Co-occurrence Of Conditions Research Articles

Patterns of Multimorbidity in Primary Care Patients at High Risk of Future Hospitalization

Care management is seen as a promising approach to address the complex care needs of patients with multimorbidity. Predictive modeling based on insurance claims data is an emerging concept to identify patients likely to benefit from care management interventions. We aimed to identify and explore patterns of multimorbidity in primary care patients with high predicted risk of future hospitalizations in order to develop a primary care-based care management intervention. We conducted a retrospective cohort study to assess insurance claims data of 6026 patients from 10 primary care practices in Germany. We stratified the population by the predicted likelihood of hospitalization (LOH) using a diagnostic cost group-based case-finding software. Co-occurrence of chronic conditions in multimorbid patients with an upper-quartile LOH score was explored by extraction of mutually exclusive patterns. Predictive modeling identified multimorbid elderly patients with a high number of co-occurring chronic conditions (mean number 7.8 [SD 3.1]). Assessing co-occurrence of highly prevalent chronic conditions in 1407 multimorbid patients with upper-quartile LOH revealed 471 mutually exclusive patterns with low single frequencies. The observed prevalence significantly exceeded expected prevalence for patterns with causal comorbidity. Additionally, chronic pain (related to osteoarthritis) or depression could be identified as discordant co-occurring conditions in 80% (12/15) of the most common multimorbidity patterns. High-risk primary care patients suffer from heterogeneous individual patterns of co-occurring chronic conditions. Care management interventions will have to account for discordant co-occurring conditions such as osteoarthritis and depression.

O1-3.5 Can we intervene to promote capability and well-being?

Chronic conditions are common in the older population and the co-occurrence of multiple conditions increases with increasing age. Ultimately, the consequences of chronic conditions, particularly functional consequences, play a critical...

TRAUMA REENACTMENTS IN AGING VETERANS WITH DEMENTIA

To the Editor: Two recent studies1,2, including one reported in the Journal of the American Geriatrics Society,1 utilized Veterans Administration (VA) patient data bases to establish posttraumatic stress disorder (PTSD) as a risk factor for dementia. PTSD and dementia are common and place considerable burden on patients, caretakers, and society.3, 4 The co-occurrence of conditions involving memory loss (dementia) and intrusive expression of trauma memories (PTSD) underscores the need to better understand their interactions. Reports of cases where PTSD worsened with cognitive decline5 and mild cognitive impairment as a precipitant for “delayed onset PTSD”6 suggest that pathways between dementia and PTSD are bidirectional, and that neurodegeneration can disinhibit trauma memories. Current models of PTSD refer to amygdala activation that is inadequately inhibited by higher cortical structures.7 Specific dementia subtypes affect cortical and subcortical structures differently.8 The objectives of our study were to characterize activation of war trauma memories in veterans with dementia and evaluate relationships with dementia subtypes. This study was inspired by dramatic presentations evaluated by the Principal investigator (PI) (DLD). It was conducted by reviewing patient records and was approved by the Washington DC VA Medical Center Institutional Review Board. Cases were identified from the complete roster of psychiatric evaluations for a geriatric medicine clinic over a two year period based on a diagnosis of dementia and a caregiver’s report of new onset disruptive behavior related to patients’ traumatic military experiences. Controls were selected at a 2:1 ratio by identifying patients with dementia who had also served in a war zone but did not have reports of reenactments of traumatic military experiences. After cases and controls were identified from the clinic roster by the PI, their chart files were reviewed by post graduate trainees guided by a chart review instrument. Data included demographics; war theater of service; the presence of PTSD, hypertension, diabetes, stroke, Parkinson’s disease (PD), symptoms associated with Lewy body dementia (LBD) (severe sensitivity to antipsychotic medications, visual hallucinations, and severe sleep wake disturbance); and dementia subtypes which had been previously diagnosed by the PI (DLD) utilizing available clinical and laboratory data. Sixteen cases out of 197 (8%) patients seen by the PI during the study period met the case criteria. All had episodes with vocalizations of war-related references, e.g. asking for help from soldiers, “secure the perimeter”. For all cases, most episodes occurred at night and appeared to arise from sleep. Seven had episodes where they had been physically combative including by shielding a spouse from perceived danger. All of the cases and 2 of the 32 controls had prior diagnoses of PTSD (p < .001). There were no differences in the frequency of other diagnoses except a trend for higher rates of strokes (p < .09), and LBD features were more frequent in the cases (all p’s < .001). As indicated in the Figure, the distribution of dementia subtypes was significantly different in the 2 groups with all but one case having been diagnosed with a subcortical type of dementia. FIGURE Percent of cases and controls with specific dementia subtypes While preliminary due to the limitations of retrospective chart review and the experience of one clinic, our observations suggest that trauma related re-enactments are not uncommon among aging war veterans with dementia and occur in those previously diagnosed with PTSD. Episodes that appear to be dissociative flashbacks can be quite dramatic and disruptive. We also found a predominance of sleep related episodes and a preliminary association with subcortical dementias. These associations suggest a relationship with REM behavior disorder (RBD) which features behavioral enactments during sleep due to failure of the normal inhibition of motor activity of rapid eye movement sleep. RBD has been found to be a prodrome of LBD and PD9 and has been linked to PTSD.10 Thus RBD might provide a relevant model for understanding relationships between trauma memory reactivation of PTSD and dementia.

