Common Comorbid Disorders Research Articles

The Immune-Brain Interface: Exploring PANS and PANDAS in Pediatric Neuropsychiatry

PANDAS/PANS is a burdening disorder that affects children, adolescents and caregivers. Despite numerous investigations to establish evidence-based interventions and clinical practices, more controversies and disagreements arise. This quantitative literature review established fundamental evidence regarding viral infections, bacterial infections, comorbidity, antibiotic therapy and immunotherapy. We conducted a qualitative and quantitative literature search on, Google Scholar and PubMed/Medline. The Boolean operators were used to combine search terms. An additional manual search was performed on the reference lists of the potential literature. The literature search was limited to English publications between 2014 to 2024. Results: Literature shows diverse aspects of PANDAS and PANS among children with OCD, adolescents, and other populations. The disease has been associated with bacterial and viral infections. We found a wealth of evidence on the controversial antibiotic therapy, comorbidities, immunotherapy and reports on infections. Proponents of bacterial and viral infections, alongside antibiotic therapy, emphasized the role of the infectious agents and the therapeutic effects of the antibacterial agents. Additionally, the importance of immunotherapy, NSAIDs and corticosteroids emerged, marking fundamental developments in the management of the disorder. Streptococcal and viral infections are risk factors of PANDAS/PANS, while immunotherapy, corticosteroids, NSAIDs, and antibiotic therapy produce positive clinical outcomes. However, this literature review established controversies on comorbidity, and antibiotic therapy as doctors disagree. However, we found that the authors agree that anxiety is a common comorbid disorder. Keywords: Immune-Brain Interface, PANS, PANDAS, Pediatric Neuropsychiatry, Neuroimmune Disorders

From Zero to Overwhelm: PANS and PANDAS as Culprits Behind Sudden OCD in Pediatrics

Pediatric autoimmune neuropsychiatric disorders (PANDAS) and patient neuropsychiatric syndrome (PANS) are psychiatric illnesses characterized by a rapid onset of symptoms, including obsessive-compulsive disorder (OCD), behavioral symptoms and poor motor functions in children. The rapid onset and severity of OCD symptoms prompted investigations to provide an evidence-based intervention. This case series investigates the causes, diagnosis and treatment of the disease among children presenting with neuropsychiatric symptoms and acute-onset OCD. The diagnostic procedures provided grounds for the indication of medication. Methods: Bacterial infections, autoimmune cases and viral infections among 12 children with PANDAS and PANS were retrospectively studied. Pre- and post-treatment symptomatology were examined to monitor the effectiveness of interventions, following laboratory diagnostic approaches, including the Cunningham panel, serology, stool sample analysis, polymerase chain reaction (PCR), and bacterial cultures to determine the cause of the disorder. Diagnostic results informed treatments like non-steroidal anti-inflammatory drugs (NSAIDs), intravenous immunoglobulin (IVIG), fluid therapy, antibiotics, antivirals, steroids, and selective serotonin reuptake inhibitors (SSRIs) in each child. Post-treatment diagnostic results revealed remarkably improved symptoms of PANDAS and PANS, like inflammation and viral or bacterial infection. A combined therapy of antibiotics and NSAIDs or steroids was used to clear bacterial infections and manage inflammation. SSRIs and antiviral or fluid therapy were indicated for OCD and viral infections, respectively. Conclusions: OCD is a common comorbid disorder among children with PANS and PANDAS. Despite the severity and prevalence, OCD in children raises health concerns. The case series demonstrated the effectiveness of antibiotic therapy, RRIs, cognitive behavioral therapy, IVIG, steroids and NSAIDs in managing OCD in PANDAS and PANS, with a unique rationale of indication to every child. Keywords: PANS, PANDAS, Sudden Onset OCD, Pediatric OCD, Autoimmune Neuropsychiatric Disorders

Attention-deficit Hyperactivity Disorder and Autism Spectrum Disorder: Towards Better Diagnosis and Management.

Attention-deficit hyperactivity disorder (ADHA) is one of the most common comorbid disorders of autism spectrum disorder (ASD) that can accompany autism, triggered by it, or be a consequence of it. This review explored the prevalence of the comorbidity of both disorders, neurobiological background, symptoms, latest assessment methods, and therapeutic approaches. Results and Discussion: It concluded that effective assessment, diagnosis and management of ADHD in ASD children and adults is essential for this group of patients to thrive and live a good quality of life. Further research is recommended to explore the most effective intervention for such important members of our society. More studies are needed to understand the mechanisms underlying these comorbidities, and to prevent the misdiagnosis and mismanagement of these disorders. Also, to develop up to date personalized therapeutic plans for such children.

