Comorbid Diagnoses Research Articles

Defining patterns of comorbidity accrual before and after the diagnosis of heart failure

Abstract Introduction People with heart failure (HF) usually have multiple comorbidities and these confer adverse prognosis. The chronology of comorbidity development in relation to HF has not been investigated, which hinders development of preventative strategies. Purpose We aimed to define the chronology of comorbidity diagnoses in relation to HF diagnosis and hypothesised that HF is preceded by most of its comorbidities. Methods We used UK Biobank data to identify 21,127 people with HF diagnosis at any stage before or after recruitment. Comorbidities were defined using primary care records, and were not included if self-reported or their date of diagnosis unknown. Comorbidities were selected based on methods of Conrad et al. (Lancet 2018; 391(10120): 572-580), and defined using CALIBER or UK Biobank criteria. We investigated the time between first diagnosis of HF and first diagnosis of 15 common comorbidities, including after stratification by sex and age at HF diagnosis. Analysis was conducted using RStudio. Results For all studied comorbidities, except dementia, at least half of diagnoses predated or developed synchronously with HF. For myocardial infarction, obesity, cancer, atrial fibrillation, hypertension, diabetes and depression, at least three quarters of diagnoses predated or developed synchronously with HF. The median time between comorbidity and HF diagnoses varied substantially between comorbidities, ranging from depression preceding HF by 10.7 years to dementia proceeding HF by 0.7 years. The interquartile range of time between comorbidity and HF diagnoses varied substantially, ranging from 2.4 years for myocardial infarction to 15.2 years for depression, indicating most cases of the former develop in a narrow window (usually prior to HF diagnosis). All comorbidities presented earlier in women, with this being most marked for cancer (median time between cancer and HF -2.6 years for men and -7.1 years for women). As the age of HF diagnosis increased, the time spent with all studied comorbidities also increased. Indeed, in HF diagnosed before the age of 60, a majority of comorbidity diagnoses (except for depression) occurred after HF. Conclusion HF most often develops late in the process of comorbidity accrual, although this pattern is reversed in people developing HF at younger ages. Sex differences are also notable, with women developing comorbidities earlier in relation to their HF diagnosis. Understanding the chronology of comorbidity development may help to guide strategies to prevent multimorbidity, which are likely to require a personalised approach. For people with established HF, our data also emphasise the importance of holistic care that accounts for complex multimorbidity.Figure 1

The impact of comorbidities on therapy-optimization and their prognostics role among hospitalized patients with heart failure with reduced ejection fraction

Abstract Background The early, accurate diagnosis and proper treatment of comorbidities (CMs) are of strategic importance in heart failure (HF), as stated in the current ESC HF Guidelines. Unquestionably, the presence of CMs is associated with worse prognosis. Moreover, CMs can unfavourably affect the implementation of the guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF). Aim To assess the prevalence of the relevant prognosis-modifying CMs among patients requiring hospitalization due to HFrEF, investigate their effect on the implementation and optimization of GDMT, and examine the impact of the presence of CMs on the prognosis in HFrEF. Patients and methods The data of 313 patients requiring hospitalization at our Institution due to HFrEF between 2021-2023 (male: 77%, age: 60[50-70]years, coronary artery disease: 46%, diabetes: 36%, hypertension: 65%, atrial fibrillation: 42%, LVEF: 24[20-30]%, eGFR at admission: 57[46-74]mL/min/1.73m², NT-proBNP at admission: 5035[2376-9369]pg/mL, SBP: 121[110-140]mmHg; GDMT at admission - RASi[ACEi/ARB/ARNI]: 60%, βB: 59%, MRA: 44%, SGLT2i: 14%) were analyzed retrospectively. Based on the number of diagnosed CMs, patients were divided into 3 categories: 0-1 vs. 2-3 vs. ≥4 CMs. The implemented GDMT at discharge was compared among CM categories with Chi-square test, while all-cause mortality (ACM) rates were investigated with Kaplan-Meier method and multivariate Cox-regression analysis. Results During the hospitalization in the total cohort the proportion of patients on GDMT increased significantly (RASi: 91%, βB: 85%, MRA: 96%, SGLT2i: 57%; patients on triple [TT] therapy [RASi+βB+MRA]: 83%, patients on quadruple therapy [TT+SGLT2i]: 52%; p＜0.05). However, among patients with higher rates of CMs, the application of GDMT was less favourable (RASi: 97% vs. 94% vs. 82%; βB: 93% vs. 89% vs. 75%; p＜0.05; 0-1 vs. 2-3 vs. ≥4 CMs), the proportion of patients on TT and QT remained remarkably high even among those with ≥4 CMs (TT: 93% vs. 87% vs. 71%; QT: 65% vs. 52% vs. 45%; p＜0.05). During the median follow-up period of 1.3 year, the ACM of patients with increased burden of CMs was higher (12% vs. 18% vs. 37%, p＜0.001). According to the results of the multivariate Cox-regression analysis, more advanced left ventricular systolic dysfunction (/1%), previously confirmed diagnosis of HFrEF, the growing number of CMs proved to be negative independent predictors of ACM, while the application of TT or QT reduced the risk of ACM significantly (HR: 0.471, 95% CI: 0.271-0.819, p=0.008). Conclusions According to our real-world analysis, although among HFrEF patients with an increased burden of CMs, less favourable prognosis can be expected, the application of modern GDMT is even possible among them, resulting in a significantly improved prognosis. Thus, clinicians should insist on the early, conscious implementation of GDMT among these patients as well.

