Comorbidities Research Articles

Comorbidity of anxiety and depression disorder among clinical referral patients: a longitudinal study based on network analysis

Comorbidity of anxiety and depression disorder among clinical referral patients: a longitudinal study based on network analysis

Psychiatric comorbidities among patients hospitalized in the addictology department of Ar Razi hospital in Morocco

IntroductionComorbidity between psychiatric disorders and disorders linked to psychoactive substance use is common and represent a real public health problem.The association of a psychiatric disorder can, in certain cases, modify the treatment methods and also the evolution of the addictive behavior.ObjectivesDetermining the prevalence of psychiatric comorbidities in patients with substance use disorder Identify the sociodemographic and clinical characteristics of patients hospitalized in the addictology department.MethodsWe conducted a cross-sectional study with descriptive and analytical aims, in order to study psychiatric comorbidities in 150 patients with substance use disorder hospitalized in the addictology department of Ar Razi hospital in Salé over a period from June 1, 2022 to August 30, 2023.Data collection was done using a questionnaire including clinical and socio-demographic characteristics, the prevalence of problematic use of psychoactive substances and the comorbidity of psychiatric disorders (diagnoses assessed by DSM 5 criteria).ResultsA male predominance was noted (80%). The main substances consumed in the last 12 months were tobacco (98%), cannabis (74%), alcohol and benzodiazepines.The majority of patients presented at least one psychiatric comorbidity (80%), with a predominance of depressive disorder and anxiety disorders.Personal history of suicide attempts was found in 30% of the sample Substance dependency that prompted initially the consultation was higher in patients with psychiatric comorbidity (p < 0.05)Post-traumatic stress disorder was significantly associated with the presence of problematic cocaine and alcohol use. Social phobia is associated with the absence of a criminal record.ConclusionsAddictive behaviors are often associated with psychiatric disorders. The most common psychiatric comorbidities are depression, anxiety and personality disorders, hence the need for simultaneous treatment of psychiatric pathologies and addictive behaviorDisclosure of InterestNone Declared

Comorbidity of mental disorders in synthetic cannabinoids abuse: clinical dynamics, behavior, adaptation

IntroductionThe study of the phenomenon of deformation of mental disorders, clinical dynamics, behaviors, and adaptations in case of abuse of synthetic cannabinoids is of relevance.ObjectivesTo study the phenomenon of deformation of mental disorders, clinical dynamics, behaviors, and adaptations in case of abuse of synthetic cannabinoidsMethodsCatamnestic, clinical-psychopathological methods (PANS, SANS, CGI, MMPI, CGI, STAI, LSI, TPA, ICD-10), statistical (Python 3.11.0).Results291 men (age from 18 to 35 years) were examined: 240 - F12.2xx, of which 98 - F60.xx-F62.xx, 142 - F20.xx and 51 - F20.xx without substance abuse. The study took place from 2018 to 2023 based on psychiatric institutions of the Russia, Tomsk region, St. Petersburg, Noyabrsk and Nizhnevartovsk.ConclusionsThe phenomenon of abuse of synthetic cannabinoids is a factor in the deformation of mental disorders. Persistent exogenous visual and delusional disorders contribute to the symptoms of exacerbations of schizophrenia; schizophrenic symptoms are included in psychotic episodes in personality disorders. In remission of schizophrenia, there is a quasi-adaptation from socio-professional environments, mostly addictive and criminalized, a pronounced smoothing of emotional impoverishment, a stigmatizing symptom is mainly a volitional defect, as well as frequent rehospitalizations not indirectly related to drugs. In remissions of drug use in patients with personality disorder, persistent schizophrenia of behavior. In patients with schizophrenia and patients with personality disorders, there is a distortion of behavior with a predominance in patterns of inclinations to delict, nonconformity, isolation in an addictive environment, suspiciousness. Drug abuse may initiate auto-aggression predominantly in individuals with personality disorders and to a lesser extent in patients with schizophrenia. True suicides in drug users include only episodes with depressive symptoms.Disclosure of InterestNone Declared

Somatic disorders in patients followed for a psychiatric disorder at the Ar Razi hospital in Morocco

