Concomitant Psychiatric Conditions Research Articles

Comorbid psychiatric conditions with temporomandibular disorders (TMD) in a tertiary referral clinic

Patients with chronic pain have a higher prevalence of mood disorders with depression and anxiety contributing to higher pain intensity, emotional allodynia, and neuro-anatomical changes. We sought to quantify the prevalence of psychiatric comorbidities (PCs) in a tertiary referral clinic for temporomandibular disorders (TMDs). Medical records of all patients attending clinics run by three tertiary temporomandibular joint (TMJ) surgeons for the period January to April 2022 inclusive were audited for the prevalence of concomitant psychiatric conditions. A total of 166 patients were identified with a female to male ratio of 5:1 and mean (SD) age of 45.1 (15.2) years. A total of 124 (89.9%) patients were tertiary referrals and 72 (43.4%) patients had concomitant psychiatric diagnoses, with 58 (34.9%) being on some form of psychotropic medication (PM) (patients on anticonvulsants for neuropathic pain were not included). A majority of 136 (81.9%) patients had some form of intervention (including Dysport® and minimally invasive surgery) which appeared more common in patients with co-existing psychiatric issues (p < 0.05). A higher proportion of mental health issues exist among TMD patients in a tertiary referral clinic than would be expected in the general population. We suggest a holistic approach to patients with multidisciplinary care taking into account this prevalence to ensure decision-making that contextualises the patient and not simply the pathology.

What happens to patients undergoing cancer surgery with psychiatric comorbidities?: A nationwide retrospective cohort study.

We aimed to describe the surgical outcomes and readmissions rates in patients with psychological comorbidities who underwent surgical intervention for cancer. The Hospital Readmission Reduction Program, a campaign by the Affordable Care Act, penalizes hospitals for greater readmission rates. One prevalent patient risk factor associated with hospital readmission is a comorbid psychiatric condition. Currently, no studies exist identifying psychiatric comorbidities and their effects on patients with cancer undergoing surgical intervention. A cross-sectional analysis was performed using the Nationwide Readmissions Database for 2010-2014 and included adult patients undergoing cancer resection operations. Multivariable logistic regression analyses were utilized to assess determinants of surgical outcomes and readmissions. Of 1 016 636 eligible patients, 11.6% had psychiatric comorbidities. Patients with psychiatric disorders had greater risks of mortality (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.18-1.25), complications (OR = 1.51, 95%CI = 1.50-1.52), extended length of stay (OR = 1.21, 95%CI = 1.20-1.22), and incurred healthcare expenditure at primary admission (OR = 1.16, 95% CI = 1.15-1.18). Psychiatric comorbidities were associated with an increased likelihood of readmission (OR = 1.13, 95%CI = 1.11-1.15). Concomitant psychiatric conditions were attributed to poor surgical outcomes and a higher risk of readmissions. Multidisciplinary care within the perioperative setting should be encouraged for patients with psychiatric disorders.

S608 Intentional Foreign Body Ingestion and Post-Traumatic Stress Disorder: A Review of Case Reports, Endoscopic Outcomes, and Interdisciplinary Management

Introduction: This study endeavors to fill the knowledge gap concerning deliberate foreign body ingestion (DFBI) in relation to psychiatric disorders. It concentrates on DFBI among adults diagnosed with post-traumatic stress disorder (PTSD) regarding types of foreign body (FB) ingested, motivation for DFBI, and outcomes of endoscopic FB retrieval. Methods: A review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: 261785) was performed, searching electronic bibliographic databases from January 1, 2015 to June 1, 2021. Case reports written in English detailing endoscopic findings of DFBI among adults (≥18 years) were included. Articles without the number and type of items deliberately ingested were excluded. Eligible studies were assessed using the Joanna Briggs Institute critical appraisal tool. Results: Of the 55 included case reports, the 5 PTSD patients (9%) were older (μ age: 41.60 vs 34.16 years, p=0.15), less predominantly male (M:F Ratio: 1.5:1 vs 1.75:1, p=0.56), reported less abdominal pain presentations (40% vs 46%, p=0.40), and had a higher average of concomitant psychiatric conditions (μ=3 vs 1, p< 0.01), than the 55 non-PTSD patients. PTSD patients ingested more items (μ=34.8 vs 7.74, p< 0.05); specifically more large paper (μ=0.2 vs 0, p< 0.01), large wood (μ=2.8 vs 0.04, p< 0.01), small metal (μ=14 vs 0.34, p< 0.01), sharps/blades (μ=12.4 vs 1.32, p< 0.05), batteries (μ=5.4 vs 0.48, p< 0.01), than those without PTSD. The primary reasons for ingestion for both PTSD and non-PTSD patients included prior history of repeated DFBI [n=3 (60%) vs n=18 (36%), p=0.15, respectively] and suicidality (n=1 (20%) vs n=9 (18%), p=0.45, respectively]. PTSD patients had a higher average success rate of endoscopic removal (without need for post-endoscopic surgery) than non-PTSD patients (μ=1 vs 0.66, p=0.12), as well as reported use of interdisciplinary management (μ=1 vs 0.82, p=0.31). Though there was little difference in mean number of total interdisciplinary referrals made (μ=1.8 vs 1.3, p=0.28), the most common referrals were to psychiatry (47%) and gastroenterology (33%). Conclusion: In DFBI cases of patients with PTSD, a high index of suspicion is required with regards to presentation, type of FB ingested, and reason for ingestion. Further research is needed to determine if PTSD or interdisciplinary management are factors for successful endoscopic FB removal and surgery should endoscopy fail.

