Co-occurring Psychiatric Disorders Research Articles

Methylphenidate substitution for methamphetamine addiction and implications for future randomized clinical trials: a unique case series

Background: Methamphetamine Use Disorders (MUD) pharmacotherapy research yields contradictory results.Objective: Our objective was to identify treatment outcome features of intravenous users of methamphetamine (IUM) treated by one healthcare provider using stable methylphenidate (MPH) substitution protocols over an extended interval.Method: We retrospectively examined a database of all intravenous MUD cases (24 patients) treated with short acting MPH and psychotherapy between 2007 and 2013 in a single outpatient addiction treatment facility.Results: Mean duration of treatment was 8 months (<1–31 months). Treatment resulted in full abstinence in 10 cases – maintained until the end of the observation period. Patients who stayed in treatment for more than a month and remained abstinent were more likely to be regular pattern users of methamphetamine (MA), female and characterized as having co-occurring psychiatric disorders that responded to treatment. These patients discontinued intravenous MA use and demonstrated stabilization of their health conditions. One adverse effect was reported by one patient who required emergency department treatment for accidental alcohol poisoning.Conclusion: Our clinical series indicated favorable outcomes and low dropout rates in patients with MUD who were treated several months with short acting MPH with individualized dosing. Adverse effects were rare. Keeping patients engaged in treatment in the first four weeks was critical for good clinical outcomes. Our findings indicated the need for the possible application of pre-selective criteria regarding patterns of use prior to initiation of (MPH) agonist pharmacotherapy of MA dependence. Prospective studies are needed to confirm or reject these clinical observations.

Modelo predictivo de ansiedad y depresión en pacientes españoles con enfermedad pulmonar obstructiva crónica estable

IntroductionThe association between chronic obstructive pulmonary disease (COPD) and anxiety and depression is not yet completely characterized, and differences between countries may exist. We used a predictive model to assess this association in a Spanish population. Patients and methodProspective transversal descriptive study of 204 patients with stable COPD. Concomitant anxiety or depression were diagnosed by psychiatric assessment, using the diagnostic criteria of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Sociodemographic, clinical and lung function parameters were analyzed. ResultsIn total, 36% of stable COPD patients had psychiatric comorbidities, but 76% were unaware of their diagnosis. Nineteen percent had a pure anxiety disorder, 9.8% had isolated depression, and 7.3% had a mixed anxiety-depression disorder. Predictive variables in the multivariate analysis were younger age, higher educational level, lack of home support, higher BODE index, and greater number of exacerbations. The ROC curve of the model had an AUC of 0.765 (P<0.001). ConclusionsIn COPD, concomitant psychiatric disorders are significantly associated with sociodemographic factors. Anxiety disorders are more common than depression. Patients with more severe COPD, according to BODE, younger patients and those with a higher educational level have a greater risk of being diagnosed with anxiety or depression in a structured psychiatric interview. In our population, most patients with psychiatric comorbidities remain unidentified.

Motivation for Treatment and Motivation for Change in Substance-Dependent Patients with Co-Occurring Psychiatric Disorders

The aims of this study were to examine the relationship between motivation for treatment and for change, and to explore their role in the prediction of treatment completion. The sample was composed of 560 predominantly polydrug-using inpatients with co-occurring psychiatric disorders. Motivation for treatment was assessed with the Motivation for Treatment Scales, and motivation for change was measured with the Readiness to Change Questionnaire. Patients indicated strong motivation to change illegal drug and alcohol use. In initial factor analysis, motivation for treatment and for change did not load on the same factors, confirming that these are distinct domains. Four categories were discerned with respect to readiness for treatment and for change, with low agreement between the two. In performing survival analysis, we found that being in readiness category 4 (RT↑RC↑) was associated with a greater chance of remaining in treatment for a period of 105 days without premature attrition (Log Rank chi-sq = 5.000; p = 0.02). To a limited extent, intake measures of motivation can be used to predict attrition from treatment. Clinicians can use motivation assessment both for clinical purposes and in the prediction of those who need extra monitoring due to increased risk of premature attrition.

