patients over 60 years old who may have comorbidities. The prevalence and impact of comorbidities on the clinical course of IPF is unclear.This systematic literature review examined the prevalence of comorbidities and mortality associated with comorbidities in IPF patients. Relevant observational studies published in English from January 1990 to January 2015 identified via MEDLINE and EMBASE were included; bibliographies of articles were also searched.Among the 126 studies included, prevalence of pulmonary hypertension (PH) was 3-86%, 6-91% for obstructive sleep apnoea, 3-48% for lung cancer and 6-67% for chronic obstructive pulmonary disease (COPD). Nonrespiratory comorbidities included ischaemic heart disease (IHD) (3-68%) and gastro-oesophageal reflux (GER) (0-94%). Mortality was highest among patients with IPF and lung cancer. Most studies assessed relatively small samples of patients with IPF.PH, COPD, lung cancer, GER and IHD are significant comorbidities; differences in IPF severity, case definitions and patient characteristics limited the comparability of findings. The identification and prompt treatment of comorbidities may have a clinically significant impact on overall outcome that is meaningful for patients with IPF. PMID:26424523

  13. 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. PMID:25979489

  14. Migraine: Clinical pattern and psychiatric comorbidity

    PubMed Central

    Bhatia, Manjeet Singh; Gupta, Ravi

    2012-01-01

    Background: Migraine is a common disorder which has psychiatric sequelae. Objective: The objective of this study was to determine the clinical pattern and psychiatric comorbidity of migraine. Materials and Methods: 100 cases of migraine seen over a period of one year were analysed to know the sociodemographic characteristics, clinical pattern and psychiatric morbidity. Results: Maximum patients were between 31-40 years of age group (40%), females (78.0%), married (76%) and housewives (56.0%). Family history of migraine was present in 12% cases. Average age of onset was 22 years. Unilateral and throbbing type of headache was most common. The commonest frequency was one to two per week. Migraine without aura was commonest sub-type (80%). Generalized anxiety disorder (F41.1) was the most common psychiatric disorder (34%), followed by mixed anxiety and depressive disorder (F41.2) (18%) and depressive episode (F32) (14%). In 22% cases, no psychiatric disorder could be elicited. Conclusion: The present study confirms that majority patients with migraine had psychiatric disorders. This needs timely detection and appropriate intervention to treat and control the migraine effectively. PMID:23766573

  15. 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

  16. 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. PMID:27542883

  17. 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. PMID:26617352

  18. Personality Traits and Comorbidity in Adults With ADHD.

    PubMed

    Instanes, Johanne Telnes; Haavik, Jan; Halmøy, Anne

    2013-11-22

    Objective: To assess personality traits using the Temperament and Character Inventory (TCI) in a group of 63 previously diagnosed ADHD patients and 68 population controls and investigate the impact of common comorbid psychiatric disorders on these personality measures. Method: Psychiatric comorbidity was assessed with the Mini International Neuropsychiatric Interview Plus and personality traits by the TCI. Results: The patient group had significantly higher scores on the TCI dimensions Harm avoidance and Novelty seeking compared with the control group. However, when adjusting for comorbid anxiety and depressive disorder, the ADHD group no longer showed higher Harm avoidance than the control group. The difference in Novelty seeking between the patient and control groups was correlated with lifetime diagnosis of antisocial personality disorder (ASPD). Conclusion: It is important to take comorbid psychiatric disorders into account while investigating personality traits in ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX). PMID:24271945

  19. Comorbidities of epilepsy: current concepts and future perspectives.

    PubMed

    Keezer, Mark R; Sisodiya, Sanjay M; Sander, Josemir W

    2016-01-01

    The burden of comorbidity in people with epilepsy is high. Several diseases, including depression, anxiety, dementia, migraine, heart disease, peptic ulcers, and arthritis are up to eight times more common in people with epilepsy than in the general population. Several mechanisms explain how epilepsy and comorbidities are associated, including shared risk factors and bidirectional relations. There is a pressing need for new and validated screening instruments and guidelines to help with the early detection and treatment of comorbid conditions. Preliminary evidence suggests that some conditions, such as depression and migraine, negatively affect seizure outcome and quality of life. Further investigation is needed to explore these relations and the effects of targeted interventions. Future advances in the investigation of the comorbidities of epilepsy will strengthen our understanding of epilepsy and could play an important part in stratification for genetic studies. PMID:26549780

  20. Prospective analysis of comorbidity: tobacco and alcohol use disorders.

    PubMed

    Jackson, K M; Sher, K J; Wood, P K

    2000-11-01

    Alcohol use disorders (AUD) and tobacco use disorders (TD) frequently co-occur. The authors examined AUD-TD comorbidity over time using a state-trait (ST) model. The ST model represents variance in AUD/TD as a traitlike factor that spans measurement occasion and identifies distinct sources of variance in AUD-TD comorbidity. The ST model was evaluated on 450 young adults (baseline age = 18.5 years; 51% with family history of alcoholism) assessed 5 times over 7 years. The ST model demonstrated superior fit over a first-order autoregressive model. The tendency to diagnose with AUD and TD was partially explained by family history of alcoholism; this relationship was mediated by childhood stressors, alcohol expectancies, and behavioral undercontrol. Results supported a common third-variable influence (vs. directional) model of comorbidity. The ST model is an important conceptual and methodological approach to the prospective study of comorbidity in general. PMID:11195992

  1. Psychiatric comorbidities among female adolescents with anorexia nervosa.

    PubMed

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

    2008-09-01

    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 differences across AN subtypes. Mood disorders (60.4%) were most commonly identified, followed by the category anxiety disorders without obsessive-compulsive disorders (OCD) (25.7%), OCD (16.8%) and substance use disorders (7.9%). Two specific diagnoses differed across the two subtypes of AN. Substance use disorder was 18 times, and the category anxiety disorder without OCD was three times as likely to co-occur with AN binge-eating disorder and purging type than with AN restricting type. Clinicians should be alerted to the particularly high rate of psychiatric comorbidities in adolescents suffering from AN. PMID:17987378

  2. [Prevalence and prognostic meaning of comorbidity in heart failure].

    PubMed

    Conde-Martel, A; Hernández-Meneses, M

    2016-05-01

    Heart failure (HF) predominantly affects elderly individuals and has a significant impact on the health systems of developed countries. Comorbidities are present in most patients with HF by acting as the cause, the consequence or a mere coincidence. In addition to their high prevalence, they have considerable relevance because they can mask symptoms, impede the diagnosis and treatment, contribute to progression and negatively influence the prognosis of HF. Most of the associated comorbidities result in a greater number of hospitalisations, poorer quality of life and increased mortality. Given that many of these comorbidities are underdiagnosed, their detection could improve the outcome and quality of life of patients with HF. This article reviews the prevalence and prognostic meaning of the most prevalent comorbidities associated with HF. PMID:26455791

  3. 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

  4. Psychiatric comorbidities in dystonia: emerging concepts.

    PubMed

    Zurowski, Mateusz; McDonald, William M; Fox, Susan; Marsh, Laura

    2013-06-15

    Psychiatric disorders are highly prevalent in patients with dystonia and have a profound effect on quality of life. Patients with dystonia frequently meet criteria for anxiety disorders, especially social phobia, and major depressive disorder. Deficits in emotional processing have also been demonstrated in some dystonia populations. Onset of psychiatric disturbances in patients with dystonia often precedes onset of motor symptoms, suggesting that the pathophysiology of dystonia itself contributes to the genesis of psychiatric disturbances. This article examines the hypothesis that mood and anxiety disorders are intrinsic to the neurobiology of dystonia, citing the available literature, which is derived mostly from research on focal isolated dystonias. Limitations of studies are identified, and the role of emotional reactivity, especially in the context of pain secondary to dystonia, is recognized. Available evidence underscores the need to develop dystonia assessment tools that incorporate psychiatric measures. Such tools would allow for a better understanding of the full spectrum of dystonia presentations and facilitate research on the treatment of dystonia as well as the treatment of psychiatric illnesses in the context of dystonia. This article, solicited for a special Movement Disorders issue on novel research findings and emerging concepts in dystonia, addresses the following issues: (1) To what extent are psychiatric disturbances related to the pathophysiology of dystonia? (2) What is the impact of psychiatric disturbances on outcome measures of current assessment tools for dystonia? (3) How do psychiatric comorbidities influence the treatment of dystonia? Answers to these questions will lead to an increased appreciation of psychiatric disorders in dystonia, a better understanding of brain physiology, more nuanced research questions pertaining to this population, better clinical scales that can be used to further patient management and research, and improved

  5. 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

  6. 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. PMID:23791463

  7. Prevalence of psychiatric comorbidities in chronic obstructive pulmonary disease patients

    PubMed Central

    Chaudhary, Shyam Chand; Nanda, Satyan; Tripathi, Adarsh; Sawlani, Kamal Kumar; Gupta, Kamlesh Kumar; Himanshu, D; Verma, Ajay Kumar

    2016-01-01

    Introduction: Psychiatric disorders, especially anxiety and depression have been reported to have an increased prevalence in chronic obstructive pulmonary disease (COPD) patients, but there is a paucity of data from India. Aims and Objectives: Aim of our study is to study the frequency of psychiatric comorbidities in COPD patients and their correlation with severity of COPD, as per global initiative for obstructive lung disease guidelines. Materials and Methods: This study was conducted in outpatient department of a tertiary care hospital (King George's Medical University). A total of 74 COPD patients were included in this study and compared with 74 controls. The diagnosis and severity of COPD were assessed by spirometry. Psychiatric comorbidities were assessed using the Mini International Neuropsychiatric Interview questionnaire. Results: The frequency of psychiatric comorbidities was significantly higher (P < 0.05) in COPD patients (28.4%) as compared to controls (2.7%). As regards to severity, the frequency was significantly increased in severe and very severe COPD. The frequency of psychiatric comorbidities in COPD patients increased significantly with the increase in duration of symptoms being present in 67% of patients with duration of symptoms more than 10 years and only 23% of patients with duration of symptoms ≤5 years. Conclusion: The frequency of psychiatric comorbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric comorbidity, if any. PMID:27051106

  8. Comorbid Problem Gambling and Major Depression in a Community Sample.

    PubMed

    Quigley, Leanne; Yakovenko, Igor; Hodgins, David C; Dobson, Keith S; El-Guebaly, Nady; Casey, David M; Currie, Shawn R; Smith, Garry J; Williams, Robert J; Schopflocher, Don P

    2015-12-01

    Major depression is among the most common comorbid conditions in problem gambling. However, little is known about the effects of comorbid depression on problem gambling. The present study examined the prevalence of current major depression among problem gamblers (N = 105) identified from a community sample of men and women in Alberta, and examined group differences in gambling severity, escape motivation for gambling, family functioning, childhood trauma, and personality traits across problem gamblers with and without comorbid depression. The prevalence of major depression among the sample of problem gamblers was 32.4%. Compared to problem gamblers without depression (n = 71), problem gamblers with comorbid depression (n = 34) reported more severe gambling problems, greater history of childhood abuse and neglect, poorer family functioning, higher levels of neuroticism, and lower levels of extraversion, agreeableness, and conscientiousness. Furthermore, the problem gamblers with comorbid depression had greater levels of childhood abuse and neglect, worse family functioning, higher neuroticism, and lower agreeableness and conscientiousness than a comparison sample of recreational gamblers with depression (n = 160). These findings underscore the need to address comorbid depression in assessment and treatment of problem gambling and for continued research on how problem gambling is related to frequently co-occurring disorders such as depression. PMID:25112217

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

    PubMed

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

    2015-12-22

    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 specifically useful for comorbid chronic

  10. 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

  11. Comorbidity delays diagnosis and increases disability at diagnosis in MS

    PubMed Central

    Marrie, R A.; Horwitz, R; Cutter, G; Tyry, T; Campagnolo, D; Vollmer, T

    2009-01-01

    Background: Comorbidity is common in the general population and is associated with adverse health outcomes. In multiple sclerosis (MS), it is unknown whether preexisting comorbidity affects the delay between initial symptom onset and diagnosis (“diagnostic delay”) or the severity of disability at MS diagnosis. Objectives: Using the North American Research Committee on Multiple Sclerosis Registry, we assessed the association between comorbidity and both the diagnostic delay and severity of disability at diagnosis. In 2006, we queried participants regarding physical and mental comorbidities, including date of diagnosis, smoking status, current height, and past and present weight. Using multivariate Cox regression, we compared the diagnostic delay between participants with and without comorbidity at diagnosis. We classified participants enrolled within 2 years of diagnosis (n = 2,375) as having mild, moderate, or severe disability using Patient Determined Disease Steps, and assessed the association of disability with comorbidity using polytomous logistic regression. Results: The study included 8,983 participants. After multivariable adjustment for demographic and clinical characteristics, the diagnostic delay increased if obesity, smoking, or physical or mental comorbidities were present. Among participants enrolled within 2 years of diagnosis, the adjusted odds of moderate as compared to mild disability at diagnosis increased in participants with vascular comorbidity (odds ratio [OR] 1.51, 95% CI 1.12–2.05) or obesity (OR 1.38, 95% CI 1.02–1.87). The odds of severe as compared with mild disability increased with musculoskeletal (OR 1.81, 95% CI 1.25–2.63) or mental (OR 1.62, 95% CI 1.23–2.14) comorbidity. Conclusions: Both diagnostic delay and disability at diagnosis are influenced by comorbidity. The mechanisms underlying these associations deserve further investigation. GLOSSARY BMI = body mass index; EDSS = Expanded Disability Status Scale; MS

  12. Genetic and environmental influences on psychiatric comorbidity: A systematic review

    PubMed Central

    Cerdá, M.; Sagdeo, A.; Johnson, J.; Galea, S.

    2009-01-01

    Background The purpose of this review is to systematically appraise the peer-reviewed literature about the genetic and environmental determinants of psychiatric comorbidity, focusing on four of the most prevalent types of psychopathology: anxiety disorders, depression, conduct disorder and substance abuse. Methods We summarize existing empirical research on the relative contribution that genetic, nonshared and shared environmental factors make to the covariance between disorders, and evidence about specific genes and environmental characteristics that are associated with comorbidity. Results 94 articles met the inclusion criteria and were assessed. Genetic factors play a particularly strong role in comorbidity between major depression and generalized anxiety disorder or posttraumatic stress disorder, while the non-shared environments makes an important contribution to comorbidity in affective disorders. Genetic and non-shared environmental factors also make a moderate-to-strong contribution to the relationship between CD and SA. A range of candidate genes, such as 5HTTLPR, MAOA, and DRD1-DRD4, as well as others implicated in the central nervous system, has been implicated in psychiatric comorbidity. Pivotal social factors include childhood adversity/ life events, family and peer social connections, and socioeconomic and academic difficulties. Limitations Methodological concerns include the use of clinical case-control samples, the focus on a restricted set of individual-level environmental risk factors, and restricted follow-up times. Conclusions Given the significant mental health burden associated with comorbid disorders, population-based research on modifiable risk factors for psychiatric comorbidity is vital for the design of effective preventive and clinical interventions. PMID:20004978

  13. Sex differences in comorbidity at diagnosis of multiple sclerosis

    PubMed Central

    Patten, Scott B.; Tremlett, Helen; Wolfson, Christina; Warren, Sharon; Svenson, Lawrence W.; Jette, Nathalie; Fisk, John

    2016-01-01

    Objective: To determine the prevalence of comorbidity in the multiple sclerosis (MS) population at the time of MS diagnosis. We also compared the prevalence of comorbidity in the MS population to that in a matched cohort from the general population. Methods: Using population-based administrative health data from 4 Canadian provinces, we identified 23,382 incident MS cases and 116,638 age-, sex-, and geographically matched controls. We estimated the prevalence of hypertension, diabetes, hyperlipidemia, heart disease, chronic lung disease, epilepsy, fibromyalgia, inflammatory bowel disease, depression, anxiety, bipolar disorder, and schizophrenia at MS diagnosis using validated case definitions. We compared the populations using rate ratios. Results: Of the MS cases, 16,803 (71.9%) were female. The most prevalent comorbidity was depression (19.1%). Compared to the matched population, all comorbidities except hyperlipidemia were more common in the MS population. Relative to the matched populations, the prevalence of hypertension was 16% higher for women with MS and 48% higher for men with MS, thus there was a disproportionately higher prevalence of hypertension in men with MS than women. Men with MS also had a disproportionately higher prevalence than women with MS for diabetes, epilepsy, depression, and anxiety. Conclusions: Comorbidity is more common than expected in MS, even around the time of diagnosis. The prevalence of psychiatric comorbidity is particularly high and highlights the need for clinical attention to this issue. The observed sex-specific differences in the burden of comorbidity in MS, which differ from those in the matched population, warrant further investigation. PMID:26962066

  14. Age and comorbidity considerations related to radiotherapy and chemotherapy administration.

    PubMed

    Rodrigues, George; Sanatani, Michael

    2012-10-01

    Oncological treatment decision-making is a highly complex enterprise integrating multiple patient, tumor, treatment, and professional factors with the available medical evidence. This management complexity can be exacerbated by the interplay of patient age and comorbid non-cancer conditions that can affect patient quality of life, treatment tolerance, and survival outcomes. Given the expected increase in median age (and associated comorbidity burden) of Western populations over the next few decades, the use of evidence-based therapies that appropriately balance treatment intensity and tolerability to achieve the desired goal of treatment (radical, adjuvant, salvage, or palliative) will be increasingly important to health care systems, providers, and patients. In this review, we highlight the evidence related to age and comorbidity, as it relates to radiotherapy and chemotherapy decision making. We will address evidence as it relates to age and comorbidity considerations separately and also the interplay between the factors. Clinical considerations to adapt radiation and/or chemotherapy treatment to deal with comorbidity challenges will be discussed. Knowledge gaps, future research, and clinical recommendation in this increasingly important field are highlighted as well. PMID:22985810

  15. 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

  16. 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. PMID:27375503

  17. Transcending Psychosis: The Complexity of Comorbidity in Schizophrenia.

    PubMed

    Yum, Sun Young; Hwang, Michael Y; Nasrallah, Henry A; Opler, Lewis A

    2016-06-01

    Schizophrenic illness encompasses diverse clinical phenomena and consists of unclear underlying pathogeneses. For the past century, the comorbidities in schizophrenia have drawn persistent interest and debate due to its high prevalence rate and a need for better management. However, its clinical and biological diversity continue to challenge both the practicing clinicians and researchers. Emerging clinical and research evidence in the past decade suggest a distinct biopsychosocial pathogenesis and unique clinical attributes in some comorbid disorders in patients with schizophrenia. In addition, current evidence also supports improved outcomes with specific assessment and treatment of these subgroup of schizophrenia. The recent changes in DSV-5 and shift in the NIMH focus towards the real world clinical practice and research provide increased impetus to explore the pathogeneses and treatment of schizophrenia with comorbid disorders. PMID:27216903

  18. Comorbid psychiatric and substance abuse disorders: recent treatment research.

    PubMed

    Riggs, Paula; Levin, Frances; Green, Alan I; Vocci, Frank

    2008-01-01

    Psychiatric comorbidity is defined as the co-occurrence of a psychiatric disorder in a patient with a substance use disorder. Psychiatric disorders in substance abuse patients can antedate the substance use disorder or be a consequence of the substance abuse. There is emerging evidence that drug use in adolescence may alter the onset of certain psychiatric disorders in vulnerable individuals. Patients with concurrent comorbid disorders present special challenges for the substance abuse treatment system in terms of diagnosis and management because each disorder has the capability of exacerbating the other. This manuscript is a summary of an ISAM symposium that featured three speakers who discussed the following topics: 1. Etiology and treatment of comorbid psychiatric and substance use disorders in adolescents; 2. Treatment of ADHD and substance use disorders in adults; 3. Effects of substance abuse on the onset, severity, and treatment of schizophrenia. Recommendations for further research will be presented. PMID:19042206

  19. Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria

    PubMed Central

    Hajebi, Ahmad

    2014-01-01

    Objectives. Cooccurring psychiatric disorders influence the outcome and prognosis of gender dysphoria. The aim of this study is to assess psychiatric comorbidities in a group of patients. Methods. Eighty-three patients requesting sex reassignment surgery (SRS) were recruited and assessed through the Persian Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Results. Fifty-seven (62.7%) patients had at least one psychiatric comorbidity. Major depressive disorder (33.7%), specific phobia (20.5%), and adjustment disorder (15.7%) were the three most prevalent disorders. Conclusion. Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity. PMID:25180172

  20. 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

  1. Pregnancy with co-morbidities: Anesthetic aspects during operative intervention

    PubMed Central

    Bajwa, Sukhminder Jit Singh; Bajwa, Sukhwinder Kaur; Ghuman, Gagandeep Singh

    2013-01-01

    The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries. PMID:25885972

  2. Biological effects of bariatric surgery on obesity-related comorbidities.

    PubMed

    Noria, Sabrena F; Grantcharov, Teodor

    2013-02-01

    The prevalence of obesity has increased so rapidly over the last few decades that it is now considered a global epidemic. Obesity, defined as a body mass index (BMI) of 30 or more, is associated with several comorbid conditions that decrease life expectancy and increase health care costs. Diet therapies have been reported to be ineffective in the long-term treatment of obesity, and guidelines for the surgical therapy of morbid obesity (BMI ≥ 40 or BMI ≥ 35 in the presence of substantial comorbidities) have since been established. Considering the number of bariatric surgical procedures has dramatically increased since these guidelines were established, we review the types of bariatric surgical procedures and their impact on diabetes, sleep apnea, dyslipidemia and hypertension - 4 major obesity-related comorbidities. PMID:23351555

  3. Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review

    PubMed Central

    Cohen, Adam L.; McMorrow, Meredith; Walaza, Sibongile; Cohen, Cheryl; Tempia, Stefano; Alexander-Scott, Marissa; Widdowson, Marc-Alain

    2015-01-01

    Infectious diseases and underlying medical conditions common to Africa may affect influenza frequency and severity. We conducted a systematic review of published studies on influenza and the following co-infections or co-morbidities that are prevalent in Africa: dengue, malaria, measles, meningococcus, Pneumocystis jirovecii pneumonia (PCP), hemoglobinopathies, and malnutrition. Articles were identified except for influenza and PCP. Very few studies were from Africa. Sickle cell disease, dengue, and measles co-infection were found to increase the severity of influenza disease, though this is based on few studies of dengue and measles and the measles study was of low quality. The frequency of influenza was increased among patients with sickle cell disease. Influenza infection increased the frequency of meningococcal disease. Studies on malaria and malnutrition found mixed results. Age-adjusted morbidity and mortality from influenza may be more common in Africa because infections and diseases common in the region lead to more severe outcomes and increase the influenza burden. However, gaps exist in our knowledge about these interactions. PMID:26068416

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

    PubMed

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

    2016-04-01

    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

  5. 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. PMID:27199853

  6. 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

  7. 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

  8. 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

  9. [Autism spectrum disorder and substance use disorder: an unknown comorbidity?].

    PubMed

    Singh, S K B; Hellemans, H; Dom, G

    2012-01-01

    We describe the diagnosis and treatment of a patient with autism spectrum disorder (ASD) and substance use disorder (SUD). The patient had been given the dual diagnosis of Asperger’s disorder and SUD. On that basis the approach adopted and the treatment provided seemed appropriate. Little is known about the comorbidity of ASD and SUD and it has hardly been reported in the scientific literature or in clinical practice. Epidemiological research shows that this dual diagnosis occurs in clinical populations. A careful psychiatric diagnosis is important in order to ensure that the comorbidity is recognised at an early stage and treated in an appropriate manner. PMID:23074034

  10. [Anorexia nervosa is frequently associated with psychiatric co-morbidity].

    PubMed

    Panchenko, Anna; Arnfred, Sidse Marie Hemmingsen

    2015-09-21

    Recent literature is explored focusing on the relationship between symptoms of anorexia nervosa (AN) and other psychiatric disorders and lines of treatment. In AN, restrictive subtype, anxiety and obsessive-compulsive disorders are the most frequent co-morbidities. In AN, bulimic subtype, depression, emotional instability/borderline and dependency disorders are most frequent. Psychopharmacological treatment could be tried in cases with AN and co-morbid depression, but otherwise the evidence base is lacking and pharmacological treatment relies on case stories and experience. PMID:26418641

  11. [Comorbid state in coal miners suffering from lumbosacral radiculopathy].

    PubMed

    Yakovleva, N V; Gorbljansky, Yu Yu; Pictushanskaya, T E

    2016-01-01

    The authors considered topics of occupational and general comorbidity of occupational lumbosacral radiculopathy in coal miners (2791 examinees) observed over 1976-2014 in occupational center. In patients having lumbosacral radiculopathy without occupational mixed diseases, the occupational disease was diagnosed at the age 3-5 years younger, and 2-4 years earlier from primary visit. Analysis of occurrence of general comorbid conditions with lumbosacral radiculopathy revealed some regularities: patients manifested with symptoms due to vibration have more frequent arterial hypertension than in those with lumbalgia, whereas in risk group of hearing affected by noise IHD was more possible. PMID:27048141

  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. PMID:26829434

  13. Rationale for hospital-based rehabilitation in obesity with comorbidities.

    PubMed

    Capodaglio, P; Lafortuna, C; Petroni, M L; Salvadori, A; Gondoni, L; Castelnuovo, G; Brunani, A

    2013-06-01

    Severely obese patients affected by two or more chronic conditions which could mutually influence their outcome and disability can be defined as "complex" patients. The presence of multiple comorbidities often represents an obstacle for being admitted to clinical settings for the treatment of metabolic diseases. On the other hand, clinical Units with optimal standards for the treatment of pathological conditions in normal-weight patients are often structurally and technologically inadequate for the care of patients with extreme obesity. The aims of this review paper were to review the intrinsic (anthropometrics, body composition) and extrinsic (comorbidities) determinants of disability in obese patients and to provide an up-to-date definition of hospital-based multidisciplinary rehabilitation programs for severely obese patients with comorbidities. Rehabilitation of such patients require a here-and-now multidimensional, comprehensive approach, where the intensity of rehabilitative treatments depends on the disability level and severity of comorbidities and consists of the simultaneous provision of physiotherapy, diet and nutritional support, psychological counselling, adapted physical activity, specific nursing in hospitals with appropriate organizational and structural competences. PMID:23736902

  14. 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…

  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. 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…

  17. Comorbidities in Heart Failure: Are There Gender Differences?

    PubMed

    Hopper, Ingrid; Kotecha, Dipak; Chin, Ken Lee; Mentz, Robert J; von Lueder, Thomas G

    2016-02-01

    Compared to men, women with heart failure (HF) are often older, smoke less, and have more preserved ejection fraction (EF) and hypertensive HF rather than HF of ischemic etiology. Gender-stratified outcomes on comorbidities data in HF are scarce. Women have traditionally been underrepresented in HF trials. Although data suggest that overall prognosis may be better in women, they experience lower quality of life with greater functional impairment from HF compared to men. Gender differences have been reported for comorbid diabetes, chronic obstructive pulmonary disease, renal dysfunction, anemia, and depression and may explain gender disparity in outcomes. However, possible confounding of comorbidities with known prognostic determinants in HF (such as EF) as well as gender differences in the utilization of medical therapies obscures interpretation. In this review, we will explore the evidence for gender differences in non-cardiovascular comorbidities in HF. Our findings may guide clinicians to individualize HF care, according to best practice, in the hope of improving prognosis for this chronic and debilitating condition. PMID:26829930

  18. 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 Association,…

  19. 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.

  20. 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…

  1. 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…

  2. 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

  3. Genetic variation and shared biological susceptibility underlying comorbidity in neuropsychiatry.

    PubMed

    Palomo, Tomas; Kostrzewa, Richard M; Beninger, Richard J; Archer, Trevor

    2007-07-01

    Genetic factors underlying alcoholism, substance abuse, antisocial and violent behaviour, psychosis, schizophrenia and psychopathy are emerging to implicate dopaminergic and cannabinoid, but also monoaminergic and glutamatergic systems through the maze of promoter genes and polymorphisms. Candidate gene association studies suggest the involvement of a range of genes in different disorders of CNS structure and function. Indices of comorbidity both complicate the array of gene-involvement and provide a substrate of hazardous interactivity. The putative role of the serotonin transporter gene in affective-dissociative spectrum disorders presents both plausible genetic variation and complication of comorbidity The position of genetic variation is further complicated through ethnic, contextual and social factors that provide geometric progressions in the comordity already underlying diagnostic obstacles. The concept of shared biological susceptibility to two or more disorder conditions of comorbidity seems a recurring observation, e.g., bipolar disorder with alcoholism or schizophrenia with alcohol/substance abuse or diabetes with schizopsychotic disorder. Several lines of evidence seem to suggest that the factors influencing variation in one set of symptoms and those affecting one or more disorders are observed to a marked extent which ought to facilitate the search for susceptibility genes in comorbid brain disorders. Identification of regional genetic factors is awaited for a more compelling outline that ought eventually to lead to greater efficacy of symptom-disorder arrangements and an augmentation of current pharmacological treatment therapies. PMID:17513198

  4. Heterogeneity in ADHD: Neuropsychological Pathways, Comorbidity and Symptom Domains

    ERIC Educational Resources Information Center

    Wahlstedt, Cecilia; Thorell, Lisa B.; Bohlin, Gunilla

    2009-01-01

    The aim of the present study was to investigate different neuropsychological impairments and comorbid behavioral problems in relation to symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), studying the independent effects of different functions as well as specific relations to symptoms of hyperactivity/impulsivity and inattention. A…

  5. Comorbid Psychopathology with Autism Spectrum Disorder in Children: An Overview

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Nebel-Schwalm, Marie S.

    2007-01-01

    Comorbidity, the co-occurrence of two or more disorders in the same person, has been a topic receiving considerable attention in the child psychopathology literature overall. Despite many publications in the ADHD, depression and other child literatures, autism spectrum disorder has not received such scrutiny. The purpose of this review will be to…

  6. 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…

  7. 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…

  8. 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)

  9. 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…

  10. Comorbidity of Personality Disorders and Depression: Implications for Treatment.

    ERIC Educational Resources Information Center

    Shea, M. Tracie; And Others

    1992-01-01

    Reviews studies of impact of comorbidity of personality disorders and depression on response to various forms of treatment. Notes that findings support belief that personality disorders are associated with poorer response to treatment for depression. Also notes that limited data available suggest that depression may be positive prognostic…

  11. 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…

  12. Comorbidity in adults with epilepsy--United States, 2010.

    PubMed

    2013-11-01

    Epilepsy, a spectrum disorder characterized by recurring seizures, affects approximately 2.3 million U.S. adults. Epilepsy poses challenges because of uncontrolled seizures, treatment complexity, social disadvantages (e.g., unemployment), and stigma. Persons with epilepsy are at increased risk for early mortality and for comorbidities that can complicate epilepsy management, increase health-care costs, and shorten the lifespan. Numerous studies have described higher rates of psychiatric comorbidity (e.g., depression and anxiety) in persons with epilepsy. However, fewer studies have examined nonpsychiatric comorbidity in a nationally representative U.S. sample of adults with epilepsy. To assess the prevalence of nonpsychiatric comorbidities, CDC analyzed data from the 2010 National Health Interview Survey (NHIS). Adults with epilepsy had a higher prevalence of cardiovascular, respiratory, some inflammatory, and other disorders (e.g., headache, migraine, and various other types of pain) than adults without epilepsy. Public health agencies can work with health-care providers, the Epilepsy Foundation, and other partners to ensure that adults with epilepsy have access to health promotion resources and chronic disease self-management programs. PMID:24172878

  13. 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

  14. 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…

  15. 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

  16. 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

  17. 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

  18. Racial Differences in the Impact of Comorbidities on Survival Among Elderly Men With Prostate Cancer

    PubMed Central

    Putt, Mary; Long, Judith A.; Montagnet, Chantal; Silber, Jeffrey H.; Chang, Virginia W.; Liao, Kaijun; Schwartz, J. Sanford; Pollack, Craig Evan; Wong, Yu-Ning; Armstrong, Katrina

    2009-01-01

    This study investigates differences in the effects of comorbidities on survival in Medicare beneficiaries with prostate cancer. Medicare data were used to assemble a cohort of 65- to 76-year-old Black (n = 6,402) and White (n = 47,458) men with incident localized prostate cancer in 1999 who survived ≥1 year postdiagnosis. Comorbidities were more prevalent among Blacks than among Whites. For both races, greater comorbidity was associated with decreasing survival rates; however, the effect among Blacks was smaller than in Whites. After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comorbidities. Differential effects of comorbidities on survival were also evident when examining different classes of comorbid conditions. Adjusting for treatment had little impact on these results, despite variation in the racial difference in receipt of prostatectomy with differing comorbidity levels. PMID:19357389

  19. Comorbid Psychopathology in Adults with Autism Spectrum Disorders and Intellectual Disabilities

    ERIC Educational Resources Information Center

    LoVullo, Santino V.; Matson, Johnny L.