IntroductionSomatic disorders in patients suffering from psychiatric disorders have become an important issue in the overall care of these patientsComorbidity studies show that 30 to 60% of patients consulted or hospitalized in psychiatry present an associated organic pathologyHowever, the detection of somatic conditions in psychiatric patients remains too late and this exposes them to sometimes lethal somatic complicationsObjectivesTo evaluate the prevalence of somatic disorders in patients followed for a psychiatric disorder at Ar Razi hospital in Salé – Morocco, and to determine the associated factorsMethodsWe carried out a cross-sectional study with 80 patients followed for a psychiatric disorder at Ar Razi hospital in Salé presenting clinical signs in favor of an organic pathology and transferred for specialized advice to the medical-surgical services, in the period from September 1st, 2022 until August 31st, 2023.ResultsMost of our patients were male (65%) with ages ranging from 18 to 65 years. Addictive behaviors were found in more than half of our patients.The most frequent reasons for requests for advice from medical-surgical services was the suspicion of an organic cause of psychiatric symptoms in 25% of cases or the presence of an organic warning sign in 30% of cases.The comorbidity of somatic illness and psychiatric disorder was noted in 35% of cases.Somatic comorbidities were essentially: infections and cardiovascular diseases.Side effects of psychotropic drugs were predominantly neurological in 40 % of casesConclusions Somatic comorbidities in patients hospitalized or in consultation in psychiatric hospitals are very common, often unrecognized, hence the need for early screening in order to improve care.Disclosure of InterestNone Declared

Neuropathogenic role of astrocyte-derived extracellular vesicles in HIV-associated neurocognitive disorders.

Our previous findings demonstrated that astrocytic HIF-1α plays a major role in HIV-1 Tat-mediated amyloidosis which can lead to Alzheimer's-like pathology-a comorbidity of HIV-Associated Neurocognitive Disorders (HAND). These amyloids can be shuttled in extracellular vesicles, and we sought to assess whether HIV-1 Tat stimulated astrocyte-derived EVs (ADEVs) containing the toxic amyloids could result in neuronal injury in vitro and in vivo. We thus hypothesized that blocking HIF-1α could likely mitigate HIV-1 Tat-ADEV-mediated neuronal injury. Rat hippocampal neurons when exposed to HIV-1 Tat-ADEVs carrying the toxic amyloids exhibited amyloid accumulation and synaptodendritic injury, leading to functional loss as evidenced by alterations in miniature excitatory post synaptic currents. The silencing of astrocytic HIF-1α not only reduced the biogenesis of ADEVs, as well as amyloid cargos, but also ameliorated neuronal synaptodegeneration. Next, we determined the effect of HIV-1 Tat-ADEVs carrying amyloids in the hippocampus of naive mice brains. Naive mice receiving the HIV-1 Tat-ADEVs, exhibited behavioural changes, and Alzheimer's 's-like pathology accompanied by synaptodegeneration. This impairment(s) was not observed in mice injected with HIF-1α silenced ADEVs. This is the first report demonstrating the role of amyloid-carrying ADEVs in mediating synaptodegeneration leading to behavioural changes associated with HAND and highlights the protective role of HIF-1α.

Exploring the link between comorbidities and Alzheimer's dementia in the Australian Imaging, Biomarker & Lifestyle (AIBL) study.

Mounting evidence suggests that certain comorbidities may influence the clinical evolution of Alzheimer's dementia (AD). We conducted logistic regression analyses on the medical history and cognitive health diagnoses of participants in the Australian Imaging, Biomarker & Lifestyle study (n=2443) to investigate cross-sectional associations between various comorbidities and mild cognitive impairment (MCI)/AD. A mixture of associations were observed. Higher comorbidity of anxiety and other neurological disorders was associated with higher odds of AD, while arthritis, cancer, gastric complaints, high cholesterol, joint replacement, visual defect, kidney and liver disease were associated with lower odds of AD. This study underscores the links between specific comorbidities and MCI/AD. Further research is needed to elucidate the longitudinal comorbidity-MCI/AD associations and underlying mechanisms of these associations. Comorbidities that significantly increased AD odds included anxiety and other neurological disorders.Arthritis, cancer, gastric complaints, high cholesterol, joint replacement, visual defect, kidney and liver disease were associated with lower odds of AD.Alcohol consumption had the most significant confounding effect in the study.Visual-AD association was modified by age, sex, and APOE ε4 allele status.Anxiety-AD and depression-AD associations were modified by sex.

Mental and physical health morbidity among people in prisons: an umbrella review

People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.

School Readiness in Preschool-Age Children with Critical Congenital Heart Disease.

