Assessment Of Psychiatric Comorbidity Research Articles

Assessment of psychiatric comorbidities in DRE (drug -resistant epilepsy) patients

Assessment of psychiatric comorbidities in DRE (drug -resistant epilepsy) patients

Assessment of Psychiatric Comorbidities and Disability in Patients with a Complaint of Headache Attending Psychiatric Outpatient Department at Tertiary Care Center

Abstract Background: Headache is one of the most common complaints seen among the patients attending the psychiatric outpatient department. Psychiatric comorbidities worsen the headache and there is a vicious cycle of headache and psychiatric symptoms, aggravating each other. This further complicates headache management so it is better to explore psychiatric symptoms whenever we come across a headache patient. Aims and Objectives: The aim and objective of the study are to assess the psychiatric comorbidities and disability among the patients complaining of headaches. Materials and Methods: This was a cross-sectional study carried out at a tertiary care center. Patients attending the outpatient department with complaints of headaches were enrolled. Psychiatric comorbidities were assessed by using patient health questionnaire-9, generalized anxiety disorder-7 scale, depression, anxiety, and stress 21 scale along with allodynia symptom checklist-12. Disability in the past 3 months was assessed by Migraine Disability Assessment Scale (MIDAS) scale. A semi-structured Performa was used to record sociodemographic details and clinical variables. Results: Majority of the patients (69%) were of the age group 20–40 years. Females (75%) predominated in the study. The average severity of headaches reported by 63% of patients was moderate over Likert’s scale. Temple area (73%) was the main location. Throbbing (81%) was the main type of headache. One-third of the patients got compelled to wake at night due to headache attacks. The main premonitory symptoms were depression, irritability, and sensitivity to sound. Other associated symptoms during headache attacks were sensitivity to sound, anxiety, and irritability. Psychological stress was the main provoking factor. The majority of patients (75%) show mild disability in the past 3 months over the MIDAS scale. 25% of the patient-reported moderate depression over the patient health questionare-9 scale. The majority of the patients (85%) reported moderate-to-severe anxiety and nearly half of the patients reported severe stress. Conclusion: Patients with headaches have high chances of associated psychiatric comorbidities that make worse outcomes of each other so it is better to do detailed psychiatric workup and treat them efficiently keeping in view of psychiatric symptoms.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Characterization of sexual health among portuguese trans population

Objectives To characterize the sexual health of the population with Gender Dysphoria followed at the Sexology consultation at the Lisboa Psychiatric Hospital Center and to analyse the relationship between psychiatric morbidity, sexual desire and quality of life. Methods A cross-sectional study of people followed in the Sexology consultation with the diagnosis of Gender Dysphoria, was performed before the beginning of hormone therapy. Sociodemographic characterization, assessment of psychiatric comorbidity and application of the Sexual Desire Inventory 2 questionnaire and WHOQOL-BREF, validated for the Portuguese population. Informed consent was obtained from all participants. Results 53 participants were selected 52.8% (n=28) transgender men and 45.3% transgender women (n=24), with a mean age of 25 years. Most participants were single (94.5%, n=49) and attending 10th through 12th grade (45.1%, n= 23). About 60% (n=27) had no comorbid psychiatric disorder. There was no statistically significant difference between transgender men and transgender women concerning the total values and the dyadic and solitary factors of the SDI-2. Most people reported regular quality of life at the WHOQOL-BREF. Discussion Sexual health is defined by WHO as a state of physical, emotional, mental and social well-being concerning sexuality. It is influenced by biological, psychosocial, historical-political, legal, and religious/spiritual factors. The sexuality of transgender people may be influenced by trans-specific or other factors common to the cisgender population. The literature suggests that sexual experience, function and satisfaction before and during the medical transition process, influence clinical outcomes and the person's satisfaction with their sexuality. Conclusions In the clinical follow-up of people with gender dysphoria, it is essential to perform a multidimensional assessment of sexuality and sexual function, as well as to explore expectations regarding gender-affirming medical-surgical interventions, fostering sexual self-determination and enhancing favourable clinical outcomes. Conflicts of Interest No conflicts of interest. To characterize the sexual health of the population with Gender Dysphoria followed at the Sexology consultation at the Lisboa Psychiatric Hospital Center and to analyse the relationship between psychiatric morbidity, sexual desire and quality of life. A cross-sectional study of people followed in the Sexology consultation with the diagnosis of Gender Dysphoria, was performed before the beginning of hormone therapy. Sociodemographic characterization, assessment of psychiatric comorbidity and application of the Sexual Desire Inventory 2 questionnaire and WHOQOL-BREF, validated for the Portuguese population. Informed consent was obtained from all participants. 53 participants were selected 52.8% (n=28) transgender men and 45.3% transgender women (n=24), with a mean age of 25 years. Most participants were single (94.5%, n=49) and attending 10th through 12th grade (45.1%, n= 23). About 60% (n=27) had no comorbid psychiatric disorder. There was no statistically significant difference between transgender men and transgender women concerning the total values and the dyadic and solitary factors of the SDI-2. Most people reported regular quality of life at the WHOQOL-BREF. Sexual health is defined by WHO as a state of physical, emotional, mental and social well-being concerning sexuality. It is influenced by biological, psychosocial, historical-political, legal, and religious/spiritual factors. The sexuality of transgender people may be influenced by trans-specific or other factors common to the cisgender population. The literature suggests that sexual experience, function and satisfaction before and during the medical transition process, influence clinical outcomes and the person's satisfaction with their sexuality. In the clinical follow-up of people with gender dysphoria, it is essential to perform a multidimensional assessment of sexuality and sexual function, as well as to explore expectations regarding gender-affirming medical-surgical interventions, fostering sexual self-determination and enhancing favourable clinical outcomes.