    2009-01-01

    There is an abundance of research investigating Autism Spectrum Disorders (ASD) in children; however, little emphasis has been placed on ASD in adults, especially in regards to comorbid psychopathology. Although scales are available that measure comorbidity in adults with ID, what is needed are scales that measure comorbidity in adults with ID and…

  20. 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…

  1. The impact of comorbidity profiles on clinical and psychosocial functioning in childhood anxiety disorders.

    PubMed

    Johnco, Carly J; Salloum, Alison; Lewin, Adam B; McBride, Nicole M; Storch, Eric A

    2015-09-30

    Despite the high rates of comorbidity in pediatric anxiety disorder samples, there are few studies that systematically examine differences in clinical and psychosocial functioning between different comorbidity profiles. Those that have, typically combine youth with comorbid conduct problem and those with comorbid ADHD, despite likely differences in the etiology and course of these conditions. This study compared the profile of children with a primary anxiety disorder without comorbidity to those with different comorbidity profiles in a treatment-seeking sample of 111 children recruited from community mental health settings. Anxiety severity and depressive symptomatology did not vary by comorbidity profile. Anxious children without comorbidity had lower levels of attention problems, rule breaking, aggressive and externalizing behaviors compared to the comorbid ADHD and comorbid conduct problems groups, as well as lower levels of functional impairment and social problems. There were some differences in clinical phenomenology and psychosocial functioning between the comorbid ADHD and comorbid conduct problems groups, with the conduct problems group having higher levels of rule breaking, aggressive and externalizing behaviors, as well as higher levels of functional impairment, providing preliminary evidence of separate clinical profiles. PMID:26205632

  2. Comorbidity among Anxiety Disorders: Implications for Treatment and DSM-IV.

    ERIC Educational Resources Information Center

    Brown, Timothy A.; Barlow, David H.

    1992-01-01

    Considers definitional, methodological, and theoretical issues of comorbidity, then reviews data on comorbidity among anxiety disorders as well as data on comorbidity of anxiety disorders with depressive, personality, and substance use disorders. Presents treatment implications with preliminary data on effects of psychosocial treatment of panic…

  3. Substance abuse and post-traumatic stress disorder comorbidity.

    PubMed

    Brown, P J; Wolfe, J

    1994-03-01

    This article reviews the extant literature on substance abusers with and without a comorbid diagnosis of post-traumatic stress disorder (PTSD) and reveals the discontinuity between clinical lore and empirical research. Included is an overview of PTSD-substance abuse theoretical models and comorbidity prevalence rates, as well as an evaluation of the comparative data on treatment outcome and psychosocial factors, such as coping skills, for PTSD versus non-PTSD substance abusers. In addition, we discuss the controversy surrounding sequential versus simultaneous treatment approaches for such 'dually-diagnosed' patients. We conclude by identifying gaps in current knowledge about the nature and impact of PTSD on substance abuse treatment outcome and outlining needs for future research. PMID:8082556

  4. Molecular and clinical diseasome of comorbidities in exacerbated COPD patients.

    PubMed

    Faner, Rosa; Gutiérrez-Sacristán, Alba; Castro-Acosta, Ady; Grosdidier, Solène; Gan, Wenqi; Sánchez-Mayor, Milagros; Lopez-Campos, Jose Luis; Pozo-Rodriguez, Francisco; Sanz, Ferran; Mannino, David; Furlong, Laura I; Agusti, Alvar

    2015-10-01

    The frequent occurrence of comorbidities in patients with chronic obstructive pulmonary disease (COPD) suggests that they may share pathobiological processes and/or risk factors.To explore these possibilities we compared the clinical diseasome and the molecular diseasome of 5447 COPD patients hospitalised because of an exacerbation of the disease. The clinical diseasome is a network representation of the relationships between diseases, in which diseases are connected if they co-occur more than expected at random; in the molecular diseasome, diseases are linked if they share associated genes or interaction between proteins.The results showed that about half of the disease pairs identified in the clinical diseasome had a biological counterpart in the molecular diseasome, particularly those related to inflammation and vascular tone regulation. Interestingly, the clinical diseasome of these patients appears independent of age, cumulative smoking exposure or severity of airflow limitation.These results support the existence of shared molecular mechanisms among comorbidities in COPD. PMID:26250499

  5. Adult ADHD Among NSW Prisoners: Prevalence and Psychiatric Comorbidity.

    PubMed

    Moore, Elizabeth; Sunjic, Sandra; Kaye, Sharlene; Archer, Vicki; Indig, Devon

    2013-10-17

    Objective: Given the paucity of research among prisoners, this study aimed to examine the prevalence and psychiatric comorbidity associated with adult ADHD. Method: The study was conducted at four NSW correctional facilities (2 male; 2 female). Results: Thirty-five percent of the sample screened positive for adult ADHD, and 17% of the sample met criteria for a full diagnosis. After adjustment, benzodiazepine dependence, borderline personality disorder, social phobia, antisocial personality disorder, and a number of lifetime psychological disorders remained significantly and independently associated with the diagnosis of adult ADHD. Lowering the threshold on the ADHD Self-Rating Scale to ≥3 (vs. ≥4) increased the sensitivity (80%-93%), but lowered the specificity (55%-47%). Conclusion: Adult ADHD among NSW prisoners is elevated, with substance use disorders and psychiatric comorbidity common. A greater acceptance of this disorder among prisoners, and appropriate treatment, is warranted. (J. of Att. Dis. XXXX; XX(X) XX-XX). PMID:24134874

  6. Strategies to deal with comorbid physical illness in psychosis.

    PubMed

    Docherty, M; Stubbs, B; Gaughran, F

    2016-06-01

    Individuals with serious mental illnesses such as psychosis still experience higher mortality rates than the general population, decades after data have linked the gap to increased rates of physical illness, delayed diagnosis, low treatment rates and worse outcomes from treatment received. The nature of the relationship between psychosis and comorbid physical illness is complex. Multiple strategies directed at different levels of disease process, health care systems and stakeholder culture are likely required to make sustained progress in reducing the mortality gap. Evidence for strategies that effectively reduce the burden of physical co-morbidity and lead to improved health outcomes are still in their infancy but growing at a reassuringly fast rate. This editorial considers the existing evidence base and makes suggestions for the development and future direction of this urgent research agenda and how this knowledge can be implemented in clinical practice. PMID:26888363

  7. Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis

    PubMed Central

    Terzi, Rabia

    2014-01-01

    Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISH-related events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH. PMID:25232544

  8. Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis.

    PubMed

    Terzi, Rabia

    2014-09-16

    Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISH-related events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH. PMID:25232544

  9. Common Mechanisms Underlying Epileptogenesis and the Comorbidities of Epilepsy.

    PubMed

    Mazarati, Andrey; Sankar, Raman

    2016-01-01

    The importance of comorbidities in determining the quality of life of individuals with epilepsy and their families has received increasing attention in the past decade. Along with it has come a recognition that in some individuals, certain comorbidities may have preexisted, and may have contributed to their developing epilepsy. Many mechanisms are capable of interconnecting different dysfunctions that manifest as distinct disorders, often diagnosed and managed by different specialists. We review the human data from the perspective of epidemiology as well as insights gathered from neurodiagnostic and endocrine studies. Animal studies are reviewed to refine our mechanistic understanding of the connections, because they permit the narrowing of variables, which is not possible when studying humans. PMID:27371669

  10. An Adolescent Boy with Comorbid Anorexia Nervosa and Hashimoto Thyroiditis.

    PubMed

    Pehlivantürk Kızılkan, Melis; Kanbur, Nuray; Akgül, Sinem; Alikaşifoğlu, Ayfer

    2016-03-01

    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

  11. Perioperative management of patient with alkaptonuria and associated multiple comorbidities

    PubMed Central

    Pandey, Ravindra; Kumar, Anil; Garg, Rakesh; Khanna, Puneet; Darlong, Vanlal

    2011-01-01

    Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott's spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine. PMID:21772695

  12. 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". PMID:26775235

  13. 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

  14. 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. PMID:27025465

  15. 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

  16. Gender-Based Comorbidity in Benign Paroxysmal Positional Vertigo

    PubMed Central

    Ogun, Oluwaseye Ayoola; Janky, Kristen L.; Cohn, Edward S.; Büki, Bela; Lundberg, Yunxia Wang

    2014-01-01

    It has been noted that benign paroxysmal positional vertigo (BPPV) may be associated with certain disorders and medical procedures. However, most studies to date were done in Europe, and epidemiological data on the United States (US) population are scarce. Gender-based information is even rarer. Furthermore, it is difficult to assess the relative prevalence of each type of association based solely on literature data, because different comorbidities were reported by various groups from different countries using different patient populations and possibly different inclusion/exclusion criteria. In this study, we surveyed and analyzed a large adult BPPV population (n = 1,360 surveyed, 227 completed, most of which were recurrent BPPV cases) from Omaha, NE, US, and its vicinity, all diagnosed at Boys Town National Research Hospital (BTNRH) over the past decade using established and consistent diagnostic criteria. In addition, we performed a retrospective analysis of patients’ diagnostic records (n = 1,377, with 1,360 adults and 17 children). The following comorbidities were found to be significantly more prevalent in the BPPV population when compared to the age- and gender-matched general population: ear/hearing problems, head injury, thyroid problems, allergies, high cholesterol, headaches, and numbness/paralysis. There were gender differences in the comorbidities. In addition, familial predisposition was fairly common among the participants. Thus, the data confirm some previously reported comorbidities, identify new ones (hearing loss, thyroid problems, high cholesterol, and numbness/paralysis), and suggest possible predisposing and triggering factors and events for BPPV. PMID:25187992

  17. Children's Hospital Association Consensus Statements for Comorbidities of Childhood Obesity

    PubMed Central

    Eneli, Ihuoma; Hampl, Sarah; Mietus-Snyder, Michele; Mirza, Nazrat; Rhodes, Erinn; Sweeney, Brooke; Tinajero-Deck, Lydia; Woolford, Susan J.; Pont, Stephen J.

    2014-01-01

    Abstract Background: Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this article is to provide accessible, user-friendly clinical consensus statements to facilitate the screening, interpretation of results, and early treatment for some of the most common childhood obesity comorbidities. Methods: Members of the Children's Hospital Association (formerly NACHRI) FOCUS on a Fitter Future II (FFFII), a collaboration of 25 US pediatric obesity centers, used a combination of the best available evidence and collective clinical experience to develop consensus statements for pediatric obesity-related comorbidities. FFFII also surveyed the participating pediatric obesity centers regarding their current practices. Results: The work group developed consensus statements for use in the evaluation and treatment of lipids, liver enzymes, and blood pressure abnormalities and PCOS in the child with overweight and obesity. The results of the FFFII survey illustrated the variability in the approach for initial evaluation and treatment as well as pattern of referrals to subspecialists among programs. Conclusions: The consensus statements presented in this article can be a useful tool for PCPs in the management and overall care of children with overweight and obesity. PMID:25019404

  18. Prevalence of Vitiligo and Associated Comorbidities in Korea

    PubMed Central

    Lee, Hemin; Lee, Mu-Hyoung; Lee, Dong Youn; Kang, Hee Young; Kim, Ki Ho; Choi, Gwang Seong; Shin, Jeonghyun; Lee, Hee Jung; Kim, Dong Hyun; Kim, Tae Heung; Lee, Ai-Young; Lee, Seung Chul; Lee, Sanghoon; Kim, Kyoung Wan; Hann, Seung-Kyung

    2015-01-01

    Purpose Vitiligo prevalence and its associated comorbidities rate have been reported variably among different populations. We aimed to determine the prevalence of vitiligo in Korea along with the baseline rate of comorbidities and compared the risks to the general population using hospital visit information of the total population in Korea. Materials and Methods We assessed demographic characteristics of vitiligo patients in Korean population from 2009 to 2011 in a nationwide data from Health Insurance Review Assessment Service. Patients who had at least one visit to Korea's primary, secondary, or tertiary referral hospitals with International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code for vitiligo were identified. As a supplementary study, comorbidities associated with vitiligo were selected for further review to calculate relative risks compared to the general population. Results The annual prevalence of vitiligo determined by hospital-visiting rate in Korea was 0.12% to 0.13% over a three year period. In sync with other previous epidemiological studies, there was bimodal distribution among the age groups and no difference between genders. Also, vitiligo in Korean population was associated with various autoimmune/non-autoimmune diseases such as thyroiditis, atopic dermatitis, and psoriasis. Conclusion This study was by far the most comprehensive review on prevalence of vitiligo using a data of total population in Korea. The prevalence is within a range of those reported in previous literatures, and increased risk of comorbidities such as thyroid diseases and psoriasis in vitiligo might aid clinicians in the initial work up of vitiligo patients and concurrent follow ups. PMID:25837178

  19. Suicidal behavior in adolescents with comorbid depression and alcohol abuse.

    PubMed

    Ganz, D; Sher, L

    2009-06-01

    Depression, alcohol abuse and suicidality each continue to threaten adolescent populations throughout the world. The comorbidity between these diseases has been found to be up to 73% with consistent positive correlations between adolescent drinking, depression and suicidality. Alcohol abuse, depression and suicidal behavior in adolescents have also been found to have biochemical and genetic correlates. This article explores the contributing and causative factors and directional models underlying such prevalent comorbidities. Alcohol use is shown to be both a distal and proximal cause of suicide attempts in adolescent populations. Individuals with both alcoholism and depression who attempt or complete suicide often present with significantly high levels of aggression and impulsivity. These factors may be caused or nuanced by poor or underdeveloped coping skills as well as other comorbid psychiatric conditions. Such behaviors, alone or in comorbidity, may be a consequence of childhood abuse, social pressures, low self-esteem and/or delinquency- all of which may be particularly salient among adolescent populations. Such adolescent stressors are implicated as the cause for the self-medication model. Some studies suggest that depression encourages alcohol use as self-medication and then leads to suicidality, while others imply that the initial alcohol consumption is responsible for increasing depressive and suicidal symptoms in adolescents. This article discusses the social stigma associated with alcoholism, depression and suicidality, and how that may serve to enhance these disorders in adolescent populations. Many directional models are presented based on past research and as suggestions for future research. There is a lot that can be done by clinicians, legal and educational professionals and society at large that may help to prevent and treat such problems. PMID:19461576

  20. 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

  1. Development of a Comorbidity Index for Use in Obstetric Patients

    PubMed Central

    Bateman, Brian T.; Mhyre, Jill M.; Hernandez-Diaz, Sonia; Huybrechts, Krista F.; Fischer, Michael A.; Creanga, Andreea A.; Callaghan, William M.; Gagne, Joshua J.

    2013-01-01

    Objective To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality. Methods Data were derived from the Medicaid Analytic eXtract for the years 2000 to 2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The dataset was randomly divided into a 2/3 development cohort and a 1/3 validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index. Results The cohort included 854,823 completed pregnancies of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37, 95% Confidence Interval (CI) 1.35 to 1.39. The c-statistic for this model was 0.657, 95% CI 0.647 – 0.666. The derived score performed significantly better than available comorbidity indexes in predicting maternal morbidity and mortality. Conclusion This new maternal morbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research. PMID:24104771

  2. How I treat acute myeloid leukemia presenting with preexisting comorbidities.

    PubMed

    Ofran, Yishai; Tallman, Martin S; Rowe, Jacob M

    2016-07-28

    Acute myeloid leukemia (AML) is a devastating disease with an incidence that progressively increases with advancing age. Currently, only ∼40% of younger and 10% of older adults are long-term survivors. If untreated, the overall prognosis of AML remains dismal. Initiation of therapy at diagnosis is usually urgent. Barriers to successful therapy for AML are the attendant toxicities directly related to chemotherapy or those associated with inevitable aplasia. Organ dysfunction often further complicates such toxicities and may even be prohibitive. There are few guidelines to manage such patients and the fear of crossing the medico-legal abyss may dominate. Such clinical scenarios provide particular challenges and require experience for optimal management. Herein, we discuss select examples of common pretreatment comorbidities, including cardiomyopathy, ischemic heart disease; chronic renal failure, with and without dialysis; hepatitis and cirrhosis; chronic pulmonary insufficiency; and cerebral vascular disease. These comorbidities usually render patients ineligible for clinical trials and enormous uncertainty regarding management reigns, often to the point of withholding definitive therapy. The scenarios described herein emphasize that with appropriate subspecialty support, many AML patients with comorbidities can undergo therapy with curative intent and achieve successful long-term outcome. PMID:27235136

  3. Living Well With Medical Comorbidities: A Biopsychosocial Perspective

    PubMed Central

    Ryff, Carol D.

    2012-01-01

    Objectives. We take a biopsychosocial perspective on age-related diseases by examining psychological correlates of having multiple chronic conditions and determining whether positive psychological functioning predicts advantageous profiles of biological risk factors. Method. Respondents to the national survey of Midlife in the United States who participated in clinical assessments of health and biological processes (n = 998) provided information on chronic medical conditions and multiple domains of psychological functioning. Serum concentrations of interleukin-6 (IL-6) and C-reactive protein (CRP) were determined from fasting blood samples. Results. Life satisfaction declined with increasing comorbidity while negative affect increased. In contrast, positive affect, purpose in life, and positive relations with others were unrelated to comorbidity status. Significant interactions showed that although IL-6 and CRP increased with increasing number of chronic conditions, respondents with higher levels of purpose in life, positive relations with others, and (in the case of CRP) positive affect had lower levels of inflammation compared with those with lower well-being scores. Discussion. The results suggest that many older adults with medical comorbidities maintain high levels of positive psychological functioning that are in turn linked to better profiles of biological disease risk. PMID:22377799

  4. Autism Spectrum Disorder Symptoms and Comorbidity in Emerging Adults.

    PubMed

    Gadke, Daniel L; McKinney, Cliff; Oliveros, Arazais

    2016-04-01

    Autism spectrum disorder (ASD) continues to grow in prevalence each passing year. As more children are diagnosed, it makes sense that the emerging adult and adult population with ASD also will continue to grow. Although the body of research is quite large for children with ASD, the literature for emerging adults with ASD is sparse in comparison. The current study aimed to extend existing literature further by beginning to explore the realm of emerging adulthood. Specifically, the study investigated the presence of comorbid psychiatric symptoms in emerging adults who also presented with ASD symptoms as measured by the Adult Self-Report (Rescorla and Achenbach in The Achenbach System of Empirically Based Assessment (ASEBA) for ages 18 to 90 years. The use of psychological testing for treatment planning and outcomes assessment: volume 3: instruments for adults, 3rd edn. Lawrence Erlbaum Associates, Mahwah, pp 115-152, 2004). Emerging adults were categorized as having normal, mild, moderate, or severe levels of ASD symptoms and were compared for the presence of comorbid psychiatric symptoms. Overall, results suggested that emerging adults who presented with greater ASD symptom severity were more likely to experience the presence of additional comorbid symptoms. PMID:25995020

  5. Management of diabetes mellitus in older people with comorbidities.

    PubMed

    Huang, Elbert S

    2016-01-01

    Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management. PMID:27307175

  6. Psychological Co-morbidity in Children with Specific Learning Disorders.

    PubMed

    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

  7. Body Mass Index and Comorbidities in Adult Severe Asthmatics

    PubMed Central

    Bruno, Andreina; Pace, Elisabetta; Cibella, Fabio; Chanez, Pascal

    2014-01-01

    Both severe asthma and obesity are growing health problems. Severe asthma leads to a poor quality of life. The relationship among BMI, comorbidities, and severe asthma control in adults is still unclear. The aim of the study is to better understand the effect of the comorbidities as atopy, type II diabetes, OSAS, gastroesophageal reflux, hypertension, cardiovascular diseases, osteoporosis, infections, and psychological factors with BMI on asthma control in a cohort of adult severe asthmatics. One hundred and two patients were enrolled in a cross-sectional study assessing asthma control, treatments, pulmonary function, inflammatory markers, and comorbidities. Patients were divided into 3 classes according to BMI: normal weight, overweight, and obese. We found that the optimal state of asthma control is lower. whereas the score of Asthma Control Questionnaire, the number of asthma exacerbations during last year, the oral corticosteroids requirement during the previous year, and the LABA treatments are higher in obese than in overweight and normal weight severe asthmatics. The number of subjects with type II diabetes and OSAS are higher among obese and overweight patients than in normal weight asthmatics. In conclusion, BMI represents per se a factor for the deterioration in disease control in severe asthma. PMID:24987694

  8. Apolipoprotein E Related Co-Morbidities and Alzheimer's Disease.

    PubMed

    Singhrao, Sim K; Harding, Alice; Chukkapalli, Sasanka; Olsen, Ingar; Kesavalu, Lakshmyya; Crean, StJohn

    2016-01-01

    The primary goal of advancement in clinical services is to provide a health care system that enhances an individual's quality of life. Incidence of diabetes mellitus, cardiovascular disease, and associated dementia coupled with the advancing age of the population, have led to an increase in the worldwide challenge to the healthcare system. In order to overcome these challenges, prior knowledge of common, reliable risk factors and their effectors is essential. Oral health constitutes one such relatively unexplored but indispensable risk factor for aforementioned co-morbidities, in the form of poor oral hygiene and tooth loss during aging. Behavioral traits such as low education, smoking, poor diet, neglect of oral health, lack of exercise, and hypertension are few of the risk factors that are shared commonly among these conditions. In addition, common genetic susceptibility traits such as the apolipoprotein E gene, together with an individual's lifestyle can also influence the development of co-morbidities such as periodontitis, atherosclerosis/stroke, diabetes, and Alzheimer's disease. This review specifically addresses the susceptibility of apolipoprotein E gene allele 4 as the plausible commonality for the etiology of co-morbidities that eventually result from periodontal diseases and ultimately progress to dementia. PMID:26923007

  9. Quantifying comorbidity in individuals with COPD: a population study.

    PubMed

    Gershon, Andrea S; Mecredy, Graham C; Guan, Jun; Victor, J Charles; Goldstein, Roger; To, Teresa

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) has been associated with many types of comorbidity. We aimed to quantify the real world impact of COPD on lower respiratory tract infection, cardiovascular disease, diabetes, psychiatric disease, musculoskeletal disease and cancer, and their impact on COPD through health services. A population study using health administrative data from Ontario, Canada, in 2008-2012 was conducted. Absolute and adjusted relative rates of ambulatory care visits, emergency department visits and hospitalisations for the comorbidities of interest in people with and without COPD were determined and compared. Among 7 241 591 adults, 909 948 (12.6%) had COPD. Over half of all lung cancer, a third of all lower respiratory tract infection and cardiovascular disease, a quarter of all low trauma fracture, and a fifth of all psychiatric, musculoskeletal, non-lung cancer and diabetes ambulatory care visits, emergency department visits and hospitalisations in Ontario were used by people with COPD. Individuals with COPD used about five times more health services for lung cancer, and two times more health services for lower respiratory tract infections and cardiovascular disease than people without COPD. Individuals with COPD use a disproportionate amount of health services for comorbid disease, placing significant burden on the healthcare system. PMID:25142481

  10. Cough in the Elderly Population: Relationships with Multiple Comorbidity

    PubMed Central

    Song, Woo-Jung; Morice, Alyn H.; Kim, Min-Hye; Lee, Seung-Eun; Jo, Eun-Jung; Lee, Sang-Min; Han, Ji-Won; Kim, Tae Hui; Kim, Sae-Hoon; Jang, Hak-Chul; Kim, Ki Woong; Cho, Sang-Heon; Min, Kyung-Up; Chang, Yoon-Seok

    2013-01-01

    Background The epidemiology of cough in the elderly population has not been studied comprehensively. The present study aimed to investigate the epidemiology of cough in a community elderly population, particularly in relation with their comorbidity. Methods A cross-sectional analysis was performed using a baseline dataset from the Korean Longitudinal Study on Health and Aging, a community-based elderly population cohort study. Three types of cough (frequent cough, chronic persistent cough, and nocturnal cough) were defined using questionnaires. Comorbidity was examined using a structured questionnaire. Health-related quality of life was assessed using the Short Form 36 questionnaire. Results The prevalence was 9.3% for frequent cough, 4.6% for chronic persistent cough, and 7.3% for nocturnal cough. In multivariate logistic regression analyses, smoking, asthma and allergic rhinitis were found to be risk factors for cough in the elderly. Interestingly, among comorbidities, constipation and uncontrolled diabetes mellitus (HbA1c ≥ 8%) were also found to have positive associations with elderly cough. In the Short Form 36 scores, chronic persistent cough was independently related to impairment of quality of life, predominantly in the mental component. Conclusions Cough has a high prevalence and is detrimental to quality of life in the elderly. Associations with smoking, asthma and rhinitis confirmed previous findings in younger populations. Previously unrecognised relationships with constipation and uncontrolled diabetes mellitus suggested the multi-faceted nature of cough in the elderly. PMID:24205100

  11. 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

  12. Epidemiology and clinical impact of major comorbidities in patients with COPD

    PubMed Central

    Smith, Miranda Caroline; Wrobel, Jeremy P

    2014-01-01

    Comorbidities are frequent in chronic obstructive pulmonary disease (COPD) and significantly impact on patients’ quality of life, exacerbation frequency, and survival. There is increasing evidence that certain diseases occur in greater frequency amongst patients with COPD than in the general population, and that these comorbidities significantly impact on patient outcomes. Although the mechanisms are yet to be defined, many comorbidities likely result from the chronic inflammatory state that is present in COPD. Common problems in the clinical management of COPD include recognizing new comorbidities, determining the impact of comorbidities on patient symptoms, the concurrent treatment of COPD and comorbidities, and accurate prognostication. The majority of comorbidities in COPD should be treated according to usual practice, and specific COPD management is infrequently altered by the presence of comorbidities. Unfortunately, comorbidities are often under-recognized and under-treated. This review focuses on the epidemiology of ten major comorbidities in patients with COPD. Further, we emphasize the clinical impact upon prognosis and management considerations. This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD. PMID:25210449

  13. Comorbid conditions are associated with healthcare utilization, medical charges and mortality of patients with rheumatoid arthritis.

    PubMed

    Han, Guang-Ming; Han, Xiao-Feng

    2016-06-01

    This study aims to examine the associations between comorbid conditions and healthcare utilization, medical charges, or mortality of patients with rheumatoid arthritis (RA). Nebraska state emergency department (ED) discharge, hospital discharge, and death certificate data from 2007 to 2012 were used to study the comorbid conditions of patients with RA. RA was defined using the standard International Classification of Diseases (ICD-9-CM 714 or ICD-10-CM M05, M06, and M08). There were more comorbid conditions in patients with RA than in patients without RA. Comorbid conditions were majorly related to healthcare utilization and mortality of patients with RA. In addition to injury, fracture, sprains, and strains, symptoms of cardiovascular and digestive systems, respiratory infection, and chronic obstructive pulmonary disease (COPD) were common comorbid conditions for ED visits. In addition to joint replacement and fracture, infections, COPD and cardiovascular comorbidities were common comorbid conditions for hospitalizations. Cardiovascular, cerebrovascular, and respiratory comorbidities, dementia, malignant neoplasm, and diabetes mellitus were common comorbid conditions for deaths of patients with RA. In addition, the numbers of comorbid conditions were significantly associated with the length of hospital stay and hospital charges for patients with RA. The findings in this study indicated that comorbid conditions are associated with healthcare utilization, medical charges, and mortality of patients with RA. PMID:27106546

  14. Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management

    PubMed Central

    Putcha, Nirupama; Drummond, M. Bradley; Wise, Robert A.; Hansel, Nadia N.