Management and outcomes of acute myocardial infarction in patients with Alzheimer's disease: a study of 2.7 million individuals with myocardial infarction, 2010 - 2020

Abstract Background As a consequence of population ageing, the prevalence of Alzheimer’s Disease (AD) is rising. Evidence-based clinical decision-making for those with AD that present with acute myocardial infarction (MI) is limited by difficulty in identifying which patients will benefit from guideline-directed invasive management versus a more conservative approach. Purpose This study aimed to assess the prevalence of AD in patients presenting with acute MI and characterise its association with patient factors, treatment utilisation and clinical outcomes. Methods A retrospective cohort study was conducted using the United States National Readmission Database (NRD), 2010–2020. International Classification of Disease (ICD; version 9 and 10, Clinical Modification) codes were used to identify patients with a principal diagnosis of MI, pre-existing AD and other comorbidities, in addition to invasive procedures (invasive coronary angiography ± percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG] surgery). Logistic and flexible parametric survival models (adjusted for age, sex, MI subtype, smoking status, comorbidities, and MI treatments) were used to evaluate the association between AD and in-hospital and 1-year clinical outcomes, respectively. Results Overall, 2,750,798 individuals were admitted with MI during the study period, of which 35,367 had Alzheimer’s disease; 1.3%; Figure 1). Patients with AD were older (median age 85 vs. 67), more likely to be female (57.6 vs. 37.9%), present with non-ST-elevation MI (77.7 vs. 69.5%), and had a greater burden of individual comorbidities (including chronic kidney disease and depression) and multimorbidity (≥2 long-term conditions; 77.4 vs. 71.0%). Patients with AD were less likely to undergo invasive management (coronary angiography ± PCI/CABG; 27.7 vs 77.6%; p < 0.001; adjusted odds ratio [aOR] 0.24, 95% confidence intervals [CI] 0.23–0.25). Patients with AD had greater mortality both in-hospital (11.9 vs. 5.2%; aOR 1.30 (95% CI: 1.26–1.35, p < 0.001) and 1-year (15.9 vs. 7.3%; adjusted hazard ratio [aHR] 1.21; 95% CI 1.18–1.25). AD was associated with a greater risk of major adverse cardiovascular events (MACE; myocardial infarction, stroke or all-cause mortality; 27.8 vs. 17.7%; aHR 1.10, 95% CI 1.08–1.12) at 1-year post-MI (figure 2). However, patients with AD that were selected to undergo invasive management experienced reduced MACE (aHR 0.74, 95% CI 0.70–0.77) and all-cause mortality (aHR 0.53, 95% CI 0.49–0.57) in comparison to those managed conservatively. Conclusions Patients with Alzheimer’s Disease presenting with acute MI face a poor prognosis marked by a high rate of MACE and all-cause mortality. Future research should seek to identify those who benefit most from invasive management. At present, individualised, shared and multidisciplinary decision-making is key to guide the management of patients with AD that present with acute MI.

