Comorbid Medical Disorders Research Articles

P-2190. Gender Differences in Hepatitis C Treatment in the New York City Jail System, 2019-2023

Abstract Background Little is known about Hepatitis C (HCV) care outcomes among women experiencing incarceration. Women make up only 7% of the New York City (NYC) jail population, but represent 18% of individuals diagnosed with active HCV. This study examines progress through the HCV care cascade among women and men in the NYC jail system and describes potential gender-related factors in cascade outcomes. Methods Persons admitted to the NYC jail system and who completed a medical intake between October 2019 and December 2023 were included in this retrospective cohort analysis. We constructed a care cascade describing rates of universal opt-out HCV screening, confirmatory testing, diagnosis, linkage to jail-based clinical HCV care, and jail-based HCV treatment among the jail population stratified by documented gender. Demographic characteristics and medical history were also examined and stratified by documented gender. Results 71,130 persons were included in our analysis, of whom 5,085 (7.1%) were women and 66,045 (92.9%) were men. Compared to men, women were screened at higher rates (88.7% vs. 28.1%; p< 0.001), underwent confirmatory testing at lower rates (9.6% vs 11.2%; p=0.002), and had similar rates of active HCV (51.2% vs 47.8%; p=0.22). Women with active HCV were seen by an HCV clinician at similar rates as men (55.4% vs. 59.6%; p=0.32) but initiated HCV treatment at nearly half the rate of men (15.3% vs. 30.3%; p< 0.001). Additionally, women in the NYC jails had significantly higher rates of homelessness (23.5% vs. 19.5%), HIV (3.7% vs. 2.7%), mental health needs (53.7% vs. 30.8%), and history of select substance use disorders (58.6% vs. 45.8%) when compared to men (p< 0.001). Conclusion Large HCV treatment gaps exist between women and men experiencing incarceration. Disproportionally higher rates of comorbid medical, mental health, and substance use disorders and more re-entry support needs likely contribute to treatment disparities. Gender-specific strategies centered on the needs of women with justice involvement are needed to enhance the equitable uptake of jail-based HCV treatment. Enhancing treatment access for all persons with justice involvement is critical for HCV elimination efforts. Disclosures All Authors: No reported disclosures

Influencing factors of elderly hospitalized psychiatric patients complicated with physical disease: a cross-sectional study of 332 patients in Guangzhou China

ObjectiveTo investigate the influencing factors of the number of physical diseases in elderly hospitalized psychiatric patients.MethodsA total of 332 hospitalized elderly patients with mental illness were enrolled in this study. The number of combined physical diseases was divided into three groups, which were 0, 1 ~ 2, and ≥ 3. Data collected included sociodemographic characteristics, depressive symptoms, anxiety symptoms, delirium status, social support, medication adherence, social functioning, ability to perform daily living, and swallowing function.ResultsThe sample included 64.2% of female patients, mainly concentrated in 60 ~ 69 years old (48.2%). The length of hospital stay of patients was mainly 15 ~ 30 days (55.7%), and the course of disease was mainly 2 ~ 10 years (38.3%). After adjusting for confounding factors such as gender, poor lifestyle habits, course of disease, length of hospital stay, psychiatric symptoms, depressive symptoms, anxiety symptoms, delirium, social functioning, social support, and drug therapy compliance, we found that the number of physical disorders in elderly patients with mental illness was related to age, ability of daily living, and swallowing function. The increase of age, the decrease of the ability of daily living, and poor swallowing function contribute to a higher number of comorbid medical disorders in elderly patients with mental illness (P < 0.05).ConclusionAccording to the results, age, ability of daily living and swallowing function were the main influencing factors in the number of complicated physical diseases in elderly patients with mental illness. Future research should focus on improving the daily living ability and swallowing function of elderly patients with mental illness, in order to reduce the prevalence of other physical diseases in elderly patients with mental illness.