    2016-01-01

    Comorbidities impact a large proportion of patients with chronic obstructive pulmonary disease (COPD), with over 80% of patients with COPD estimated to have at least one comorbid chronic condition. Guidelines for the treatment of COPD are just now incorporating comorbidities to their management recommendations of COPD, and it is becoming increasingly clear that multimorbidity as well as specific comorbidities have strong associations with mortality and clinical outcomes in COPD, including dyspnea, exercise capacity, quality of life, healthcare utilization, and exacerbation risk. Appropriately, there has been an increased focus upon describing the burden of comorbidity in the COPD population and incorporating this information into existing efforts to better understand the clinical and phenotypic heterogeneity of this group. In this article, we summarize existing knowledge about comorbidity burden and specific comorbidities in COPD, focusing on prevalence estimates, association with outcomes, and existing knowledge about treatment strategies. PMID:26238643

  15. Neuropsychiatric co-morbidities in non-demented Parkinson's disease

    PubMed Central

    Rai, Nirendra Kumar; Goyal, Vinay; Kumar, Nand; Shukla, Garima; Srivastava, Achal Kumar; Singh, Sumit; Behari, Madhuri

    2015-01-01

    Objective: To evaluate neuropsychiatric co-morbidities (depression, psychosis and anxiety) in non-demented patients with Parkinson's disease (PD). Background: Non-motor symptoms like neuropsychiatric co-morbidities are common in Parkinson's disease and may predate motor symptoms. Currently there is scarcity of data regarding neuropsychiatry manifestations in Indian patients with PD. Methods: In this cross-sectional study consecutive 126 non-demented patients with PD (MMSE ≥25) were enrolled. They were assessed using Unified Parkinson's disease rating scale (UPDRS), Hoehn & Yahr (H&Y) stage, Schwab and England (S&E) scale of activity of daily life. Mini-international neuropsychiatric interview (MINI) was used for diagnosis of depression, psychosis and anxiety. Beck's depression inventory (BDI), Brief psychiatric rating scale (BSRS) and Hamilton rating scale for anxiety (HAM-A) scales were used for assessment of severity of depression, psychosis and anxiety respectively. Results: Mean age and duration of disease was 57.9 ± 10.9 years and 7.3 ± 3.6 years respectively. At least one of the neuropsychiatric co-morbidity was present in 64% patients. Depression, suicidal risk, psychosis and anxiety were present in 43.7%, 31%, 23.8% and 35.7% respectively. Visual hallucinations (20.6%) were most frequent, followed by tactile (13.5%), auditory (7.2%) and olfactory hallucinations (1.6%). Patients with depression had higher motor disability (UPDRS-motor score 33.1 ± 14.0 vs 27.3 ± 13.3; and UPDRS-total 50.7 ± 21.8 vs 41.0 ± 20.3, all p values <0.05). Patients with psychosis were older (63.6 ± 8.0 years vs 56.1 ± 11.1 years, p < 0.05) and had longer duration of illness (8.6 ± 3.4 years vs 6.9 ± 3.5, p < 0.05). Conclusions: About two third patients with Parkinson's disease have associated neuropsychiatric co-morbidities. Depression was more frequent in patients with higher disability and psychosis with longer duration of disease and older age. These co-morbidities

  16. Survival in COPD: impact of lung dysfunction and comorbidities.

    PubMed

    Miniati, Massimo; Monti, Simonetta; Pavlickova, Ivana; Bottai, Matteo

    2014-09-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in industrialized countries. Recent studies investigated the impact of comorbidities on the survival in COPD, but most of them lacked a referent group of comorbidity-matched, nonobstructed individuals.We examined the 10-year mortality in a sample of 200 COPD patients and 201 nonobstructed controls. They were part of a larger cohort enrolled in a European case-control study aimed at assessing genetic susceptibility to COPD. By design, the COPD group included patients with a forced expiratory volume in 1 second (FEV1) ≤70% predicted. Cases and controls were matched on age, sex, and cumulative smoking history, and shared a nearly identical prevalence of cardiovascular and metabolic disorders. We estimated the hazard of death with Cox regression and percentiles of survival with Laplace regression. COPD was the main exposure variable of interest. Five comorbidities (hypertension, coronary artery disease, prior myocardial infarction, chronic heart failure, and diabetes) were included as covariates in multiple regression models.The all-cause mortality rate was significantly higher in cases than in controls (43% vs 16%, P < 0.001). The unadjusted hazard of death for COPD was 3-fold higher than the referent category (P < 0.001), and remained nearly unchanged after introducing the 5 comorbidities in multiple regression. Patients with COPD had significantly shorter survival percentiles than comorbidity-matched controls (P < 0.001). Notably, 15% of the nonobstructed controls died by 10.3 years into the study; the same proportion of COPD patients had died some 6 years earlier, at 4.6 years.In a separate analysis, we split the whole sample into 2 groups based on the lower tertile of FEV1 and carbon monoxide lung diffusing capacity (DLCO). The hazard of death for COPD patients with low FEV1 and DLCO was nearly 3.5-fold higher than in all the others (P < 0.001), and decreased

  17. Survival in COPD: Impact of Lung Dysfunction and Comorbidities

    PubMed Central

    Miniati, Massimo; Monti, Simonetta; Pavlickova, Ivana; Bottai, Matteo

    2014-01-01

    Abstract Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in industrialized countries. Recent studies investigated the impact of comorbidities on the survival in COPD, but most of them lacked a referent group of comorbidity-matched, nonobstructed individuals. We examined the 10-year mortality in a sample of 200 COPD patients and 201 nonobstructed controls. They were part of a larger cohort enrolled in a European case–control study aimed at assessing genetic susceptibility to COPD. By design, the COPD group included patients with a forced expiratory volume in 1 second (FEV1) ≤70% predicted. Cases and controls were matched on age, sex, and cumulative smoking history, and shared a nearly identical prevalence of cardiovascular and metabolic disorders. We estimated the hazard of death with Cox regression and percentiles of survival with Laplace regression. COPD was the main exposure variable of interest. Five comorbidities (hypertension, coronary artery disease, prior myocardial infarction, chronic heart failure, and diabetes) were included as covariates in multiple regression models. The all-cause mortality rate was significantly higher in cases than in controls (43% vs 16%, P < 0.001). The unadjusted hazard of death for COPD was 3-fold higher than the referent category (P < 0.001), and remained nearly unchanged after introducing the 5 comorbidities in multiple regression. Patients with COPD had significantly shorter survival percentiles than comorbidity-matched controls (P < 0.001). Notably, 15% of the nonobstructed controls died by 10.3 years into the study; the same proportion of COPD patients had died some 6 years earlier, at 4.6 years. In a separate analysis, we split the whole sample into 2 groups based on the lower tertile of FEV1 and carbon monoxide lung diffusing capacity (DLCO). The hazard of death for COPD patients with low FEV1 and DLCO was nearly 3.5-fold higher than in all the others (P < 0

  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. The high comorbidity burden of the hepatitis C virus infected population in the United States

    PubMed Central

    2012-01-01

    Background Chronic hepatitis C (HCV) disease can be complicated with comorbid conditions that may impact treatment eligibility and outcomes. The aim of the study was to systematically review comorbidities and symptoms in an HCV infected population, specifically assessing comorbidities associated with HCV anti-viral treatment and disease, as well as comparing comorbidities between an HCV infected and uninfected control population. Methods This was a retrospective cohort study within a United States medical claims database among patients with chronic HCV designed to estimate the two-year period prevalence of comorbidities. Patients with two HCV diagnosis codes, 24 months of continuous health insurance coverage, and full medical and pharmacy benefits were included. Results Among a chronic HCV cohort of 7411 patients, at least one comorbid condition was seen in almost all patients (> 99%) during the study period. HCV-infected patients reported almost double the number of comorbidities compared to uninfected controls. Of the 25 most common comorbidities, the majority of the comorbidities (n = 22) were known to be associated with either HCV antiviral treatment or disease. The five most frequent comorbidities were liver disease [other] (37.5%), connective tissue disease (37.5%), abdominal pain (36.1%), upper respiratory infections (35.6%), and lower respiratory disease (33.7%). Three notable comorbidities not known to be associated with antiviral treatment or disease were benign neoplasms (24.3%), genitourinary symptoms & ill-defined conditions (14.8%), and viral infections (13.8%). Conclusions This US medically insured HCV population is highly comorbid. Effective strategies to manage these comorbidities are necessary to allow wider access to HCV treatment and reduce the future burden of HCV disease and its manifestations. PMID:22494445

  20. 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. PMID:25262317

  1. Epidemiology, patterns of comorbidity, and associated disabilities of social phobia.

    PubMed

    Wittchen, H U; Fehm, L

    2001-12-01

    Social phobia is a common condition, with current prevalence estimates in the range of 4% to 6% and a lifetime risk of 7% to 13%. It has an early onset and, without appropriate intervention, it has a disproportionately higher risk for persistence compared with other anxiety disorders. Presentation differs between age groups; the disorder in teenagers and in those in their early 20s tends to look different in terms of types of problems and the associated distress to that expected in the 30s and 40s age groups, when these individuals have already endured 20 years of suffering and disability. There is an increased risk for depression and substance abuse disorders even in adolescence, in addition to an increased risk for psychosocial impairment and disability resembling that experienced by depressed outpatients. This finding is particularly true in cases affected by generalized SP, which might have slightly different etiologic pathways than the nongeneralized type. Social phobia is in itself a disabling disorder, and individuals who develop comorbid conditions have a more severe level of disability. Early recognition, diagnosis, and treatment of SP could minimize sufferers' problems throughout their subsequent lives, preventing the development of comorbidity and a worsened prognosis. Developing models for early recognition and treatment should improve the outcome for the patient, as well as reduce future demand on health care resources. Epidemiologic studies, with their methodologic strengths and unique methods, can be instrumental in this respect. They may, for example, provide time-efficient, simple screening tools for use by physicians or even patients, based on the existing diagnostic instruments used in epidemiologic surveys. They may provide further guidance in making treatment decisions and developing treatment algorithms by offering criteria, which with additional vulnerability and risk factors, will lead to more severe, chronic, and comorbid course in a given

  2. Comorbid Latent Adrenal Insufficiency with Autoimmune Thyroid Disease

    PubMed Central

    Yamamoto, Toshihide

    2015-01-01

    Background Autoimmune thyroid disease (ATD) has been occasionally observed in patients with primary adrenal insufficiency (PAI). In contrast, less than 20 cases of comorbid PAI with ATD have been found in the English literature. One conceivable reason is difficulty in detecting latent PAI. Objective Information of clinical presentation and diagnostics is sought to facilitate diagnosis of latent PAI. Methods Latent PAI was pursued in 11 patients among 159 ATD patients. All of them were maintained in a euthyroid state. Except for one patient with nonrheumatic musculoskeletal symptoms, the other patients, who were asymptomatic in their daily lives, presented with recurrent nonspecific gastrointestinal symptoms or fatigue in stress-associated circumstances. Morning cortisol level <303 nmol/l was used as an inclusion criterion. Their basal adrenocorticotropic hormone levels were normal. The adrenal status was examined by a provocation test, either an insulin-induced hypoglycemia test or a 1-μg intravenous corticotrophin test. Eleven patients showed subnormal cortisol response. They were supplemented with hydrocortisone of doses ≤15 mg/day. After a few months of supplementation, PAI was confirmed by another provocation test. Three patients were excluded because of dissociation of two provocation tests. Results Comorbid latent PAI with ATD was pursued from the symptoms stated above and proven by two provocation tests; it was found in 5% (8/159) of the patients. Conclusion When patients with ATD are troubled by recurrent stress-associated gastrointestinal or constitutional symptoms or nonrheumatic musculoskeletal symptoms which have remained unrelieved by adjustment of thyroid medication, these symptoms may be a manifestation of comorbid latent PAI. It is worth investigating such patients for latent PAI. PMID:26558238

  3. 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. PMID:26483181

  4. Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity.

    PubMed

    Herpertz-Dahlmann, Beate

    2015-01-01

    The prevalence of eating disorders among adolescents continues to increase. The starvation process itself is often associated with severe alterations of central and peripheral metabolism, affecting overall health during this vulnerable period. This article aims to convey basic knowledge on these frequent and disabling disorders, and to review new developments in classification issues resulting from the transition to DSM-5. A detailed description is given of the symptomatology of each eating disorder that typically manifests during adolescence. New data on epidemiology, and expanding knowledge on associated medical and psychiatric comorbidities and their often long-lasting sequelae in later life, are provided. PMID:25455581

  5. Bipolar disorder and ADHD: comorbidity and diagnostic distinctions.

    PubMed

    Marangoni, Ciro; De Chiara, Lavinia; Faedda, Gianni L

    2015-08-01

    Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) are neurodevelopmental disorders with onset in childhood and early adolescence, and common persistence in adulthood. Both disorders are often undiagnosed, misdiagnosed, and sometimes over diagnosed, leading to high rates of morbidity and disability. The differentiation of these conditions is based on their clinical features, comorbidity, psychiatric family history course of illness, and response to treatment. We review recent relevant findings and highlight epidemiological, clinical, family history, course, and treatment-response differences that can aid the differential diagnosis of these conditions in an outpatient pediatric setting. PMID:26084666

  6. 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

  7. The pharmacological management of psychiatric comorbidities in patients with epilepsy.

    PubMed

    Mula, Marco

    2016-05-01

    Psychiatric disorders represent a frequent comorbidity in patients with epilepsy affecting quality of life, morbidity and mortality. Evidence-based data on the management of these conditions are limited but a number of recommendations are now available to guide clinical practice. The present paper reviews the pharmacological treatment of psychiatric problems in epilepsy with special attention to data coming from randomised controlled trials (RCTs), pharmacological interactions with AEDs and the issue of seizure worsening during treatment with psychotropic drugs. Epidemiologically or clinically relevant psychiatric conditions are discussed namely mood and anxiety disorders, psychoses and attention deficit hyperactivity disorder. PMID:27001226

  8. [Psychological comorbidities in patients with psychosomatic disorders of micturition].

    PubMed

    Hohenfellner, U

    2016-08-01

    Many patients with chronic urological diseases report a long-term suffering. Because of previous failure to recognize the psychosomatic diagnosis they are inefficiently treated or even suffer from complications of unsuccessful therapy attempts, which in retrospect were not indicated. The patients are desperate and put all their hopes and expectations in every new doctor, which is why they put us urologists under tremendous pressure to perform and are a challenge for our diagnostic and therapeutic expertise. Knowledge of psychological comorbidities and their effect on the urogenital tract are essential for the differential diagnostics of the urological complaints and for a purposeful therapy. PMID:27472946

  9. Pharmacotherapeutic Management of Chronic Lymphocytic Leukaemia in Patients with Comorbidities: New Agents, New Hope.

    PubMed

    Goede, Valentin; Hallek, Michael

    2015-11-01

    Chronic lymphocytic leukaemia (CLL) is mostly considered a disease of the elderly. As such, many patients present with comorbidities. Several scores allow for a qualitative and quantitative assessment of comorbidity in patients with CLL. Although our knowledge about the impact of comorbidity on outcomes in patients with CLL is still incomplete, it is becoming increasingly apparent that comorbidities could negatively interfere with CLL treatment. Recently, a number of new agents have been approved for use in patients with previously untreated CLL and comorbidities (i.e. obinutuzumab, ofatumumab), as well as in patients with previously treated or high-risk CLL (i.e. idelalisib, ibrutinib). This review discusses the role of comorbidity in patients with CLL, together with the changing treatment landscape for CLL in this patient population. PMID:26446155

  10. Reframing the association and significance of co-morbidities in heart failure.

    PubMed

    Triposkiadis, Filippos; Giamouzis, Gregory; Parissis, John; Starling, Randall C; Boudoulas, Harisios; Skoularigis, John; Butler, Javed; Filippatos, Gerasimos

    2016-07-01

    Several co-existing diseases and/or conditions (co-morbidities) are present in patients with heart failure (HF), with diverse clinical relevance. Multiple mechanisms may underlie the co-existence of HF and co-morbidities, including direct causation, associated risk factors, heterogeneity, and independence. The complex inter-relationship of co-morbidities and their impact on the cardiovascular system contribute to the features of HF, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). The purpose of this work is to provide an overview of the contribution of major cardiac and non-cardiac co-morbidities to HF development and outcomes, in the context of both HFpEF and HFrEF. Accordingly, epidemiological evidence linking co-morbidities to HF and the effect of prevalent and incident co-morbidities on HF outcome will be reviewed. PMID:27358242

  11. Under-recognised co-morbidities in idiopathic pulmonary fibrosis: A review.

    PubMed

    de Boer, Kaïssa; Lee, Joyce S

    2016-08-01

    Co-morbidities in idiopathic pulmonary fibrosis are common. These co-morbidities include obstructive sleep apnoea, gastro-oesophageal reflux disease, pulmonary hypertension and depression. The presence of co-morbidities among patients with idiopathic pulmonary fibrosis contributes to worse quality of life, morbidity and mortality. Despite the high prevalence of certain co-morbidities in idiopathic pulmonary fibrosis, the optimal screening and management of many of these conditions remains unclear. The impact of co-morbidities on this patient population is becoming more apparent. Their relevance will only increase as significant effort is being made to develop novel therapeutics that will alter the disease trajectory of patients with idiopathic pulmonary fibrosis. The purpose of this review is to focus on the epidemiology, pathophysiology, diagnosis and management of select co-morbidities, including obstructive sleep apnoea, gastro-oesophageal reflux disease, pulmonary hypertension and depression, in idiopathic pulmonary fibrosis. PMID:26365251

  12. Data on burden of comorbidities in the united states and medicaid expansion status.

    PubMed

    Akinyemiju, Tomi; Moore, Justin Xavier

    2016-09-01

    The high prevalence of comorbidities among US adults is a major public health problem. However, there is limited data on the geographic distribution of comorbidities. In addition, recent changes to health insurance programs in the US through the Affordable Care Act, and the Medicaid expansion program specifically, has the potential to significantly improve the prevention and management of comorbid conditions in the US. In a recent analysis, we examined disparities in the burden of comorbidities among US adults by state Medicaid expansion status, (Akinyemiju et al., 2016) [1]. Here, we provide additional data showing the state level mean number of comorbidities in all 50 US states for African-Americans and whites, stratified by Medicaid expansion status. In addition, we provide a map of the US states showing the geographic distribution of comorbidities and stratified by race/ethnicity and gender. PMID:27294179

  13. Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research.

    PubMed

    Dowling, N A; Merkouris, S S; Lorains, F K

    2016-07-01

    Despite significant psychiatric comorbidity in problem gambling, there is little evidence on which to base treatment recommendations for subpopulations of problem gamblers with comorbid psychiatric disorders. This mini-review draws on two separate systematic searches to identify possible interventions for comorbid problem gambling and psychiatric disorders, highlight the gaps in the currently available evidence base, and stimulate further research in this area. In this mini-review, only 21 studies that have conducted post-hoc analyses to explore the influence of psychiatric disorders or problem gambling subtypes on gambling outcomes from different types of treatment were identified. The findings of these studies suggest that most gambling treatments are not contraindicated by psychiatric disorders. Moreover, only 6 randomized studies comparing the efficacy of interventions targeted towards specific comorbidity subgroups with a control/comparison group were identified. The results of these studies provide preliminary evidence for modified dialectical behavior therapy for comorbid substance use, the addition of naltrexone to cognitive-behavioral therapy (CBT) for comorbid alcohol use problems, and the addition of N-acetylcysteine to tobacco support programs and imaginal desensitisation/motivational interviewing for comorbid nicotine dependence. They also suggest that lithium for comorbid bipolar disorder, escitalopram for comorbid anxiety disorders, and the addition of CBT to standard drug treatment for comorbid schizophrenia may be effective. Future research evaluating interventions sequenced according to disorder severity or the functional relationship between the gambling behavior and comorbid symptomatology, identifying psychiatric disorders as moderators of the efficacy of problem gambling interventions, and evaluating interventions matched to client comorbidity could advance this immature field of study. PMID:26900888

  14. Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations.

    PubMed

    Frye, Mark A; Salloum, Ihsan M

    2006-12-01

    Classic Kraepelian observations and contemporary epidemiological studies have noted a high prevalence rate between bipolar disorder and alcoholism. The extent to which these two illnesses are comorbid (i.e., two distinct disease processes each with an independent course of illness), genetically linked, or different phenotypic expressions of bipolar illness itself continues to be investigated. It is increasingly clear that co-occurring alcohol abuse or dependence in bipolar disorder phenomenologically changes the illness presentation with higher rates of mixed or dysphoric mania, rapid cycling, increased symptom severity, and higher levels of novelty seeking, suicidality, aggressivity, and impulsivity. It is very encouraging that interest and efforts at evaluating pharmacotherapeutic compounds has substantially increased over the past few years in this difficult-to-treat patient population. This article will review the clinical studies that have evaluated the effectiveness of conventional mood stabilizers (lithium, carbamazepine, divalproex, and atypical antipsychotics) in the treatment of alcohol withdrawal and relapse prevention in patients with alcoholism and in the treatment of bipolar disorder with comorbid alcoholism. A number of add-on, adjunctive medications, such as naltrexone, acamprosate, topiramate, and the atypical antipsychotics quetiapine and clozapine, may be candidates for further testing. PMID:17156154

  15. Understanding COPD: A vision on phenotypes, comorbidities and treatment approach.

    PubMed

    Fragoso, E; André, S; Boleo-Tomé, J P; Areias, V; Munhá, J; Cardoso, J

    2016-01-01

    Chronic Obstructive Pulmonary Disease (COPD) phenotypes have become increasingly recognized as important for grouping patients with similar presentation and/or behavior, within the heterogeneity of the disease. The primary aim of identifying phenotypes is to provide patients with the best health care possible, tailoring the therapeutic approach to each patient. However, the identification of specific phenotypes has been hindered by several factors such as which specific attributes are relevant, which discriminant features should be used for assigning patients to specific phenotypes, and how relevant are they to the therapeutic approach, prognostic and clinical outcome. Moreover, the definition of phenotype is still not consensual. Comorbidities, risk factors, modifiable risk factors and disease severity, although not phenotypes, have impact across all COPD phenotypes. Although there are some identified phenotypes that are fairly consensual, many others have been proposed, but currently lack validation. The on-going debate about which instruments and tests should be used in the identification and definition of phenotypes has contributed to this uncertainty. In this paper, the authors review present knowledge regarding COPD phenotyping, discuss the role of phenotypes and comorbidities on the severity of COPD, propose new phenotypes and suggest a phenotype-based pharmacological therapeutic approach. The authors conclude that a patient-tailored treatment approach, which takes into account each patient's specific attributes and specificities, should be pursued. PMID:26827246

  16. Alcoholism and co-morbid psychiatric disorders among American Indians.

    PubMed

    Westermeyer, J

    2001-01-01

    Much of the data reported here regarding American Indian (AI) people has originated from specific areas with particular peoples. Thus, one must be cautious in applying information from one tribe to the hundreds of tribes living across the United States. As with any people, psychiatric disorder may be a pre-existing rationale for using alcohol. Or alternatively, alcohol may lead to various psychiatric disorders, such as organic mental conditions, posttraumatic stress disorder, or other conditions. A third alternative is that both alcoholism and other psychiatric disorder merely happen to affect the same person by chance. Recognizing alcoholism and treating it in a timely manner before disabling or even permanent psychiatric disorders ensue are key strategies. In addition, clinicians must be able to recognize and then either treat or refer co-morbid patients for appropriate care. Some psychiatric disorders, such as panic disorder, posttraumatic stress disorder, and various organic mental disorders may occur more often in some AI groups. Other co-morbid conditions, such as eating disorders, may occur less often among AI patients with alcoholism. It could be argued that resources should go solely to preventive efforts, thereby negating the need for psychiatric services. However, successful prevention of alcoholism may hinge upon, and increase the need for greater psychiatric services in AI communities. PMID:11698982

  17. 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

  18. Comorbidity between depression and disordered eating in adolescents.

    PubMed

    Santos, Melissa; Richards, C Steven; Bleckley, M Kathryn

    2007-12-01

    Depression is one of the most common mental health disorders seen in adolescence. Low self-esteem, lack of social support and poor body image have been found to be risk factors for depression. However, these risk factors have not adequately explained why adolescent female rates of depressive episodes rise to almost twice that of males. This study had three purposes. The first is to identify the prevalence and comorbidity of depressive and disordered eating symptoms in a sample of high school students. The second is to examine predictors of depressive and disordered eating symptoms. Finally, a model predicting depressive symptoms is examined. Significant depressive and disordered eating symptomatology and a high level of comorbidity were observed in this sample. Predictors of depressive and disordered eating symptoms were similar for both genders. Finally, a model predicting depressive symptoms, via body image factors, was found to be supported in both boys and girls. The results of this study suggest that males and females are more similar than different, regarding predictors of depressive symptoms and disordered eating symptoms. PMID:17950932

  19. Preschool Anxiety Disorders in Pediatric Primary Care: Prevalence and Comorbidity

    PubMed Central

    Franz, Lauren; Angold, Adrian; Copeland, William; Costello, E. Jane; Towe-Goodman, Nissa; Egger, Helen

    2013-01-01

    Objective We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety disorder, separation anxiety disorder, and social phobia, in preschool aged children. Method The Duke Preschool Anxiety Study, a screen-stratified, cross-sectional study, drew from pediatric primary-care and oversampled for children at risk for anxiety. 917 parents of preschoolers (aged 2 to 5 years) completed the Preschool Age Psychiatric Assessment. Results Generalized anxiety disorder, separation anxiety disorder, and social phobia are common in preschool-aged children attending pediatric primary care. Three quarters of preschoolers with an anxiety disorder only had a single anxiety disorder. Generalized anxiety disorder displayed the greatest degree of comorbidity: with separation anxiety disorder (odds ratio [OR] = 4.1, 95% CI, 2.0–8.5), social phobia (OR = 6.4, 95% CI, 3.1–13.4), disruptive behavior disorders (OR = 5.1, 95% CI, 1.6–15.8), and depression (OR = 3.7, 95% CI, 1.1–12.4). Conclusions The weakness of association between generalized anxiety disorder and depression stands in contrast to substantial associations between these 2 disorders reported in older individuals. Attenuated associations in preschool aged children could translate into clinical opportunities for targeted early interventions, aimed at modifying the developmental trajectory of anxiety disorders. PMID:24290462

  20. Treatment of schizophrenia and comorbid substance abuse: pharmacologic approaches.

    PubMed

    Green, Alan I

    2006-01-01

    Co-occurring substance use disorder is common among patients with schizophrenia, and its presence greatly worsens the course of schizophrenia. A number of theories have been introduced to explain the increased rate of substance use disorder in these patients. These theories include the notion that substance use could trigger psychotic symptoms in vulnerable individuals and the idea that the substances are used to self-medicate symptoms of schizophrenia. Our group and others have advanced a neurobiological hypothesis to explain this comorbidity-that a mesocorticolimbic brain reward circuit underlies the substance use disorder in patients with schizophrenia. Treatment of substance use disorder in these patients is best done with integrated treatment programs that combine psychosocial interventions with pharmacotherapy. Recent data suggest that the atypical antipsychotic clozapine and perhaps other atypical agents may lessen substance use in patients with schizophrenia. My colleagues and I have proposed that clozapine's effect in these patients may be related to its ability to decrease the brain reward circuit dysfunction. Research is continuing on the use of atypical antipsychotics in patients with schizophrenia and comorbid substance abuse. The adjunctive use of naltrexone or other agents also may be helpful. Further research on the optimal pharmacologic approach to patients with dual diagnosis is needed. PMID:16961422

  1. [Heterogeneity and comorbidity of obsessive-compulsive disorder].

    PubMed

    Zaudig, M

    2011-03-01

    Although the DSM-IV-TR suggests that obsessive-compulsive disorder (OCD) is a coherent syndrome, scientific evidence offers a compelling case that OCD is highly heterogeneous and possibly composed of many different subtypes. OCD can display completely distinct symptom patterns thus making it difficult to identify a single "textbook" profile of OCD. The present state of research concerning subtyping is presented. There is a high comorbidity with depression and anxiety disorders, but all together data concerning OCD comorbidity are still not convincing. Currently obsessive-compulsive spectrum disorders (OCS) are described as a set of disorders lying on a continuum from compulsive to impulsive, with the unifying feature being an inability to regulate behaviour as a consequence of defects in inhibition. OCS disorders fall into three major clusters: impulsive disorders, disorders associated with appearance in bodily sensations, and neurological disorders characterized by repetitive behaviour. How these putative OCS disorders overlap with and are independent from obsessive-compulsive disorder itself is thoroughly discussed. PMID:21347693

  2. 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

  3. Stress, psychiatric co-morbidity and coping in patients with chronic idiopathic urticaria.

    PubMed

    Chung, Man Cheung; Symons, Christine; Gilliam, Jane; Kaminski, Edward R

    2010-04-01

    This study examined life event stress, perceived stress and psychiatric co-morbidity among patients with Chronic Idiopathic Urticaria (CIU). It also investigated the relationship between coping, stress, the severity of CIU and psychiatric co-morbidity. Total of 100 CIU patients and 60 allergy patients participated in the study. They completed the General Health Questionnaire, the Social Readjustment Rating Scale, the Perceived Stress Scale, and the Ways of Coping Checklist. Compared with allergy patients, CIU patients had worse co-morbidity and higher levels of life event stress and perceived stress. Emotion-focussed coping was associated with the severity of CIU; perceived stress was associated with co-morbidity. PMID:20204926

  4. Excess Costs of Comorbidities in Chronic Obstructive Pulmonary Disease: A Systematic Review

    PubMed Central

    Huber, Manuel B.; Wacker, Margarethe E.; Vogelmeier, Claus F.; Leidl, Reiner

    2015-01-01

    Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Comorbidities are often reported in patients with COPD and may influence the cost of care. Yet, the extent by which comorbidities affect costs remains to be determined. Objectives To review, quantify and evaluate excess costs of comorbidities in COPD. Methods Using a systematic review approach, Pubmed and Embase were searched for studies analyzing excess costs of comorbidities in COPD. Resulting studies were evaluated according to study characteristics, comorbidity measurement and cost indicators. Mark-up factors were calculated for respective excess costs. Furthermore, a checklist of quality criteria was applied. Results Twelve studies were included. Nine evaluated comorbidity specific costs; three examined index-based results. Pneumonia, cardiovascular disease and diabetes were associated with the highest excess costs. The mark-up factors for respective excess costs ranged between 1.5 and 2.5 in the majority of cases. On average the factors constituted a doubling of respective costs in the comorbid case. The main cost driver, among all studies, was inpatient cost. Indirect costs were not accounted for by the majority of studies. Study heterogeneity was high. Conclusions The reviewed studies clearly show that comorbidities are associated with significant excess costs in COPD. The inclusion of comorbid costs and effects in future health economic evaluations of preventive or therapeutic COPD interventions seems highly advisable. PMID:25875204

  5. 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) . PMID:23334941

  6. 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

  7. 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. PMID:27542877

  8. Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

    PubMed Central

    White, Kamila S.; Barlow, David H.; Shear, M. Katherine; Gorman, Jack M.; Woods, Scott W.

    2009-01-01

    Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed. PMID:20421906

  9. Improved Comorbidity Adjustment for Predicting Mortality in Medicare Populations

    PubMed Central

    Schneeweiss, Sebastian; Wang, Philip S; Avorn, Jerry; Glynn, Robert J

    2003-01-01

    Objective To define and improve the performance of existing comorbidity scores in predicting mortality in Medicare enrollees. Data Sources Study participants were two Medicare populations who had complete drug coverage either through Medicaid or a statewide pharmacy assistance program: New Jersey Medicare enrollees (NNJ=235,881) and Pennsylvania Medicare enrollees (NPA=230,913). Study Design Frequently used comorbidity scores were computed for all subjects during the baseline year (January 1, 1994, to December 31, 1994, and one year later in Pennsylvania). The study outcome was one-year mortality during the following year. Performance of scores was measured with the c-statistic derived from multivariate logistic regression models. Empirical weights were derived in the New Jersey population and the performance of scores with new weights was validated in the Pennsylvania population. Principal Findings A score based on ICD-9-diagnoses (Romano) performed 60 percent better than one based on patterns of medication use (Chronic Disease Score, or CDS-1) (c=0.771 vs. c=0.703). The performance of the Romano score was further improved slightly by inclusion of the number of different prescription drugs used during the past year. Modeling the 17 conditions included in the Romano score as separate binary indicators increased its performance by 8 percent (c=0.781). We derived elderly-specific weights for these scores in the New Jersey sample, including negative weights for the use of some drugs, for example, lipid lowering drugs. Applying these weights, the performance of Romano and CDS-1 scores improved in an independent validation sample of Pennsylvania Medicare enrollees by 8.3 percent and 43 percent compared to the scores with the original weights. When we added an indicator of nursing home residency, age, and gender, the Romano score reached a performance of c=0.80. Conclusions We conclude that in epidemiologic studies of the elderly, a modified diagnosis-based score using

  10. Restless legs syndrome as a comorbidity in rheumatoid arthritis.

    PubMed

    Gjevre, John A; Taylor Gjevre, Regina M

    2013-01-01

    Rheumatoid arthritis (RA) is a multisystem disease with a complex immunologic pathophysiology. Likewise, sleep disorders can involve a complicated interplay between the neurologic pathways, immune system, and respiratory system. Recent studies have shown an elevated prevalence of sleep abnormalities in connective tissue disorders compared to the general population. Restless legs syndrome (RLS) may be present in up to 30% of RA patients. These findings may be related to cytokine release and other immunomodulatory responses. TNF- α levels relate to sleep physiology and anti-TNF- α therapy may improve sleep patterns. Most of the patients with this disorder can distinguish their RLS sensations from their arthritic symptoms. RLS is a common comorbidity seen with RA, and prompt recognition and treatment can improve patient quality of life. PMID:23840943

  11. 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. PMID:26654208

  12. [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. PMID:12017957

  13. Restless Legs Syndrome: Psychiatric Comorbidities Are More Important Than Neuroticism.

    PubMed

    Trautmann, Ellen; Barke, Antonia; Frisch, Johanna U; Schmidt, Anna-Lena; Kunert, Fabia; Canelo, Monica; Sixel-Döring, Friederike; Trenkwalder, Claudia

    2015-01-01

    Restless legs syndrome (RLS) is often associated with psychopathological symptoms. We compared psychiatric diagnoses, psychological complaints, sleep and personality traits in RLS patients and a control group The RLS patients also answered the IRLS, RLS-6, and QoL-RLS. The RLS patients showed more depressive disorders, psychopathological symptoms, and lower well-being than controls, but no differences in personality traits. The slightly, but not significantly, higher neuroticism found in RLS patients can be explained by the higher rates of depression among the patients. It is advisable to screen RLS patients for psychiatric comorbidities. The design using a matched control group without sleep disorders limits the conclusions that can be drawn regarding the frequency of psychiatric diagnoses and controls with sleep problems. PMID:24945565

  14. [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. PMID:26059306

  15. [An update on gout: diagnostic approach, treatment and comorbidity].