The clinical characterisation of the patient with primary psychosis aimed at personalisation of management

The view that the management of the patient with primary psychosis should be personalized is currently endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. We describe systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient’s needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.DisclosureNo significant relationships.

The clinical characterization of the patient with primary psychosis aimed at personalization of management.

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.

ADHD and the Importance of Comorbid Disorders in the Psychosocial Development of Children and Adolescents

The attention deficit hyperactivity disorder (ADHD), one of the most common disorders in the childhood and adolescence population, but also in the reproductive period, affects and influences learning, social relations and their quality of life. There are strong neuropathological similarities between ADHD and various concomitant psychiatric conditions. ADHD frequently coexists with learning and language disabilities, sleep disorders, impulse control personality and anxiety disorders, intellectual disability, substance use disorders and mood disorders, as well as autism spectrum disorders and tic disorders. The overlapping symptoms of ADHD and other morbidities constitute challenges but also an imperative need for the experts to be able to detect and clarify so as to achieve the proper diagnosis and the relative treatment. The expression of the disease differs accordingly depending on the age group and the presence of comorbidities. In school-age, symptoms of ADHD include inattention, hyperactivity, and impulsivity. In adolescence, depending on the gender, hyperactivity decreases but the problems in learning and psychopathology still remain. Therefore, it is recommended that when ADHD coexists with other psychopathologies in childhood and adolescence to first and directly treat the most weakened condition so that the child or the adolescent can change the course of their psychiatric morbidity and improve their ability to function and socialize.

Mental health of orthopaedic trauma patients during the 2020 COVID-19 pandemic

PurposeThe outbreak of the SARS-CoV-2 virus has been associated with reports of increased anxiety, depression and fear among the general population. People with underlying psychiatric disorders are more susceptible to stress than the general population. The purpose of this study was to determine the prevalence of concomitant psychiatric conditions in the orthopaedic trauma population during the COVID-19 pandemic.MethodsThis retrospective cohort study evaluated orthopaedic trauma patients who received care at our institution between February through April of 2019 and February through April of 2020. Patient sex, age, mechanism of injury, associated injuries, fracture location, tobacco use, employment status, mental health diagnosis and presence of interpersonal violence were documented. Mental health diagnoses were defined based on International Classification of Diseases-10 classification.ResultsThe study included 553 orthopaedic patients evaluated at our institution during the defined time period. Patients in the 2020 cohort had a higher prevalence of mental health diagnoses (26% vs. 43%, p < 0.0001) compared with the 2019 group. The odds ratio for mental health disorder in the 2020 patients was 2.21 (95% CI 1.54, 3.18) compared with the 2019 cohort. The 2020 cohort had a higher percentage of patients who reported interpersonal violence (20% vs. 11%, p = 0.005).ConclusionOur study showed a higher prevalence of psychiatric disease among orthopaedic trauma patients during the COVID-19 pandemic when compared with those seen during the same time of the year in 2019. Stress induced by the coronavirus pandemic can place patients with mental illness at a higher risk for perilous behaviours and subsequent fractures.