Common Data Elements to Facilitate Sharing and Re-use of Participant-Level Data: Assessment of Psychiatric Comorbidity Across Brain Disorders.

The Ontario Brain Institute's “Brain-CODE” is a large-scale informatics platform designed to support the collection, storage and integration of diverse types of data across several brain disorders as a means to understand underlying causes of brain dysfunction and developing novel approaches to treatment. By providing access to aggregated datasets on participants with and without different brain disorders, Brain-CODE will facilitate analyses both within and across diseases and cover multiple brain disorders and a wide array of data, including clinical, neuroimaging, and molecular. To help achieve these goals, consensus methodology was used to identify a set of core demographic and clinical variables that should be routinely collected across all participating programs. Establishment of Common Data Elements within Brain-CODE is critical to enable a high degree of consistency in data collection across studies and thus optimize the ability of investigators to analyze pooled participant-level data within and across brain disorders. Results are also presented using selected common data elements pooled across three studies to better understand psychiatric comorbidity in neurological disease (Alzheimer's disease/amnesic mild cognitive impairment, amyotrophic lateral sclerosis, cerebrovascular disease, frontotemporal dementia, and Parkinson's disease).

Assessment of psychiatric comorbidities and sociodemographic profiles of the patients referred to the general hospital psychiatric unit of a tertiary care hospital in Kolkata, West Bengal

Background: According to the previous studies, psychiatric symptoms are high in patients with physical illness, but the referral rates are much below expectation. Aims and Objectives: Here a descriptive cross-sectional study has been conducted using self designed semi structured proforma to asses the socio demographic profile and psychiatric diagnosis of patient with physical illness referred from other departments in a tertiary medical care centre for consultation liaison (C-L) psychiatry care. Materials and Methods: The study population consists of the patients referred to psychiatry department for consultation purpose from all the other departments in a 4 months period. The data were collected on a self designed semi structured pro forma and all the diagnosis were made according to International Classification of Disease -10 (ICD-10) criteria. Analysis has been done using descriptive statistics. Results: A total numbers of 203 patient has been referred to psychiatry department during the study period . Among them 144 were inpatient and 59 were outdoor based referral. Majority were female, married . The maximum referral were from general medicine department followed by neuromedicine. Most common reason of referral being suicidal attempt by different means followed by patients having depressive features .The most common psychiatric diagnosis was depression followed by delirium. Conclusion: C-L psychiatry plays a significant role in better evaluation and management of patients with psychiatric comorbidities referred from non-psychiatric departments.