Role of Metformin in Reducing the Incidence of Gestational Diabetes Mellitus in Obese Women

Objective: To evaluate whether metformin administration reduces the incidence of gestational diabetes mellitus in obese women and to examine its impact on the incidence of preeclampsia, birth weight, and the APGAR scores of newborns. Methods: This experimental study was done at Shalamar Hospital, affiliated with Shalamar Medical &amp; Dental College, Lahore, Pakistan, from May1st 2022 to June 30, 2024. A total of 150 women with a BMI ≥ 30kg/m2, aged 18-40 years, between 11 to 14 weeks pregnant, were included. Those with contraindications to metformin, pre-existing diabetes, or any co-morbid medical disorder were excluded. The participants were divided into two groups with 75 in each: Group A the control group with only standard care. and Group B receiving metformin 250mg three times daily orally in addition to standard care. The oral glucose tolerance test was performed between 24 to 28 weeks and later at 32 weeks. The participants were followed till delivery to record preeclampsia, neonatal birth weight, and APGAR score. Results: The mean age, gestational age, and BMI were similar between Group A (32.37 years, 11.37 weeks, 32.37 kg/m²) and Group B (31.35 years, 11.27 weeks, 32.3 kg/m²). The incidence of GDM (10% vs. 42%) and preeclampsia (13% vs. 74%) was significantly lower in the metformin group (p = 0.000). However, no significant differences were observed in birth weights or APGAR scores. Conclusion: Metformin reduces the incidence of GDM and preeclampsia in obese women when started at 11 to 14 weeks of gestation, without affecting birth weight and APGAR score of neonates.

Pharmacotherapy for alcohol use disorder among adults with medical disorders in Sweden

BackgroundAlcohol-attributable medical disorders are prevalent among individuals with alcohol use disorder (AUD). However, there is a lack of research on prescriptions of pharmacological treatment for AUD in those with comorbid conditions. This study aims to investigate the utilization of pharmacological treatment (acamprosate, disulfiram and naltrexone) in specialist care among patients with AUD and comorbid medical diagnoses.MethodsThis was a descriptive register-based Swedish national cohort study including 132,728 adults diagnosed with AUD (N = 270,933) between 2007 and 2015. The exposure was alcohol-attributable categories of comorbid medical diagnoses. Odds ratios (OR) were calculated using mixed-effect logistic regression analyses for any filled prescription of acamprosate, disulfiram or oral naltrexone within 12 months post AUD diagnosis.ResultsIndividuals with comorbid alcohol-attributable medical diagnoses had lower odds of filling prescriptions for any type of AUD pharmacotherapy compared to those without such comorbidities. Cardiovascular (OR = 0.41 [95% CI: 0.39–0.43]), neurological (OR = 0.52 [95% CI: 0.48–0.56]) and gastrointestinal (OR = 0.57 [95% CI: 0.54–0.60]) diseases were associated with the lowest rates of prescription receipt. The presence of diagnoses which are contraindications to AUD pharmacotherapy did not fully explain the low prescription rate.ConclusionThere is a substantial underutilization of AUD pharmacotherapy in patients with AUD and comorbid medical disorders in specialist care. Increasing the provision of pharmacotherapy to this group of patients is essential and may prevent morbidity and mortality. There is a need to further understand barriers to medical treatment both from the patient and prescriber perspective.