P198: Correlation between depressive symptom severity and functional status in patients with mild cognitive impairment.

Objectives:Although depression is a common co-morbid disorder in patients with mild cognitive impairment (MCI), not all patients with MCI exhibit depressive symptoms. This study aimed to investigate the effect of depression on cognitive and functional decline in MCI.Methods:281 patients with MCI (MCI) defined by 0.5 score on Clinical Dementia Rating were included in the study. Patients were divided into three groups based on their Geriatric Depression Scale (GDS) scores: MCI without depression (GDS<10, n=50), MCI with mild depression (GDS10~19, n=120), and MCI with severe depression (GDS>20, n=111). Cognitive function tests (cognitive domains in CERAD-K including letter fluency, trail making test-A and B, and verbal learning test) and Blessed Dementia Scale-Activities of Daily Living (BDS-ADL) were measured. Group differences were analyzed using an analysis of variance (ANOVA). Correlation between GDS scores and BDS-ADL were analyzed.Results:An ANOVA test showed that activities of daily living differed significantly across groups (F(2, 276) = 13.53, p<0.001). Post-hoc analysis showed MCI with severe depression had a significantly higher mean BDS-ADL score compared with both MCI without depression and MCI with mild depression (both, p<0.001). Correlation analysis showed significant positive correlation between GDS and BDS-ADL (r=0.366, p<0.001). However, mean scores of cognitive function tests were not different among three groups.Conclusions:The present study suggests that co-morbid depressive symptoms may have negative impact on functional status in patients with MCI. This may further suggest the importance of evaluation and treatment of depressive symptoms in patients with MCI.

Impaired Lactate Release in Dorsal CA1 Astrocytes Contributed to Nociceptive Sensitization and Comorbid Memory Deficits in Rodents.

Memory deficits are a common comorbid disorder in patients suffering from neuropathic pain. The mechanisms underlying the comorbidities remain elusive. The hypothesis of this study was that impaired lactate release from dysfunctional astrocytes in dorsal hippocampal CA1 contributed to memory deficits. A spared nerve injury model was established to induce both pain and memory deficits in rats and mice of both sexes. von Frey tests, novel object recognition, and conditioned place preference tests were applied to evaluate the behaviors. Whole-cell recording, fiber photometry, Western blotting, and immunohistochemistry combined with intracranial injections were used to explore the underlying mechanisms. Animals with spared sciatic nerve injury that had displayed nociception sensitization or memory deficit comorbidities demonstrated a reduction in the intrinsic excitability of pyramidal neurons, accompanied by reduced Ca2+ activation in astrocytes (ΔF/F, sham: 6 ± 2%; comorbidity: 2 ± 0.4%) and a decrease in the expression of glial fibrillary acidic protein and lactate levels in the dorsal CA1. Exogenous lactate supply or increasing endogenous lactate release by chemogenetic activation of astrocytes alleviated this comorbidity by enhancing the cell excitability (129 ± 4 vs. 88 ± 10 for 3.5 mM lactate) and potentiating N-methyl-d-aspartate receptor-mediated excitatory postsynaptic potentials of pyramidal neurons. In contrast, inhibition of lactate synthesis, blocking lactate transporters, or chemogenetic inhibition of astrocytes resulted in comorbidity-like behaviors in naive animals. Notably, β2-adrenergic receptors in astrocytes but not neurons were downregulated in dorsal CA1 after spared nerve injury. Microinjection of a β2 receptor agonist into dorsal CA1 or activation of the noradrenergic projections onto the hippocampus from the locus coeruleus alleviated the comorbidity, possibly by increasing lactate release. Impaired lactate release from dysfunctional astrocytes, which could be rescued by activation of the locus coeruleus, led to nociception and memory deficits after peripheral nerve injury.

