Co-occurrence Of Other Psychiatric Disorders Research Articles

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

Bipolar disorder and its relation to major psychiatric disorders: a family-based study in the Swedish population.

Bipolar disorder (BPD) shares genetic components with other psychiatric disorders; however, uncertainty remains about where in the psychiatric spectra BPD falls. To understand the etiology of BPD, we studied the familial aggregation of BPD and co-aggregation between BPD and schizophrenia, depression, anxiety disorders, attention-deficit hyperactivity disorder, drug abuse, personality disorders, and autism spectrum disorders. A population-based cohort was created by linking several Swedish national registers. A total of 54,723 individuals with BPD were identified among 8,141,033 offspring from 4,149,748 nuclear families. The relative risk of BPD in relatives and the co-occurrence of other psychiatric disorders in patients with BPD and their relatives were compared to those of matched-population controls. Structural equation modeling was used to estimate the heritability and tetrachoric correlation. The familial risks for relatives of BPD probands were 5.8-7.9 in first-degree relatives, and decreased with genetic distance. Co-occurrence risks for other psychiatric disorders were 9.7-22.9 in individuals with BPD and 1.7-2.8 in full siblings of BPD probands. Heritability for BPD was estimated at 58%. The correlations between BPD and other psychiatric disorders were considerable (0.37-0.62) and primarily due to genetic effects. The correlation with depression was the highest (0.62), and was 0.44 for schizophrenia. The high familial risks provide evidence that genetic factors play an important role in the etiology of BPD, and the shared genetic determinants suggest pleiotropic effects across different psychiatric disorders. Results also indicate that BPD is in both the mood and psychotic spectra, but possibly more closely related to mood disorders.

P-182 - Familial aggregation of bipolar disorder and the course of the illness with cognitive and social functioning of patients in subsequent generations

Offspring of parents with Bipolar Disorder are at increased risk for a range of psychopathology, including Bipolar Disorder, ADHD and disruptive behavior disorders and problems in their psychosocial and cognitive functioning. Familial aggregation of BD is associated with earlier age of onset, more frequent co-occurrence of other psychiatric disorders, more severe illness course. To compare subsequent generations of BD patients in one family, taking account of a number of variables related to course of illness and patients’ functioning. Twelve patients with (1) adolescent-diagnosed BD and (2) BD in first-degree relatives in at least three generations, were analyzed. The first-degree relatives with Bipolar Disorder in each family were compared regarding: age of onset; cognitive functioning (WCST); social functioning; course of illness, medication response, co-occurrence of other psychiatric disorders. In subsequent generations, familial aggregation of Bipolar Disorder was associated with: earlier age of onset; more severe episodes and co-occurrence of other psychiatric disorders; worse medication response (Lithium) for a part of families; lower cognitive and social functioning. In order to reduce the risk for long-term functional impairment in offspring, interventions addressing parental functioning and early interventions targeting the child's psychopathology should be introduced.

ADHD Comorbidities: Handbook for ADHD Complications in Children and Adultsedited by BrownThomas E., Ph.D., Washington, DC, American Psychiatric Publishing, 2009, 478 pp., $99.00.