This study examined the nature, variability, and predictors of school readiness difficulties in young children with critical congenital heart disease (CCHD). We hypothesized that, compared to a community control (CC) group, children with CCHD would score less well on measures of readiness and that readiness would be associated with CCHD-related risk factors. Children (60 CCHD and 60 CC) were 4 to 5 years of age and not yet attending kindergarten. Readiness measures included tests of cognition, executive function, motor ability, and pre-academic skills. Caregivers provided child behavior ratings. Analyses examined group differences in readiness, readiness profiles, and associations of readiness with CCHD-related medical risk factors. The CCHD group had lower scores than the CC group on testing and higher caregiver ratings of problems in social communication, as well as higher rates of deficits on several of the measures. Latent class analysis provided evidence for different readiness profiles, with more children with CCHD displaying profiles characterized by weaknesses in readiness. CCHD-related medical risk factors associated with readiness problems in the CCHD group included a co-morbid genetic disorder, postnatal diagnosis of CCHD, major perioperative complication, and longer periods of hospitalizations, cardiopulmonary bypass, and aortic cross-clamp placements. Findings document multiple problems in school readiness in young children with CCHD. Deficits vary across individuals and are associated with higher medical risk. Results confirm the importance of screening for school readiness in these children and suggest areas to target in designing screening measures and providing early childhood interventions.

Neural Abnormalities in Panic Disorder and Agoraphobia: A Meta-Analysis of Functional Activation Studies

IntroductionPanic disorder (PD) and agoraphobia (AG) are highly comorbid anxiety disorders with an increasing prevalence that have a significant clinical and public health impact but are not adequately recognized and treated. Although the current functional neuroimaging literature has documented a range of neural abnormalities in these disorders, primary studies are often not sufficiently powered and their findings have been inconsistent.ObjectivesThis meta-analysis aims to advance our understanding of the neural underpinnings of PD and AG by identifying the most robust patterns of differential neural activation that differentiate individuals diagnosed with one of or both these disorders from age-matched healthy controls.MethodsWe conducted a comprehensive literature search in the PubMed database for all peer-reviewed, whole-brain, task-based functional magnetic resonance imaging (fMRI) activation studies that compared adults diagnosed with PD and/or AG with age-matched healthy controls. Each of these articles was screened by two independent coding teams using formal inclusion criteria and according to current PRISMA guidelines. We then performed a voxelwise, whole-brain, meta-analytic comparison of PD/AG participants with age-matched healthy controls using multilevel kernel density analysis (MKDA) with ensemble thresholding (p<0.05-0.0001) to minimize cluster size detection bias and 10,000 Monte Carlo simulations to correct for multiple comparisons.ResultsWith data from 34 primary studies and a substantial sample size (N=2138), PD/AG participants, relative to age-matched healthy controls, exhibited a reliable pattern of statistically significant, (p<.05-0.0001; FWE-corrected) abnormal neural activation in multiple brain regions of the cerebral cortex and basal ganglia across a variety of experimental tasks.ConclusionsIn this meta-analysis we found robust patterns of differential neural activation in participants diagnosed with PD/AG relative to age-matched healthy controls. These findings advance our understanding of the neural underpinnings of PD and AG and inform the development of brain-based clinical interventions such as non-invasive brain stimulation (NIBS) and treatment prediction and matching algorithms. Future studies should also investigate the neural similarities and differences between PD and AG to increase our understanding of possible differences in their etiology, diagnosis, and treatment.Disclosure of InterestNone Declared