Direct Cost and Complications Associated With Total Joint Arthroplasty in Patients With Preoperative Anxiety and Depression

IntroductionThe outcome of total joint arthroplasty (TJA) may be affected by numerous factors including the mental health status of patients and the presence of psychological disorders Therefore, the present study was designed and conducted to determine the impact of concomitant psychiatric disorders on the hospitalization charges and complications in patients with preoperative depression or anxiety undergoing TJA. Materials and MethodsInternational Classification of Diseases, Ninth Revision, codes were used to identify perioperative complications in patients with and without concomitant diagnosis of depression or anxiety who underwent TJA at our institution during 2009. Hospitalization charges and complications were compared for patients with and without depression or anxiety undergoing TJA. ResultsRespectively, 12.7% and 6.4% of knee and the hip arthroplasty patients had concomitant depression or anxiety. In the knee but not the hip group, the charge was $3420 higher in patients with depression/anxiety (P < .001). Anxiety and depression and higher American Society of Anesthesiologists score were independent predictors of complications. DiscussionDepression or anxiety was a predictor of increased complications after TJA. Therefore, patients with depression or anxiety undergoing TJA need to be counselled appropriately, and all efforts need to be invested to minimize complications and the added cost in these patients.

Sexual orientation disparities in psychiatric and drug use disorders among a nationally representative sample of women with alcohol use disorders

Background and aimsSexual minority women (SMW) are at greater risk for alcohol use disorders (AUDs) compared to heterosexual women. However, there is a dearth of research on sexual orientation disparities in co-occurring disorders among women with AUDs. We examined disparities in lifetime co-occurring psychiatric and drug use disorders among a nationally representative sample of women with lifetime AUDs. MethodsData were analyzed from the 2004–2005 (Wave 2) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which was collected in structured diagnostic face-to-face interviews. Adult women with AUDs (N=4342) were included in the analyses and approximately 191 of those women self-identified as SMW. Lifetime alcohol and drug use disorders and psychiatric disorders were assessed using DSM-IV criteria. We conducted multivariate logistic regression analyses to compare SMW and heterosexual women with lifetime AUDs on lifetime psychiatric disorders and drug use disorders, while adjusting for sociodemographic variables. FindingsWhile accounting for several covariates, SMW with lifetime AUDs were more likely than heterosexual women with lifetime AUDs to have lifetime psychiatric disorders (e.g., mood, anxiety, panic disorders) and drug use disorders (e.g., prescription drugs, cannabis use disorders). ConclusionsSexual minority women with lifetime alcohol use disorders are at heightened risk for co-occurring psychiatric and drug use disorders than heterosexual women with lifetime alcohol use disorders. The findings warrant the need for more research and empirically based interventions for the comprehensive treatment and prevention of alcohol use disorders among sexual minority women.

Co-occurring psychiatric and drug use disorders among sexual minority men with lifetime alcohol use disorders

BackgroundEmerging evidence indicates multiple health risks associated with harmful alcohol use among sexual minority men in the United States. In particular, sexual minority men with alcohol use disorders (AUD) might have greater co-occurring health problems compared with heterosexual men. We used nationally representative data to compare the prevalence of diagnostic co-occurring psychiatric disorders and drug use disorders (DUD) among sexual minority men with AUD compared with heterosexual males with a lifetime AUD diagnosis. MethodsWe analyzed data from 6899 adult males with AUD participating in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Using weighted multivariable logistic regression models, we compared the odds of lifetime diagnosis of mood disorders, anxiety disorders, and drug use disorders in sexual minority and heterosexual adult males with AUD. ResultsOf participants included in this analysis, 176 (2.6%) self-identified as a sexual minority. In adjusted analyses, sexual minority men with AUD were more likely than heterosexual men with AUD to have any mood disorder (including major depressive episode), any anxiety disorder (including panic disorder without agoraphobia, specific phobia, posttraumatic stress disorder, and generalized anxiety disorder), and lifetime DUD. ConclusionsThe elevated co-occurrence of psychiatric disorders and DUD among sexual minority men with AUD suggests that future research is warranted. A better understanding of the etiology of diagnostic co-occurring mental health and substance use disorders among sexual minority men is needed in order to develop effective integrated prevention and treatment programs.