    PubMed

    Diller, Magnus; Fleck, Martin

    2016-08-01

    Muskuloskeletal ultrasound and dual-energy-CT (DECT) findings are increasingly relevant for the establishment of the diagnosis of gout, and are therefore incorporated into the novel ACR / EULAR classification criteria. Canakinumab, a monoclonal antibody directed against interleukin-1β (IL-1β) has been approved in 2013 for the treatment of acute gout and for prophylaxis of flares. In patients demonstrating an inadequate response upon treatment with allopurinol or febuxostat, combination therapy with lesinurad might reduce uric acid levels to the target of < 6 mg / dl (< 5 mg / dl in tophaceous gout). Rapid lowering of uric acid levels and effective tophi reduction can be achieved with pegloticase, which can be utilized in selected patients presenting contraindications to xanthine oxidase inhibitors and uricosuric drugs. This article summarizes current scientific aspects of diagnosis, treatment and comorbidities of gout in the context of clinical relevance. PMID:27509346

  16. [Empowerment approach to the management of comorbid diabetes and cancer].

    PubMed

    Ohashi, Ken

    2015-12-01

    Diabetes mellitus is a frequent comorbidity of cancer patients. Recent data show that diabetes may negatively impact both cancer risks and outcomes of treatment. It is important to identify patients at risk for complications that arise from cancer treatment in the setting of pre-existing diabetes. Additionally, underlying hyperglycemia or hidden diabetes in a patient undergoing cancer treatment such as chemotherapy including steroid administration and total parenteral nutrition should be identified and managed. Strategies for monitoring and managing hyperglycemia during the course of cancer treatment will be reviewed. The role of interdisciplinary care and empowerment approach is crucial to supporting patients and their families as they manage through the challenges of facing two life-threatening diseases. PMID:26666166

  17. The role of the community nurse in psoriatic comorbidities interventions.

    PubMed

    Aldridge, Annette

    2014-01-01

    Psoriasis is a chronic disease that affects more than the skin. It has an impact on every facet of an individual's life and is associated with numerous comorbidities, such as obesity, diabetes, cardiovascular disease, psoriatic arthritis, metabolic syndrome, squamous cell carcinoma, lymphoma, depression, anxiety and other immune-related conditions, such as Crohn's disease. Obesity is inextricably linked with type 2 diabetes, hypertension, hyperlipidemia, and cardiovascular disease. Hypertension and cardiovascular disease are precursors for myocardial infarction and stroke. Lifestyle choices, such as smoking, alcohol consumption, inadequate nutrition and physical exercise are behaviours that need to be addressed. With the right education from the community nurse, patients can be informed about the decisions they make and can ultimately choose to live a healthier life. PMID:24800325

  18. Mood disorders and substance use disorder: a complex comorbidity.

    PubMed

    Quello, Susan B; Brady, Kathleen T; Sonne, Susan C

    2005-12-01

    Mood disorders, including depression and bipolar disorders, are the most common psychiatric comorbidities among patients with substance use disorders. Treating patients' co-occurring mood disorders may reduce their substance craving and taking and enhance their overall outcomes. A methodical, staged screening and assessment can ease the diagnostic challenge of distinguishing symptoms of affective disorders from manifestations of substance intoxication and withdrawal. Treatment should maximize the use of psychotherapeutic interventions and give first consideration to medications proven effective in the context of co-occurring substance abuse. Expanded communication and collaboration between substance abuse and mental health providers is crucial to improving outcomes for patients with these complex, difficult co-occurring disorders. PMID:18552741

  19. Diagnosis, assessment, and comorbidity in psychosocial treatment research.

    PubMed

    Achenbach, T M

    1995-02-01

    This paper identifies problems in prevailing terminology and conceptual models that may hinder research on treatment. To avoid the multiple meanings of diagnosis, the term assessment is used in reference to identifying the distinguishing features of individual cases, while taxonomy is used to designate the grouping of cases according to their distinguishing features. Treatment research requires clear specification of the behavioral/emotional problems and competencies targeted for intervention. Artifactual comorbidity can be avoided by specifying treatment targets at several levels, including competencies, specific problems, syndromes, profiles of syndrome scores, and global problem scores. To select subjects for treatment research and to evaluate outcomes, multisource data can be coordinated by using a cross-informant computer program, taxonomic decision tree, and averaging of multisource standard scores. PMID:7759674

  20. Healthy aging and age-adjusted nutrition and physical fitness.

    PubMed

    Hammar, Mats; Ostgren, Carl Johan

    2013-10-01

    Expected life span is gradually increasing worldwide. Healthy dietary and exercise habits contribute to healthy ageing. Certain types of diet can prevent or reduce obesity, and may reduce the risk of diseases (e.g., cardiovascular disease). Exercise also reduces the risk of diseases (e.g., cardiovascular disease, osteoporosis, some cancers and some mental disturbances). A less sedentary life style seems at least as important as regular exercise. Exercise can probably be tailored to reduce the risk of cardiovascular disease and extent of bone loss. To ensure adherence, it is important to increase slowly the frequency, duration and intensity of exercise, and to find activities that suit the individual. More research is needed to find ideal modes and doses of exercise, and to increase long-term adherence. Dietary and exercise modification seem to be strong promoters of healthy ageing. PMID:23499263

  1. To Correct or Not to Correct: Age Adjustment for Prematurity.

    ERIC Educational Resources Information Center

    Aylward, Glen P.; And Others

    To evaluate whether conceptional or chronologic age should be used to determine scores in developmental follow-up studies, a study was made of 236 normal and 66 neurologically abnormal infants who were similar with respect to conceptional age but different with respect to degree of prematurity. Assessments of possible differences in cognitive and…

  2. Personality traits and psychiatric comorbidities in alcohol dependence.

    PubMed

    Donadon, M F; Osório, F L

    2016-01-01

    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

  3. 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

  4. [Organic and comorbid causes of depression: a first step].

    PubMed

    Campagne, D M

    2012-01-01

    The primary objective of this review is to obtain a clinical orientation as to evidence-supported common «other» causes of depressive symptomatology, which predominantly are: medical issues; life events; vitamin, mineral and diet-related deficiencies; and hormones. A secondary goal was to reflect those more frequent "other" causes in a checklist for clinical use, comprising also the preferred treatment (medical/dietary, antidepressants, or psychological) resulting from the available evidence. Medline, Cochrane and main related databases were searched from 4(th) October 2010 to 27(th) April 2011, no language limits, with keywords: depression; organic; comorbid; medication; life events; hormones; vitamin; mineral; diet; disease; as well as further searches into each upcoming possibly related issue. Total studies contemplated: 3.211; total studies reviewed: 301, with criteria of relevancy; date of study or review; size and type; journal status. Data were abstracted based upon probable clinical relevancy and use. The main results obtained were evidence-supported indications as to these other causes of depressive symptomatology, that warrant early screening, attention and treatment, possibly before antidepressant or psychological therapy is started. PRELIMINARY CONCLUSION: There appears to be a clinical rationale for early checking of a number of evidence-based causes of depressive symptoms for which first-line testing is readily available. In several cases clinical treatment may be simple, and improvements in depressive symptoms rapidly obtainable. Using a pre-treatment protocol, both patients and health systems could benefit from biological and comorbid causes of depressive symptoms being established early. An enhanced response to low-cost corrective measures can decrease the risk of suicide. PMID:23544777

  5. Common Genetic Influences Underlie Comorbidity of Migraine and Endometriosis

    PubMed Central

    Nyholt, Dale R.; Gillespie, Nathan G.; Merikangas, Kathleen R.; Treloar, Susan A.; Martin, Nicholas G.; Montgomery, Grant W.

    2009-01-01

    We examined the co-occurrence of migraine and endometriosis within the largest known collection of families containing multiple women with surgically confirmed endometriosis and in an independent sample of 815 monozygotic and 457 dizygotic female twin pairs. Within the endometriosis families, a significantly increased risk of migrainous headache was observed in women with endometriosis compared to women without endometriosis (odds ratio [OR] 1.57, 95% confidence interval [CI]: 1.12–2.21, P = 0.009). Bivariate heritability analyses indicated no evidence for common environmental factors influencing either migraine or endometriosis but significant genetic components for both traits, with heritability estimates of 69 and 49%, respectively. Importantly, a significant additive genetic correlation (rG = 0.27, 95% CI: 0.06–0.47) and bivariate heritability (h2 = 0.17, 95% CI: 0.08–0.27) was observed between migraine and endometriosis. Controlling for the personality trait neuroticism made little impact on this association. These results confirm the previously reported comorbidity between migraine and endometriosis and indicate common genetic influences completely explain their co-occurrence within individuals. Given pharmacological treatments for endometriosis typically target hormonal pathways and a number of findings provide support for a relationship between hormonal variations and migraine, hormone-related genes and pathways are highly plausible candidates for both migraine and endometriosis. Therefore, taking into account the status of both migraine and endometriosis may provide a novel opportunity to identify the genes underlying them. Finally, we propose that the analysis of such genetically correlated comorbid traits can increase power to detect genetic risk loci through the use of more specific, homogenous and heritable phenotypes. PMID:18636479

  6. 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.…

  7. 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…

  8. 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…

  9. Five-Year Follow-up of Preschoolers with Autism and Comorbid Psychiatric Disorders

    ERIC Educational Resources Information Center

    Kim, Joanne J.; Freeman, Stephanny F. N.; Paparella, Tanya; Forness, Steven R.

    2012-01-01

    Although several studies have examined the prevalence of comorbid psychiatric disorders in children with autism spectrum disorders, there are no current longitudinal studies of such children regarding the impact of comorbidity. In this study, 44 of an original sample of 175 preschoolers were located after 5 1/2 years, at an average chronological…

  10. 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.

  11. 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…

  12. Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida

    PubMed Central

    Xiao, Hong; Tan, Fei; Goovaerts, Pierre; Adunlin, Georges; Ali, Askal Ayalew; Gwede, Clement K.; Huang, Youjie

    2015-01-01

    To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems. PMID:25542838

  13. The Comorbidity of Conduct Problems and Depression in Childhood and Adolescence

    ERIC Educational Resources Information Center

    Wolff, Jennifer C.; Ollendick, Thomas H.

    2006-01-01

    An extensive body of research documents the high prevalence of comorbidity among child and adolescent disorders in general and between conduct problems and depression in particular. These problems co-occur at significantly higher rates than would be expected by chance and their comorbidity may have significant implications for nosology, treatment,…

  14. 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…

  15. ADHD and Comorbid Psychiatric Disorders: Adult Student Perspectives on Learning Needs and Academic Support

    ERIC Educational Resources Information Center

    Hubbard, Laura E.

    2011-01-01

    The focus of this study is to understand, from their own perspective, the learning needs of adult college students with comorbid attention deficits and psychiatric disabilities, and to identify services and practices that support their success in the college environment. Adult students with comorbid attention deficits and psychiatric disorders…

  16. 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…

  17. 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…

  18. 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…

  19. Exploring Maternal and Child Effects of Comorbid Anxiety Disorders among African American Mothers with Depression.

    PubMed

    Boyd, Rhonda C; Tervo-Clemmens, Brenden

    2013-06-01

    Comorbid depression and anxiety disorders are commonly experienced in mothers. Both maternal depression and anxiety as well as their comorbidity has been shown to increase psychopathology in children, however, there is limited research focusing on African American families. The aim of this study is to examine whether comorbid anxiety disorders are associated with maternal depression severity, kinship support, and child behavioral problems in a sample of African American mothers with depression. African American mothers (n = 77) with a past year diagnosis of a depressive disorder and a child between the ages of ages 8-14 were administered a clinician interview and measures of maternal depression severity, kinship support, and child behavior problems (internalizing and externalizing) in a cross-sectional design. Results showed that more than half (58%) of the mothers had a comorbid anxiety disorder and a third had Posttraumatic Stress Disorder (PTSD). Regression analyses showed that comorbid PTSD and Social Phobia were positively associated with maternal depression severity. Maternal comorbid Obsessive Compulsive Disorder (OCD) was associated with child internalizing symptoms. The findings are consistent with other research demonstrating negative outcomes with maternal comorbidity of depression and anxiety, however, there is limited research focused on maternal depression and OCD or PTSD. The study suggests that it is important to consider comorbid anxiety and cultural issues when conceptualizing, studying, and treating mothers with depression and their families. PMID:24040577

  20. Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida.

    PubMed

    Xiao, Hong; Tan, Fei; Goovaerts, Pierre; Adunlin, Georges; Ali, Askal Ayalew; Gwede, Clement K; Huang, Youjie

    2016-07-01

    To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems. PMID:25542838

  1. Comorbidity of Anxiety and Depression in Children and Adolescents: 20 Years After

    PubMed Central

    Cummings, Colleen M.; Caporino, Nicole E.; Kendall, Philip C.

    2014-01-01

    Brady and Kendall (1992) concluded that although anxiety and depression in youth are meaningfully linked, there are important distinctions, and additional research was needed. Since then, studies of anxiety-depression comorbidity in youth have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youth with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youth with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youth with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression, and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youth with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youth with co-primary generalized anxiety disorder and depression, and Pathway 3 including depressed youth with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted. PMID:24219155

  2. 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…

  3. 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…

  4. 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…

  5. Adolescent Depression and Externalizing Problems: Testing Two Models of Comorbidity in an Inpatient Sample

    ERIC Educational Resources Information Center

    Evans, Allison Schettini; Frank, Susan J.

    2004-01-01

    Differentiating between additive (quantitative) and interactive (qualitative) effects of comorbidity has important treatment implications. This study illustrates the heuristic superiority of a multifactorial approach over simple group comparisons in testing quantitative versus qualitative models of comorbidity. Analysis of variance was used to…

  6. 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…

  7. 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…

  8. Effects of Comorbid ADHD with Learning Disabilities on Anxiety, Depression, and Aggression in Adults

    ERIC Educational Resources Information Center

    McGillivray, J. A.; Baker, K. L.

    2009-01-01

    Objective: ADHD and learning disabilities (LD) frequently coexist and there are indications that comorbidity may increase the risk of psychopathology. Method: The current study examined the gender distribution and frequency of comorbidity and its impact on the prevalence of symptoms of anxiety, depression, and aggression in a clinic sample of 80…

  9. 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…

  10. 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:…

  11. Comorbidity of anxiety and depression in children and adolescents: 20 years after.

    PubMed

    Cummings, Colleen M; Caporino, Nicole E; Kendall, Philip C

    2014-05-01

    Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted. PMID:24219155

  12. Psychiatric Comorbidity in Children with Autism Spectrum Disorders: A Comparison with Children with ADHD

    ERIC Educational Resources Information Center

    van Steensel, Francisca J. A.; Bogels, Susan M.; de Bruin, Esther I.

    2013-01-01

    The present study was conducted with the aim to identify comorbid psychiatric disorders in children with autism spectrum disorders (ASD) (n = 40) and to compare those comorbidity rates to those in children with attention deficit hyperactivity disorder (ADHD) (n = 40). Participants were clinically referred children aged 7-18 years. DSM-IV…

  13. 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…

  14. Stability of Comorbid Psychiatric Diagnosis among Youths in Treatment and Aftercare for Alcohol Use Disorders

    ERIC Educational Resources Information Center

    Hawke, Josephine M.; Kaminer, Yifrah; Burke, Rebecca; Burleson, Joseph A.

    2008-01-01

    Objectives: To examine the stability of comorbid psychiatric diagnoses among a sample of 50 adolescents in cognitive-behaviorally-based treatment for alcohol and other substance use disorders (AOSUD). Methods: A standardized psychiatric interview was administered at baseline and 12 month later to obtain current comorbid psychiatric disorders. Chi…

  15. 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.…

  16. 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…

  17. Altered emotion regulation capacity in social phobia as a function of comorbidity.

    PubMed

    Burklund, Lisa J; Craske, Michelle G; Taylor, Shelley E; Lieberman, Matthew D

    2015-02-01

    Social phobia (SP) has been associated with amygdala hyperreactivity to fear-relevant stimuli. However, little is known about the neural basis of SP individuals' capacity to downregulate their responses to such stimuli and how such regulation varies as a function of comorbid depression and anxiety. We completed an functional magnetic resonance imaging (fMRI) study wherein SP participants without comorbidity (n = 30), with comorbid depression (n = 18) and with comorbid anxiety (n = 19) and healthy controls (n = 15) were scanned while completing an affect labeling emotion regulation task. Individuals with SP as a whole exhibited a reversal of the pattern observed in healthy controls in that they showed upregulation of amygdala activity during affect labeling. However, subsequent analyses revealed a more complex picture based on comorbidity type. Although none of the SP subgroups showed the normative pattern of amygdala downregulation, it was those with comorbid depression specifically who showed significant upregulation. Effects could not be attributed to differences in task performance, amygdala reactivity or right ventral lateral prefrontal cortex (RVLPFC) engagement, but may stem from dysfunctional communication between amygdala and RVLPFC. Furthermore, the particularly altered emotion regulation seen in those with comorbid depression could not be fully explained by symptom severity or state anxiety. Results reveal altered emotion regulation in SP, especially when comorbid with depression. PMID:24813437

  18. 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

  19. 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

  20. The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls.

    PubMed

    Brand-Gothelf, Ayelet; Leor, Shani; Apter, Alan; Fennig, Silvana

    2014-10-01

    We examined the impact of comorbid depression and anxiety disorders on the severity of anorexia nervosa (AN) in adolescent girls. Adolescent girls with AN (N = 88) were divided into one group with and another group without comorbid disorders, and selected subjective and objective measures of illness severity were compared between the two groups. The comorbid group had significantly higher scores than the noncomorbid group for all four subscales and total scores of the Eating Disorders Examination as well as for all Eating Disorders Inventory-2 subscales, except for bulimia. The comorbid group also had significantly more suicide attempts and hospitalizations compared with the noncomorbid group. There were no significant group differences for the lowest ever body mass index, duration of AN symptoms, and age at AN onset. Our findings suggest that AN with comorbid depression and anxiety disorder is a more severe clinical variant of the disorder, especially with respect to severity of psychological symptoms and suicide risk. PMID:25265267

  1. 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. PMID:25179388

  2. 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. PMID:25662998

  3. 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

  4. 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. PMID:23144063

  5. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis

    PubMed Central

    Marrie, R.A.; Rudick, R.; Horwitz, R.; Cutter, G.; Tyry, T.; Campagnolo, D.; Vollmer, T.

    2010-01-01

    Background: Vascular comorbidity adversely influences health outcomes in several chronic conditions. Vascular comorbidities are common in multiple sclerosis (MS), but their impact on disease severity is unknown. Vascular comorbidities may contribute to the poorly understood heterogeneity in MS disease severity. Treatment of vascular comorbidities may represent an avenue for treating MS. Methods: A total of 8,983 patients with MS enrolled in the North American Research Committee on Multiple Sclerosis Registry participated in this cohort study. Time from symptom onset or diagnosis until ambulatory disability was compared for patients with or without vascular comorbidities to determine their impact on MS severity. Multivariable proportional hazards models were adjusted for sex, race, age at symptom onset, year of symptom onset, socioeconomic status, and region of residence. Results: Participants reporting one or more vascular comorbidities at diagnosis had an increased risk of ambulatory disability, and risk increased with the number of vascular conditions reported (hazard ratio [HR]/condition for early gait disability 1.51; 95% confidence interval [CI] 1.41–1.61). Vascular comorbidity at any time during the disease course also increased the risk of ambulatory disability (adjusted HR for unilateral walking assistance 1.54; 95% CI 1.44–1.65). The median time between diagnosis and need for ambulatory assistance was 18.8 years in patients without and 12.8 years in patients with vascular comorbidities. Conclusions: Vascular comorbidity, whether present at symptom onset, diagnosis, or later in the disease course, is associated with a substantially increased risk of disability progression in multiple sclerosis. The impact of treating vascular comorbidities on disease progression deserves investigation. GLOSSARY EDSS = Expanded Disability Status Scale; HR = hazard ratio; MS = multiple sclerosis; NARCOMS = North American Research Committee on Multiple Sclerosis; PDDS

  6. Prevalence of Comorbidities in Asthma and Nonasthma Patients: A Meta-analysis.

    PubMed

    Su, Xinming; Ren, Yuan; Li, Menglu; Zhao, Xuan; Kong, Lingfei; Kang, Jian

    2016-05-01

    This study compares the prevalence rates of comorbidities between asthma and nonasthma control patients reported in the literature.Literature was searched in several electronic databases. After the selection of studies by following précised eligibility criteria, meta-analyses of odds ratios were carried out with subgroup and sensitivity analyses.Eleven studies studying 117,548 asthma patients compared with 443,948 non-asthma controls were included in the meta-analysis. The prevalence of cardiovascular comorbidities (odds ratio (OR): [95% CI] 1.90 [1.70, 2.14]; P < 0.00001), cerebrovascular comorbidities (OR 1.44 [1.29, 1.60]; P < 0.00001), obesity (OR 1.51 [1.14, 2.01]; P < 0.00001), hypertension (OR 1.66 [1.47, 1.88]; P < 0.00001, diabetes (OR 1.25 [1.08, 1.44]; P < 0.00001), other metabolic and endocrine comorbidities (OR 1.60 [1.40, 1.83]; P < 0.00001), psychiatric and neurological comorbidities (OR 1.62 [1.44, 1.82]; P < 0.00001), gut and urinary comorbidities (OR 1.91 [1.47, 2.49]; P < 0.00001),), cancer (OR 1.17 [1.10, 1.25]; P < 0.00001), and respiratory comorbidities (OR 5.60 [4.22, 7.44]; P < 0.00001) were significantly higher in the asthma patients in comparison with nonasthma controls.Asthma is associated with significantly higher comorbidities including cardio-/cerebrovascular diseases, obesity, hypertension, diabetes, psychiatric and neurological comorbidities, gut and urinary conditions, cancer, and respiratory problems other than asthma. Respiratory comorbidities are found 5 times more prevalent in asthma than in non-asthma patients. PMID:27258489

  7. [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

  8. [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

  9. 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. PMID:26442944

  10. 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. PMID:26521103

  11. Mental and Physical Comorbid Conditions and Days in Role Among Persons with Arthritis

    PubMed Central

    Stang, Paul; Brandenburg, Nancy; Lane, Michael; Merikangas, Kathleen R.; Von Korff, Michael; Kessler, Ronald

    2007-01-01

    Objective To estimate the prevalence of comorbidity among people with arthritis in the US adult population and to determine the role of comorbidity in accounting for the association of arthritis with days out of role. Methods Data come from the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 9282 respondents ages 18 and older carried out in 2001–3. Arthritis was assessed by self-report in a chronic conditions checklist along with a wide range of other physical conditions. Mental and substance use disorders were ascertained with the WHO Composite International Diagnostic Interview (CIDI). Number of days out of role was assessed for the 30 days before the interview. Results Arthritis was reported by 27.3% of respondents, 80.9% of whom also reported at least one other physical or mental disorder, including 45.6% with another chronic pain condition, 62.3% with another chronic physical condition, and 24.3% with a 12-month mental disorder. Arthritis was significantly associated with days out of role, but comorbidity explained more than half of this association. No significant interactions were found between arthritis and the other conditions in predicting days out of role. Conclusions Comorbidity is the rule rather than the exception among people with arthritis. Comorbidity accounts for most of the days out of role associated with arthritis. The societal burden of arthritis needs to be understood and managed within the context of these comorbid conditions. PMID:16449426

  12. [Comorbidity of substance use and other psychiatric disorders--theoretical foundation and evidence based therapy].

    PubMed

    Gouzoulis-Mayfrank, E

    2008-05-01

    The coincidence of two or more psychiatric disorders in the same person (comorbidity or dual diagnosis) is no rare exception. It is rather common and therapeutically highly relevant. Comorbid patients exhibit frequently severe manifestations of the disorder(s) and they require intensive treatment to meet their special needs and the interdependencies of their disorders. The present overview deals with the theoretical foundations of comorbidity of substance use and other psychiatric disorders. We present data on the prevalence of different comorbidities and discuss the models, which have been proposed to explain how substance use and other disorders relate with each other. Furthermore, we describe the clinical characteristics and long-term course of comorbid patients, as well as some general therapeutic principles including the advantages of integrated therapeutic programmes. In addition, we carried out a systematic literature search on specific pharmaco- and psychotherapies for common comorbidities using the databases MEDLINE, EMBASE and PsycInfo (up to December 2007), and assessed the methodological quality of the identified trials. Based on this search we present the empirical evidence for the effectiveness of specific treatments and make therapeutic recommendations which are graded according to the strength of existing evidence. In conclusion, integrated treatment programs are more effective, provided they take into account the multiple deficits of comorbid patients, adjust and adapt the different therapeutic components to each other, and set realistic goals. The next step should be a broader application of integrated treatment programs and their adoption as standard treatment within the national health systems. PMID:18557218

  13. Comorbidity profile among patients with rheumatoid arthritis and the impact on prescriptions trend.

    PubMed

    Al-Bishri, J; Attar, Sm; Bassuni, Nawal; Al-Nofaiey, Yasser; Qutbuddeen, Hamed; Al-Harthi, Salma; Subahi, Sarah

    2013-01-01

    Comorbid conditions play a pivotal role in rheumatoid arthritis management and outcomes. We estimated the percentage of comorbid illness among rheumatoid arthritis patients and explored the relationship between this comorbidity and different prescriptions. A cross-sectional study of patients with rheumatoid arthritis in three centers in Saudi Arabia was carried out. Comorbidity and antirheumatoid medication regimens prescribed were recorded on a specially designed Performa. The association between comorbidity and different drugs was analyzed. A total of 340 patients were included. The most comorbidities were hypertension 122 (35.9%), diabetes 105 (30.9%), osteoporosis 88 (25.8%), and dyslipidemia in 66 (19.4). The most common drug prescribed was prednisolone in 275 (80.8%) patients followed by methotrexate in 253 (74.4%) and biological therapy in 142 (41.5%) patients. Glucocorticoids were prescribed considerably more frequently in hypertensive and diabetic patients as well as in patients with osteoporosis and dyslipidemia. Most patients with rheumatoid arthritis suffered from comorbid diseases. PMID:23645988

  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. 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

  16. Pharmacogenetics of alcohol use disorders and comorbid psychiatric disorders.

    PubMed

    Helton, Sarah G; Lohoff, Falk W

    2015-12-15

    Alcohol use disorders (AUDs) represent a significant health burden worldwide. Currently, there are three medications approved by the U.S. Food and Drug Administration for the treatment of AUDs, and other drugs are being prescribed off-label for this purpose. However, response rates for pharmacologic treatment are low, and extant research suggests that treatment effects may partially depend on genetic factors. Personalized medicine, or using a patient's genetics and/or personal history to determine efficacy of treatment prior to prescription, is an emerging tool that will help clinicians treat their patients more effectively and safely. This review systematically discusses current findings from AUD pharmacotherapy trials examining disulfiram, acamprosate, naltrexone, the injectable naltrexone, and topiramate. Furthermore, it presents pharmacogenetics findings associated with these medications in an attempt to further the field of personalized medicine. Research from trials examining AUDs and comorbid major depressive disorder and anxiety disorders is also presented, and pharmacogenetic findings for these treatments are discussed. Lastly, the authors comment on the present and future states of the field of personalized medicine for AUD. PMID:26455758

  17. 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

  18. Migraine: treatments, comorbidities, and quality of life, in the USA

    PubMed Central

    Malone, Christopher D; Bhowmick, Amrita; Wachholtz, Amy B

    2015-01-01

    This study sought to characterize the experience of stress, treatment patterns, and medical and disability profile in the migraineur population to better understand how the experience of migraines impacts the social and psychological functioning of this group. A 30-minute self-report survey was presented via a migraine-specific website with data collection occurring between May 15 and June 15, 2012. Recruitment for the study was done through online advertisements. In total, 2,907 individuals began the survey and 2,735 met the inclusion criteria for the study. The sample was predominantly female (92.8%). Migraine-associated stress was correlated with length of time since first onset of symptoms (P<0.01) and number of symptoms per month (P<0.01). Disorders related to stress, such as depression (P<0.01) and anxiety (P<0.01), were also positively correlated with the measured stress resulting from migraines. Migraine-associated stress must be understood as a multidimensional experience with broader impacts of stress on an individual correlating much more highly with negative mental and physical health profiles. Stress resulting from frequent migraine headaches may contribute to the development of medical and psychological comorbidities and may be a part of a cyclical relationship wherein stress is both a cause and effect of the social and medical impairments brought about by migraine. PMID:26316804

  19. 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

  20. [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. PMID:25924044

  1. 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

  2. [Comorbidity of eating disorders and bipolar affective disorders].

