Comorbidity Of Other Psychiatric Disorders Research Articles

Depression and anxiety disorders among immigrants living in Finland: Comorbidity and mental health service use

BackgroundThe aims of this study were to (1) compare differences in psychiatric comorbidity of depression and anxiety disorders between immigrants and native Finns and to (2) compare differences in the intensity of psychiatric care received by different immigrant groups and Finnish-born controls with depression and/or anxiety disorders. MethodsThe study uses registered-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression and/or an anxiety disorder during the follow-up (2011–2015) (immigrants n = 6542, Finnish-born controls n = 9281). We compared differences in comorbidity between the immigrants and the Finnish-born controls using chi-squared tests. Multinomial logistic regression was used to predict psychiatric treatment intensity by immigrant status, region of origin, and other background factors. ResultsIn both diagnosis groups, Finnish-born participants exhibited greater comorbidity of other psychiatric disorders. Immigrants more often received lower intensity treatment and less often higher intensity treatment. These differences were most striking among those from Eastern Europe, the Middle East, and Africa. LimitationsWe did not have the information on the perceived need for the services, which limits us from drawing further conclusions about the mechanisms behind the observed patterns. ConclusionsImmigrants in Finland receive less intensive treatment for depression and anxiety disorders compared to the Finnish-born population. Since lower symptom levels can unlikely alone explain these differences, they could reflect a need for improvement in the psychiatric services for immigrants.

Psychiatric comorbidity among children and adolescents with dyslexia

BackgroundOne of the most consistent findings in childhood psychopathology literature is that children with dyslexia frequently presented with additional psychiatric disorders. Over 60% of children with dyslexia meets criteria for at least one additional diagnosis.Aim of resultsDyslexia shows high comorbidity with ADHD, ODD, and CD (18%, 14%, and 8%, respectively) than ccontrols that affect dyslexic boys more than girls. Dyslexic group show marked increase in internalizing and externalizing syndromes than control group. Dyslexic girls show more internalizing behaviors than dyslexic boys, unlike externalizing syndromes which was more evident in boys).ConclusionHigh comorbidity of other psychiatric disorders with dyslexia gets attention to evaluate students with dyslexia for other psychiatric comorbidity and referring them for psychiatric management.