Impact of comorbid coronary artery disease on short and medium-term outcomes after carotid artery stenting

Abstract Background Current recommendations acknowledge carotid artery disease as a clinical criteria for very high cardiovascular risk and carotid artery stenting (CAS) as one of the main therapeutic options for carotid artery stenosis. Carotid artery disease is often present in patients with coronary artery disease (CAD), presumably enhancing the cardiovascular risk of these patients. In this study, we aimed to appraise the prevalence and prognostic effects of comorbid CAD diagnosis in patients with significant carotid artery disease undergoing CAS. Methods We conducted a single-center retrospective analysis including consecutive patients that underwent CAS, between January 2007 and August 2023. Our main objective was to analyze the association of comorbid CAD in patients undergoing CAS, regarding 30-day major adverse cardiovascular events (MACE), 30-day global mortality, 1-year global mortality and major periprocedural complications. On a second perspective, we strived to identify if there was any modifiable factor that influenced worse outcomes in these populations, addressed by a Chi-Square Test. Data was collected by the medical team in our Centre, over the years of follow-up. Results A total of 380 patients were enrolled in this study, with a mean age of 72.1±8.3 years and no major differences concerning demographic characteristics. Based on the presence of previous CAD diagnosis, there was no statistical significance in 30-days MACE (p=0.442), 30-days global mortality (p=0.161), 1-year mortality (p=0.658) or periprocedural complications (p=0.062). Despite these results, there was a statistically significant difference in individuals with CAD and comorbid hypertension in 30-days CV death (p=0.002), 30-days global mortality (p=0.007) and 1-year global mortality (p=0.036). Conclusions Comorbid CAD in patients undergoing CAS due to carotid stenosis does not seem to be significantly associated with medium-term adverse events. Nevertheless, the results of this casuistry support the importance of rigorous blood pressure control in patients with significant carotid artery disease.Baseline CharacteristicsStudy outcomes

Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis

BackgroundIn adults aged 50 + years, vaccine-preventable diseases (VPDs) pose a significant health burden and can lead to additional ‘downstream effects’ of infection beyond the acute phase e.g., increasing the risk for non-communicable disease and exacerbating chronic conditions. The aim was to understand and quantify the burden of VPD downstream effects in hospitalised adults in the United States.MethodsThis retrospective observational study analysed hospitalisation claims data (2016–2019) with 1-year follow-up, in adults with a VPD diagnosis versus matched controls (using Optum’s de-identified Clinformatics Data Mart Database). Outcomes included mortality; increase in Charlson Comorbidity Index (CCI) score; new diagnosis of comorbidities; and loss of independence (defined by need for home health/home care and/or move to long-term facility).ResultsMortality was significantly increased in VPD cases versus controls at 30-day (risk ratio [RR] of 4.08 [95% CI 3.98–4.18]) and 1-year follow-up (RR 2.76 [2.73–2.80]). Over a 1-year follow-up period, morbidity increased following VPD hospitalisation: 65–86% of VPD cases had new comorbidities diagnosed (versus 13–41% of controls); with a significantly higher mean increase in CCI score versus baseline (3.23 in VPD cases versus 0.89 in controls, p < 0.001). Adults were observed to experience a worsening of their health status and were less likely to return to their original health state. In addition, 41% of VPD cases had a loss of independence following hospitalisation versus 12% of controls; as seen by an increased need for home assistance (in 25% versus 9% of controls) and/or a move to a long-term care facility (in 29% versus 6% of controls).ConclusionsThis analysis suggests that VPD hospitalised cases suffer significantly worse clinical outcomes than controls, with downstream effects that include increased mortality and morbidity, and greater loss of independence. Evidence on potential downstream effects of infection is relatively new, and this additional burden is generally not considered in vaccine decision-making. More research is needed to disentangle the effect of VPDs on new comorbidities versus the natural course of the condition. Increasing awareness among adults, healthcare providers and decision makers could help to increase adult vaccination coverage, and reduce the clinical burden of VPDs.