Co-occurring Psychiatric Disorders in Preschool and Elementary School-Aged Children with Autism Spectrum Disorder.

We employed a clinical sample of young children with ASD, with and without intellectual disability, to determine the rate and type of psychiatric disorders and possible association with risk factors. We assessed 101 children (57 males, 44 females) aged 4.5-9.8 years. 90.5% of the sample met the criteria. Most common diagnoses were: generalized anxiety disorder (66.5%), specific phobias (52.7%) and attention deficit hyperactivity disorder (59.1%). Boys were more likely to have oppositional defiant disorder (OR 3.9). Higher IQ was associated with anxiety disorders (OR 2.9) and older age with agoraphobia (OR 5.8). Night terrors was associated with parental psychological distress (OR 14.2). Most young ASD children met the criteria for additional psychopathology.

Inpatient Care of Transsexual Patients: Recent Experience

Introduction In the early 80’s Dr Zoran Rakic, from the Department of Psychiatry? in Belgrade was a pioneer in transgender care in Serbia and former Yugoslavia. Occasionally he used to hospitalize transsexual patients for diagnostic assessment, treatment of comorbid and concomitant psychiatric disorders and post-surgical care. His pioneer work was continued by the Counseling Service for Sexual Disfunction and Gender Dysphoria team. Aim To assess frequency, indication for and results of inpatient treatment of transsexual clients. Method Case history review and outpatient follow-up. Results During last 3 years hospitalization was performed in 16 cases (50% F?M and M?F). Mean age on admission was 23.1 for F?M and 27.5 for M?F patients. Assessment of transsexualism was performed in 3 F?M clients; 62.5% (10) were admitted for assessment and treatment of comorbid disorder (7 M?F and 2 F?M before and 1 M?F patient after gender reassignment surgery) with only one currently not in remission; physical assessment was performed in 3 F?M clients before referral for hormone therapy (financial reasons). Conclusion Transsexual individuals are exposed to double stigmatization, as members of the LGBT community and as „psychiatric patients'. Therefore inpatient psychiatric assessment and treatment should be avoided. Results of our clinical work show that inpatient care can be beneficial for these patients and accelerate further treatment process especially in cases with comorbid and concomitant psychiatric disorder when adequate setting is provided and medical staff are educated and sensitized to address specific needs of this population.

NIAAA Track Focuses on Pharmacotherapy, Alcohol Disorder Guidelines

The National Institute on Alcohol Abuse and Alcoholism will hold a four-day research track on the theme “Advances in Treatment of Alcohol and Co-occurring Psychiatric Disorders Across Patient Populations and Settings” at this year’s annual meeting.

Clinical Correlates of Co-occurring Psychiatric and Autism Spectrum Disorder (ASD) Symptom-Induced Impairment in Children with ASD.

Although psychiatric symptom severity and impairment are overlapping but nevertheless distinct illness parameters, little research has examined whether variables found to be associated with the severity are also correlated with symptom-induced impairment. Parents and teachers completed ratings of symptom-induced impairment for DSM-IV-referenced syndromes, and parents completed a background questionnaire for a consecutively referred sample of primarily male (81%) 6-to-12 year olds with autism spectrum disorder (ASD) (N = 221). Some clinical correlates (e.g., IQ < 70, maternal level of education, pregnancy complications, current use of psychotropic medication, season of birth) were associated with impairment for several disorders, whereas others were correlated with only a few syndromes (e.g., gender, co-morbid medical conditions) or were not related to impairment in any disorder (e.g., family psychopathology). There was little convergence in findings for parents' versus teachers' ratings. Some clinical correlates (e.g., season of birth, current psychotropic medication, maternal education) were unique predictors of three or more disorders. Pregnancy complications were uniquely associated with social anxiety and schizoid personality symptom-induced impairment. IQ was a unique predictor of schizophrenia, ASD, oppositional defiant disorder symptom-induced impairment. Children whose mothers had relatively fewer years of education had greater odds for symptom-induced impairment in social anxiety, depression, aggression, and mania and greater number of impairing conditions. Season of birth was the most robust correlate of symptom-induced impairment as rated by teachers but not by parents. Children born in fall evidenced higher rates of co-occurring psychiatric and ASD symptom-induced impairment and total number of impairing conditions. Many variables previously linked with symptom severity are also correlated with impairment.

