Concurrent Psychiatric Disorders Research Articles

Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome

BackgroundDiabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the ICU each year, with mortality rates up to 5-10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality. MethodsWe conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 – 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by ICD-9-CM, ICD-10-CM codes for psychiatric diagnoses that were present in patients EMR at any point in this observational period. Outcomes included number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and ESRD/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at p <0.05. Results7756 patients were admitted for DKA or HHS, 66.9% of which had a concurrent psychiatric disorder. 54.5% of these patients were male, 70.4% White, and an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of which were male, 72.1% White, and an average of 68.2 years . A concurrent psychiatric disorder was associated with increased odds of rehospitalization (aOR= 1.62 95%Cl 1.35 - 1.95, p<0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% Cl 1.002 – 1.035, p = 0.02), and in leaving AMA (aOR = 6.44 95%Cl 4.46 – 9.63, p <0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of -7.5 years (95% Cl -9.3 5.8) compared to those without a psychiatric disorder. Conclusion66.9% of patients with DKA/HHS have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and have a lower age of mortality.

Do psychotropic drugs cause seizures?

Patients with epilepsy often present with concurrent psychiatric disorders, posing unique challenges for healthcare providers. This review explores the intricate relationship between psychiatric comorbidities, epilepsy, and psychotropic medications to inform clinical decision-making. The bidirectional association between epilepsy and psychiatric conditions complicates treatment, with psychiatric symptoms preceding or following seizure onset. The review discusses the seizure risks associated with antidepressants, CNS stimulants, and antipsychotics, shedding light on both historical perspectives and recent empirical evidence. Antidepressants, particularly tricyclic antidepressants (TCAs), are known to pose seizure risks, while newer agents like selective serotonin reuptake inhibitors (SSRIs) exhibit lower incidences and even potential anticonvulsant effects. Contrary to common beliefs, CNS stimulants used in attention-deficit/hyperactivity disorder (ADHD) treatment show efficacy without significantly increasing seizure risk. However, the association between ADHD and seizures warrants careful consideration. Among antipsychotics, clozapine stands out for its heightened seizure risks, especially during titration and at high doses, necessitating close monitoring and individualized approaches. Understanding the nuanced seizure risks associated with different psychotropic medications is crucial for optimizing patient care and minimizing iatrogenic seizures in this vulnerable population. By recognizing the complexities of psychiatric comorbidities in epilepsy and considering the unique challenges they pose, healthcare providers can make informed decisions to enhance patient safety and treatment outcomes. This review offers practical insights to guide clinicians in navigating the intricate landscape of managing psychiatric comorbidities in patients with epilepsy.

Psychiatric and Substance Use Disorders Are Independent Predictors of Treatment Response and Outcomes in United States Veterans with Newly Diagnosed Acute Myeloid Leukemia Treated with Venetoclax Combinations