Comorbid disorders and therapy of persistent postural perceptual dizziness

Persistent postural perceptual dizziness (PPPD) is the most common cause of vague chronic vertigo and severely limits patients' quality of life.Limited data are available on comorbidities, the typical treatment of patients with PPPD, and the efficacy of combination therapy for PPPD.Objective: to identify comorbid disorders and evaluate the efficacy of complex therapy in patients with PPPD.Material and methods. Sixty patients (mean age 42.5±13.8 years) with PPPD were studied. All patients were prescribed complex treatment that included antidepressants (selective serotonin reuptake inhibitors), vestibular exercises, and an educational program. In 28 patients, Arlevert (combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as drug therapy. A clinical otoneurologic examination, videonystagmography, assessments by Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Spielberger State-Trait Anxiety Inventory (STAI), Dizziness Handicap Inventory (DHI) and otoneurologic examination were performed at baseline and at the end of treatment (mean, one month).Results. All patients had previous misdiagnoses, among which vertebrobasilar insufficiency and chronic cerebral ischemia predominated. Thirty two (53.33%) patients with PPPD had anxiety-depressive disorders (ADD) as the main comorbidity, 20 (33.33%) patients had migraine, 8 (13.33%) patients had previously had peripheral vestibular disorders that were not diagnosed. The severity of dizziness according to the otoneurological questionnaire and the DHI decreased after one month of therapy in the group with PPPD and ADD from 44.00±16.80 to 29.6±12.80 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 49.20±14.04 to 31.60±17.69 points (p<0.001), in the group with PPPD and migraine – from 43.58±16.28 to 28.50±7.20 points (p<0.001). The severity of anxiety and depression according to BAI decreased in the group with PPPD and ADD from 30.00±6.99 to 16.12±4.16 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 28.40±8.35 to 16.60±4.62 points (p<0.001), in the group with PPPD and migraine – from 24.11±3.80 to 14.26±3.43 points (p<0.001). The severity of depression according to BDI decreased in the group with PPPD and ADD from 9.62±5.26 to 6.25±3.20 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 14.80±8.26 to 8.40±5.37 points (p<0.001), in the group with PPPD and migraine – from 11.32±5.10 to 6.53±3.44 points (p<0.001). The severity of anxiety according to HADS decreased in the group with PPPD and ADD from 13.75±3.20 to 9.25±2.43 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 12.40±5.77 to 7.80±3.83 points (p<0.001), in the group with PPPD and migraine – from 14.26±3.16 to 8.74±2.18 points (p<0.001).The severity of depression according to HADS decreased in the group with PPPD and ADD from 4.88±4.12 to 3.88±3.09 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 8.40±3.58 to 5.60±2.88 points (p<0.001), in the group with PPPD and migraine – from 5.74±3.11 to 3.47±2.32 points (p<0.001). Situational anxiety according to STAI decreased in the group with PPPD and ADD from 47.62±6.57 to 40.12±3.68 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 58.20±7.85 to 48.00±7.65 points (p<0.001), in the group with PPPD and migraine – from 46.26±7.01 to 35.68±5.11 points (p<0.001). Personal anxiety according to STAI decreased in the group with PPPD and ADD from 52.25±10.73 to 42.12±7.06 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 58.40±5.64 to 48.60±6.77 points (p<0.001), in the group with PPPD and migraine – from 53.32±8.78 to 40.63±5.60 points (p<0.001).Conclusion. Patients with PPPD are often misdiagnosed with cerebrovascular disease. The most common comorbid disorders in PPPD are anxiety disorders and migraine, and less commonly peripheral vestibular disorders. An integrated approach to the management of patients with PPPD, including treatment of comorbid disorders, is effective.

Craniofacial disorders and headaches. A narrative review

ObjectivesCraniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies. MethodA narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors’ personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described. ResultsFrom an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache. ConclusionHeadaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words)

Гнездная алопеция — классическая коморбидность витилиго

INTRODUCTION: Vitiligo is an acquired autoimmune skin disease clinically manifested by foci of depigmentation due to the death of epidermal melanocytes. Although vitiligo most often runs in isolation, being limited to a pathological process in skin, this disease can lead to the development of a number of comorbid disorders. Alopecia areata also being an autoimmune disorder of skin appendages, is one of the most common comorbid disorders in vitiligo, manifesting along with the main disease, against the background main disease, or as the main disease itself. In the article, a clinical case of association of vitiligo and alopecia areata is presented, similarities and differences in their pathogenesis are discussed, and other comorbid disorders are described. CONCLUSION: Determination and identification of comorbid disorders with the underlying chronic dermatosis is an important task aiming to prevent the development of probable autoimmune and autoinflammatory disorders. Despite the fact that vitiligo usually runs without systemic manifestations, identification and prevention of a comorbid pathology of the dermatosis should not be ignored by clinicians of different profiles.