Culturally Responsive CBT for Psychological and Physical Symptoms in Pakistani Youth: Role of Religious and Cultural Attunement

Cognitive Behavioral Therapy (CBT) is used widely throughout the world in diverse populations for successful treatment of a wide range of psychiatric and comorbid conditions. Over the years clinicians have been making efforts to culturally adapt CBT to various groups. This paper discusses the assessment and treatment of a young female from Pakistan with depression and anxiety with comorbid headache. After ruling out all organic causes, the treatment continued over 20 sessions with the initial phase consisting of introduction to CBT, risk assessment, and identification of treatment goals. Following this, the patient was helped in identifying automatic thoughts, feelings, and behaviors. Finally, tools such as thought substitutions, reappraisals, and positive diversions were used effectively to decrease automatic negative thoughts. A focus on the patient’s religio-cultural identity was maintained throughout. Understanding of contextual factors like religio-cultural values and family dynamics helped to bring about favorable therapy outcomes. A case conceptualization that cohesively addressed factors relating to ethnicity, class, and gender yielded a positive result in our case. Involvement of the family and psychoeducation regarding neurobiological causes also proved to be helpful. Such an approach can facilitate a culturally responsive application of CBT in Pakistani youth experiencing comorbid medical and psychiatric disorders.

High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine.

The COVID-19 pandemic resulted in marked disruptions in healthcare delivery in Ukraine related to emergency guidance in response to treating opioid use disorder (OUD). Patients with OUD, a group with high levels of comorbid medical and psychiatric disorders, and prescribed opioid agonist therapies (OAT) were rapidly shifted to take-home dosing if they were deemed clinically stable. The impact of these shifts on patient stress and related substance use during the pandemic, however, is unknown. In early May 2020, 269 randomly selected OAT patients in Ukraine were surveyed to assess their stress level and substance use using the validated Perceived Stress Scale and examined correlates of severe perceived stress. Overall, 195 (72.5%) met criteria for moderate to severe levels of stress, which was independently correlated with having started OAT within the past 12 months (aOR: 1.33; 95%CI: 1.15-1.55), living in a large metropolitan area (aOR: 1.31; 95%CI: 1.18-1.46), having been asked by others to share their medication (aOR: 1.13; 95%CI: 1.02-1.25), and having an increase of over 10 min in transportation time to get to treatment (aOR: 1.16; 95%CI: 1.04-1.29). Twenty seven (10%) patients felt at high risk of relapse, while 24 (8.9%) patients reported purchasing drugs. During a time of great uncertainty soon after emergency guidance to the COVID-19 pandemic, there was extraordinary high levels of perceived stress reported. In response to emergency guidance, OAT patients should be screened for perceived stress and certain subgroups should be targeted for additional psychosocial support.

The Association between Parkinson's Disease and Congestive Heart Failure in Korea: A Nationwide Longitudinal Cohort Study.

The purpose of this nationwide longitudinal follow-up study is to investigate the relationship between Parkinson's disease (PD) and congestive heart failure (CHF) patients in Korea. Patient data were collected using the National Health Insurance Service (NHIS) Health Screening (HEALS) cohort. The International Classification of Diseases 10-CM code G-20 distinguished 6475 PD patients who were enrolled in the PD group. After removing 1039 patients who were not hospitalized or attended an outpatient clinic less than twice, the total number of participants was reduced to 5436 individuals. Then, 177 patients diagnosed before 1 January 2004 were removed for relevancy, leaving us with 5259 PD patients. After case-control matching was completed using 1:5 age- and gender-coordinated matching, 26,295 people were chosen as part of the control group. The Cox proportional hazards regression analysis and the Kaplan-Meier technique were used to assess the risk of CHF in patients with Parkinson's disease. After controlling for age and gender, the hazard ratio of CHF in the PD group was 5.607 (95% confidence interval (CI), 4.496-6.993). After that, the hazard ratio of CHF in the PD group was modified against for comorbid medical disorders, resulting in a value of 5.696 (95% CI, 4.566-7.107). In subgroup analysis, CHF incidence rates were significantly increased in the PD group compared to the control group (males and females; aged ≥ 65 and <65; the non-diabetes and diabetes, hypertension and non-hypertension, and dyslipidemia and non-dyslipidemia subgroups). This nationwide longitudinal study shows a higher incidence rate of CHF in PD patients.

