Comorbid Axis Research Articles

Suicide attempts in bipolar I patients: impact of comorbid personality disorders.

Objective:To evaluate the association between personality disorders (PDs) and suicide attempts (SAs) in euthymic patients with type I bipolar disorder (BD).Methods:One-hundred twenty patients with type I BD, with and without history of SA, were evaluated during euthymia. The assessment included a clinical and sociodemographic questionnaire, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was employed to determine associations between history of SA and patient characteristics.Results:History of SA was significantly associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Only cluster B PDs, high attentional impulsivity, and lack of paid occupation remained significant after multivariate analysis.Conclusions:Cluster B PDs were significantly associated with SA in patients with type I BD. High attentional impulsivity and lack of gainful employment were also associated with SA, which suggests that some cluster B clinical and social characteristics may exacerbate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.

Clinical features of Japanese patients with Hording Disorder

Event Abstract Back to Event Clinical features of Japanese patients with Hording Disorder TOMOHIRO NAKAO1*, SATOSHI YAMADA1, KEITARO MURAYAMA1, MASUMI KUWANO1, KEISUKE IKARI1, HIROFUMI TOMIYAMA1, SUGURU HASUZAWA1 and SHIGENOBU KANBA1 1 Graduate School of Medical Sciences, Kyushu University, Neuropsychiatry, Japan 【Objective】In the DSM-5 published in 2013, primary hoarding symptoms were separated from OCD and defined as a new diagnosis called Hording Disorder (HD). Patients with HD show persistent difficulty discarding or parting with personal possessions, even those apparently useless or of limited value, due to strong urges to save items and the distress and/or indecision associated with discarding. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Patients with HD also show stronger inheritance, earlier onset and poorer treatment response compared to OCD. However, there has been little information about HD. To clarify the clinical characteristics of HD, we conducted a clinical survey for HD. 【Methods】Participants who are suffering hoarding symptoms were recruited from the Department of Neuropsychiatry, Kyushu University Hospital and the related clinics. The diagnoses of HD were assessed by The Structured Interview for Hoarding Disorder (SIHD). Comorbid axis I disorders were screened by the Structured Clinical Interview for DSM-IV (SCID). Clinical information of each participants such as onset age of hoarding symptom were investigated individually in detail. The study was approved by the local ethics committee, and each participants provided a written informed consent after receiving a complete description of the study. 【Conclusion】Thirty-three participants completed the survey. Among them, twenty-one participants were diagnosed as HD. The mean age of participants with HD were 45.1±13.5. The age of onset were 18.1±12.8. Comorbid axis I disorders are as follows: Major Depression=11, ADHD=5, OCD=2, Bipolar Disorder=2, Panic Disorder=2. The results suggested that HD occurs in adolescence and have a chronic course. Our results also showed that most participants with HD had comorbid mental disorders including depression and ADHD. Acknowledgements This study was supported by a Grant-in-Aid for Scientific Research (C) (15K09834) from the Japanese Ministry of Education, Culture, Sports, Science and Technology, Keywords: Hoarding disorder, OCD, ADHD, Comorbidity, clinical survey Conference: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future, London, United Kingdom, 6 Jul - 7 Jul, 2017. Presentation Type: Poster Topic: Diagnosis / Classification Citation: NAKAO T, YAMADA S, MURAYAMA K, KUWANO M, IKARI K, TOMIYAMA H, HASUZAWA S and KANBA S (2019). Clinical features of Japanese patients with Hording Disorder. Front. Psychiatry. Conference Abstract: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future. doi: 10.3389/conf.fpsyt.2017.48.00009 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 26 May 2017; Published Online: 25 Jan 2019. * Correspondence: PhD. TOMOHIRO NAKAO, Graduate School of Medical Sciences, Kyushu University, Neuropsychiatry, Fukuoka, 8128582, Japan, nakao.tomohiro.275@m.kyushu-u.ac.jp Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers TOMOHIRO NAKAO SATOSHI YAMADA KEITARO MURAYAMA MASUMI KUWANO KEISUKE IKARI HIROFUMI TOMIYAMA SUGURU HASUZAWA SHIGENOBU KANBA Google TOMOHIRO NAKAO SATOSHI YAMADA KEITARO MURAYAMA MASUMI KUWANO KEISUKE IKARI HIROFUMI TOMIYAMA SUGURU HASUZAWA SHIGENOBU KANBA Google Scholar TOMOHIRO NAKAO SATOSHI YAMADA KEITARO MURAYAMA MASUMI KUWANO KEISUKE IKARI HIROFUMI TOMIYAMA SUGURU HASUZAWA SHIGENOBU KANBA PubMed TOMOHIRO NAKAO SATOSHI YAMADA KEITARO MURAYAMA MASUMI KUWANO KEISUKE IKARI HIROFUMI TOMIYAMA SUGURU HASUZAWA SHIGENOBU KANBA Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Psychiatric Comorbidity and Physical Correlates in Alcohol-dependent Patients.