BACKGROUND: Venetoclax (VEN) combinations have become the standard frontline therapy for patients with newly diagnosed acute myeloid leukemia (AML) who are deemed unable to tolerate intensive induction chemotherapy, either due to age or comorbidities. However, outcomes in the real-world setting have been inferior to those observed in clinical trials. Preexisting psychiatric diagnoses and substance use disorders (SUDs) have previously been associated with increased mortality in patients with cancer, but their prognostic influence in veterans with AML is unclear. The aim of this study was to measure the prevalence of psychiatric and SUDs in veterans with AML treated with VEN combinations, determining the impact of these conditions on treatment response and outcomes. METHODS: This was a retrospective cohort study of veterans with newly diagnosed AML who received frontline therapy with VEN combinations within the national Veterans Affairs (VA) Healthcare System. To measure the prevalence of psychiatric and SUDs, we used the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse algorithm, which tracks health conditions by administrative claims data with International Classification of Diseases (ICD) diagnostic and procedural codes. Our endpoints were rates of complete remission or complete remission with incomplete marrow recovery (CR/CRi), early mortality (EM, or death within 60 days of treatment initiation), intensive care unit (ICU) admissions, and overall survival (OS). We evaluated the relationship between comorbid medical conditions and outcomes using Kaplan-Meier analysis and Cox proportional hazards regression models, first unadjusted, and then adjusted for all covariates. Patients who underwent allogeneic stem cell transplantation (HSCT) were excluded from statistical analyses. RESULTS: We identified 452 veterans treated with VEN up to April 1, 2022 (Table 1). In combination with VEN, 60% (n=270) received azacitadine, 37% (n=168) received decitabine, and 3% (n=14) received low-dose cytarabine. Median age was 74.3 years (IQR: 71.2-78.5) with 52% ≥75 years. By European LeukemiaNet (ELN) 2017 risk classification, 61% (n=274) were classified as adverse risk. Forty-six percent (n=206) of veterans had a preexisting psychiatric diagnosis, and 19% (n=84) had SUDs; 11% (n=49) had both comorbidities. Psychiatric disorders were significantly more prevalent in younger veterans (68% in &amp;lt;65 years vs 50% in 65-74 years vs 39% in ≥75 years, p&amp;lt;0.003); same was true for SUDs (38% in &amp;lt;65 years vs 26% in 65-74 years vs 9% in ≥75 years, p&amp;lt;0.001). For the entire cohort, CR/CRi was achieved by 57% (n=257), and only 3% (n=12) received HSCT. Zero veterans with SUDs and 8 with psychiatric diagnoses were transplanted. At the end of study period, 69% (n=310) had died. Median OS was 216 days (95% CI: 195-254). The 60-day mortality rate was 20% (n=87), of which 8 veterans had primary refractory AML. ICU admissions after treatment initiation was significantly higher in veterans with SUDs compared to those without history of SUDs (5.0 versus 2.2 per 5 person-years, p&amp;lt;0.001). On multivariable analyses (Table 2), both psychiatric and SUDs were independently associated with decreased odds of CR/CRi. Veterans with psychiatric disturbances had a 1.97 times higher hazard of EM (95% CI: 1.16-3.39, p=0.01) and a 1.28 times higher hazard of death (95% CI: 1.00-1.64, p=0.05) compared to veterans without concurrent psychiatric disorders. CONCLUSION: Psychiatric diagnoses and SUDs were not only prevalent among veterans with AML, but they also negatively impacted treatment response, EM, and OS-independently of age, sociodemographic variables, markers of disease risk, and VEN combination. Veterans with SUDs also had significantly higher ICU admissions after treatment initiation for AML. Compared to published clinical trials data, veterans experienced inferior outcomes. Veterans with psychiatric and SUDs may have difficulty adhering to regimens, reemergence of their mental instability and illness that is triggered by AML diagnosis and its treatment, or biologic mechanisms associated with these comorbidities. Better understanding of these factors contributing to health disparities and targeting these comorbidities with supportive care interventions alongside AML-specific therapy may improve outcomes and warrant further study.

Associations between direct contact with the oil and worsened health indicators after Deepwater Horizon oil spill: Results from Gulf States Population Survey