SA110 - SHARED POLYGENIC RISK ANALYSIS OF ALCOHOLISM AND 5 MAJOR PSYCHIATRIC DISORDERS

Background Alcohol is the most commonly used and abused substance. Addictions to alcohol and other legal/illicit drugs are heritable disorders influenced by a large number of variants of small effect, frequently being a comorbidity of other psychiatric disorders. This comorbidity between a mental illness and a Substance Use Disorder (SUD) is consistently contributing to an increased disability in individuals. In spite of this evidence of important comorbidity, shared genetic factors remain partially understudied. Previous GWAS of SUD showed evidence of genetic overlap with schizophrenia, bipolar disorder and major depressive disorder. We tested individual associations using Polygenic Risk Scores (PRS) from the Psychiatric Genomics Consortium's Cross-Disorder meta-analysis as discovery samples, and each of the five psychiatric disorders included in the study (ADHD, AUT, BIP, MDD, and SCZ), including 2014 PGC schizophrenia mega-analysis results, and, as target sample, a 1144 individuals case/control sample of alcohol abuse/dependence from Galicia, northwest Spain. Methods A total of 572 substance dependent patients were included. Inclusion criteria were: age between 18 and 65, born in Galicia and follow DSM-IV criteria for dependence of at least one substance and abuse/dependence of other substance. The substances registered in the study were: alcohol, tobacco, cannabis, cocaine, opiates, hypnotics, stimulants, hallucinogens and solvents. Most patients (N=540) were diagnosed with alcohol abuse/dependence. A total number of 604 controls from Galicia were included (mean age at recruitment: 40.26, SD: 10.70). DNA was extracted from blood samples and genotyping was performed using Illumina Infinium PsychArray. Variant imputation was executed with SHAPEIT and IMPUTE2, and PRS models were derived from the summary statistics of the PGC cross-disorder meta-analysis (CROSS) and 2014 PGC schizophrenia mega-analysis (SCZ2). Extensive data cleaning and Quality Control (QC) was employed. SNPs within the extended MHC region were excluded from part of the analysis. Associations between every PRS model and our data were tested using logistics regression. Results After QC and imputation, a total number of 503 alcohol cases and 587 controls remained (728 males and 362 females) and genotypic data remained in a total number of 6294324 SNPs. Covariates were included in regression analysis for correction (missing genotyping rate, significant MDS dimensions, sex and age). General CROSS-disorder PRSs (5 disorders included) showed a strong association with alcohol dependence (P=7.39e-06, ΔR=2%). After analyzing each disease separately, significant results were found in bipolar disorder (P=0.0064, ΔR=0.7%) and schizophrenia (P=7.06e-05, ΔR=1.5%). A consistent result was achieved using the greater sample of SCZ2 were obtained a consistent (P=4.49e-10, ΔR=4.1%). SCZ2 and general CROSS-disorders results are robust after Bonferroni multiple test correction (7 thresholds and 7 pathologies employed). Discussion The use of a greater sample in SCZ2 improves results in schizophrenia, showing the consistency of these in this pathology. Moreover, the variability percent explained is high considering previous data of shared genetic susceptibility between schizophrenia and other psychiatric disorders. Despite the fact that the sample used in major depression disorder was bigger than the one in bipolar disorder, these results were not significant. It is necessary to consider that a fraction of PGC individuals show comorbidity with SUDs. As evidenced in this study, an increase in the number of PGC discovery individuals sample will improve the ability to detect this shared genetic susceptibility.

Clinical profile of children with specific learning disability presenting to a psychiatric clinic

Background: Specific learning disability (SLD) is highly prevalent in school going children. Early detection and remedial training may benefit these children. Objectives: Our study aimed to assess the clinical profile and co-morbid psychiatric disorders of children with specific learning disability in an Indian setting. Materials and Methods: 160 consecutive children who were diagnosed as SLD by psycho educational testing during the period of January 2014 to January 2015, in the Department of Psychiatry, at Amala Institute of Medial Sciences, Thrissur were taken as the sample. Subjects were interviewed using a structured questionnaire to assess socio-demographic details. Edinburgh Handedness Inventory was used to assess handedness and Family Interview of Genetics studies were used to systematically assess family history. Statistical analysis was done using descriptive statistics and chi-square tests using SPSS statistical software version 16. Results: Specific learning disability was more common in boys (82.5 %) and is more commonly referred for evaluation in the age group of 10-15 years (56.2%). Sixty per cent children had co-morbid ADHD. Other co morbid conditions were conduct and oppositional defiant disorder (20%), anxiety disorder (15%) and depression (7%). We found a significant association between dysgraphia, dyslexia and age group 5-9 years and 10-15 years (P= 0.0015, 0.0152 respectively). Conclusion: Awareness regarding specific learning disability among parents, teachers and children are essential for early detection and timely intervention. Children referred with any behavioral and emotional disorders need to be assessed for SLD. Co-morbidity of other psychiatric disorders worsens the prognosis.

Effects of co-occurring disorders on the perception of family functioning

ABSTRACTIntroduction: Comorbidity of other psychiatric disorders is a common issue in individuals with substance use disorder (SUDs); this phenomenon is known as co-occurring disorders (CODs). Previous studies have pointed that CODs are strongly associated with familial difficulties. There are CODs where the association between family function and COD remains unknown. The objective of this study was to analyze the relation between CODs and family functioning in a sample of individuals with SUDs receiving treatment in residential addiction facilities. Method: A total of 490 participants were evaluated with Mini International Neuropsychiatric Interview for psychiatric disorders and Intra-family Relationships Scale (IRS) for family functioning. Two models were analyzed using multiple linear regression, predictors for each model were (1) any disorders and (2) each disorders, in order to evaluate the relation between psychiatric disorders and factors from the IRS. Models were compared through ANOVA. Results: Model 1 (including any disorder as predictor) was significant for every dimension of the family functioning. In Model 2, significant associations between the three IRS factors and antisocial personality disorder, major depressive disorder, and anorexia nervosa were found, being negative in difficulties and positive in cohesion and support and expression. Posttraumatic stress disorder was only significantly associated with cohesion and support. Conclusions: CODs displayed differential relations in the family functioning.