Aim:To examine the prevalence and pattern of comorbidity in alcohol dependence and its relationship with physical and laboratory findings.Materials and Methods:Eighty males with alcohol dependence were examined using the Hindi version of Diagnostic Interview for Genetic Studies, the International Classification of Disease-10th Edition Personality Disorder Examination, Alcohol Use Disorder Identification Test for alcohol use, global assessment of functioning, blood sampling electrocardiogram, and ultrasonogram.Results:Eighty-seven percent had a comorbid Axis I or an Axis II psychiatric disorder, over 78% had nicotine dependence, and 56% had comorbid Axis II disorder, antisocial personality being the most common. Gamma glutamyl transpeptidase levels were significantly associated with comorbidity.Conclusions:High comorbidity of Axis I psychiatric disorders was found among persons with alcohol dependence. Axis II disorders were also present.

Sex- and Subtype-Related Differences in the Comorbidity of Adult ADHDs

Objective: Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences from studies with small sample size. Method: A large sample of 910 individuals (458 males, 452 females) affected with aADHD was recruited at a tertiary referral center. All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders to assess comorbidity. This study will provide additional information regarding the co-morbidity of Axis I disorders in the currently largest clinical referral sample. However, the main objective of this study is to gain information about sex- or subtype-related differences. Results: Affected females show higher rates of mood (61% vs. 49%), anxiety (32% vs. 22%), and eating disorders (16% vs. 1%) than affected males, while substance use disorders were more frequent in affected males (45% vs. 29%), which mirrors sex differences in prevalence in the general population. There were hardly any relevant differences in comorbidities between subtypes, with the exception of the inattentive subtype having an especially low prevalence of panic disorder. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status. Conclusion: Sex-related differences in the comorbidity of aADHD are more pronounced than subtype-related differences.

Treatment-Resistant Obsessive-Compulsive Disorder: Neurocognitive and Clinical Correlates

There are a number of studies examining clinical and comorbidity profiles among patients with treatment-resistant obsessive-compulsive disorder (TR-OCD); however, there have been far fewer investigations of neurocognitive function among such patients. Five patients with treatment-refractory obsessive-compulsive symptoms underwent neurocognitive and clinical/personality testing. A number of TR-OCD patients met diagnostic criteria for major axis I disorders (particularly mood and anxiety disorders) as well as clusters A, B, and C personality disorders. TR-OCD patients demonstrated significant performance deficits on neurocognitive tests of visuospatial working memory, visuoconstructive ability, and executive control as well as one test of processing speed, but not a second, relative to healthy normative controls. TR-OCD patients and normative controls did not differ significantly on measures of verbal working memory, sequencing, figure copy organization, inhibitory control, and odor identification. In addition, TR-OCD patients were directly compared to five healthy controls evaluated in our laboratory for a separate unpublished study. TR-OCD patients demonstrated significant performance deficits on tests of visuospatial working memory, information processing speed, and executive control, and obtained substantially higher scores on dimensional measures of social anxiety and depressive symptom severity, but not schizotypal personality features. Group differences of tests of verbal working memory, inhibitory control, and additional tests of executive function were not significant. In summary, patients with TR-OCD presented with comorbid axis I conditions (primarily mood and anxiety disorders) and personality disorders. TR-OCD patients demonstrated deficits on some, but not all, tests of working memory and executive control. Neurocognitive test findings lend partial support to the hypothesis that right hemisphere (particularly dorsolateral-prefrontal, but not orbitofrontal) dysfunction is associated with TR-OCD, and a number of TR-OCD patients met diagnostic criteria for major axis I disorders (particularly mood and anxiety disorders) as well as cluster A, B, and C personality disorders further complicating treatment.