Serum levels of erythropoietin in patients with chronic obstructive pulmonary disease and anemia

The important association of erythropoietin (EPO) serum levels and chronic obstructive pulmonary disease (COPD) with anemia has been inadequately studied and remains a controversial issue. We aimed to shed light on this matter by comparing EPO levels in anemic and non-anemic COPD patients, along with a review of published literature. This cross-sectional study was conducted on COPD patients referred to the pulmonary clinic of Shahid Faghihi Hospital and Motahari clinic, Shiraz, Iran, for one year. We measured complete blood count, red blood cell indices, serum iron, TIBC and ferritin levels, serum EPO levels, and body mass index. Among 35 patients in this study, 28 males and 7 females were enrolled with a mean age of 54.57 ± 8.07 years. The average Forced expiratory volume in first second (FEV1) was 37.26 ± 7.33% and FEV1/FVC was 0.46 ± 0.12. Mean EPO levels were 30.29 ± 2.066 mU/mL. No statistically significant association was observed among erythropoietin levels and Hb, COPD severity, and age. There was no significant difference in EPO levels between anemic and non-anemic patients. EPO level, against the traditional expectation, didn’t increase in COPD patients. EPO production also didn’t compensate for the anemia of chronic disease which considers as a common comorbid disorder in these patients.

Periodontal disease in cats under primary veterinary care in the UK: frequency and risk factors.

Periodontal disease is a multifactorial inflammatory disease that can have major welfare implications in cats. This study aimed to report the frequency and demographic risk factors of periodontal disease and to explore associations with common comorbid disorders in cats in the UK. The study included a random sample of 18,249 cats obtained from 1,255,130 cats under primary care during 2019 from clinics participating in the VetCompass programme. All disorders recorded during 2019 were extracted and reported. Risk factor and comorbid disorder analysis used multivariable logistic regression modelling. Periodontal disease had a 1-year period prevalence of 15.2% (95% confidence interval [CI] 14.72-15.76). Breeds with the highest prevalence included Siamese (18.7%, 95% CI 12.24-26.72) and Maine Coon (16.7%, 95% CI 11.37-23.18). The median age of cats with periodontal disease (9.47 years, interquartile range [IQR] 5.96-12.97) was higher than for cats without periodontal disease (4.94 years, IQR 1.95-9.51; P <0.001). Increasing adult body weight, increasing age and sex-neuter status were significantly associated with rising odds of periodontal disease. Cats with periodontal disease had a higher median count of comorbid disorders per individual cat (3, IQR 2-4, range 1-14) than cats without periodontal disease (1, IQR 0-2, range 0-15; P <0.001). Cats with periodontal disease had 1.79 times the odds (95% CI 1.62-1.99, P <0.001) of diagnosis with at least one comorbid disorder disease than cats without periodontal disease. Periodontal disease is the most common specific diagnosis in cats and is confirmed as a leading health issue in cats. Ageing is identified as the strongest predictor of periodontal disease risk in cats, suggesting the potential for increasing health gains from emphasis on dental care and health in cats as they age. The study offers evidence on a close link between periodontal disease and reduced overall health in cats.

Dorsal bed nucleus of stria terminalis in depressed and nondepressed temporal lobe epilepsy patients.

Temporal lobe epilepsy (TLE) and depression are common comorbid disorders whose underlying shared neural network has yet to be determined. Although animal studies demonstrate a role for the dorsal bed nucleus of the stria terminalis (dBNST) in both seizures and depression, and human clinical studies demonstrate a therapeutic effect of stimulating this region on treatment-resistant depression, the role of the dBNST in depressed and nondepressed TLE patients is still unclear. Here, we tested the hypothesis that this structure is morphologically abnormal in these epilepsy patients, with an increased abnormality in TLE patients with comorbid depression. In this case-controlled study, 3-T structural magnetic resonance imaging scans were obtained from TLE patients with no depression (TLEonly), TLE patients with depression (TLEdep), and healthy control (HC) subjects. TLE subjects were recruited from the Yale University Comprehensive Epilepsy Center, diagnosed with the International League Against Epilepsy 2014 Diagnostic Guidelines, and confirmed by video-electroencephalography. Diagnosis of major depressive disorder was confirmed by a trained neuropsychologist through a Mini International Neuropsychiatric Interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The dBNST was delineated manually by reliable raters using Bioimage Suite software. The number of patients and subjects included 35 TLEonly patients, 20 TLEdep patients, and 102 HC subjects. Both TLEonly and TLEdep patients had higher dBNST volumes compared to HC subjects, unilaterally in the left hemisphere in the TLEonly patients (p= .003) and bilaterally in the TLEdep patients (p< .0001). Furthermore, the TLEdep patients had a higher dBNST volume than the TLEonly patients in the right hemisphere (p= .02). Here, we demonstrate an abnormality of the dBNST in TLE patients, both without depression (left enlargement) and with depression (bilateral enlargement). Our results demonstrate this region to underlie TLE both with and without depression, implicating it as a target in treating the comorbidity between these two disorders.

