Effects Of Psychiatric Comorbidity Research Articles

Effects of Psychiatric Comorbidities on the Prognosis of New-Onset Pediatric Epilepsy: A Retrospective Nationwide Cohort Study.

Background/Objectives: To determine the impact of psychiatric disorders on epilepsy treatment outcomes and healthcare utilization in children with epilepsy (CWE) based on the presence or timing of the onset of psychiatric disorders. Methods: This retrospective controlled study enrolled children (age < 18 years) with newly diagnosed epilepsy into four groups stratified by the presence and timing of the onset of psychiatric disorders (None: no psychiatric disorders; Before: psychiatric disorders only preceding the epilepsy diagnosis; After: new psychiatric disorders diagnosed only after the epilepsy diagnosis; Mixed: different psychiatric disorders diagnosed both before and after epilepsy diagnosis) and compared the intergroup differences in epilepsy treatment outcomes and healthcare utilization. Results: Among the CWE (n = 37,678), 13,285 (35.26%) had comorbid psychiatric disorders. The After (n = 7892), Mixed (n = 3105), and Before (n = 2288) groups had significantly longer treatment periods than those in the None group (p < 0.001). Compared with the None group, the remaining groups had significantly higher frequencies of outpatient visits, emergency room visits, and admissions and higher rates of status epilepticus and drug-resistant epilepsy (p < 0.001, respectively), with higher odds ratios [95% confidence interval] for status epilepticus (2.92 [2.68-3.18]) and drug-resistant epilepsy (3.01 [2.85-3.17]) in the After group. Conclusions: Psychiatric comorbidities, diagnosed before and after epilepsy diagnosis, negatively affected the treatment outcomes. CWE without prior psychiatric disorders that were newly diagnosed during epilepsy treatment had the worst outcomes and the highest healthcare utilization rates.

Analysis of Time to Relapse among Schizophrenia Patients in St. Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

Objective: To investigate the associated factors that affect time to relapse in patients with schizophrenia at St. Amanuel Mental Specialized Hospital, with recurrent events model.Material and Methods: A hospital-based retrospective review of the medical records of 332 patient with schizophrenia, covering a two-year period, were examined. Parametric frailty models were used to determine the correlation between discharge times and relapse, and to identify risk factors using R-software. Results: The distribution number of relapses was 162, and the median survival time of patients with schizophrenia was 665 days. The unobserved heterogeneity in patients and correlation between relapses, as estimated by the Weibull-gamma frailty model, was p-value≤0.001 and Kendall’s Tau (Γ)=0.498. This indicated that there was heterogeneity among participants and a correlation between relapses. The final model showed that the effect of psychiatric comorbidity (hazard ratio (HR)=6.522, p-value≤0.001), employment status (HR=5.334, p-value=0.001), history of suicide attempt (HR=2.167, p-value=0.003) and history of traditional treatment (HR=1.973262, p-value=0.021) had a significant effect on the hazard time to relapse. Onset Age of schizophrenia and drug adherence were not predictive. Subsequent relapses are likely dependent on both the first and previous relapses.Conclusion: Comorbidity, employment status, history of suicide attempt and history of traditional treatment are imperative risk factors influencing the hazard of time to relapse, which increases the risk of relapse.

Psychiatric disorders during pregnancy in asymptomatic and mildly symptomatic SARS-CoV-2 positive women: Prevalence and effect on outcome