Neural correlates of hallucinations in bipolar disorder.

Objective:Approximately one-half of all patients affected by bipolar disorder present with psychotic features on at least one occasion. Several studies have found that alterations in the activity of mesolimbic and prefrontal regions are related to aberrant salience in psychotic patients. The aim of the present study was to investigate the structural correlates of a history of hallucinations in a sample of euthymic patients with bipolar I disorder (BD-I).Methods:The sample consisted of 21 euthymic patients with BD-I and no comorbid axis I DSM-IV-TR disorders. Voxel based morphometry (VBM) was used to compare patients with and without a lifetime history of hallucinations. Preprocessing was performed using the Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) algorithm for VBM in SPM8. Images were processed using optimized VBM.Results:The main finding of the present study was a reduction in gray matter volume in the right posterior insular cortex of patients with BD-I and a lifetime history of hallucinations, as compared to subjects with the same diagnosis but no history of hallucinations.Conclusions:This finding supports the presence of abnormalities in the salience network in BD patients with a lifetime history of hallucinations. These alterations may be associated with an aberrant assignment of salience to the elements of one’s own experience, which could result in psychotic symptoms.

A Two Year Follow up Study of Group Metacognitive Therapy for Depression in Norway

Objective: Preliminary data support the implementation of individual metacognitive therapy (MCT) for depression and recently published data indicate that group MCT in the treatment of depression is effective and well-accepted. This study examined 12 and 24 months follow up of patients treated with group MCT. We conducted a one and two year follow-up of an open trial of group MCT. Method: Ten patients who were consecutively referred by general practitioners to a specialist psychiatric practice in Norway participated in an open trial of the effects and feasibility associated with group MCT for depression. All of the patients met the DSM-IV criteria for major depressive disorder (MDD) and were followed up for 6 months, one and two year. The primary symptom outcome measure was severity of depression whilst secondary outcome measures included levels of anxiety, rumination, and metacognitive beliefs. We also assessed recovery rates and changes in comorbid Axis I and Axis II diagnoses at one and two year follow up. Result: Large clinically significant improvements across all measures that were detected at post-treatment were maintained at one year and two year follow up. Based on objectively defined recovery criteria, 70% of the patients were classified as recovered at 1 year and 80% at 2 year follow up. Conclusion: These preliminary data indicate that group MCT in the treatment of depression had sustained efficacy after one and two years, beyond what has been typically reported for cognitive behavioral therapy (CBT).

Metabolic Syndrome in First Manic Episode: A Comparison between Patients with or without Previous Depressive Episode