Evidence Base Update on Behavioral Treatments for Overweight and Obesity in Children and Adolescents

ABSTRACT Objective This review provides an update to a previous Evidence Base Update addressing behavioral treatments for overweight and obesity in children and adolescents. Method Articles were identified through a systematic search of the biomedical literature in PubMed/MEDLINE (1946-), Elsevier EMBASE (1947-), SCOPUS (1823-), Clarivate Web of Science Core Collection (WOS, 1900-), PsycINFO (1800-), The Cochrane Library and Clinicaltrials.gov published between June 2014 and August 2022. Results Family-based treatment (FBT) remains a well-established treatment for overweight and obesity in children and is now well-established in adolescents and toddlers. Parent-only behavioral treatment remains well-established in children and is now well-established among adolescents and children. Possibly effective treatments continue to include FBT-parent only for adolescents, and behavioral weight loss (BWL) with a family component for adolescents, children, and toddlers. Several variations of FBT and BWL can now be considered possibly effective including FBT+motivational interviewing, FBT+social facilitation maintenance, group-based FBT, low-dose FBT, BWL+stress management, and camp-based BWL. Cognitive behavioral treatment (CBT) for adolescents also met criteria for possibly effective treatments. Current research has also established that behavioral treatments can be effectively delivered in alternative settings (e.g. primary care) and through alternative mediums (e.g. telehealth). Conclusions Research continues to support the use of multicomponent lifestyle interventions in accordance with recent recommendations from the American Academy of Pediatrics, the American Psychological Association, and the United State Preventative Services Task Force. However, more work is needed to ensure appropriate access for children with comorbid medical and psychiatric disorders and children from socially, politically, and economically marginalized groups.

A Retrospective Cohort Study to Assess the Long-term Retention and Outcome among Inpatients Admitted to a Tertiary Care Addiction Psychiatry Unit in India

Background and Aims: Understanding the long-term outcomes of patients with substance use disorders can help to understand their course and prognosis. We aimed to find out the 10-year retention of patients who underwent short-term inpatient treatment at a tertiary care addiction psychiatry treatment facility. Methodology: This retrospective cohort study evaluated the medical records of patients who underwent short-term inpatient treatment in the year 2009 in an addiction treatment facility. The last year retention in treatment was ascertained at 1, 2, 5, and 10 years using case records. Attempt was made to contact the patients to assess their current status using telephonic interview. Results: Of the 572 patients included in the study, 40.9%, 24.7%, 10.5%, and 5.1% of the initial sample were retained at 1, 2, 5, and 10 years, respectively. Only 3.0% of the sample were retained in treatment continuously without dropping out even once. Several factors such as having a comorbid medical disorder, previous inpatient setting treatment, or routine planned discharge were associated with better retention in treatment at some time points. Of the 58 patients who could be contacted telephonically to assess the 10-year outcomes, a significant proportion (41.4%) was abstinent from all substances except tobacco. Among these patients who could be followed up (about 10% of the initial sample), the most common reason of not being in treatment was that they were abstinent from substances. Conclusion: Gradual attrition from treatment occurs over long-term time course among patients admitted with substance use disorders, though many re-enter treatment process.

SUDs Cost Employer Health Insurance $35 Billion Per Year

SUDs Cost Employer Health Insurance $35 Billion Per Year

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Sleep disorders are very important in clinical practice due to their prevalence and impact on health and quality of life. The most common problems are insomnia, excessive daytime sleepiness, respiratory disorders, or abnormal movements or behaviors during sleep. A detailed, targeted case history, specifically recording the impression of bedfellows or family members, is essential. Sleep tests performed in the laboratory (polysomnography and multiple sleep latency test) are fundamental in the diagnosis of certain sleep disorders (such as sleep-related breathing disorders or central hypersomnias) or in specific populations (such as children or individuals with comorbid medical disorders). Technological advances allow the use of other methods to evaluate a patient's sleep, such as respiratory polygraphy, actigraphy, or applications connected to smart devices. Advances in the research of the physiopathology of these disorders has allowed for the development of specific medications and new treatments. However, a multidisciplinary approach is essential for the proper management of these diseases, which includes improving sleep hygiene and cognitive behavioral therapy.

