Co-occurring Psychiatric Conditions Research Articles

Brief Report: Self-Reported Medication Use in Individuals Diagnosed with Autism Spectrum Disorder in Adulthood: A U.S. Clinic Sample from 2012 to 2022.

As the understanding of autism spectrum disorder (ASD) across the lifespan has increased, so has the number of individuals being identified with ASD for the first time in adulthood. Understanding co-occurring psychiatric conditions in this subset of the ASD population is a growing focus of research; however, little is known about the rate at which psychiatric medications are prescribed to adults with a first-time diagnosis of ASD. The purpose of this study was to examine self-reported medication use in persons diagnosed with ASD in adulthood in a clinic sample (2012-2022) in the United States. The present study was a retrospective record review. Participants (n = 281) were drawn from an outpatient clinic specializing in the diagnosis of ASD in adults. Participants self-reported previous and current psychiatric medication prescription using a medication checklist. Approximately 50% of participants self-reported being prescribed at least one psychiatric medication at the time of their initial evaluation appointment. The most commonly prescribed psychiatric medications were antidepressants (23.8%), followed by stimulants (16.7%). Similar to individuals diagnosed with ASD in childhood, those identified with ASD for the first time in adulthood are prescribed psychiatric medication at a much higher rate than their same-age non-autistic peers. These results can inform future research and practice for improving outcomes for autistic adults, particularly those who were undiagnosed for much of their lives.

Previous psychiatric hospitalizations as risk factors for single and multiple future alcohol-related hospitalizations in patients with alcohol use disorders.

People with alcohol use disorder (AUD) often have co-occurring psychiatric conditions. The association between psychiatric conditions and AUD relapse has not yet been fully explored. This study aimed to quantify different psychiatric comorbidities as risk factors for first and multiple AUD rehospitalizations in patients already hospitalized once for AUD. We used a nation-wide routine health-care database in Scotland, UK, between 2010 and 2019. Individuals with a first hospitalization for AUD (codes F10.0-9 in the ICD-10 codes) were checked for previous hospitalizations where the main or co-occurring cause was a psychiatric condition (any other F0-F99 code in ICD-10). The final cohort included 23 529 patients, 18 620 of whom did not have a history of any other psychiatric comorbidity. First, individuals with a history of any previous psychiatric hospitalization were grouped and compared with those without on the basis of time to AUD rehospitalization. Then, individuals with different histories of psychiatric hospitalization were compared with each other. Cox and Prentice, Williams and Peterson gap-time models were used for single and multiple AUD rehospitalizations, respectively. The AUD rehospitalization rate in individuals with a previous psychiatric hospitalization was 8% higher compared with those without [hazard ratio (HR) = 1.08, 95% confidence interval (CI) = 1.01-1.14]. The difference in rehospitalization rate reduced following the first rehospitalization (HR at second rehospitalization from first: 0.95, 95% CI = 0.87-1.04 and HR at third rehospitalization from second: 0.94, 95% CI = 0.84-1.07). Mood disorders and neurotic, stress-related and somatoform disorders were associated with a 54% (HR = 1.54, 95% CI = 1.38-1.72) and 39% (HR = 1.39, 95% CI = 1.17-1.66) increase in the risk of a first AUD rehospitalization. Other conditions, such as disorders due to psychoactive substance use or schizophrenia, were associated with decreases in future AUD rehospitalization (HR = 0.89, 95% CI = 0.82-0.97 and HR = 0.82, 95% CI = 0.58-1.16, respectively). Patients with AUD appear to have different rates of AUD rehospitalization based on different co-occurring psychiatric conditions. Addiction-related characteristics may be more relevant risk indicators for multiple AUD readmission than psychiatric comorbidities.

Addressing co-occurring conditions in behavioural therapy for tic disorders: a review and guideline.