Multimorbidity raises the odds of decease in COVID-19 patients: An Iranian prospective study

Introduction: The prevalence of noncommunicable diseases is high in Iran. We postulated that multimorbidity may affect the rate of mortality from COVID-19. So, we investigated the relationship between multimorbidity and COVID-19 mortality. Methods: We used medical reports for collecting clinical laboratory data of patients with COVID-19 in this prospective investigation. Moreover, we documented whether the patient had a known diagnosis of different comorbidities. The patients with more than one comorbidity were considered multimorbidity. The length of follow-up was till participants were discharged from the hospital or deceased. The main outcome was to evaluate the relationship between multimorbidity and death in COVID-19 hospitalized patients. Results: The present prospective study included 1842 patients with COVID-19 with a multimorbidity rate of 37.40%. About 24.6% of participants with more than four comorbidities died. However, this value was about 17% in participants with less than four comorbidities. The odds of mortality from COVID-19 were 53% greater in patients with diabetes. Also, the odds of death were 2.05 (1.21, 3.45) times greater in patients with comorbidities≥4. Conclusion: The results indicated a high rate of multimorbidity in patients with COVID-19 which is related to a higher death rate. So, in countries with higher multimorbidity rates such as Iran, it is necessary to design efficient approaches to alleviate the spread of COVID-19.

Association Between Body Mass Index and Risk of Aortic Stenosis in Women in the Swedish Medical Birth Registry.

Overweight and obesity are increasing globally with aging, as are life expectancy and aging-associated disorders, including calcific aortic stenosis (AS). Studies investigating the correlation between high body mass index (BMI) and AS are contradictory and inconclusive. This study examines a potential association between BMI and AS in women. By linking the Swedish Medical Birth Register and the Swedish National Patient Register, we included women aged 18 to 55 years with a first childbirth from 1981 to 2020. Diagnosis of AS and comorbidities were defined according to the International Classification of Diseases (ICD) codes. The women were divided into groups on the basis of BMI. Cox proportional hazards regression models were used to investigate the difference in the risk of being diagnosed with AS, with reference BMI 20 to <22.5 kg/m2. Among the 1 722 625 included women, the mean age was 28 years, and mean BMI was 24 kg/m2, with 21% being overweight (BMI 25 to <30 kg/m2) and 8.5% obese (BMI ≥30 kg/m2). During median follow-up of 19.5 years, 2488 women (0.14%) were diagnosed with AS. The age-adjusted risk of being diagnosed with AS increased with higher BMI to 2.82 (95% CI, 2.44-3.25) times higher in women with BMI 30 to <35 kg/m2, and to 3.72 (95% CI, 2.95-4.70) times higher in those with BMI ≥35 kg/m2. Similar results were found after excluding AS of rheumatic pathogenesis. An increase in BMI from its upper normal range was consistently and independently associated with the risk of developing AS in women.

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Unveiling the comorbidity burden of male breast cancer

Male breast cancer (MBC) is a rare condition with unique characteristics compared to female breast cancer (FBC). Despite its scarceness, there is growing evidence that MBC should not be studied and treated as FBC due to factors like later diagnosis stage and distinct genetic makeup. Retrospective observational study in the EpiChron Cohort, selecting all the prevalent patients with breast cancer between 2010 and 2019. Logistic models were used to determine associated comorbidities. Between 2010 and 2019, 105 MBC and 11,657 FBC patients were found in the EpiChron Cohort. MBC patients had a high mean age at diagnosis and number of comorbidities. Paying attention to comorbidity prevalences in breast cancer patients, it was clear that MBC patients tended to be prone to cardio-metabolic coexisting diseases, while FBC patients were more prone to hormone-, bone- and mental diseases. There were nine chronic conditions associated to MBC patients, but after a year-by-birth matching only four associations remained. Two of them were associated previously [odds ratio (95% confidence interval)]: “Disorder of lipid metabolism” [1.65 (1.03–2.64)] and “Genitourinary symptoms and ill-defined conditions” [2.03 (1.07–3.87)]; and the other two were new, “Anxiety disorders” [2.05 (1.09–3.87)] and “Osteoporosis” [3.58 (1.26–10.14)]. After comparing associated comorbidities in FBC with those in MBC, it seems MBC patients share some of them, but they have their own particular set of coexisting diseases. In fact, once a year-by-birth matching was performed in MBC patient cohort, it was more obvious MBC comorbidities behave more similar to none-Breast-Cancer male population than to FBC patients. These findings highlight the distinct characteristics of the MBC patient population and the need for a tailored approach of managing MBC.