The Treatment of Obsessive Compulsive Disorder in a Patient with Down Syndrome

Many mental health professionals do not properly recognize the co-occurrence of psychiatric disorders and intellectual disorders. Most mental health professionals do not receive training in the diagnosis and treatment of dual diagnosed individuals. Little is known about the clinical presentation and treatment of OCD in individuals who have Down Syndrome. We describe a case of OCD in an individual with Down Syndrome in which the diagnosis of OCD was overlooked for four years after first contact with mental health professionals. The treatment of the patient is reviewed, including medication management as well as the challenges in using evidence based psychotherapy

Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD).

The reasons why women and men are treated with different antihypertensive drugs are not clear. Whether socioeconomic factors influence prescription patterns and blood pressure control differently in women and men has not been investigated. This cross-sectional study performed in a cohort of hypertensive patients from the Swedish Primary Care Cardiovascular Database (SPCCD) examined the influence of educational level, country of birth, gender and concomitant psychiatric disorder on prescription pattern and blood pressure control in 40,825 hypertensive patients. Men were more often than women treated with calcium channel blocker and angiotensin-converting enzyme inhibitor (ACEI), irrespective of education, country of birth and psychiatric disorder. Educational level influenced the prescription pattern to some extent, where the gender differences were reduced in patients with a higher educational level. In women, but not in men, high educational level and concomitant psychiatric disorder were associated with a higher proportion reaching target blood pressure. The predominant use of ACEI and calcium channel blockers in men is not influenced by educational level, country of birth or psychiatric disorder. Thus other explanations must be considered such as gender differences in side effects. Educational level seems to have a greater impact on reaching target blood pressure in women compared with men.

E28 The Alterations In Transcranial Sonography Of Huntington Disease Patients With Psychiatric Symptoms

Objective Studies of TCS report changes of the echotexture of mesencephalic raphe in patients with major depression and depressive symptoms in some neurodegenerative disorders (Parkinson’s disease (PD), Wilson’s disease (WD)). The aim of this study was to test the usefulness of TCS in diagnosing of patients with genetically confirmed HD and concomitant psychiatric disorder. It is well established that the presence of reduced nucleus raphe echogenicity correlates with signs of depression in patients with affective as well as neurodegenerative disorders (Walter et al ., 2010). TCS may be helpful in selection of the patients at risk of depression and can be useful in monitoring and management of HD patients. Methods TCS was performed in 55 patients with HD. The neurological and psychiatric examination was performed using the battery of tests Unified Huntington’s Disease Rating Scale (UHDRS motor, behavioural and cognitive), PBA-s (Problem Behaviours Assessment-Short), PBA-HD and HADS-SIS (Hospital Anxiety and Depression Scale combined with the Snaith Irritability Scale), the Hamilton Rating Scale for Depression, the Beck Depression Inventory and the Marin’s Apathy Evaluation Scale (AES). Results Hypoechogenicity of raphe nucleus was found in 80% of patients with depression (16/20), 22% of patients with irritability (2/9), 30% of patients with OCD (3/10 number) and 12,5% of patients without present or past history of psychiatric disturbances (2/16). Another finding, hyperechogenic substantia nigra was visualised in 45% and hyperechogenicity of lentiform nucleus was visualised in 55% of patients with genetically confirmed HD. Conclusions Our preliminary findings seem to confirm the relationship between changes in mesencephalic raphe echogenicity and the presence of depressive symptoms also in patients with HD.