Evaluation of rosmarinic acid against myocardial infarction in maternally separated rats.

Depression and coronary heart diseases are the common comorbid disorder affecting humans globally. The present study evaluated the effectiveness of rosmarinic acid (RA) against myocardial infarction (MI) in comorbid depression induced by maternal separation in rats. Maternal stress is one of the childhood crises that may be a potential risk factor for coronary heart disease in later part of life. As per protocol, 70-80% of pups were separated daily for 3h between postnatal day 1 (PND1) and postnatal day 21 (PND21). Forced-swim test, sucrose preference test, and electrocardiography were performed during the experiment. Body weight was measured on PND0, PND35, and PND55. Orally rosmarinic acid (25mg/kg and 50mg/kg) and fluoxetine (10mg/kg) was done from PND35 to PND55. On PND53 and PND54, isoproterenol (100mg/kg, subcutaneously) was administered to induce myocardial infarction. On PND55, blood was collected and animals sacrificed, and plasma corticosterone, brain-derived neurotrophic factor, cardiac biomarkers, interleukine-10, and anti-oxidant parameters were measured. Rosmarinic acid and fluoxetine ameliorated the maternal separation-induced increase in immobility period, anhedonia, body weight, ST elevation, corticosterone, creatine kinase-MB (CK-MB), and lactate dehydrogenase (LDH). At the same time, both drugs elevated the tissue levels of BDNF, IL-10, glutathione, and superoxide dismutase activity. This study provides the first experimental evidence that maternal stress is an independent risk factor of cardiac abnormalities in rats. Moreover, maternal stress synergistically increases the severity of cardiac abnormalities induced by isoproterenol. Interestingly, fluoxetine and rosmarinic acid effectively ameliorated behavioral anomalies and myocardial infarction in maternally separated rats. Schematic representation of possible molecular mechanism of action of rosmarinic acid against MS-induced myocardial infarction. RA, rosmarinic acid; MS, maternal separation; PND, postnatal days; ISO, isoproterenol; BDNF, brain-derived neurotrophic factor; GSH, glutathione; SOD, superoxide dismutase; IL-10, interleukin-10; MI, myocardial infarction.

0471 Identifying Trauma-Informed Adaptations to Cognitive Behavioral Therapy for Insomnia among Women Veterans: Results of an Expert Panel