BACKGROUND Oil spills were known to affect human health through the exposure of inherent hazardous chemicals. The aim of the study was to examine the associations between direct contact with the oil (DCO) and health indicators among the adult residents in the 25 coastal counties or parishes most directly affected by the Deepwater Horizon oil spill (DHOS) in the Gulf of Mexico. METHODS Data were based on the Gulf States Population Survey (GSPS). The GSPS collected survey data from a random sample of households, with the majority of the interviews conducted in the 25 coastal counties or parishes that were most directly affected by the spill. After identifying the confounding variables, associations of DCO with poor quality of life (QoL), poor self-rated health (SRH), psychiatric disorders, asthma, and cardiovascular disease among the adult residents after DHOS were analyzed using logistic regressions. RESULTS The mean age of total of 5,167 adult residents at the time of questionnaire completion was 53.93 (SD=16.29) ranging from 18 to 95 years. Controlling for confounding variables, DCO was associated with higher odds of poor mental QoL (adjusted odds ratio [aOR]: 1.284; 95% confidence interval [CI]: 1.045-1.578; _p_=.018), poor SRMH (aOR=1.278; 95%CI: 1.021-1.601; _p_=.033), anxiety (aOR=1.680; 95%CI: 1.395-2.024; _p_&lt;.001), depression (aOR=1.182; 95%CI: 0.977-1.430; _p_=.086), and suicidality (aOR=1.920; 95%CI: 1.411-2.614; _p_&lt;.001) after DHOS. CONCLUSIONS In conclusions, the prevalence of co-occurring poor SRHs, co-existing poor QoL, and concurrent psychiatric disorders was high in adult residents after DHOS. Similarly, DCO had association with poor mental QoL, poor SRMH, and psychiatric disorders. The empirical findings of this research presented the managerial implications in the field of environmental health.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

Anorectal manometry for the diagnosis of pelvic floor disorders in patients with hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome

IntroductionFunctional gastrointestinal disorders (FGID) including impaired rectal evacuation are common in patients with Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). The effect of connective tissue pathologies on pelvic floor function in HSD/hEDS remains unclear. We aimed to compare clinical characteristics and anorectal pressure profile in patients with HSD/hEDS to those of age and sex matched controls.MethodsWe conducted a retrospective review of all FGID patients who underwent high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) for evaluation of impaired rectal evacuation. Patients with HSD/hEDS were age and sex matched to a randomly selected cohort of control patients without HSD/hEDS. An abnormal BET was defined as the inability to expel a rectal balloon within 2 minutes. Wilcoxon rank sum test and Fisher’s exact test were used to make comparisons and logistic regression model for predictive factors for abnormal evacuation.ResultsA total of 144 patients (72 with HSD/hEDS and 72 controls) were analyzed. HSD/hEDS patients were more likely to be Caucasian (p < 0.001) and nulliparous. Concurrent psychiatric disorders; depression, and anxiety (p < 0.05), and somatic syndromes; fibromyalgia, migraine and sleep disorders (p < 0.001) were more common in these patients. Rate of abnormal BET were comparable among the groups. HDS/hEDS patients had significantly less anal relaxation and higher residual anal pressures during simulated defecation, resulting in significantly more negative rectoanal pressure gradient. The remaining anorectal pressure profile and sensory levels were comparable between the groups. While diminished rectoanal pressure gradient was the determinant of abnormal balloon evacuation in non HSD/hEDS patients, increased anal resting tone and maximum volume tolerated were independent factors associated with an abnormal BET in HSD/hEDS patients. Review of defecography data from a subset of patients showed no significant differences in structural pathologies between HSD/hEDS and non HSD/hEDS patients.ConclusionsThese results suggest anorectal pressure profile is not compromised by connective tissue pathologies in HSD patients. Whether concurrent psychosomatic disorders or musculoskeletal involvement impact the pelvic floor function in these patients needs further investigation.

Approach and Clinical Practice of Functional Movement Disorders Among Neurologists in Saudi Arabia.