    PubMed

    Kamińska, Katarzyna; Rybakowski, Filip

    2006-01-01

    Eating disorders--anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified (EDNOS) occur usually in young females. The significant pathogenic differences between patients who only restrict food, and patients with binge eating and compensatory behaviours, such as vomiting and purging were described. The prevalence of bipolar affective disorders--especially bipolar II and bipolar spectrum disorders (BS) may reach 5% in the general population. About half of the depressive episodes are associated with a "mild" bipolar disorder, and such a diagnosis is suggested by impulsivity and mood-instability. Previously, majority of research on the comorbidity between eating and affective disorders focused on depressive symptomatology, however difficulties in the reliable assessment of hypomania may obfuscate the estimation of the co-occurrence of eating disorders with BS. Epidemiological studies suggest the association between BS and eating disorders with binge episodes (bulimia nervosa, anorexia- bulimic type and EDNOS with binge episodes). Co-occurrence of such disorders with depressive symptoms probably suggests the diagnosis of BS, not recurrent depression. Bulimic behaviours, impulsivity and affective disorders might be related to the impairment of the serotonergic neurotransmission, which may result from the genetic vulnerability and early life trauma. Currently, the first-line pharmacological treatment of co-occurring eating disorders with binge episodes and BS are selective serotonin reuptake inhibitors. However in some cases, the use of mood-stabilising agents as monotherapy or in combination with serotonergic drugs may be helpful. PMID:17037812

  3. Comorbid antisocial and borderline personality disorders: mentalization-based treatment.

    PubMed

    Bateman, Anthony; Fonagy, Peter

    2008-02-01

    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. PMID:18186112

  4. [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. PMID:20795523

  5. Comorbidity of gender dysphoria and other major psychiatric diagnoses.

    PubMed

    Cole, C M; O'Boyle, M; Emory, L E; Meyer, W J

    1997-02-01

    Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more "normal" in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder. PMID:9015577

  6. 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. PMID:22285502

  7. [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. PMID:25314794

  8. Obesity and asthma: co-morbidity or causal relationship?

    PubMed

    van Huisstede, A; Braunstahl, G J

    2010-09-01

    There is substantial evidence that obesity and asthma are related. "Obese asthma" may be a unique phenotype of asthma, characterized by decreased lung volumes, greater symptoms for a given degree of lung function impairment, destabilization or lack of asthma control, lack of eosinophilic inflammation and a different response to controller medication. Whether this relationship between obesity and asthma is causal or represents co-morbidity due to other factors is unclear. In previous reviews concerning the relationship between obesity and asthma, five hypotheses were put forth. One of these hypotheses is that a low grade systemic inflammation caused by adipokines from the fat tissue causes or enhances bronchial inflammation. In animal models, there is an increasing amount of evidence for the role of adipokines derived from fat tissue in the relationship between obesity and asthma. The data are conflicting in humans. Since obesity is a component of the metabolic syndrome and the metabolic syndrome is also a form of systemic inflammation, it is to be expected that there is a relationship between metabolic syndrome and asthma. The few data that are available show that there is no relationship between metabolic syndrome and asthma, but there is one between the metabolic syndrome and asthma-like symptoms. Further research is needed to confirm the relationship between obesity and asthma in humans, where a rigorous approach in the diagnosis of asthma is essential. PMID:21214041

  9. 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. PMID:21999484

  10. [ADHD and addiction; application of the Belgian guideline with particular reference to comorbid affective disorders].

    PubMed

    Matthys, F; Joostens, P; Tremmery, S; Stes, S; Sabbe, B

    2013-01-01

    Two patients with a multi-substance use disorder and an apparent comorbid ADHD disorder were given psychiatric treatment for both illnesses. Each patient had a comorbid affective disorder. In both cases the approach was based on the Belgian guideline Good clinical practice in the recognition and treatment of young adults with addiction problems& squo. We use the case-reports to demonstrate the usefulness and relevance of the guideline in an outpatient setting compared to an inpatient setting and look particularly at the implications of other kinds of comorbidity encompassed by the guideline. PMID:24046250

  11. 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

  12. Psychiatric Comorbidity and Perceived Alcohol Stigma in a Nationally Representative Sample of Individuals with DSM-5 Alcohol Use Disorder

    PubMed Central

    Glass, Joseph E.; Williams, Emily C.; Bucholz, Kathleen K.

    2014-01-01

    Background Alcohol use disorder (AUD) is among the most stigmatized health conditions and is frequently comorbid with mood, anxiety, and drug use disorders. Theoretical frameworks have conceptualized stigma-related stress as a predictor of psychiatric disorders. We described profiles of psychiatric comorbidity among people with AUD and compared levels of perceived alcohol stigma across profiles. Methods Cross-sectional data were analyzed from a general population sample of United States adults with past-year DSM-5 AUD (n=3,368) from the National Epidemiologic Survey on Alcohol and Related Conditions, which was collected 2001–2005. Empirically derived psychiatric comorbidity profiles were established with latent class analysis and mean levels of perceived alcohol stigma were compared across the latent classes while adjusting for sociodemographic characteristics and AUD severity. Results Four classes of psychiatric comorbidity emerged within this AUD sample, including those with: (1) high comorbidity, reflecting internalizing (i.e. mood and anxiety disorders) and externalizing (i.e. antisocial personality and drug use disorders) disorders; (2) externalizing comorbidity; (3) internalizing comorbidity; and (4) no comorbidity. Perceived alcohol stigma was significantly higher in those with internalizing comorbidity (but not those with high comorbidity) as compared to those with no comorbidity or externalizing comorbidity. Conclusions Perceived stigma, as manifested by anticipations of social rejection and discrimination, may increase risk for internalizing psychiatric comorbidity. Alternatively, internalizing psychiatric comorbidity could sensitize affected individuals to perceive more negative attitudes towards them. Future research is needed to understand causal and bidirectional associations between alcohol stigma and psychiatric comorbidity. PMID:24848495

  13. 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. PMID:25969609

  14. 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

  15. [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. PMID:23864520

  16. 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

  17. Using a Clinical Knowledge Base to Assess Comorbidity Interrelatedness Among Patients with Multiple Chronic Conditions

    PubMed Central

    Zulman, Donna M.; Martins, Susana B.; Liu, Yan; Tu, Samson W.; Hoffman, Brian B.; Asch, Steven M.; Goldstein, Mary K.

    2015-01-01

    Decision support tools increasingly integrate clinical knowledge such as medication indications and contraindications with electronic health record (EHR) data to support clinical care and patient safety. The availability of this encoded information and patient data provides an opportunity to develop measures of clinical decision complexity that may be of value for quality improvement and research efforts. We investigated the feasibility of using encoded clinical knowledge and EHR data to develop a measure of comorbidity interrelatedness (the degree to which patients’ co-occurring conditions interact to generate clinical complexity). Using a common clinical scenario—decisions about blood pressure medications in patients with hypertension—we quantified comorbidity interrelatedness by calculating the number of indications and contraindications to blood pressure medications that are generated by patients’ comorbidities (e.g., diabetes, gout, depression). We examined properties of comorbidity interrelatedness using data from a decision support system for hypertension in the Veterans Affairs Health Care System. PMID:26958279

  18. Intervention effects for students with comorbid forms of learning disability: understanding the needs of nonresponders.

    PubMed

    Fuchs, Lynn S; Fuchs, Douglas; Compton, Donald L

    2013-01-01

    In this article, we considered evidence from our intervention research programs on whether students with learning disability (LD) in reading and mathematics (comorbid LD) respond differently to intervention, compared to students with reading LD alone (RD) or to students with mathematics LD alone (MD). The goal was to gain insight into whether comorbid disorder represents an LD subtype distinct from RD or from MD, which requires differentiated forms of intervention. Our analysis suggested that students with comorbid LD respond differently than those with MD, depending on the nature of mathematics intervention, and may therefore represent a distinctive subtype. By contrast, students with RD appear to respond to intervention in similar ways, regardless of whether they experience RD alone or in combination with MD. Results also suggest that distinctions between comorbid and single-order LD may depend on whether LD is defined in terms of lower- versus higher-order academic skill. Recommendations for future study are provided. PMID:23232441

  19. 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

  20. Treatment of co-morbid obsessive compulsive disorder, mood, and anxiety disorders.

    PubMed

    Coffey, Barbara J; Shechter, Rachel L

    2006-01-01

    In Sumary, OCD, non-OCD anxiety disorders and mood disorders are common co-morbid psychiatric disorders are common co-morbid psychiatric disorders in clinically referred youth with TS. Emotional disorders such as anxiety and depression may be more problematic to the patient than the tics, with regard to overall illness severity and the potential for adverse outcomes, such as school and social failure. The emotional symptoms and co-morbid mood and anxiety disorders must be comprehensively identified because they will require specific intervention and treatment. Treatment must be tailored to each individual, and should ideally include education, monitoring, and prioritization of symptoms based on distress and impairment. There is growing evidence to support the use of several medications, particularly the selective serotonin reuptake inhibitors, and some cognitive behavioral techniques to treat the psychiatric co-morbid disorders. PMID:16536368

  1. 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

  2. Memory for Therapy in Bipolar Disorder and Comorbid Insomnia

    PubMed Central

    Lee, Jason Y.; Harvey, Allison G.

    2014-01-01

    Objective To examine the extent to which patients recall the contents of therapy from one session to the next and to determine whether recall is associated with treatment outcome. Method Thirty inter-episode individuals with bipolar disorder and comorbid insomnia (ages 21-62 years, 56.7% female, 56.7% Caucasian) participated in an RCT of psychotherapies. Patients received either Cognitive Behavioral Therapy for Insomnia (CBTI-BP; n = 17) or Psychoeducation (PE; n = 13). At the beginning of each weekly session, patients freely recalled as many therapy points (i.e., distinct ideas, principles, and experiences) as they could from their previous session. After each session, therapists recorded a list of all therapy points delivered. Treatment outcome was measured via the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Patient-Reported Outcome Measurement Info System—Sleep (PROMIS-Sleep), and Quality of Life—Sleep (QOL-Sleep), administered at pre and post treatment, and treatment evaluation questions administered at post treatment. Results Patients recalled 19.6% to 36.9% of therapy points listed by therapists. Raw numbers of therapy points recalled were positively correlated with reductions in ISI and gains in QOL-Sleep, and with most treatment evaluation questions. Percentages of therapy points recalled were positively correlated with gains in QOL-Sleep, but with no other sleep outcome measures or any of the treatment evaluation questions. Patients in CBTI-BP recalled more therapy points than those in PE, but did not differ in the percentages of points recalled. Conclusions Memory for therapy is poor. The amount of content recalled is positively associated with treatment outcome. Enhancing memory for therapy might play a key role in improving treatment outcome. PMID:25222800

  3. Temporal Comorbidity of Mental Disorder and Ulcerative Colitis

    PubMed Central

    Cawthorpe, David; Davidson, Marta

    2015-01-01

    Objectives: Ulcerative colitis is an inflammatory bowel disease that rarely exists in isolation in affected patients. We examined the association of ulcerative colitis and International Classification of Diseases mental disorder, as well as the temporal comorbidity of three broad International Classification of Diseases groupings of mental disorders in patients with ulcerative colitis to determine if mental disorder is more likely to occur before or after ulcerative colitis. Methods: We used physician diagnoses from the regional health zone of Calgary, Alberta, for patient visits from fiscal years 1994 to 2009 for treatment of any presenting concern in that Calgary health zone (763,449 patients) to identify 5113 patients age younger than 1 year to age 92 years (2120 males, average age = 47 years; 2993 females, average age = 48 years) with a diagnosis of ulcerative colitis. Results: The 16-year cumulative prevalence of ulcerative colitis was 0.0058%, or 58 cases per 10,000 persons (95% confidence interval = 56–60 per 10,000). Although the cumulative prevalence of mental disorder in the overall sample was 5390 per 10,000 (53.9%), we found that 4192 patients with ulcerative colitis (82%) also had a diagnosis of a mental disorder. By annual rate of ulcerative colitis, patients with mental disorder had a significantly higher annual prevalence. The mental disorder grouping neuroses/depressive disorders was most likely to arise before ulcerative colitis (odds ratio = 1.87 for males; 2.24 for females). Conclusions: A temporal association was observed between specific groups of International Classification of Diseases mental disorder and ulcerative colitis, indicating a possible etiologic relationship between the disorders or their treatments, or both. PMID:25663206

  4. Chronic widespread pain: clinical comorbidities and psychological correlates.

    PubMed

    Burri, Andrea; Ogata, Soshiro; Vehof, Jelle; Williams, Frances

    2015-08-01

    Recent studies have provided consistent evidence for a genetic influence on chronic widespread pain (CWP). The aim of this study was to investigate (1) the etiological structure underlying CWP by examining the covariation between CWP and psychological comorbidities and psychoaffective correlates and (2) the decomposition of the covariation into genetic and environmental components. A total of 3266 female twins (mean age 56.6 years) were subject to multivariate analyses. Using validated questionnaires to classify twins as having CWP, the prevalence of CWP was 20.8%. In the multivariate analysis, the most suitable model was the common pathway model. This model revealed 2 underlying latent variables, one common to anxiety, emotional intelligence, and emotional instability (f1) and the other common to depression and CWP (f2), the latter being highly heritable (86%). Both latent variables (f1 and f2) shared an additive genetic and a nonshared environmental factor. In addition, a second additive genetic factor loading only on f2 was found. This study reveals the structure of genetic and environmental influences of CWP and its psychoaffective correlates. The results show that the clustering of CWP and depression is due to a common, highly heritable, underlying latent trait. In addition, we found evidence that CWP, anxiety, emotional instability, and emotional intelligence are influenced by different underlying latent traits sharing the same genetic and nonshared environmental factors. This is the first study to reveal the structure and relative importance of genetic and environmental influences on complex etiological mechanisms of CWP and its correlates. PMID:25851458

  5. Psychiatric comorbidities among patients with epilepsy in Montenegro.

    PubMed

    Vujisić, Slavica; Vodopić, Sanja; Radulović, Ljiljana; Injac-Stevović, Lidija

    2014-12-01

    The aim of this study was to evaluate the prevalence of psychiatric comorbidities, depression and anxiety, among patients with epilepsy in the outpatient Clinic for Epilepsy, Clinical Centre of Montenegro. Patients aged 18 and above with a diagnosis of epilepsy for at least one year were consecutively enrolled during a six-month period. Patients anonymously filled out a questionnaire which included data on the gender, age, education, marital status and degree of seizure control. The Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were used to evaluate the presence or absence of anxiety and depression. Total number of study patients was 70, including 52 patients with partial seizures and 18 patients with generalized tonic-clonic seizures. The mean patient age was 37 ± 7.92 years. The prevalence of depression in our sample was 32.8%, whereas the prevalence of anxiety was 21.4%. Patients with partial seizures were more depressed, while those with idiopathic generalized seizures were more anxious (p < 0.01). Depression was associated with a lower educational level, unemployment and poor seizure control (p < 0.05). The number of antiepileptic drugs showed a trend towards negative association with depression (p = 0.005). Anxiety was associated with the level of education and uncontrolled seizures (p < 0.01). Neither depression nor anxiety was associated with age, gender, marital status, age at onset and duration of epilepsy. Psychiatric disorders among patients with epilepsy are quite common but yet under-recognized. Therefore, appropriate recognition and efficient treatment of these disorders in patients with epilepsy might improve their quality of life and could consequently lead to better treatment success. PMID:25868308

  6. Axis I diagnostic comorbidity and borderline personality disorder.

    PubMed

    Zimmerman, M; Mattia, J I

    1999-01-01

    Borderline personality disorder (PD) has been the most studied PD. Research has examined the relationship between borderline PD and most axis I diagnostic classes such as eating disorders, mood disorders, and substance use disorders. However, there is little information regarding the relationship of borderline PD and overall comorbidity with all classes of axis I disorders assessed simultaneously. In the present study, 409 patients were evaluated with semistructured diagnostic interviews for axis I and axis II disorders. Patients with a diagnosis of borderline PD versus those who did not receive the diagnosis were assigned significantly more current axis I diagnoses (3.4 v 2.0). Borderline PD patients were twice as likely to receive a diagnosis of three or more current axis I disorders (69.5% v 31.1%) and nearly four times as likely to have a diagnosis of four or more disorders 147.5% v 13.7%). In comparison to nonborderline PD patients, borderline PD patients more frequently received a diagnosis of current major depressive disorder (MDD), bipolar I and II disorder, panic disorder with agoraphobia, social and specific phobia, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), eating disorder NOS, and any somatoform disorder. Similar results were observed for lifetime diagnoses. Overall, borderline PD patients were more likely to have multiple axis I disorders than nonborderline PD patients, and the differences between the two groups were present across mood, anxiety, substance use, eating, and somatoform disorder categories. These findings highlight the importance of performing thorough evaluations of axis I pathology in patients with borderline PD in order not to overlook syndromes that are potentially treatment-responsive. PMID:10428182

  7. [Treatment response of depressive patients with comorbid problem drink].

    PubMed

    Ishikawa, Hiromi; Hashimoto, Eri; Tayama, Masaya; Saito, Toshikazu

    2013-10-01

    In this study, we investigated the impact of Problem Drink on depression. Forty participants with depression were divided into 2 groups: non-Problem Drinker (NPD) group (n = 22) and Problem Drinker (PD) group (n = 18) according to Alcohol Use Disorder Identification Test (AUDIT) score (NPD < 12, PD > or = 12). Depression was assessed by the Mini-International Neuropsychiatric Interview. The effect of medication on depressive symptoms was monitored over 12 weeks using the Hamilton Rating Scale for Depression (HAM-D). Significant improvement in HAM-D score was observed at 2 weeks in NPD patients but not until 4 weeks in PD patients. Total HAM-D scores were lower in NPD than in PD patients at the end of the treatment period. Therapeutic doses (dose of antidepressant used was equivalent to greater than 75 mg of imipramine) of antidepressants resulted in significant improvement in HAM-D scores at 2 weeks in NPD patients, but not until 8 weeks in PD patients and brought lower HAM-D scores in NPD than in PD patients at the end of the treatment period. The AUDIT score and total alcohol consumption during the study period were negatively correlated to the improvement in HAM-D score. In NPD patients, the level of education of patients in remission was higher than those by patients not in remission. In contrast, level of education of patients in remission were similar to those in PD patients not in remission. The above results suggest that co-occurrence of alcohol use disorders with depression is associated with a lower response to antidepressants which may reflect not only the result of biological alterations in the brain by chronic ethanol ingestion but also an inhibitory effect of ethanol on antidepressant action in the brain. Drinking-related cognitive dysfunction may also relate to the decreased response to treatment in the depressed patients with comorbid Problem Drinker. PMID:24427900

  8. Comorbid Analysis of Genes Associated with Autism Spectrum Disorders Reveals Differential Evolutionary Constraints.

    PubMed

    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

  9. Simultaneous bilateral hip fractures following a simple fall in an elderly patient without predilecting comorbidities.

    PubMed

    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 rareness potentially leads to misses of this diagnosis. PMID:27161143

  10. Increased health burden associated with comorbid depression in older Brazilians with diabetes

    PubMed Central

    Blay, S. L.; Fillenbaum, G.G.; Marinho, V.; Andreoli, S.B.; Gastal, F.L.

    2013-01-01

    Background The health burden associated with comorbid depression and diabetes in older community residents in middle income countries is unclear. Methods Data came from a statewide representative sample (N= 6,963, age ≥60) in Brazil. Controlled polytomous logistic regression was used to determine whether four mutually exclusive groups (all possible combinations of the presence or absence of depression and diabetes) differed in sociodemographic characteristics, social resources, health behaviors, and selected health conditions. Results While 2.37% were expected to have comorbid depression/diabetes given sample base rates (depression: 20.92% [1457/6963]; diabetes: 11.35% [790/6959]), comorbidity was present in 3.62% (52.5% beyond expectation; P<0.0001; OR = 1.58, 95% Confidence Interval 1.29–1.95). Depression without diabetes was reported by17.3%, and diabetes without depression by 7.7%. In controlled analyses, the depression group had poorer socioeconomic status and health behaviors, and a greater likelihood of vascular, respiratory, and musculoskeletal problems than the diabetes group. Vascular, respiratory, and urinary problems were exacerbated in comorbid depression/diabetes; the comorbid group was also more likely to be female and younger. Limitations cross-sectional design. Conclusions To our knowledge, this is the first study that explicitly reports on all four possible depression/diabetes combinations in an older representative community-resident sample, using controlled analyses to identify unique associations with sociodemographic characteristics and other health conditions. The burden of comorbid depression/diabetes in Brazil, a middle income country, appears to be comparable to that found in higher income countries. So, similarly, depression without diabetes had a greater odds of adverse sociodemographic and health conditions than diabetes without depression; comorbid depression/diabetes was more likely in women and young elderly, and the odds of

  11. 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

  12. [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. PMID:27191019

  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. 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 rareness potentially leads to misses of this diagnosis. PMID:27161143

  15. The impact of ruxolitinib treatment on inflammation-mediated comorbidities in myelofibrosis and related neoplasms

    PubMed Central

    Bjørn, Mads Emil; Hasselbalch, Hans Carl

    2015-01-01

    Key clinical message The inflammation-mediated comorbidities in myelofibrosis (MF) and related neoplasms (MPNs) likely reflect the concurrent immune deregulation and systemic inflammatory nature of the MPNs, emphasizing the link between chronic systemic inflammation, immune deregulation, and the malignant clone. JAK1-2 inhibitors in MF-patients reduce constitutional symptoms and splenomegaly, but also taget autoimmune and inflammation-mediated comorbidities. PMID:26185657

  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. A comparison of comorbidities obtained from hospital administrative data and medical charts in older patients with pneumonia

    PubMed Central

    2011-01-01

    Background The use of comorbidities in risk adjustment for health outcomes research is frequently necessary to explain some of the observed variations. Medical charts reviews to obtain information on comorbidities is laborious. Increasingly, electronic health care databases have provided an alternative for health services researchers to obtain comorbidity information. However, the rates obtained from databases may be either over- or under-reported. This study aims to (a) quantify the agreement between administrative data and medical charts review across a set of comorbidities; and (b) examine the factors associated with under- or over-reporting of comorbidities by administrative data. Methods This is a retrospective cross-sectional study of patients aged 55 years and above, hospitalized for pneumonia at 3 acute care hospitals. Information on comorbidities were obtained from an electronic administrative database and compared with information from medical charts review. Logistic regression was performed to identify factors that were associated with under- or over-reporting of comorbidities by administrative data. Results The prevalence of almost all comorbidities obtained from administrative data was lower than that obtained from medical charts review. Agreement between comorbidities obtained from medical charts and administrative data ranged from poor to very strong (kappa 0.01 to 0.78). Factors associated with over-reporting of comorbidities were increased length of hospital stay, disease severity, and death in hospital. In contrast, those associated with under-reporting were number of comorbidities, age, and hospital admission in the previous 90 days. Conclusions The validity of using secondary diagnoses from administrative data as an alternative to medical charts for identification of comorbidities varies with the specific condition in question, and is influenced by factors such as age, number of comorbidities, hospital admission in the previous 90 days, severity

  18. Issues related to symptomatic and disease-modifying treatments affecting cognitive and neuropsychiatric comorbidities of epilepsy.

    PubMed

    Brooks-Kayal, Amy R; Bath, Kevin G; Berg, Anne T; Galanopoulou, Aristea S; Holmes, Gregory L; Jensen, Frances E; Kanner, Andres M; O'Brien, Terence J; Whittemore, Vicky H; Winawer, Melodie R; Patel, Manisha; Scharfman, Helen E

    2013-08-01

    Many symptoms of neurologic or psychiatric illness--such as cognitive impairment, depression, anxiety, attention deficits, and migraine--occur more frequently in people with epilepsy than in the general population. These diverse comorbidities present an underappreciated problem for people with epilepsy and their caregivers because they decrease quality of life, complicate treatment, and increase mortality. In fact, it has been suggested that comorbidities can have a greater effect on quality of life in people with epilepsy than the seizures themselves. There is increasing recognition of the frequency and impact of cognitive and behavioral comorbidities of epilepsy, highlighted in the 2012 Institute of Medicine report on epilepsy. Comorbidities have also been acknowledged, as a National Institutes of Health (NIH) Benchmark area for research in epilepsy. However, relatively little progress has been made in developing new therapies directed specifically at comorbidities. On the other hand, there have been many advances in understanding underlying mechanisms. These advances have made it possible to identify novel targets for therapy and prevention. As part of the International League Against Epilepsy/American Epilepsy Society workshop on preclinical therapy development for epilepsy, our working group considered the current state of understanding related to terminology, models, and strategies for therapy development for the comorbidities of epilepsy. Herein we summarize our findings and suggest ways to accelerate development of new therapies. We also consider important issues to improve research including those related to methodology, nonpharmacologic therapies, biomarkers, and infrastructure. PMID:23909853

  19. PTSD, Comorbid Depression, and the Cortisol Waking Response in Victims of Intimate Partner Violence: Preliminary Evidence

    PubMed Central

    Pinna, Keri L. M.; Delahanty, Douglas L.

    2013-01-01

    Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV; Johnson, Delahanty, & Pinna, 2008). Hypothalamic Pituitary Adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, Area Under the Waking Curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD+MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed. PMID:24283327

  20. Comorbidities in patients with COPD and pulmonary rehabilitation: do they matter?

    PubMed

    Franssen, Frits M E; Rochester, Carolyn L

    2014-03-01

    It is now recognised that chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with many systemic features. Cardiovascular, metabolic, musculoskeletal and psychological comorbidities contribute to the morbidity and mortality in all stages of the disease. The presence of comorbid conditions has important consequences for disease assessment and management. In addition to treatment of the structural and functional changes in the lungs, clinical programmes for COPD should also assess and manage patients' comorbidities. Thus, there is an increasing need to understand the interaction between existing therapies and comorbidities. Pulmonary rehabilitation is an evidence-based intervention that has been shown to improve clinical outcomes in COPD. However, the impact of comorbidities on outcomes of pulmonary rehabilitation and vice versa is only partially understood. To date, there is limited information on the need for adapting specific interventions in pulmonary rehabilitation to comorbidities or the potential adverse effects of pulmonary rehabilitation in these patients. This article addresses the currently available literature and suggests novel areas for research. PMID:24591670

  1. Abnormal hippocampal structure and function in clinical anxiety and comorbid depression.

    PubMed

    Cha, Jiook; Greenberg, Tsafrir; Song, Inkyung; Blair Simpson, Helen; Posner, Jonathan; Mujica-Parodi, Lilianne R

    2016-05-01

    Given the high prevalence rates of comorbidity of anxiety and depressive disorders, identifying a common neural pathway to both disorders is important not only for better diagnosis and treatment, but also for a more complete conceptualization of each disease. Hippocampal abnormalities have been implicated in anxiety and depression, separately; however, it remains unknown whether these abnormalities are also implicated in their comorbidity. Here we address this question by testing 32 adults with generalized anxiety disorder (15 GAD only and 17 comorbid MDD) and 25 healthy controls (HC) using multimodal MRI (structure, diffusion and functional) and automated hippocampal segmentation. We demonstrate that (i) abnormal microstructure of the CA1 and CA2-3 is associated with GAD/MDD comorbidity and (ii) decreased anterior hippocampal reactivity in response to repetition of the threat cue is associated with GAD (with or without MDD comorbidity). In addition, mediation-structural equation modeling (SEM) reveals that our hippocampal and dimensional symptom data are best explained by a model describing a significant influence of abnormal hippocampal microstructure on both anxiety and depression-mediated through its impact on abnormal hippocampal threat processing. Collectively, our findings show a strong association between changes in hippocampal microstructure and threat processing, which together may present a common neural pathway to comorbidity of anxiety and depression. © 2016 Wiley Periodicals, Inc. PMID:26743454

  2. Is it time to consider comorbid substance abuse as a new indication for antipsychotic drug development?

    PubMed

    Awad, A George

    2012-07-01

    Comorbid drug abuse in schizophrenia has been consistently reported as high, with estimates ranging between 10-70%. Comorbid addictive states in schizophrenia are possibly multifactorial, yet recent research assigns a significant neurobiological role in its genesis. Abnormalities in hippocampal/cortical function in schizophrenia which mediate reward and reinforcement behavior are identified as central to the development and maintenance of comorbid addictive states. Preliminary data suggest that the vulnerability of patients with schizophrenia to substance use disorders may be a primary disease symptom. The management of comorbid substance abuse in schizophrenia relies on the use of antipsychotic medications. Recent data raise the concern about whether first-generation antipsychotics in long-term use can conversely lead to enhancement of the abused substance's reinforcing properties. Some recent reports have assigned a favorable outcome to clozapine and second-generation antipsychotics, pointing to a possible differential role for various antipsychotics. In view of the high prevalence of comorbid drug abuse in schizophrenia, its impact on outcome of treatment and the recent emerging neurobiological information, it is my contention that comorbid drug abuse constitutes a dimension by itself and deserves to receive an indication in the development of new antipsychotics similar to negative symptoms or cognitive deficits. PMID:22170735

  3. Risk of interactions between complementary and alternative medicine and medication for comorbidities in patients with melanoma.

    PubMed

    Loquai, Carmen; Dechent, Dagmar; Garzarolli, Marlene; Kaatz, Martin; Kaehler, Katharina C; Kurschat, Peter; Meiss, Frank; Stein, Annette; Nashan, Dorothee; Micke, Oliver; Muecke, Ralph; Muenstedt, Karsten; Stoll, Christoph; Schmidtmann, Irene; Huebner, Jutta

    2016-05-01

    Complementary and alternative medicine (CAM) is used widely among cancer patients. Beside the risk of interaction with cancer therapies, interactions with treatment for comorbidities are an underestimated problem. The aim of this study was to assess prevalence of interactions between CAM and drugs for comorbidities from a large CAM usage survey on melanoma patients and to classify herb-drug interactions with regard to their potential to harm. Consecutive melanoma outpatients of seven skin cancer centers were asked to complete a standardized CAM questionnaire including questions to their CAM use and their taken medication for comorbidities and cancer. Each combination of conventional drugs and complementary substances was evaluated for their potential of interaction. 1089 questionnaires were eligible for evaluation. From these, 61.6 % of patients reported taking drugs regularly from which 34.4 % used biological-based CAM methods. Risk evaluation for interaction was possible for 180 CAM users who listed the names or substances they took for comorbidities. From those patients, we found 37.2 % at risk of interaction of their co-consumption of conventional and complementary drugs. Almost all patients using Chinese herbs were at risk (88.6 %). With a high rate of CAM usage at risk of interactions between CAM drugs and drugs taken for comorbidities, implementation of a regular assessment of CAM usage and drugs for comorbidities is mandatory in cancer care. PMID:27090799

  4. Insomnia, Comorbidity, and Risk of Injury Among Insured Americans: Results from the America Insomnia Survey

    PubMed Central

    Kessler, Ronald C.; Berglund, Patricia A.; Coulouvrat, Catherine; Fitzgerald, Timothy; Hajak, Goeran; Roth, Thomas; Shahly, Victoria; Shillington, Alicia C.; Stephenson, Judith J.; Walsh, James K.