Abstract Introduction Trauma-informed care is an emerging area of health services research. While trauma-focused care specifically targets symptoms of posttraumatic stress disorder (PTSD), trauma-informed care involves tailoring interventions to meet the unique needs of patients who have experienced trauma. Insomnia and PTSD are common comorbid disorders, but no known previous studies have identified trauma-informed adaptations to cognitive behavioral therapy for insomnia (CBT-I). Methods We identified PTSD clinical presentations that may interfere with the delivery of effective CBT-I and possible adaptations to standard CBT-I that may address these clinical presentations based on a literature review. We then incorporated trauma-informed adaptations into a 5-session CBT-I protocol. Four Veterans Affairs (VA) Expert Trainers in CBT-I were sent the trauma-informed CBT-I materials and rating forms. They were asked to rate the extent to which PTSD clinical presentations serve as barriers to CBT-I (1=low barrier; 5=high barrier), the feasibility of possible adaptations (1=low feasibility; 5=high feasibility), and to provide qualitative feedback. A 60-minute panel meeting was convened and aggregated data from rating forms were presented and discussed. We then revised the trauma-informed CBT-I materials. Panelists reviewed the revised trauma-informed CBT-I materials and completed post-panel rating forms. Results The highest-ranked clinical presentations based on rating forms and panel consensus included: sleep avoidance/nighttime arousal, sleep-related self-efficacy, substance/medication use to induce sleep, and safety behaviors intended to reduce nighttime arousal. Panel meeting consensus identified the following trauma-informed adaptations to CBT-I: PTSD-related nighttime hyperarousal psychoeducation, identification of alternatives to PTSD-related safety behaviors, nightmare psychoeducation, psychoeducation about PTSD avoidance in the context of substance/medication use, cognitive techniques, and behavioral tracking to challenge beliefs and avoidant behaviors. Panelists agreed the revised trauma-informed CBT-I materials adequately addressed the PTSD clinical presentations that may limit the effectiveness of standard CBT-I for patients with comorbid PTSD. Conclusion This was the first study to use an expert panel to identify trauma-informed adaptations to CBT-I. Trauma-informed adaptations, including supplemental materials, may improve CBT-I outcomes for patients with comorbid PTSD. Future studies should incorporate feedback from patients with insomnia and PTSD to refine trauma-informed adaptations to CBT-I further. Support (If Any) VA HSR&amp;D (RCS-20-191, Martin), NHLBI (K23HL143055, Martin)

P103 Mapping the clinical profile of ankylosing spondylitis patients prescribed etanercept in India (The ESMA Study)

Abstract Background/Aims Tumor necrosis factor (TNF) blocking therapies like etanercept (ETN) have revolutionized the management of ankylosing spondylitis (AS). Clinical trials suggest that Etanercept exhibits beneficial effects in terms of improving disease severity of AS patients. Etanercept has also been shown to have a good safety profile as compared to other TNF inhibitors in terms of risk of tuberculosis (TB) which seems to be an important aspect especially in India, considering the high prevalence of TB here. Despite having an established efficacy and safety profile, data regarding patient profile of AS patients who are prescribed etanercept is not clear. Methods This retrospective, multicentric, cross sectional, data collection form based observational study was planned to evaluate the patient profile of AS patients who are prescribed etanercept in India. Results Retrospective data of 423 AS patients was collected across 48 centers in India. Mean age of AS patients prescribed ETN was 53.26±8.60 years. 84.63% patients were males while the remaining 15.37% were females. To some extent, this can be attributed to the epidemiology of AS which is seen more commonly in males. Average height and weight of the patients were 68.30±7.11 kg and 166.75±3.98 cm respectively. Mean Body mass index (BMI) of the patient group was 24.59±2.66 kg/m2. 6.38% patients were obese while 21.27% patients were in the overweight category. Most of the patients had a medication history of taking some or other non-steroidal anti-inflammatory drug (NSAID) (95.98%). Other drugs which were previously consumed by the patients included sulfasalazine (74.47%), methotrexate (26.95%), steroids (13.95%). 11.11% of patients had a previous medication history of biologic medications including infliximab (6.86%), adalimumab (2.84%), secukinumab (0.95%) and golimumab (0.47%). Most common comorbid disorder reported in the patient group was hypertension (15.60%). Other comorbidities were diabetes mellitus (7.32%), inflammatory bowel disorder (4.3%) and psoriasis (1.65%). Erythrocyte sedimentation rate (ESR) was done in 29.74% of the patients with a mean value of 20.42 ±10.35 mm/hr. C-reactive protein (CRP) was done in 25.76% patients with a mean value of 10.82±4.27 mg/L was reported.HLA-B27 antigen testing was done only for 13.23% patients. Among patients who were subjected to HLA-B27 testing, 78.57% were HLA-B27 positive while the remaining 21.43% patients were HLA-B27 negative. 95.03% of the patients were prescribed ETN dose of 50mg/week through subcutaneous route while 4.97% of patients received ETN dose of 25mg twice weekly. Sulfasalazine was prescribed in 78.72% of these patients and was the most commonly co-prescribed drug along with ETN. Other commonly co-prescribed medications included NSAIDS (32.62%), methotrexate (28.37%) and steroids (5.67%). Conclusion Etanercept is commonly used in patients not responding to NSAIDS &amp; sulfasalazine. It is even used in patients who have been on biologics previously. Disclosure A.B. Jain: Corporate appointments; Medical Advisor to Intas Pharmaceuticals Ltd, India. S. Warudkar: Corporate appointments; Medical Advisor to Intas Pharmaceuticals Ltd, India. N. Dave: Corporate appointments; Medical Advisor to Intas Pharmaceuticals Ltd, India. A. Chaturvedi: Corporate appointments; Medical Advisor to Intas Pharmaceuticals Ltd, India.

