Comorbid Affective Disorders Research Articles

Troubles affectifs et comorbidités éthyliques

The comorbidity of affective disorders with alcohol use disorder remains insufficiently taken into account. In spite of the well-known frequency of the addict comorbidity in most psychiatric disorders, the level of association between affective disorders and alcohol is still underestimated and poorly understood. The label of "double diagnosis" relates to a simple addition of two independent pathologies. It is suggested to consider a "dual psychopathology" combining the effects of one disorder on the other. Interactions between the two disorders commit a complex state calling a new clinical reading, an adapted therapeutic strategy through a necessary integration of care. Association of alcohol use disorder and affective disorder, particularly in bipolar disorders, is correlated with severity, unstable course, treatment resistance and a greater risk of suicide. Alcohol aggravates depression and hampers therapeutics. Alcohol and mania remain a dreaded danger. The mechanism of the comorbid association does not only refer to a behavioral strategy of compensation but seems strongly based on a shared and crossed vulnerability, related to the genetics of the 5HT carrier and gene Clock. Therapeutic limitations do suggest the implementation of an "integrated" device which supposes a new organization of care and facilitation of collaborations between Addiction and Psychiatry.

Phenotype Matters

Studies have associated chronic low back pain (cLBP) with grey matter thinning. But these studies have not controlled for important clinical variables (such as a comorbid affective disorder, pain medication, age, or pain phenotype), which may reduce or eliminate these associations. We conducted cortical thickness and voxel-based morphometry (VBM) analyses in 14 cLBP patients with a discogenic component to their pain, not taking opioids or benzodiazepines, and not depressed or anxious. They were age and gender matched to 14 pain-free controls (PFCs). An ROI-driven analysis (regions of interest) was conducted, using 18 clusters from a previous arterial spin labeling study demonstrating greater regional cerebral blood flow (rCBF) in these cLBP subjects than the PFCs. Cortical thickness and VBM-based gray matter volume measurements were obtained from a structural MRI scan and group contrasts were calculated. Multivariate analysis of variance showed a trend toward cortical thickening in the right paracentral lobule in cLBP subjects (F1,17=3.667, P<0.067), and significant thickening in the right rostral middle frontal gyrus (F1,17=6.880, P<0.014). These clusters were non-significant after including age as a covariate (P<0.891; P<0.279). A whole-brain cortical thickness and VBM analysis also did not identify significant clusters of thinning or thickening. Exploratory analyses identified group differences for correlations between age and cortical thickness of the right rostral middle frontal gyrus (cLBP: R=-0.03, P=0.9; PFCs: R=-0.81, P<0.001), that is, PFCs demonstrated age-related thinning while cLBP patients did not. Our pilot results suggest that controlling for affect, age, and concurrent medications may reduce or eliminate some of the previously reported structural brain alterations in cLBP.

Are we really mapping psychosis risk? Neuroanatomical signature of affective disorders in subjects at ultra high risk.

The majority of people at ultra high risk (UHR) of psychosis also present with co-morbid affective disorders such as depression or anxiety. The neuroanatomical and clinical impact of UHR co-morbidity is unknown. We investigated group differences in grey matter volume using baseline magnetic resonance images from 121 participants in four groups: UHR with depressive or anxiety co-morbidity; UHR alone; major depressive disorder; and healthy controls. The impact of grey matter volume on baseline and longitudinal clinical/functional data was assessed with regression analyses. The UHR-co-morbidity group had lower grey matter volume in the anterior cingulate cortex than the UHR-alone group, with an intermediate effect between controls and patients with major depressive disorder. In the UHR-co-morbidity group, baseline anterior cingulate volume was negatively correlated with baseline suicidality/self-harm and obsessive-compulsive disorder symptoms. Co-morbid depression and anxiety disorders contributed distinctive grey matter volume reductions of the anterior cingulate cortex in people at UHR of psychosis. These volumetric deficits were correlated with baseline measures of depression and anxiety, suggesting that co-morbid depressive and anxiety diagnoses should be carefully considered in future clinical and imaging studies of the psychosis high-risk state.