Conceptualization and implementation of an interdisciplinary clinic for children with drug-resistant epilepsy during the COVID-19 pandemic

ObjectiveTo describe the rapid conceptualization and implementation of an interdisciplinary epilepsy clinic for children with drug-resistant epilepsy (DRE) at Arkansas Children's Hospital (ACH) during the COVID 19 pandemic. MethodsFocusing on care design and care coordination for children with DRE, multiple stakeholder groups decided to implement a clinic after the systematic rating of constructs present in a theoretical meta-analytic framework. Based on the projected success, the new interdisciplinary clinic (composed of an epileptologist, a neurosurgeon, and a neuropsychologist and coordinated by a full-time nurse) was established. Clinic operations were further refined through discussions with patients, families, and care providers. We collected data retrospectively (August 2020 to June 2021) to determine referral patterns, clinic scheduling metrics, patient characteristics, clinical recommendations, and epilepsy quality metrics. ResultsOf the 32 Consolidated Framework for Implementation Research constructs assessed, 24 were positively rated to predict a high probability of successful implementation of the clinic. For approximately 100 patient visits, appearance and usage rates were >75%, yielding a clinic utilization rate of approximately 60%. Among 76 unique patients (average age of 12 years, 60% focal epilepsy), 39 patients (51.3%) were deemed eligible for epilepsy surgery evaluation. The majority of the patients (53.9%) were advised for additional diagnostic testing, and 31.6% of patients were scheduled for vagus nerve stimulation. More patients (33%) had changes in their existing anti-seizure medication (ASM) regimen rather than an addition of a new ASM (7.9%). Standardized epilepsy quality measures showed >80% to 90% adherence in 3 (reproductive counseling, depression and anxiety screening, documentation of seizure frequency) out of 4 metrics. SignificanceThis is the first study to show that an interdisciplinary clinic can be a valuable attribute of care models in high-need children with DRE by enabling comprehensive one-stop service for diagnostic evaluation, surgical consideration, and brief assessment of psychiatric comorbidities without compromising consensus-based best practices.

Assessment of psychiatric comorbidities and serotonergic or noradrenergic medication use on blood pressure using 24-hour ambulatory blood pressure monitoring.

In this study, the authors aimed to assess both nighttime and daytime blood pressure (BP) variability using 24‐hour ambulatory BP monitoring (ABPM) in persons with and without psychiatric conditions and with or without selective serotonin reuptake inhibitors (SSRIs) or serotonin‐norepinephrine reuptake inhibitors (SNRIs) treatment. In this retrospective study, patients who underwent psychiatric evaluation and ABPM within 6 months of each other between January 1, 2012 and December 31, 2017 were identified using billing data. Participants were divided into three groups—participants with no psychiatric diagnosis and no psychiatric medicine (−Diagnosis/−Medication), those with psychiatric diagnosis and on SSRIs/SNRIs (+Diagnosis/+Medication), and psychiatric diagnosis but no psychiatric medications (+Diagnosis/−Medication). Day and nighttime systolic and diastolic BPs were compared between groups controlling for relevant variables using multivariable linear regression models. A total of 475 participants met inclusion criteria including 135 in the −Diagnosis/−Medication group, 232 in the +Diagnosis/+Medication group, and 108 in the +Diagnosis/−Medication group. In adjusted multivariable analysis, the +Diagnosis/+Medication group had higher nighttime systolic BP (median 120 vs 110 mm (Hg); p = .01) and nighttime diastolic BP (median 68 vs 63 mm (Hg); p = .006) as compared to −Diagnosis/−Medication. No statistically significant differences in BPs between the −Diagnosis/−Medication and +Diagnosis/−Medication groups were observed, after adjustment. Use of SSRIs/SNRIs was associated with significantly higher nocturnal systolic and diastolic BP among patients with psychiatric diagnosis using SSRIs/SNRIs but not associated with psychiatric diagnosis without SSRI/SNRI use. SSRIs/SNRIs use may be associated with higher BP levels and this merits future prospective studies using ABPM to assess day and nighttime BP changes with SSRIs/SNRIs use.