Co-occurring psychiatric conditions are very common in tic disorders and Tourette syndrome. These additional symptoms are often detrimental to quality of life and may impact upon the implementation and efficacy of evidence-based behavioural therapies (BT) for tics. Combining a review of the available literature, relevant theory, and expert clinical practice, we present a guideline for implementing behavioural and psychosocial interventions when common comorbidities are present. These include attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, disruptive behaviour, autism spectrum disorder (ASD) and depression. Practical recommendations are provided for assessment, formulation and management of specific and multiple comorbidities in BT for both children and adults. Despite comorbidities being common in tic disorders, few studies have comprehensively addressed how they may influence the efficacy or implementation of existing therapies or how such treatments may need to be modified or sequenced. We outline recommendations for future research, including randomised control trials of BT for those with specific or multiple comorbidities, as well as adequately powered sub-group analyses within larger scale trials or naturalistic study designs. Transdiagnostic models of psychiatric disorders and treatment, including modular cross-diagnostic therapies, which recognise the dimensionality of psychiatric disorders are also highlighted as an important focus in treatment development in tic disorders.

Co-occurring ADHD symptoms in autistic adults are associated with less independence in daily living activities and lower subjective quality of life.

Outcomes for autistic adults are generally poor, including activities of daily living and self-ratings of quality of life. Co-occurring psychiatric conditions contribute to these poor outcomes. Attention-deficit/hyperactivity disorder is one of the most common co-occurring conditions in autistic individuals. However, we know little about the association between attention-deficit/hyperactivity disorder symptoms and outcomes in autistic adults. A total of 724 autistic adults (18-83 years; 58% female) recruited from the Simons Foundation Powering Autism Research participant registry completed questionnaires on demographics, co-occurring psychiatric conditions, activities of daily living, and subjective quality of life. Autistic adults who rated themselves as having more attention-deficit/hyperactivity disorder symptoms also rated themselves as having less independence in activities of daily living and a lower quality of life. This is the first study to show these relationships in autistic adults. These findings highlight that additional research and better supports for co-occurring attention-deficit/hyperactivity disorder symptoms may be critical to improving independence and quality of life for autistic adults.

S. W. White, B. D. Maddox, & C. A. Mazefsky (Eds.): The Oxford Handbook of Autism and Co-occurring Psychiatric Conditions (Oxford Library of Psychology)

S. W. White, B. D. Maddox, & C. A. Mazefsky (Eds.): The Oxford Handbook of Autism and Co-occurring Psychiatric Conditions (Oxford Library of Psychology)

A Manualized Yoga Intervention for Adolescents with Co-Occurring Physical and Psychiatric Conditions Shows Improvements in Mental and Physical Health

A Manualized Yoga Intervention for Adolescents with Co-Occurring Physical and Psychiatric Conditions Shows Improvements in Mental and Physical Health

Ethical Considerations in Fertility Preservation for Transgender Youth: A Case Illustration.

Increasing numbers of transgender adolescents are presenting for transition-related medical care, including gender-affirming estrogen and testosterone. The decision to transition with hormones has long-term implications, including possible irreversible impairment of future reproductive functioning. The commentary by Hudson, Nahata, Dietz, and Quinn (2017) outlines the importance of fertility counseling for transgender adolescents and young adults as ethical, interdisciplinary practice. Key considerations raised include implementing shared decision-making strategies that account for youths' maturity and individual decisional capacity, evaluating co-occurring psychiatric conditions that could interfere with future-oriented decision-making, and considering benefits and harms of fertility preservation (FP) in the context of a youth's values, identity, and comfort. This report includes two case illustrations of transmasculine youth which highlight how ethical considerations emerge in clinical practice and underscore the nuance and complexity of fertility-related decision-making among transgender adolescents.

7.5 Pharmacotherapy for Co-Occurring Psychiatric Conditions in Intellectual Disability and Autism Spectrum Disorder

The goal of this session is to provide a review of what is known (and what is not known) about the pharmacological treatment of co-occurring psychiatric conditions in patients suffering from intellectual disability (ID) and autism spectrum disorder (ASD). Furthermore, medication treatment data on neurogenetic syndromes that are associated with ID/ASD will also be considered. The clinical relevance of the extant research data and evidence-based treatment approaches will be discussed.

Demographic and Clinical Characteristics Associated with Engagement in Behavioral Health Treatment Among Children with Autism Spectrum Disorders

This study investigates demographic and clinical factors associated with initiation, continuation, and adherence to behavioral health treatment (BHT) among children with autism spectrum disorder. Among 293 insured children referred for applied behavior analysis (ABA) based BHT, 23% never initiated treatment. Among those initiating treatment, 31% discontinued treatment within 1 year of treatment initiation, and only 15% received 80% or more of recommended treatment hours. Younger age at referral to treatment, private health insurance, and receiving more than 10 h/week of BHT were associated with treatment engagement. Co-occurring psychiatric and medical conditions were related to treatment discontinuation among children 5 years or older. These findings suggest specific subgroups that may benefit from additional support with engaging in recommended behavioral health treatment.