Growth charts of Brazilian girls with Turner syndrome without the use of GH or oxandrolone

ObjectiveThe development of specific growth charts for Turner Syndrome (TS) promotes adequate assessment of growth and weight gain, and earlier diagnosis of comorbidities, and may help to analyze the effectiveness of treatments to promote growth and puberty. The aim of this study was to construct a growth chart with the largest possible series of patients with a cytogenetic diagnosis of TS from a Brazilian reference center. MethodsThis is a longitudinal study, with 259 cases of TS born between 1957 and 2014 and followed between 1975 and 2019, without the use of GH or oxandrolone. 3,160 height measurements and 2,918 wt measurements were used, with subsequent calculation of the Body Mass Index (BMI). For data analysis, the “GAMLSS” package of the “R” software was used. ResultsThe mean target height was 157.8 cm (standard deviation 5.2; median 160.4 cm). The mean height of patients with TS at 20 years of age was 145.6 cm (standard deviation 5.9; median 146.7 cm). Height, weight, and BMI by age graphs were developed for TS girls between 2 and 20 years. ConclusionThese growth charts may be used to monitor the growth of girls with TS and to verify the effect of adjuvant treatments on promoting growth.

Motor function and gait decline in individuals with cerebral palsy during adulthood: a narrative review of potential physiological determinants.

Cerebral palsy (CP) is the most common childhood-onset disability. The evolution of gait according to severity is well known amongst children and thought to peak between 8 and 12years of age among those walking without assistive devices. However, among adults, clinical experience as well as scientific studies report, through clinical assessments, questionnaires and interviews, increasing walking difficulties leading to an increased dependency of assistive devices in everyday ambulation. For many individuals with CP, this change will occur around 30-40years, with the risk of losing mobility increasing with age. This narrative review aims to first provide objective evidence of motor function and gait decline in adults with CP when ageing, and then to offer mechanistic hypotheses to explain those alterations. Many studies have compared individuals with CP to the typically developing population, yet the evolution with ageing has largely been understudied. Comorbid diagnoses comprise one of the potential determinants of motor function and gait decline with ageing in people with CP, with the first manifestations happening at an early age and worsening with ageing. Similarly, ageing appears to cause alterations to the neuromuscular and cardiovascular systems at an earlier age than their typically developing (TD) peers. Future studies should, however, try to better understand how the physiological particularities of CP change with ageing that could pave the way for better strategies for maintaining function and quality of life in people with CP.

Acute Augmented Effect of Virtual Reality (VR)-Integrated Relaxation and Mindfulness Exercising on Anxiety and Insomnia Symptoms: A Retrospective Analysis of 103 Anxiety Disorder Patients With Prominent Insomnia.