Prevalence of suicidal behavior in bipolar type 1 patients

IntroductionThe prevalence of suicidal behavior in individuals diagnosed with Bipolar Disorder Type 1 is a topic of great concern within the field of psychiatry and mental health research. Bipolar Disorder Type 1 is characterized by extreme mood fluctuations that can contribute to a heightened risk of suicidal ideation, attempts, and completions in affected individuals.Objectives-To examine the socio-demographic and clinical profiles of Bipolar Type 1 patients admitted to the “C” psychiatry department at Hedi Chaker Hospital in Sfax, Tunisia.-To identify and understand the factors associated with suicidal behavior in this population. MethodsWe conducted a retrospective descriptive and analytic study of hospitalized patients suffering from bipolar disorder type 1 in the psychiatry department “C”, Hedi Chaker Hospital, Sfax Tunisia from 2021 to 2023. Socioeconomic data and clinical profiles of patients were collected from archived files.Results The total number of patients was 98, with an average age of 36.74 ± 12.3 years. The majority were single (67%), living with their families (76.5%), jobless (45.9%), and receiving family support (94.9%). In terms of psychoactive substance use, 81.6% have used tobacco, 46.9% have used alcohol, and 34.7% have used cannabis.Concerning family history, 55% of patients had at least one family member being treated for a mood disorder. Among them, 7.1% had attempted suicide, and 6.1% had died by suicide.Concerning the clinical profile of the study population, 28.6% had a personal somatic history. The diagnosis of bipolar disorder was made at the age of 27.52±8.6 years. 11.2% had a comorbid personality disorder with bipolar disorder.The majority of patients were on antipsychotics (95.9%), 84.7% were using mood stabilizers, 33.7% were prescribed anxiolytics, and only 4.1% were on antidepressants. Treatment compliance was poor in 61.2% of cases and 63.3% of patients had a poor insight.Ten percent of these patients had attempted suicide, 50% during a depressive episode, 50% occurring during a depressive episode, 30% during a manic episode, and 40% of attempts were related to discontinuation of treatment. 3.1% had used hanging, and 3.1% had engaged in voluntary drug ingestion as a method of self-harm. None of the suicide attempts necessitated intensive care hospitalization, but 60% of the individuals were admitted to psychiatric care. There was a statistically significant correlation between suicide attempts and a family history of suicide (p=0.049).ConclusionsBipolar patients face a heightened risk of suicide, which is closely tied to the distinctive attributes of the disorder, including biological factors, thymic decompensation, and psychological aspects. Consequently, managing their condition necessitates a tailored approach, demanding ongoing vigilance for individuals diagnosed with bipolar disorder.Disclosure of InterestNone Declared

Mentalizing Abilities in Major Depressive Disorder and Borderline Personality Disorder: Measuring Hypermentalization and Implicit Mentalization with the Hungarian Version of the MASC

IntroductionBorderline Personality Disorder (BPD) is the most common personality disorder in psychiatric care. BPD often co-occurs with Major Depressive Disorder (MDD). Both BPD and MDD are associated with various impairments of social functioning. Among these, mentalizing disturbances are the most extensively studied.ObjectivesThe Movie for the Assessment of Social Cognition (MASC) is an ecologically valid video-based test, which is suitable for measuring both hypermentalization and implicit mentalization. Based on the literature, it is sensitive enough to detect mild deficits in mentalization capacities. In this study, we investigated mentalization deficits with a special focus on implicit mentalization and hypermentalization in patients with MDD and MDD+BPD with a set of well-established mentalization tests including MASC.MethodsWe examined patients with MDD (n=43) during the depressive episode. A subgroup of these patients was also diagnosed with BPD (MDD+BPD group; n=23), the other group had no comorbid personality disorder (MDD group; n=20). We assessed the patients’ mentalization abilities using the Hungarian version of the Reading the Mind in the Eyes test, the Faux Pas test, and the MASC test. Additionally, symptom scales (measuring the severity of anxiety, and depression), WAIS (Wechsler Adult Intelligence Scale), the Childhood Trauma Scale, as well as scales measuring affect regulation and attachment were used during the assessment.ResultsThere were no differences between the two groups in terms of age, IQ, or the severity of depression and anxiety. The MDD+BPD group exhibited significantly poorer performance in the MASC total mentalization score (MW U=118, df=1,41, p< 0,001), as well as in the hypermentalization score (MW U=98,5, df=1,41, p< 0,001). The MDD+BPD group achieved significantly lower results on the emotion recognition and mentalization measures in the RMET test (t=2,883, df=1,41, p< 0,001). The MDD+BPD group performed significantly worse on the Faux Pas test measuring mentalization (MW U=144,5, df=1,41, p< 0,001). In the whole sample, MASC performance correlated with overall IQ.ConclusionsThe MASC, RMET, and Faux Pas tests show a consistent trend and indicate significant differences between the mentalization abilities of MDD+BPD and MDD patients. Our findings are in line with data in the literature: BPD patients’ implicit mentalization with a predominance of hypermentalization is impaired. This impairment is detectable when we compare their performance with MDD patients without BPD. In the future, a larger sample size, additional tests, and the inclusion of a control group are needed to further investigate MDD and MDD+BPD patients’ mentalizing deficits. However, our results emphasize the significance of mentalization-based therapies in the therapy of patients with BPD and depression.Disclosure of InterestNone Declared

A randomized controlled trial comparing trauma-focused treatment with and without concurrent personality disorder treatment in patients with posttraumatic stress disorder and comorbid borderline personality disorder

IntroductionPosttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) often co-occur. There is growing motivation among clinicians to offer trauma-focused treatments, such as Eye Movement Desensitization and Reprocessing (EMDR), to patients with PTSD and comorbid BPD. However, a large subgroup of these patients does not sufficiently respond to trauma-focused treatment and is more likely to be excluded or dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with prolonged exposure is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of trauma-focused treatment with and without concurrent PD treatment has not been investigated yet.ObjectivesThe current study will therefore evaluate the comparative clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD.MethodsAdult patients were randomly assigned to EMDR with (n = 63) or without concurrent DBT (n = 63). A wide range of clinician-administered and self-report assessments were conducted before, during and up to six months after treatment. The longitudinal change in PTSD severity as the primary outcome was measured using multilevel mixed regression in SPSS. The present study is part of the overarching Prediction and Outcome Study in comorbid PTSD and Personality Disorders (PROSPER), which consists of a second RCT comparing trauma-focused treatment with and without concurrent PD treatment in patients with PTSD and cluster C PD.ResultsResults, available in January 2024, will reveal which treatment works best for this difficult-to-treat group of patients.ConclusionsThis is the first study to compare the clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD. Results will reveal which treatment works best for this difficult-to-treat group of patients.Disclosure of InterestNone Declared

Obesity and Aging: Optimizing Health at the Intersection of Ageism and Weight Bias

Obesity is a chronic and complex disease that can negatively impact health, functioning and quality of life. In the past decade, obesity's largest prevalence growth occurred in older adults, particularly among racial and ethnic minorities. By the year 2030, an estimated 50% of the population over 65 is likely to be living with obesity. Until recently, little attention has been given to obesity as a chronic disease, and those living with obesity have encountered challenges accessing high quality medical care. Despite growing evidence for bariatric and obesity medicine, these treatments remain inaccessible for most patients, especially for older adults. Obesity research focused on older adults has been very limited and ideal weight standards for older adults are more controversial, especially in later life where frailty and sarcopenia may develop. As concerns about the public health effects of obesity have risen in the U.S., so too have negative and stigmatized views of individuals with obesity. Weight stigma has serious negative emotional and physical health consequences including low self-esteem, negative body image, engagement in disordered eating patterns, reduced physical activity and may promote weight gain. Older adults with obesity may encounter the double stigma of both ageism and weight bias, which are two of the most socially acceptable forms of bias and discrimination in the U.S. This interactive session will focus on three areas related to obesity and older adults. Through case examples, small and large group discussions, the presenters will: i) explore potential weight bias amongst participants and discuss strategies to mitigate this bias in working with older adults; ii) discuss complex connections between obesity and frailty syndrome in older adults, and the risks associated with weight loss in later life; iii) introduce evidence-based assessment and treatment recommendations for older adults interested in obesity treatment. This session will focus on the role of psychiatrists and other mental health clinicians in the care of older patients with co-morbid obesity and mental health disorders. Also, presenters will discuss the importance of increasing awareness, advocacy, and practical strategies to combat the impact of weight bias and ageism in healthcare settings. Ultimately, the goal is to raise awareness of this complex problem and provide clinically helpful information to improve care for older patients with obesity. This symposium is sponsored by the AAGP's IDEA committee.

Comparison of personality factors, adherence to medication and quality of life in bipolar disorder-I patients with or without substance use disorder

IntroductionSome specific personality factors in patients of bipolar disorder are potential risk factors for developing comorbid substance use disorder. Comorbid substance use disorder is one of the most common factors associated with non-adherence to treatment in bipolar disorder patients leading to poor quality of life. We compared all three variables in bipolar disorder-1patients with or without substance use disorder. MethodsIt is a cross-sectional study done on 90 patients of Bipolar disorder-1 diagnosed as per DSM-5, 45 without and 45 with comorbid substance use disorder. Personality factors, non-adherence to medication and quality of life were assessed and compared between both the groups using standardized tools and appropriate statistical analysis methods. ResultsThere was a significant difference between the groups in terms of distribution of socio-economic status (Bias Corrected Cramer'sV = 0.31 moderate association), gender (Bias Corrected Cramer'sV = 0.37 moderate association), distribution of 16 personality factor B (Cramer's V = 0.28) and factor G (χ2 = 6.222, p = 0.045) (Cramer's V = 0.26). LimitationsSmall sample size and a cross-sectional study design. ConclusionSUD and NSUD group differed on 16 PF factor B and G which are factors for reasoning and Rule-Consciousness respectively although on regression analysis this difference was not significant for factor G. In binary logistic regression multivariable model, an average score (as compared to low score) of personality factor B was found to significantly increase the ODDS of substance use. SUD group had more severity and greater number of episodes, had lower level of education, belonged to low socio-economic status.