Glucose-Related Traits and Risk of Migraine-A Potential Mechanism and Treatment Consideration.

Migraine and glucose-related (glycaemic) traits (fasting glucose, fasting insulin, and type 2 diabetes) are common and complex comorbid disorders that cause major economic and social burdens on patients and their families. Studies on the relationship between migraine and glucose-related traits have yielded inconsistent results. The purpose of this review is to synthesise and discuss the information from the available literature on the relationship between fasting glucose, fasting insulin, and type 2 diabetes (T2D) with migraine. Publications on migraine and fasting glucose, migraine and fasting insulin, and migraine and T2D were identified from a PubMed and Google Scholar database search and reviewed for this article. Multiple publications have suggested that the comorbidity of migraine and glucose-related traits may have a similar complex pathogenic mechanism, including impaired glucose homeostasis, insulin resistance, reduced cerebrovascular reactivity, abnormal brain metabolism, shared genetic factors, neurotransmitters, and sex hormones. Furthermore, several studies have found a bi-directional link between migraine with insulin resistance and T2D. There is strong evidence for a biological association between migraine headache and glucose-related traits, and burgeoning evidence for shared genetic influences. Therefore, genetic research into these comorbid traits has the potential to identify new biomarkers and therapeutic targets and provide biological insight into their relationships. We encourage healthcare professionals to consider the co-occurrence of migraine with glucose-related traits in the evaluation and treatment of their patients.

Varieties of Comorbid Disorders in Children with Mental Retardation

The subject of the study is comorbid disorders of children with mental retardation. The object of the study is the frequency of comorbid disorders of the children with mental retardation. Using a retrospective analysis of medical records, the authors examine in detail the neuropsychiatric manifestations and behavioral stereotypes that frequently occur in the study sample of children. These behavioral stereotypes or comorbid disorders were noted by parents or health care professionals who interacted with the children. The total sample included 1,000 preschool and young children (from 1.5 to 7 years old) with various neuropsychiatric speech diagnoses - delayed speech development, autism spectrum disorders, delayed psycho speech development, and other unspecified speech diagnoses. The main finding of this study is that a list of the most common comorbid disorders was compiled. Using this list of the most common behavioral disorders, it is possible to make a screening assessment of mental development and identify the degree of its delay on the basis of the formed behavioral and speech patterns. This will help specialists (psychologists, speech therapists, defectologists and neuropsychologists) working with children to provide them with the necessary assistance in a timely manner. The scientific novelty of the study lies in the fact that previously no comprehensive list of the most common behavioral disorders of the children with mental retardation was compiled. This list made it possible to differentiate the primary diagnosed child into one or another group according to the belonging to the diagnosis, with subsequent more thorough verification of the diagnosis.

Factors Influencing Stress Perception among Hemodialysis Patients: A Systematic Review

Background: Stress is a common comorbid disorders among hemodialysis patients and diverse factors contributed for stress perception among hemodialysis patients. Although, many findings have been consistent across the literature, there has been a surprising lack of consensus in which factor is most influence the stress perception. Objectives: This systematic review aimed to provide executive review on factors contribute for stress perception among hemodialysis patients Methods: Systematic review was conducted in Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, EBESCOhost, Google scholar, Medline and Web of Science (WOS) databases. Rigorous search narrowed to 16 observational studies (Total N=3567) on factors determine for stress perception among hemodialysis patients. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline were inco-operated. Selected 16 articles were used in the qualitative synthesis. Results: Stressors were clustered as Biological, Psychological/Behavioral, or Social/Environmental factors. Effect of socio-demographic factors on stress perception was scarce and inconsistent; whilst fatigue and itching were distressing biological factors. Limitations on time and place on vacation, limitation of food and fluid, decrease in social life with substantial economic burden were enlightened as psychological and social stressors respectively. Conclusion: Multidisciplinary factors were inspired for stress perception among hemodialysis patients. Nursing care plans should addressed holistic nature of stress with appropriate nursing interventions. Although this review adopted the strict selection criteria, it remains difficult to conclude determinants due to methodological drawbacks. Thus, future research in this scope is highly appreciated with prospective longitudinal nature to produce solid clinical conclusions.