Validity and reliability of the Turkish Version of the Clinician Rated Severity of Autism Spectrum and Social Communication Disorders Scale

Objective: The purpose of the present study was to investigate the validity and reliability of the Turkish form of the Clinician Rated Severity of Autism Spectrum and Social Communication Disorders Scale. The scale was originally developed to measure the severity of autism spectrum and social communication disorders regarding the DSM-5 criteria. Methods: The study was conducted in the Department of Psychiatry at Celal Bayar University Hospital. The participants were in- or out-patients diagnosed with any psychotic disorders according to DSM-5. The exclusion criteria were comorbidity of other psychiatric disorders and/or physical diseases. The study was carried out with a total of 49 patients who were diagnosed with schizophrenia (n=40), schizoaffective disorder (n=3), and not otherwise specified psychotic disorder (n=3). One hundred and one volunteers without any mental or physical disease were also included to represent the healthy control. Reliability analysis was performed to examine the internal consistency of the Turkish version of the scale. Additionally, item-total correlations were reported. In validity analyses, compari-son of the total score of the scale in the patient and control groups was evaluated for the discriminative validity. ROC analysis was also performed. Results: 52.7% of the sample were male (n=79). 69.3% of them were graduated from university (n=104), 19.3% from high school (n=29), and 8% from elementary school (n=12). The mean age of the study group was 26.3±10.3 years. Disease duration of psychotic disorder group was 18,29±6.43 years. The internal consistency of the Autism Spectrum and Social Communication Disorder Scale was 0.81. Furthermore, item-total correlations revealed that all items in the scale contributed to the consistency of scores with item-total correlations approaching 0.70. The mean score of the scale in the patient group on the scale was 1.42 whereas the mean score of the healthy group was 0.0. The t-test analysis indicated that there was a statistically significant difference between the sample group and the healthy group in their scores on the scale. In the ROC analysis, the area under the curve was 0.84. Conclusion: Results demonstrated that the Turkish version of Autism Spectrum and Social Communication Disorder Scale was a valid and reliable instrument which may serve as useful in guiding future research that aims to understand autism spectrum and social communication disorder.

Reliability and validity of Turkish Form of Agoraphobia Scale

Objective: The purpose of the present study was to investigate the validity and reliability of the Turkish Form of the Agoraphobia Scale. The scale was originally developed to measure the severity of agoraphobia regarding the DSM-5 criteria. Methods: This study was conducted at the Department of Psychiatry in Celal Bayar University Hospital. The participants were in- or out-patients diagnosed with any anxiety disorder according to the DSM-5. The exclusion criteria were comorbidity of other psychiatric disorders and/or physical diseases. Accordingly, 50 patients with anxiety disorder were included in the study and these were distributed as panic disorder in 14 patients, generalized anxiety disorder in 10 patients, agoraphobia and obsessive-compulsive disorder in four patients, post-traumatic stress disorder in one patient and not otherwise specified anxiety disorder in 17 patients. One hundred and three volunteers without any mental or physical disease were also included to represent the healthy control. Additionally the most widely used self-rated scale of the Spielberger’s State-Trait Anxiety Inventory was used for concurrent validity. Reliability analysis was performed to examine the internal consistency of the Turkish version of the scale. Additionally, item-total correlations were reported. In terms of examining the validity of the scale, subgroup validity analysis was conducted to investigate whether two groups of patients differ in their scores on the scale. ROC analysis was also performed. Results: The mean age of the study group was 29.0±11.8 and 60.1% of the sample group (n=92) were female. 66.0% of the group were college graduates, 19.0% primary school graduates, 15.0% is also high school graduates. Disease duration of anxiety disorder group was 17.1±9.7 years. The internal consis-tency of the Agoraphobia Scale was 0.95 and, item-total score correlation coefficients of the Agoraphobia Scale were between 0.66 and 0.87. In the explanatory factor analysis, for sample adequacy Kaiser-Meier-Olkin (KMO) coefficient was 0.92 and Bartlett coefficient was 1.57. Single-factor solution was obtained and the eigenvalue was 7.16, explaining 71.68% of the total variance. Factor loadings of the items were between 0.71 and 0.90. Coefficient of Spearman correlation analysis was r=0.31. Conclusion: Results demonstrated that the Turkish version of the Agoraphobia Scale was a valid and reliable instrument which may serve as useful in guiding future research that aims to measure agoraphobia severity.