Affective temperament and emotional dysregulation in cyclothymia and adult ADHD: differential characteristics and clinical implications.

IntroductionEmotional dysregulation is central to the problem of the overlap between attention‐deficit/hyperactivity disorder (ADHD) and cyclothymia.ObjectivesWe aimed to compare clinical characteristics, psychiatric comorbidity, affective temperament, and emotional dysregulation among subjects with attention-deficit/hyperactivity disorder (ADHD) and cyclothymia.MethodsIn this cross-sectional study, 187 participants were consecutively recruited between January 2018 and December 2019 at the outpatient clinic of the 2nd Psychiatry Unit of the University Hospital of Pisa. Eighty-one subjects were diagnosed with ADHD, 62 with cyclothymic disorder, and 44 with both conditions. Participating psychiatrists collected socio-demographic and clinical data, psychiatric comorbidities according to DSM-5 criteria, familiarity for psychiatric disorders, and any previous responses to antidepressant drug therapy. To study the temperamental characteristics of the participants, the short version of the Memphis, Pisa, Paris and San Diego Temperament Assessment (Brief-TEMPS-M) was administered, while emotional dysregulation was measured through the Reactivity, Intensity, Polarity, Stability questionnaire (RIPoSt-40).ResultsCyclothymic subjects, both with and without ADHD, were more often female (p<0.001) than subjects with ADHD. Participants with ADHD showed significantly lower educational attainment than subjects without ADHD (p<0.001). In addition, participants with ADHD alone showed comorbid substance use disorder more frequently (p<0.001) than subjects with cyclothymia alone. On the other hand, the latter showed higher rates of eating disorders (p=0.033) and familiarity for major depressive disorder (p=0.009) and panic disorder (p=0.029). Depressive and anxious temperament was significantly more represented in cyclothymic subjects without ADHD, as was negative emotionality, while hyperthymic temperament showed an opposite trend. No significant differences were observed between groups for cyclothymic temperament and overall negative emotional dysregulation, but patients comorbid with both conditions had the highest scores in these subscales.ConclusionsADHD and cyclothymia show high and overall similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality (“dark cyclothymia”). It is possible that individuals with “sunny” cyclothymic features may escape clinical attention if ADHD is not present in comorbidity.Disclosure of InterestNone Declared

Exploring predictors of Treatment Attendance in Patients with PTSD and Comorbid Personality Disorders: Secondary Analysis of a Randomized Controlled Trial

IntroductionPosttraumatic stress disorder (PTSD) and personality disorders (PD) often co-occur and treatment dropout remains a challenging problem for both disorders. The literature on predictors of treatment dropout is highly mixed and few reliable predictors have been identified for both PTSD and PD treatments separately, let alone for concurrent PTSD and PD treatment.ObjectivesThe aim of the present study was to identify predictors of treatment attendance among a wide range of variables in patients with PTSD and comorbid PD who received trauma-focused treatment with and without concurrent PD treatment.MethodsData were used from the prediction and outcome study in comorbid PTSD and personality disorders (PROSPER), a study consisting of two randomized clinical trials (RCT) testing the effectiveness of trauma-focused treatment (eye movement desensitization and reprocessing or imagery rescripting) with versus without concurrent PD treatment (dialectical behavior therapy or group schema therapy). 256 patients with PTSD and comorbid personality disorder participated in the study. The potential predictors included demographic (e.g. work status), patient severity (e.g. PTSD severity), patient-therapist (e.g. working alliance) and therapist (e.g. therapist experience) variables. The ordinal outcome variable was treatment attendance (0, 1-7, 8-11, 12+ trauma-focused treatment sessions). Relevant predictors were identified by a series of ordinal regression analyses (threshold for inclusion p < .10). Relevant predictors were then entered together in a final ordinal regression model. Multiple imputation was used to handle missing data.ResultsThe final model included ten predictor variables and provided a good fit for the data (pooled R2Nagelkerke = .29). Higher education level (OR = 1.22, p = .009), self-rated PTSD severity (OR = 1.04, p = .036) and working alliance (OR = 1.72, p = .047) were associated with a larger number of attended sessions. Higher levels of inadequate social support from a friend (OR = 0.90, p = .042) and being randomized in the concurrent treatment condition (OR = 0.52, p = .022) were associated with a smaller number of attended sessions.ConclusionsIn terms of treatment attendance rates, the results suggest that trauma-focused treatment is preferred over concurrent trauma-focused and personality disorder treatment for patients presenting with PTSD and PD. Clinicians should further be aware of the risk of lower treatment attendance for patients with a lower educational background and those reporting inadequate social support. Enhancing working alliance may protect against early treatment termination. Finally, patients with higher levels of PTSD severity at baseline may need a larger number of treatment sessions.Disclosure of InterestNone Declared