Objective: The purpose of this study was to investigate, whether an association between metabolic syndrome (MetS) and clinical features and affective temperaments exists or not in first manic episode of bipolar disorder (BD) with or without previous depressive episode. Methods: Diagnosed with dipolar disorder type I according to DSM-IV criteria fifty four patients who were had a least one previous depressive episode (PDE) and 87 patients who were experiencing their first manic episode (FME) evaluated consecutively for inclusion. Comorbid axis I disorders and alcohol or substance use were excluded. NCEP ATP III formulated an operational definition of MetS based on the presence of three or more of the following characteristics: abdominal obesity (waist circumference), hypertriglyceridemia, low HDL or being on an antilipidemic agent, high blood pressure or being on an antihypertensive agent, and fasting hyperglycemia or being on antiglycemic agent. The patients who had been in remission period for at least 8 weeks were evaluated with SCIP-TURK and TEMPS-A. Remission was defined as YMRS score<5. Results: MetS was found to be more frequent in these patients than the patients who didn’t have a PDE. PDE, negative family history, childhood trauma and seasonality are determined as the predictors of MetS. Anxious temperament scores were higher in MetS (+) FME patients of both groups. Irritable temperament scores were higher only in MetS (+) FME patients without PDE group. Conclusion: The presence of MetS seems to be correlated with the onset and progression of BD. This may also contribute to the discovery of biological markers, increase in our diagnostic tools, development of protective and individual-spesific treatment options.

Inclusion/exclusion criteria in placebo-controlled studies of vortioxetine: Comparison to other antidepressants and implications for product labeling

BackgroundWe recently conducted a comprehensive review of the psychiatric inclusion/exclusion criteria used in 170 placebo-controlled antidepressant efficacy trials (AETs) published during the past 20 years and found that the criteria of more recent studies were significantly more restrictive than prior studies. Vortioxetine is the most recently approved medication for the treatment of major depressive disorder (MDD). We compared the inclusion/exclusion criteria of the vortioxetine studies to the criteria used in other AETs, and discuss the broader issue of the generalizability of AETs and the implications this might have for the labeling of antidepressants receiving FDA approval. MethodsWe conducted a comprehensive literature review of placebo-controlled AETs published from January, 1995 through December, 2014. We identified 170 AETs published during this 20 year period and compared the inclusion/exclusion criteria used in the 12 studies of vortioxetine to those used in the nonvortioxetine studies. A second analysis compared vortioxetine to the 3 antidepressants most recently approved prior to vortioxetine (desvenlafaxine, levomilnacipran extended release, vilazodone). ResultsCompared to the nonvortioxetine AETs, the vortioxetine studies significantly more often excluded patients with any comorbid Axis I disorder (p<.001) and more often required the current depressive episode to be longer than the DSM minimum symptom duration requirement of 2 weeks (p<.01). The cutoff on the Montgomery Asberg Depression Rating Scale required for inclusion in the vortioxetine studies was higher than the cutoff used in the other AETs (p<.01). LimitationsA limitation of the present analysis is that it was based on published placebo-controlled studies of antidepressants. ConclusionThe inclusion/exclusion criteria in the studies of vortioxetine were more restrictive than the criteria used in other AETs. Inconsistent with FDA guidelines on the labeling of medications, the label of vortioxetine does not include a description of the limits to the group of patients with MDD for whom the medication has been shown to be effective.

Psychiatric comorbidity among inpatients in an addiction clinic and its association with the process of addiction

Objective: Epidemiological studies find a high comorbidity of other Axis I and Axis II disorders with substance use disorders among adults. This study examines comorbid Axis I and Axis II disorders in order to investigate their association with sociodemographic variables and relapse among inpatients diagnosed with substance use disorders. Method: Of 403 inpatients hospitalized between January 2012 and December 2013 in an addiction clinic, 323 were enrolled in this retrospective study using their medical records and sociodemographic data. These patients were all diagnosed with alcohol and substance abuse/dependence according to DSM-IV TR by two different psychiatrists, and comorbidities were also diagnosed by two different psychiatrists. Results: Among 323 inpatients with substance use disorder, 240 (74.3%) were diagnosed with another Axis I comorbidity and 238 (73.7%) had an Axis II disorder. No statistical difference was found between patients with and without an Axis I or Axis II comorbidity in terms of age, years of education, marital status, occupation, duration of drug use, rate of relapse in 6 months, and rate of dropout. Comorbidity of an Axis I and/or Axis II disorder raised the number of hospitalizations; comorbid Axis I disorder prolonged the duration of hospitalization, whereas Axis II disorder had an inverse effect. In addition, inpatients with an Axis II comorbidity had more legal issues and shorter duration until first use after treatment than inpatients without comorbidity. Conclusion: Comorbidity of substance use disorders and other Axis I and Axis II disorders is very common. Patients with dual diagnose use health services more often and have more legal issues than patients with substance use disorders only. Comprehensive care and treatment are needed for dual-diagnosed patients.