    2012-01-01

    Study Objectives: To estimate associations of broadly defined insomnia (i.e., meeting inclusion criteria for International Classification of Diseases, Tenth Revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), or Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2) diagnosis) with workplace/nonworkplace injuries controlling for comorbid conditions among workers in the America Insomnia Survey (AIS). Design/Setting: Cross-sectional telephone survey. Participants: National sample of 4,991 employed health plan subscribers (age 18 yr and older). Interventions: None. Measurements and Results: Broadly defined insomnia with duration of at least 12 mo was assessed with the Brief Insomnia Questionnaire (BIQ). Injuries in the 12 mo before interview were assessed with a standard self-report measure of injuries causing role impairment or requiring medical attention. Eighteen comorbid condition clusters were assessed with medical/pharmacy claims records and self-reports. Insomnia had significant gross associations (odds ratios, ORs) with both workplace and nonworkplace injuries (OR 2.0 and 1.5, respectively) in logistic regression analyses before controlling for comorbid conditions. The significant population attributable risk proportions (PARPs) of total injuries with insomnia was 4.6% after controlling for comorbid conditions. Only 2 other conditions had PARPs exceeding those of insomnia. The associations of insomnia with injuries did not vary significantly with worker age, sex, or education, but did vary significantly with comorbid conditions. Specifically, insomnia was significantly associated with workplace and nonworkplace injuries (OR 1.8 and 1.5, respectively) among workers having no comorbid conditions, with workplace but not nonworkplace injuries (OR 1.8 and 1.2, respectively) among workers having 1 comorbid condition, and with neither workplace nor nonworkplace injuries

  5. Adjusting for dependent comorbidity in the calculation of healthy life expectancy

    PubMed Central

    Mathers, Colin D; Iburg, Kim M; Begg, Stephen

    2006-01-01

    Background Healthy life expectancy – sometimes called health-adjusted life expectancy (HALE) – is a form of health expectancy indicator that extends measures of life expectancy to account for the distribution of health states in the population. The World Health Organization has estimated healthy life expectancy for 192 WHO Member States using information from health interview surveys and from the Global Burden of Disease Study. The latter estimates loss of health by cause, age and sex for populations. Summation of prevalent years lived with disability (PYLD) across all causes would result in overestimation of the severity of the population average health state because of comorbidity between conditions. Earlier HALE calculations made adjustments for independent comorbidity in adding PYLD across causes. This paper presents a method for adjusting for dependent comorbidity using available empirical data. Methods Data from five large national health surveys were analysed by age and sex to estimate "dependent comorbidity" factors for pairs of conditions. These factors were defined as the ratio of the prevalence of people with both conditions to the product of the two total prevalences for each of the conditions. The resulting dependent comorbidity factors were used for all Member States to adjust for dependent comorbidity in summation of PYLD across all causes and in the calculation of HALE. A sensitivity analysis was also carried out for order effects in the proposed calculation method. Results There was surprising consistency in the dependent comorbidity factors across the five surveys. The improved estimation of dependent comorbidity resulted in reductions in total PYLD per capita ranging from a few per cent in younger adult ages to around 8% in the oldest age group (80 years and over) in developed countries and up to 15% in the oldest age group in the least developed countries. The effect of the dependent comorbidity adjustment on estimated healthy life

  6. Phenomenology, psychiatric comorbidity and family history in referred preschool children with obsessive-compulsive disorder

    PubMed Central

    2012-01-01

    Objective The study aimed to investigate phenomenology, psychiatric comorbidity, and family history of obsessive-compulsive disorder (OCD) in a clinical sample of normally developing preschool children with OCD. Method Subjects in this study were recruited from a clinical sample of preschool children (under 72 months of age) who were referred to a university clinic. Subjects with a normal developmental history and significant impairment related to OCD symptoms were included in the study. Children’s Yale-Brown Obsessive-Compulsive Scale was used to assess OCD symptoms. Each subject was assessed for comorbid DSM-IV psychiatric disorders using a semi-structured interview. Parents were evaluated for lifetime history of OCD in individual sessions. Results Fifteen boys and ten girls (age range: 28 to 69 months; 54.12±9.08 months) were included. Mean age of onset of OCD was 35.64±13.42 months. All subjects received at least one comorbid diagnosis. The most frequent comorbid disorders were non-OCD anxiety disorders (n=17; 68.0%), attention-deficit hyperactivity disorder (ADHD) (n=15; 60.0%), oppositional defiant disorder (ODD) (n=12; 48.0%), and tic disorders (n=6; 24.0%). Mean number of comorbid disorders was 3.65 and 2.35 for boys and girls, respectively. At least one parent received lifetime OCD diagnosis in 68 percent of the subjects. Conclusions The results indicated that OCD in referred preschool children is more common in males, highly comorbid with other psychiatric disorders, and associated with high rates of family history of OCD. Given the high rates of comorbidity and family history, OCD should be considered in referred preschool children with disruptive behavior disorders and/or with family history of OCD. PMID:23173690

  7. The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough.

    PubMed

    Lorenc, Ava; Ananthavarathan, Piriyankan; Lorigan, James; Jowata, Mohamade; Brook, Gary; Banarsee, Ricky

    2014-01-01

    Background HIV has changed from a rapidly deteriorating illness to a complex chronic disease, with increasing incidences of comorbidity, including cancer, and liver, lung and cardiovascular diseases. North West London has 6719 individuals living with the human immunodeficiency virus (HIV), 873 of whom reside in the London Borough of Brent. Traditionally, commissioning services have focused on HIV therapy alone without considering how comorbidity affects treatment outcome and total service costs. Setting The setting for the study was NHS Brent Primary Care Trust, London UK. Question What associated comorbidities are present in people in Brent (London, UK) living with HIV, and how common are they? Methods A point-prevalence audit of retrospective data was conducted on all HIV-positive patients in Brent (financial year 2011/12). Data were collected from genito-urinary medicine (GUM) services, community services and general practitioners (GPs) on HIV diagnosis, patient demographics and past/current comorbidities: hepatitis B and C, cardiovascular disease, diabetes and mental health disorders. Results This study identified that 29% of people living with HIV/AIDS (PLWHA) in Brent have at least one comorbidity. The most common was hepatitis, followed by mental health disorders and cardiovascular disease (CVD). Comorbidity was more likely in older male patients (in particular CVD and diabetes) and White patients (except for diabetes which was more common in Asian groups). Discussion/Conclusion Many PLWHA in Brent suffer from a number of other conditions, which appear largely independent of HIV. Findings confirm the need to treat HIV as a long-term condition, including patient education, empowerment and encouraging self-management. The multi-morbidity of many PLWHA suggests a role for both primary care and collaborative, holistic, patient-centred and individualised healthcare. Service providers and commissioners need to consider comorbidities in their treatment of and

  8. The complexity of ADHD: diagnosis and treatment of the adult patient with comorbidities.

    PubMed

    Newcorn, Jeffrey H; Weiss, Margaret; Stein, Mark A

    2007-08-01

    Attention-deficit/hyperactivity disorder (ADHD) is an impairing but usually treatable condition. Popular culture propagates the myth that ADHD recedes with age; this is not the case. Although it is common, <20% of adults with ADHD are diagnosed or treated. Adults with ADHD show significant comorbidities with depressive disorders, anxiety disorders, substance use, oppositional defiant disorder, personality disorders, sleep problems, and learning disabilities. However, symptoms that result from ADHD, such as mood symptoms or lability, are often mistaken for comorbid disorders. Comorbidity with ADHD impacts treatment compliance, treatment response, and patient insight. Insufficient data on the interaction between ADHD and comorbidities impedes proper diagnosis and treatment. Better clinical tools for assessing these conditions are needed. Food and Drug Administration-approved pharmacologic treatments for adult ADHD include stimulants, dexmethylphenidate, and the nonstimulant atomoxetine. Effect sizes of approved medicines at approved doses are half those seen in children. Adults may also need longer duration of medication effects than children. Short-acting stimulants are likely to result in poorer adherence and have a higher risk for diversion or abuse. Risk of abuse is a major concern; stimulant treatments are controlled substances, and children with ADHD show increased risk of substance abuse. Psychosocial interventions may be beneficial in treating both ADHD and comorbidities.In this expert roundtable supplement, Margaret Weiss, MD, PhD, presents a comprehensive overview of complications surrounding differential diagnosis in adults with ADHD. Next, Mark A. Stein, PhD, reviews evaluation, comorbidity, and development of a treatment plan in this population. Finally, Jeffrey H. Newcorn, MD, provides a discussion on the pharmacologic options available for adults with ADHD, considering dosages specific to adults and common comorbidities. PMID:17667893

  9. Comorbidity, knowledge and attitude towards sex among patients with Dhat syndrome: A retrospective study.

    PubMed

    Grover, Sandeep; Gupta, Sunil; Mehra, Aseem; Avasthi, Ajit

    2015-10-01

    This study aimed to assess the knowledge about sex, attitude towards sex, prevalence of psychiatric comorbidity and relationship of the comorbidity with onset of symptoms of Dhat syndrome. Treatment records of 264 patients diagnosed with Dhat syndrome were reviewed for clinical profile including psychiatric comorbidity and sexual dysfunction and information on sexual knowledge and attitude using Sex Knowledge and Attitude Questionnaire (SKAQ-II). None of the patients gave all the correct responses on the SKAQ-II. Poor knowledge about sexual matters was not limited to the semen formation only, but also involved other aspects of sexuality, like masturbation, relationship of pregnancy with orgasm in women, breast feeding and pregnancy, relationship of sexual desire with addictive drugs and sexually transmitted diseases can be cured by having sex with a virgin girl. Higher level of education showed significant association with better sexual knowledge and liberal attitude. There was significant positive correlation between sexual knowledge and attitude. About half (51.9%) of patients had at least one comorbid psychiatric disorder and/or sexual dysfunction. Among the psychiatric disorders, depressive disorders were the most common and premature ejaculation was the most common comorbid sexual dysfunction. Among those with comorbidity, symptoms of Dhat syndrome preceded the onset of other disorders. Patients with Dhat syndrome have high rates of comorbidity and poor sexual knowledge and less liberal attitude, which was not only limited to loss of semen but also involves other spheres of sexuality. Accordingly psychoeducation in patients of Dhat syndrome should not be limited to addressing the myths and lack of knowledge about semen formation, but also should address poor sexual knowledge on all the aspects related to sexuality and the negative attitude towards sex. PMID:26259894

  10. Comorbidity profile of poliomyelitis survivors in a Chinese population: a population-based study.

    PubMed

    Kang, Jiunn-Horng; Lin, Herng-Ching

    2011-06-01

    Previous reports of comorbid conditions in poliomyelitis survivors mainly focused on some disease categories, such as respiratory diseases, gastrointestinal diseases, psychiatric diseases, neurological diseases and cancer. Data regarding a wide spectrum of medical comorbidities in patients with poliomyelitis is still sparse. This study aimed to investigate and profile the wide range of comorbidities among the survivors of paralytic poliomyelitis in a Chinese population. In total, 2,032 paralytic poliomyelitis patients were selected as the study group and the comparison group consisted of 10,160 randomly selected enrollees. The comorbidities for analysis were based on a modified version of the Elixhauser Comorbidity Index. Conditional logistic regression analyses were computed to investigate the risk of comorbidities for these two groups. As compared to controls, patients with paralytic poliomyelitis had significantly higher prevalence of hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, cardiac arrhythmias, peripheral vascular disorder, stroke, paralysis, migraines, Parkinson's disease, rheumatoid arthritis, ankylosing spondylitis, pulmonary circulation disorders, chronic pulmonary disease, liver disease, peptic ulcers, hepatitis B or C, deficiency anemias, depression, and lymphoma. Most of the differences are of clinical interest, ORs often being between 2 and 3. No significant difference between poliomyelitis patients and controls was observed in the prevalence of SLE, tuberculosis, alcohol abuse and drug abuse. Our findings demonstrate that survivors of paralytic poliomyelitis in Taiwan are at higher risk of having multiple medical comorbidities although some potential confounding factors including educational level, marital status, obesity and physical activity are not available in our database. The pattern is generally consistent with previous observations from Western populations. Nevertheless, we found several novel associations

  11. The Prevalence, Comorbidity, and Age of Onset of Social Anxiety Disorder among U.S. Latinos

    PubMed Central

    Polo, Antonio; Alegría, Margarita; Chen, Chih-Nan; Blanco, Carlos

    2013-01-01

    Objective Social Anxiety Disorder (SAD) is increasingly being recognized as a prevalent, unremitting, and highly comorbid disorder1 yet studies focusing on this disorder among U.S. Latinos and immigrant populations are not available. This article evaluates ethnic differences in the prevalence, comorbidity, and age of onset of SAD. Cultural and contextual factors associated with risk of SAD are also examined within the Latino population. Method Data are analyzed using the National Latino and Asian American Study (NLAAS) and the National Comorbidity Survey-Replication (NCS-R). Both studies utilized the World Mental Health – Composite International Diagnostic Interview, which estimates the prevalence of lifetime and 12-month psychiatric disorders according to DSM-IV criteria. Results Latinos (LAT) reported lower lifetime and 12-month SAD prevalence and a later age of onset than U.S.-born non-Latino Whites (NLW). On the other hand, LAT diagnosed with 12-month SAD reported higher impairment across home, work, and relationship domains than their NLW counterparts. Overall, high SAD comorbidity was found with depressive, anxiety, and substance-related disorders among both ethnic groups. However, relative to NLW, LAT who entered the U.S. after the age of 21 were less likely to have lifetime SAD comorbidity with drug abuse and dependence and more likely to report lifetime SAD comorbidity with agoraphobia. Conclusion Varied trajectories of SAD risk are present across ethnicity and nativity groups. Clinicians must consider how culture and ethnicity shape these different presentations and determine treatment options accordingly. Outreach efforts are needed to reach immigrant Latinos, and those with comorbid SAD and Agoraphobia in particular. PMID:21899817

  12. The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough

    PubMed Central

    Lorenc, Ava; Lorigan, James; Jowata, Mohamade; Brook, Gary; Banarsee, Ricky

    2014-01-01

    Background HIV has changed from a rapidly deteriorating illness to a complex chronic disease, with increasing incidences of comorbidity, including cancer, and liver, lung and cardiovascular diseases. North West London has 6719 individuals living with the human immunodeficiency virus (HIV), 873 of whom reside in the London Borough of Brent. Traditionally, commissioning services have focused on HIV therapy alone without considering how comorbidity affects treatment outcome and total service costs. Setting The setting for the study was NHS Brent Primary Care Trust, London UK. Question What associated comorbidities are present in people in Brent (London, UK) living with HIV, and how common are they? Methods A point-prevalence audit of retrospective data was conducted on all HIV-positive patients in Brent (financial year 2011/12). Data were collected from genito-urinary medicine (GUM) services, community services and general practitioners (GPs) on HIV diagnosis, patient demographics and past/current comorbidities: hepatitis B and C, cardiovascular disease, diabetes and mental health disorders. Results This study identified that 29% of people living with HIV/AIDS (PLWHA) in Brent have at least one comorbidity. The most common was hepatitis, followed by mental health disorders and cardiovascular disease (CVD). Comorbidity was more likely in older male patients (in particular CVD and diabetes) and White patients (except for diabetes which was more common in Asian groups). Discussion/Conclusion Many PLWHA in Brent suffer from a number of other conditions, which appear largely independent of HIV. Findings confirm the need to treat HIV as a long-term condition, including patient education, empowerment and encouraging self-management. The multi-morbidity of many PLWHA suggests a role for both primary care and collaborative, holistic, patient-centred and individualised healthcare. Service providers and commissioners need to consider comorbidities in their treatment of and

  13. The associations of migraines and other headaches with work performance: results from the National Comorbidity Survey Replication (NCS-R).

    PubMed

    Kessler, R C; Shahly, V; Stang, P E; Lane, M C

    2010-06-01

    It is unknown if comorbid conditions account for the association between migraines and work performance. This issue was investigated in the National Comorbidity Survey Replication (n = 9282). Twelve-month severe or persistent migraines and other headaches were assessed with comorbid 12-month mental and physical disorders using the WHO Composite International Diagnostic Interview. Work performance was assessed using the WHO Health and Work Performance Questionnaire. Significant associations of these conditions with work disability disappeared with controls for comorbid disorders, but severe or persistent migraines continued to predict work loss days even with controls. Individual-level and societal-level annual human capital values were $1165 and $9.3 billion for this subset of migraines. Roughly 20% of these associations were due to comorbidity, 60% to direct effects and 20% to indirect effects through temporally secondary comorbidities. These strong associations suggest that workplace interventions for severe or persistent migraines might have a positive return-on-investment for employers. PMID:20511212

  14. Personality Traits Elucidate Sex Differences in Attention-Deficit/Hyperactivity Disorder Comorbidity During Early Childhood

    PubMed Central

    Martel, Michelle M.; Gremillion, Monica L.; Tackett, Jennifer L.

    2013-01-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is highly comorbid with other childhood disorders, and there are striking sex differences in this comorbidity, particularly during early childhood. For example, boys with ADHD are more likely to exhibit comorbid disruptive behavior and neurodevelopmental disorders, compared to girls, during early childhood. Yet, explanations for these well-established sex differences remain in short supply. The current study evaluated the novel hypothesis that personality traits may serve as intermediate phenotypes that help explain sex differences in common ADHD comorbidity profiles during early childhood. Study participants were 109 children between the ages of 3 and 6 and their primary caregivers and teachers/daycare providers, recruited from the community and over-recruited for ADHD-related problems. Primary caregivers completed the Child Behavior Checklist, and teachers/daycare providers completed the Teacher Report Form as a measure of child behavior problems. Examiners completed the California Q-Sort as a measure of child personality traits. Moderated mediation analyses suggested that personality traits explain associations between ADHD and oppositional-defiance, aggression, and language problems in a sex-specific manner. While high neuroticism mediated associations between ADHD and oppositional-defiance in girls, disagreeableness mediated associations between ADHD and aggression and low conscientiousness mediated associations between ADHD and neurodevelopmental language problems in boys. Sex differences in trait-psychopathology associations may help explain sex differences in comorbidity profiles with possible implications for child assessment and personalized early intervention. PMID:25598574

  15. Pregnant women's cortisol is elevated with anxiety and depression - but only when comorbid.

    PubMed

    Evans, Lynn M; Myers, Michael M; Monk, Catherine

    2008-07-01

    Elevated cortisol during pregnancy is associated with adverse birth outcomes and may alter fetal development and subsequent adult health. Numerous studies link elevated cortisol to depression and anxiety, but only a few have examined these relationships during pregnancy and in response to laboratory stressors. No studies have investigated the impact of comorbid anxiety and depression on cortisol during pregnancy. Salivary cortisol samples were collected twice before and once after a set of computer-based tasks (Stroop color-word matching task and either mental arithmetic or a controlled breathing task) from 180 pregnant women at approximately 36 weeks gestation. Based on psychiatric diagnoses, four groups of women were compared: 121 control, 16 depression, 34 anxiety, and 9 comorbid. Women also completed symptom and stress self-report scales. There was a significant main effect for maternal diagnosis on cortisol levels. Post hoc comparisons showed that comorbid subjects had higher salivary cortisol levels than controls, but subjects with only one diagnosis did not. Similar to cortisol, the comorbid subjects also had higher ratings on pregnancy-specific distress. Comorbidity during pregnancy, versus depression or an anxiety disorder alone, is uniquely associated with elevated cortisol and a negative evaluation of pregnancy. The potential impact of this combined psychiatric diagnosis on fetal development and future adult health needs further investigation. PMID:18493710

  16. 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. PMID:24629482

  17. 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. PMID:26416590

  18. Psychiatric syndromes comorbid with mental retardation: differences in cognitive and adaptive skills.

    PubMed

    Di Nuovo, Santo F; Buono, Serafino

    2007-11-01

    The study concerns the specific cognitive and adaptive skills of persons dually diagnosed with mental retardation (MR) and comorbid pathologies, as schizophrenia, personality and mood disorders, pervasive developmental disorders, epilepsy and ADHD. The sample was composed of 182 subjects, diagnosed as mild or moderate MR level, age range from 6 years 8 months to 50 years 2 months, mean age 17.1 (standard deviation 7.9). All the subjects were inpatients in a specialized structure for the diagnosis and the treatment of MR. The instruments of the study were Wechsler Intelligence Scale (WAIS-R or WISC-R according to the chronological age of subjects) and Vineland Adaptive Behavior Scale (VABS). Results confirm that comorbidity is a factor differentiating among mentally retarded subjects. Both verbal processes requiring memory retrieval and visuo-spatial processes are involved as differentiating features. ADHD strongly increases the impairment of cognitive skills, while behavioral disorders are less damaging in MR performance. In adult samples, the differentiating role of comorbid syndromes in MR individuals is reduced for cognitive skills, and limited to some basic verbal abilities, more impaired in mood disorder, less in schizophrenic disorder. The areas of adaptation and socialization, motor and daily living skills, are impaired more in generalized development disturbances than in comorbid schizophrenic and personality and mood disorders. An accurate psychological assessment of dual diagnoses is useful in detecting the specific underlying processes differentiating the comorbid syndromes, and in planning an appropriate rehabilitative treatment. PMID:16697412

  19. Pharmacological treatment of comorbid PTSD and substance use disorder: recent progress.

    PubMed

    Sofuoglu, Mehmet; Rosenheck, Robert; Petrakis, Ismene

    2014-02-01

    Previous research has identified a strong association between posttraumatic stress disorder (PTSD) and substance use disorder (SUD), necessitating the development of treatments that address both conditions. Some pharmacotherapies are effective for the treatment of PTSD and SUD alone, however; no medications have been proven to be effective for the combination of these conditions. We review the recent advances in pharmacological treatment of comorbid PTSD and SUD. A randomized clinical trial of sertraline, a serotonin reuptake inhibitor (SSRI), did not show overall efficacy for comorbid PTSD and alcohol dependence (AD), although it may have efficacy among light drinkers. Another clinical trial demonstrated the efficacy of both disulfiram and naltrexone for the treatment of AD in individuals with PTSD. A more recent clinical trial suggested that norepinephrine uptake inhibitors may also have efficacy for the treatment of comorbid PTSD and AD. In animal and preliminary human studies, brain norepinephrine and glutamate/GABA have emerged as potential treatment targets for comorbid PTSD and SUD. Noradrenergic medications that are promising for comorbid PTSD and SUD include prazosin, guanfacine, and atomoxetine. Promising glutamate/GABA medications include topiramate, memantine, acamprosate, N-acetylcysteine (NAC), and ketamine. The safety and efficacy of these medications for the treatment of PTSD and SUD need to be tested in controlled clinical trials. PMID:24035645

  20. Quantification of diabetes comorbidity risks across life using nation-wide big claims data.

    PubMed

    Klimek, Peter; Kautzky-Willer, Alexandra; Chmiel, Anna; Schiller-Frühwirth, Irmgard; Thurner, Stefan

    2015-04-01

    Despite substantial progress in the study of diabetes, important questions remain about its comorbidities and clinical heterogeneity. To explore these issues, we develop a framework allowing for the first time to quantify nation-wide risks and their age- and sex-dependence for each diabetic comorbidity, and whether the association may be consequential or causal, in a sample of almost two million patients. This study is equivalent to nearly 40,000 single clinical measurements. We confirm the highly controversial relation of increased risk for Parkinson's disease in diabetics, using a 10 times larger cohort than previous studies on this relation. Detection of type 1 diabetes leads detection of depressions, whereas there is a strong comorbidity relation between type 2 diabetes and schizophrenia, suggesting similar pathogenic or medication-related mechanisms. We find significant sex differences in the progression of, for instance, sleep disorders and congestive heart failure in diabetic patients. Hypertension is a highly sex-sensitive comorbidity with females being at lower risk during fertile age, but at higher risk otherwise. These results may be useful to improve screening practices in the general population. Clinical management of diabetes must address age- and sex-dependence of multiple comorbid conditions. PMID:25855969

  1. Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations.

    PubMed

    Nordin, Margareta; Hiebert, Rudi; Pietrek, Markus; Alexander, Michelle; Crane, Michael; Lewis, Stuart

    2002-07-01

    We examined the relationship between comorbidity and first return to work after episodes of work-disabling, nonspecific low back pain (NSLBP). An inception cohort of workers with new episodes of NSLBP was identified from administratively maintained occupational health records. We compared 6-month return-to-work rates between workers with one or more comorbid conditions with those without documented comorbidity. Workers with comorbidity were 1.31 times more likely to remain work disabled than those with uncomplicated NSLBP, after adjusting for age, gender, lifting demands, and company membership (adjusted hazards ratio [HR] = 1.31; 95% confidence interval [CI] 1.12 to 1.52). Concurrent injury (i.e., sprains or strains of the neck, upper extremity, and lower extremity; contusions; and lacerations) had the strongest association (adjusted HR = 1.49; 95% CI, 1.21 to 1.83), followed by musculoskeletal disorders (adjusted HR = 1.13; 95% CI, 0.77 to 1.66). Comorbidities should be routinely evaluated at first visit by occupational health professionals to better manage disability associated with LBP. PMID:12134532

  2. Association of comorbidities with increasing severity of peripheral neuropathy in diabetes mellitus

    PubMed Central

    Sachedina, Shafina; Toth, Cory

    2013-01-01

    AIM: To analyze a large population of patients with diabetes and peripheral neuropathy (PN) to determine other meaningful comorbid etiologies for PN. METHODS: Peripheral Neuropathy is a common complication of type 1 and 2 diabetes mellitus; however, other potential causes for PN may be co-existing in patients with diabetes. A prospective cohort study was performed to assess patients with diabetes and PN. We compared patients having PN due solely to diabetes with patients possessing co-existing comorbidities, performing clinical (Toronto Clinical Scoring System and the Utah Early Neuropathy Scale), laboratory and electrophysiological assessments in all patients. RESULTS: Patients with either type 1 or 2 diabetes mellitus and co-existing comorbidities did not have more severe clinical or electrophysiological PN phenotypes overall. However, in patients with type 1 diabetes, presence of a lipid disorder was associated with greater PN severity. In type 2 diabetes patients, both a lipid disorder and cobalamin deficiency were associated with greater PN severity. There was no additive effect upon PN severity with presence of three or more comorbid etiologies. CONCLUSION: The presence of specific, and not general, comorbidities in patients with type 1 or 2 diabetes corresponds with greater PN severity. PMID:23961324

  3. Quantification of Diabetes Comorbidity Risks across Life Using Nation-Wide Big Claims Data

    PubMed Central

    Klimek, Peter; Kautzky-Willer, Alexandra; Chmiel, Anna; Schiller-Frühwirth, Irmgard; Thurner, Stefan

    2015-01-01

    Despite substantial progress in the study of diabetes, important questions remain about its comorbidities and clinical heterogeneity. To explore these issues, we develop a framework allowing for the first time to quantify nation-wide risks and their age- and sex-dependence for each diabetic comorbidity, and whether the association may be consequential or causal, in a sample of almost two million patients. This study is equivalent to nearly 40,000 single clinical measurements. We confirm the highly controversial relation of increased risk for Parkinson’s disease in diabetics, using a 10 times larger cohort than previous studies on this relation. Detection of type 1 diabetes leads detection of depressions, whereas there is a strong comorbidity relation between type 2 diabetes and schizophrenia, suggesting similar pathogenic or medication-related mechanisms. We find significant sex differences in the progression of, for instance, sleep disorders and congestive heart failure in diabetic patients. Hypertension is a highly sex-sensitive comorbidity with females being at lower risk during fertile age, but at higher risk otherwise. These results may be useful to improve screening practices in the general population. Clinical management of diabetes must address age- and sex-dependence of multiple comorbid conditions. PMID:25855969

  4. Psychiatric Comorbidity at the Time of Diagnosis in Adults With ADHD: The CAT Study.

    PubMed

    Piñeiro-Dieguez, Benjamin; Balanzá-Martínez, Vicent; García-García, Pilar; Soler-López, Begoña

    2014-01-24

    Objective: The CAT (Comorbilidad en Adultos con TDAH) study aimed to quantify and characterize the psychiatric comorbidity at the time of diagnosis of ADHD in adult outpatients. Method: Cross-sectional, multicenter, observational register of adults with ADHD diagnosed for the first time. Results: In this large sample of adult ADHD (n = 367), psychiatric comorbidities were present in 66.2% of the sample, and were more prevalent in males and in the hyperactive-impulsive and combined subtypes. The most common comorbidities were substance use disorders (39.2%), anxiety disorders (23%), and mood disorders (18.1%). In all, 88.8% patients were prescribed pharmacological treatment for ADHD (in 93.4% of cases, modified release methylphenidate capsules 50:50). Conclusion: A high proportion of psychiatric comorbidity was observed when adult outpatients received a first-time diagnosis of ADHD. The systematic registering of patients and comorbidities in clinical practice may help to better understand and manage the prognostic determinants in adult ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX). PMID:24464326

  5. Targeting oxidant-dependent mechanisms for the treatment of COPD and its comorbidities.

    PubMed

    Bernardo, Ivan; Bozinovski, Steven; Vlahos, Ross

    2015-11-01

    Chronic obstructive pulmonary disease (COPD) is an incurable global health burden and is characterised by progressive airflow limitation and loss of lung function. In addition to the pulmonary impact of the disease, COPD patients often develop comorbid diseases such as cardiovascular disease, skeletal muscle wasting, lung cancer and osteoporosis. One key feature of COPD, yet often underappreciated, is the contribution of oxidative stress in the onset and development of the disease. Patients experience an increased burden of oxidative stress due to the combined effects of excess reactive oxygen species (ROS) and nitrogen species (RNS) generation, antioxidant depletion and reduced antioxidant enzyme activity. Currently, there is a lack of effective treatments for COPD, and an even greater lack of research regarding interventions that treat both COPD and its comorbidities. Due to the involvement of oxidative stress in the pathogenesis of COPD and many of its comorbidities, a unique therapeutic opportunity arises where the treatment of a multitude of diseases may be possible with only one therapeutic target. In this review, oxidative stress and the roles of ROS/RNS in the context of COPD and comorbid cardiovascular disease, skeletal muscle wasting, lung cancer, and osteoporosis are discussed and the potential for therapeutic benefit of anti-oxidative treatment in these conditions is outlined. Because of the unique interplay between oxidative stress and these diseases, oxidative stress represents a novel target for the treatment of COPD and its comorbidities. PMID:26297673

  6. The relationship between personality disorders and Axis I psychopathology: deconstructing comorbidity.

    PubMed

    Links, Paul S; Eynan, Rahel

    2013-01-01

    The purpose of this review is (a) to study and systematically review the recent literature examining the co-occurrence and relationships between Axis I psychiatric disorders and Axis II personality disorders, specifically the six originally proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, and (b) to consider the clinical utility of the current Axis I and Axis II approach in the DSM-IV-TR and apply findings to state a position on the issue of collapsing together Axis I and Axis II. Community surveys or prospective cohort studies were reviewed as a priority. Our review indicates that the associations between clinical disorders and personality disorders clearly varied within each disorder and across the six personality disorders. Our understanding has advanced, particularly related to the clinical utility of comorbidity, and there may be sufficient evidence to support moving borderline personality disorder to Axis I. However, it seems premature to conclude that comorbidity is best conceptualized by having all disorders in a single category or by deleting disorders so that comorbidity is reduced. Our review suggests some priorities for future research into comorbidity, such as including personality disorders in future multivariate comorbidity models. PMID:23157449

  7. Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995-2010.

    PubMed

    van Leersum, N J; Janssen-Heijnen, M L G; Wouters, M W J M; Rutten, H J T; Coebergh, J W; Tollenaar, R A E M; Lemmens, V E P P

    2013-05-01

    Comorbidity has large impact on colorectal cancer (CRC) treatment and outcomes and may increase as the population ages. We aimed to evaluate the prevalence and time trends of comorbid diseases in patients with CRC from 1995 to 2010. The Eindhoven Cancer Registry registers comorbidity in all patients with primary CRC in the South of the Netherlands. We analyzed the prevalence of serious comorbid diseases in four time frames from 1995 to 2010. Thereby, we addressed its association with age, gender and socio-economic status (SES). The prevalence of comorbidity was registered in 27,339 patients with primary CRC. During the study period, the prevalence of comorbidity increased from 47% to 62%, multimorbidity increased from 20% to 37%. Hypertension and cardiovascular diseases were most prevalent and increased largely over time (respectively 16-29% and 12-24%). Pulmonary diseases increased in women, but remained stable in men. Average age at diagnosis increased from 68.3 to 69.5 years (p = 0.004). A low SES and male gender were associated with a higher risk of comorbidity (not changing over time). This study indicates that comorbidity among patients with CRC is common, especially in males and patients with a low SES. The prevalence of comorbidity increased from 1995 to 2010, in particular in presumably nutritional diseases. Ageing, increased life expectancy and life style changes may contribute to more comorbid diseases. Also, improved awareness among health care providers on the importance of comorbidity may have resulted in better registration. The increasing burden of comorbidity in patients with CRC emphasizes the need for more focus on individualized medicine. PMID:23015513

  8. Type, Rather than Number, of Mental and Physical Comorbidities Increases the Severity of Symptoms in Patients with Irritable Bowel Syndrome

    PubMed Central

    Lackner, Jeffrey M.; Ma, Chang-Xing; Keefer, Laurie A.; Brenner, Darren M.; Gudleski, Gregory D.; Satchidanand, Nikhil; Firth, Rebecca; Sitrin, Michael D.; Katz, Leonard; Krasner, Susan S.; Ballou, Sarah K; Naliboff, Bruce D.; Mayer, Emeran A.