Temporal Epilepsy: Morphological Substantiation of Psychoemotional Disorders

The most common psychopathological comorbid disorder in epilepsy is depression. We conducted a comprehensive examination of 80 patients with epilepsy. All the patients underwent neuroimaging and electroencephalography mapping. Beck and Spielberger-Khanin tests were used to assess a degree of severity of interictal depression and anxiety disorder. The presence of structural-metabolic disorders is important in the development of depression in patients with epilepsy. First of all, it is the deficit of corpus callosum, fornix and brain stem tracts that is registered when conducting a voxel-morphometry and diffusion tensor imaging. The findings indicate the presence of a larger deafferentation on the side of an epileptic focus. According to our results, psychoemotional disorders in epilepsy are associated with neurometabolic disorders in external parts of brain temporal lobes. The reduction of main peak amplitude P300, which is an objective characteristic of attention processes, correlates with metabolic process disorders in hippocampal structures. The combination of the cluster of a tractographic picture depletion in frontal parts and the cluster of the reduction of imaging brain commissures is the most unfavorable one in relation to developing cognitive and psychoemotional disorders in epilepsy. Modern neuroimaging techniques add more clinical criteria for epilepsy.

Psychiatric comorbidity and quality of life in patients with bipolar disorder

Psychiatric comorbidity in patients with bipolar disorder (BD) has been associated with an earlier onset, rapid cycling, worsening severity and outcome, and increased suicidality. Patients with BD have been reported to have poor quality of life (QOL) even during remission. Estimate the prevalence of psychiatric comorbidity and assess the QOL in patients with BD, and find the associated sociodemographic and clinical variables. This cross-sectional study was done in a general hospital psychiatric unit on 100 patients (both inpatients and outpatients) with DSM-IV-TR BD in partial or complete remission. Patients were assessed using a semi-structured pro forma, Mini International Neuropsychiatric Interview 6.0 - Hindi version, Hamilton Rating Scale for Depression or Young Mania Rating Scale and World Health Organization QOL instrument, short-form (WHOQOL-BREF), Hindi Version. Sixty-one percent of the sample had at least one psychiatric comorbidity, and the commonest comorbid disorders were substance use disorders (SUD) (30%) and anxiety disorders (AD) (28%). Male gender was identified as a predictor for comorbidity in BD. The mean QOL-BREF score was 85.96 ± 14.35. Poor QOL was associated with older age at onset of comorbidity, multiple comorbidities, mixed episodes, rapid cycling, partial remission, and increased severity of depression while patients with current hypomanic symptoms were found to have better QOL. BD with comorbidity had worse QOL than those without comorbidity. The majority of patients with BD had at least one comorbidity. SUD were the most common comorbid disorders. QOL, already poor in BD patients, was poorer in cases with comorbidity.

Association between bipolar affective disorder, use of antidepressants and osteoporosis

Introduction/Objective. Osteoporosis is one of the most common comorbid disorders in depressive mood disorder. The aim of this study was to assess the association between the use of antidepressants and osteoporosis in patients with bipolar affective disorder (BPAD). Methods. The study included 73 inpatients, aged 50?72 years, male and female, hospitalized with a depressive episode of BPAD from 2016 to 2020 at the Clinic of Psychiatry, Clinical Centre of Vojvodina, divided into two groups: a) the first group (40) was treated with selective serotonin reuptake inhibitors (SSRIs) in combination with mood stabilizer (lithium carbonate/lamotrigine); b) the second group (33) was treated with mood stabilizer only. Study included two control groups as well. Clinical measurements of bone mineral density at lumbar spine and hip was made using dual energy X-ray absorptiometry. CrossLaps and levels of calcium and vitamin D were collected from blood samples. The data was analyzed by the analysis of variance and the Kruskal?Wallis test. Results. Osteoporosis was registered in 25% of patients in the first group and in 18% of patients in the second group, while osteopenia was observed within 40% of patients in the first group and in 37% of patients in the second group. There was significant difference in value of CrossLaps, and the level of 25(OH)D vitamin between the control groups and the first two groups, as well as in prevalence of osteoporosis and osteopenia. Conclusion. Depressive episodes in BPAD is connected with higher prevalence of osteoporosis. Patients treated with SSRIs have higher prevalence of osteoporosis than patients treated with mood stabilizers only.