Comorbid atypical depression in borderline personality disorder is common and correlated with anxiety-related psychopathology

BackgroundThe core features of borderline personality disorder (BPD) are affective instability, unstable relationships and identity disturbance. Axis I comorbidities are frequent, in particular affective disorders. The concept of atypical depression is complex and often underestimated. The purpose of the study was to investigate the comorbidity of atypical depression in borderline patients regarding anxiety-related psychopathology and interpersonal problems. MethodsSixty patients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) as well as the Atypical Depression Diagnostic Scale (ADDS). Additionally, patients completed a questionnaire (SCL-90-R, BDI, STAI, STAXI, IIP-C). ResultsForty-five BPD patients (81.8%) had a comorbid affective disorder of which 15 (27.3%) were diagnosed with an atypical depression.In comparison to patients with major depressive disorder or no comorbid depression, patients with atypical depression showed significant higher scores in psychopathological symptoms regarding anxiety and global severity as well as interpersonal problems. ConclusionsThe presence of atypical depression in borderline patients is correlated with psychopathology, anxiety, and interpersonal problems and seems to be of clinical importance for personalized treatment decisions.

S24 * NEW DEVELOPMENTS IN THE TREATMENT OF ALCOHOL USE DISORDERS

S24 * NEW DEVELOPMENTS IN THE TREATMENT OF ALCOHOL USE DISORDERS

Remission of obsessive-compulsive disorders and syndromes; evidence from a prospective community cohort study over 30 years

Objective. Studies suggest that obsessive-compulsive disorder (OCD) is an unremitting disorder. We report a prospective, longitudinal investigation into OCD and sub-diagnostic OC syndrome (OCS) over a 30-year period to determine the extent to which individuals with clinically relevant OC symptomatology cumulatively remit, as well as the remission latency. Methods. Five hundred and ninety-one participants drawn from the general population of Zurich, Switzerland, participated in a series of seven interviews over a period of 30 years. Results. Median duration for OCD, OCS and unimpairing OC symptoms was 16, 14 and 6 years, respectively, suggesting a better prognosis for remission for less severe illness. Individuals with a longer duration of illness, greater number of OC-burdened years and those seeking professional help experienced significantly delayed remission. In addition, these factors together with the presence of comorbid anxiety disorders were associated with significantly reduced remission rates. We found a trend towards statistical significance for comorbid affective disorders and reduced remission rates. Conclusions. Our findings suggest a lack of diagnostic stability over the long-term and a high chance of eventual remission, albeit often after several years of illness, for obsessive-compulsive syndromes including OCD. However, roughly one-third of OCD cases do not remit by 50 years of age.

The risk and associated factors of methamphetamine psychosis in methamphetamine-dependent patients in Malaysia

ObjectiveThe objective of this study was to determine the risk of lifetime and current methamphetamine-induced psychosis in patients with methamphetamine dependence. The association between psychiatric co-morbidity and methamphetamine-induced psychosis was also studied. MethodsThis was a cross-sectional study conducted concurrently at a teaching hospital and a drug rehabilitation center in Malaysia. Patients with the diagnosis of methamphetamine based on DSM-IV were interviewed using the Mini International Neuropsychiatric Interview (M.I.N.I.) for methamphetamine-induced psychosis and other Axis I psychiatric disorders. The information on sociodemographic background and drug use history was obtained from interview or medical records. ResultsOf 292 subjects, 47.9% of the subjects had a past history of psychotic symptoms and 13.0% of the patients were having current psychotic symptoms. Co-morbid major depressive disorder (OR=7.18, 95 CI=2.612–19.708), bipolar disorder (OR=13.807, 95 CI=5.194–36.706), antisocial personality disorder (OR=12.619, 95 CI=6.702–23.759) and heavy methamphetamine uses were significantly associated with lifetime methamphetamine-induced psychosis after adjusted for other factors. Major depressive disorder (OR=2.870, CI=1.154–7.142) and antisocial personality disorder (OR=3.299, 95 CI=1.375–7.914) were the only factors associated with current psychosis. ConclusionThere was a high risk of psychosis in patients with methamphetamine dependence. It was associated with co-morbid affective disorder, antisocial personality, and heavy methamphetamine use. It is recommended that all cases of methamphetamine dependence should be screened for psychotic symptoms.