Validation of Addiction Severity Index (ASI) for Assessment of Psychiatric Comorbidity in Multi-Site Randomized Controlled Trials

Objective: This study aimed to assess the validity of the psychiatric problems subscale of the Addiction Severity Index (ASI-psych) to ascertain psychiatric comorbidity among individuals participating in randomized controlled trials (RCTs) of substance use disorder (SUD) treatments.Methods: The ASI-psych score among 1,660 RCT participants of National Institute of Drug Abuse Clinical Trials Network studies was compared against diagnosis of any serious mental disorder based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (SCID) or Mini-International Neuropsychiatric Interview (MINI). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for detecting any serious mental disorders were estimated by the receiver operating characteristic (ROC) analysis.Results: Based on the overall sample, the AUC score for any serious mental disorder was 0.72 (95% confidence interval [CI], [0.69, 0.75]) with the optimal ASI-psych score of 24.6. There was no statistically significant difference in AUCs based on the SCID and MINI (χ2 = 0.05, p = .82) or by target drugs of RCTs (χ2 =1.33, p = .72).Conclusions: Results support the utility of the ASI in screening for psychiatric comorbidity among patients receiving SUD treatments in RCT settings.

Depression among adolescents in a rural community of north India: A cross-sectional study

Background:There is a paucity of literature on depression among adolescents in the north Indian community.Objectives:The aim of this study was to estimate the prevalence of depression among adolescents residing in a rural community of north India, and to determine associated factors, psychiatric comorbidities, and functional impairment.Methods:A simple random sample of 630 adolescents aged 10-19 years was drawn. Participants were enrolled in house-to-house visits, and screened for depression using the nine-item version of Patient Health Questionnaire (PHQ-9). Diagnostic confirmation and assessment of psychiatric comorbidities was done using Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) for 10-17-year-old adolescents, and MINI for 18 year olds. Prevalence was reported with 95% confidence interval. Multivariable logistic regression analysis was done to determine the association of depression with socio-demographic and other factors. Children's Global Assessment Scale (CGAS) was used to assess functional impairment.Results:The prevalence of depression was 3.7% (95% CI: 2.3–5.2) (n = 583), comparable in both sexes. Over half the participants with depression had psychiatric comorbidities; the most common were conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder; nearly two-fifth had suicidal ideas/attempt. About two-third of participants with depression had functional impairment. Depression was associated with perceived frequent conflicts at home [adjusted odds ratio (aOR) = 4.0 (95% CI: 1.0-16.0), P = 0.049], and perceived stressful event (s) in past six months [aOR = 7.0 (95% CI: 2.4-20.3), P < 0.01], which were predominantly related to academics.Conclusion:Study results indicate the need to strengthen diagnostic and therapeutic/rehabilitative mental health services in adolescent age group. Low-stress lifestyle could be a promising approach to sidestep depressive symptoms.

Assessment of psychiatric co-morbidities in patient of bronchial asthma attending a tertiary medical centre (Multicentric study).

Aims and Objectives:Asthma is a chronic inflammatory condition, which is associated with increase in airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing. Asthma is a very common respiratory illness, in which some of the disease related factors may increases the vulnerability to psychiatric disorders. This study was done to determine the prevalence of psychiatric co-morbidity in patients of bronchial asthma.Methodology:It is an observational study conducted in 110 follow-up patients of bronchial asthma attending respiratory medicine OPD at tertiary care centre in central India. Psychiatric co-morbidities are assessed by pre-designed short-structured questionnaire using Mini international neuropsychiatric interview.Result:Among 110 patients of bronchial asthma 28% had psychiatric co-morbidity mainly depressive episode (59%). A significant association is found between lower socioeconomic status (P = 0.01), duration of of active illness (more than 1 year) (P = 0.001), and age of patient above 60 years (P = 0.001) with psychiatric co-morbidity of asthma patient.Conclusion:Our study shows there is increased prevalence of psychiatric co-morbidities in patients of bronchial asthma, higher than the national average. The predominant psychiatric disorder seen is depressive disorder, so treatment of asthma should be a multidisciplinary approach including medical treatment of asthma and psychiatric evaluation to prevent psychiatric co-morbidity or its early management. This will greatly reduce the morbidity, visits to hospital, expenditure on treatment and thereby having better outcomes in our patients of asthma.