Background Functional movement disorders (FMDs) are neurological disorders that consist of abnormal and involuntary movements that have no specific organic cause. Given the prevalence of FMDs and the scarcity of information on neurologists' approaches to FMDs, we aimed to assess the neurologists' approaches and clinical practice in managing FMDs in Saudi Arabia. Methods A validated online questionnaire in English was used. The data were collected through a self-reported questionnaire. The data were analyzed using the statistical software IBM SPSS version 22 (SPSS, Inc., Armonk, NY). Results A total of 231 neurologists completed the study survey. A total of 129 (55.8%) were males. Regarding the predictors for a diagnosis other than FMD, the highest rating predictor was for evidence of physical injury and lack of psychiatric history of psychological stressors, while the lowest rating was for the male gender. Regarding the effective treatment strategies of FMD, the most effective treatment strategy reported by the clinicians was patient education, while the least was alternative or complementary medicine. The management ability of clinicians was generally restricted by cultural beliefs about psychological illnesses and the availability of referral services. The reported predictors by clinicians for a better prognosis of FMD include acceptance of the diagnosis by the patient followed by identification and management of psychological stressors and concurrent psychiatric disorder and a supportive social network. Generally, the most used terminology in this study was "functional movement disorder". Conclusions There is a variation in the approach and clinical practice of FMD among neurologists in Saudi Arabia. Shared knowledge regarding diagnosis and effective management is crucial. Collaborative efforts are required to establish practice guidelines in the future.

Gender differences among persons entering medication treatment for opioid use disorder in the community.

We evaluated gender differences among persons initiating medications for opioid use disorder (MOUD). Analyses of baseline assessments for a study evaluating the impact of MOUD on outcomes included: demographics, DSM-5 diagnoses, depression severity, quality of life (QoL), and medication history (N = 125). When compared to men, women had a greater prevalence of generalized anxiety and posttraumatic stress disorders; and worse psychological QoL. Women were less likely to be prescribed psychiatric medications. Women may benefit from tailored multidisciplinary programs with MOUD. This study identified that women with OUD seeking MOUD in the community had greater sedative hypnotic nonprescribed medication use and psychiatric comorbidity than men, all of which can contribute to poorer retention on MOUD and higher risk of morbidity and mortality. Thus, concurrent psychiatric disorder screening and treatment integrated with MOUD may improve retention on MOUD, opioid relapse and overdose for women.

Psychological impacts of Intentional Non-Medical Fentanyl Use Among People Who Use Drugs: A Systematic Review

IntroductionThe use of non-medical fentanyl and structurally related compounds has changed drastically over the last ten years. Community members working with individuals who use fentanyl intentionally currently struggle with the rapidly evolving drug markets and patterns of use, thereby failing to adapt treatment approaches and harm reduction strategies to individuals with severe opioid use disorder (OUD) and concurrent psychiatric disorders.ObjectivesThis systematic review aims to evaluate intentional fentanyl among PWUD by summarizing demographic variance, concurrent disorders, and resulting patterns of use.MethodsThe search strategy in this study was developed with a combination of free text keywords and Mesh and non-Mesh keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO (May 2021). The search results resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. A total of 42 articles were included in this review.ResultsIt was found that individuals who use fentanyl intentionally were more likely to be young, male, and Caucasian. Individuals who intentionally use fentanyl were more commonly homeless, unemployed or working illegally, and live-in cities. Independent correlates of any purposeful fentanyl use included moderate/severe depression.ConclusionsIndividuals who intentionally use fentanyl are more likely to report injection drug use and polysubstance use, including cocaine use, heroin use, and methamphetamine use. Among PWUD, individuals who intentionally use fentanyl have the most severe substance use patterns, the most precarious living situation, and the most extensive overdose history and higher proportion of ever having a mental health diagnosis.DisclosureNo significant relationships.

Epidemiology of psychotic-like experiences by subtypes and their relationship with emotional regulation and affective lability among Chinese college students