Somatoform Disorders and Expressed Emotions in the Family: Results from a Cross-Sectional Observational Study to Evaluate a Novel Relationship

Abstract Background: Expressed emotions (EEs) in the family affect the presentation and course of psychiatric disorders. Somatoform disorders with their psychosocial origins may be caused or perpetuated by family dynamics like EEs. Aims: The study aimed to assess the prevalence, type, and levels of EEs in the families of patients with somatoform disorders. Methods: One hundred and six adult patients with somatoform disorders (F45; ICD-10) and their family member were recruited for the study. Patients with any comorbid medical or psychiatric disorder and substance use disorders (except tobacco dependence) or subjects living alone were excluded from the study. The study participants were assessed for somatoform disorders and EEs using a sociodemographic proforma, Mini-International Neuropsychiatric Interview structured interview, Patient Health Questionnaire-15 (PHQ-15), Family Emotional Involvement and Criticism Scale, and perceived criticism measure (PCM). Final analysis was done using statistical tests including Chi-square test, Fisher’s exact test, Student’s t-test, Pearson’s correlation coefficient, and univariate and multiple regression analysis. P ≤ 0.05 was considered to denote statistical significance. Results: The most common somatoform disorder in the sample was somatization disorder (33%) followed by persistent somatoform pain disorder (18.87%) and undifferentiated somatoform disorder (15.09%). Age (P = 0.007), married status (c2 = 6.752, P = 0.034), and a diagnosis of hypochondriacal disorder and somatization disorder (c2 = 14.613, P = 0.023) were significantly associated with perceived criticism (P &lt; 0.05), while emotional overinvolvement (EOI) was high in subjects with somatoform autonomic dysfunction disorder (21.75) (P &lt; 0.05). Significant positive correlation was seen between PCM and PHQ15 (severity measure) scores (r = 0.209; P = 0.032). Conclusions: Moderate level of EEs were found in the families of patients with somatoform disorders with the association being significant for criticism in hypochondriacal and somatization disorders and for EOI in somatoform autonomic dysfunction disorders. The hypothesis needs further study with follow-up and stronger statistical models to establish causation.

Transcranial Magnetic Stimulation: New Sapience into How Brain Stimulation Palliates Symptoms of PTSD

Posttraumatic stress disorder (PTSD) is a chronic, often debilitating psychological state disorder that may develop after a traumatic life event. Most patients get over the initial symptoms naturally, but those that experience persistent symptoms require standard treatment approaches such as 1: 1 psychotherapy, psychotropic medications, or both whichever have relevance. However, there are secondary hindrances such as drug safety and drug tolerability associated with these psychotropic medications, that interdict an appropriate course of treatment. The upshot of those events is that it creates a breach in our potential to properly manage PTSD in a significant number of patients, leaving them endangered to surfacing complications like employment-related incapacities, suicidal ideations, co-morbid medical disorders, and illicit drug abuse. Thus, there is a need for more worthwhile, tolerable, and long-standing approaches. Transcranial magnetic stimulation may be a safe and non-invasive treatment technique used to treat various psychiatric and neurological disorders. This neuromodulation technique involves stimulation of specific deep brain regions by the assembly of high and low-intensity magnetic fields thus filling the therapeutic void. This text mainly focuses on the results of controlled and pragmatic trials for efficacy, safety, and tolerability of patients affected by PTSD. The alternative treatment for PTSD currently is psychotherapy and antidepressant medications.Despite receiving these alternatives, there are about 50% of patients who continue to experience major symptoms..That is, the reason why TMS came out as another suitable option. Atleast 5 directories such as MEDLINE, CINAHL, Psych INFO, SCOPUS and EMBASE were probed to pinpoint pragmatic studies and randomized controlled trials that were designed for the treatment of PTSD with TMS. A total of 28 studies were found worthy for this review, out of which 5 are mentioned in this article. Although, so far it looks propitious in spite of the manifoldness as far as its outcomes and its clinical importance are concerned. Hence, still researches involving stimulation constraints are to be conducted in the near future.