Alopecia areata is characterized by dysregulation in systemic type 17 and type 2 cytokines, which may contribute to disease-associated psychological morbidity.

Alopecia areata (AA) is a common autoimmune disease, causing patchy hair loss that can progress to involve the entire scalp (totalis) or body (universalis). CD8+ NKG2D+ T cells dominate hair follicle pathogenesis, but the specific mechanisms driving hair loss are not fully understood. To provide a detailed insight into the systemic cytokine signature associated with AA, and to assess the association between cytokines and depression. We conducted multiplex analysis of plasma cytokines from patients with AA, patients with psoriatic arthritis (PsA) and healthy controls. We used the Hospital Anxiety and Depression Scale (HADS) to assess the occurrence of depression and anxiety in our cohort. Our analysis identified a systemic inflammatory signature associated with AA, characterized by elevated levels of interleukin (IL)-17A, IL-17F, IL-21 and IL-23 indicative of a type 17 immune response. Circulating levels of the type 2 cytokines IL-33, IL-31 and IL-17E (IL-25) were also significantly increased in AA. In comparison with PsA, AA was associated with higher levels of IL-17F, IL-17E and IL-23. We hypothesized that circulating inflammatory cytokines may contribute to wider comorbidities associated with AA. Our assessment of psychiatric comorbidity in AA using HADS scores showed that 18% and 51% of people with AA experienced symptoms of depression and anxiety, respectively. Using linear regression modelling, we identified that levels of IL-22 and IL-17E are positively and significantly associated with depression. Our data highlight changes in both type 17 and type 2 cytokines among people with AA, suggesting that complex systemic cytokine profiles may contribute both to the pathogenesis of AA and to the associated depression. What's already known about this topic? NKG2D+ CD8+ T cells cause hair loss in alopecia areata (AA) but the immunological mechanisms underlying the disease are not fully understood. AA is associated with changes in levels of interleukin (IL)-6, tumour necrosis factor-α, IL-1β and type 17 cytokines. Psychiatric comorbidity is common among people with AA. What does this study add? People with AA have increased plasma levels of the type 2 cytokines IL-33, IL-31 and IL-17E (IL-25), in addition to the type 17 cytokines IL-17A, IL-21, IL-23 and IL-17F. Levels of IL-17E and IL-22 positively predict depression score. What is the translational message? AA is associated with increased levels of multiple inflammatory cytokines, implicating both type 17- and type 2 immune pathways. Our data indicate that therapeutic strategies for treating AA may need to address the underlying type 17- and type 2 immune dysregulation, rather than focusing narrowly on the CD8+ T-cell response. An immunological mechanism might contribute directly to the depression observed in people with AA.

School Refusal Behavior in Indian Children: Analysis of Clinical Profile, Psychopathology and Development of a Best-Fit Risk Assessment Model.

School refusal is seen as an emergency in child psychiatry and various risk factors have been analyzed. Children who present with school refusal have been shown to have several associated psychiatric comorbidities. However, risk assessment of psychiatric comorbidities is lacking, particularly in the Indian context. The authors aimed to study the sociodemographic profile and associated psychopathology in children with school refusal. They compared the prevalence rates of psychiatric illnesses to that of the community. A best-fit model for risk assessment of psychopathology was formulated. Past records of children aged 5-16 y, who presented with school refusal in the period from June 2013 through June 2015 to authors' Child Guidance Clinic were studied and their sociodemographic details, symptoms and diagnoses were obtained. Chi square test of proportion was used to compare the prevalence rates between the study population and community. Multinomial analysis was used to elucidate a best-fit model of risk assessment. School refusal was seen in 3.6% of children. 77.8% of the children had a psychiatric diagnosis, most common being depression (26.7%), followed by anxiety (17.7%). Prevalence of psychiatric disorders was significantly higher in the study population than community (p < 0.05). A best-fit model of 4 factors: academic difficulties, adjustment problems at school, behavioral problems and parental conflicts is suggested (p < 0.05). School refusal is associated with significant psychopathology, most commonly depression, followed by anxiety. The best-fit model for risk assessment can predict the likelihood of psychopathology and help in early diagnosis.