Although psychotic-like experiences (PLEs) are transient and not pathognomonic for psychiatric disorders, they may increase the risk of concurrent and future psychiatric disorders. However, the prevalence of PLEs and the different effects of PLE subtypes on mood outcomes are still unclear. Thus, this study seeks to investigate the prevalence of PLE subtypes and explore their relationship with the use of specific emotion regulation strategies and the level of affective lability among college students. The history of PLEs, the level of affective lability, and the use of specific emotion regulation strategies were assessed via self-reported questionnaires, and 1905 college students and 1812 college students were included in separate analyses. This study found that 14.44% of college students reported ever experiencing any of the five PLEs, with males reporting more PLE symptoms and a higher number of PLEs than females. Different PLE subtypes had different effects on the use of specific emotion regulation strategies (cognitive reappraisal or suppression) and the level of affective lability and also showed gender differences. Cognitive reappraisal and suppression differently predicted affective lability in males and females, and cognitive reappraisal mediated the relationship between hearing voices in PLEs and affective lability in males. In conclusion, PLEs were common in Chinese college students and gender differences were revealed in the prevalence of PLE subtypes. PLEs were associated with the use of specific emotion regulation strategies and the level of affective lability. Cognitive reappraisal may be a promising target for intervention aimed at relieving the effect of PLEs in non-clinical individuals.

Childhood trauma exposure and reward processing in healthy adults: A functional neuroimaging study

The association between childhood trauma exposure and risk of developing psychopathology may in part be mediated by the effects of chronic stress on dopaminergic neurotransmission. However, little is known about the differential effects of distinct trauma types on reward processing, particularly in adults without concurrent medical or psychiatric disorders. We examined the association of childhood trauma exposure, including the differential effects of abuse and neglect, with reward processing in healthy adults (n = 114). Functional magnetic resonance imaging during a monetary incentive delay task was used to assess neural activity in the ventral striatum and orbitofrontal cortex in relation to reward anticipation and reward outcome, respectively. Exposure to childhood trauma, including abuse and neglect, was assessed using the Childhood Trauma Questionnaire‐Short Form. We found a significant effect for abuse on ventral striatal activation during reward anticipation, adjusting for age, sex, scanner site, educational level, and household monthly income. There were no effects for abuse or neglect, independently or combined, on orbitofrontal cortex activation during reward outcome. Our findings suggest differential effects of childhood abuse on ventral striatum activation during reward anticipation in healthy adults.

The Utility of Research Domain Criteria in Diagnosis and Management of Dual Disorders: A Mini-Review.

The Research Domain Criteria (RDoC) initiative has been considered a comprehensive alternative classification framework for understanding neuropsychiatric ailments, as opposed to the longstanding, traditional DSM framework. Where the DSM categorizes neuropsychiatric disorders as each being distinct and diagnostically defined by the presence of specified symptoms, RDoC provides a multidimensional conceptualization of psychiatric disorders with neurobiological roots. By taking a multidimensional approach, RDoC overcomes two major constraints of the DSM framework: that is, that the DSM is categorical in its approach to psychiatric disorders to the point of understating the intersectionality between concomitant disorders, and that the DSM focuses mainly on clinical features. RDoC seems to better account for the intersection between dual disorders and considers a range of factors, from the more microscopic (e.g., genetics or molecular functions) to the more macroscopic (e.g., environmental influences). The multidimensional approach of RDoC is particularly appealing in the context of dual disorders. Dual disorders refers to a concurrent psychiatric disorder with an addiction disorder. RDoC accounts for the fact that there is often overlap in symptoms across and bidirectional influence between various disorders. However, to date, there is limited research into the clinical utility of RDoC, and less so in the context of the clinical management of dual disorders. In this Mini-Review, we discuss how RDoC differs from the DSM, what outcomes have been reported in utilizing RDoC clinically, the utility of RDoC for the diagnosis, management, and monitoring of psychopathology, and the limitations of RDoC as well as avenues for future research.