Reliability and validity of the Turkish Version of DSM-5 Level 2 Anger Scale

Objective: The purpose of the present study was to investigate the reliability and validity of the Turkish Form of Level 2 Anger Scale. The scale was originally developed to measure the severity of anger regarding the DSM-5 criteria. Methods: This study was conducted in the Department of Psychiatry in Celal Bayar University Hospital. The participants were in- or out-patients diagnosed with any psychotic disorders according to the DSM-5. The exclusion criteria were comorbidity of other psychiatric disorders and/or physical diseases. The participants were 49 patients who were diagnosed with schizophrenia (n=40), schizoaffective disorder (n=3), and not otherwise specified psychotic disorder (n=6). One hundred and one volunteers without any mental or physical disease were also included to represent the healthy control. In the assesment beside Level 2 Anger Scale, 18-item Brief Psychi-atric Rating Scale was used. In reliability analysis internal consistency coefficient and item-total correlation analysis were performed; for validity analysis exploratory factor analysis was performed. In concurrent validity correlation analyses between Level 2 Anger Scale and BPRS tension, hostility, uncooperativeness, and elated mood subscales were computed. In order to discriminate between the psychosis and the control group, group means of Anger Scale were compared with t-test. Results: The mean age of the study group was 26.0±10.3 and 52.7% of the sample group were female (n=79). 69.3% of them were graduated from university (n=104), 19.3% from high school (n=29), and 8% from elementary school. Disease duration of psychotic disorder group was 17.1±9.7 years. The internal consistency of the Level 2 Anger Scale was 0.91 and, item-total correlation coefficients were between 0.74-0.83. For the exploratory factor analysis of sample adequacy of Level 2 Anger Scale Kaiser-Meðer-Olkin (KMO) coef-ficients 0.81 and Bartlett coefficient 1.03 was found. Single-factor solution was obtained and the eigenvalue is 3.79, representing 75.80 % of the total variance. Factor loadings of the items of the scale were between 0.83-0.90.The mean of score was 5.09±0.72 in the psychosis group while it was calculated as 3.65±0.36 in the control group. There was a statistically significant difference between the groups. There were moderate to high correlations be-tween Level 2 Anger Scale and BPRS tension, hostility, uncooperativeness, and elated mood. Conclusion: Results demonstrated that the Turkish version of Level 2 Anger Scale is a valid and reliable.

Comorbidities in Adult Attention-Deficit/Hyperactivity Disorder: A Practical Guide to Diagnosis in Primary Care

Diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) in adults is complex and challenging because of the frequent comorbidity of other psychiatric disorders that have symptoms overlapping with those of ADHD. The presence of comorbidities can create challenges to making an accurate diagnosis and also impact treatment options and outcomes. This review discusses disorders that may be comorbid with ADHD in adults, including anxiety, mood, substance use disorder, antisocial personality disorder, and borderline personality disorder. Suggestions for recognizing these comorbidities and distinguishing them from ADHD and perspectives on their possible impact on ADHD treatment are included. Adjunctive nonpharmacologic modalities may be especially helpful in the case of comorbid mood, anxiety, substance abuse, or personality disorders.