    2013-01-01

    BACKGROUND Irritable bowel syndrome (IBS) has significant mental and physical comorbidities. However, little is known about the day-to-day burden these comorbidities place on quality of life (QOL), physical and mental function, distress, and symptoms of patients. METHODS We collected cross sectional data from 175 patients with IBS, diagnosed based on Rome III criteria (median age, 41 y; 78% women), referred to 2 specialty care clinics. Patients completed psychiatric interviews, a physical comorbidity checklist, the IBS symptom severity scale, the IBS quality of life instrument, the brief symptom inventory, the abdominal pain intensity scale, and the SF-12 health survey. RESULTS Patients with IBS reported an average of 5 comorbidities (1 mental, 4 physical). Subjects with more comorbidities reported worse QOL after adjusting for confounding variables. Multiple linear regression analyses indicated that comorbidity type was more consistently and strongly associated with illness burden indicators than disease counts. Of 10, 296 possible physical–mental comorbidity pairs, 6 of the 10 most frequent dyads involved specific conditions (generalized anxiety, depression, back pain, agoraphobia, tension headache, insomnia). These combinations were consistently associated with greater illness and symptom burdens (QOL, mental and physical function, distress, more severe symptoms of IBS, pain). CONCLUSIONS Comorbidities are common among patients with IBS. They are associated with distress and reduced QOL. Specific comorbidities are associated with more severe symptoms of IBS. PMID:23524278

  9. Epidemiology, Comorbidity, and Behavioral Genetics of Antisocial Personality Disorder and Psychopathy

    PubMed Central

    Werner, Kimberly B.; Few, Lauren R.; Bucholz, Kathleen K.

    2015-01-01

    Psychopathy is theorized as a disorder of personality and affective deficits while antisocial personality disorder (ASPD) diagnosis is primarily behaviorally based. While ASPD and psychopathy are similar and are highly comorbid with each other, they are not synonymous. ASPD has been well studied in community samples with estimates of its lifetime prevalence ranging from 1-4% of the general population.4,5 In contrast, psychopathy is almost exclusively investigated within criminal populations so that its prevalence in the general population has been inferred by psychopathic traits rather than disorder (1%). Differences in etiology and comorbidity with each other and other psychiatric disorders of these two disorders are also evident. The current article will briefly review the epidemiology, etiology, and comorbidity of ASPD and psychopathy, focusing predominately on research completed in community and clinical populations. This paper aims to highlight ASPD and psychopathy as related, but distinct disorders. PMID:26594067

  10. ADHD Subtypes and Comorbid Anxiety, Depression, and Oppositional-Defiant Disorder: Differences in Sleep Problems

    PubMed Central

    Calhoun, Susan L.; Bixler, Edward O.; Vgontzas, Alexandros N.; Mahr, Fauzia; Hillwig-Garcia, Jolene; Elamir, Belal; Edhere-Ekezie, Linda; Parvin, Matthew

    2009-01-01

    Objective Sleep problems were analyzed in children with ADHD (Attention-deficit hyperactivity disorder). Methods Scales were completed by parents of 135 control children and 681 children with ADHD combined type (ADHD-C) or inattentive type (ADHD-I) with or without comorbid oppositional defiant disorder (ODD), anxiety, or depression. Results Children with ADHD-I alone had the fewest sleep problems and did not differ from controls. Children with ADHD-C had more sleep problems than controls and children with ADHD-I. Comorbid anxiety/depression increased sleep problems, whereas ODD did not. Daytime sleepiness was greatest in ADHD-I and was associated with sleeping more (not less) than normal. Medicated children had greater difficulty falling asleep than unmedicated children. Conclusions Differences in sleep problems were found as a function of ADHD subtype, comorbidity, and medication. PMID:18676503

  11. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

    PubMed Central

    Balaban, Carey D; Jacob, Rolf G; Furman, Joseph M

    2011-01-01

    The comorbidity among balance disorders, anxiety disorders and migraine has been studied extensively from clinical and basic research perspectives. From a neurological perspective, the comorbid symptoms are viewed as the product of sensorimotor, interoceptive and cognitive adaptations that are produced by afferent interoceptive information processing, a vestibulo–parabrachial nucleus network, a cerebral cortical network (including the insula, orbitofrontal cortex, prefrontal cortex and anterior cingulate cortex), a raphe nuclear–vestibular network, a coeruleo–vestibular network and a raphe–locus coeruleus loop. As these pathways overlap extensively with pathways implicated in the generation, perception and regulation of emotions and affective states, the comorbid disorders and effective treatment modalities can be viewed within the contexts of neurological and psychopharmacological sites of action of current therapies. PMID:21375443

  12. Therapeutic Effects of Melatonin Receptor Agonists on Sleep and Comorbid Disorders

    PubMed Central

    Laudon, Moshe; Frydman-Marom, Anat

    2014-01-01

    Several melatonin receptors agonists (ramelteon, prolonged-release melatonin, agomelatine and tasimelteon) have recently become available for the treatment of insomnia, depression and circadian rhythms sleep-wake disorders. The efficacy and safety profiles of these compounds in the treatment of the indicated disorders are reviewed. Accumulating evidence indicates that sleep-wake disorders and co-existing medical conditions are mutually exacerbating. This understanding has now been incorporated into the new Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Therefore, when evaluating the risk/benefit ratio of sleep drugs, it is pertinent to also evaluate their effects on wake and comorbid condition. Beneficial effects of melatonin receptor agonists on comorbid neurological, psychiatric, cardiovascular and metabolic symptomatology beyond sleep regulation are also described. The review underlines the beneficial value of enhancing physiological sleep in comorbid conditions. PMID:25207602

  13. The Comorbidity of Bipolar Disorder and Migraine: The Role of Inflammation and Oxidative and Nitrosative Stress.

    PubMed

    da Costa, S C; Passos, I C; Réus, G Z; Carvalho, A F; Soares, J C; Quevedo, J

    2016-01-01

    Comorbid migraine in the course of bipolar disorder has been reported as highly prevalent and associated with increased morbidity. Patients with bipolar disorder and comorbid migraine tend to present with higher rates of rapid cycling, increased number of depressive episodes, more severe depression, and increased suicidality when compared to subjects with bipolar disorder alone. Both conditions display similar clinical features, such as relapsing-recovering presentation, and vulnerability to psychological and physical stress. Clinical implications of this association have been well established, however the biological underpinnings involved in both conditions remain poorly understood. Inflammation and oxidative and nitrosative stress seem to play a role as mediators in the cross-sensitization between bipolar disorder and migraine. Therefore, the present study aims to review the role of inflammation, oxidative and nitrosative stress as underlying mechanisms in the natural history of bipolar disorder comorbid with migraine. PMID:26812917

  14. [Health-related quality of life (SF-36) in chronic low back pain and comorbid depression].

    PubMed

    Ahrens, C; Schiltenwolf, M; Wang, H

    2010-06-01

    The purpose is to clarify if comorbidity of depression reduces health-related quality of life (SF-36) in patients with chronic low back pain (CR) and if those comorbid patients (CR+DE) benefit from multimodal pain treatment. Two groups (CR and CR+DE) each with 29 patients are compared over 6 months on study days 0, 21 (inpatient) and 180 (outpatient). Differences exist only at days 0 and 21, not at day 180, with group CR exhibiting higher SF-36 values in each case. Group CR+DE improves in the inpatient phase and especially in the outpatient phase and therefore over the entire study period more than group CR which increases solely in the inpatient phase. The comorbid group is more severely affected by their illness, but improves very constantly. The outpatient improvement suggests a good long-term prognosis. PMID:20458502

  15. Emerging issues on comprehensive hemophilia care: preventing, identifying, and monitoring age-related comorbidities.

    PubMed

    Coppola, Antonio; Santoro, Cristina; Franchini, Massimo; Mannucci, Caterina; Mogavero, Selene; Molinari, Angelo Claudio; Schinco, Piercarla; Tagliaferri, Annarita; Santoro, Rita Carlotta

    2013-10-01

    Life expectancy for persons with hemophilia (PWH) has considerably increased in the last decades as a direct result of the availability of modern therapies to control the clotting defect. Because their life expectancy now matches that of the general population, PWH are experiencing age-related comorbidities, such as, cardiovascular diseases, metabolic syndrome, renal diseases, sexuality issues, malignancies, and neurologic problems, that until recently have been rarely seen in this group of patients. In this article, we present a summary of the current knowledge on the aging PWH along with the clinical approaches that may be integrated into the routine comprehensive care of these patients for preventing, diagnosing, and monitoring age-related comorbidities. In general, patients with and without hemophilia should receive similar care, with close collaboration between the physician treating PWH and the specialty expert treating the comorbid disease. PMID:24014070

  16. Comorbidity and radiation: methodological aspects of health assessment of persons exposed to the Chornobyl accident factors.

    PubMed

    Nosach, O V

    2013-01-01

    Comorbidity is one of the most challenging problems of a modern medicine. In a population exposed to the factors of the Chornobyl accident there is an obvious increase in the number of diseases occurring simultaneously against the background of rising prevalence of different classes of chronic medical nosology. The scientific data analysis are presented on the methodological approaches that can be used to create a specialized system for integrated assessment of the health of patients with comorbid disorders. Developing such a system it should be taken into account the trends of changes in the incidence, prevalence and structure of chronic disease, factors and regularities of comorbid disease in the cohorts of Chornobyl accident clean-up workers, evacuees and dwellers of contaminated territories. The system should provide a non-random selection of combinations (clusters) of the most common diseases with serious consequences for the survivors. PMID:25191728

  17. Specificity of Stress Generation: A Comparison of Adolescents with Depressive, Anxiety, and Comorbid Diagnoses

    PubMed Central

    Connolly, Nicole P.; Eberhart, Nicole K.; Hammen, Constance L.; Brennan, Patricia A.

    2012-01-01

    Individuals with a history of depression experience more stress that is dependent in part on their own actions. However, it is unclear whether stress generation is a unique feature of depression, or a universal process that is also present in other types of psychopathology, such as anxiety disorders. The current study addressed this issue by comparing adolescents with a history of “pure” (i.e., non-comorbid) depressive disorders, pure anxiety disorders, comorbid depression and anxiety, and no disorder, on their levels of dependent and independent stress. Results indicated that adolescents with pure depression experienced more dependent stress than adolescents with pure anxiety, and adolescents with any internalizing diagnosis experienced more dependent stress than controls. Further, adolescents with comorbid depression and anxiety reported the highest levels of stress generation. The results suggest that while stress generation may be more strongly associated with depression than anxiety in adolescence, it is not unique to depression. PMID:22724042

  18. Comorbidities and race/ethnicity among adults with stimulant use disorders in residential treatment.

    PubMed

    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

  19. Medical anticancer treatment of lung cancer associated with comorbidities: a review.

    PubMed

    Sculier, J P; Botta, I; Bucalau, A M; Compagnie, M; Eskenazi, A; Fischler, R; Gorham, J; Mans, L; Rozen, L; Speybrouck, S; Wang, X; Meert, A P; Berghmans, Th

    2015-03-01

    Comorbidities are frequent in patients with lung cancer, who are often treated with systemic anticancer therapy. The purpose of the present review is to report the adaptations recommended for the various drugs used in lung cancer treatment, in the context of a specific comorbidity. The literature was reviewed for neurologic, endocrine, hepatic, renal, digestive, cardiovascular, pulmonary, blood and systemic diseases. The comorbidities impact on the systemic anticancer treatment is poorly assessed. There are no good data with a high level of evidence and literature is often limited to experts' opinion and to case reports. We need to improve our knowledge about those patients by adequate multicentric and prospective studies and registries in order to offer them better care in term of evidence-based medicine. PMID:25617984

  20. Course of comorbidity of tobacco and marijuana use: Psychosocial risk factors

    PubMed Central

    Lee, Jung Yeon; Finch, Stephen J.; Brown, Elaine N.

    2010-01-01

    Introduction: This longitudinal study examined the psychosocial factors associated with the comorbidity of pairs of tobacco and marijuana use trajectories from adolescence extending into adulthood in two ethnic groups, Blacks and Puerto Ricans. Methods: Data on psychosocial functioning and tobacco and marijuana use at four points in time were obtained. Results: The association between the trajectories of tobacco and marijuana use was quite high. Pairs of comorbid trajectories of tobacco and marijuana use may share at least three kinds of influence: (a) a constellation of externalizing personality risk factors, (b) Depressive Mood and low Ego Integration, and (c) identification with certain group values. Discussion: Knowledge of the risk and protective factors for pairs of comorbid trajectories of use may strengthen the foundation for individual and group targets for prevention and treatment programs. PMID:20231241

  1. Criminality in men with major mental disorder with and without comorbid substance abuse.

    PubMed

    Modestin, Jiri; Wuermle, Othmar

    2005-02-01

    Violent and criminal behavior in the mentally ill remains an issue of major importance and in this context the role of comorbid substance abuse must be addressed. Data on criminal behavior in 282 men with schizophrenia and 261 men with affective disorder were studied. Samples of patients with and without additional substance abuse were compared. Also, non-abusing patients from both diagnostic groups were compared with matched controls from the general population. Substance abuse was found in half of all men in both groups of major mental disorders, and substance abusers had twice as high a probability of having a criminal record. However, compared with the matched sample from the general population, violent criminality was increased in schizophrenic patients without comorbid substance abuse, and patients with affective disorders without substance abuse had a higher probability of committing crimes against property. Men with major mental disorder have an increased probability of becoming criminal even when there is no comorbid substance abuse. PMID:15679536

  2. Healthcare use by children with attention deficit/hyperactivity disorder with and without psychiatric comorbidities.

    PubMed

    DeBar, Lynn L; Lynch, Frances L; Boles, Myde

    2004-01-01

    This study examined healthcare services used by children with attention-deficit/hyperactivity disorder (ADHD), with and without psychiatric comorbidities. The study was conducted in a large health maintenance organization in the Pacific Northwest on all continuously enrolled children aged 5 to 12 from January 1997 through July 1998. The study measured all outpatient medical care, specialty mental health care services, and prescription drug dispensings from computer records. Children with ADHD, with and without other psychiatric comorbidities, use more general medical services than do other groups of children, including outpatient visits, acute care (emergency room [ER] urgent care) visits. ADHD and other psychiatric comorbidities lead to higher use of specialty mental health services and greater use of psychotropic medications. PMID:15263869

  3. Effects of Baseline Comorbidities on Cancer Screening Trial Adherence among Older African American Men

    PubMed Central

    Ford, Marvella E.; Havstad, Suzanne L.; Fields, Maya E.; Manigo, Brandy; McClary, Beth; Lamerato, Lois

    2012-01-01

    Background The purpose of this study was to examine the effects of baseline comorbidities on screening adherence in a sample of older African American men (ages ≥55 years) enrolled in a case management intervention in a cancer screening trial. Methods Baseline comorbidity data were obtained from 683 African American men who were randomly assigned to a case management intervention group (n = 344) or to a case management control group (n = 339). The effects of comorbidities on the screening adherence rates of each group were then assessed. Results No statistically significant interactions were found between each health history characteristic and the intervention. Therefore, analyses were not stratified by intervention status. In general, participants with comorbidities were no less likely to adhere to trial screening than participants without comorbidities. Exceptions were current smokers and participants with chronic bronchitis. Current smokers were less likely than others to adhere to the prostate-specific antigen test (P = 0.02) and the digital rectal examination for prostate cancer screening (P = 0.01), to the chest X-ray for lung cancer screening (P < 0.01), and to the flexible sigmoidoscopy for colorectal cancer screening (P = 0.04). Participants with chronic bronchitis had lower rates of adherence to the chest X-ray (P = 0.06). Having a relative with cancer positively influenced adherence to the digital rectal examination (P = 0.05). Conclusions Overall, older African American men with comorbidities appear to be very good candidates for participation in longitudinal cancer screening trials. However, smoking had a statistically significant and deleterious effect on adherence to all types of screening. PMID:18463399

  4. Sex- and Subtype-Related Differences in the Comorbidity of Adult ADHDs.

    PubMed

    Groß-Lesch, Silke; Dempfle, Astrid; Reichert, Susanne; Jans, Thomas; Geissler, Julia; Kittel-Schneider, Sarah; Nguyen, Thuy Trang; Reif, Andreas; Lesch, Klaus-Peter; Jacob, Christian Peter

    2013-11-01

    Objective: Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences from studies with small sample size. Method: A large sample of 910 individuals (458 males, 452 females) affected with aADHD was recruited at a tertiary referral center. All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders to assess comorbidity. This study will provide additional information regarding the co-morbidity of Axis I disorders in the currently largest clinical referral sample. However, the main objective of this study is to gain information about sex- or subtype-related differences. Results: Affected females show higher rates of mood (61% vs. 49%), anxiety (32% vs. 22%), and eating disorders (16% vs. 1%) than affected males, while substance use disorders were more frequent in affected males (45% vs. 29%), which mirrors sex differences in prevalence in the general population. There were hardly any relevant differences in comorbidities between subtypes, with the exception of the inattentive subtype having an especially low prevalence of panic disorder. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status. Conclusion: Sex-related differences in the comorbidity of aADHD are more pronounced than subtype-related differences. (J. of Att. Dis. XXXX; XX(X) XX-XX). PMID:24196345

  5. Family and Community Predictors of Comorbid Language, Socioemotional and Behavior Problems at School Entry

    PubMed Central

    Sciberras, Emma; Goldfeld, Sharon

    2016-01-01

    Objectives To identify the prevalence and family and community-level predictors of comorbid speech-language difficulties and socioemotional and behavioral (SEB) difficulties across a population of children at school entry. Methods The School Entry Health Questionnaire is a parent survey of children’s health and wellbeing, completed by all children starting school in Victoria, Australia (N = 53256). It includes parental report of speech-language difficulties, the Strengths and Difficulties Questionnaire (behavior), and numerous family and community variables. Following univariate analysis, family and community risk characteristics were entered into a multinomial logistic regression model to identify the associated relative risk of comorbid speech/language and SEB needs. The influence of experiencing multiple risk factors was also examined. Results 20.4% (n = 10,868) began school with either speech-language or SEB difficulties, with 3.1% (n = 1670) experiencing comorbid needs. Five factors predicted comorbidity: the child having witnessed violence; a history of parent mental illness; living in more deprived communities; and the educational attainment of each parent (independently). The relative risk of comorbidity was 6.1 (95% Confidence Interval: 3.9, 9.7) when a child experienced four or more risk factors, compared to those with no risk factors. Conclusions The risk of comorbidity in early childhood is associated with a range of family and community factors, and elevated by the presence of multiple factors. Children growing up in families experiencing multiple, complex needs are therefore at heightened risk of the early development of difficulties likely to impact upon schooling. Early identification of these children offers opportunities for appropriate and timely health and education intervention. PMID:27379668

  6. Comorbid Influences on Generic Health-Related Quality of Life in COPD: A Systematic Review

    PubMed Central

    Huber, Manuel B.; Wacker, Margarethe E.; Vogelmeier, Claus F.; Leidl, Reiner

    2015-01-01

    Background Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and of loss of disability-adjusted life years worldwide. It often is accompanied by the presence of comorbidity. Objectives To systematically review the influence of COPD comorbidity on generic health-related quality of life (HRQoL). Methods A systematic review approach was used to search the databases Pubmed, Embase and Cochrane Library for studies evaluating the influence of comorbidity on HRQoL in COPD. Identified studies were analyzed according to study characteristics, generic HRQoL measurement instrument, COPD severity and comorbid HRQoL impact. Studies using only non-generic instruments were excluded. Results 25 studies met the selection criteria. Seven studies utilized the EQ-5D, six studies each used the SF-36 or SF-12. The remaining studies used one of six other instruments each. Utilities were calculated by four EQ-5D studies and one 15D study. Patient populations covered both early and advanced stages of COPD and ranged from populations with mostly stage 1 and 2 to studies with patients classified mainly stage 3 and 4. Evidence was mainly created for cardiovascular disease, depression and anxiety as well as diabetes but also for quantitative comorbid associations. Strong evidence is pointing towards the significant negative association of depression and anxiety on reduced HRQoL in COPD patients. While all studies found the occurrence of specific comorbidities to decrease HRQoL in COPD patients, the orders of magnitude diverged. Due to different patient populations, different measurement tools and different concomitant diseases the study heterogeneity was high. Conclusions Facilitating multimorbid intervention guidance, instead of applying a parsimony based single disease paradigm, should constitute an important goal for improving HRQoL of COPD patients in research and in clinical practice. PMID:26168154

  7. AB026. Excess medical cost in patients with asthma and the role of comorbidity

    PubMed Central

    Chen, Wenjia; Lynd, Larry D.; FitzGerald, J. Mark; Marra, Carlo A.; Balshaw, Robert; To, Teresa; Tavakoli, Hamid; Sadatsafavi, Mohsen

    2016-01-01

    Background Comorbid conditions are prevalent in asthma patients but its impact on the economic burden of asthma is not well understood. To estimate the excess direct medical costs in patients with asthma, accounting for both the costs attributable to asthma and to comorbidities. Methods We created a propensity-score matched cohort of individuals aged 5 to 55 years between 1997 and 2012 with incident asthma and a comparison group of individuals without asthma from the health administrative data of British Columbia (BC), Canada. Sixteen major disease categories were identified using the International Classification of Diseases (ICD) codes. Excess costs [in 2013 Canadian dollars, ($)] were defined as the adjusted difference in total costs between the two groups. Results There were 145,742 individuals in both asthma and comparison groups. Average excess costs were $1,186.5/person-year (95% CI: 1,130.4–1,242.6) overall, of which $145.2 (143.0–147.4) were attributable to asthma and $787.7 (95% CI: 743.7, 831.7) to major comorbidity classes. Psychological disorders were the largest component of excess comorbidity costs, followed by other respiratory diseases, digestive disorders and diseases of nervous system. Comorbidity-attributable excess costs greatly increased with age but did not increase over the 10-year course of asthma. Conclusions In the asthma group, the excess costs attributable to comorbidity are five-times higher than costs attributable to asthma, which aggregated over age. In evaluating options for asthma management, consideration of asthma-related costs alone may result in sub-optimal policies and clinical decisions.

  8. Psychosocial co-morbidity affects treatment outcome in children with fecal incontinence.

    PubMed

    van Everdingen-Faasen, Els Q; Gerritsen, Bert J; Mulder, Paul G H; Fliers, Ellen A; Groeneweg, Michael

    2008-09-01

    Fecal incontinence is a common disorder in children. Many children with fecal incontinence have psychosocial co-morbidity. In this study, the effect of psychosocial co-morbidity on the treatment outcome of children with fecal incontinence was evaluated. One hundred and fifty children with fecal incontinence were treated in a multidisciplinary program. All children had been treated unsuccessfully for at least one year before entering the program. The treatment consisted of laxative treatment, psychosocial interventions, and biofeedback training. Psychosocial co-morbidity was classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). One hundred and forty-one children were completely analyzed (102 boys, mean age 9.6 (range 6.5-16.5) years). Of these, 31 (22%) children had fecal incontinence without constipation and 110 (78%) children had fecal incontinence associated with constipation. In 95% of children, at least one psychosocial co-morbidity was present. Treatment was successful at 12 months in 69% of patients. Treatment was less successful in children with attention deficit hyperactivity disorder (ADHD), in children with parent-child relational problems, and in mentally retarded children. The results indicate that the early assessment and treatment of psychosocial co-morbidity might improve treatment response in children with fecal incontinence. Children with fecal incontinence are treated less successfully in the first year if they have ADHD, parent-child relational problems, or mental retardation. Psychosocial evaluation and the early assessment and treatment of psychosocial co-morbidity is indicated in order to improve response rate. Family counseling--aimed at improving parent-child relations--should be an integral part of a multidisciplinary treatment program for fecal incontinence. PMID:17952465

  9. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview.

    PubMed

    Pliszka, S R

    1998-01-01

    Attention-deficit/hyperactivity disorder (ADHD) has been noted to be comorbid with a variety of psychiatric disorders. These include oppositional defiant and conduct disorders, as well as affective, anxiety, and learning disorders. Considerable debate has revolved as to the meaning of this overlap. Does it occur by chance or is it an artifact of referral bias? Are the comorbid conditions secondary to the ADHD, or can other psychiatric disorders masquerade as attentional problems? Alternatively, ADHD may exist as distinct subtypes, each with its specific comorbidity. Studies that have examined the comorbidity of oppositional, conduct, affective, anxiety, and learning disorders in ADHD are reviewed. ADHD and ADHD with conduct disorder appear to be distinct subtypes, possibly with different etiologies. While the short-term response to stimulants is the same in these two groups, children with ADHD and conduct disorder children have higher rates of antisocial personality as adults. Coexisting anxiety appears to attenuate impulsivity in ADHD, and stimulant response is poorer in ADHD children with comorbid anxiety. Anxiety and ADHD appear to be inherited independently. A subset of ADHD children also meet criteria for bipolar disorder, although the exact prevalence of this diagnosis in ADHD children is strongly debated. Regardless of prevalence, this is a severely impaired group of ADHD children, with high rates of aggression and psychiatric disorder in their families. The comorbidity of ADHD and major depression is much less studied, and few firm conclusions can be made about it. Finally, about 20%-25% of ADHD children meet criteria for a learning disorder, but learning disorders appear to be independent of ADHD. PMID:9680053

  10. Association between comorbid conditions and BADL/IADL disability in hypertension patients over age 45

    PubMed Central

    Qian, Jiahui; Ren, Xiaohui

    2016-01-01

    Abstract Hypertension usually coexists with other chronic conditions and can cause disability in relation to activities of daily living. We examined the association between the number and categories of comorbid conditions and disability affecting activities of daily living in hypertension patients. The data were collected from the 2013 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS), which contains information about chronic conditions and disability. Additionally, socio-demographic characteristics of 3754 hypertension patients aged 45 and older were included in this study. Comorbid conditions included dyslipidemia, stroke, and 12 other chronic conditions. Disability in relation to activities of daily living was assessed using the basic activities of daily living (BADL) and the instrumental activities of daily living (IADL) instruments. Differences in BADL/IADL disability among patients with different comorbid conditions were compared using the chi-square test, and the influence of chronic conditions and socio-demographic characteristics on BADL/IADL disability was analyzed using logistic models. Without considering the influence of specific chronic conditions on BADL/IADL, hypertension patients with additional comorbid conditions were more likely to suffer from BADL/IADL disability. When considering the effect of specific chronic conditions, the number of comorbid conditions did not significantly influence BADL/IADL disability. Dyslipidemia, chronic lung disease, stroke, memory-related diseases, and arthritis/rheumatism were associated with BADL disability. Chronic lung diseases, heart diseases, stroke, stomach/digestive system diseases, emotional/nervous/psychiatric problems, memory-related diseases, arthritis/rheumatism, and asthma were associated with IADL disability. Additionally, female, people with lower education level, people living in village, and people living in middle and western China were more likely suffer from BADL

  11. HIV-Associated Neurocognitive Disorders: The Relationship of HIV Infection with Physical and Social Comorbidities

    PubMed Central

    Tedaldi, Ellen M.; Minniti, Nancy L.; Fischer, Tracy

    2015-01-01

    The prevalence of HIV (human immunodeficiency virus) associated neurocognitive disorders (HAND) will undoubtedly increase with the improved longevity of HIV-infected persons. HIV infection, itself, as well as multiple physiologic and psychosocial factors can contribute to cognitive impairment and neurologic complications. These comorbidities confound the diagnosis, assessment, and interventions for neurocognitive disorders. In this review, we discuss the role of several key comorbid factors that may contribute significantly to the development and progression of HIV-related neurocognitive impairment, as well as the current status of diagnostic strategies aimed at identifying HIV-infected individuals with impaired cognition and future research priorities and challenges. PMID:25815329

  12. 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

  13. Chronic comorbid conditions associated with risk of febrile neutropenia in breast cancer patients treated with chemotherapy.