Asthma induces psychiatric impairments in association with default mode and salience networks alteration: A resting-state EEG study

Asthma is a chronic inflammatory disease associated with a high prevalence of psychiatric disorders. There are specific brain networks responsible for emotional processes, including two important networks associated with psychiatric problems: the default mode network (DMN), which is more active in the resting state, and the salience network (SN), which is structurally connected to DMN. Although previous studies suggested that neuro-phenotypes of asthma may be recognizable by the neural activity of brain circuits, an association between the brain's functional alterations and psychiatric impairments induced by asthma remains unknown. We aimed to assess DMN and SN activity and its association with psychiatric indices and clinical parameters in asthmatic patients. Electroencephalography was recorded during the resting state with an awake and eyes-open condition in thirty-eight sex and age-matched subjects (19 atopic asthma patients and 19 healthy participants). Power spectrum and functional connectivity were computed for DMN and SN. We examined psychiatric disorders (including depression, anxiety, and stress) and pulmonary function using the DASS questionnaire and spirometry test, respectively. The results showed that DASS scores were significantly higher in asthmatic patients compared to healthy subjects. Asthmatic patients also demonstrate a significant enhancement in power and functional connectivity in the two networks. Notably, these power enhancements of the networks were correlated with psychiatric problems scores, pulmonary function, asthma duration, and poor asthma control. These results introduce new evidence for the association between altered brain activity, the existence of psychiatric disorders, and asthma-related features, including pulmonary function. Also, we provide new insights into asthma-induced inflammatory response and the importance of developing novel interventions and therapeutic strategies for managing allergic inflammation patients who suffer from concurrent psychiatric disorders.

Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis

Family interventions are efficacious for relapse prevention in schizophrenia. Multiple different models have been developed. We aimed to compare the efficacy, acceptability, and tolerability of family interventions for relapse prevention in schizophrenia. In this systematic review and network meta-analysis, we searched for randomised controlled trials that investigated family intervention models aimed at preventing relapse in patients with schizophrenia. We searched EMBASE, MEDLINE, PsycINFO, BIOSIS, CENTRAL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform up to Jan 20, 2020 and PubMed up to July 15, 2021. We included blinded and open-label randomised controlled trials in which at least 80% of patients had schizophrenia spectrum disorders. We excluded studies in which all patients were acutely ill, had a concurrent medical or psychiatric disorder, or were prodromal or "at risk of psychosis". Study selection and data extraction were done by two independent reviewers. Data were extracted about overall, positive, negative, and depressive symptoms of schizophrenia, quality of life, adherence, overall functioning, family burden, expressed emotion, and discontinuations due to inefficacy. The primary outcome was relapse, measured with operationalised criteria, psychiatric hospital admissions, or clinical judgement. We did a frequentist, random-effects, network meta-analysis to calculate odds ratios ([ORs]; dichotomous outcomes) or standardised mean differences (continuous outcomes) with 95% CIs. The study protocol was registered with PROSPERO, CRD42020169951. We identified 28 395 studies through the database search and 334 from references of previous studies. We compared 11 family intervention models tested on a total of 90 randomised controlled trials with 10 340 participants (3579 females and 5632 males with sex indicated; median age 31 years [range 14-65]) in the network meta-analysis. Ethnicity data were not available. All interventions, with the exception of crisis-oriented interventions and family psychoeducation with two sessions or fewer, reduced the relapse rate significantly when compared with treatment as usual at the primary timepoint of 12 months. ORs compared with treatment as usual ranged from 0·18 (95% CI 0·12-0·27) for family psychoeducation alone to 0·63 (0·42-0·94) for community-based interventions involving family members. The results were robust in various sensitivity and subgroup analyses. The confidence in the estimates ranged from moderate to very low for different comparisons. Almost all family intervention models were efficacious in preventing relapse in schizophrenia. Family psychoeducation alone, without behavioural or skills training, was superior to the more complex models. Our results suggest that in contexts where there are financial constraints, family psychoeducation alone should be implemented. German Ministry for Education and Research.

