Disorder Comorbidity In Patients Research Articles

Central sensitization and comorbid disorders in patients with coronary heart disease

Study of central sensitization (CS), insomnia and meteosensitivity in patients with coronary heart disease (CHD) admitted for a routine examination. 67 patients (29 men and 38 women), aged 50-87 years, average age 73 [67; 85] years, with chronic forms of coronary heart disease were examined. The examination included the Russian version of the central sensitization inventory (CSI); assessment of meteosensitivity using a visual analogue scale (VAS); questionnaire for semi-quantitative assessment of subjective sleep characteristics (ASHS). Patients with the presence of CS were prescribed Anvifen 250 mg 3 times a day; in addition, patients could take the drug during the day if necessary, as well as during night or early morning awakening (without exceeding the maximum daily dose of 1500 mg). The duration of drug administration and observation of patients was 30 days. The severity of CS (before and after treatment): subclinical - in 14 and 20, mild - in 15 and 37, moderate - in 17 and 10, severe - in 14 and 0, critical - in 7 and 0 patients, respectively. The average CSI score was 40.5[30; 50] and 32.5[25; 37.3] (p=0.00001). The severity of meteosensitivity according to VAS before and after treatment was 70 [60; 80] and 25 [20; 30] points (p=0.00002). The average ASHS score for subjective sleep characteristics before and after treatment was 13 [12; 15] and 26 [25; 28] points (p=0.00001). Central nervous system, insomnia and meteosensitivity are common clinical conditions in patients with coronary artery disease. Inattention to them leads to insufficient effectiveness of specific therapy and worsening of the course of cardiovascular diseases. The GABAergic drug Anvifen effectively reduces CS, meteosensitivity and improves sleep. The CSI is a simple and informative tool for assessing cerebral dysfunction in patients with coronary artery disease and can be recommended for daily routine practice in order to optimize personalized medical care.

P198: Correlation between depressive symptom severity and functional status in patients with mild cognitive impairment.

Objectives:Although depression is a common co-morbid disorder in patients with mild cognitive impairment (MCI), not all patients with MCI exhibit depressive symptoms. This study aimed to investigate the effect of depression on cognitive and functional decline in MCI.Methods:281 patients with MCI (MCI) defined by 0.5 score on Clinical Dementia Rating were included in the study. Patients were divided into three groups based on their Geriatric Depression Scale (GDS) scores: MCI without depression (GDS<10, n=50), MCI with mild depression (GDS10~19, n=120), and MCI with severe depression (GDS>20, n=111). Cognitive function tests (cognitive domains in CERAD-K including letter fluency, trail making test-A and B, and verbal learning test) and Blessed Dementia Scale-Activities of Daily Living (BDS-ADL) were measured. Group differences were analyzed using an analysis of variance (ANOVA). Correlation between GDS scores and BDS-ADL were analyzed.Results:An ANOVA test showed that activities of daily living differed significantly across groups (F(2, 276) = 13.53, p<0.001). Post-hoc analysis showed MCI with severe depression had a significantly higher mean BDS-ADL score compared with both MCI without depression and MCI with mild depression (both, p<0.001). Correlation analysis showed significant positive correlation between GDS and BDS-ADL (r=0.366, p<0.001). However, mean scores of cognitive function tests were not different among three groups.Conclusions:The present study suggests that co-morbid depressive symptoms may have negative impact on functional status in patients with MCI. This may further suggest the importance of evaluation and treatment of depressive symptoms in patients with MCI.

Posttraumatic stress disorder comorbidity in patients undergoing ECT for major depressive disorder.

Posttraumatic stress disorder (PTSD) is not recognized as an indication for electroconvulsive therapy (ECT). However, research indicates promise for this treatment modality. To elucidate the effects of ECT for treating PTSD, prospective research is needed. The first step in assessing the feasibility of such research is to determine if many patients being treated with ECT have comorbid PTSD. This study examined the PTSD comorbidity rates and compared demographic data among patients with major depressive disorder (MDD) who were treated with ECT vs patients with MDD who were not treated with ECT. Data from patients with MDD were obtained from the Nationwide Inpatient Sample. Approximately 10% of patients undergoing ECT for MDD also had PTSD. The difference in comorbidity of PTSD in those treated with ECT vs those not treated with ECT was approximately 1%. Prospective naturalistic studies that examine the response of PTSD to ECT are feasible because a sizable number of patients with PTSD are receiving ECT.