Evaluation of Psychiatric High and Intensive Care (EPHIC-study): monitoring innovative care from a value-based approach

IntroductionSystematic monitoring and evaluation of innovative healthcare programs are essential to develop sustainable solutions to health needs in the population (Porter & Teisberg, 2006). Development of Psychiatric High and Intensive Care Units (HIC’s) in Belgium, following the Dutch Model (van Mierlo et al., 2013), is an innovative model for patients with acute and severe psychiatric illness, resulting in potential danger. HIC aims to provide intensive, need-adapted care with interventions that reduce (perceived) coercion, focusing on participative processes and continuity of care.Objectives(1) What are the clinical characteristics of admitted patients? (2) How does clinical symptomatology evolve during admission? (3) How do patients, relatives and caregivers experience the process of care and recovery? (4) What is the role of HIC’s in the reformed mental health care?MethodsThis is an explorative, hypothesis-generating study, using a mixed-method approach, consisting of qualitative and quantitative methods against a value-based framework. Data collection lasted 18 months in the first 9 HIC’s in Belgium. Results are based on validated questionnaires completed by adult patients and their HIC caregivers at admission and discharge (N=472).ResultsWe provide the first, preliminary results. Suicidality, psychotic and substance-related symptoms are the most important primary symptoms. Almost 70% have 2 or more symptoms, with psychiatric comorbidity of 50%. Substance-related- and psychotic disorders are the two most common diagnoses, followed by personality disorder cluster B and depressive disorder. 83% have been in residential care in the past, of whom 87% twice or more. The median age is 36 years, but the median age of onset of mental disorders is 21 years, which equals to 15 years in mental disorder progress and comorbidity development. Over 50% meet the criteria for Severe Mental Illness and 56% are involuntary admitted. There is a high degree of unmet needs: no outpatient care is provided for one out of five prior to admission and there is a low follow-up by mobile teams prior to and after admission (around 12% each). We found significant improvements after an average stay of 22 days for aggression, suicidality and crisis (respectively decrease of 68%, 25% and 9%); readiness to change and motivation for treatment (respectively increase of 5% and 14%) The Client Satisfaction Questionnaire scores range from 1 to 4, with an average score 3.15 out of 4.ConclusionsBased on these preliminary results we can conclude that aggression, suicidality, crisis, readiness to change and motivation for treatment all improve significantly after a short stay of 3 weeks. Despite a vulnerable, severely distressed population, patients are generally satisfied with received care. There is a high degree of unmet needs: insufficient provided outpatient care and low follow up by mobile teams.Disclosure of InterestNone Declared

Specific intervention program for ARFID comorbid with ASD in a Children’s Youth Autism Day Hospital

IntroductionChildren and adolescents with ASD are more likely to have eating problems compared to the general population of the same age, one of the disorders whose prevalence is increased in people with ASD is avoidant/restrictive eating disorder Food (ARFID) ARFID is characterized by a lack of interest in eating or avoidance of food intake, which in the case of people with ASD is usually related to impaired sensory processing and cognitive rigidity. For this reason, the Autism Day Hospital carries out a specific food intervention program.ObjectivesTo retrospectively evaluate the results of the Food Program of the Autism Day Hospital during the year 2022.MethodsA retrospective analysis of the cases of patients admitted to the Food Program of the Autism Day Hospital during the year 2022 is carried out. Results of the sensory pattern and presence of genetic alterations of each one of the patients are compared. And the results of the intervention are evaluated by quantifying the new foods introduced into the diet at the end of the admission.ResultsThe sample is made up of a total of 5 children (4 boys and 1 girl) aged between 7 and 12 years. All of them meet diagnostic criteria for Autism Spectrum Disorder and present comorbidity with ARFID. Of the total sample, 1 of the patients presented in the genetic study a microdeletion S. in 15q13.3, duplication in 2q13 and duplication in 5p12-p11, with the genetic studies in the rest of the patients in the sample being normal. Regarding the results of the sensory pattern (Infant/Toddler Sensory profile test), all the patients presented differences in relation to other children of their age in the oral sensory pattern, this difference being definitive in 3 of the 5 patients in the sample. All the patients included in the program presented a satisfactory evolution, introducing at least 15-20 new foods into their usual diet, including different textures and consistencies.ConclusionsThe therapeutic approach to ARFID in children with ASD carried out from a multidisciplinary perspective; sensory integration, behavioral approach and, if necessary, psychopharmacological, has shown, based on the results obtained from the food program of the ASD Day Hospital, a favorable evolution of the eating disorder. For this reason, we consider the detection of this typical comorbidity of ASD and its referral to specific therapeutic programs to be of special importance.Disclosure of InterestNone Declared

The approach of physiotherapists in the management of patients with persistent pain and comorbid anxiety/depression: are there any differences between male and female professionals?