Anxiety disorder is one of the most common mental disorders and often accompanied with sleep disturbance which can in turn exacerbate anxiety symptoms, creating a vicious cycle. In addition to psychopharmacological therapy, the effectiveness of psychotherapy as cognitive behavioral therapy (CBT) for treating anxiety disorders and insomnia has been well documented and widely accepted, but it is labor-intensive and costly. However, virtual reality (VR)-integrated CBT may improve this condition but needs more evidences to support its extensive application in routine clinical practice. This explorative study was aimed to conduct a retrospective analysis to evaluate the acute (2 weeks) augmented effect of VR-integrated relaxation and mindfulness exercising in improving anxiety and insomnia symptoms for patients who were diagnosed with anxiety disorders and concurrently with prominent insomnia symptoms and admitted to the Department of Psychiatry, The Affiliated Guangdong Second Provincial General Hospital of Jinan University during January 2021 to June 2021. All patients who were admitted to the department of psychiatry during January 1, 2021 to June 30, 2021 were screened with inclusion criteria and exclusion criteria, and the sociodemographic and clinical data of those included patients were collected from the electronic medical record system of the hospital using a self-designed case report form (CRF). Subjects who were administrated with medication alone were designated as conventional group, and those receiving treatment of medication combined with VR-integrated CBT (VR relaxation and mindfulness exercising) as VR group. The baseline and 2-week posttreatment data were compared between the two groups. In total, there were 103 patients (70 female, 68%) included in the study. Among all, 68 (66.02%) were designated as the "VR group," and 35 (33.98%) as the "conventional group." The majority of patients (67%) were diagnosed with generalized anxiety disorder (GAD). Twenty-three (22.3%) patients had a comorbid diagnosis with primary insomnia, and insomnia was just one of the accompanying symptoms with anxiety for the rest 80 subjects. No statistically significant differences were found between VR and conventional groups in all baseline sociodemographic and clinical characteristics except for occupation. There were statistically significant differences for the remission rates of anxiety symptoms or insomnia symptoms and reduction of Hamilton Anxiety Rating Scale or Insomnia Severity Index total scores between conventional and VR groups. Greater remission rates or score reductions were found in VR group than in conventional group either for anxiety or for insomnia. Robust differences still existed when controlled for the variable "occupation." Two-week augmented VR-integrated relaxation and mindfulness exercising is acutely beneficial for relieving both anxiety and insomnia symptoms and worth being recommended for routine clinical practice. Further prospective and randomized study compared to traditional CBT to explore its acute and long-term effect on anxiety and insomnia is needed.

Association of adolescent obesity with Anxiety, Depression and Attention-Deficit/Hyperactivity disorder in the Arab population in Israel - a nationwide study

BackgroundThe health ramifications of adolescent obesity are understudied in the Israeli Arab population, and the impact of ethnicity on the association of obesity with mental health problems is unclear. AimTo examine the association of weight categories with Anxiety, Depression and Attention-Deficit/Hyperactivity Disorder (ADHD) among Arab adolescents in Israel and to compare this association to a Jewish comparison group. MethodsA cross-sectional nationwide study of 313,936 Arab adolescents aged 14–19 years between the years 2007–2022, and 289,616 Jewish adolescents in a comparison group. ResultsThe aORs for Anxiety, Depression and ADHD in Arab adolescents increased from a reference ‘normal weight’ category to ‘class 3 obesity’, reaching aORs (95 % CI) of 1.31 (1.16–1.47), 1.64 (1.31–2.02) and 1.51 (1.40–1.63) in ‘class 2 obesity’, and 1.51 (1.20–1.87), 2.81(2.00–3.84) and 1.69 (1.45–1.96) in ‘class 3 obesity’, respectively. The dose-dependent association between weight categories and psychiatric comorbidity was confirmed in sensitivity analyses with comorbidity with the purchase of medications serving as the dependent variable. The Jewish comparison group demonstrated a comparable increment in aORs with increase in weight category. The association between excessive weight categories and psychiatric comorbidities was stronger in Arab females, than in males. LimitationsRelying on the recorded weight and height measurements and the diagnoses of psychiatric comorbidity could lead to bias. ConclusionThe study findings emphasize the need to relate to the mental health of adolescents with excessive weight, which can improve their overall quality of life and the success of adolescent weight loss intervention programs.

Antipsychotics and chronic dystonia at a Botulinum Toxin clinic.

Chronic dystonia, characterised by sustained muscle contractions and abnormal postures, poses clinical challenges, especially when associated with antipsychotic medication use. To delineate the demographic and clinical profiles of adults with dystonia and examine the association with antipsychotic medication. Botulinum Toxin Clinic at Tygerberg Hospital, Cape Town, South Africa. We conducted a retrospective cohort study of adult patients seen at the Botulinum Toxin Clinic between January 2018 and June 2022. Of the 119 patients studied, those assessed with antipsychotic-induced dystonia (32.69%) presented at a younger age (p < 0.001), were more likely female (p = 0.04), received higher average dose of Botulinum toxin (p < 0.001), and incurred a higher estimated Botulinum toxin treatment cost (p = 0.01) compared to those with primary dystonia. Logistic regression identified age and Botulinum toxin dose as factors associated with psychotropic-related dystonia (p = 0.005 and p = 0.012, respectively). Clinical and demographic factors are associated with dystonia in adults taking antipsychotic medication. These patients generally manifested symptoms at an earlier age, had a higher male prevalence, and required prolonged treatment with Botulinum toxin, leading to increased costs. In those assessed with antipsychotic-induced dystonia, a comorbid diagnosis of a mood disorder was more common than that of a psychotic disorder. By identifying the demographic and clinical profile of individuals with dystonia because of antipsychotic medication, this study provides a basis for preventative strategies and enhanced patient care.