Impulse control disorders in elderly patients

ObjectiveThere is no epidemiological study on the prevalence of impulse control disorders (ICDs) in the elderly population. The studies on ICDs in elderly patients are limited and some of them are case reports about pathological gambling and kleptomania. The comorbidity of other psychiatric disorders makes diagnosis difficult and has negative effects on both treatment and the prognosis of ICDs. The aim of this study was to determine the prevalence of ICDs among elderly patients and to evaluate the related sociodemographic and clinical features. MethodA total of 76 patients aged 60 and over who have been referred to our outpatient clinics in a one-year period were included in the study. A demographic data form was completed. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) was used to determine axis I psychiatric disorders. The prevalence of ICDs was investigated by using the modified version of the Minnesota Impulse Disorders Interview (MIDI). Impulsivity was measured with the Barratt Impulsiveness Scale Version 11 (BIS-11). The Mini-Mental State Examination (MMSE) test was performed to evaluate the cognitive status of patients and to exclude the diagnosis of dementia. In addition, all patients completed Symptom Check List-90 (SCL-90). ResultsThe prevalence rate of at least one comorbid ICD in our sample was 17%. When patients with a diagnosis of ICDs not otherwise specified (ICD-NOS) were included, the prevalence rate increased to 22.4%. The most common ICD was intermittent explosive disorder (15.8%), followed by pathological gambling (9.2%). The majority of the sample was men (54%), married (80%), had a high school education (51%), and mid-level socioeconomic status (79%). The only statistically significant difference between the sociodemographic characteristics of patients with or without ICDs was gender. The lifetime prevalence of ICDs was 34.1% in men and 8.6% in women. The prevalence of childhood conduct disorder was significantly higher in the group with ICD. There was no statistically significant difference in the number of suicide attempts, history of physical illness and family history of psychiatric disorders between the groups with or without ICDs. Comorbidity of alcohol/substance abuse was found to be 17.6% in patients with ICD whereas no cases were found in the group without ICD. ConclusionThe result of this study has shown that approximately one fifth of patients over 60years had at least one lifetime ICD comorbidity. The prevalence rates of ICDs seem to decrease with aging. The male gender and childhood conduct disorder are related with higher prevalence rates of ICDs in elderly.

P-127 - A case control study of cognitive deficits and memory disturbances in patients with post-traumatic stress disorder

Intruduction Some studies have demonstrated high cognitive deficits in patients with post-traumatic stress disorder (PTSD). Objectives Considering the limited available information about this issue, we decided to assess the cognitive deficits and memory disturbances in these patients. Methods The present study is a case control research conducted on 50 patients with post-traumatic stress disorder who were admitted to Ibn-e-Sina psychiatric hospital in Mashhad, in north-eastern part of Iran in 2008. The control group included 50 people of first degree relatives of these patients who met the inclusion criteria of the study. Case and control groups were selected by simple sampling method; and for all of them, a questionnaire of demographic information, Wechsler memory scale, and mini mental status examination (MMSE) were completed. The gathered data were analyzed using SPSS 14 th edition by chi square, T test, and analyze of variance. Results The mean score of Wechsler memory scale in patients with PTSD (80.78 ± 18.39) was signifantly higher than control group (67.92 ± 7.38) (P = 0.000). The mean score of MMSE was significantly lower in patients with PTSD compared to control group (P = 0.000). The determined disability level assessed by Iranian veterans’ organization and also comorbidity of other psychiatric disorders with PTSD did not have a significant relationship with cognitive deficits, but the duration of PTSD and age of patients were signifantly related to the level of cognitive deficits. Conclusion Cognitive deficits and memory disturbances are higher in patients with PTSD than general population.