The effect of psychiatric comorbidity on pregnancy outcome among SARS-CoV-2 positive women with asymptomatic and mildly symptomatic infections remains largely unknown. We reviewed the electronic medical records of all pregnant women who received care at Mayo Health System and tested positive for SARS-CoV-2 (RT-PCR) from March 2020 through October 2021. Among 789 patients, 34.2% (n = 270) had psychiatric comorbidity. Of those with psychiatric comrobidity, 62.2% (n = 168) had depression prior to pregnancy, and 5.2% (n = 14) reported new-onset depression during pregnancy. Before pregnancy, 65.6% (n = 177) had anxiety, and 4.4% (n = 12) developed anxiety during pregnancy Thirteen percent of SARS-CoV-2 positive pregnant women (n = 108) received psychotropic medication during pregnancy. In addition, 6.7% (n = 18) and 10.7% (n = 29) of pregnant women with psychiatric comorbidity had documented nicotine, cannabis and/ or illicit substance use during and prior to pregnancy, respectively. We depicted a significantly higher risk for cesarean delivery [35.6% vs. 24.9%) in asymptomatic and mildly symptomatic SARS-CoV-2 positive pregnant women with psychiatric comorbidity. In conclusion, the prevalence rates of depression, anxiety, and prescribed antidepressant medications during pregnancy among asymptomatic and mildly symptomatic SARS-CoV-2 infected women were substantially higher than average, which negatively impacted pregnancy and neonatal outcomes.

Effects of psychiatric comorbidities in persons with epilepsy on recurrent emergency department visits

BackgroundCoexisting mental health disorders in persons with epilepsy present as substantial burdens to patients and healthcare systems. Study design and methodsIn this retrospective study, we reviewed 160 patients presenting to a safety net hospital Emergency Department (ED) with seizures to investigate whether differences in clinical workup, follow-ups, and ED visit recurrence existed between epilepsy patients with epilepsy with and without a coexisting psychiatric disorder. ResultsPatients with epilepsy with a psychiatric comorbidity had more subsequent ED visits (45 % vs 26 %, p = 0.01) and fewer outpatient follow-up opportunities (74 % vs 87 %, p = 0.042) compared to patients with epilepsy without psychiatric comorbidities, highlighting a healthcare gap that needs to be addressed. InterpretationOur findings suggest a need for ED providers to shift their clinical practice in favor of offering more outpatient follow-up opportunities, to ensure long-term management of seizures in patients with epilepsy with comorbid psychiatric disorders.

The Effect of Psychiatric Comorbidity on Healthcare Utilization for Youth With Newly Diagnosed Systemic Lupus Erythematosus.

To examine the effect of psychiatric diagnoses on healthcare use in youth with systemic lupus erythematosus (SLE) during their first year of SLE care. We conducted a retrospective cohort study using claims from 2000 to 2013 from Clinformatics Data Mart (OptumInsight). Youth aged 10 years to 24 years with an incident diagnosis of SLE (≥ 3 International Classification of Diseases, 9th revision, codes for SLE 710.0, > 30 days apart) were categorized as having: (1) a preceding psychiatric diagnosis in the year before SLE diagnosis, (2) an incident psychiatric diagnosis in the year after SLE diagnosis, or (3) no psychiatric diagnosis. We compared ambulatory, emergency, and inpatient visits in the year after SLE diagnosis, stratified by nonpsychiatric and psychiatric visits. We examined the effect of childhood-onset vs adult-onset SLE by testing for an interaction between age and psychiatric exposure on outcome. We identified 650 youth with an incident diagnosis of SLE, of which 122 (19%) had a preceding psychiatric diagnosis and 105 (16%) had an incident psychiatric diagnosis. Compared with those without a psychiatric diagnosis, youth with SLE and a preceding or incident psychiatric diagnosis had more healthcare use across both ambulatory and emergency settings for both nonpsychiatric and psychiatric-related care. These associations were minimally affected by age at time of SLE diagnosis. Psychiatric comorbidity is common among youth with newly diagnosed SLE and is associated with greater healthcare use. Interventions to address preceding and incident psychiatric comorbidity may decrease healthcare burden for youth with SLE.