Electroconvulsive Therapy in an Adolescent With Autism and Bipolar I Disorder

We report a positive response to electroconvulsive therapy in a severely functionally impaired adolescent with autistic disorder and classic bipolar I disorder, including an episodic pattern of decreased need for sleep, hypersexuality, expansive and agitated affect, aggression, self-injury, and property destruction. After ineffective trials of mood stabilizers and antipsychotics as well as inability to sustain a positive response to lithium due to medication noncompliance, a course of acute and maintenance electroconvulsive therapy was attempted. A marked and sustained improvement across all symptom categories, as measured by directly observed frequency counts of target behaviors in an inpatient setting, was obtained. Electroconvulsive therapy should be considered a potentially useful intervention in cases of children with autistic disorder and a severe comorbid affective disorder.

Anxiety- rather than depression-like behavior is associated with adult neurogenesis in a female mouse model of higher trait anxiety- and comorbid depression-like behavior

Adult neurogenesis has been implicated in affective disorders and the action of antidepressants (ADs) although the functional significance of this association is still unclear. The use of animal models closely mimicking human comorbid affective and anxiety disorders seen in the majority of patients should provide relevant novel information. Here, we used a unique genetic mouse model displaying higher trait anxiety (HAB) and comorbid depression-like behavior. We demonstrate that HABs have a lower rate of hippocampal neurogenesis and impaired functional integration of newly born neurons as compared with their normal anxiety/depression-like behavior (NAB) controls. In HABs, chronic treatment with the AD fluoxetine alleviated their higher depression-like behavior and protected them from relapse for 3 but not 7 weeks after discontinuation of the treatment without affecting neurogenesis. Similar to what has been observed in depressed patients, fluoxetine treatment induced anxiogenic-like effects during the early treatment phase in NABs along with a reduction in neurogenesis. On the other hand, treatment with AD drugs with a particularly strong anxiolytic component, namely the neurokinin-1-receptor-antagonist L-822 429 or tianeptine, increased the reduced rate of neurogenesis in HABs up to NAB levels. In addition, challenge-induced hypoactivation of dentate gyrus (DG) neurons in HABs was normalized by all three drugs. Overall, these data suggest that AD-like effects in a psychopathological mouse model are commonly associated with modulation of DG hypoactivity but not neurogenesis, suggesting normalization of hippocampal hypoactivity as a neurobiological marker indicating successful remission. Finally, rather than to higher depression-related behavior, neurogenesis seems to be linked to pathological anxiety.

P03-544 - Comorbidity of affective disorders

IntroductionThe studies about the comorbidity of major depressive disorder (MDD) and bipolar disorder (BD) have increased in the last years. The comorbidity with Axis I psychiatric disorders complicates the diagnosis, prognosis and treatment.ObjectivesTo analyze the prevalence of affective disorders associated with another Axis I psychiatric disorders to treat correctly from the beginning of the diagnosis and to improve the course of the disorder and the quality of life of these patientsMethodsThe subjects who participated in the study were diagnosed of bipolar I disorder, bipolar II disorder and MDD, according to DSM-IV-TR criteria. The sample (n = 114) was divided into three groups: MDD (n = 58), BD (n = 31) and a control group of healthy subjects (n = 25). The diagnosis and stability were assessed using the MINI International Neuropsyquiatric Interview and the Hamilton Depression Rating Scale (HDRS).ResultsBD had a significantly association with risk of suicide (38%), anxiety disorder (3.3%) and social phobia (12.9%). It was also reported a significant association between MDD and risk of suicide (71%), manic/hypomanic episodes (25.9%), anxiety disorder (37.9%), social phobia (25.9%) and generalized anxiety disorder (37.9%).ConclusionsIt is necessary for clinical practice an integrative model which takes into account the comorbidity of affective disorders to improve the response to treatment and the prognosis of these mental disorders