Pregnancy-Onset Obsessive-Compulsive Disorder: Clinical Features, Comorbidity, and Associated Factors

Objective: The prevalence rate of obsessive-compulsive disorder (OCD) was found to be higher in women during pregnancy and puerperium than that estimated in the general population. Additionally, the symptomatology of OCD shows several variations during the lifetime of women. Objective of the current study was to examine the clinical characteristics and comorbidity with other anxiety and mood disorders of pregnancy-onset obsessive-compulsive disorder (POCD) and to investigate factors related to POCD. Method: The study sample was composed of three groups. The first group (POCD group) included 20 consecutive pregnant women meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for OCD, showing an onset of OCD during their current pregnancy. The second group (non-OCD group) consisted of 207 consecutive pregnant women without any mood or anxiety disorders to assess factors associated with POCD. In addition, the study included a control group to compare the symptoms of POCD and non-pregnancy-onset OCD. The control group was composed of 40 nonpregnant female outpatients with OCD. Type and severity of obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). OCD and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV (SCID-I). Comorbid axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Results: The mean onset time of OCD in the POCD group was 13.3±6.35 (week5-28) gestational weeks. OCD occurred during the first trimester of pregnancy in 9 women (45%), during the second trimester in 10 (50%) women, and during the third trimester in 1 (5%) woman. The most common obsessions were contamination (n=16, 80%) and symmetry/exactness (n=6, 30%), and the most common compulsions were cleaning/ washing (n=16, 80%) and checking (n=12, 60%) in POCD. Thirteen (65%) of the pregnant OCD patients met the criteria for a mood or anxiety disorder. Generalized anxiety disorder was the most frequently diagnosed axis I disorder (40%, n=8). The independent factors associated with POCD were cigarette smoking (p=0.002), the existence of an anxiety disorder at onset of pregnancy (p=0.000), and obsessive-compulsive personality disorder (p=0.003). Conclusion: The present study suggests that POCD presents similar clinical characteristics with nonpregnancy-onset OCD. Mood or anxiety disorder comorbidity is observed in more than half of the women with POCD. Additionally, pregnant women who have at least one of 3 factors (cigarette smoking, the existence of an anxiety disorder at onset of pregnancy, and obsessive-compulsive personality disorder) seem to be at risk for POCD.

Have Treatment Studies of Depression Become Even Less Generalizable? A Review of the Inclusion and Exclusion Criteria Used in Placebo-Controlled Antidepressant Efficacy Trials Published During the Past 20 Years

ObjectiveTo compare the inclusion and exclusion criteria used in antidepressant efficacy trials (AETs) published during the past 5 years with those used in studies published during the previous 15 years. Patients and MethodsWe conducted a comprehensive literature review of placebo-controlled AETs published from January 1995 through December 2014. We included trials whether or not the medication has received regulatory approval for the treatment of depression. We compared the inclusion and exclusion criteria of studies published during the past 5 years (2010-2014) with those of studies published during the previous 15 years (1995-2009). ResultsWe identified 170 placebo-controlled AETs published during the past 20 years, 56 of which were published during the past 5 years. The more recent studies were significantly more likely to exclude patients with comorbid Axis I disorders and personality disorders, patients with the episode duration either too long or too short, and patients who had made a suicide attempt in the past. The severity threshold on depression rating scales required for inclusion was higher in the more recent studies. ConclusionThe inclusion and exclusion criteria of AETs have become more stringent over the past 5 years, thereby suggesting that AETs may be even less generalizable than they were previously (when concerns about their generalizability had already been raised).

