Comorbid Physical Illness Research Articles

Prevalence and clinical correlates of residual symptoms in remitted patients with bipolar disorder: An exploratory study.

Objective:This cross-sectional study aimed to evaluate the prevalence and factors associated with residual symptoms (both depressive and manic) in subjects with bipolar disorder (BD).Materials and Methods:A total of 844 subjects diagnosed BD with an illness of 2 years' duration and minimum of two lifetime episodes and in clinical remission were evaluated for residual symptoms using Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Based on the severity of residual symptoms, the study groups were divided into four groups.Results:Sixty-nine percent of the subjects had residual depressive symptoms (i.e., HAM-D score in the range of 1–7) and 59% had residual manic symptoms (i.e., YMRS score in the range of 1–7). The most common residual depressive symptom was psychic anxiety (34%) followed by impaired insight (29%). The most common manic symptom was poor insight (31%) followed by sleep disturbances (25%). Subjects with both sets of residual symptoms had onset of BD at a relatively young age, when compared to those with only residual depressive symptoms. Presence of any comorbid physical illness and substance abuse disorder was significantly higher in those with both sets of residual symptoms.Conclusions:The present study suggests that a substantial proportion of patients with BD have residual symptoms of both types. Comorbid physical illness and substance use were associated with residual symptoms. Identification and management of residual symptoms are highly essential to improve the overall outcome of patients with BD.

Supporting better mental health services for rural Australians: Secondary analysis from the Australian National Social Survey.

People with mental illness experience poorer physical health, less access to physical health care and live shorter lives compared to the general population.1 Managing physical health issues along with mental illness can be difficult, especially for those living in rural locations, given that access to mental health services diminishes as remoteness increases.2 Bridging health service disparities between regional and urban localities must be a national imperative since people with mental illness in rural areas have higher rates of early mortality due to physical illness.3 The aim of the present study was to offer additional evidence for bridging this gap by comparing the prevalence of co-morbid mental and physical illness between urban and rural areas. Participants in the Australian National Social Survey (n = 1265) self-reported demographic, quality of life, chronic disease and health behaviour characteristics. Dichotomous (Yes/No) self-reported chronic disease status including being told by a doctor, they have depression and/or anxiety was recorded. Urban and rural classifications were based on self-report. In this secondary analysis, Chi-square and independent samples t tests were conducted to test differences in proportion of respondents with self-reported depression and/or anxiety in urban and rural areas with co-morbid physical conditions, and the number of co-morbid physical conditions, respectively. Statistical significance was accepted where P < 0.05. Participant characteristics are shown in Table 1. Depression and/or anxiety was reported by n = 216 respondents. Urban residents comprised 74% (n = 159) of the sample. Co-morbid physical illness was reported in n = 109 (69%) and n = 45 (79%) urban and rural residents, respectively (χ2 = 2.215, df = 1, P > .05). Those in urban and rural areas reported 1.6 ± 1.7 (range: 0-9) and 2.1 ± 1.8 (range: 0-7) co-morbid chronic conditions, respectively (t = −1.848, df = 214, P > .05). Participants provided informed consent, and the study was approved by Central Queensland University's Human Research Ethics Committee (Approval No: H14/09-203). There was no difference in the prevalence of at least one other co-morbid chronic condition between people with self-reported depression and/or anxiety who resided in urban versus rural areas. Acknowledging limitations of self-reporting health status, small sample size, and potential confounders such as age, this is a novel finding. Although the prevalence of psychological distress is similar between rural and urban areas, people with mental illness in rural areas have more than 300% greater risk of premature death due to co-morbid physical health conditions, compared to their urban counterparts.3 In part, this can be explained by the reduced access and more barriers to mental health services for people living in rural areas compared to than people living in urban areas.4 Given the common prevalence of co-morbidity, our findings argue strongly for better access to health care services in rural areas that address mental health care but with capacity and capability to address physical health care to reduce disease burden in these communities. Telehealth services may reduce this disparity, but service location remains “urban-centric.” One potential solution may be to develop and implementation multi-skilled practitioners who can provide mental and physical health services simultaneously. Achieving this requires efforts directed at funding, attracting, and retaining medical and allied health professionals to rural communities, especially those who come from and feel connected with rural communities. Recently, the Federal Government announced the Stronger Rural Health Strategy aimed at addressing the higher disease burden and risk of early mortality faced by those in rural areas. However, this strategy has been criticised as being overly focussed on medical professionals, with a relative absence of attention to allied health professionals.5 Together with limited funding for rural health promotion, rural residents may be worse off, thereby widening, rather than bridging, the current disparity in health service provision. Clearly, more needs to be done to develop and support the rural workforce to help communities in need and achieve health service parity with metropolitan areas. The authors have no conflicts of interest to declare.

Nationwide analysis of medical utilization in people with severe mental illness receiving home care case management

AimThis nationwide study investigated the change in medical utilization of psychiatric home care case management (CM). MethodsThis nationwide study enrolled patients receiving CM (N = 10,274) from January 1, 1999 to December 31, 2010, from Taiwan's National Health Insurance Research Database. Through a 2-year mirror-image comparison weighted by the contributed person-time for each subject, we evaluated changes in medical utilization. Furthermore, a case-crossover analysis was used to verify the independent effect of CM in changing medical utilization by adjusting the time-variant variables between the pre-2-year (within 2 years before receiving CM) and post-2-year (within years after receiving CM) periods. The same methodology was applied for the subsequent 2-year comparison to assess the maintenance effect. ResultsOf the 10,274 patients receiving CM, 69.7% had schizophrenia. The results showed a chronological trend for the intervention of CM. The adjusted mirror-image analysis revealed a significant decrement of psychiatric and involuntary admissions after the intervention, and the utilization shifted toward psychiatric outpatient service. The case-crossover analysis with the adjustment of time-variant covariates confirmed the independent effect of CM on the changes of medical utilization. The comparable effect persisted after the next 2 years of intervention. However, CM showed no impact on lowering the admission rate for comorbid physical illnesses after the intervention. ConclusionsThe CM model can effectively reduce psychiatric hospitalization and involuntary admission frequency but has no effect on comorbid physical illnesses. Care models aimed at ameliorating physical problems in such patients are needed.

Clinical presentation and neuropsychological profiles of Functional Cognitive Disorder patients with and without co-morbid depression

ABSTRACTIntroduction: Functional Cognitive Disorder (FCD) is poorly understood. We sought to better characterise FCD in order to inform future diagnostic criteria and evidence based treatments. Additionally, we compared FCD patients with and without co-morbid depression, including their neuropsychological profiles, to determine whether these two disorders are distinct.Methods: 47 FCD patients (55% female, mean age: 52 years) attending a tertiary neuropsychiatric clinic over a one year period were included. We evaluated sociodemographic characteristics and clinical features including presentation, medications, the presence and nature of co-morbid psychiatric or physical illnesses, and the results of neuropsychometric testing.Results: 23/47 (49%) patients had co-morbid depression. Six had cognitive difficulties greater than expected from their co-morbid conditions suggesting “functional overlay”. 34 patients had formal neuropsychological testing; 12 demonstrated less than full subjective effort. 16/22 (73%) of the remaining patients had non-specific cognitive impairment in at least one domain. There were no significant differences between those with and without co-morbid depression.Conclusions: Our study informs future diagnostic criteria. For example, they should not exclude patients with co-morbid psychiatric illness or abnormal neuropsychometric testing and clinicians should remain open to the possibility of “functional overlay”. Furthermore, FCD and depression are distinct disorders that can exist co-morbidly.

Hospitalisation of people with dementia: evidence from English electronic health records from 2008 to 2016

Hospitalisation of people with dementia is associated with adverse outcomes and high costs. We aimed to examine general, i.e. non-psychiatric, hospitalisation rates, changes since 2008 and factors associated with admission. We also aimed to compare admission rates of people with dementia with age-matched people without dementia. We conducted a cohort study of adults ≥ 65 years, with dementia diagnosed during the 2008–2016 study window, derived from a large secondary mental healthcare database in South London, UK. We used national general hospital records to identify emergency and elective hospitalisations. We calculated the cumulative incidence and rate of hospitalisation and examined predictors of hospitalisation using negative binomial regression, with multiple imputation for missing covariate data. We calculated age-standardised admission ratio for people with dementia compared to those without. Of 10,137 people, 50.6% were admitted to hospital in the year following dementia diagnosis and 75.9% were admitted during median 2.5 years follow-up. Annual admission rate was 1.26/person-year of which 0.90/person-year were in emergency. Emergency hospitalisation rate increased throughout the study period. Compared to controls without diagnosed dementia in the catchment area, the age-standardised emergency admission ratio for people with dementia was 2.06 (95% CI 1.95, 2.18). Male, older, white and socio-economically deprived people and those with clinically significant comorbid physical illness, depressed mood, activity of daily living or living condition problems had more hospitalisations. Emergency hospitalisations of people with dementia are higher than those without, and increasing. Many factors associated with admission are social and psychological, and may be targets for future interventions that aim to reduce avoidable admissions.

Prevalence of suicidality and its correlates in geriatric depression: A multicentric study under the aegis of the Indian Association for Geriatric Mental Health

Aim of the Study: This study aimed to evaluate the prevalence and risk factors for suicidal ideations (SIs) and suicidal attempts (SAs) among elderly patients with depression, seeking treatment in psychiatric setups. Methodology: The study sample comprised 488 elderly patients (age ≥60 years) with depression recruited across eight centers. These patients were evaluated on the Columbia Suicide Severity Rating Scale, Geriatric Depression Scale-30, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-15 Scale, UCLA Loneliness Scale, Revised Social Connectedness Scale, and Montreal Cognitive Assessment Scale. Results: “Wish to die” was present in one-fifth (21.7%) and about one-fourth (26.6%) of the study samples at the time of assessment and in the lifetime, respectively. Overall, one-fourth (25.8%; n = 126) of the participants had SIs at the time of assessment and two-fifths (41.5%; n = 203) had SIs in the lifetime. Overall, about one-tenth (9.2%) of the participants made an SA just before assessment and one-sixth (16.6%) had at least one SA in the lifetime. Compared to those with no SIs in the lifetime, those with current and lifetime SIs had lower age of onset and longer duration of illness, less often had a comorbid physical illness, more often had recurrent depressive disorder, had significantly higher anxiety as assessed on GAD-7 scale, and had significantly higher prevalence of loneliness and significantly higher prevalence of cognitive deficits. When those with any current and lifetime SAs and those with no lifetime SAs were compared, those with SAs had longer duration of current treatment and more often had comorbid physical illness and significantly higher cognitive deficits. Conclusions: The present study suggests that about one-fourth (25.8%) of the elderly with depression have SIs at the time of assessment and about two-fifths (41.5%) have lifetime SIs. About one-sixth of the elderly patients with depression make at least one SA in the lifetime and about one-tenth attempt suicide in recent past. In terms of risk factors for SIs and SAs, the present study suggests that the presence of comorbid anxiety, loneliness, and cognitive deficits possibly predispose the elderly to suicidal behaviors.

Early-Life Adversity, Systemic Inflammation and Comorbid Physical and Psychiatric Illnesses of Adult Life.

Recently, the evidence of increased immune activation in patients with schizophrenia has suggested a role for the immune system in the development of psychosis. However, what is causing this increased immune activation and how this leads to the development of psychopathology remain still unclear. In this chapter we discuss the evidence about the role of childhood trauma as possible underlying cause of the increased immune activation in patients with schizophrenia. According to preclinical and clinical models, early adverse events can disrupt the homeostatic control of immune responses and lead to enduring inflammatory dysregulation at a peripheral and central level. In fact, persisting systemic inflammation may facilitate peripheral tissues damage and breach the blood-brain barrier, leading to microglia activation and to neuroinflammation.Such chronic immune dysregulation also appear to partially explain the frequent comorbidity between psychosis and metabolic abnormalities, which have previously mainly considered as side effect of antipsychotic treatment.Overall, this evidence suggests that early stress may contribute to development of schizophrenia spectrum disorders through a modulation of the peripheral and central immune system and support the immune pathways as possible future therapeutic approach for psychosis.

Cognitive Processes in Anxiety and Comorbid Physical Illness and Health Behavior: Introduction to the Special Issue.

Anxiety symptoms and disorders are the most common psychiatric problems world-wide and are vastly overrepresented among individuals with chronic illness and poor health behavior. The purpose of the current special series is to bolster attention and highlight new research on cognitive processes as a basic element that may undergird the association between anxiety and chronic illness and health behavior. Findings in this issue highlight cognitive-based risk and resilience factors related to anxiety in individuals with various chronic conditions problematic health behaviors.

Challenges in management of Major Depression in patients with co-morbid medical conditions

Depression is a heterogeneous illness and depression with co-morbid physical illness may represent a phenotype of depression. Concurrent medical illness in depression is associated with greater functional and social impairment and significantly higher health care costs. A variety of mechanisms including lifestyle factors, immune-inflammatory pathways, medications and psychological factors have been proposed to explain the association between depression and physical illness. However, each of these pathways engenders unique challenges in managing such patients. Of utmost importance is to establish the nature of the underlying medical or psychological cause(s) which will inform customized management plans. This article initially reviews the prevalence of depression in medical conditions and vice versa. Subsequently, we move on to discuss specific approaches to diagnosis of depression in the context of medical co-morbidity. Finally, we describe evidence based pharmacological and psychosocial intervention strategies with some recommendations for common clinical scenarios. Evidence based care models to manage depression with physical illness are described which may be adapted for use in low resource settings.

Challenges in management of Major Depression in patients with co-morbid medical conditions

Depression is a heterogeneous illness and depression with co-morbid physical illness may represent a phenotype of depression. Concurrent medical illness in depression is associated with greater functional and social impairment and significantly higher health care costs. A variety of mechanisms including lifestyle factors, immune-inflammatory pathways, medications and psychological factors have been proposed to explain the association between depression and physical illness. However, each of these pathways engenders unique challenges in managing such patients. Of utmost importance is to establish the nature of the underlying medical or psychological cause(s) which will inform customized management plans. This article initially reviews the prevalence of depression in medical conditions and vice versa. Subsequently, we move on to discuss specific approaches to diagnosis of depression in the context of medical co-morbidity. Finally, we describe evidence based pharmacological and psychosocial intervention strategies with some recommendations for common clinical scenarios. Evidence based care models to manage depression with physical illness are described which may be adapted for use in low resource settings.

Patterns of benzodiazepines use in primary care adults with anxiety disorders

BackgroundBenzodiazepines are among the most commonly prescribed drugs for anxiety disorders. While they are indicated as adjunctive treatment for short-term use according to clinical practice guidelines, previous studies have shown patterns of long-term use of benzodiazepines, which is problematic due to side effects, dependence and potential of abuse. The aims of this study were to examine among a large sample of primary care adults suffering from anxiety disorders: 1) benzodiazepine use patterns; and 2) correlates of long-term benzodiazepine use. MethodsData were drawn from the “Dialogue” project, a large primary care study conducted in 64 primary care clinics in the province of Quebec, Canada. Following a mental health screening in waiting rooms, patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). A sample of 740 adults meeting DSM-IV criteria for Generalized Anxiety Disorder, Panic Disorder or Social Anxiety Disorder in the past 12 months took part in this study. ResultsBenzodiazepines were used by 22.6% of participants with anxiety disorders in our primary care sample. A large majority of benzodiazepine users (88.4%) met our indicator of long-term use, as defined by utilization for more than 12 weeks including regular and as-needed use. Based on a logistic regression model, individual correlates associated with long-term benzodiazepine use included: being 30 years or older, having a comorbid physical illness, meeting criteria for comorbid agoraphobia, reporting the use of sleep-aids, and concurrent SSRI utilization. LimitationData collection with self-reported questionnaires may be subject to information bias. ConclusionsDespite knowledge of the risks of long-term use of benzodiazepines, this remains a pervasive problem. Clinicians need to be mindful of patterns and risk factors leading to long-term use of benzodiazepines in patients with anxiety disorders. Results of this study should raise awareness regarding appropriate prescription practices for benzodiazepines, including decision-making in initiation, duration of prescription, and use of strategies for discontinuation in current long-term benzodiazepine users.

Prevalence of Comorbid Mental and Physical Illnesses and Risks for Self-Harm and Premature Death Among Primary Care Patients Diagnosed with Fatigue Syndromes

Background: Fatigue syndromes affect large numbers of individuals, yet evidence from epidemiological studies on adverse outcomes, such as premature death, is limited. Methods: Cohort study involving 385 general practices in England that contributed to the Clinical Practice Research Datalink (CPRD) with linked inpatient Hospital Episode Statistics (HES) and Office for National Statistics (ONS) cause of death information. A total of 10,477 patients aged 15 years and above, diagnosed with a fatigue syndrome during 2000-2014, were individually matched with up to 20 comparator patients without history of having a fatigue syndrome. Prevalence ratios (PRs) were estimated to compare the fatigue syndrome and comparison cohorts on clinical characteristics. Adjusted hazard ratios (HRs) for subsequent adverse outcomes were estimated from stratified Cox regression models. Outcomes: Among patients diagnosed with fatigue syndromes, we found elevated baseline prevalence of: any psychiatric illness (PR 1.77; 95% CI 1.72-1.82), anxiety disorders (PR 1.92; 1.85-1.99), depression (PR 1.89; 1.83-1.96), psychotropic prescriptions (PR 1.68; 1.64-1.72), and comorbid physical illness (PR 1.28; 1.23-1.32). We found no significant differences in risks for: all-cause mortality (HR 0.99; 0.91-1.09), natural death (HR 0.99; 0.90-1.09), unnatural death (HR 1.00; 0.59-1.72), or suicide (HR 1.68; 0.78-3.63). We did, however, observe a significantly elevated non-fatal self-harm risk: HR 1.83; 1.56-2.15. Interpretation: The absence of elevated premature mortality risk is reassuring. The raised prevalence of mental illness and increased non-fatal self-harm risk indicate a need for enhanced assessment and management of psychopathology associated with fatigue syndromes. Funding: NIHR Greater Manchester Patient Safety Translational Research Centre. Conflict of interest statement: PDW is a member of the Independent Medical Experts Group; an advisory non-departmental public body, which advises the UK Ministry of Defence regarding the Armed Forces Compensation Scheme. In the past, PDW has provided unpaid advice to the UK Department for Work and Pensions regarding mental health issues. PDW does paid consultancy work for a re-insurance company. NK is supported by Greater Manchester Mental Health and Social Care Trust. NK chaired the guideline development group for the 2012 NICE guidelines on the longer term management of self-harm and currently chairs the guideline development group for the NICE depression in adults guideline. NK is also a member of the Suicide Prevention Advisory Group at the Department of Health. Ethical Approval Statement: The study was approved by the independent scientific advisory committee (ISAC) for Clinical Practice Research Datalink research (protocol number: 16_050R).

Socio-demographic and Comorbidity Profiles of Migraine Patients in a Headache Clinic of a Tertiary Care Hospital in Dhaka City

Background: Comorbidities of migraine patients are not uncommon.Objective: This study was done to find out sociodemographic characteristics and the important comorbid psychiatric and physical illness in migraine patients.Methodology: This cross sectional study was carried out in the Neurology Outdoor and Headache Clinic at Dhaka Medical College Hospital, Dhaka from July 2010 to June 2011 for a period of 1 year. Patients with migraine (on the basis of International headache society migraine headache criteria), age ≥16 years with total duration of headache six months or more, having comorbidities like major depressive disorder (MDD), generalized anxiety disorder (GAD), hypertension (HTN), diabetes mellitus (DM) or obesity were included in the study (n=33).The sociodemographic and relevant data were collected in a preformed data sheet from each patient.Result: The mean age of the participants was 33.8±8.8 years. Most of them were in 31-40 year age group (39.4%), followed by 21-30 year age group (36.4%). Most of the participants were female (72.7%) and housewives (57.6%). The symptoms of migraine was severe according to Migraine Severity Scale (MIGSEV) in 19 (57.6%), moderate in 8 (24.2%) and mild in 6 (18.2%) participants. Among the comorbidities, psychiatric problems like GAD and MDD was present in 8 (24.2%) and 6 (18.2%) participants respectively. Seven (21.2%) were obese, 4 (12.1%) hypertensive and 8 (24.2%) diabetic. Frequency of headache/month was observed to be higher in participants with hypertension (5.0±1.4 episodes/month) and duration of episodic migraine headache was higher in those with MDD (23.4±10.3 hours).Conclusion: Patients of migraine have comorbidities like GAD, MDD, obesity, hypertension and DM which need to be addressed appropriately for proper migraine headache management.Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 48-51

19.2 RECOVERY THROUGH RELOCATION: FROM NURSING HOME TO COMMUNITY USING COGNITIVE ADAPTATION TRAINING

BackgroundTexans with severe mental illness live 29 years less than other Americans and have more health problems earlier in life. Since 2001, over 46,000 Texans have returned home under the State’s Money Follows the Person program and federal demonstration grant. Despite this impressive achievement, people with mental health and substance use conditions continue to be institutionalized in nursing facilities (NF). Nationally, the number of NF residents under age 65 with a primary diagnosis of mental illness is nearly three times that of older residents. The Texas Money Follows the Person Behavioral Health Pilot (MFP-BHP), assists nursing facility residents with co-morbid mental and physical illnesses relocate into the community. The transition from institutionalization to independent living is a crucial time for treatment intervention to maintain independence and reduce high risk adverse outcomes, including hospitalization, exacerbation of symptoms or homelessness.MethodsIn addition to service coordination from Managed Care Organizations, participants receive Cognitive Adaptation Training (CAT) for six months in the nursing facility and one year in the community. CAT is a home-based psychosocial treatment utilizing environmental supports such as medication containers, signs, checklists and the organization of belongings to bypass deficits in cognitive functioning and cue and sequence adaptive behavior, to improve functional outcomes for individuals with mental illness. This demonstration project assessed the effectiveness of providing CAT to improve functional and social outcomes, measured at baseline, each three months for one year, and each six months post intervention for one additional year.ResultsOver 500 individuals have been transitioned into the community since 2008, with 60% maintaining independence. Findings indicate a significant improvement in targeted functional outcomes post facility discharge on the Multnomah Community Ability Scale (p<.0001), Social and Occupational Functioning Scale (p<.001) and the Quality of Life Scale (p< .01). Preliminarily analyses indicate that Medicaid costs for participants are considerably lower on average than costs prior to discharge. At the end of 2015, the savings to the state via the Pilot were tens of millions. The Pilot ends in December 2017 and final cost analyses will be conducted at this time.DiscussionCAT was successfully applied to persons with co-occurring mental and physical disorders relocating from nursing facilities to independent living environments with good preliminary outcomes indicating better quality of life, social and occupational role function and in overall community functioning. The majority of persons have successfully remained in the community. The MFP Behavioral Health Pilot shows Medicaid participants residing in nursing facilities with significant mental health issues can successfully maintain their residence in the community which results in significant cost savings, even taking into account the standard MFP costs plus the intervention. MFP Pilot participants improved their functional status, which extended after the intervention period ended. Current implementation efforts are in place to integrate and sustain CAT in the statewide managed care system.

Prevalence of physical comorbidity and prescription patterns in elderly patients with depression: A multicentric study under the aegis of IAGMH

Aim of the Study: This study aims to evaluate the prevalence of physical comorbidities and prescription patterns in elderly patients with depression. Materials and Methods: This study included 488 elderly patients (aged ≥60 years) with depression recruited across eight centers. A self-designed physical comorbidity checklist was used to assess for the presence of various physical comorbidities and prescription of psychotropic medications was recorded. Results: More than three-fourth of the study sample (n = 384; 78.7%) had at least one physical comorbidities and one-third (36.7%) of the samples had at least three physical illnesses. About half of the study samples had hypertension (47.3%) and slightly more than one-fourth had diabetes mellitus (29%). The most common physical illness involved the cardiovascular system (51.5%), followed by endocrinological system (39.3%), orthopedic and joint-related diseases (35%), and ophthalmological problems (22.3%). Those with physical comorbidity had higher severity of depression, anxiety, and somatic symptom. Sertraline was the most preferred antidepressant followed by escitalopram and mirtazapine. Only 12.7% of the sample was prescribed antipsychotics of which quetiapine and olanzapine were the most commonly used agents. Benzodiazepines were prescribed to more than half of the study samples (56.55%), with clonazepam being the most preferred benzodiazepine followed by lorazepam. Compared to those without hypertension, those with hypertension were more commonly prescribed sertraline and escitalopram and less commonly prescribed fluoxetine. Similarly, compared to those without diabetes mellitus, those with diabetes mellitus were more commonly prescribed sertraline and less commonly prescribed fluoxetine. Conclusion: Comorbid physical illnesses are highly prevalent in elderly participants with depression with hypertension being the most common physical comorbidity followed by diabetes mellitus and osteoarthritis. The presence of physical comorbidity is associated with more frequent prescription of sertraline and escitalopram.

Predictors of short-term repetition of self-harm among patients admitted to an emergency room following self-harm: A retrospective one-year cohort study

We conducted a retrospective chart-review study, examining predictors of the repetition of short-term self-harm (<1 month and <6 months) among the patients who were admitted to an emergency department in Japan following self-harm. A total of 405 patients were enrolled and were followed-up for a subsequent one year. The incidence of repeated self-harm within one- and six- months were 6.4% and 13.1%, respectively. Cox's proportional hazards model analyses demonstrated that history of self-harm and comorbid physical illness were associated with repeated self-harm within one month. The patients who lived alone and who were directly discharged from the emergency room after referral to a psychiatrist were at higher risk for repeated self-harm within both one and six months. Living on public assistance and having been discharged from psychiatric wards within the past 12 months were associated with repetition within six months. These risk factors should be incorporated into routine assessment at an emergency room, and elaborate follow-up plan should be provided to the patients with these risk factors upon discharge from the emergency room. Further prospective studies are warranted, addressing more comprehensive factors that are associated with short-term risk for self-harm and suicide.

Co-Morbid Physical Illness among Depressed Prisoners in a Nigerian Prison Population

Co-Morbid Physical Illness among Depressed Prisoners in a Nigerian Prison Population

Care coordinator views and experiences of physical health monitoring in clients with severe mental illness: A qualitative study.

Excess mortality among people with severe mental illness (SMI) is largely attributed to co-morbid physical illness. Improving the physical health of this population is critically important; however, physical health monitoring among people with SMI is often inadequate. This study aimed to facilitate an enhanced understanding of barriers to successfully attend to clients' physical health in mental health settings, through exploring care coordinators' views and experiences regarding their ability to monitor physical health in clients with SMI (specifically, psychosis). Semi-structured interviews were conducted with seven care coordinators from a South East London (UK) community mental health team. Data were analysed using thematic analysis principles. Three themes were identified in these data, capturing (1) how care coordinators viewed the professional roles of other clinical staff and themselves, (2) views on barriers to the provision of physical healthcare and (3) factors that motivated care coordinators to attend to clients' physical health. Our findings can inform efforts to implement physical healthcare interventions within mental health settings. Such insights are timely, as academic literature and guidelines regarding clinical practice increasingly promote the value of integrated provision of mental and physical healthcare.

Comorbidity of mental and physical disorders: A major challenge for medicine in the 21st century

Demographic changes and successes of medicine in preserving and prolonging life are among the main reasons for the significant increase of comorbidity of mental and physical illness. The simultaneous presence of these disorders leads to a worse prognosis of both types of disorder, significant increases of cost of treatment and heightened mortality.Although these facts are becoming known among members of the profession and among decision makers in the field of health little is done to provide adequate and timely treatment and care for all the diseases from which a person suffers. The fragmentation of medicine into ever finer and more narrow specialties contributes to the decreasing quality of care for people who have the misfortune of having comorbid mental and physical illnesses as does the stigma of mental illness which decreases the probability of timely help and leads to well documented discrimination of those who have mental illness in health services.The paper will present some information about comorbidity of mental and physical disorders and suggest reforms of health care that might help to resolve the problems which comorbidity produces.Disclosure of interestThe author has not supplied his declaration of competing interest.

Suicide among the Elderly: A Psychological Perspective

This theoretical paper focusses on the psychological aspects of understanding the impact of elderly suicide on society. The reasons associated with the prevalence of suicide among the elderly population and the preventive measures that can be utilised for enhancement and adjustment of the elderly with respect to their standing in their personal and social life. The elderly population of India has a noteworthy risk of suicide compared to the other age groups. Hence, it becomes pertinent to identify the suicidal risk factors prevalent among the elderly, which can further help in planning and prevention of suicides among this group. It has been found that amongst the Indian geriatric populace factors such as, co-morbid physical illness, mental illness, and family burden of psychiatric illness, lower educational background, unemployment, widowhood are prominent predictors for elderly suicide attempts. Thus, suicide prevention for the elderly needs specific interventions specially personalised for this population, such as, familial and social support, improved identification, assessment and treatment of depression, attention to medical problems, dependency issues, and education of primary care physicians can be promoted as interventions for reduction of suicide among the elderly.