P01-162 - A case control study of cognitive deficits and memory disturbances in patients with post-traumatic stress disorder

IntroductionSome studies have demonstrated high cognitive deficits in patients with post-traumatic stress disorder (PTSD). Considering the limited available information about this issue, we decided to assess the cognitive deficits and memory disturbances in these patients.MethodsThe present study is a case control research conducted on 50 patients with post-traumatic stress disorder who were admitted to Ibn-e-Sina psychiatric hospital in Mashhad, in north-eastern part of Iran in 2008. The control group included 50 people of first degree relatives of these patients who met the inclusion criteria of the study. Case and control groups were selected by simple sampling method; and for all of them, a questionnaire of demographic information, Wechsler memory scale, and mini mental status examination (MMSE) were completed. The gathered data were analyzed using SPSS 14th edition by chi square, T test, and analyze of variance.ResultsThe mean score of Wechsler memory scale in patients with PTSD (80.78±18.39) was signifantly higher than control group (67.92±7.38) (P=0.000). The mean score of MMSE was significantly lower in patients with PTSD compared to control group (P=0.000). The determined disability level assessed by Iranian veterans organization and also comorbidity of other psychiatric disorders with PTSD did not have a significant relationship with cognitive deficits, but the duration of PTSD and age of patients were signifantly related to the level of cognitive deficits.DiscussionCognitive deficits and memory disturbances are higher in patients with PTSD than general population.

Pathological Gambling: A Clinical Guide to Treatment

Pathological Gambling: A Clinical Guide to Treatment

Specific phobia 10-16 years after treatment

Twenty eight participants, initially treated for specific phobia as part of a comparative treatment study, were evaluated 10 to 16 years (X = 12 years) later. A comprehensive, in-person, semi-structured diagnostic interview was utilized, which also assessed comorbid disorders. Of 21 patients who had been rated as responders (much improved or very much improved) at treatment termination, 13 (62%) had clinically significant avoidance or endurance with dread subsequent to treatment. Among a subgroup of these responders who had been considered completely recovered (n = 11), 5 (45%) had clinically significant symptoms following treatment. None of the seven subjects who had been considered unimproved at treatment termination recovered from phobia symptoms in the intervening years. Positive response to treatment was associated with better long term outcome. Clinical characteristics, such as phobia subtype, age of onset, baseline severity, and lifetime comorbidity of other psychiatric disorders were not associated with long term outcome in this sample. Type of treatment was not associated with long term outcome. Results challenge the notion that recovery from specific phobia following treatment is characterized by complete and enduring cessation of symptoms.

Specific phobia 10–16 years after treatment

Twenty eight participants, initially treated for specific phobia as part of a comparative treatment study, were evaluated 10 to 16 years (X=12 years) later. A comprehensive, in-person, semi-structured diagnostic interview was utilized, which also assessed comorbid disorders. Of 21 patients who had been rated as responders (much improved or very much improved) at treatment termination, 13 (62%) had clinically significant avoidance or endurance with dread subsequent to treatment. Among a subgroup of these responders who had been considered completely recovered (n=11), 5 (45%) had clinically significant symptoms following treatment. None of the seven subjects who had been considered unimproved at treatment termination recovered from phobia symptoms in the intervening years. Positive response to treatment was associated with better long term outcome. Clinical characteristics, such as phobia subtype, age of onset, baseline severity, and lifetime comorbidity of other psychiatric disorders were not associated with long term outcome in this sample. Type of treatment was not associated with long term outcome. Results challenge the notion that recovery from specific phobia following treatment is characterized by complete and enduring cessation of symptoms. Depression and Anxiety 10:105–111, 1999. © 1999 Wiley-Liss, Inc.

The Course and Outcome of Bulimia Nervosa

This article briefly reviews the epidemiology and clinical features of bulimia nervosa and then focuses on course and outcome. Recovery rates among different studies are reviewed. Although significant differences exist among outcome studies, outcome appears to be best characterized by remission and relapse. Comorbidity of other psychiatric disorders with bulimia nervosa is reviewed.