Child maltreatment and adult psychopathology in an Irish context

One-hundred-ninety-nine adult mental health service users were interviewed with a protocol that included the Childhood Trauma Questionnaire, the Structured Clinical Interviews for Axis I and II DSM-IV disorders, the Global Assessment of Functioning scale, the SCORE family assessment measure, the Camberwell Assessment of Need Short Appraisal Schedule, and the Readiness for Psychotherapy Index. Compared to a U.S. normative sample, Irish clinical cases had higher levels of maltreatment. Cases with comorbid axis I and II disorders reported more child maltreatment than those with axis I disorders only. There was no association between types of CM and types of psychopathology. Current family adjustment and service needs (but not global functioning and motivation for psychotherapy) were correlated with a CM history. It was concluded that child maltreatment may contribute to the development of adult psychopathology, and higher levels of trauma are associated with co-morbid personality disorder, greater service needs and poorer family adjustment. A history of child maltreatment should routinely be determined when assessing adult mental health service users, especially those with personality disorders and where appropriate evidence-based psychotherapy which addresses childhood trauma should be offered.

The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities

Background: There is little research on the subject of personality disorder (PD) in individuals with borderline intellectual functioning (BIF). Unlike in most countries, in the Netherlands, patients with BIF are eligible for specialized mental health care. This offers the unique possibility of examining the rates of PDs in patients, who in other countries are treated relatively invisibly in regular mental health care. Aim: To compare, in a naturalistic setting, the frequency of PD diagnoses in outpatients with BIF with outpatients from regular mental health care and outpatients with mild ID. Methods: We compared the rates of all DSM-IV-TR axis II PDs in outpatients with BIF (BIF group; n = 235) with rates of the same disorders in outpatients from regular mental health care (RMHC group; n = 1026) and outpatients with mild intellectual disability (ID) (mild ID group; n = 152) in a naturalistic cross-sectional anonymized medical chart review. Results: Over half of the patients with BIF (52.8%) were diagnosed with a PD, compared with one in five in the RMHC group (19.3%) and one in three of the mild ID group (33.6%). All PD diagnoses, except for cluster A PDs and histrionic PDs, were most frequently diagnosed in the BIF group. PD NOS and borderline PD were the most frequently diagnosed PDs in BIF. The majority of PD patients had one or more comorbid axis I disorder. Conclusion: There is a high frequency of PD diagnoses in BIF outpatients in daily clinical practice. In anticipation of further scientific research, results suggest that PDs should not be overlooked in patients with BIF.

Clinical audit of women with substance use disorders: findings and implications.

Aim:To examine the socio-demographic, clinical and psychosocial profiles of women seeking treatment for substance use disorders (SUDs) in order to understand their treatment needs.Materials and Methods:The psychiatric case records of 40 women with SUDs who sought consultation between the year 2012 and 2013 were analysed.Results:The mean age of the sample was 38 years (standard deviation, S.D = ± 7.24). Among these, 52.5% were married and 30% were separated or divorced. Mean age of onset of substance dependence was 28.68 years (S.D. = ± 7.02) with an average of 9.65 years (S.D = ± 7.69) of dependence. Alcohol dependence was present in 80% of the patients, followed by nicotine dependence in 54% of the patients. Co-morbid Axis I and Axis II disorders were present in 62.5% and 10% of the patients respectively. Childhood adverse experiences such as abuse and neglect were reported by 20% of the patients. The factors contributing to initiation and maintenance of substance use were marital discord and interpersonal conflicts (70%), influence of significant others (66%), death of a family members (10%) and other stressful life events (25%). Major consequences of substance use were substance-induced physical problems (62.5%) and interpersonal conflicts (40%). Data analysis indicated poor follow up and relapse rate of 50%.Conclusions:Adverse life events and interpersonal conflicts are significant contributing factors to substance use among women. The study has implications for planning gender sensitive, multi-dimensional treatment programmes for women seeking treatment for SUDs in India.