Impaired Lactate Release in Dorsal CA1 Astrocytes Contributed to Nociceptive Sensitization and Comorbid Memory Deficits in Rodents.

Memory deficits are a common comorbid disorder in patients suffering from neuropathic pain. The mechanisms underlying the comorbidities remain elusive. The hypothesis of this study was that impaired lactate release from dysfunctional astrocytes in dorsal hippocampal CA1 contributed to memory deficits. A spared nerve injury model was established to induce both pain and memory deficits in rats and mice of both sexes. von Frey tests, novel object recognition, and conditioned place preference tests were applied to evaluate the behaviors. Whole-cell recording, fiber photometry, Western blotting, and immunohistochemistry combined with intracranial injections were used to explore the underlying mechanisms. Animals with spared sciatic nerve injury that had displayed nociception sensitization or memory deficit comorbidities demonstrated a reduction in the intrinsic excitability of pyramidal neurons, accompanied by reduced Ca2+ activation in astrocytes (ΔF/F, sham: 6 ± 2%; comorbidity: 2 ± 0.4%) and a decrease in the expression of glial fibrillary acidic protein and lactate levels in the dorsal CA1. Exogenous lactate supply or increasing endogenous lactate release by chemogenetic activation of astrocytes alleviated this comorbidity by enhancing the cell excitability (129 ± 4 vs. 88 ± 10 for 3.5 mM lactate) and potentiating N-methyl-d-aspartate receptor-mediated excitatory postsynaptic potentials of pyramidal neurons. In contrast, inhibition of lactate synthesis, blocking lactate transporters, or chemogenetic inhibition of astrocytes resulted in comorbidity-like behaviors in naive animals. Notably, β2-adrenergic receptors in astrocytes but not neurons were downregulated in dorsal CA1 after spared nerve injury. Microinjection of a β2 receptor agonist into dorsal CA1 or activation of the noradrenergic projections onto the hippocampus from the locus coeruleus alleviated the comorbidity, possibly by increasing lactate release. Impaired lactate release from dysfunctional astrocytes, which could be rescued by activation of the locus coeruleus, led to nociception and memory deficits after peripheral nerve injury.

Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points.

Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.

Symptomatic and Therapeutic Significance of Generalized Anxiety Disorder Comorbidity in Patients with Obsessive-Compulsive Disorder

Background: Psychiatric disorders frequently accompany comorbid conditions, which can have negative prognostic effects. The etiological and phenomenological distinctions between these conditions may have significant implications for their therapeutic approach and clinical course. Objectives: Our study aimed to investigate the symptomatic and therapeutic significance of comorbid generalized anxiety disorder (GAD) on obsessive-compulsive disorder (OCD). Methods: This cross-sectional study included OCD patients referred to private and institutional psychiatric clinics in Rasht, Guilan, in 2021. All participants were divided into two groups: those with OCD and those with both OCD and GAD (OCD-GAD). The diagnoses were determined using structured clinical interviews that followed the DSM-5-research version (DSM-5-RV) criteria and included psychiatric histories. Patients were assessed using the Hamilton anxiety rating (HAM) scale, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and Global Assessment of Functioning (GAF). The data were analyzed using SPSS version 20. Results: Out of the 146 participants, 80 had only OCD, while 66 had both OCD and GAD. Both groups demonstrated significant improvements in GAF scores throughout the treatment period (P < 0.0001); however, there was no significant difference between the groups in terms of these improvements. The Y-BOCS score was significantly higher in the OCD group at baseline (P < 0.0001), and it decreased more during the first 3 months in the OCD-GAD group (P = 0.006). The severity of obsessive-compulsive symptoms related to symmetry (P = 0.014), hoarding (P = 0.034), taboo thoughts (P = 0.023), and aggression (P = 0.002) was significantly higher in the group with OCD. Both HAM-A and Y-BOCS scores decreased over time, but HAM-A showed a greater decline at the first follow-up, while Y-BOCS showed a greater decline at the second follow-up. Conclusions: Considering our findings, OCD-GAD diagnosis is not a unique subcategory of current psychiatric disorders, and it is not necessarily beneficial to regard it as such. However, we found that the comorbidity of GAD did not harm the prognosis of patients with OCD. Further investigations are recommended to evaluate the clinical significance of OCD-GAD comorbidity.