IntroductionChronic pain is a prevalent condition that is frequently complicated by concomitant mood and anxiety disorders. Very preliminary data indicate that female physiotherapists could have a better attitude towards psychiatric disorders.ObjectivesPurpose of the present article is to identify eventual differences in the management of patients with chronic pain and anxiety/mood disorders depending on the physiotherapists’ gender.MethodsAn ad-hoc questionnaire was developed and sent to physiotherapists by e-mail. The two group identified by gender were compared by unpaired sample t tests for continuous variables and χ2 tests for qualitative ones. A binary logistic regression was then performed with factors resulted statistically significant at univariate analyses as independent variables and gender as dependent one.ResultsFemale physiotherapists (compared to male ones) resulted to be more confident in the prosecution of physiotherapy by patients with Generalized Anxiety Disorder (GAD)comorbidity (t=2.46, p=0.01) and by patients who had received a visit with a mental health professional (t=2.79, p=0.01). Furthermore, female physiotherapists versus male ones believed that pharmacotherapy was less associated with motor side effects (t=2.90, p<0.01) and more frequently recognized the importance of a training to identify affective disorders (t=2.65, p=0.01) and the need of more education in mental health (t=2.85, p=0.01). The binary logistic regression model confirmed that female professionals (compared to male ones) were less likely to work as freelance in private institutions (p=0.015) and were more confident in the prosecution of physiotherapy by patients with GAD comorbidity (p=0.05).ConclusionsFemale compared to male physiotherapists resulted to be more comfortable with patients affected by mental conditions and to be more aware of the need of training on mental health. Implementation of mental health education for male physiotherapists is probably necessary and further studies are needed to confirm the results of the present study.Disclosure of InterestNone Declared

Prevalence of Autism Spectrum Disorder and Co-Morbidities in Children and Adolescents: A Systematic Literature Review.

Individuals with autism spectrum disorder often present somatic and/or psychiatric co-morbid disorders. The DSM-5 allows for consideration of additional diagnoses besides ASD and may have impacted the prevalence of co-morbidities as well as being limited in capturing the true differences in prevalence observed between males and females. We describe the prevalence of ASD and frequently observed co-morbidities in children and adolescents (<18 years) in the United States and five European countries. Two systematic literature reviews were conducted in PubMed and Embase for the period 2014-2019 and focusing on the prevalence of ASD and nine co-morbidities of interest based on their frequency and/or severity: Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depressive disorders, epilepsy, intellectual disability (ID), sleep disorders, sight/hearing impairment/loss, and gastro-intestinal syndromes (GI). Thirteen studies on prevalence of ASD and 33 on prevalence of co-morbidities were included. Prevalence of ASD was 1.70 and 1.85% in U.S children aged 4 and 8 years respectively, while prevalence in Europe ranged between 0.38 and 1.55%. Additionally, current evidence is supportive of a global increase in ASD prevalence over the past years. Substantial heterogeneity in prevalence of co-morbidities was observed: ADHD (0.00-86.00%), anxiety (0.00-82.20%), depressive disorders (0.00-74.80%), epilepsy (2.80-77.50%), ID (0.00-91.70%), sleep disorders (2.08-72.50%), sight/hearing impairment/loss (0.00-14.90%/0.00-4.90%), and GI syndromes (0.00-67.80%). Studies were heterogeneous in terms of design and method to estimate prevalence. Gender appears to represent a risk factor for co-morbid ADHD (higher in males) and epilepsy/seizure (higher in females) while age is also associated with ADHD and anxiety (increasing until adolescence). Our results provide a descriptive review of the prevalence of ASD and its co-morbidities in children and adolescents. These insights can be valuable for clinicians and parents/guardians of autistic children. Prevalence of ASD has increased over time while co-morbidities bring additional heterogeneity to the clinical presentation, which further advocates for personalized approaches to treatment and support. Having a clear understanding of the prevalence of ASD and its co-morbidities is important to raise awareness among stakeholders.Appeared originally in Front Psychiatry 2021; 12:744709.