FC25-04 - Comorbid mood and anxiety disorders in adult ADHD patients

IntroductionADHD is a highly heritable neurodevelopmental syndrome with significant lifetime risk for psychiatric comorbidities. Several psychiatric conditions are significantly more common in patients with ADHD than in control subjects.MethodsTo evaluate the incidence of comorbid affective disorders, patients with adult ADHD who were first seen at the outpatient clinic of the Department of Psychiatry and Psychotherapy were evaluated for symptoms of major depression, brief recurrent depression, bipolar depression and anxiety disorders. Patients aged between 18 and 75 years were included into the study. All patients were evaluated according to DSM IV TR criteria. So far, from February 2007 until May 2010, 330 patients (192 males and 138 females) were included into the study.ResultsThe mean age of the patients at diagnosis was 33, 7 years for males (range: 18-75) and 35, 9 years for females (range: 18–64). Affective disorders were most frequently diagnosed as comorbid conditions in our patients and occurred in 26% of the patients in our sample. 13% had a minor depressive episode, 7% a major depressive episode and 6% were diagnosed with bipolar disorder. 21% of our patients were diagnosed with one or several comorbid anxiety disorders.ConclusionMost adults with ADHD are not diagnosed properly and therefore remain untreated although they are usually diagnosed and treated for comorbid psychiatric disorders. In the present study, we systematically analyzed comorbid anxiety and depression in a sample of adult ADHD outpatients in order to estimate the incidence of these disorders in an undiagnosed patient population.

Policy initiative to improve access to psychological services for people with affective and anxiety disorders: population-level analysis

In 2006, Australia introduced new publicly funded psychological services for people with affective and anxiety disorders (the Better Access programme). Despite massive uptake, it has been suggested that Better Access is selectively treating socioeconomically advantaged people, including some who do not warrant treatment, and people already receiving equivalent services. To explore potential disparities in Better Access treatment using epidemiological data from the 2007 National Survey of Mental Health and Wellbeing. Logistic regression analyses examined patterns and correlates of service use in two populations: people who used the new psychological services in the previous 12 months; and people with any ICD-10 12-month affective and anxiety disorder, regardless of service use. Most (93.2%) Better Access psychological services users had a 12-month ICD-10 mental disorder or another indicator of treatment need. Better Access users without affective or anxiety disorders were not more socioeconomically advantaged, and received less treatment than those with these disorders. Among the population with affective or anxiety disorders, non-service users were less likely to have a severe disorder and more likely to have anxiety disorder, without a comorbid affective disorder, than Better Access users. Better Access users comprised more new allied healthcare recipients than other service users. A substantial minority of non-service users (13.5%) had severe disorders, but most did not perceive a need for treatment. Better Access does not appear to be overservicing individuals without potential need or contributing to social inequalities in mental healthcare. It appears to be reaching people who have not previously received psychological care. Treatment rates could be improved for some people with anxiety disorders.

Medical comorbidity in recurrent versus first-episode depressive patients

This study compares the comorbidity of affective disorders and medical diseases in primary care patients with either a first or recurrent depressive episode. A cross-sectional epidemiological study in primary care centres in Spain was designed. A total of 10,257 primary care patients suffering a DSM-IV major depressive episode (MDD) were analysed. Depression was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS), and World Health Organization (WHO) medical diagnoses were provided by the patient's general practitioner according to medical records revised on the basis of radiology or laboratory test data. A total of 88.6% of recurrent patients and 71.1% of first-episode depressive patients reported a medical condition (aOR = 2.61, CI = 2.31-2.93). All medical conditions were more prevalent in the recurrent group than in first-episode group, and with the exception of myocardial infarction, psoriasis and migraine, all other crude ORs showed statistically significant differences between first- and recurrent episodes patients after adjusting for gender, age, education, socioeconomic status and body mass index (BMI). Recurrent depression is associated with a decrement in health that is significantly greater than in first-episode depression. Special attention needs to be paid to the physical health in the middle- and long-term management of patients with affective disorders.