Commentary: A Gene-Based Association Method for Mapping Traits Using Reference Transcriptome Data.

Commentary: A Gene-Based Association Method for Mapping Traits Using Reference Transcriptome Data.

Alcohol Dependence, Co-occurring Conditions and Attributable Burden

Alcohol dependence is associated with high rates of co-occurring disorders which impact health-related quality of life (HRQoL) and add to the cost-of-illness. This study investigated the burden of alcohol dependence and associated co-occurring conditions on health and productivity. A cross-sectional survey was conducted in eight European countries. Physicians (Psychiatrists and General Practitioners) completed patient record forms, which included assessment of co-occurring conditions, and patients completed matching self-completion forms. Drinking risk level (DRL) was calculated and the relationship between DRL, co-occurring conditions, work productivity, hospitalisations and rehabilitation stays was explored. Data were collected for 2979 alcohol-dependent patients (mean age 48.8 ± 13.6 years; 70% male). In total, 77% of patients suffered from moderate-to-severe co-occurring psychiatric and/or somatic conditions. High DRL was significantly associated with depression, greater work productivity losses, increased hospitalisations and rehabilitation stays. Co-occurring conditions were significantly associated with poorer HRQoL and decreased work productivity, with a statistical trend towards an increased frequency of rehabilitation stays. Alcohol-dependent patients manifest high rates of co-occurring psychiatric and somatic conditions, which are associated with impaired work productivity and HRQoL. The continued burden of illness observed in these already-diagnosed patients suggests an unmet need in both primary and secondary care.

Co-Occurring Psychiatric Conditions Among Athletes Experiencing Prolonged Recovery from Sports-Related Concussion

Co-Occurring Psychiatric Conditions Among Athletes Experiencing Prolonged Recovery from Sports-Related Concussion

Rapid triage evaluation: one initiative solves three pain clinic performance imperatives

Multidisciplinary pain clinics face a growing number of challenges: Access to multidisciplinary pain care can take months. Opioid management has become increasingly complex as standards change and the risks of chronic opioid therapy are headlined. Co-occurring psychiatric conditions and substance use disorders can be barriers to successful treatment within a multidisciplinary framework. Reimbursement for multidisciplinary treatment is declining. Fairview Pain Management Center provides multidisciplinary pain management to over forty affiliated primary care clinics. We were faced with three imperatives: 1. Reduce the wait times for pain evaluations to less than two weeks and provide timely help and guidance to the referring primary care physician. 2. Enhance the screening of patients to assure that those we do treat are likely to participate fully and have successful outcomes, while avoiding enrollment of patients for whom multidisciplinary care is unlikely to be effective or practical. 3. Increase patient volumes (i.e. revenue) to meet the expectations of a health system that is facing budgetary challenges. The Rapid Triage Evaluation (RTE) was developed to address these challenges. Patients are scheduled within two weeks for a RTE without our customary preliminary screening. The RTE is a 20-30 min evaluation carried out by the pain specialist in order to get a quick assessment of the nature of the pain problem, suitability for multidisciplinary pain treatment, appropriateness of opioid therapy, and to identify other interventions that a primary physician can initiate without delay. No prescriptions are written and no procedures are carried out during the RTE. Comparing outcomes before and after instituting RTE, we demonstrate reductions in wait times, higher engagement among patients entering multidisciplinary care with fewer missed appointments, higher volumes, and increased satisfaction among referring physicians who are given immediate treatment recommendations and practical advice about opioids.