P81. Effect of psychiatric comorbidities on outcomes following anterior cervical discectomy and fusion

<h3>BACKGROUND CONTEXT</h3> The incidence and prevalence of psychiatric disorders is increasing both domestically and internationally. Numerous studies have linked psychiatric comorbidities to increased health risks, poor treatment outcomes and higher use of health care resources. <h3>PURPOSE</h3> To assess the relationship between psychiatric comorbidities and medication use with outcomes following anterior cervical discectomy and fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective chart review of all patients undergoing anterior cervical discectomy and fusion over the course of 8 months at a local community hospital. <h3>PATIENT SAMPLE</h3> A total of 79 patients underwent anterior cervical discectomy and fusion. The mean age was 55.7 years. <h3>OUTCOME MEASURES</h3> Length of stay, disposition. <h3>METHODS</h3> Seventy-nine patient charts were reviewed retrospectively over the course of 8 months at Monmouth Medical Center. The procedure as well as age were recorded. DSM-V psychiatric diagnoses were noted in the patients' problem list or admission diagnoses. Psychiatric medications from the admission medical reconciliation were recorded. Lastly, disposition was noted (rehabilitation facility versus home) for each patient. <h3>RESULTS</h3> Of the 79 patients included in this study, 31 had a diagnosed DSM-V psychiatric disorder. Of the patients with psychiatric diagnoses, 15 had anxiety, 11 had depression, 1 had bipolar disorder, 1 had obsessive compulsive disorder, 4 with both anxiety and depression and 1 had diagnosed with anxiety and bipolar disorder. The average length of stay for all patients was 1.4 +/- 1.0 days. For those with depression, the average length of stay was 1.5 +/- 0.9 days. In patients with anxiety, the average length of stay was 1.6 +/- 1.5 days. Lastly in patients with bipolar disorder, the average length of stay was 3 +/- 0 days. When compared to patients without psychiatric diagnoses, the difference in length of stay was statisically significant only for patients with bipolar disorder (p = .000408). In addition, patients with psychiatric diagnoses had a higher rate of nonroutine disposition compared to those without psychiatric diagnoses (OR 15.9, p 0.0471). Lastly, the difference in length of stay in patients taking psychoactive medications (1.7 +/-1.4 days) versus those that did not (1.23 +/- 0.6 days) was statistically significant (p 0.021523). <h3>CONCLUSIONS</h3> Patients with bipolar disorder and those that take psychiatric medications may be at risk for increased length of stay following anterior cervical discectomy and fusion. Additionally, patients with psychiatric diagnoses are at a higher risk for discharge to a rehabilitation facility compared to home. Patients undergoing anterior cervical discectomy and fusion may benefit from presurgical screening for psychiatric comorbidities. This may lead to improved patient expectations regarding discharge and a better understanding of outcomes in this population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

PO-1504 The effect of psychiatric comorbidities on treatment decisions for - and survival after radiotherapy

PO-1504 The effect of psychiatric comorbidities on treatment decisions for - and survival after radiotherapy

Clinical Course of Migraine during Strict Quarantine due to SARS-CoV-2: Effect of Psychiatric Comorbidities in a Clinical Cohort

Objective: During the SARS-CoV-2 pandemic, there has been a significant increase in the prevalence of anxiety and depression. This study sought to establish the probability of migraine progression by comparing data from week 0 with week 12 of quarantine. Methods: A retrospective cohort study. Three hundred ten patients were included, 238 with episodic migraine and 33 with chronic migraine; they all completed a self-administered questionnaire with demographic, clinical, and psychiatric symptom information. A multivariate statistical analysis was conducted to identify factors associated with the progression of migraine. Results: This study demonstrated a 22.5% progression probability from episodic migraine to chronic migraine with an RR 2.7 and CI (1.92–3.95, p < 0.001). The increase in depression scores (p < 0.005), anxiety (p < 0.001), and alteration in sleep quality (p < 0.003) were associated with the worsening of migraine. Conclusion: During the SARS-CoV-2 pandemic, depression, anxiety, and the deterioration of sleep quality influenced the probability of progression from episodic migraine to chronic migraine.

Chronic Migraine Preventive Treatment by Prefrontal-Occipital Transcranial Direct Current Stimulation (tDCS): A Proof-of-Concept Study on the Effect of Psychiatric Comorbidities.

Chronic migraine (CM) is often complicated by medication overuse headache (MOH) and psychiatric comorbidities that may influence the clinical outcome. This study aimed to investigate the relationship between psychiatric comorbidities and the effect of transcranial direct current stimulation (tDCS) in patients with CM with or without MOH. We recruited 16 consecutive CM patients who had an unsatisfactory response to at least three pharmacological preventive therapies. They were treated with anodal right-prefrontal and cathodal occipital tDCS (intensity: 2 mA, time: 20 min) three times per week for 4 weeks. All patients underwent a psychopathological assessment before and after treatment, and five of them were diagnosed with bipolar disorder (BD). After treatment, all the patients showed a significant decrease of severe and overall headache days per month. Despite having a higher migraine burden at baseline, patients with CM and BD showed a significantly greater reduction of severe headaches and psychiatric symptoms. Overall, tDCS seems to be effective in the treatment of CM patients with a poor response to different classes of pharmacological therapies, whereas BD status positively influences the response of migraineurs to tDCS.

The Effects of Psychiatric Co-Morbidity on Recurrent Emergency Department (ED) Visits in Patients with Epileptic Seizures – Experience from a Single County Hospital (1645)

The Effects of Psychiatric Co-Morbidity on Recurrent Emergency Department (ED) Visits in Patients with Epileptic Seizures – Experience from a Single County Hospital (1645)

Effect of psychiatric co-morbidity on adherence to anti tubercular treatment: a cross sectional study from North India

Background: Study explores relationship between depressive disorder and adherence to DOTS (Directly Observed Therapy Short Course) and whether treatment of depressive disorder according to severity of depressive disorder should be an option to improve adherence to DOTS.Methods: Study included 182 newly diagnosed adult cases of tuberculosis who were on anti- tuberculosis therapy (ATT) as per program guidelines and were in third month under DOTS category I and category II therapy. Patients were screened for depressive and anxiety disorder using PHQ-9 and GAD-7. Modified ACTG baseline questionnaire was used to collect data about adherence and reasons for partial adherence.Results: Overall prevalence of depressive disorder amongst participants was found to be 37.9% and that of partial adherence (missed two or more than two doses) was 12.1%. Partial adherence was mostly seen in the first month, followed by third and second month of DOTS. Twenty- two percent patients with depressive disorder were partially adherent to ATT. Odds ratio suggests higher risk being partially adherent to ATT were greater in the participants who had depressive disorder.Conclusions: This study highlights the benefit of screening patients while diagnosing tuberculosis patients for depressive disorder, to improve disease outcome and reduce likelihood of MDR-TB.

The Effect of Psychiatric Comorbidities on Headache-Related Disability in Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.

ObjectiveTo examine the influences of depression and anxiety on headache‐related disability in people with episodic migraine or chronic migraine.BackgroundDepression and anxiety are common comorbidities in people with migraine, especially among those with chronic migraine.MethodsThis cross‐sectional analysis of data from the longitudinal, internet‐based Chronic Migraine Epidemiology and Outcomes Study assessed sociodemographic and headache features, and headache‐related disability (Migraine Disability Assessment Scale). Four groups were defined based on scores from validated screeners for depression (9‐item Patient Health Questionnaire) and anxiety (7‐item Generalized Anxiety Disorder Scale): depression alone, anxiety alone, both, or neither.ResultsRespondents (N = 16,788) were predominantly women (74.4% [12,494/16,788]) and white (84.0% [14,044/16,788]); mean age was 41 years. Depression was more likely in persons with chronic migraine vs episodic migraine (56.6% [836/1476] vs 30.0% [4589/15,312]; P < .001), as were anxiety (48.4% [715/1476] vs 28.1% 4307/15,312]; P < .001) and coexisting depression and anxiety (42.0% [620/1476] vs 20.8% [3192/15,312]; P < .001). After controlling for headache frequency and other covariates, depression alone, and anxiety alone were associated with 56.0% (rate ratio [RR], 1.56; 95% confidence interval [CI], 1.46‐1.66) and 39.0% (RR, 1.39; 95% CI, 1.30‐1.50) increased risks of moderate/severe migraine‐related disability (both P < .001), respectively; the combination had an even greater effect on risk of moderate/severe disability (79.0% increase; RR, 1.79; 95% CI, 1.71‐1.87; P < .001).ConclusionsDepression alone and anxiety alone are associated with greater headache‐related disability after controlling for sociodemographic and headache features. Coexisting depression and anxiety are more strongly associated with disability than either comorbidity in isolation. Interventions targeting depression and anxiety as well as migraine itself may improve headache‐related disability in people with migraine.