Predictors of quit attempts and successful quit attempts among individuals with alcohol use disorders in a nationally representative sample

BackgroundThis study sought to identify predictors of attempting to quit and of successfully quitting alcohol abuse or dependence in the general population. MethodsData were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). ResultsApproximately 10% of individuals with alcohol abuse and 18% of those with dependence attempted to quit over the three year follow-up period. Of those who tried, 38% of individuals with abuse and 30% of those with dependence successfully quit. Among individuals with alcohol abuse or dependence, being single, younger than 40 years old, having low income, a co-occurring psychiatric disorder and greater number of dependence symptoms increased the likelihood of attempting to quit. Among individuals with alcohol abuse, male gender and low educational attainment further increased the odds of quit attempts. However, greater severity of alcohol use disorder, having a co-occurring drug use disorder and greater number of psychiatric disorders decreased the odds of success among individuals with alcohol abuse, while female gender, being married and older than 40 years old increased the odds of success. Among individuals with alcohol dependence, having nicotine dependence, greater number of psychiatric disorders and personality disorders decreased the odds of success. ConclusionsPredictors of attempts to quit are different and sometimes opposite from those leading to successful quitting probably indicating that some factors that increase motivation may decrease ability to quit. These findings may help in the development of more targeted and effective interventions for alcohol use disorders.

Improving opioid prescription practices and reducing patient risk in the primary care setting.

Chronic pain is complex, and the patient suffering from chronic pain frequently experiences concomitant medical and psychiatric disorders, including mood and anxiety disorders, and in some cases substance use disorders. Ideally these patients would be referred to an interdisciplinary pain program staffed by pain medicine, behavioral health, and addiction specialists. In practice, the majority of patients with chronic pain are managed in the primary care setting. The primary care clinician typically has limited time, training, or access to resources to effectively and efficiently evaluate, treat, and monitor these patients, particularly when there is the added potential liability of prescribing opioids. This paper reviews the role of opioids in managing chronic noncancer pain, including efficacy and risk for misuse, abuse, and addiction, and discusses several models employing novel technologies and health delivery systems for risk assessment, intervention, and monitoring of patients receiving opioids in a primary care setting.

Therapeutic targeting of GSK3β enhances the Nrf2 antioxidant response and confers hepatic cytoprotection in hepatitis C

ObjectiveImpaired adaptive response to oxidative injuries is a fundamental mechanism central to the pathogenesis of chronic hepatitis C (CHC). Glycogen synthase kinase (GSK) 3β is an indispensable regulator of the...

Interrelationship of PTSD, perceived health, and treatment satisfaction

Purpose – The residential therapeutic community (TC) treatment modality has been shown to effectively reduce drug use and improve psychiatric/medical health among clients who are often disproportionately impacted by medical conditions and have a co-occurring psychiatric disorder such as Posttraumatic Stress Disorder (PTSD). Yet not much is known regarding how clients’ health may impact their treatment satisfaction. Using path analysis, the interrelationship between PTSD, perceived health, and treatment satisfaction was examined. The paper aims to discuss these issues. Design/methodology/approach – A survey including the Posttraumatic Stress Disorder Checklist-Specific (PCL-S), a perceived health rating, and a Treatment Satisfaction Scale was collected from 303 clients at three comparable long-term residential TC treatment programs in New York City. Findings – Findings indicated that clients with PTSD rated their health significantly worse than those without PTSD. Although no direct relationship between PTSD and treatment satisfaction was found, there was a significant positive correlation between perceived health and treatment satisfaction. Research limitations/implications – Findings likely constitute a regional sample thus generalizability is limited. Practical implications – Simultaneously addressing addiction, PTSD, and medical issues can improve clients’ treatment satisfaction, consequently increasing treatment retention and producing greater positive post-treatment outcomes. Originality/value – Few if any studies have examined the extent to which PTSD and perceived health impact treatment satisfaction within residential substance abuse treatment programs.

Challenges and Outcomes of Parallel Care for Patients With Co-Occurring Psychiatric Disorder in Methadone Maintenance Treatment