Assessment of Psychiatric Comorbidity and WISC-R Profiles in Cases Diagnosed with Specific Learning Disorder According to DSM-5 Criteria.

In this study, the frequency of psychiatric comorbidity in children and adolescents who were diagnosed with specific learning disorder, the factors that affect the frequency of comorbidity, the subtypes of specific learning disorder and the effects on cognitive profile have been investigated. Our study was performed among 80 cases with the age range 6-15 years who diagnosed with specific learning disorder Child and Adolescent Psychiatry Department between January and June 2015. In the study, DSM-IV Based Screening and Evaluation Scale for Child and Adolescent Behavioral Disorders, Specific Learning Disability Evaluation Scale and the WISC-R test were performed. During the interview, reading-writing-math abilities evaluation list (error analysis) was performed in order to define the specific learning disorder subgroup and to evaluate the detailed error profile of the specific learning disorder subgroup. Kiddie Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Turkish Version (KSADS) was performed to detect psychiatric comorbidity diagnoses. 92.5% of the cases have a comorbid psychiatric disorder. The most frequent psychiatric comorbidity was attention deficit hyperactivity disorder (82.3%), followed by specific phobia (46.3%), oppositional defiant disorder (26.3%), enuresis (25%) and tic disorders (22.5%). Psychiatric comorbidity is detected more often in patients with specific learning disorder accompanied by attention deficit and hyperactivity disorder. The most frequent subtype of specific learning disorder is combined type disorder consisting of reading, writing and math disorder (37.5%). The WISC-R score of the patients who had math disorder were found to be lower than the others, and also it was detected that they learned reading and writing later, and have more comorbid psychiatric disorders. The results of our study indicate that associated psychiatric disorders are frequent with specific learning disorder. Specific learning disorder should not be considered as a single disorder, but should be assessed and treated with comorbid psychiatric disorders.

Are psychiatric comorbidities and associated cognitive functions related to treatment response to methylphenidate in boys with attention-deficit/hyperactivity disorder?

BackgroundMethylphenidate (MPH) has been found to be an effective medication for attention-deficit/hyperactivity disorder (ADHD). However, there are neither consistent nor sufficient findings on whether psychiatric comorbidities and associated cognitive functions of ADHD are related to treatment response to MPH in ADHD children.ObjectivesThis study investigated whether psychiatric comorbidities, IQ, and neurocognitive deficits are related to treatment response to MPH in ADHD children. In some ways, it is preferable to have a drug that the effectiveness of which to a disorder is not affected by its associated cognitive functions and psychiatric comorbidities. On the other hand, it is likely that the baseline symptom severity of ADHD is associated with the effectiveness of MPH treatment on the symptoms post treatment.MethodsA total of 149 Chinese boys (aged 6–12 years) with ADHD, combined type, and normal IQ participated in this study. Assessment of ADHD symptom severity was conducted pre and post MPH treatment, while assessment of psychiatric comorbidities, IQ, and neurocognitive deficits was performed in a non-medicated condition. Treatment response was defined as the ADHD symptom severity post MPH treatment.ResultsResults indicated that MPH treatment was effective, significantly improving the ADHD condition. Yet, comorbid disorders, IQ, and neurocognitive deficits were not related to MPH treatment response on ADHD symptoms. These findings indicated that the effectiveness of MPH was not affected by psychiatric comorbidities and associated cognitive functions of ADHD. Instead, as expected, it was the baseline symptom severity that was mainly related to the treatment response, ie, the milder the baseline condition, the better the treatment response.ConclusionThe current findings positively endorse the widespread clinical use of MPH for treating ADHD. It improves the behavioral symptoms of ADHD regardless of varying psychiatric comorbidities, IQ, and neurocognitive deficits.