Panik bozukluğu olan hastalarda Eksen I ve Eksen II eştanısı açısından cinsiyet farklılıkları

Gender differences in terms of Axis I and Axis II comorbidity in patients with panic disorder Objectives: Comorbidity in psychiatric disorders significantly affects the clinical course, the severity of symptoms, and the response to the treatment. Panic disorder can cause considerable disability, reduction of interpersonal relationships, avoidance of certain social situations, and staying away from high-risk jobs and consequently lowering work performance causing loss of job. A number of studies have shown that panic disorder is observed more frequently in females, indicating a gender risk factor. This study investigated potential gender differences in the distribution of Axis I and Axis II comorbidity. Method: A total of 63 patients who satisfied the inclusion criteria and had been diagnosed with panic disorder according to DSM-IV participated in this study. 31 (49.2%) patients were female, and 32 (50.8%) were male. Panic disorder was diagnosed with SCID-I (Structured Clinical Interview for DSM-IV-TR Axis I Disorders). Sociodemographic data were collected using a form developed by the researchers, and the Panic Agoraphobia scale was applied in all cases. The existence of possible childhood separation anxiety was also investigated, and SCID-II was applied to identify Axis II personality disorders. Gender differences in demographic and clinical characteristics and in the comorbidity of Axis I and Axis II disorders were then investigated. Results: The reported prevalence of separation anxiety was considerably higher in the female than in the male patients. Depression, social anxiety disorder, and specific phobias were more common in the female patients, whereas alcohol abuse was more common among the male patients. There was no gender difference in Axis II comorbidity. Conclusions: This comparison of gender differences in Axis I and Axis II disorders that coexist with panic disorders indicated that comorbidities of depression, social and specific phobias, and alcohol abuse comorbidities are different among the genders. However, there appeared to be gender differences in Axis II comorbidities.

The International Study to Predict Optimized Treatment in Depression (iSPOT-D): Outcomes from the acute phase of antidepressant treatment

We aimed to characterize a large international cohort of outpatients with MDD within a practical trial design, in order to identify clinically useful predictors of outcomes with three common antidepressant medications in acute-phase treatment of major depressive disorder (MDD). The international Study to Predict Optimized Treatment in Depression has presently enrolled 1008 treatment-seeking outpatients (18–65 years old) at 17 sites (five countries). At pre-treatment, we characterized participants by symptoms, clinical history, functional status and comorbidity. Participants were randomized to receive escitalopram, sertraline or venlafaxine-extended release and managed by their physician following usual treatment practices. Symptoms, function, quality of life, and side-effect outcomes were assessed 8 weeks later. The relationship of anxiety to response and remission was assessed by comorbid Axis I diagnosis, presence/absence of anxiety symptoms, and dimensionally by anxiety symptom severity. The sample had moderate-to-severe symptoms, but substantial comorbidity and functional impairment. Of completers at week 8, 62.2% responded and 45.4% reached remission on the 17-item Hamilton Rating Scale for Depression; 53.3% and 37.6%, respectively on the 16-item Quick Inventory of Depressive Symptoms. Functional improvements were seen across all domains. Most participants had side effects that occurred with a frequency of 25% or less and were reported as being in the “none” to minimal/mild range for intensity and burden.Outcomes did not differ across medication groups. More severe anxiety symptoms at pre-treatment were associated with lower remission rates across all medications, independent of depressive severity, diagnostic comorbidity or side effects. Across medications, we found consistent and similar improvements in symptoms and function, and a dimensional prognostic effect of comorbid anxiety symptoms. These equivalent outcomes across treatments lay the foundation for identifying potential neurobiological and genetic predictors of treatment outcome in this sample.

Pituitary volume in medication-naïve adults with obsessive compulsive disorder.