Affective, anxiety, and substance-related disorders in patients undergoing herniated disc surgery

At present only a small number of studies have investigated psychiatric comorbidity in disc surgery patients. Objectives of this study are (1) to examine the prevalence rate of comorbid affective, anxiety, and substance-related disorders in nucleotomy patients in comparison to the German general population and (2) to investigate associations between psychiatric comorbidity and socio-demographic and illness-related characteristics. The study refers to 349 consecutive disc surgery patients (response rate 87%) between the age of 18 and 55years. The final study sample consists of 239 lumbar and 66 cervical nucleotomy patients. Face-to-face interviews were conducted approximately 3.45days (SD 3.170) after disc surgery, during hospital stay. Psychiatric comorbidity was assessed by means of the Composite International Diagnostic Interview (CIDI-DIA-X). The corresponding data of the German general population were derived from the German National Health Interview and Examination Survey (GHS). 12-Month prevalence rates of any affective, anxiety or substance-related disorders range between 33.7% in cervical and 23.5% in lumbar disc surgery patients. Four-week prevalence rates of any affective, anxiety or substance disorder vary between 13.2% in cervical and 14.0% in lumbar nucleotomy patients. Disc surgery patients suffer more often from affective disorders and illicit substance abuse than the general population. Significant associations were found between psychiatric comorbidity and gender, as well as pain intensity. Disc surgery patients show a higher risk to suffer from mental disorders than the general population. The assessment of psychiatric distress and the assistance by mental health professionals should be considered during hospital and rehabilitation treatment.

Zentrale Schmerzverarbeitung bei funktionellen somatischen Syndromen

Functional pain syndromes usually are characterized by a local or generalized increase in pain sensitivity, spontaneous ongoing pain, and a variety of other common symptoms. Classification or definition of a syndrome is usually somewhat arbitrarily based on the predominantly affected body region or a main symptom, resulting in significant overlap between conditions. Support for the involvement of the central nervous system (CNS) comes from the frequent comorbidity of affective disorders and symptomatology, disturbances in cognitive function, changes in neuroendocrine function, and dysregulation of the autonomic nervous system, although only subgroups of patients are affected. Findings of neuroimaging studies in functional pain syndromes typically reveal plausible correlates for the patients' subjective complaints and indicate a central augmentation in pain processing but also in other sensory systems including a postulated interoceptive system. The pathophysiology of this augmentation is not clear, and the importance of peripheral input remains unresolved, as well as the contribution of spinal and supraspinal mechanisms. Affective and cognitive factors clearly influence pain processing in these syndromes, but do not fully explain the observed augmentation. For FMS, chronic low back pain, and irritable bowel syndrome a dysfunction of the descending inhibitory systems is supported by these findings. However, longitudinal studies are needed to confirm the causality of the reported associations and to establish a primary role of the CNS in these syndromes. Current techniques like VBM and H-MRS have revealed potential yet highly variable structural abnormalities of the CNS in several of the syndromes, but clinical relevance and conclusions from these studies remain far from clear. New theoretical concepts should drive prospective and interdisciplinary research based on well-defined hypotheses to use the full potential of the current neuroimaging techniques.