Back to table of contents Previous article Next article Communications and UpdatesFull AccessADHD Comorbidities: Handbook for ADHD Complications in Children and AdultsManpreet Kaur Singh, M.D., M.S.,Manpreet Kaur SinghSearch for more papers by this author, M.D., M.S.,Published Online:1 May 2011https://doi.org/10.1176/appi.ajp.2011.11010072AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by BrownThomas E., Ph.D., Washington, DC, American Psychiatric Publishing, 2009, 478 pp., $99.00.In recognition of the fact that attention deficit hyperactivity disorder (ADHD) is a complex disorder, with the co-occurrence of other psychiatric disorders being among the most challenging complications, this textbook provides a comprehensive review of how ADHD relates to other disorders and how this interaction can be effectively recognized and treated. In addition, the book provides updated information about developmental aspects of ADHD not current in its preceding volume (Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults, published in 2000). To my knowledge, there are few definitive textbooks that cover this clinical disorder over the life span and provide a developmental context for its various presentations over time. Moreover, phenomenological descriptions are not limited to DSM criteria but rather integrated with the rich knowledge gained about this disorder from the field of neuroscience. After establishing the developmental complexities, genetics, and common presentations of ADHD from preschool to adulthood, the body of the book focuses on the co-occurrence of the disorder with a variety of psychiatric syndromes, including mood and anxiety disorders, oppositionality and aggression, obsessive-compulsive disorders, language and learning disorders, substance use disorders, autism spectrum disorders, developmental coordination disorder, sleep disturbances, and Tourette's syndrome. This thematic organization is helpful not only to a clinician but also to educators and laypersons, who might observe attentional problems manifested in a variety of different contexts outside of a clinical setting.Compared with the earlier edition of this book, interim knowledge has suggested conceptual models of ADHD that embrace its heterogeneity among individuals and its susceptibility to change across development and environmental variations. In addition, ADHD is no longer considered simply a disorder of executive function as defined by neuropsychological tests but rather a complex syndrome of impairments across multiple overlapping cognitive operations, including motivation and emotion regulation. This book also makes the point that whereas early studies cautioned against the use of psychostimulant therapy for individuals with ADHD and comorbid conditions such as mood or anxiety disorders, recent literature suggests that many patients may in fact benefit from such treatment. This new framework is illustrative of the contemporary view that individual patients rarely have symptoms that fit neatly into unified diagnostic groups. Moreover, treatment should be tailored to target overlapping symptoms and dimensional features and should incorporate pertinent sources of stress and support. Although controversies abound regarding the diagnosis and treatment of highly comorbid conditions such as ADHD, DSM-5 work groups are being challenged to consider alternative views of psychiatric diagnoses that incorporate these types of complexities. In this way, this textbook will prove to be an excellent compendium to the DSM, focused specifically on attentional dysfunction and related disorders.As a child psychiatrist and pediatrician, I found myself drawn to the case vignettes, information about clinical course with complicated ADHD, and treatment recommendations. Each chapter ends with key clinical bullets, recommended readings, and Internet resources, all useful tools for a busy clinician. The chapters at the end of the book provide another level of guidance on the assessment and intervention of ADHD, synthesizing special considerations described in the preceding chapters. It would be nice to see more speculation on gaps in current knowledge and what kind of study designs will help advance research in this field. For example, although much has been learned in the past decade about the benefits of certain medications and behavioral approaches for the treatment of ADHD from the Preschool ADHD Treatment Study, the Multimodal Treatment Study of Children with ADHD, and the National Comorbidity Survey Replication, few studies have helped us optimize treatments and outcomes for individuals with predominantly ADHD inattentive type, familial ADHD, or ADHD as a result of a perinatal developmental insult (e.g., fetal alcohol syndrome). If advancements in the past decade are any indication of the trajectory of knowledge gained in this field, I look forward to the next generation of studies that will provide even greater levels of sophistication in the evaluation and treatment of ADHD.Stanford, Calif.Book review accepted for publication January 2011.Dr. Singh receives research grant support from the Klingenstein Third Generation Foundation, the National Alliance for Research on Schizophrenia and Affective Disorders, the National Institute of Mental Health (Grant MH085919), the American Psychiatric Association, and Stanford's Child Health Research Program. FiguresReferencesCited byDetailsCited ByCurrent World LiteratureCurrent Opinion in Psychiatry, Vol. 25, No. 3 Volume 168Issue 5 May 2011Pages 555-555 Metrics PDF download History Accepted 1 January 2011 Published online 1 May 2011 Published in print 1 May 2011

Chronic methylphenidate treatment during adolescence increases anxiety-related behaviors and ethanol drinking in adult spontaneously hypertensive rats

Methylphenidate (MPD) is the most widely used drug in the treatment of attention-deficit hyperactivity disorder (ADHD), the symptoms of which can persist into adolescence and adulthood. The cooccurrence of other psychiatric disorders, such as anxiety and alcoholism, in adults with ADHD is very common, but its etiology remains largely unknown. This study examined the effects of chronic MPD treatment during adolescence on emotional and consummatory behaviors in adult spontaneously hypertensive rats (SHRs), often proposed as an animal model of ADHD. Adolescent SHRs of both sexes were given chronic treatment with MPD (2 mg/kg intraperitoneally; twice daily for 16 days) or vehicle and were subsequently tested in adulthood. The tests used were the open-field and the elevated plus-maze, thought to measure locomotor and emotionality-related behaviors, and a protocol of ethanol consumption. MPD elicited anxious-like behavior in the open-field (but not in the elevated plus-maze) regardless of sex, and enhanced ethanol intake in females. These findings suggest that MPD treatment during adolescence induces persistent changes on emotionality and ethanol consumption in SHRs, but these effects depend on the sex and behavioral test used. Potential clinical implications of these findings are discussed.