Opinions and clinical practice of functional movement disorders: a nationwide survey of clinicians in China

BackgroundThere is rare reports about opinions and clinical practice of functional movement disorders (FMD) in China. The present survey aimed to investigate the views of FMD in Chinese clinicians.MethodsThe Chinese version survey of FMD were conducted in nationwide practitioners by means of an online questionnaire.ResultsFour hundred and thirty-four Chinese clinicians completed a 21-item questionnaire probing diagnostic and management issues in FMD. More than 80% of respondents considered that atypical movement disorder, multiple somatizations, and emotional disturbance were essential or absolutely necessary for clinically definite diagnosis of FMD. About three quarters of respondents requested standard neurological investigations to rule out organic causes. Over half believed that prior diagnosis of an organic disorder (59.9%), lack of associated non-physiologic deficits (51.8%), and evidence of physical injury (50.0%) were ‘very influential’ or ‘extremely influential’ for a non-FMD diagnosis. The majority (77.4%) of the respondents may refer patients to a neuropsychiatrist or psychiatrist experienced in FMD, followed by psychologist or psychotherapist experienced in FMD (53.2%). However, lack of guidelines, physician knowledge, and training often limited clinicians’ ability in managing patients with FMD. Early diagnosis of FMD, identification and management of concurrent psychiatric disorder, and acceptance of the diagnosis by the patient were considered most important for predicting a favorable prognosis.ConclusionsOpinions and clinical practice of Chinese practitioners not only varied among Chinese neurologists, but also differed from international peers. Combined efforts are needed to promote related research and establish practice guidelines in China in the future.

User involvement in interprofessional team meetings within services for substance use disorders.

Background:People with substance use disorders (SUD) and concurrent mental health disorders often need prolonged, coordinated health and welfare services. Interprofessional team meetings are designed to tailor services to users’ needs and should be based on interprofessional collaboration involving the user.Aims:To investigate service users’ experiences with interprofessional team meetings and to identify potential barriers to successful user involvement.Methods:Semi-structured interviews with five male service users aged 27–36 years with concurrent substance use and psychiatric disorders, and observations of team meetings involving both users and relevant professionals. Users were interviewed shortly after commencing treatment and after the team meeting. A phenomenographical approach framed the data analysis.Results:Users described the interprofessional team meetings as less than useful, and perceived that lack of a targeted process and of information hindered their collaboration with professionals. Observations revealed that users were given a subordinate role in the meetings, which largely undermined their involvement. Three categories reflecting lack of information as a core obstacle to user involvement emerged from the data material: (i) unclear role responsibilities and unclear professional role functions, (ii) unclear practices regarding rules and routines, and (iii) absence of user knowledge.Conclusions:User involvement in team meetings may be improved by facilitating adequate information, clarifying role expectations, emphasising user knowledge, increasing professionals’ awareness of the importance of collaboration, and by teaching skills that enhance user involvement.

Misuse and dependence of dimenhydrinate: A mixed studies systematic review

BackgroundDimenhydrinate (DMH) is an antihistamine used to treat nausea and vomiting. Although widely available in pharmacies as an over the counter medication, there have been reports of potential DMH tolerance and dependence and a possible euphoric potential accompanying heavy use (>100 mg/day). Despite the potential for misuse, there is a gap in the literature concerning patterns, characteristics, and potential mechanisms of DMH misuse. AimsThis review aimed to synthesize evidence on the pharmacology, clinical effects, and management of DMH misuse and dependence to inform clinical decision making and relevant drug policy. MethodsWe conducted a systematic review in accordance with the PRISMA guidelines and using Cochrane collaboration methods. We searched seven databases from their inception through July 2019. To be included in the review, studies needed to measure or focus on one or more dimensions of morbidity or mortality related to the misuse of DMH. Quantitative, qualitative and mixed-method studies were included in order to capture the breadth of possible studies. Studies were excluded if they did not fit into the conceptual framework of the study of if they focused primarily on the misuse of other substances. A narrative synthesis of study findings was pursued given the limited capacity for a quantitative meta-analysis. FindingsWe identified 24 studies, which described a range of neuropsychiatric sequelae related to DMH consumption, including seizures, psychosis, depression, intoxication (resembling anticholinergic syndrome) and withdrawal. The sedative and euphoric properties, readily available nature, and low cost of DMH appear to facilitate DMH dependence, which were more commonly reported among individuals who had concurrent psychiatric disorders, displaying symptoms such as low motivation, poor concentration, and delirium. The overall quality of studies identified by this review was low—largely because the majority of studies were case reports or review articles, with few intervention or cohort studies. ConclusionsThere is some evidence to suggest the existence of DMH-related syndromes involving intoxication, withdrawal, and dependence, more commonly among long-term, heavy DMH consumers. However, higher quality studies are needed to confirm preliminary findings that there may be a biological basis for such syndromes.