Symptom networks and psychiatric categories

The network approach to psychiatric phenomena has the potential to clarify and enhance psychiatric diagnosis and classification. However, its generally well-justified anti-essentialism views psychiatric disorders as invariably fuzzy and arbitrary, and overlooks the likelihood that the domain includes some latent categories. Network models misrepresent these categories, and fail to recognize that some comorbidity may represent valid co-occurrence of discrete conditions.

The Relationship Between ADHD and Creativity

Free AccessThe Relationship Between ADHD and CreativityDione M. Healey and Julia J. RucklidgeDione M. HealeySearch for more papers by this author and Julia J. Rucklidge1 Lecturer at the University of Otago, Dunedin, New Zealand ([email protected])2 Senior Lecturer at the University of Canterbury, Christchurch, New Zealand; E-mail: [email protected].Search for more papers by this authorPublished Online:July 2008https://doi.org/10.1521/adhd.2008.16.3.1PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Next article FiguresReferencesRelatedDetails Cited byCited by1. Characterizing Creative Thinking and Creative Achievements in Relation to Symptoms of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum DisorderOnline publication date: 1 July 2022. Go to citation Crossref Google Scholar2. Creativity and ADHD: A review of behavioral studies, the effect of psychostimulants and neural underpinningsOnline publication date: Go to citation Crossref Google Scholar3. Creativity in children with ADHD: Effects of medication and comparisons with normal peersOnline publication date: Go to citation Crossref Google Scholar4. The prevalence and co-occurrence of psychiatric conditions among entrepreneurs and their familiesOnline publication date: 11 May 2018. Go to citation Crossref Google Scholar5. Unity and diversity of executive functions in creativityOnline publication date: Go to citation Crossref Google Scholar6. Scope of Semantic Activation and Innovative Thinking in College Students with ADHDOnline publication date: 29 July 2016. Go to citation Crossref Google Scholar7. Building Resilience by Shaping MindsetsOnline publication date: 1 April 2011. Go to citation Crossref Google Scholar8. Creative style and achievement in adults with attention-deficit/hyperactivity disorderOnline publication date: Go to citation Crossref Google Scholar Volume 16Issue 3Jun 2008 Information© The Guilford PressPDF download

Availability of Integrated Care for Co-occurring Substance Abuse and Psychiatric Conditions

The co-occurrence of psychiatric conditions and substance abuse presents significant challenges for behavioral healthcare providers. The need for integrated care has received substantial recent attention from clinical, research, and funding entities. However, the availability of integrated care has been low, carrying potential adverse implications for quality of care and treatment outcomes. This article describes the prevalence and key correlates of the availability of integrated care for co-occurring conditions within public and private-sector addiction treatment programs. Several organizational attributes, caseload characteristics, and service provision patterns were associated with the availability of integrated care.

Co-occurrence of developmental disabilities with birth defects.

This article begins with a discussion of the concepts of comorbidity and co-occurrence of diseases and health conditions. These concepts are then applied to the literature on the population-based prevalence of developmental disabilities and birth defects. Most of the existing literature focuses on co-occurrence and obtains data from both clinical and administrative sources. Developmental disabilities occur more frequently in children with multiple, rather than with isolated, birth defects. More research, with more sophisticated study designs, will be necessary to further elucidate the contributions of birth defects to the etiology of developmental disabilities, control for other risk factors, and to identify strategies for prevention and intervention services.

Co-occurrence of disadvantage conditions in elderly subjects with depressive symptoms

The aim of this survey study is to describe the association of symptomatic depression with the co-occurrence of psycho-social, functional, and somatic disadvantage conditions in 390 over 70 subjects living at home. The most disadvantaged tertile of various conditions (age, social support, cognition, social interactions, self evaluation of health, disability, number of diseases, and somatic symptoms) was associated with greater risk of symptomatic depression. A subset of conditions that might be causally related to depression (age, social support, financial welfare, diseases, and disability) was used to divide subjects into five levels of increasing multiple disadvantage conditions (MDC). Increasing severity of MDC level was associated with greater risk of symptomatic depression even after adjustment for gender and all five conditions used to define MDC levels (odds ratios ranging from 2.7 to 11.3).

Comorbidity or multimorbidity

Aim: Comorbidity is increasingly prevalent. Moreover, many different definitions and interpretations of this phenomenon are used. Because of its social and clinical significance, it is important that the concept is clear. In this review a summary of current uses of this concept and relevant figures are given, as well as a proposal for future use.Method: A computerised search and an additional literature search were performed to identify relevant papers on comorbidity and related subjects. Available literature on the subject (nequals;38) was reviewed on definition, operationalisation, occurrence and potential determinants.Results: The definitions in use are ambiguous; while some just imply coexistence of several diseases, others require medical conditions additional to an index disease. Other differences are related to the population and the number and type of diseases under study. Reported prevalence of comorbidity varies from less than 1% to over 50%, with higher prevalence among the elderly. Consequences such as disability and decreased quality of life are reported for the individual. There are also effects on the family and close friends which can be expressed in the social prevalence of disease. In addition there are consequences for the economy and health care. Explanations for observed comorbidity include causal mechanisms, bias and a general susceptibility for disease.Discussion: Since the introduction of the term comorbidity about 30 years ago, the concept has been used in many different ways. Because of the ambiguity of the term, we suggest a distinction between comorbidity based on the ‘classical’ definition (implying an index disease) and multimorbidity, meaning any co-occurrence of medical conditions within a person. Eur J Gen Pract 1996; 2: 65–70.