Obsessions and Compulsions in the Community: Prevalence, Interference, Help-Seeking, Developmental Stability, and Co-Occurring Psychiatric Conditions

It is unclear how many people in the community have obsessions and compulsions and associated levels of interference. It is also unknown what variables predict help-seeking for these symptoms, whether they are developmentally stable, and whether they increase the risk of mental disorders. The authors analyzed data from the prospective longitudinal Dunedin study of an unselected birth cohort. The presence of obsessions and compulsions and mental disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 11, 26, and 32. Data on interference and help-seeking were obtained at ages 26 and 32. Obsessions and compulsions were frequent in individuals with mental disorders other than obsessive-compulsive disorder (OCD) and among people without mental disorders. Even in the latter group, these symptoms caused significant interference. The presence of anxiety/depression and of obsessions (particularly aggressive and shameful thoughts), but not compulsions, was associated with help-seeking. Harm/checking was the most prevalent symptom dimension. Symptom dimensions were temporally stable and associated with increased comorbidity. Obsessive-compulsive symptoms at age 11 predicted a high risk of an adult OCD diagnosis as well as elevated adult symptom dimensions. Obsessions and compulsions are common in the adult population, have their roots in childhood, and are associated with interference, risk for disorders, and help-seeking. Subclinical obsessions and compulsions should be taken into account in research, intervention, and DSM-V.

Adolescent Substance Abuse: Psychiatric Comorbidity and High-Risk Behaviorsedited by Yifrah Kaminer, Oscar G. Bukstein. New York, Taylor and Francis, 2007, 528 pp., $59.95.

Back to table of contents Previous article Next article Book ForumFull AccessAdolescent Substance Abuse: Psychiatric Comorbidity and High-Risk BehaviorsROBERT D. DAVIES M.D.,ROBERT D. DAVIES M.D.Search for more papers by this author,Published Online:1 Jan 2009https://doi.org/10.1176/appi.ajp.2008.08071017AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Despite the gradual decline of illicit substance use by adolescents, the prevalence of actual substance use disorders among youths has nearly doubled over the past decade. Substance abuse among youths is a particularly complicated clinical issue, with the majority of adolescents who have substance use disorders also exhibiting other psychiatric comorbidities. Unfortunately, such co-occurring psychiatric conditions are typically unrecognized and/or untreated in this population. Even when the comorbid psychiatric conditions are identified, these youths are typically treated in a sequential manner, with some period of abstinence required before the psychiatric condition is addressed. This is of particular significance, given research demonstrating that youths with untreated comorbid psychiatric disorders typically have poorer substance use disorder treatment outcomes (1 , 2) . Although the National Institute on Drug Abuse has included concurrent treatment for comorbid psychiatric conditions as one of the nine fundamental principles of substance use disorder treatment since 1999, less than one-half of current substance use disorder treatment facilities offer dual diagnosis programs, with the majority of these lacking the necessary components for adequate services (3) . A variety of barriers exist that impede the effective, wide-spread implementation of truly integrated treatment for substance use disorders and psychiatric comorbidities among adolescents. These barriers include 1) a relative lack of empirical data on treatment modalities for youths with substance use disorders and psychiatric comorbidities; 2) the exclusion of these youths from psychiatric medication trials, leading to a lack of evidence of safety and tolerability of such medications in this population; 3) a lack of widespread training for clinicians in existing empirically based substance use disorder interventions; and 4) the fiscal constraints resulting from different payer sources for substance use disorder and psychiatric treatments. The topic of integrated treatment has typically been relegated to single chapters in texts on adolescent substance use disorder treatment. Adolescent Substance Abuse is the first to specifically address this issue in a direct, comprehensive manner. Drs. Kaminer and Bukstein have included contributions from some of the top researchers in the field of adolescent substance abuse. The initial chapters of the book are focused primarily on the etiology, phenomenology, assessment, and treatment of adolescent substance use disorder. It is in the second section that the focus turns more specifically to the topic of psychiatric comorbidities. The editors have included chapters not only on the most common psychiatric conditions among youths who abuse substances, such as conduct disorder, attention deficit hyperactivity disorder (ADHD), and depression, but also on less common disorders, such as eating disorders, self-harm, and gambling. The volume ends with several excellent chapters addressing the barriers to integrated treatment and the ethical/policy issues that arise in treating this population.Given the constraints inherent in a topic for which little empirical evidence exists, the contributors to this text have done an admirable job compiling all the relevant existing research on treatment for both adolescent substance use disorders and adolescent psychiatric conditions. For those areas in which no empirical evidence exists, the various authors also include relevant findings from adult treatment literature. The chapters are most successful when the authors have truly integrated the discussion of adolescent substance use disorder and psychiatric comorbidity, as in the chapters on ADHD, anxiety disorders, and bipolar disorder. In these chapters, you will find comprehensive discussions of the phenomenological interplay between substance abuse and the psychiatric condition, with recommendations and guidelines offered for comprehensive assessment and clinical management. In the chapters in which this does not occur, however, it only serves to underscore the current state of the science and the need for further research in this area.With this volume, Drs. Kaminer and Bukstein have succeeded in bringing to the fore the issue of psychiatric comorbidity among adolescents with substance use disorders. It should be of interest and particular benefit to addiction researchers, clinicians working with adolescents who abuse substances, and, hopefully, to primary care physicians. What is most clear in reading this book is the imperative need for the field to increase its focus on developing empirically based guidelines for comprehensive screening and evaluation, acute integrated treatment, and ongoing continuing care for this often overlooked and underserved population.Denver, Colo.Book review accepted for publication July 2008 (doi: 10.1176/appi.ajp.2008.08071017).