Pituitary volume is considered to reflect hypothalamic-pituitary-adrenal axis dysregulation, and this has been studied in various psychiatric disorders. This study demonstrates that pituitary volume as assessed through the region of interest manual tracing method in 50 medication-naïve adult patients with obsessive-compulsive disorder was not significantly different compared with 40 healthy control subjects (687.80 ± 126.60 versus 694.73 ± 131.59, F=0.55, p=0.46). The authors also compared the patients with obsessive-compulsive disorder without any comorbid axis I conditions (N=35) with healthy control subjects and found no difference in the pituitary volumes (681.62 ± 130.85 versus 694.72 ± 131.59, F=0.90, p=0.35). This emphasizes the need to examine hypothalamo-pituitary axis structures after taking into consideration various potential confounders such as medications and depression.

Treatment characteristics and outcome of depression among depressed adolescent outpatients with and without comorbid Axis II disorders.

In the literature, disagreement exists on the impact of Axis II comorbidity on the treatment outcome of depression. The aim of the present study was to examine in a naturalistic treatment setting the 1-year outcome and treatment characteristics of depressed adolescent outpatients with and without comorbid Axis II disorders. The 151 participants were interviewed for Axis I and II diagnoses at baseline and follow-up. Those diagnosed with a personality disorder were significantly more impaired at follow-up than those without. The given treatment did not differ between the two groups in length, intensity, or hospitalization, but the group with Axis II comorbidity received more psychotropic medication. The treatment outcome of depression was poorer for the group with Axis II disorders compared to those without. In conclusion, a personality disorder diagnosis is a sign of more severe overall symptoms. Special attention should be paid to Axis II traits when planning and conducting the treatment of adolescent depression.

Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial.

Antidepressant medication (ADM) is efficacious in the treatment of depression, but not all patients achieve remission and fewer still achieve recovery with ADM alone. To determine the effects of combining cognitive therapy (CT) with ADM vs ADM alone on remission and recovery in major depressive disorder (MDD). A total of 452 adult outpatients with chronic or recurrent MDD participated in a trial conducted in research clinics at 3 university medical centers in the United States. The patients were randomly assigned to ADM treatment alone or CT combined with ADM treatment. Treatment was continued for up to 42 months until recovery was achieved. Antidepressant medication with or without CT. Blind evaluations of recovery with a modified version of the 17-item Hamilton Rating Scale for Depression and the Longitudinal Interval Follow-up Evaluation. Combined treatment enhanced the rate of recovery vs treatment with ADM alone (72.6% vs 62.5%; t451 = 2.45; P = .01; hazard ratio [HR], 1.33; 95% CI, 1.06-1.68; number needed to treat [NNT], 10; 95% CI, 5-72). This effect was conditioned on interactions with severity (t451 = 1.97; P = .05; NNT, 5) and chronicity (χ2 = 7.46; P = .02; NNT, 6) such that the advantage for combined treatment was limited to patients with severe, nonchronic MDD (81.3% vs 51.7%; n = 146; t145 = 3.96; P = .001; HR, 2.34; 95% CI, 1.54-3.57; NNT, 3; 95% CI, 2-5). Fewer patients dropped out of combined treatment vs ADM treatment alone (18.9% vs 26.8%; t451 = -2.04; P = .04; HR, 0.66; 95% CI, 0.45-0.98). Remission rates did not differ significantly either as a main effect of treatment or as an interaction with severity or chronicity. Patients with comorbid Axis II disorders took longer to recover than did patients without comorbid Axis II disorders regardless of the condition (P = .01). Patients who received combined treatment reported fewer serious adverse events than did patients who received ADMs alone (49 vs 71; P = .02), largely because they experienced less time in an MDD episode. Cognitive therapy combined with ADM treatment enhances the rates of recovery from MDD relative to ADMs alone, with the effect limited to patients with severe, nonchronic depression. clinicaltrials.gov Identifier: NCT00057577.