Drawing the Eczema Aesthetic: The Psychological Effects of Chronic Skin Disease as Depicted in the Works of John Updike, Elizabeth Bishop, and Zelda Fitzgerald

How might the psycho-social effects of chronic skin disease, its treatments (and discontents) be figuratively expressed in writing and painting? Does the art reveal common denominators in experience and representation? If so, how do we understand the cryptic language of these expressions? By examining the works of artists with chronic skin diseases--John Updike, Elizabeth Bishop, and Zelda Fitzgerald--some common features can be noted. Chronically broken skin can fracture the ego or self-perception, resulting in a disturbed body image, which leads to personality disorders and co-morbid affective disorders such as anxiety and depression. The vertiginous feeling that results can be noted in the paradoxical characters, figures, and psyches portrayed in the works of these artists. This essay will examine the more specific ways in which artists disclose and/or conceal their experiences and the particular ways in which these manifest in their works. While certain nuances exist, the common denominators give us a starting point for developing an eczema aesthetic, a code for interpreting the ways in which artists' experiences with skin disease manifest in their works.

S15-04 - Do symptoms of emotional dysregulation respond to pharmacological treatment of adult ADHD?

The core psychopathology of ADHD comprises attentional deficits, hyperactivity and impulsivity. At least in subpopulations the majority of individuals suffering from ADHD present with emotional symptoms additonally. There is an ongoing and controversial debatte whether emotional symptoms belong to the disorder as further intrinsic ADHD psychopathology or may have their origin in comorbid affective disorders. There is growing evidence that emotional symptoms of ADHD as measured by the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) respond to treatment with Methylphenidate (MPH), while the classical symptoms of depression or anxiety disorder show no significant improvement.We report on a 24-week, placebo controlled treatment study with MPH-extended release in 359 adults with ADHD. Emotional symptoms were assessed with the WRAADDS. Symptoms of depression and anxiety were endorsed by use of the Symptom Checklist-90-Revised (SCL-90-R).As compared with placebo we found a significant treatment response in favour of MPH-ER regarding emotional symptoms like affective lability, emotional overreactivity and temper control. The psychopathology of depression and anxiety did not display a significant treatment response.

The role of personality in comorbidity among anxiety and depressive disorders in primary care and specialty care: a cross-sectional analysis

Objective Almost no cross-sectional studies directly compared the rate and pattern of comorbidity of affective disorders in relation to personality traits of patients seen in primary care versus specialty mental health care. Method Using data from the Netherlands Study of Depression and Anxiety, we compared 1086 primary care patients with 790 consecutive specialized mental health care patients. All participants had at least one lifetime Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition-based diagnosis of depression or anxiety. Personality was assessed with the NEO Five-Factor Inventory. Results In both settings it was common to have at least one lifetime comorbid affective disorder. Compared to primary care patients, specialty care patients showed elevated scores for Neuroticism and lower scores for Extraversion and Conscientiousness. The odds of having another disorder given any one disorder was no longer significant after accounting for personality dimensions. Only Neuroticism proved to be positively associated with comorbidity per se. Conclusions Prevalence of and comorbidity among anxiety and depressive disorders in primary care were very similar to those in specialty care. Neuroticism — but no other personality traits — may help to understand the comorbidity among anxiety and depressive disorders irrespective of recruitment setting.

Affective disorders: analysis of their comorbidity in the more frequent psychiatric disorders

Comorbidity is defined as the presence of two or more independent diseases in the same subject. This paper reviews the comorbidity of affective disorders with other mental disorders. We focus on the disorders of anxiety, schizophrenia, dependence on psychoactive substances, eating disorders, personality disorders and obsessive-compulsive disorder. To this end, we have carried out an extensive review that has taken account of numerous studies, as well as of different diagnostic orientations (categorical or dimensional). In general the presence of affective symptoms and/or disorders in the context of other mental pathologies is high. Moreover, comorbidity has a high transcendence with respect to clinical prognosis (worse response to treatments, greater symptomatic persistence, greater tendency to chronicity and greater risk of mortality) and the social consequences (decline in work performance and greater use of resources). Nonetheless, we must bear in mind that the analysis of the comorbidity of affective disorders in other mental disorders is complex and controversial, not only because of its high frequency, but also because of the existence of symptomatic overlap, scarcity of signs and pathognomonic symptoms, variability of diagnostic criteria, applied methodological differences, as well as a scarcity of longitudinal and prospective studies.