Stages of major depressive disorder and behavioral multi-morbidities: Findings from nationally representative epidemiologic study

Objective: To present a three stage-model of major depressive disorder (MDD) and evaluate differences in behavioral histories/experiences and multi-morbidities between stages.Methods: We used data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions–III, a nationally representative cross-sectional survey of US adults (n = 36,309). Based on DSM-5 diagnostic criteria, we identified and compared three groups of adults with MDD histories: 1) new onset MDD (n = 509; 5.6%); 2) chronic MDD (n = 3,871; 46.1%); and 3) recovered from MDD (n = 3,673; 48.3%). Multivariable analyses tested independent group differences in behavioral histories/experiences and diagnostic multi-morbidities between 1) recovered MDD vs. new onset MDD; 2) chronic MDD vs. new onset MDD; and 3) recovered MDD vs. chronic MDD.Results: Adults who have recovered from MDD as compared to those with chronic MDD were 2.5 times more likely to have recovered from two or more psychiatric disorders in addition to MDD (95% confidence intervals [CI]=1.76–3.61) and from alcohol use disorder (adjusted odds ratio [AOR]=1.28; 95% CI=1.08–1.52). They were also less likely than those with chronic MDD to have borderline personality disorder (p<0.001), pain (p<0.001), or medical co-morbidity (p = 0.003). Adults with new onset MDD were younger than other groups, and more likely than those who have recovered to have borderline personality disorder and concurrent psychiatric or substance use disorders (p<0.05 for all).Conclusion: Behavioral histories/experiences and multi-morbidities differ significantly across stages of MDD. These concurrent problems may impede recovery and foster chronicity and should therefore be an integral focus of treatment.

Multiple Psychiatric Morbidity and Continued Use of Naltrexone for Alcohol Use Disorder.

Despite substantial evidence of the efficacy of naltrexone in treating alcohol use disorder (AUD), naltrexone is used infrequently and often for short durations. Understanding factors related to the initiation and continued use of naltrexone could identify targets for improving its use in clinical practice. We used the Fiscal year 2012 national data from the Veterans Health Administration to identify the proportion of veterans diagnosed with AUD who initiated and then continued to receive naltrexone for AUD over a 6-month period (N = 67,788). We further examined correlates of any use and continued use, and patterns of use in inpatient and outpatient mental health services and psychotropic prescription fills. Comparisons were made using bivariate analyses and multinomial logistic regression. Among the veterans diagnosed with AUD, 2.02% initiated treatment with naltrexone. Naltrexone initiation was associated with recent homelessness, concurrent psychiatric disorders, receipt of psychiatric outpatient services, psychotropic prescription fills, residential treatment, and psychiatric and medical-surgical hospitalization. Of the 1,366 patients initiating naltrexone, 43.2% (590) received 2 to 5 prescriptions and 16.3% (223) received more than 5 prescriptions for naltrexone. Use of naltrexone beyond one prescription was associated with homelessness, major depressive disorder, schizophrenia, psychotropic medication use, and psychiatric hospitalization. Veterans with AUD who used and continued naltrexone were primarily those with multimorbidity and extensive involvement in psychiatric treatment. Prior studies examined the correlates of initiation of naltrexone but retention in treatment has received less attention. This study identified the frequency and important patient and service correlates of continued use of naltrexone. (Am J Addict 2021;30:55-64).