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported. Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year. Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company. Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Configuration of services used by depressed older adults

As a more comprehensive service use measure, this study identifies service use configurations based on the use of 17 services. Factors associated with service use configurations are examined guided by the Andersen and Network Episode models. Self-report data at admission and at six-month follow-up were collected, along with information from medical charts among 140 older adults hospitalized for major depression. The data document service access and levels of use in three sectors of care (psychiatric, medical, and psychosocial services) and assess need, predisposing, enabling, and social network factors associated with use. Three distinct service use configurations were identified with cluster analysis: (1) home care users; (2) moderate users of outpatient mental health services; and (3) heavy users of all formal services. Rather than psychiatric needs, post-acute service use was related to: (1) concurrent physical conditions; (2) the availability of formal and informal services; and (3) financial stability. No difference in psychiatric outcomes was found by service use configuration. It is important to understand service use patterns as a measure of service use, given the co-occurring medical, psychiatric, and psychosocial conditions of older adults and corresponding needs in multiple sectors of care.

Recent developments in the pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD).

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder typically first identified in childhood that has been demonstrated to persist into adulthood. Core symptoms of the disorder include inattention (e.g., difficulty sustaining attention and effort in the classroom), overactivity (e.g., fidgets, difficulty remaining seated during meals), impulsivity (e.g., blurts out answers), and frequent shifts from one activity to another (American Psychiatric Association [APA], 1994). For the purpose of making a diagnosis, at least six symptoms must be identified, and the severity of symptoms must render a child as functionally impaired (APA, 1994). Onset of symptoms must be prior to 7 years of age, and symptoms must persist for a minimum of 6 months. Initial symptoms of ADHD typically appear at preschool, but the diagnosis is frequently made in elementary school when there is increased demand for modulating behavior and following directions. Symptoms during the elementary years are often more apparent due to greater demands for sustaining attention, particularly at school. There has been compelling data to suggest that the core symptoms of ADHD persist into adolescence and well into adulthood, with up to one half of ADHD children reporting problems as adults (see Brown et al., 2001). The prevalence of the disorder is estimated to range from 4% to 12% in general primary care settings (American Academy of Pediatrics [AAP], 2000), whereas the estimate is even higher in referred populations. The gender ratio is estimated to range from four to nine boys for every girl. The etiology of the disorder has been posited to be both neurological (i.e., differences in brain morphology between children with ADHD relative to their normally developing peers; Zametkin et al., 1990) and genetic, with approximately 65% of children with ADHD having at least one relative with ADHD, compared with 15% of normally developing peers (Barkley, 2001; Biederman, Farone, Keenan, Knee, & Tsuang, 1990). ADHD is frequently comorbid with other disorders, including mood, anxiety, learning disabilities, and disruptive behavior disorders (Brown et al., 2001). Co-occurring psychiatric conditions are believed to range from 9% to nearly one third of the children identified with ADHD within the primary care setting. Among referred populations, the prevalence of comorbidity is estimated to be about 33%. Proper assessment in addition to a comprehensive diagnostic interview must include data from collateral sources (i.e., parents and teachers), often collected by incorporating teacher and parent rating scales. In particular, the Conners Rating Scales (Conners, 1997) and the SNAP Checklist (Atkins, Pelham, & Licht, 1989) have been noted to perform well in the identification of children with ADHD. Contrary to popular lore, there is no specific psychometric assessment instrument, laboratory test, or diagnostic procedure (e.g., electronencephalogram, magnetic resonance imaging) that has demonstrated validity in the identification of the disorder.