Psychiatric comorbidity and suicide risk in patients with psoriasis

IntroductionPsoriasis has a significant impact on the mental and emotional functioning.ObjectiveIt has been reported that the risk of psychiatric comorbidity increases with the severity of the disorder, and the most frequent associations appear to be those with depression and anxiety.AimsTo analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients affected by psoriasis. To investigate the differences between psoriasis patients and patients with other dermatologic diseases.MethodsParticipants were 242 consecutive patients (142 women and 100 men), 112 patients with psoriasis (46.3%), 77 with melanoma (31.8%) and 53 with allergy (21.0%). All patients were administered a structured sociodemographic interview and the following measures: the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). We also assessed current and previous suicidal ideation and previous suicide attempts.ResultsPatients with psoriasis (compared to other groups of patients) more frequently had a comorbid mood disorder (16.1% vs 3.9% and 0.0%, respectively for patients with melanoma and patients with allergy; χ22 = 14.98; P &lt; 0.001), past suicidal ideation (33.9% vs 15.6% and 18.9%, respectively for patients with melanoma and patients with allergy; χ22 = 2.05; P &lt; 0.01) and attempts (6.3% vs 0.0% and 0.0%, for the other groups of patients; χ22 = 8.37; P &lt; 0.05). Patients with psoriasis reported higher HAM-D scores than melanoma patients.ConclusionsThe clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities and the routinely assessment of suicide risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis.

Objective:The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers.Methods:A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies.Results:Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5–93.9) and lifetime (75.5%, 95% CI 46.5–91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9–34.0), alcohol use disorders (21.2%, 95% CI 15.6–28.1), anxiety disorders (17.6%, 95% CI 10.8–27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7–24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7–75.2) and major depressive disorder (29.9%, 95% CI 20.5–41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4–24.2), alcohol dependence (15.2%, 95% CI 10.2–22.0), social phobia (14.9%, 95% CI 2.0–59.8), generalised anxiety disorder (14.4%, 95% CI 3.9–40.8), panic disorder (13.7%, 95% CI 6.7–26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4–35.7), cannabis use disorder (11.5%, 95% CI 4.8–25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1–19.6), adjustment disorder (9.2%, 95% CI 4.8–17.2), bipolar disorder (8.8%, 95% CI 4.4–17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4–18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies.Conclusions:The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.

Personalized sleep medicine applied to melatonin treatment for circadian rhythm sleep disorders: current status and future

Introduction Personalized sleep medicine is an emerging area of research and practice. Recent studies have identified clear inter-individual differences in performance vulnerability to sleep loss. Although clear biomarkers for this vulnerability are not known, new research indicates that genetic influences on sleep and circadian systems may be important. To assess the clnical applicabilty of these findings for diagnosis and treatment of patients with circadian rhythm disorders we summarized the present knowledge and speculate about futural developments. Materials and methods Literature search using PubMed. Results Dim Light melatonin Onset (DLMO) plays a key role in the diagnosis of circadian rhythm sleep disorders. It cannot be predicted by sleep parameters or polymorphisms of clock- or other sleep related genes. For melatonin treatment DLMO is crucial, as this treatment is most effective if administered at a time which is related to the DLMO. Efficacy of melatonin treatment depends not only on its personalized time of administration, but also on the speed of its metabolisation. For slow melatonin metabolisation may pile up daily melatonin levels and consequently stop melatonin efficacy. Melatonin metabolisation is influenced by CYP1A2 gene activity. Several methods to assess Cyp1A2 activity are being developed, using melatonin, coffee, green tea and chocolate as test substances or measuring CYP1A2 polymorphisms. Co-morbidities including ADHD and autism spectrum disorder (ASD) influence circadian sleep rhythm and their response to melatonin treatment. CYP1A2 polymorphisms might be correlated with slow melatonin metabolisation and ASD. Conclusion DLMO, melatonin metabolisation tests and assessment of psychiatric co-morbidity are crucial for effective diagnosis and treatment of circadian rhythm sleep disorders. Further development of techniques to measure melatonin and its metabolisation will increase the clinical applicability. Acknowledgement This is a non-sponsored study.