Traumatic Events and Posttraumatic Stress in Childhood

Traumatic events are common and are related to psychiatric impairment in childhood. Little is known about the risk for posttraumatic stress disorder (PTSD) across different types of trauma exposure in children. To examine the developmental epidemiology of potential trauma and posttraumatic stress (PTS) in a longitudinal community sample of children. A representative population sample of 1420 children aged 9, 11, and 13 years at intake were followed up annually through 16 years of age. Main Outcome Measure Traumatic events and PTS were assessed from child and parent reports annually to 16 years of age. Risk factors and DSM-IV disorders were also assessed. More than two thirds of children reported at least 1 traumatic event by 16 years of age, with 13.4% of those children developing some PTS symptoms. Few PTS symptoms or psychiatric disorders were observed for individuals experiencing their first event, and any effects were short-lived. Less than 0.5% of children met the criteria for full-blown DSM-IV PTSD. Violent or sexual trauma were associated with the highest rates of symptoms. The PTS symptoms were predicted by previous exposure to multiple traumas, anxiety disorders, and family adversity. Lifetime co-occurrence of other psychiatric disorders with traumatic events and PTS symptoms was high, with the highest rates for anxiety and depressive disorders. In the general population of children, potentially traumatic events are fairly common and do not often result in PTS symptoms, except after multiple traumas or a history of anxiety. The prognosis after the first lifetime trauma exposure was generally favorable. Apart from PTSD, traumatic events are related to many forms of psychopathology, with the strongest links being with anxiety and depressive disorders.

Enhanced serum cholesterol and triglyceride levels in bulimia nervosa: Relationships to psychiatric comorbidity, psychopathology and hormonal variables

Increased levels of cholesterol have been reported in patients with bulimia nervosa (BN), but all but one of the published studies were performed on non-fasting subjects, which limits the interpretation of this finding. Moreover, the relationships between serum lipids and comorbid psychiatric disorders or bulimic psychopathology have scarcely been investigated. We measured serum levels of total cholesterol, triglycerides, glucose, 17β-estradiol and thyroid hormones in 75 bulimic women and 64 age-matched healthy females after an overnight fast. Compared with healthy women, bulimic patients exhibited significantly enhanced serum levels of cholesterol and triglycerides, but similar values of glucose, 17β-estradiol, FT3 and FT4. No significant differences emerged in these variables between patients with or without comorbid depression, borderline personality disorder or lifetime anorexia nervosa. Circulating cholesterol was positively correlated to the patients' drive for thinness, ineffectiveness, enteroceptive awareness and impulse regulation sub-item scores of the Eating Disorder Inventory-2. These findings confirm that BN is associated with increased levels of serum lipids. This alteration may be involved in the pathophysiology of certain psychopathological characteristics of BN and cannot be explained by the co-occurrence of other psychiatric disorders.

Psychiatric Comorbidity in Adolescent Inpatients with Substance Use Disorders

To assess DSM-III-R Axis I and Axis II co-occurrence and comorbidity in adolescent inpatients with substance use disorders (SUD). A consecutive series of 138 adolescent inpatients were reliably assessed with structured diagnostic interviews for Axis I disorders and Axis II personality disorders. To determine significant co-occurrence of diagnoses, comparisons were between 69 patients with SUD and 69 patients without SUD. Disruptive behavior disorders were diagnosed significantly more frequently in patients with SUD than in those without SUD. Conduct disorder was diagnosed more frequently and oppositional defiant disorder was diagnosed less frequently in the SUD patients than in the non-SUD patients. Anxiety disorders were diagnosed less frequently in the SUD group. Cluster B personality disorders and borderline personality disorder were diagnosed more frequently in the SUD group. The findings replicate previous research showing high rates of co-occurrence of other psychiatric disorders in adolescent inpatients with SUD. The use of a relevant psychiatric comparison group allows for finer distinctions regarding significant comorbidity and the psychopathological implications thereof.