Tolerability and efficacy of lacosamide and controlled-release carbamazepine monotherapy in patients with newly diagnosed epilepsy and concomitant psychiatric conditions: Post hoc analysis of a prospective, randomized, double-blind trial

Psychiatric comorbidities are common in patients with epilepsy. A double-blind noninferiority monotherapy trial (SP0993; NCT01243177) enrolled newly diagnosed patients (≥16 years) with focal or generalized tonic-clonic seizures. Patients were randomized 1:1 to lacosamide or carbamazepine controlled-release (carbamazepine-CR). Here, we report data from an exploratory post hoc analysis of patients who reported ongoing psychiatric conditions (Medical Dictionary for Regulatory Activities System Organ Class). Of 886 treated patients in the trial, 126 (14.2%; 64 on lacosamide; 62 on carbamazepine-CR) reported at least one ongoing psychiatric condition at screening, most commonly depression (38.1%), insomnia (27.8%), and anxiety (26.2%). In this subgroup, 32/64 (50.0%) patients on lacosamide and 22/62 (35.5%) on carbamazepine-CR completed the trial. The most common reasons for discontinuation in patients on lacosamide and carbamazepine-CR were adverse events (10.9%, 24.2%) and lack of efficacy (18.8%, 11.3%). Treatment-emergent adverse events (TEAEs) were reported in 52 (81.3%) of patients on lacosamide and 56 (90.3%) of patients on carbamazepine-CR, most commonly (≥10% patients in either treatment group; lacosamide, carbamazepine-CR) dizziness (12.5%, 16.1%), headache (12.5%, 14.5%), nasopharyngitis (12.5%, 9.7%), fatigue (7.8%, 14.5%), nausea (7.8%, 11.3%), somnolence (1.6%, 12.9%), and gamma-glutamyltransferase increase (1.6%, 12.9%). Overall, 15 (23.4%) lacosamide-treated and 10 (16.1%) carbamazepine-CR treated patients reported psychiatric TEAEs, most commonly (≥3 patients in either treatment group; lacosamide, carbamazepine-CR) depression (4.7%, 0) and anxiety (3.1%, 6.5%). There were no reports of psychotic disorder, epileptic psychosis, acute psychosis, or serious psychiatric TEAEs. Stratified Kaplan–Meier estimates for 6- and 12-month seizure freedom at the last evaluated dose were similar with lacosamide and carbamazepine-CR (6 months 81.0%, 75.6%; 12 months 62.5%, 66.6%). A higher proportion of patients on lacosamide than carbamazepine-CR completed 6 (67.2%, 45.2%) and 12 months (50.0%, 37.1%) of treatment at the last evaluated dose without a seizure. This exploratory post hoc analysis indicated that lacosamide monotherapy was efficacious and generally well tolerated in patients with newly diagnosed epilepsy and concomitant psychiatric conditions. In this subpopulation, lacosamide showed similar efficacy and numerically better effectiveness than carbamazepine-CR.

Noncancer Pain Conditions and Risk of Suicide

There are limited data on the extent to which suicide mortality is associated with specific pain conditions. To examine the associations between clinical diagnoses of noncancer pain conditions and suicide among individuals receiving services in the Department of Veterans Affairs Healthcare System. Retrospective data analysis. Data were extracted from National Death Index and treatment records from the Department of Veterans Healthcare System. Individuals receiving services in fiscal year 2005 who remained alive at the start of fiscal year 2006 (N = 4 863 086). Analyses examined the association between baseline clinical diagnoses of pain-related conditions (arthritis, back pain, migraine, neuropathy, headache or tension headache, fibromyalgia, and psychogenic pain) and subsequent suicide death (assessed in fiscal years 2006-2008). Controlling for demographic and contextual factors (age, sex, and Charlson score), elevated suicide risks were observed for each pain condition except arthritis and neuropathy (hazard ratios ranging from 1.33 [99% CI, 1.22-1.45] for back pain to 2.61 [1.82-3.74] for psychogenic pain). When analyses controlled for concomitant psychiatric conditions, the associations between pain conditions and suicide death were reduced; however, significant associations remained for back pain (hazard ratio, 1.13 [99% CI, 1.03-1.24]), migraine (1.34 [1.02-1.77]), and psychogenic pain (1.58 [1.11-2.26]). There is a need for increased awareness of suicide risk in individuals with certain noncancer pain diagnoses, in particular back pain, migraine, and psychogenic pain.

Anxiety and mood disorders in psychogenic nonepileptic seizures

The diagnosis of psychogenic nonepileptic seizures (PNES), particularly in patients with epilepsy, poses a special challenge to the physician in care of these patients. Psychiatric disorders (PD) are more common among patients with epilepsy than in the general population, and this appears to be even more important in patients with PNES. Depression and other mood disorders, as well as anxiety disorders - particularly panic attacks - may make the management of these patients even more difficult in the clinical practice. Concomitant psychiatric conditions have been associated with a poor outcome in patients with PNES]. Psychiatric and psychological intervention has been shown to be associated with improved outcome in PNES in outcome studies, although data is conflicting in this matter. The intricacies and practical implications of such issues are discussed.