Effects of comorbid alcohol use disorder on bipolar disorder: Focusing on neurocognitive function and inflammatory markers

BackgroundAlcohol use disorder (AUD) is a highly prevalent comorbid disorder in patients with bipolar disorder (BD). Both BD and AUD were found to be associated with inflammation and cognitive deficits, but few study has been done on BD comorbid with AUD (BD+AUD). We aimed to investigate the impacts of comorbid AUD and BD on cognitive function, inflammatory and neurotrophic markers. MethodWe recruited 641 BD patients, 150 patients with BD+AUD, and 185 healthy controls (HC). Neuropsychological tests [Wisconsin card sorting test (WCST), continuous performance test (CPT), and Wechsler memory scale - third edition (WMS-III)] and cytokine plasma levels [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-8 (IL-8), transforming growth factor-β1 (TGF-β1), and brain-derived neurotrophic factor (BDNF)] were assessed. ResultsBD+AUD patients had worse cognitive performance than those without AUD. There was a significant difference in the plasma levels of TNF-α, IL-8, and BDNF (P < 0.001, <0.001, and 0.01, respectively) between the patients and the HC groups. Post hoc analysis showed that BD+AUD patients had higher levels of TNF-α and IL-8 than BD-only patients (P < 0.001). Additionally, plasma IL-8 levels were negatively associated with number of completed categories in WCST (P = 0.02), and TNF-α levels were negatively associated with visual immediate index in WMS-III (P = 0.05). ConclusionOur results suggest that comorbid AUD and BD might worsen cognitive impairments and inflammatory processes. Further longitudinal studies on BD+AUD may be needed.

Thermal grill illusion of pain in patients with chronic pain: a clinical marker of central sensitization?

The thermal grill illusion of pain (TGIP) is a paradoxical burning pain sensation elicited by the simultaneous application of innocuous cutaneous warm and cold stimuli with a thermode ("thermal grill") consisting of interlaced heated and cooled bars. Its neurophysiological mechanisms are unclear, but TGIP may have some mechanisms in common with pathological pain, including central sensitization in particular, through the involvement of N-methyl- d -aspartate receptors. However, few studies have investigated TGIP in patients with chronic pain and its clinical relevance is uncertain. We hypothesized that the TGIP would be increased in comparison with controls in patients with fibromyalgia or irritable bowel syndrome, which are regarded as typical "nociplastic" primary pain syndromes related to changes in central pain processing. We compared the sensations elicited by a large range of combinations of temperature differentials between the warm and cold bars of a thermal grill applied to the hand between patients with fibromyalgia (n = 30) or irritable bowel syndrome (n= 30) and controls (n = 30). The percentage of TGIP responses and the intensity and unpleasantness of TGIP were significantly greater in patients than controls. Furthermore, positive correlations were found between TGIP intensity and clinical pain intensity and between TGIP intensity and the cold pain threshold measured on the hand. These results are consistent with our working hypothesis of shared mechanisms between TGIP and clinical pain mechanisms in patients with nociplastic chronic pain syndromes and suggest that TGIP might represent a clinical marker of central sensitization in these patients.

Effectiveness of the anxiolytic Anvifen in the treatment of post-COVID brain fog

To determine the significance of anxiety disorder and comorbid disorders in patients with post-covid brain fog, to determine the effectiveness of the GABAergic nootropic drug with an anxiolytic effect - Anvifen. 92 post-COVID-19 patients with no organic brain damage who complain of brain fog 12 weeks after the onset of COVID-19 symptoms. Group 1 (n=40; 43.4±4.5 years) were treated at home; group 2 (n=32; 44.9±5.5 years) were treated in a hospital without oxygen support; group 3 (n=20; 45.1±4.8 years) were treated in a hospital with oxygen support. Assessment scales: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment Scale (MoCA); Trail Making Test part B (TMT-B); a scoring questionnaire for the subjective characteristics of sleep; Fatigue Assessment Scale (FAS), 36-Item Short Form Survey (SF-36). According to the indicated scales, no statistically significant differences were found between the groups, therefore, the data of all patients were combined into one group, the indicators were compared before and after treatment (Anvifen 500 mg three times a day for 21 days). Results before/after treatment: HADS anxiety 10.5 [8.5;12]/7 [5;8] (p=0.000025); HADS depression 5 [4; 7] / 4 [4; 6] (p=0.00003); MoCA 22 [21; 22] / 25 [24; 26] (p=0.00001); TMT-B 281 [279; 290] sec / 231 [220; 236] sec (p=0.00001); FAS 27 [23; 31] / 20 [23; 31] (p=0.00001); questionnaire for scoring the subjective characteristics of sleep 15 [15; 16] / 25 [25; 26] (p=0.00001); SF-36 Physical Health 43.8 [42.3; 47.4] / 53.8 [52.3; 20] (p=0.00001); SF-36 Mental Health 34 [32.5; 35] / 47 [45.5; 48] (p=0.00001). The authors conclude that anxiety disorder and asthenia play an important role in the pathogenesis of post-COVID brain fog syndrome. Anvifen effectiveness is considered from the point of view of the participation of GABAergic structures in the pathogenesis of the phenomenon under study.

Sleep disorders in children and adolescents with tension-type headaches

Introduction. Tension-type headache (TTH) represents a widespread and recurrent disease in adults, children, and adolescents, adversely affecting the quality of life, learning achievements, and social functioning. In recent publications, a high incidence of comorbid disorders in patients with TTH is discussed, in particular sleep disorders. The aim of the study was to assess the nature and prevalence of sleep disorders in children and adolescents with frequent episodic TTH and chronic TTH. Materials and methods. One hundred fifty patients aged from 8 years to 16 years 11 months with TTH were examined. Of them, 91 (49 boys, 42 girls) had frequent episodic TTH, 59 (26 boys, 33 girls) had chronic TTH. There was used Sleep Disturbance Scale for Children including 26 questions for parents. Results. The present study confirms the high incidence of sleep disorders among TTH children and adolescents. TTH was diagnosed in 129 (86.0%) out of 150 patients. The most frequently diagnosed varying degrees of severity (clinically relevant and borderline, when assessing sleep disorders in children) were insomnia (disorders of initiating and maintaining sleep) - in 65.3% of patients (including 60.4% with frequent episodic TTH and 72.9% with chronic TTH), excessive somnolence - in 74.7% (67.1% and 86.4%), sleep breathing disorders - in 26.7% (23.1% and 32.2%), disorders of arousal/nightmares - in 46.0% (42.9% and 50.8%), sleep-wake transition disorders - in 65.3% (67.1% and 62.7%), sleep hyperhidrosis - in 31.3% (26.4% and 39.0%). Thus, all sleep disorders (except for sleep-wake transition disorders) were significantly more common among the patients with chronic TTH. At the same time, in the subgroup of patients with TTH and any sleep disorders, significantly more prominent indicators of the frequency, the intensity of TTH and its negative impact on the daily activity were revealed, compared to patients with TTH lacking sleep disorders. Conclusion. The results of the assessment of children and adolescents with TTH show that when planning preventive therapy for TTH and evaluating its results, not only main clinical characteristics of TTH should be taken into account, but also the manifestations and severity of comorbid disorders, including sleep disorders observed in most patients with TTH. The revealed prevalence of various sleep disorders in the subgroup of patients with chronic TTH confirms that sleep disorders and anxiety disorders refer to significant risk factors for the transition of TTH to a chronic form, and such patients need more active multimodal treatment.

Chronic musculoskeletal low back pain: comorbid disorders and therapy

Low back pain is one of the most common reasons for seeking medical attention. Musculoskeletal (nonspecific) pain is the most common (90%) cause of chronic pain. Depressive and anxiety disorders, sleep disorders, mainly in the form of insomnia, which negatively affect the course of the disease, are often encountered as comorbid disorders in patients with chronic musculoskeletal low back pain (CMLBP). When managing patients, it is effective to use an integrated approach: drug therapy, kinesitherapy and psychological methods. Kinesitherapy uses various types of exercise and walking; it is important that they are performed regularly under the supervision of a specialist, excluding excessive physical and static loads. Cognitive-behavioral therapy is the most effective psychological effect in CMLBP, which should be directed not only to pain, but also to insomnia, depression and anxiety disorders. Non-steroidal anti-inflammatory drugs (NSAIDs) are used as drugs for chronic pain. It is important to take into account the presence of risk factors, concomitant diseases, interactions with other drugs. The use of etoricoxib (Arcoxia) for chronic low back pain is discussed. The author presents his own experience in managing 71 patients (average age 55) with CMLBP using kinesitherapy, psychological methods, and NSAIDs. As a result of treatment after 3 months, a significant decrease in VAS was achieved from 8 (6-8) to 2 (0-4) points (p &lt; 0.0001), the depression decreased from 7 (5-9) to 4 (3-6) points in HADS (p = 0.002), the anxiety from 7 (5-10) to 5 (3-7) points in HADS (p = 0.0003), a decrease in disabilities according to the Oswestry question-naire from 46 (34-57.77) to 11.11 (4.44-26) percent (p &lt; 0.0001), increase in physical activity according to IPAQ-SF from 11 (7-16) to 23 (15-26 ) points (p = 0.0002), decrease insomnia according to ISI from 12 (7-15) to 6 (2-10) points (p &lt; 0.001), improvement in sleep quality according to PSQI from 9 (7-13) points up to 4 (2-9) points (p &lt; 0.001). The widespread introduction of complex treatment of patients with CMLBP is of great medical and social importance.

Структура коморбидных расстройств при тикозных гиперкинезах у детей

Purpose. To study the structure of comorbid disorders in children with tycotic hyperkinesis of the city of Tyumen. Materials and methods. We examined 103 children aged 5 to 14 years. Patients were divided into 2 groups: group 1 – local tics (n = 43), group 2 – common tics (n = 60). All patients received anticitotic therapy. Using various scales and questionnaires, an assessment of tic hyperkinesis, the level of anxiety, a study of the rational, emotional and behavioral components of the relationship between parents and a child, an investigation of the emotional sphere, and neuropsychological testing were carried out. Results. Manifestations of ticks contribute to various stressful situations, school adaptation stress. The tics are intensified by emotional overstrain, mental overwork, eye strain. A risk factor for the formation of tic hyperkinesis is family education by the type of symbiosis and hypersocialization. Comorbid disorders in patients with ticose hyperkinesis in most cases are represented by ADHD, anxiety, the prevalence of a combination of stress with pathological compensation, and the presence of a headache. The neuropsychological plan revealed impaired attention, auditory-speech and visual memory, and writing. Conclusion. Identified comorbid disorders in children with tic hyperkinesis significantly reduce the quality of life of patients, disrupts their social adaptation and require timely correction.

Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care.

ObjectivesDepression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care.Methods274 patients aged 18–77 were referred from four secondary psychiatric care clinics in Sweden during 2012–2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training.ResultsSCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001).ConclusionsImportant psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.

Clinical correlates of obsessive-compulsive disorder comorbidity in patients with schizophrenia.

Background/Aim:The primary aim of this study was to evaluate the clinical correlates of obsessive-compulsive disorder (OCD) comorbidity in patients with schizophrenia.Materials and Methods:This study included fifty schizophrenia patients with an existing OCD comorbidity and 200 schizophrenia patients who did not have an OCD diagnosis for a lifetime. The participants were administered Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions Severity Scale (CGI-S), Scale for the Assessment of Positive and Negative Symptoms (SAPS/SANS), Calgary Depression Scale for Schizophrenia (CDSS), Yale–Brown Obsessive Compulsive Scale, and Global Assessment of Functioning Scale.Results:Patients with OCD comorbidity had higher BPRS, SANS, and CGI-S scores compared to patients without OCD. In addition, patients with OCD showed worse functional impairment; however, sociodemographic variables, SAPS, CDSS, and insight scores did not show a significant difference depending on the presence of OCD. The present study also showed higher negative and depressive symptoms in patients with preexisting OCD compared to those manifesting OCD during the course of schizophrenia.Conclusions:In this study, patients with schizophrenia and OCD comorbidity showed different clinical features compared to those not showing an OCD presence for a lifetime. In this study, positive symptoms were not determinative in the differentiation of patients with and without OCD. It is important to assess OCD symptoms in patients with schizophrenia, and psychosocial therapies should be provided in patients with OCD to improve negative symptoms and functionality. Patients with preexisting OCD displayed more severe symptoms and seemed to require a different clinical approach in treatment.

Factors Associated with Depression among Heart Failure Patients at Cardiac Follow-Up Clinics in Northwest Ethiopia, 2017: A Cross-Sectional Study.

Background Depression is a comorbid disorder in patients with heart failure and it is a major public health problem worldwide. Little is known about the depression among heart failure patients in low-income countries, while, in Ethiopia, none was studied. Objective This study is to assess the prevalence of depression and associated factors among heart failure patients at cardiac follow-up clinics at Amhara Region Referral Hospitals, Northwest Ethiopia, 2017. Methods A hospital based cross-sectional study was conducted between March 30, 2017, and May 15, 2017, G.C., by using a systematic random sampling technique to select 422 of 1395 HF patients. Structured interviewer-administered questionnaires and patient card review with a checklist that incorporates the PHQ-9 tool for depression measurement were used. The collected data were checked, coded, and entered into Epi-info version 7 and exported to SPSS version 20. Bivariate logistic regression at p-value <0.2 was exported to multivariate logistic regressions and p-value <0.05 was considered statistically significant. Results A total of 403 were included with a response rate of 95.5%. Among the participants, 51.1% had depressive symptoms. Factors associated with depressive symptoms were poor self-care behavior 1.60 [AOR (95% CI=1.01, 2.55)], poor social support 1.90 [AOR (95% CI=1.16, 3.12)], being female 2.70 [AOR (95% CI=1.44, 5.07)], current smoking history 4.96 [AOR (95% CI=1.54, 15.98)], and duration of heart failure (>1 year) 1.64 [AOR (95% CI=1.04, 2.59)]. Conclusions Around half of the patients were depressive. The patients who had poor self-care behavior, were females, had poor social support, had a current history of smoking, and had duration of chronic heart failure >1 year need special attention. Therefore, all referral hospitals need efforts to focus on those problems and target improvements of depressive symptoms.

Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: Prevalence and predictors

BackgroundPatients with obsessive-compulsive disorder (OCD) often present with comorbidities, mainly anxiety and affective disorders, which may influence OCD course, help-seeking and treatment response. Some authors have studied bipolar disorder (BD) comorbidity in patients with OCD, but usually in small samples. The objective was to estimate the lifetime prevalence of BD in a large clinical sample of OCD patients, and to compare demographic and clinical features of patients with and without BD comorbidity. MethodThis cross-sectional study with 955 adult OCD patients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC) used several assessment instruments, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Beck Depression and Anxiety Inventories, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Descriptive and bivariate analyses were followed by logistic regression. ResultsThe lifetime prevalence of BD was 7.75% (N = 74). The variables that were independently associated with BD comorbidity were: panic disorder with agoraphobia, impulse control disorders, and suicide attempts. LimitationsThe cross-sectional design does not permit causal inferences; the external validity may be limited, as the participants were from tertiary services. Despite the large sample size, some analyses may have been underpowered due to the relatively low prevalence of the outcome and of some explanatory variables. ConclusionsPatients with OCD comorbid with BD have some clinical features indicative of greater severity, including higher suicide risk, and require a careful therapeutic approach for the appropriate treatment of both disorders.

Psychometric properties of the Polish version of the Hamilton Anxiety Rating Scale in patients with epilepsy with and without comorbid anxiety disorder

ObjectiveAnxiety disorders (ADs) are frequent comorbid disorder in patients with epilepsy (PWE). The availability of validated screening instruments to detect AD in PWE is limited. The aim of the present study was to validate the Polish version of the Hamilton Anxiety Rating Scale (HARS) in adult PWE for the detection of AD. MethodsA total of 96 outpatient PWE completed the self-report symptom scale, the HARS, and were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HARS. ResultsReceiver operating characteristic analyses showed areas under the curve at 81.2%. For diagnoses of AD, the HARS demonstrated the best psychometric properties for a cutoff score ≥17 with sensitivity of 68.8%, specificity of 87.5%, positive predictive value of 52.4%, and negative predictive value of 93.3%. ConclusionsThe Polish version of the HARS performed moderately well as a screening instrument for ADs in PWE. In the epilepsy setting, the HARS maintains moderate sensitivity, high specificity, and excellent Negative perdictive value (NPV) but low Positive perdictive value (PPV) for diagnosing ADs with an optimum cutoff score ≥17. These results suggest that the HARS performed better to rule out anxiety, however, because of moderate sensitivity, some cases of anxiety might be missed.

Psychometric properties and diagnostic utility of the State–Trait Anxiety Inventory in epilepsy with and without comorbid anxiety disorder

ObjectiveAnxiety disorders are frequent comorbid disorder in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate State–Trait Anxiety Inventory (STAI) in adult PWEs for the detection of anxiety disorders. MethodsA total of 96 outpatients with epilepsy completed the self-report symptom scale and were diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the State-Trait Anxiety Inventory State (STAI-S) and State-Trait Anxiety Inventory Trait (STAI-T) anxiety subscales. ResultsReceiver operating characteristic analyses for STAI-T showed area under the curve at 84.7%. For diagnoses of anxiety disorders, the STAI-T demonstrated the best psychometric properties for a cutoff score ≥ 52 with sensitivity of 81.3%, specificity of 77.5%, positive predictive value (PPV) of 41.9%, and negative predictive value (NPV) of 95.4%. ConclusionsThe STAI-T proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in PWEs. In the epilepsy setting, STAI-T maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥ 52.

Effect of adult attention-deficit hyperactivity on disability and quality of life of bipolar patients

Background Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disease, usually first diagnosed during childhood or adolescence. A significant portion (∼50–65%) of ADHD symptoms persist into adulthood. Adult ADHD and bipolar disorder (BD) are common comorbid psychiatric conditions. Comorbidity between BD and adult ADHD has been reported in both ADHD and BD cases.Aim To determine the effect of comorbid adult ADHD on disability and quality of life of patients with bipolar disorder.Patients and methods This is a cross-sectional study that was done at the Psychiatric Department in the Zagazig University Hospitals, Sharkia Governorate, Egypt, during the period from May to November, 2017. One hundred and two euthymic patients with Diagnostic and statistical manual of mental disorders, 4th ed. − text revision diagnosis of BD I were selected by simple random probability sampling from the patients with bipolar disorder who came for follow-up and to receive their medications from psychiatric outpatient clinic.Results The mean age of the participants ranged from 18 to 40 years, and 51% were female. Patients with bipolar disorder with adult ADHD had more disability in work, social life, and family life than patients with pure bipolar disorder. Moreover, patients with bipolar disorder without adult ADHD had significant better quality of life in all domains as reflected by higher scores in WHO quality-of-life scale than patients with adult ADHD.Conclusion Adult ADHD is a frequent comorbid disorder in patients with BD. Adult ADHD comorbidity negatively affects functioning and quality of life of patients with BD.

Validation of the Polish version of the Hospital Anxiety and Depression Scale for anxiety disorders in patients with epilepsy

ObjectiveAnxiety disorders are frequent comorbid disorders in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate the Polish version of the Hospital Anxiety and Depression Scale (HADS) in adult PWEs for the detection of anxiety disorders. MethodsA total of 96 outpatients with epilepsy completed the self-reported symptom scale, the HADS, and were diagnosed using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HADS anxiety subscale (HADS-A). ResultsReceiver operating characteristic analyses showed areas under the curve at 80.8%. For diagnoses of anxiety disorder, the HADS-A demonstrated the best psychometric properties for a cutoff score ≥10 with sensitivity of 81.3%, specificity of 70.0%, PPV of 31.5%, and NPV of 94.9%. ConclusionsThe HADS-A proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in our sample of PWEs. In the epilepsy setting, the HADS-A maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥10.