Developmental stuttering and comorbid psychiatric disorders in school age children

Objective: Previous researchs suggested that psychiatric problems and stuttering may be associated with common neurophysiological reasons or because of the social and psychological difficulties caused by stuttering. The aim of this study was to evaluate comorbid psychiatric disorders in school age children with stuttering and to compare stuttering patients with and without psychiatric comorbidity in terms of age, gender and stuttering severity. Methods: This is a cross-sectional, retrospective study and the study was conducted with 89 children aged 6-12 years who were diagnosed as stuttering. Diagnosis of developmental stuttering was established by child psychiatrists based on DSM 5 childhood-onset speech fluency disorder (stuttering) diagnostic criteria. The Clinical Global Impression Scale was used to assess the severity of stuttering. The psychiatric evaluation of the participants was conducted with Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Results: The rate of comorbid psychiatric disorders in school-aged children with stuttering was 51.7%. The comorbid psychiatric disorders were attention deficit and hyperactivity disorder (30.3%), social anxiety disorder (12.4%) and specific learning disorder (4.5%). The participants were divided into two groups according to the presence or absence of psychiatric comorbidity and compared in terms of age, gender and stuttering severity. The results showed that psychiatric comorbidity was significantly higher in boys (56%) than girls (23%), and the mean age of those with psychiatric comorbidity (8.06) was significantly higher than those without psychiatric comorbidity (7.16). There was no significant difference between the groups in terms of stuttering severity. Discussion: The results of this study revealed that one of two children in school age children with stuttering had a comorbid psychiatric disorder. Considering the literature data emphasizing the negative effects of psychiatric comorbidity in stuttering especially on stuttering treatment, we think that determination of psychiatric comorbidity and interventions will provide important benefits for both professionals and patients.

A399 The Effect of Psychiatric Comorbidities in Patients Undergoing Bariatric Surgery

A399 The Effect of Psychiatric Comorbidities in Patients Undergoing Bariatric Surgery

Neurocognitive Characteristics of Individuals with Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a systems-based brain-gut axis disorder. Cognitive functions reflect central affective and attentional processes that are driven by genetic and epigenetic influences and effect complex brain-gut interactions. These interactions include stress-induced changes in hypothalamic-pituitary-adrenal axis and autonomic nervous system, remodelling of the immune system, and alterations in microbiota composition. This review summarises current neurocognitive findings on patients with IBS. 13 studies of neurocognition in IBS patients were identified from PubMed, Ovid MEDLINE, EMBASE, and PsycINFO. The methodology and relevant findings were systematically analysed. There are alterations in both hot and cold cognitions in IBS patients. Consistently, attentional bias towards negative emotionally valenced and gastrointestinal symptom-related stimuli is found in hot cognition tasks, with other cold cognition differences including frontal executive dysfunction and stress-related hippocampal-mediated cognitive alterations. The effect of psychiatric comorbidity on a disorder level, as well as illness chronicity, on cognitive alterations requires further examination. Attentional bias and executive dysfunction in IBS gave support to its neural network alterations accounting for visceral hypersensitivity. Further prospective neuropsychological studies should examine the effect of chronicity, current symptom severity, and psychiatric comorbidity on the cognition in different IBS subtypes.

Effect of Psychiatric Comorbidities on In-Hospital Outcomes and Cost for Cervical Spondylotic Myelopathy

The present study examined the differences in outcomes of cervical spinal surgery for patients with and without a major psychiatric comorbidity using the Healthcare Cost and Utilization Project National Inpatient Sample database. Data were queried from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2013 to 2014 for hospitalizations with a major psychiatric comorbidity and a diagnosis of cervical spondylotic myelopathy treated by an appropriate surgical procedure. The included psychiatric comorbidities were schizophrenia, episodic mood disorders (bipolar I and II disorders), delusional disorders, and psychoses not otherwise specified. Univariate and multivariate regression analyses were performed to determine the differences in outcomes between patients with and without a major psychiatric comorbidity. A total of 18,335 hospitalizations met the inclusion criteria, of which 648 (3.5%) included a major psychiatric comorbidity. Multivariate regression analysis demonstrated that psychiatric comorbidity was an independent predictor of non-home discharge (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.43-2.30; P < 0.0001) and a longer hospital stay (+0.52 day; 95% CI, 0.43-0.61; P < 0.0001) but was not an independent predictor of overall complications (OR, 0.79; 95% CI, 0.58-1.07; P= 0.13) or total hospital charges ($1992; 95% CI,-$917-$4902; P=0.18). Psychiatric comorbidity was associated with an increased risk of non-home discharge and a longer length of stay for patients undergoing surgical intervention for cervical myelopathy. However, we did not find an associated increased risk of in-hospital mortality, complications, or total hospital charges. Psychiatric comorbidity should not be weighed against patients who require surgical treatment for cervical spondylotic myelopathy, and special attention should be given to postoperative care and discharge planning for this unique patient population.

The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis.

Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.

Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study.

BackgroundImmune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood.ObjectiveThe objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants.MethodsBetween November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations.ResultsThe final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001).ConclusionsThis paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.

Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity

The purpose of this study was to investigate whether CFS patients without comorbid psychiatric diagnoses differ from CFS patients with comorbid psychiatric diagnoses and healthy control subjects in neuropsychological performance, the proportion with elevated spinal fluid protein or white cell counts, cerebral blood flow (CBF), brain ventricular lactate and cortical glutathione (GSH). The results of the study did not show any differences in any of the outcome measures between CFS patients with and without psychiatric comorbidity, thus indicating that psychiatric status may not be an exacerbating factor in CFS. Importantly, significant differences were found between the pooled samples of CFS compared to controls. These included lower GSH and CBF and higher ventricular lactate and rates of spinal fluid abnormalities in CFS patients compared to healthy controls. Thirteen of 26 patients had abnormal values on two or more of these 4 brain-related variables. These findings, which replicate the results of several of our prior studies, support the presence of a number of neurobiological and spinal fluid abnormalities in CFS. These results will lead to further investigation into objective biomarkers of the disorder to advance the understanding of CFS.

Protocol for Psychopharmacologic Management of Behavioral Health Comorbidity in Adult Patients with Diabetes and Soft Tissue Infections in a Tertiary Care Hospital Setting.

To provide information about the effect of psychiatric comorbidities on wound healing in patients with diabetes mellitus (DM). This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Discuss the connection between DM and the development of psychiatric comorbidities.2. Identify the drugs recommended in the treatment of these psychiatric comorbidities.3. List cautions and contraindications related to the drugs discussed. In patients with diabetes mellitus type 2, psychiatric comorbidities such as depressive and anxiety disorders are 60% or more prevalent than in the general population. The severity of mental illness and the duration of diabetes have been shown to correlate with worsening glycemic control, thus impeding wound healing. A retrospective chart review was conducted in all patients with diabetes mellitus admitted to the wound service with prior or current psychiatric symptoms of anxiety, depression, or cognitive impairment. A psychopharmacologic protocol was developed based on the clinical data collected and treatment parameters used by the behavioral health consultation liaison service.