Pharmacotherapy for Spine-Related Pain in Older Adults.

As the population ages, spine-related pain is increasingly common in older adults. While medications play an important role in pain management, their use has limitations in geriatric patients due to reduced liver and renal function, comorbid medical problems, and polypharmacy. This review will assess the evidence basis for medications used for spine-related pain in older adults, with a focus on drug metabolism and adverse drug reactions. A PubMed/OVID search crossing common spine, neck, and back pain terms with key words for older adults and geriatrics was combined with common drug classes and common drug names and limited to clinical trials and age over 65years. The results were then reviewed with identification of commonly used drugs and drug categories: nonsteroidal anti-inflammatories (NSAIDs), acetaminophen, corticosteroids, gabapentin and pregabalin, antispastic and antispasmodic muscle relaxants, tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tramadol, and opioids. Collectively, 138 double-blind, placebo-controlled trials were the focus of the review. The review found a variable contribution of high-quality studies examining the efficacy of medications for spine pain primarily in the geriatric population. There was strong evidence for NSAID use with adjustments for gastrointestinal and renal risk factors. Gabapentin and pregabalin had mixed evidence for neuropathic pain. SNRIs had good evidence for neuropathic pain and a more favorable safety profile than TCAs. Tramadol had some evidence in older patients, but more so in persons aged <65years. Rational therapeutic choices based on geriatric spine pain diagnosis are helpful, such as NSAIDs and acetaminophen for arthritic and myofascial-based pain, gabapentinoids or duloxetine for neuropathic and radicular pain, antispastic agents for myofascial-based pain, and combination therapy for mixed etiologies. Tramadol can be well tolerated in older patients, but has risks of cognitive and classic opioid side effects. Otherwise, opioids are typically avoided in the treatment of spine-related pain in older adults due to their morbidity and mortality risk and are reserved for refractory severe pain. Whenever possible, beneficial geriatric spine pain pharmacotherapy should employ the lowest therapeutic doses with consideration of polypharmacy, potentially decreased renal and hepatic metabolism, and co-morbid medical disorders.

Strategies and foundations for scientific discovery in longitudinal studies of bipolar disorder.

Bipolar disorder (BD) is a complex and dynamic condition with a typical onset in late adolescence or early adulthood followed by an episodic course with intervening periods of subthreshold symptoms or euthymia. It is complicated by the accumulation of comorbid medical and psychiatric disorders. The etiology of BD remains unknown and no reliable biological markers have yet been identified. This is likely due to lack of comprehensive ontological framework and, most importantly, the fact that most studies have been based on small nonrepresentative clinical samples with cross‐sectional designs. We propose to establish large, global longitudinal cohorts of BD studied consistently in a multidimensional and multidisciplinary manner to determine etiology and help improve treatment. Herein we propose collection of a broad range of data that reflect the heterogenic phenotypic manifestations of BD that include dimensional and categorical measures of mood, neurocognitive, personality, behavior, sleep and circadian, life‐story, and outcomes domains. In combination with genetic and biological information such an approach promotes the integrating and harmonizing of data within and across current ontology systems while supporting a paradigm shift that will facilitate discovery and become the basis for novel hypotheses.