Anxiety and depression among patients with Bronchial asthma, chronic obstructive pulmonary disease and diffuse parenchymatous lung diseases

Background: Psychosocial stressors, such as death of a spouse or divorce are closely related to relapses and aggravations of respiratory disease pointing to a link between psychological factors and chronic pulmonary disease. Patients with chronic obstructive pulmonary disease (COPD) cannot cope adequately with everyday needs. This inadequacy may lead to heightened anxiety and depression, which in turn may worsen the everyday inadequacy. It has been reported that this is probably a factor that leads bronchial asthma (BA) and COPD patients to frequent hospital admissions, lower treatment adherence and even intensive care unit hospitalizations. Study objectives: to assess anxiety and depressive symptoms among a sample of Egyptian patients with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA), and diffuse parenchymatous lung diseases (DPLD). Subjects & methods: A cross-sectional study conducted over a one year period on a sample of 258 Egyptian patients with chronic breathing disorders who attending the outpatient chest clinic at Al-Zahraa University Hospital. All patients diagnosed as having COPD, BA or DPLD were enrolled into the study. Anxiety and depression were assessed by using the Hospital anxiety and depression scale (HADS) and the Beck Depression Inventory (BDI). Results: Psychiatric disorders were most prevalent among DPLD cases (80.0%), followed by COPD patients (74.0%), while BA group showed the least reported cases (38.8%) with psychiatric disorders, with a statistically significant difference among the studied groups (P-value < 0.05).Depression was prevalent among 60.1% (155/258) of the studied cases, of them 23.2% had severe depression, followed by 38.7 % had moderate depression and 38.1% had mild depression. DPLD cases had the highest proportion of severe depression (31.8), COPD cases had the highest proportion of moderate depression (52.4) and BA group had the highest proportion of mild depression (68.4%), with a statistically significant difference among the studied groups (P-value < 0.05).Conclusion: results of this study revealed that mixed anxiety depression disorders, depression and anxiety were common co-morbidities among the studied sample of the Egyptian patients with DPLD, COPD and those with BA. Recommendations: physicians should take into consideration the assessment of psychiatric co-morbidities among cases with DPLD, COPD and BA. Key words:

Anxiety and depression among patients with Bronchial asthma, chronic obstructive pulmonary disease and diffuse parenchymatous lung diseases

Background: Psychosocial stressors, such as death of a spouse or divorce are closely related to relapses and aggravations of respiratory disease pointing to a link between psychological factors and chronic pulmonary disease. Patients with chronic obstructive pulmonary disease (COPD) cannot cope adequately with everyday needs. This inadequacy may lead to heightened anxiety and depression, which in turn may worsen the everyday inadequacy. It has been reported that this is probably a factor that leads bronchial asthma (BA) and COPD patients to frequent hospital admissions, lower treatment adherence and even intensive care unit hospitalizations. Study objectives: to assess anxiety and depressive symptoms among a sample of Egyptian patients with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA), and diffuse parenchymatous lung diseases (DPLD). Subjects & methods: A cross-sectional study conducted over a one year period on a sample of 258 Egyptian patients with chronic breathing disorders who attending the outpatient chest clinic at Al-Zahraa University Hospital. All patients diagnosed as having COPD, BA or DPLD were enrolled into the study. Anxiety and depression were assessed by using the Hospital anxiety and depression scale (HADS) and the Beck Depression Inventory (BDI). Results: Psychiatric disorders were most prevalent among DPLD cases (80.0%), followed by COPD patients (74.0%), while BA group showed the least reported cases (38.8%) with psychiatric disorders, with a statistically significant difference among the studied groups (P-value < 0.05).Depression was prevalent among 60.1% (155/258) of the studied cases, of them 23.2% had severe depression, followed by 38.7 % had moderate depression and 38.1% had mild depression. DPLD cases had the highest proportion of severe depression (31.8), COPD cases had the highest proportion of moderate depression (52.4) and BA group had the highest proportion of mild depression (68.4%), with a statistically significant difference among the studied groups (P-value < 0.05).Conclusion: results of this study revealed that mixed anxiety depression disorders, depression and anxiety were common co-morbidities among the studied sample of the Egyptian patients with DPLD, COPD and those with BA. Recommendations: physicians should take into consideration the assessment of psychiatric co-morbidities among cases with DPLD, COPD and BA. Key words: