Comorbid Mental Disorders Research Articles

Study protocol for a randomized controlled trial to adapt a posttraumatic stress disorder intervention of patients with opioid-stimulant polysubstance use receiving methadone maintenance treatment

BackgroundThe purpose of the Treatment for Harnessing Resiliency, Improving emotional regulation, and empowering indiViduals for a brighter future (THRIVE) study is to adapt an evidence-based posttraumatic stress disorder (PTSD) treatment for use among a polysubstance population receiving methadone maintenance treatment (MMT) at an opioid treatment program. Polysubstance use of high-risk combinations, such as illicit opioids and stimulants, is a critical public health issue. Individuals who engage in these high-risk combinations are more likely to have histories of childhood trauma, multiple traumas, PTSD, and greater PTSD severity as compared to mono-substance using individuals. Trauma, co-morbid mental health disorders such as PTSD, and polysubstance use complicate treatment outcomes. This study will use eight study phases to adapt an existing evidence-based PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in MMT who are engaged in sustained opioid-stimulant polysubstance use.Methods and analysisThe intervention is an adapted version of the STAIR-NT protocol. The massed version created includes four 60-min sessions of skill building and two weeks of four 60-min sessions of narrative therapy. A preliminary randomized controlled trial (RCT) with 80 participants, randomized 1:1, will be conducted to assess the intervention's implementation and impact on primary short-term outcomes of polysubstance use and PTSD symptoms.Ethics and disseminationThe results of this study will inform a fully-powered effectiveness trial for individuals with PTSD and polysubstance use receiving MMT. The findings are expected to provide valuable insights into improving both PTSD and substance use outcomes, and real-world implementation insights to integrating trauma-informed care in treatment settings for vulnerable populations.RegistrationThis study is registered at ClinicalTrials.Gov as NCT06307340. Registration date 03/2024.

Gut microbial and human genetic signatures of inflammatory bowel disease increase risk of comorbid mental disorders

The high prevalence of comorbid mental disorders (CMDs) in patients with inflammatory bowel disease (IBD) is well-documented. This study delves into the intricate CMD-IBD relationship through comprehensive analyses using human variants, gut microbiome, and anxiety/depression estimates from a cohort of 507 IBD patients and 75 controls. Notably, patients with IBD, especially those with CMD, exhibited lower diversity than controls. We identified 106 differentially abundant taxa (DATs) in IBD patients compared to controls and 21 DATs distinguishing CMD-affected from CMD-free IBD patients. Microbial IBD-risk scores, reflecting an individual’s microbial burden for IBD, revealed a significant enrichment of IBD-risk signatures in CMD-affected patients compared to CMD-free patients. Additionally, there was an IBD-risk variant potentially regulating the abundance of an IBD/CMD-associated DAT, suggesting an interplay between IBD-risk variants and dysbiosis in CMD. Our investigation underscores the pivotal role of IBD-associated gut dysbiosis in predisposing IBD patients to CMD, partially through genetic variant-mediated mechanisms.

8.M. Skills building seminar: Mental health and substance use in Europe

Abstract The impact of social factors on individual and population mental health are well established (Kirkbride, et al., 2024). The same social factors may trigger the substance use behavior developing into substance use disorders. Mental health disorders can contribute to the substance use and substance use disorders with worsening effects over time (EMCDDA, 2016). This association between substance use, substance use disorders and mental health disorders is a key objective for the scientific consideration and policy development. Respective phenomena are universal and a broader perspective would be useful for a better understanding of how the issue of comorbidities of substance use and mental disorders are addressed on a European level. Identification of the substance use problem, especially among populations in vulnerable situations, like migrants, becomes utterly important. Heterogenous systematic reviews show that there is a need for socially and culturally refugee sensitive instruments to measure the substance use in migrants. Oftentimes substance use is followed by the substance use disorders and drug use related infections. Injecting drug use is also a risk factor for having drug use related infections, such as hepatitis B and C, HIV, tuberculosis. Assessment of risk behaviour patterns among people who inject drugs may contribute to a higher participation in treatment and health programmes, reduce the burden of substance use and tackle comorbidities of substance use and mental health disorders. The skill building seminar aims to increase the knowledge and capacities on substance use and comorbidities, applied methodological approaches and tools in different European contexts. This workshop will support researchers, policy makers, public health planners by providing evidence base to address substance use and mental health issues. The added value of this workshop is based on the structure, content and mode of presentations - presentations will be followed by questions from participants and short discussions. The workshop will start with the general introduction to the topic of comorbidities of substance use and mental health disorders (EUPHA-PMH and EUDA). Then the European level perspective on comorbidities of substance use and mental health disorders will be presented including recent policy developments (1 presentation by Linda Montanari, EUDA). It will be supported with research results from the study conducted in Germany on substance use assessment tool development in migrant population (2 presentation by Kim-Julian Behr, Germany) and behavioural risk factor assessment study among people who inject drugs in Lithuania (3 presentation by Marija Jakubauskiene, Lithuania). Key messages • Participatory approach is useful to address the substance use problem in assessment tool development and further monitoring. • Better understanding of comorbidity of substance use and mental disorders leads to a more effective prevention.

The association between the mental health disorders, substance abuse, and tobacco use with head & neck cancer stage at diagnosis.

Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system. This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use. The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

Comorbidity of substance use and mental disorders in Europe

Abstract ‘Comorbidity of substance use and mental disorders’ refers to the co-occurrence of a substance use disorder (SUD) and another mental disorder (MHD) in the same individual: mental disorders can be a risk factor for SUD and SUD may affect the occurrence of MHD. The relevance of the mental health disorders among people who use substances is related not only to its high prevalence, but also to its difficult assessment, diagnosis, and management. The EUDA is the European Drug Agency (EUDA), a decentralised agency of the European Commission with the purpose to support the European member States to monitor, respond and be prepared to the challenges posed by the drug phenomenon, including the link between SUD and MHD. In 2015 the agency has published an overview on comorbidity of SUD and MHD where it discusses several issues regarding dual disorders, including: theoretical concepts and mechanisms of actions, tools for screening and clinical diagnosis, epidemiology and interventions available to address comorbidity in the European countries (EMCDDA, 2015). The European strategic policy documents in the drug area stress the importance of considering mental health in monitoring, evidence-based responses and training for professionals in the drug field (EC, 2021). During the COVID19 pandemic, due to the overall increased concern on mental health in the population, the EUDA conducted an ad-hoc study to its the impact on substance use and mental health, especially in people who use illicit drugs. Recent work has been done to improve the available epidemiological data on comorbidity in the current European drug monitoring tools and to describe models of care for the treatment of dual disorders in Europe. Further steps are being taken with the development of the recent new agency’s mandate.

Patients with Diabetes Mellitus and Comorbid Mental Disorders - Is there a Psychotherapeutic Undertreatment? - Results of the DiMPS Study

Diabetes mellitus is associated with an increased likelihood of mental disorders, especially depression. Despite a frequently postulated underprovision, the actual need for psychotherapeutic treatment in this patient group has hardly been investigated. The aim of this study is to analyze the care situation of diabetes patients with mental comorbidities in Germany. 240 consecutively treated patients with type 1 or type 2 diabetes were examined cross-sectionally and longitudinally in a tertiary diabetological center. After a screening and diagnostic examination, 94 patients with comorbid mental disorders were included in the study. Patients then decided on the treatment of their mental disorder according to a standardized shared decision-making process. At the 6-month follow-up, 77 of the 94 patients (81.9%) provided information about the realization of their treatment decision and the obstacles they encountered. 39.2% of patients with diabetes had a mental disorder. Of these, 44.2% were already receiving psychotherapy or medication. After six months, 46.8% were able to implement their treatment decision. Only 7.1% did not receive any treatment despite their efforts. The 6-month follow-up showed a significant reduction in diabetes-related distress (PAID; p<0.05) and an increase in psychological well-being in all subgroups, regardless of treatment initiation (WHO-5; p<0.05). Contrary to the widespread notion of a lack of access to psychotherapy for people with diabetes and mental disorders in Germany, this assumption could not be confirmed in this study. Equating the frequency of mental disorders with the need for psychotherapeutic and/or psychopharmacological treatment without considering the specific treatment needs and preferences of patients may lead to an overestimation of the need for care.

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.

Psychiatric assessment for patients who decline cancer treatment: perspectives from medical residents.

Among patients with cancer, a comorbid mental disorder is associated with higher mortality. This could be partially attributed to reduced access to oncological care, sometimes due to treatment refusal. Recommendations were issued in 2018 by the French and Francophone Society of Psycho-Oncology concerning the management of oncological treatment refusal. This study aimed to examine oncology residents' view on psychiatric assessment in this context. In February 2021, we conducted a descriptive, observational, cross-sectional pilot study among French residents involved in oncology regarding their management of cancer treatment refusal and the importance they assign to psychiatric assessment, using an online questionnaire with 12 multiple-choice questions. Among 87 respondents, only 35.6% systematically explore the history of mental disorders when facing cancer treatment refusal. Even in cases with a known history of mental disorders, only 42.5% systematically refer the patient to a psychiatrist. 96.5% of them were unaware of the 2018 recommendations. The importance given to psychiatric assessment in cases of oncological treatment refusal remains insufficient. Qualitative studies are needed to understand the underlying reasons for this refusal. The development of psychiatric consultation-liaison interventions in oncology centers is necessary to improve the management of these cases and provide appropriate training.

The Association Between COVID-fear with Psychological Distress and Substance Use: the Moderating Effect of Treatment Engagement.

The purpose of this brief report was to examine the association between COVID-fear with psychiatric symptoms severity and substance use risk in an outpatient population with co-occurring substance use and mental health disorders and whether these associations were moderated by treatment engagement, especially after providers had shifted from an in-person care model to a telehealth format. A total of 136 patients receiving outpatient treatment for comorbid substance use and mental health disorders completed self-report questionnaires on their psychiatric symptoms, substance use, and treatment engagement (i.e., frequency, length, and helpfulness of phone and video sessions with a mental health counselor, psychiatrist, or primary care provider) in the past month between November 2020 and March 2021. Results showed that COVID-fear was significantly associated with psychiatric symptom severity, but not substance use risk. Additionally, perceived helpfulness of phone counseling sessions moderated the associations between COVID-fear and global psychiatric symptom severity, such that COVID-fear and global psychiatric symptom severity were positively associated when perceived helpfulness was low, and not associated if perceived helpfulness was high. The present results highlight the importance of directly addressing fears specific to a national emergency, as well as for providers to build strong rapport with their clients.

Differences in TAVR Utilization in Aortic Stenosis Among Patients With and Without Psychiatric Comorbidities

BackgroundTranscatheter aortic valve replacement (TAVR) is one of the primary treatment modalities for aortic stenosis (AS). Disparities affecting certain groups could result in lower utilization of this life-saving procedure. This study aims to investigate the effects of associated psychiatric conditions on the likelihood of TAVR in hospitalized AS patients. MethodsOur retrospective observational study used the National Inpatient Sample to identify hospitalized patients with AS. Using the International Classification of Diseases, 10th Revision, Clinical Modification patients were stratified into those without psychiatric comorbidities, and those with psychiatric comorbidities. The primary outcome was comparing the odds of TAVR between AS patients with and without psychiatric comorbidities. The secondary outcome assessed the association between TAVR and specific psychiatric comorbidities, using multivariable logistic regression while adjusting for prespecified covariates. ResultsThe study included 1,549,785 AS patients, of which 26% had psychiatric comorbidities. Patients with any psychiatric comorbidity had a significantly reduced likelihood of TAVR (adjusted odds ratio [aOR], 0.76; P < .001). For 2 psychiatric comorbidities, (aOR, 0.80; P < .001), and for more than 2 comorbid mental disorders (aOR, 0.46; P < .001). Lower TAVR odds were observed in patients with depression (aOR, 0.79), anxiety (aOR, 0.79), bipolar disorder (aOR, 0.74), substance use (aOR, 0.73), and psychotic disorders (aOR, 0.61), with P values < .001. There was no significant difference in the odds of surgical aortic valve replacement between those with and without psychiatric comorbidities. ConclusionsAS patients with psychiatric conditions face reduced TAVR likelihood. Further research is needed to confirm, explore, and address factors contributing to this disparity.

Borderline personality disorder: part 2 – psychiatric management

SUMMARY The large volume of seemingly conflicting guidance on the management of borderline personality disorder (BPD), combined with the ongoing shortage of specialised resources, can make the task feel like an exclusive undertaking that the general psychiatrist is underprepared for. In this article, we distil current evidence to submit that sound psychiatric management principles used to treat all serious and enduring mental disorders (diagnostics, comorbidity management, rational pharmacotherapy and dynamic risk management) are readily applicable and particularly therapeutic for BPD. We offer actionable practice guidance that we hope will render the clinical management experience a more lucid and rewarding one for both practitioner and patient.

Mental disorders in children and adolescents with type 1 diabetes before and during the COVID-19 pandemic: results from the DPV registry.

The COVID-19 pandemic affected the mental health of children and adolescents in the general population, yet its impact on those with chronic conditions is relatively unknown. This study aimed to compare the incidences of comorbid mental disorders and substance misuse in children and adolescents with type 1 diabetes before and during the pandemic. A total of 42,975 patients aged 6-18 years from the multicentre DPV (Diabetes Prospective Follow-up) registry were included. Multivariable regression models were applied to compare newly diagnosed comorbid mental disorders, adjusted for demographic and clinical variables, among them the number of medical visits, during the pre-pandemic period (09/2017-02/2020) and the COVID-19 pandemic period (03/2020-08/2022). Analysing both sexes together, there were no differences in the incidence rates of overall mental disorders between the pandemic and the pre-pandemic period. However, girls showed an increased incidence rate (odds ratio 1.2, CI 1.1-1.3) during the pandemic. Adolescent girls also displayed higher incidence rates of depression, eating disorders, and self-harm. Substance misuse declined overall during the pandemic (odds ratio 0.8, CI 0.7-0.9). During the COVID-19 pandemic, we found higher incidence rates of overall mental disorders in girls, but not in boys and not in the total study population of children and adolescents with type 1 diabetes. Adolescent girls displayed increased incidence rates of depression, eating disorders, and self-harm. Substance misuse declined substantially. Clinicians should be aware of the high-risk group of adolescent girls during times of increased strain.

Preexisting Mental Disorders and Mental Distress During the Pandemic: The Roles of Stress, Risk Perception, and Loneliness.

The COVID-19 pandemic has imposed unprecedented stressors on individuals globally, leading to significant mental health challenges. This study examines the relationship between perceived adversities experienced during the pandemic-such as stress, risk perception, and loneliness-and the mental health outcomes of individuals with a specific focus on those already grappling with mental disorders. The study analyzed data from 8,259 adults who participated in surveys between waves 4 (April 2020) and 29 (June 2021) of the Understanding American Study. Participants self-reported their psychiatric diagnosis history and completed self-report measures of mental distress (PHQ-4), perceived stress, risk perception, and loneliness. Those with preexisting comorbid mental disorders reported higher levels of mental distress, COVID-19 risk perception, perceived stress as well as more days experiencing loneliness during the pandemic. Perceived adversities-stress, risk perception, and loneliness-were all positively associated with increased mental distress, indicating the risk factors for mental distress during the pandemic. Among these factors, loneliness was identified as the primary contributor, accounting for 30%-40% of the mental health gap between individuals with and without preexisting mental diagnoses. Also, the detrimental impact of these adversities was more pronounced for those with preexisting mental disorders. The research highlights that those with preexisting mental disorders, particularly those with comorbidities, face an increased risk of experiencing mental distress during the COVID-19 pandemic. These findings underscore the critical importance of providing targeted support and interventions specifically designed for this vulnerable population, with a particular focus on addressing loneliness.

Exploring the interconnections of anxiety, depression, sleep problems and health-promoting lifestyles among Chinese university students: a comprehensive network approach.

Anxiety, depression, and sleep problems are prevalent comorbid mental disorders among university students. The World Health Organization (WHO) emphasized a mental health promotion objective, recommending the consideration of protective health-promoting factors in strategies aimed at preventing mental disorders. Integrating theoretically significant constructs (such as protective factors) enhances our comprehension of the intricate mechanisms that underpin mental disorders. This study employed network analysis to first identify core and bridge symptoms within comorbid mental disorders and then explore how health-promoting lifestyles (HPLs) were associated with these disorders. The ultimate goal is to offer health promotion recommendations to enhance students' quality of life. A total of 3,896 qualified university students participated in this study. Anxiety, depression, sleep problems, and HPLs were assessed using the GAD-7, PHQ-9, PSQI, and HPLP-II scales. A Gaussian Graphical Model was used to construct the networks. The Network Comparison Test was applied to determine whether the associations between HPLs and comorbid symptoms vary by gender, educational level, family sibling, and mental health status. Low energy (PHQ4) had the highest strength centrality, followed by Daytime dysfunction (PSQI7) and Trouble relaxing (GAD4). Five bridge symptoms were identified: Daytime dysfunction (PSQI7), Self-harm even suicide (PHQ9), Sad mood (PHQ2), Low energy (PHQ4), and Feeling afraid (GAD7). Regarding protective HPLs, Physical activity, Spiritual growth, and Stress management generally emerged as the top three central mental health-promoting behaviors. Targeting core and bridge symptoms with timely and appropriate interventions can alleviate anxiety, depression, and sleep problems in this population. Moreover, promoting physical activity, fostering spiritual growth, and managing stress are likely to significantly enhance the overall mental health of university students.

Treatment, Education, and Prognosis of Slow Learners (Borderline Intelligence).

Borderline intelligence has been excluded from formal diagnostic systems and not included in disability diagnoses, leaving gaps in treatment, education, and social welfare despite various functional impairments. Therefore, we aimed to shed light on ways to enhance the intelligence and functioning of individuals with borderline intelligence by reviewing research on its progression, education, and treatment. Ten studies that met the inclusion and exclusion criteria were included in the final literature review and analyzed according to detailed topics (participant characteristics, design, and results). Borderline intelligence is associated with various comorbid conditions, such as anxiety, depression, attention deficit/hyperactivity disorder, and addictive disorders, which negatively impact its course and prognosis. Individuals with borderline intelligence often face challenges in academics, employment, interpersonal relationships, and health owing to lifelong cognitive impairments. The treatment of borderline intelligence necessitates addressing environmental factors, such as neglect and abuse, as well as treating comorbid mental disorders, which are crucial for prognosis. Tailoring treatment programs for cognitive profile characteristics have been proposed, and studies have reported the effectiveness of pharmacotherapy, working memory training, and intensive rehabilitation training. Therefore, early intervention during childhood brain development is necessary. Risk factors, such as lack of parental education, and their impact on treatment outcomes have also been reported. Extensive research is needed on education, treatment, and prognosis related to borderline intelligence. Active intervention for children with borderline intelligence is essential to improve their functioning and quality of life.

The use of psychotropic drugs in oncological diseases (review)

Background: It is estimated that at least 25-30% of cancer patients experience mental disorders. Due to the high prevalence of these disorders among this patient population, psychotropic drugs have been successfully utilized in oncology for an extended period of time. The use of psychotropic drugs enables targeted symptom management to improve the quality of life of cancer patients. However, it is essential to carefully evaluate the risks of drug interactions and potential side effects when prescribing any psychotropic medication. The aim of the study: The aim of this study was to analyze the utilization of psychopharmacotherapy in oncology practice for treating comorbid mental disorders and symptoms related to oncological diseases. An evaluation of the side effects and drug interactions of psychopharmacological and oncological drugs was conducted. Materials and methods: The eLibrary, PubMed, and Google Scholar databases were searched using the keywords “psychooncology” and “psychopharmacotherapy”. Reviews, meta-analyses, and therapy recommendations were selected from the obtained results, which provided the most comprehensive coverage of the current scientific data on this topic. Results: Anxiety disorders and depressive reactions are prevalent in cancer patients and can be successfully treated with psychopharmacological intervention. Additionally, symptoms associated with the oncological process or side effects of treatment such as anorexia, pain, and nausea can be alleviated through the use of antidepressants and antipsychotics. However, it is crucial to carefully evaluate the risks of drug interactions when prescribing any psychotropic drugs. For instance, strong cytochrome CYP2D6 inhibitors can lead to a decrease in the concentration of the active metabolite tamoxifen, while the combination of antidepressants and tramadol increases the risk of serotonin syndrome. Conclusion: The application of psychotropic drugs in the treatment of cancer can greatly enhance the patients' quality of life. However, potential side effects and drug interactions must be carefully evaluated.

Случай девушки по имени Миша: эпатаж, маскинг и нейродивергентность

The article presents the case of a girl, Arina, who, based on psychological self-examination, discovered that she had autism spectrum disorder and insisted on receiving an official psychiatric diagnosis. She reported that for many years she had been engaged in masking – hiding existing communication disorders, as a result of which she developed emotional dysregulation and “autistic burnout.” In addition, she was dissatisfied with her name and asked those around her to call her Misha, but in the feminine gender. Misha's behavior was disharmonious; she was prone to conflict due to a misunderstanding of the non-verbal reactions of her interlocutors. An analysis of the literature on the issue of comorbidity of autism spectrum disorders was carried out. It was concluded that the Asperger syndrome identified in the patient was not combined with clearly defined comorbid mental and behavioral disorders, but with abortifacient elements of certain psychopathological symptoms. It is assumed that comorbid disorders did not develop in Misha in an expanded form precisely because of the presence of specific autistic traits that made it difficult to develop a full picture of any other disorders.

Effectiveness of Usual-Care Cognitive-Behavioral Therapy for Children and Adolescents with Nonorganic Enuresis and Comorbid Mental Disorders

ABSTRACT Highly controlled randomized controlled trials (RCT) have provided considerable evidence for the efficacy of standard urotherapy (SU) consisting of cognitive-behavioral therapy (CBT) in patients with enuresis. However, the effectiveness of CBT under routine care conditions regarding wetting frequency and comorbid mental health problems has not been shown. Changes under routine CBT were analyzed in a sample of n = 220 clinically referred children and adolescents with enuresis (88.2% with at least one comorbid mental disorder) aged 6 to 18 years (M = 9.30; SD = 2.32) treated at a university outpatient clinic (experimental group, EG). At the start and end of treatment, wetting frequency as well as parent- and teacher-rated mental health problems were assessed and compared to a historical control group (CG) receiving a medical placebo. The EG showed a large, statistically significant pre-post reduction in wetting frequency (effect size d = 1.47). When comparing these results to the CG, a net effect size in favor of the EG emerged (d = 1.32). Furthermore, small to large, statistically significant reductions in mental health problems were found in the EG (range: d = 0.26 to d = 1.24). However, a substantial proportion of the EG remained in the clinical range at the end of treatment. The present study indicates that routine CBT for patients with enuresis may be effective, thus supporting the findings of more controlled efficacy trials. Trial registration: DRKS00028094 - Retrospectively registered, May 25, 2022, http://drks.de

Quality of health care for patients with coronary heart disease and comorbid mental disorders: a prospective cohort study

BackgroundCoronary heart disease (CHD) is often associated with mental disorders (MDs). Comorbid MDs reduce the quality of life and increase cardiac morbidity and mortality. Nevertheless, there is little and inconsistent research on the management of MDs in CHD patients. To bridge this gap, this study aims to gain insight into the long-term course of MD-related health care for patients with CHD, in order to identify opportunities for care improvement.MethodsIn this prospective cohort study, we investigated whether CHD patients with or without expert-rated MD at baseline (N = 364) received different MD-related health care from either their general practitioner (GP) or cardiologist at follow-up, M = 2.7 [2.0–4.0] years later. In the follow-up assessment, N = 131 CHD patients participated and received questionnaires capturing sociodemographic, mental health, and MD-related health care characteristics. Descriptive statistics, t-tests and chi-squared tests were used for analyses.ResultsWe found significant differences in MD-related health care. CHD patients with MD were more likely to be examined psychologically/psychiatrically (MD 55.9%, non-MD 16.7%, p = < .001) and diagnosed with MD (MD 55.9%, non-MD 13.5%, p = .020) by their GP or cardiologist. Recommendations for and responses to requests for psychotherapy were more likely in MD patients compared to non-MD patients (MD 38.7%, non-MD 11.8%, p = .012 and MD 38.5%, non-MD 11.8%, p = .031, respectively). No significant differences were found concerning physicians’ active demand for patients’ mental health, referral to a specialist for additional diagnostics, provision of information about the diagnosed MD and further treatment options, response to the patients’ request for psychopharmacotherapy, help received in finding psychotherapy or psychopharmacotherapy, and actual receipt of these treatments.ConclusionsThe results indicate differences in MD-related health care of CHD patients with and without comorbid MD. However, they still highlight the need to further encourage primary care physicians treating CHD to adequately address MDs, provide further diagnostics, support, and information to affected patients. To address this, physicians may benefit from awareness training on the association between CHD and MDs and on appropriate communication with MD patients.Trial registrationGerman clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: ID DRKS00022154, date of registration: 02.11.2021.

Outpatient Psychotherapy in Germany.

A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients with a comorbidity of mental disorders and chronic physical conditions (cMP). Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344). From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic physical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist. Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.