Influences of Aging on PTSD Prevalence, Neurobiology, and Clinical Course

Posttraumatic stress disorder (PTSD) affects 6.8% of adults in the United States and is associated with high rates of disability, comorbid medical and psychiatric disorders, and suicide. Recent studies report increasing prevalence rates of PTSD among older adults, and this pattern is anticipated to accelerate as the population skews older and Veterans from recent conflicts age. Most older adults suffer from chronic PTSD, which is associated with at least one disability in nearly 80% of cases. Compared to those without PTSD, individuals with chronic PTSD have exceedingly high rates of Major Depressive Disorder (MDD), triple the rates of drug abuse, and significant functional impairment. Prompt diagnosis and treatment of PTSD in later life is complicated by its differing phenomenology in older compared to younger adults and age-related changes in treatment seeking. Whereas overall symptom severity, intrusive thoughts, and avoidance behaviors are lower among older adults with PTSD, they more frequently report somatic problems (e.g., pain, insomnia, gastrointestinal upset) relative to emotional issues (e.g., specific aspects of the trauma). Older patients may not spontaneously report traumatic experiences or minimize their importance, use generic terms such as “stress”, and generally present to primary medical doctors rather than specialty mental health settings. In terms of treatment, few studies of exposure-based psychotherapies are randomized, older adults are rarely enrolled, and almost none evaluate the most evidence-based psychotherapy for PTSD, Prolonged Exposure therapy. Analyses of prescribing trends using Veterans Affairs (VA) databases suggest that only about half of veterans (all ages) with PTSD receive first-line pharmacotherapy agents such as selective serotonin reuptake inhibitors (SSRIs), with even lower medication prescription in older compared to younger adults.In this symposium the influence of age-related factors will be discussed on the prevalence, development of PTSD given a traumatic stimulus, clinical presentation in terms of symptom profiles, underlying neurobiology, treatment responsivity, and illness course. Speakers will engage the audience in a discussion of what makes PTSD different in older adults compared to younger adults and what are the implications of these differences on clinical evaluation and treatment. Dr. Joan Cook will present data comparing characteristics of younger vs. older sexual assault survivors in order to discuss clinical and research implications. Next, Dr. Vanessa Simiola will present electronic health record and utilization data and discuss age-based differences between diagnoses made in primary care versus specialty mental health, differences in mental health treatment receipt, as well as clinical characteristics of the samples. Then, Dr. Xi Zhu will delve into data suggesting higher rates of MDD in older adults with PTSD and present her analyses of network connectivity differences discriminating PTSD from comorbid PTSD/MDD. Finally, Dr. Bret Rutherford will present data from an ongoing NIMH study in which older adults with PTSD are compared to trauma-exposed healthy controls (TEHCs) on cognitive, physical functioning, and neuroimaging indices. Two-year follow up data will be reviewed to consider the differing cognitive and physical functioning trajectories experienced over time between PTSD and TEHC participants. Finally, an audience discussion synthesizing all three of the talks will be held, with ample opportunity for audience members to ask questions of each speaker.

Risk factors for Deliberate Self Harm in Bipolar Affective Disorder patients presenting to Tertiary care center- A cross-sectional study

Abstract:-&#x0D; Background: Deliberate Self Harm (DSH) is a complex event, associated with psychosomatic, biological, social factors and psychiatric disorders. Current literature shows that, there is rise in DSH in psychiatric disorders and it has been recognised as major public health problem in India. So, objective of this study was to assess the underlying risk factors for DSH in patients with Bipolar Affective Disorder (BPAD).&#x0D; Methods:&#x0D; This cross-sectional study was conducted on 150 patients diagnosed with BPAD as per International Classification of Diseases; tenth revision (ICD-10). Semi-structured socio-demographic proforma was used to record basic profile. Deliberate self harm inventory (DSHI) was administered to assess the type of DSH. Young Mania Rating scale and Beck Depression Inventory were used to assess severity of symptoms.&#x0D; Results:&#x0D; Prevalence of DSH in present study was 33%. In socio-demographic profile, younger age group, lower education levels and being single were significant risk factors for DSH (p- value &lt;.001, .016 and &lt;.001 respectively) and among clinical variables, early years of disorder, severe mania, moderate and severe depressive episode in presence of medium to high suicidal intent, family history of mood disorders and co-morbid substance use and medical disorder were significant risk factors for DSH in BPAD with statistical significance (p&lt;.0001).&#x0D; Conclusion:&#x0D; DSH is considered to be the significant predictor of suicide. BPAD is associated with high risk of DSH, which can be present in either depressive or manic episode. Patients with BPAD in early years of illness, should be evaluated thoroughly for risk factors, so that DSH risk can be minimised