Objective: Most opioid users seeking treatment in community-based substance abuse treatment programs have at least one co-occurring psychiatric disorder, and the presence of psychiatric comorbidity in this population is associated with increased psychological distress, poorer quality of life, and reduced response to substance abuse treatment. This observational study describes clinical outcomes of referring patients receiving methadone maintenance with at least one co-occurring psychiatric disorder to a community psychiatry program located on the same hospital campus. Methods: Participants (n = 156) were offered priority referrals to a community psychiatry program that included regularly scheduled psychiatrist appointments, individual and group therapy, and enhanced access to psychiatric medications for 1 year. Psychiatric distress was measured with the Symptom Checklist (SCL-90-R), which participants completed monthly. Results: While about 80% of the sample (n = 124) initiated psychiatric care, the average length of treatment was only 128.2 days (SD = 122.8), participants attended only 33% of all scheduled appointments (M = 14.9 sessions, SD = 14.1), and 84% (n = 104) did not complete a full year of care. Of those who did not complete a full year, over half (55%, n = 68) left psychiatric care while still receiving substance abuse treatment. Exploratory negative binomial regression showed that baseline cocaine and alcohol use disorder (p =.002 and.022, respectively) and current employment (p =.034) were associated with worse psychiatric treatment retention. Modest reductions in psychiatric distress over time were observed (SCL-90-R Global Severity Index change score = 2.5; paired t = 3.54, df = 121, p =.001). Conclusions: Referral of patients with co-occurring psychiatric disorders receiving methadone maintenance to a community psychiatry program is often ineffective, even after reducing common barriers to care. Service delivery models designed to improve attendance and retention, such as integrated care models, should be evaluated. This study is part of a larger clinical trial, registered at www.clinicaltrials.gov under #NCT00787735.

Chapter 33 - Co-occurring psychiatric disorders and alcoholism

Alcohol use disorder (AUD), a term that comprises both alcohol abuse and alcohol dependence, is a highly prevalent psychiatric disorder. Over 50% of treated AUD patients also suffer from other psychiatric disorder(s). Detailed study has revealed disorders across multiple psychiatric domains with rates of co-occurrence far greater than chance, suggesting a synergistic relationship. The basis of this synergy is explored along with its multiple forms, including behavioral and neurobiologic. Specific topics include the predisposition to both AUD and co-occurring psychopathology, the vulnerability to environmental risk factors that exacerbate these predispositions, and the nature of reinforcement in acute intoxication. Co-occurrence can also modify and exacerbate the neuroadaptations underpinning chronic dependence and relapse, the manifestations of acute and protracted withdrawal, emergence of medical and psychiatric complications, and ultimately the potential for relapse. The outcomes of co-occurrence as well as the unique impact it has on proper treatment are also discussed. Throughout, the significance of recognizing co-occurrence is emphasized since, both neurobiologically and clinically, the synergies between co-occurring disorders yield a result far more complex than a mere sum of the component disorders.

EPA-1395 – Psychopathological predictors of antipsychotic medication use in childhood autism spectrum disorders

Autism Spectrum Disorders (ASDs) affect 1% of children and are associated with lifelong psychosocial impairments. The majority of children with ASD will experience co-occurring psychiatric disorders. In the UK, antipsychotics remain unlicensed for use in ASDs, however 10% of children with ASD receive antipsychotic treatment; the co-occurring disorders being targeted by these medications remains unclear. To examine rates of antipsychotic medication use and identify associated co-occurring disorders among children with ASD receiving psychiatric care. The sample consisted of 2844 children aged 2 to 17 with a NHS clinician recorded ICD-10 diagnoses for ASD between 2008–2013. Clinical variables extracted from their anonymised electronic patient records included disorder severity, medication use, co-occurring ICD-10 diagnoses, family characteristics, demographics and antipsychotic use. Of the 2844 children (79% male), the majority (57%) had co-occurring psychiatric diagnoses. 313 (11%) received antipsychotic medication. The proportion of children aged 13 to 17 years and 6 to 12 years prescribed antipsychotics was 19% and 7% respectively. After controlling for socio-demographic factors, disorder severity, specialist treatment, inpatient duration, risk of self harm, violence to others, self injurious behaviour, maltreatment history, parental mental illness, caregiver anxiety, and neighbourhood deprivation, multivariate regression analysis revealed only hyperactivity disorders (O.R 1.94, 95%C.I. 1.32–2.86), psychotic disorders (O.R 5.12 95% C.I. 2.6–10.1), mood disorders (O.R 2.02, 95%C.I. 1.04–3.92) and intellectual disability (O.R 2.89 95% C.I. 1.89–4.71) were associated with anti-psychotic use. The prescription of antipsychotic medications in this UK ASD clinical sample is strongly associated with specific co-occurring psychiatric disorders and intellectual disability.