A - 48 A Preliminary Comparison of Performance on the D-KEFS Advanced Trail Making Test across ADHD, ASD, and Math LD Clinical Groups

Abstract Objective Exploratory analyses on executive function performance between clinical groups was conducted using the Delis-Kaplan Executive Function System Advanced (D-KEFS Advanced) Trail Making Test (TMT). Our goal was to see if TMT could detect differences in the cognitive profiles of examinees diagnosed with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and math learning disorder (MLD) clinical groups. Method Participants ages of 8 and 16, diagnosed with ADHD (N = 56), ASD (N = 27), or MLD (N = 25) completed the D-KEFS Advanced TMT. DSM5 diagnostic criteria were used for diagnosis. Additionally, participants with comorbid diagnoses across the three groups were excluded from the clinical samples. Mean Correct (with errors) Connection Time for the five conditions was captured for each clinical group, as well as error rates. Results Multiple differences were found, but only two reached significances at the p &amp;lt; 0.01 level. Unpaired t-test results revealed a statistically significant difference between ADHD (M = 9.34, SD = 3.16) and ASD (M = 7.00, SD = 3.16) groups in Mean Correct (with errors) Connection Time scores for TMT Number Sequencing, t(81) = 3.16, p = 0.002, 95% CI [0.87, 3.81]. Additionally, Mean Correct (with errors) Connection Time scores for TMT Switching-Distraction condition between ADHD (M = 8.41, SD = 2.51) and ASD (M = 6.48, SD = 3.04) groups was statistically significant, t(81) = 3.06, p = 0.003, 95% CI [0.67–3.19]. Conclusion Overall, these preliminary findings suggest good clinical utility; however, further research is needed to determine if performance differences can aid in the evaluation of patterns of cognitive difficulties between groups.

A - 38 Impact of Working Memory and Processing Speed on Executive Function Performances in Youth with Attention-Deficit/Hyperactivity Disorder and Learning Disorder

Abstract Objective Executive function (EF) differences exist among children and adolescents with comorbid attention-deficit/hyperactivity disorder and learning disorders (ADHD+LD), relative to ADHD or LD alone. The impact of cognitive proficiency (i.e., working memory and processing speed) on EF is unclear across these diagnoses. Method This study investigated relations between cognitive proficiency and EF measures for 360 clinic-referred youth (ages 8–18) diagnosed with ADHD, LD, ADHD+LD, or No Diagnosis of ADHD/LD following neuropsychological evaluation. Two-way ANOVAs determined if WISC-V or WAIS-IV working memory (WMI) or processing speed (PSI) indices moderate the associations between group and D-KEFS performance (i.e., Color-Word Interference, Tower, Verbal Fluency, and Trail Making Tests). Results Results revealed significant interactions between group and WMI or PSI affecting D-KEFS Verbal Fluency Category Switching (F’s = 3.00–3.13, p’s = 0.026–0.031). Better performance on WMI or PSI was associated with better performance on Verbal Fluency Category Switching across groups, but this association was significantly less for ADHD+LD compared to other groups. Positive main effects were observed between WMI or PSI and all D-KEFS measures (F’s = 7.62–84.86, p’s &amp;lt; 0.006). Significant main effects were observed between group and D-KEFS Color-Word Interference Inhibition and Trails Number-Letter Sequencing (F’s = 2.95–3.77, p’s = 0.013–0.035), where No diagnosis performed better than other groups. Conclusions Overall, stronger working memory and processing speed may aid EFs for No diagnosis, ADHD, and LD youth, but not ADHD+LD youth. This may suggest an additive impact of a comorbid diagnosis leading to worse deficits in EFs and that stronger working memory and processing speed may be less protective for youth with comorbid diagnoses. Additional research is warranted.