The prevalence and clinical correlates of medical disorders comorbidities in patients with bipolar disorder

ObjectiveMedical disorders in patients with bipolar disorder (BD) have attracted more and more attention. So far, there is still a lack of studies on this issue utilizing large sample sizes in the Chinese sample. Therefore, we conducted this study to explore the clinical characteristics of BD patients comorbid medical disorders in a relatively large Chinese sample.MethodsThis was a cross-sectional study including 1,393 BD patients (882 patients with medical disorders and 511 patients without medical disorders). Their demographic and clinical characteristics were obtained by the Hospital Information System and self-designed questionnaires.ResultsThe comorbidity rate of medical disorders in BD was 63.32%. The average number of medical disorders for a BD patient was 2.69. The top five comorbid medical disorders in BD patients were circulatory system diseases (19%), nervous system diseases (18%), endocrine and metabolic diseases (17%), digestive system diseases (16%), and respiratory system diseases (8%). BD patients with comorbid medical disorders had an older average age, lower education level, longer illness course, later onset age, lower ratio of psychotic features, more admission numbers, higher ratio of smoking and drinking alcohol, more number of manic episodes (All P < 0.05). Smoking, numbers of depressive episode, onset age, and illness course were independent risk factors of comorbidities in BD patients (All P < 0.05).ConclusionsMedical disorders in Chinese BD patients are highly prevalent. The smoking, number of depressive episodes, onset age, illness course, are correlated with BD patients comorbid medical disorders. Clinicians should pay attention to the medical disorders comorbidities in BD patients, and take effective measures to improve treatment outcome and reduce the suffering. The integrative approach should be the imperative in clinical practice.

The Relationship between Parkinson's Disease and Acute Myocardial Infarction in Korea : A Nationwide Longitudinal Cohort Study.

ObjectiveThe goal of the following statewide age and gender-coordinated cohort study in Korea is to find out if there is a link between acute myocardial infarction (AMI) and Parkinson’s disease (PD). MethodsUtilizing the National Health Insurance Sharing Service cohort, patient data were collected. Six thousand four hundred seventy-five individuals with PD were distinguished by utilizing the International Classification of Diseases 10 code G20 and have enrolled in the PD group. The number of participants decreased to 5259 after excluding 1039 patients who were hospitalized less than one time or who visited an outpatient clinic less than twice. Then, 26295 individuals were selected as part of the control group after case control matching was conducted through 1 : 5 age- and gender-coordinated matching. The Cox proportional hazard regression analysis and Kaplan-Meier method were utilized to analyze the likelihood of AMI in PD. ResultsAfter controlling for age and gender, the hazard ratio of AMI in the PD group was 3.603 (95% confidence interval [CI], 2.837–4.577). After that, the following hazard ratio of AMI in the PD group was modified against for co-morbid medical disorders, resulting in 3.551 (95% CI, 2.795–4.511). According to a subgroup analysis, in males and females aged <65 and aged ≥65 and in the non-diabetes and diabetes, hypertension and non-hypertension, dyslipidemia and non-dyslipidemia subgroups, the AMI incidence rates were dramatically higher in the PD group compared to that of the control. ConclusionIndividuals with PD have a greater chance of AMI, according to this cross-national study.

The disquietude of clozapine continuation during the COVID-19 pandemic.

The disquietude of clozapine continuation during the COVID-19 pandemic.