Data Show Percent of Canadians With Mood, Substance Disorders

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessData Show Percent of Canadians With Mood, Substance DisordersJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:6 Feb 2009https://doi.org/10.1176/pn.44.3.0018How many Canadians have both an affective disorder and a substance use disorder? Who are they? Where do they live? For what appears to be the first time, a study has tackled these questions, according to researchers.The study, which included a nationally representative population sample of some 37,000 people, was headed by Brian Rush, Ph.D., a professor of psychiatry at the University of Toronto. Results appeared in the December 2008 Canadian Journal of Psychiatry.Overall, 2 percent of Canadians had both an affective disorder and a substance use disorder in the year prior to the study. (An affective disorder could be DSM-IV depressive episodes, manic episodes, panic disorder, social phobia, or agoraphobia. A substance use disorder could be alcohol abuse short of dependence, alcohol dependence, illicit drug use short of dependence, or illicit drug dependence.) This finding surprised him and his colleagues, Rush told Psychiatric News. They thought that the percentage would be higher, but he added that he and his colleagues “were reassured [that this finding was accurate] by its comparability with the most recent and best-conducted American study.”Of course, this finding does not minimize the burden that those Canadians who have both an affective disorder and a substance use disorder experience, he stressed. Moreover, a large number of Canadians who seek mental health services have such comorbidity, he noted.Still other valuable findings emerged from the study. Among them:The prevalence of substance use disorders among Canadians with affective disorders decreased with age.The co-occurrence of an affective disorder and a substance use disorder was more common in certain subgroups of Canadians than in others. For instance, one-third of Canadian women with an illicit drug use disorder were found to have an affective disorder as well. And compared with women with an affective disorder, men with an affective disorder were twice as likely to have an alcohol use disorder and three times more likely to have an illicit drug use disorder.Canadians in certain regions were more at risk of having both an affective disorder and a substance use disorder than were Canadians in other regions. For example, a mood disorder accompanied by an alcohol use disorder was most prevalent in Atlantic Canada (Nova Scotia, New Brunswick, Newfoundland and Labrador, and Prince Edward Island) and least prevalent in Quebec. A mood disorder accompanied by an illicit drug use disorder was most common in British Columbia and least common in Quebec. Of Canadians who had both an affective disorder and a substance use disorder, most were found in Atlantic Canada and British Columbia, a fair number in Ontario and the Prairie provinces, and the fewest in Quebec. These regional differences “were unexpected,” Rush said.These results, among others from the study, raised some crucial questions, Rush and his colleagues pointed out in their report. For instance, why were Québécois less prone to a dual affective-substance use disorder than Canadians in other provinces? Rush and his group don't know. However, there are a number of possible explanations, they speculated:“ lifestyle, health care, social and legal policies, income inequality, or migration patterns.” And if they can find the answers, the answers might offer some valuable insights into factors that help protect people against a comorbid affective disorder and substance use disorder.The results likewise have implications for psychiatrists, Rush told Psychiatric News. “[They] should be vigilant for substance use disorders among those accessing their services. There also needs to be thoughtful and well-integrated mental health and addiction services to assess and respond appropriately to the co-occurring disorders. Historically people with [such comorbidity] ... have been confronted with seeking help from two separate and often ideologically conflicting service-delivery systems. Much work is being done in Canada, the United States, and other countries to rectify this situation to improve client experiences and outcomes. But much [still] remains to be done.... [Canada's] new Mental Health Commission should serve to direct needed attention to the issue of co-occurring disorders.”The research was funded by the Canadian Institutes for Health Research and the Ontario Ministry of Health and Long-term Care.“Prevalence of Co-occurring Substance Use and Other Mental Disorders in the Canadian Population” is posted at<http://publications.cpa-apc.org/browse/documents/2” under the “December 2008” issue. ▪ ISSUES NewArchived