Mental disorders in adults from Ribeirão Preto, Brazil: a cross-sectional analysis of two birth cohorts

BackgroundIn Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22–23 years old) and adults (37–38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population.MethodsParticipants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22–23, and 37–38 years, respectively.ResultsOur sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance.ConclusionsThe prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil.

Exploring real-world prescribing patterns for maintenance treatment in bipolar disorders: a focus on antidepressants and benzodiazepines

Objective Bipolar disorders (BD) are characterized by highly recurrent nature, necessitating adequate maintenance treatment for long-term disorder control. This study aimed to investigate real-world prescribing patterns among outpatients with BD, focusing on the utilisation of antidepressants (AD) and benzodiazepines (BDZ). Methods We analysed prescription patterns of the five main groups of psychotropic medications (antipsychotics, mood stabilizers, AD, BDZ, and anticholinergic medications) and their relationships with basic socio-demographic and clinical data in a sample of 107 clinically stable BD outpatients (75.7% female, age 44.8 ± 11.7). Results Maintenance therapy predominantly involved polypharmacy (92.5%), with mood stabilizers (87.9%) and antipsychotics (80.4%, predominantly second-generation) being the most commonly prescribed. Our findings highlight a high percentage of patients prescribed AD (50.5%) and BDZ (54.2%). BDZ patients, compared to the non-BDZ group in maintenance treatment, were significantly older with longer psychiatric history and a decreased likelihood of comorbid personality disorder diagnoses. Conclusions This study offers insights into prescribing practices within a university psychiatric clinic in the Western Balkans. The prevalent use of polypharmacy in real-world clinical settings, along with high percentage of patients prescribed AD and BDZ, suggests a gap between guideline recommendations and clinical practice, indicating a lack of consensus or standardized approaches in clinical practice.

Outcomes of emergency general surgery admissions in patients experiencing homelessness: A matched cohort study

BackgroundHousing status impacts outcomes after elective and emergent operations but has not been well studied in the emergency general surgery population. This study investigates the impact of housing status on complications and 30-day follow-up, emergency department visits, and readmissions after emergency general surgery admission. MethodsWe conducted a retrospective matched cohort study of adult patients admitted with an emergency general surgery diagnosis at an urban, safety net hospital from 2014 to 2021. Patients were matched 1 to 2 on the basis of age, sex, Charlson Comorbidity Index, diagnosis, and operative status. The primary exposure was unhoused status. The primary outcome was in-hospital complications. Secondary outcomes included intensive care unit admission, extended length of stay, follow-up attendance, and emergency department visit or unplanned readmission within 30 days. Multivariable conditional logistic regression was used to determine the association between housing status and the outcomes of interest. ResultsThe study included 531 patients (177 unhoused, 354 housed). There were no significant differences in complications, intensive care unit admissions, or extended length of stay. Unhoused patients had lower odds of outpatient follow-up (odds ratio, 0.54; 95% confidence interval, 0.35–0.85, P = .008) and higher odds of emergency department utilization (odds ratio, 2.72; 95% confidence interval, 1.78–4.14, P < .001) and readmission (odds ratio, 1.87; 95% confidence interval, 1.09–3.19, P = .02). ConclusionCompared with housed patients, unhoused patients with emergency general surgery conditions have lower rates of outpatient follow-up and greater odds of using the emergency department and being readmitted within 30 days of discharge. This points to a need for dedicated posthospitalization care and creative methods of engaging with this population.

Comorbidity rates of autism spectrum disorder and functional neurological disorders: A systematic review, meta-analysis of proportions and qualitative synthesis.

Autism spectrum disorder (ASD) and functional neurological disorders (FND) are relatively common conditions, and there has been recent interest in the overlap between them. Both conditions share core features of alexithymia, impaired interoception and deficits in attentional focus. To date, relatively little is known about the comorbidity rates between ASD and FND. This is the first meta-analysis and qualitative synthesis on the subject. We found that around 10% of children presenting with functional seizures have a comorbid ASD diagnosis. People with ASD are more likely than the neurotypical population to have functional somatic disorders, and there is also evidence that ASD rates are higher for other FNDs such as functional motor disorders. Since FND comes with risks of unnecessary medical procedures and investigations, it is important to recognize the potential for people with ASD to have an FND comorbidity.