    PubMed

    Chia, Victoria M; Page, John H; Rodriguez, Roberto; Yang, Su-Jau; Huynh, Julie; Chao, Chun

    2013-04-01

    Chemotherapy-induced febrile neutropenia (FN) is associated with increased patient mortality and health care costs. Comorbid conditions such as liver and renal dysfunction have been linked to increased risk of FN. However, the effects of other chronic comorbid conditions on risk of FN have not been well studied. To examine the association between chronic comorbid conditions and FN in breast cancer patients, we identified incident breast cancer patients from 2000 to 2009 treated with chemotherapy at Kaiser Permanente Southern California, a large managed care organization. Patients who received primary prophylactic granulocyte colony-stimulating factor (G-CSF) were excluded. We assessed history of comorbid conditions prior to cancer diagnosis using ICD-9 codes and disease registries. FN events were identified in the first chemotherapy cycle using a combination of ICD-9 codes and hospital discharge diagnoses. For each comorbid condition, propensity scores that included patient characteristics and other predisposing comorbid conditions were calculated and adjusted for in Cox models to determine associations between that comorbid condition and FN. We also evaluated secondary models that additionally adjusted for cancer stage, baseline absolute neutrophil count (ANC), chemotherapy regimen, and dose reductions. A total of 7,127 breast cancer patients were included; median age was 55 years, and the majority had localized (47 %) or regional (49 %) disease at diagnosis. In the first chemotherapy cycle, 335 (4.7 %) patients developed FN. Congestive heart failure (HR = 3.0; 95 % CI: 1.3-5.9), osteoarthritis (HR = 2.0; 95 % CI: 1.4-2.8), previous cancer (HR = 3.4; 95 % CI: 1.2-7.5), and thyroid disorder (HR = 1.6; 95 % CI: 1.1-2.3) were associated with increased risk of FN. These estimates were similar to those from secondary models that also adjusted for additional cancer and treatment-related covariates. Our findings suggest that several chronic comorbid

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

    PubMed

    Tyan, Paul; Abi-Khalil, Elias; Dwarki, Karthik; Moawad, Gaby

    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

  15. Patient Characteristics and Comorbidities Influence Walking Distances in Symptomatic Peripheral Arterial Disease: A Large One-Year Physiotherapy Cohort Study

    PubMed Central

    Dörenkamp, Sarah; Mesters, Ilse; van Breukelen, Gerard

    2016-01-01

    Objectives The aim of this study is to investigate the association between age, gender, body-mass index, smoking behavior, orthopedic comorbidity, neurologic comorbidity, cardiac comorbidity, vascular comorbidity, pulmonic comorbidity, internal comorbidity and Initial Claudication Distance during and after Supervised Exercise Therapy at 1, 3, 6 and 12 months in a large sample of patients with Intermittent Claudication. Methods Data was prospectively collected in standard physiotherapy care. Patients received Supervised Exercise Therapy according to the guideline Intermittent Claudication of the Royal Dutch Society for Physiotherapy. Three-level mixed linear regression analysis was carried out to analyze the association between patient characteristics, comorbidities and Initial Claudication Distance at 1, 3, 6 and 12 months. Results Data from 2995 patients was analyzed. Results showed that being female, advanced age and a high body-mass index were associated with lower Initial Claudication Distance at all-time points (p = 0.000). Besides, a negative association between cardiac comorbidity and Initial Claudication Distance was revealed (p = 0.011). The interaction time by age, time by body-mass index and time by vascular comorbidity were significantly associated with Initial Claudication Distance (p≤ 0.05). Per year increase in age (range: 33–93 years), the reduction in Initial Claudication Distance was 8m after 12 months of Supervised Exercise Therapy. One unit increase in body-mass index (range: 16–44 kg/m2) led to 10m less improvement in Initial Claudication Distance after 12 months and for vascular comorbidity the reduction in improvement was 85m after 12 months. Conclusions This study reveals that females, patients at advanced age, patients with a high body-mass index and cardiac comorbidity are more likely to show less improvement in Initial Claudication Distances (ICD) after 1, 3, 6 and 12 months of Supervised Exercise Therapy. Further research should

  16. 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…

  17. Comorbid Problems in ADHD: Degree of Association, Shared Endophenotypes, and Formation of Distinct Subtypes. Implications for a Future "DSM"

    ERIC Educational Resources Information Center

    Rommelse, Nanda N. J.; Altink, Marieke E.; Fliers, Ellen A.; Martin, Neilson C.; Buschgens, Cathelijne J. M.; Hartman, Catharina A.; Buitelaar, Jan K.; Faraone, Stephen V.; Sergeant, Joseph A.; Oosterlaan, Jaap

    2009-01-01

    We aimed to assess which comorbid problems (oppositional defiant behaviors, anxiety, autistic traits, motor coordination problems, and reading problems) were most associated with Attention-Deficit/Hyperactivity Disorder (ADHD); to determine whether these comorbid problems shared executive and motor problems on an endophenotype level with ADHD; and…

  18. Children with Comorbid Speech Sound Disorder and Specific Language Impairment Are at Increased Risk for Attention-Deficit/Hyperactivity Disorder

    ERIC Educational Resources Information Center

    McGrath, Lauren M.; Hutaff-Lee, Christa; Scott, Ashley; Boada, Richard; Shriberg, Lawrence D.; Pennington, Bruce F.

    2008-01-01

    This study focuses on the comorbidity between attention-deficit/hyperactivity disorder (ADHD) symptoms and speech sound disorder (SSD). SSD is a developmental disorder characterized by speech production errors that impact intelligibility. Previous research addressing this comorbidity has typically used heterogeneous groups of speech-language…

  19. Comorbid problems in ADHD: degree of association, shared endophenotypes, and formation of distinct subtypes. Implications for a future DSM.

    PubMed

    Rommelse, Nanda N J; Altink, Marieke E; Fliers, Ellen A; Martin, Neilson C; Buschgens, Cathelijne J M; Hartman, Catharina A; Buitelaar, Jan K; Faraone, Stephen V; Sergeant, Joseph A; Oosterlaan, Jaap

    2009-08-01

    We aimed to assess which comorbid problems (oppositional defiant behaviors, anxiety, autistic traits, motor coordination problems, and reading problems) were most associated with Attention-Deficit/Hyperactivity Disorder (ADHD); to determine whether these comorbid problems shared executive and motor problems on an endophenotype level with ADHD; and to determine whether executive functioning (EF)-and motor-endophenotypes supported the hypothesis that ADHD with comorbid problems is a qualitatively different phenotype than ADHD without comorbid problems. An EF-and a motor-endophenotype were formed based on nine neuropsychological tasks administered to 816 children from ADHD-and control-families. Additional data on comorbid problems were gathered using questionnaires. Results indicated that oppositional defiant behaviors appeared the most important comorbid problems of ADHD, followed by autistic traits, and than followed by motor coordination problems, anxiety, and reading problems. Both the EF-and motor-endophenotype were correlated and cross-correlated in siblings to autistic traits, motor coordination problems and reading problems, suggesting ADHD and these comorbid problems may possibly share familial/genetic EF and motor deficits. No such results were found for oppositional defiant behaviors and anxiety. ADHD in co-occurrence with comorbid problems may not be best seen as a distinct subtype of ADHD, but further research is warranted. PMID:19308723

  20. 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…

  1. A Synthesis on the Research of the Comorbidity of ADHD and LD in Korea: Perspective and Trend

    ERIC Educational Resources Information Center

    Kim, Dongil; Koh, Eunyoung; Jeong, Sora; Lee, Kijyung; Kim, Boongnyun; Kim, Ienai

    2011-01-01

    Attention-deficit/hyperactivity disorder (ADHD) and learning disabilities (LD) are the most commonly diagnosed childhood disorders, and they frequently co-occur with each other. It has been found that students with comorbidity of ADHD and LD experience more difficulties in school. Even though the research interests in the comorbidity of ADHD and…

  2. Availability of Education and Training for Medical Specialists about the Impact of Dementia on Comorbid Disease Management

    ERIC Educational Resources Information Center

    Ibrahim, Joseph Elias; Davis, Marie-Claire

    2013-01-01

    Individuals with dementia carry an additional health burden of multiple comorbid conditions. Effectively assessing and treating these comorbid conditions requires the medical specialist to be aware of, understand, and manage the effects of dementia on their clinical subspecialty practice. This ecological study describes the dementia-related…

  3. Comorbidities associated with COPD in the Middle East and North Africa region: association with severity and exacerbations

    PubMed Central

    Mahboub, Bassam; Alzaabi, Ashraf; Iqbal, Mohammed Nizam; Salhi, Hocine; Lahlou, Aïcha; Tariq, Luqman; El Hasnaoui, Abdelkader

    2016-01-01

    Objective To assess the frequency of comorbidities in subjects with COPD and their association with respiratory symptom severity and COPD exacerbations. Materials and methods This was an analysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of eleven countries in the Middle East and North Africa, including Pakistan. The study population consisted of a sample of subjects with COPD for whom the presence of comorbidities was documented. Three questionnaires were used. The screening questionnaire identified subjects who fulfilled an epidemiological case definition of COPD and documented any potential comorbidities; the detailed COPD questionnaire collected data on respiratory symptoms, COPD exacerbations, and comorbidities associated with COPD; the COPD Assessment Test collected data on the impact of respiratory symptoms on well-being and daily life. Results A total of 2,187 subjects were positively screened for COPD, of whom 1,392 completed the detailed COPD questionnaire. COPD subjects were more likely to report comorbidities (55.2%) than subjects without COPD (39.1%, P<0.0001), most frequently cardiovascular diseases. In subjects who screened positively for COPD, the presence of comorbidities was significantly (P=0.03) associated with a COPD Assessment Test score ≥10 and with antecedents of COPD exacerbations in the previous 6 months (P=0.03). Conclusion Comorbidities are frequent in COPD and associated with more severe respiratory symptoms. This highlights the importance of identification and appropriate management of comorbidities in all subjects with a diagnosis of COPD. PMID:26917957

  4. Exploring the Agreement between Questionnaire Information and DSM-IV Diagnoses of Comorbid Psychopathology in Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Gjevik, Elen; Sandstad, Berit; Andreassen, Ole A.; Myhre, Anne M.; Sponheim, Eili

    2015-01-01

    Autism spectrum disorders are often comorbid with other psychiatric symptoms and disorders. However, identifying psychiatric comorbidity in children with autism spectrum disorders is challenging. We explored how a questionnaire, the Child Behavior Check List, agreed with a "Diagnostic and Statistical Manual of Mental Disorders-Fourth…

  5. Fluoxetine Monotherapy in Attention-Deficit/Hyperactivity Disorder and Comorbid Non-Bipolar Mood Disorders in Children and Adolescents

    ERIC Educational Resources Information Center

    Quintana, Humberto; Butterbaugh, Grant J.; Purnell, William; Layman, Ann K.

    2007-01-01

    Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for developing comorbid non-bipolar mood disorders. Fluoxetine monotherapy is an established treatment for pediatric mood disorders; however its efficacy in ADHD and comorbid mood disorder is unknown. Therefore, we evaluated 30 children who met DSM-IV criteria for…

  6. Correlates of Conduct Problems and Depression Comorbidity in Elementary School Boys and Girls Receiving Special Educational Services

    ERIC Educational Resources Information Center

    Poirier, Martine; Déry, Michèle; Toupin, Jean; Verlaan, Pierrette; Lemelin, Jean-Pascal; Jagiellowicz, Jadzia

    2015-01-01

    There is limited empirical research on the correlates of conduct problems (CP) and depression comorbidity during childhood. This study investigated 479 elementary school children (48.2% girls). It compared children with comorbidity to children with CP only, depression only, and control children on individual, academic, social, and family…

  7. The Relationship between Psychopathology Symptom Clusters and the Presence of Comorbid Psychopathology in Individuals with Severe to Profound Intellectual Disability

    ERIC Educational Resources Information Center

    Kozlowski, Alison M.; Matson, Johnny L.; Sipes, Megan; Hattier, Megan A.; Bamburg, Jay W.

    2011-01-01

    In the typically developing population, comorbid psychopathology refers to the co-occurrence of two different psychopathologies other than cognitive impairments. With respect to individuals with intellectual disability, comorbidity is often described as cognitive deficits and one additional psychopathology manifesting together. However, just as…

  8. Children’s symptoms of posttraumatic stress and depression after a natural disaster: Comorbidity and risk factors

    PubMed Central

    Lai, Betty S.; La Greca, Annette M.; Auslander, Beth A.; Short, Mary B.

    2013-01-01

    Background The current study examined rates of comorbidity among children’s symptoms of posttraumatic stress (PTS) and depression after a natural disaster, Hurricane Ike. We also compared children with comorbid symptoms to children without comorbid symptoms, examining recovery, severity of symptoms, and risk factors. Method Children (n=277; 52% girls; 38% Hispanic, 28% White, 19% Black; grades 2–4) were assessed at 8 and 15 months postdisaster. Children completed measures of PTS and depressive symptoms at both time points and measures of exposure and recovery stressors at 8 months postdisaster. Results At 8 months postdisaster, 13% of children reported elevated PTS-only, 11% depression-only, and 10% comorbid symptoms of PTS and depression. At 15 months postdisaster, 7% of children reported elevated PTS-only, 11% depression-only, and 7% comorbid symptoms of PTS and depression. Children with comorbid symptoms of PTS and depression had poorer recovery, more severe symptoms, and they reported greater exposure and recovery stressors. Limitations We lacked information on children’s predisaster functioning and diagnostic interview of psychological distress symptoms. Conclusions Children with comorbid symptoms need to be identified early postdisaster. Levels of stressors should be monitored postdisaster, as highly stressed youth have difficulties recovering and may need help. Interventions should be tailored for children with comorbid symptoms of PTS and depression. PMID:22974469

  9. Bayesian Analysis of Current and Lifetime Comorbidity Rates of Mood and Anxiety Disorders In Individuals with Posttraumatic Stress Disorder

    PubMed Central

    Gallagher, Matthew W.; Brown, Timothy A.

    2014-01-01

    Although posttraumatic stress disorder (PTSD) is no longer considered an anxiety disorder in DSM-5, previous research has indicated high rates of comorbid anxiety and mood disorders in individuals with PTSD. The goal of the present study was to build upon previous examinations of diagnostic comorbidity by using Bayesian methods of estimating current and lifetime comorbidity rates to determine more precise estimates of the proportion of individuals in a clinical sample with PTSD that also meet criteria for various emotional disorders. Two hundred and fifty three individuals with a current or lifetime diagnosis of PTSD underwent a comprehensive assessment of current and lifetime emotional disorders. Bayesian statistical techniques were then used to calculate credibility intervals for the current and lifetime comorbidity rates of emotional disorders. The Bayesian analyses used informative priors based on previous comorbidity findings. The median number of current emotional disorders was two and the median number of lifetime comorbid emotional disorders was three. Credibility intervals indicated that social phobia and major depressive disorder were the most common current and lifetime comorbid emotional disorders. The proportion of individuals with lifetime comorbidity rates were very high for both any lifetime anxiety disorder (.91, 95% CI .88: .94) and any lifetime depressive disorder (.90, 95% CI .86: .93). Together these results indicate that despite the separation from the anxiety disorders in DSM-5, the vast majority of individuals with PTSD will present with one or more emotional disorders. Implications for the assessment and treatment of PTSD are discussed. PMID:26166944

  10. 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…

  11. 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…

  12. Physical Comorbidities in Depression Co-Occurring with Anxiety: A Cross Sectional Study in the Czech Primary Care System

    PubMed Central

    Winkler, Petr; Horáček, Jiří; Weissová, Aneta; Šustr, Martin; Brunovský, Martin

    2015-01-01

    Comorbidities associated with depression have been researched in a number of contexts. However, the epidemiological situation in clinical practice is understudied, especially in the post-Communist Central and Eastern Europe region. The aim of this study was to assess physical comorbidities in depression, and to identify whether there are increased odds of physical comorbidities associated with co-occurring depressive and anxiety disorders. Data on 4264 patients aged 18–98 were collected among medical doctors in the Czech Republic between 2010 and 2011. Descriptive statistics were calculated and multiple logistic regressions were performed to assess comorbidities among patients with depressive disorder. There were 51.29% of those who have a physical comorbidity, and 45.5% of those who have a comorbid anxiety disorders among patients treated with depression in Czech primary care. Results of logistic regressions show that odds of having pain, hypertension or diabetes mellitus are particularly elevated at those who have co-occurring depressive and anxiety disorder. Our findings demonstrate that comorbidities associated with depressive disorders are highly prevalent in primary health care practice, and that physical comorbidities are particularly frequent among those with co-occurring depressive and anxiety disorders. PMID:26690458

  13. 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 =…

  14. Is Behavioral Regulation in Children with ADHD Aggravated by Comorbid Anxiety Disorder?

    ERIC Educational Resources Information Center

    Sorensen, Lin; Plessen, Kerstin J.; Nicholas, Jude; Lundervold, Astri J.

    2011-01-01

    Background: The present study investigated the impact of coexisting anxiety disorder in children with ADHD on their ability to regulate behavior. Method: Parent reports on the Behavior Rating Inventory of Executive Function (BRIEF) in a comorbid group of children with ADHD and anxiety (n = 11) were compared to BRIEF reports in a group of children…

  15. Prevalence, Comorbidity and Course of Trauma Reactions in Young Burn-Injured Children

    ERIC Educational Resources Information Center

    De Young, Alexandra C.; Kenardy, Justin A.; Cobham, Vanessa E.; Kimble, Roy

    2012-01-01

    Background: Infants, toddlers and preschoolers are the highest risk group for burn injury. However, to date this population has been largely neglected. This study examined the prevalence, onset, comorbidity and recovery patterns of posttrauma reactions in young children with burns. Methods: Parents of 130 unintentionally burned children (1-6…

  16. Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions

    ERIC Educational Resources Information Center

    Mishra, Shiraz I.; Gioia, Deborah; Childress, Saltanat; Barnet, Beth; Webster, Ramothea L.

    2011-01-01

    This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These…

  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…

  18. Case Conceptualization and Treatment of Comorbid Body Dysmorphic Disorder and Bulimia Nervosa

    ERIC Educational Resources Information Center

    Didie, Elizabeth R.; Reinecke, Mark A.; Phillips, Katharine A.

    2010-01-01

    Body dysmorphic disorder (BDD) and eating disorders often co-occur and share some clinical features. In addition, the co-occurrence of BDD and an eating disorder may be associated with greater impairment in functioning. Furthermore, clinical impressions suggest that this comorbidity may be more treatment resistant than either disorder alone. The…

  19. Shared Genetic Influences on Negative Emotionality and Major Depression/Conduct Disorder Comorbidity

    ERIC Educational Resources Information Center

    Tackett, Jennifer L.; Waldman, Irwin D.; Van Hulle, Carol A.; Lahey, Benjamin B.

    2011-01-01

    Objective: To investigate whether genetic contributions to major depressive disorder and conduct disorder comorbidity are shared with genetic influences on negative emotionality. Method: Primary caregivers of 2,022 same- and opposite-sex twin pairs 6 to 18 years of age comprised a population-based sample. Participants were randomly selected across…

  20. Uncomplicated and comorbid obsessive-compulsive disorder in an epidemiologic sample.

    PubMed

    Hollander, E; Greenwald, S; Neville, D; Johnson, J; Hornig, C D; Weissman, M M

    This study investigated lifetime prevalence rates, demographic characteristics, childhood conduct disorder and adult antisocial features, suicide attempts, and cognitive impairment in individuals with obsessive-compulsive disorder (OCD) uncomplicated by or comorbid with any other psychiatric disorder. The data are from the NIMH Epidemiologic Catchment Area (ECA) study, and the current analyses compared subjects with uncomplicated OCD (no history of any other lifetime psychiatric disorder), comorbid OCD (with any other lifetime disorder), other lifetime psychiatric disorders, and no lifetime psychiatric disorders across these variables. OCD in its uncomplicated and comorbid form had significantly higher rates of childhood conduct symptoms, adult antisocial personality disorder problems, and of suicide attempts than did no or other disorders. Comorbid OCD subjects had higher rates of mild cognitive impairment on the Mini-Mental Status Exam than did subjects with other disorders. These findings suggest that a subgroup of OCD patients may have impulsive features, including childhood conduct disorder symptoms and an increased rate of suicide attempts; wider clinical attention to these outcomes is needed. PMID:9166639

  1. Do Symptoms of Sluggish Cognitive Tempo in Children with ADHD Symptoms Represent Comorbid Internalizing Difficulties?

    ERIC Educational Resources Information Center

    Garner, Annie A.; Mrug, Sylvie; Hodgens, Bart; Patterson, Cryshelle

    2013-01-01

    Objective: Symptoms of sluggish cognitive tempo (SCT) are correlated with inattention and internalizing difficulties. The purpose of the present study was to determine whether symptoms of SCT reflect comorbid internalizing disorder with ADHD or a separate syndrome. Method: Using a clinical sample of youth evaluated for behavioral and learning…

  2. Relation of Early Menarche to Depression, Eating Disorders, Substance Abuse, and Comorbid Psychopathology among Adolescent Girls.

    ERIC Educational Resources Information Center

    Stice, Eric; Presnell, Katherine; Bearman, Sarah Kate

    2001-01-01

    Used interview data from a community study to test whether early menarche partially accounts for increased depression, eating pathology, substance abuse, and comorbid psychopathology among adolescent girls. Found that menarche prior to 11.6 years related to elevated depression and substance abuse. Findings support assertion that early menarche is…

  3. PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

    PubMed Central

    Ralevski, Elizabeth; Olivera-Figueroa, Lening A; Petrakis, Ismene

    2014-01-01

    Background Although posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture) is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. PMID:24648794

  4. Depressed Adolescents and Comorbid Psychiatric Disorders: Are There Differences in the Presentation of Depression?

    ERIC Educational Resources Information Center

    Small, David Marc; Simons, Anne D.; Yovanoff, Paul; Silva, Susan G.; Lewis, Cara C.; Murakami, Jessica L.; March, John

    2008-01-01

    Patterns and correlates of comorbidity, as well as differences in manifest depressive profiles were investigated in a sample of depressed adolescents. A sub-sample of the youth were characterized as belonging to either a "Pure" depression group, an "Internalizing" group (depression and co-occurring internalizing disorders), or an "Externalizing"…

  5. A Comparison of Pure and Comorbid CD/ODD and Depression

    ERIC Educational Resources Information Center

    Ezpeleta, Lourdes; Domenech, Josep M.; Angold, Adrian

    2006-01-01

    Background: We studied the symptomatology of conduct/oppositional defiant disorder and major depression/dysthymic disorder in "pure" and comorbid presentations. Method: The sample comprised 382 children of 8 to 17 years of age attending for psychiatric outpatient consultation. Ninety-two had depressive disorders without conduct disorders, 165…

  6. The impact of psychiatric comorbidity on Medicare reimbursement for inpatient medical care.

    PubMed

    Goldberg, R J; Daly, J; Golinger, R C

    1994-01-01

    Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of psychiatric co-morbidities in Medicare patients on medical services could generate incremental hospital revenue by moving patients from a lower to a higher paying Diagnostic Related Group (DRG). This increased revenue could be used as a means of supporting the psychiatric C-L service. This study documents the financial impact of screening for and documenting psychiatric co-morbidities on a general acute medical service. We clinically assessed 100 consecutive Medicare admissions and found 25 psychiatric co-morbidities in 20 patients. In only one case did the psychiatric diagnosis result in moving the case to a higher DRG. However, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatric diagnoses by the medical team. The authors discuss both the financial and clinical implications of screening medical inpatients for psychiatric co-morbidities and propose directions for further studies in this area. PMID:8039679

  7. National Comorbidity Survey Replication Adolescent Supplement (NCS0A): I. Background and Measures

    ERIC Educational Resources Information Center

    Merikangas, Kathleen R.; Avenevoli, Shelli; Costello, E. Jane; Koretz, Doreen; Kessler, Ronald C.

    2009-01-01

    The goals and measures of the National Comorbidity Survey Replication Adolescent Supplement are discussed. The survey seeks to provide the first nationally representative estimate of mental disorders among U.S. adolescents aged 13 to 17 years. The survey can also be used to generate patterns of service use and barriers to treatment.

  8. Mental Disorders, Comorbidity, and Postrunaway Arrests among Homeless and Runaway Adolescents

    ERIC Educational Resources Information Center

    Chen, Xiaojin; Thrane, Lisa; Whitbeck, Les B.; Johnson, Kurt

    2006-01-01

    This study examined the associations between lifetime mental disorder, comorbidity, and self-reported postrunaway arrests among 428 (187 males, 241 females) homeless and runaway youth. The analysis examined the pattern of arrests across five lifetime mental disorders (alcohol abuse, drug abuse, conduct disorder, major depressive episode, and…

  9. Work, Recovery, and Comorbidity in Schizophrenia: A Randomized Controlled Trial of Cognitive Remediation

    PubMed Central

    McGurk, Susan R.; Mueser, Kim T.; DeRosa, Thomas J.; Wolfe, Rosemarie

    2009-01-01

    Employment is central to the concept of recovery in severe mental illness. However, common comorbid conditions present significant obstacles to consumers seeking employment and benefiting from vocational rehabilitation. We review research on the effects of three common comorbid conditions on work and response to vocational rehabilitation, including cognitive impairment, substance abuse, and medical conditions, followed by research on vocational rehabilitation. We then present the results of a randomized controlled trial evaluating the effects of adding cognitive remediation to a vocational rehabilitation program compared with vocational rehabilitation alone in 34 consumers with severe mental illness. Consumers who received both cognitive remediation and vocational rehabilitation demonstrated significantly greater improvements on a cognitive battery over 3 months than those who received vocational rehabilitation alone and had better work outcomes over the 2-year follow-up period. Substance abuse was associated with worse employment outcomes, but did not interact with treatment group, whereas medical comorbidity was not related to work outcomes. More research is warranted to evaluate the interactions between substance abuse and medical comorbidity with vocational rehabilitation and cognitive remediation. PMID:19269925

  10. Self-Regulation of Emotion, Functional Impairment, and Comorbidity among Children with AD/HD

    ERIC Educational Resources Information Center

    Anastopoulos, Arthur D.; Smith, Taylor F.; Garrett, Melanie E.; Morrissey-Kane, Erin; Schatz, Nicole K.; Sommer, Jennifer L.; Kollins, Scott H.; Ashley-Koch, Allison

    2011-01-01

    Objective: This study investigated the role of self-regulation of emotion in relation to functional impairment and comorbidity among children with and without AD/HD. Method: A total of 358 probands and their siblings participated in the study, with 74% of the sample participants affected by AD/HD. Parent-rated levels of emotional lability served…

  11. ADHD Correlates, Comorbidity, and Impairment in Community and Treated Samples of Children and Adolescents

    ERIC Educational Resources Information Center

    Bauermeister, Jose J.; Shrout, Patrick E.; Ramirez, Rafael; Bravo, Milagros; Alegria, Margarita; Martinez-Taboas, Alfonso; Chavez, Ligia; Rubio-Stipec, Maritza; Garcia, Pedro; Ribera, Julio C.; Canino, Glorisa

    2007-01-01

    Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic…

  12. Psychological Dimensions Associated with Suicidal Ideation and Attempts in the National Comorbidity Survey

    ERIC Educational Resources Information Center

    Cox, Brian J.; Enns, Murray W.; Clara, Ian P.

    2004-01-01

    Three important psychological dimensions in the suicide literature (neuroticism, self-criticism, and hopelessness) were examined in relation to suicidal ideation and attempts in the U.S. National Comorbidity Survey (Kessler et al., 1994; n = 5,877), after first controlling for the effects of previously identified sociodemographic and psychiatric…

  13. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management.

    PubMed

    Campo, Gianluca; Pavasini, Rita; Malagù, Michele; Mascetti, Susanna; Biscaglia, Simone; Ceconi, Claudio; Papi, Alberto; Contoli, Marco

    2015-04-01

    In the last few years, many studies focused their attention on the relationship between chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD), showing that these diseases are mutually influenced. Many different biological processes such as hypoxia, systemic inflammation, endothelial dysfunction, heightened platelet reactivity, arterial stiffness and right ventricle modification interact in the development of the COPD-IHD comorbidity, which therefore deserves special attention in early diagnosis and treatment. Patients with COPD-IHD comorbidity have a worst outcome, when compared to patients with only COPD or only IHD. These patients showed a significant increase on risk of adverse events and of hospital readmissions for recurrent myocardial infarction, heart failure, coronary revascularization, and acute exacerbation of COPD. Taken together, these complications determine a significant increase in mortality. In most cases death occurs for cardiovascular cause, soon after an acute exacerbation of COPD or a cardiovascular adverse event. Recent data regarding incidence, mechanisms and prognosis of this comorbidity, along with the development of new drugs and interventional approaches may improve the management and long-term outcome of COPD-IHD patients. The aim of this review is to describe the current knowledge on COPD-IHD comorbidity. Particularly, we focused our attention on underlying pathological mechanisms and on all treatment and strategies that may improve and optimize the clinical management of COPD-IHD patients. PMID:25645653

  14. Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders

    ERIC Educational Resources Information Center

    Leyfer, Ovsanna T.; Folstein, Susan E.; Bacalman, Susan; Davis, Naomi O.; Dinh, Elena; Morgan, Jubel; Tager-Flusberg, Helen; Lainhart, Janet E.

    2006-01-01

    The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and…

  15. Challenging Behavior and Co-Morbid Psychopathology in Adults with Intellectual Disability and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    McCarthy, Jane; Hemmings, Colin; Kravariti, Eugenia; Dworzynski, Katharina; Holt, Geraldine; Bouras, Nick; Tsakanikos, Elias

    2010-01-01

    We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N=124) as compared to adults with ID only (N=562). All participants were first time referrals to specialist mental health services and were living in community settings.…

  16. Excessive Picking in Prader-Willi Syndrome: A Pilot Study of Phenomenological Aspects and Comorbid Symptoms.

    ERIC Educational Resources Information Center

    Wigren, Margareta; Heimann, Mikael

    2001-01-01

    Interviews with parents of 37 individuals (ages 12-30) with Prader-Willi syndrome revealed two-thirds displayed skin picking with a frequency ranging from chronic to transient, episodic symptoms. Many individuals with skin picking also exhibited comorbid picking behaviors And individuals with excessive skin picking also had frequent tantrums and…

  17. Methylphenidate and Comorbid Anxiety Disorder in Children with both Chronic Multiple Tic Disorder and ADHD

    ERIC Educational Resources Information Center

    Gadow, Kenneth D.; Nolan, Edith E.

    2011-01-01

    Objective: To determine if comorbid anxiety disorder is associated with differential response to immediate release methylphenidate (MPH-IR) in children with both ADHD and chronic multiple tic disorder (CMTD). Method: Children with (n = 17) and without (n = 37) diagnosed anxiety disorder (ANX) were evaluated in an 8-week, placebo-controlled trial…

  18. 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…

  19. COPD Hospitalization Risk Increased with Distinct Patterns of Multiple Systems Comorbidities Unveiled by Network Modeling

    PubMed Central

    Lee, Young Ji; Boyd, Andrew D.; Li, Jianrong ‘John’; Gardeux, Vincent; Kenost, Colleen; Saner, Don; Li, Haiquan; Abraham, Ivo; Krishnan, Jerry A.; Lussier, Yves A.

    2014-01-01

    Earlier studies on hospitalization risk are largely based on regression models. To our knowledge, network modeling of multiple comorbidities is novel and inherently enables multidimensional scoring and unbiased feature reduction. Network modeling was conducted using an independent validation design starting from 38,695 patients, 1,446,581 visits, and 430 distinct clinical facilities/hospitals. Odds ratios (OR) were calculated for every pair of comorbidity using patient counts and compared their tendency with hospitalization rates and ED visits. Network topology analyses were performed, defining significant comorbidity associations as having OR≥5 & False-Discovery-Rate≤10−7. Four COPD-associated comorbidity sub-networks emerged, incorporating multiple clinical systems: (i) metabolic syndrome, (ii) substance abuse and mental disorder, (iii) pregnancy-associated conditions, and (iv) fall-related injury. The latter two have not been reported yet. Features prioritized from the network are predictive of hospitalizations in an independent set (p<0.004). Therefore, we suggest that network topology is a scalable and generalizable method predictive of hospitalization. PMID:25954392

  20. DSM-IV personality disorders in the National Comorbidity Survey Replication

    PubMed Central

    Lenzenweger, Mark F.; Lane, Michael C.; Loranger, Armand W.; Kessler, Ronald C.

    2007-01-01

    BACKGROUND The population prevalence of DSM-IV personality disorders (PDs) remains largely unknown. Data are reported here on the prevalence and correlates of clinician-diagnosed Clusters A, B, and C DSM-IV PDs in the general population of the US. METHODS PD screening questions from the International Personality Disorder Examination (IPDE) were administered in Part II (n = 5692) of the National Comorbidity Survey Replication (NCS-R). A probability sub-sample was then interviewed with the IPDE and used to link screening question responses with IDPE clinical diagnoses. The method of Multiple Imputation (MI) was then implemented to estimate prevalence and correlates of PDs in the full sample. RESULTS MI prevalence estimates were 5.7% Cluster A, 1.5% Cluster B, 6.0% Cluster C, and 9.1% any PD. All three PD clusters were significantly comorbid with a wide range of DSM-IV Axis I disorders. Significant associations of PDs with functional impairment were largely accounted for by Axis I comorbidity. CONCLUSIONS Strong Axis I comorbidity raises questions about the somewhat arbitrary separation of PDs from Axis I disorders in the DSM nomenclature. The impairment findings suggest that the main public health significance of PDs lies in their effects on Axis I disorders rather than in their effects on functioning. PMID:17217923