Effects Of Psychiatric Comorbidity Research Articles

Psychiatric comorbidity effects on compensatory cognitive training outcomes for veterans with traumatic brain injuries.

To investigate the influence of posttraumatic stress disorder (PTSD) diagnosis, and PTSD and depression severity, on the postconcussive symptom trajectory over the course of a 1-year study period. Secondary analysis of a randomized controlled trial comparing veterans who received supported employment combined with compensatory cognitive training to those who received supported employment only. Assessments were conducted at baseline, 3- (postintervention), 6-, and 12-months. Participants were 50 Operation Enduring and Iraqi Freedom (OEF/OIF) veterans with a history of mild to moderate traumatic brain injury (TBI) who were unemployed, seeking work, and who had neuropsychological impairment. Of all participants, 74% met diagnostic criteria for PTSD. All participants received supported employment and half of the sample also received Cognitive Symptom Management and Rehabilitation Therapy (CogSMART), a 12-session, manualized compensatory cognitive training intervention. Veterans with PTSD and greater depression severity endorsed significantly more severe postconcussive symptomatology at all assessment time points. However, the rate of CogSMART-associated improvement in postconcussive symptoms did not differ as a result of psychiatric symptomatology. Study results suggest that for veterans with a history of mild to moderate TBI, presence of comorbid PTSD or depressive symptoms should not preclude participation in cognitive rehabilitation interventions.

OR03-4 * PSYCHIATRIC COMORBIDITY AND EXCESS ALL-CAUSE AND CAUSE-SPECIFIC MORTALITY IN OPIOID ADDICTS

Introduction. The challenge of personalised medicine is to identify components of addiction that are relevant to an individual in a way that treatment and drug overdose preventions can be tailored. Opioid misusers continue to have recognised extremely high mortality but the influence of psychiatric comorbidity in excess all-cause and cause-specific mortality is questionable. Methods. Opioid-dependent (OD) patients were identified in London-based patient register, which contains records on over 220,000 cases linked to national mortality tracing. We used Cox regression to model the effect of psychiatric co-morbidity on mortality, controlling for a broad range of potential confounders. Results. We identified 4837 OD patients with 176 deaths. The presence of comorbid personality disorder (PD) and alcohol use disorder (AUD) was found to be associated with increased all-cause mortality in all models, including the fully adjusted model. AUD was associated with two-fold increased risk of fatal overdose and seven-fold risk for liver-related deaths. Individuals with OUD and comorbid PD had almost four-times greater risk of liver related deaths compared to those without PD. Conclusions. The study highlights the importance of assessment for PD and alcohol misuse among opioid addicts in order to identify individuals at substantially elevated mortality risk for a more personalised approach to their medical care. This research is part of a larger project, which focusses on electronic-based personalised medicine in drug addiction. The complete research plan as well as research October '14 research update will also be provided.

PRESCRIBING PRACTICES IN ADULTS WITH TOURETTE SYNDROME

ObjectiveTourette syndrome (TS) is a developmental condition characterised by tics and associated with other psychiatric diagnoses, in particular obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Despite the availability of...

Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery

To evaluate the effects of a postsurgical rehabilitation program on employment status 2 years after temporal lobe epilepsy surgery in relation to other predictors. Employment outcome 2 years after temporal lobe resection in a group of 232 adult patients with the offer of a 3-week inpatient rehabilitation program immediately after surgery ("Reha group") was compared to a group of 119 patients who had surgery before such a rehabilitation program existed. One hundred thirty-nine (59.9%) of the Reha group patients attended the rehabilitation program. Further predictors for employment outcome were analyzed using multivariate logistic regression analysis. Preoperatively, the groups did not differ significantly in variables relevant for employment, including employment rate. Two years after surgery, the rate of those not being employed had decreased in the Reha group from 38.4% to 27.6% (p < 0.001, McNemar test), and slightly increased in the control group (37.8-42.0%; n.s.), resulting in a difference of 14.4% in favor of the Reha group (p = 0.008). General unemployment rates during the two observation periods were similar. In addition to the offer of rehabilitation support ("Reha group") and preoperative employment, the following other variables were shown as significant predictors of employment post surgery in multivariate regression analysis: seizure outcome, diagnosis of a personality disorder preoperatively, and age at surgery (all, p < 0.01; Nagelkerkes R(2) = 0.59). Independently from other factors, a 3-week inpatient rehabilitation program after temporal lobe epilepsy surgery seems to improve employment status 2 years after surgery.

Anxiety and depression seem less common in patients with autoreactive chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is a common and disabling skin disease which is often associated with psychiatric comorbidities such as anxiety and depression. These conditions are widely thought to cause, drive and/or maintain CSU, and have been reported as making an important contribution to the low quality of life in patients with CSU. Almost half of all patients with CSU have autoreactive CSU which can be readily diagnosed by the autologous serum skin test. The prevalence and effects of psychiatric comorbidities in this important subgroup are largely unknown. We carried out a study on two groups of patients with CSU, and found that the anxiety and depression scores were lower in patients with autoreactive CSU than in those with nonautoreactive CSU, the first such finding, to our knowledge. In addition, we found that patients with autoreactive CSU were less likely to have Hospital Anxiety and Depression Scale scores indicative for anxiety or depression compared with patients with nonautoreactive CSU. Our results support the view that autoreactive CSU represents a distinct CSU subgroup with a different disease pattern and a lower rate of psychiatric comorbidities.

P.3.006 Effect of psychiatric co-morbidity and the method of insulin therapy on metabolic control in children with type 1 diabetes

P.3.006 Effect of psychiatric co-morbidity and the method of insulin therapy on metabolic control in children with type 1 diabetes

Commentary: Toward a unified model for investigating health service use in degenerative spinal disorders

Commentary on Konnopka A, Heinrich S, Zieger M, et al. Effects of psychiatric comorbidity on costs in patients undergoing disc surgery: a cross-sectional study. Spine J 2011;11:601–609 (in this issue) .

Effects of Psychiatric Comorbidity on Treatment Outcome in Patients Undergoing Diamorphine or Methadone Maintenance Treatment

Background: Comorbid psychiatric disorders among opioid-dependent patients are associated with several negative outcome factors. However, outcomes of maintenance treatment have not been sufficiently established, and no evidence is available with respect to heroin-assisted treatment (HAT). Methods: For patients in the German heroin trial outcome measures were analyzed for HAT versus methadone maintenance treatment (MMT) both for patients with and without a comorbid diagnosis according to CIDI. Results: 47.2% of the sample had at least one comorbid psychiatric diagnosis, mainly neurotic, stress-related or somatoform (F4) or affective (F3) disorders. HAT had a better outcome than MMT concerning improvement of health and reduction of illicit drug use in both comorbid and non-comorbid patients, but weaker effects were found in the comorbid group. Conclusions:The better outcome of HAT also in comorbid patients suggests that psychiatric comorbidity should be an inclusion criterion for HAT. The weaker advantage of HAT may be due to pharmacological or methodological reasons.

A multiplicity of approaches to characterize geriatric depression and its outcomes

Research in geriatric depression has always had a multidisciplinary bent, particularly in methods used to characterize depression. Understanding diagnosis, psychiatric comorbidities, and course continues to be a goal of clinical researchers. Those interested in cognitive neuroscience and basic neuroscience have more recently trained their sights on late-life depression. This review identifies recent progress in the characterization of geriatric depression using a variety of methodologies. Depression in the elderly remains underdetected and underdiagnosed, particularly in nonmental health settings. Studies of the impact of psychiatric comorbidities and of the negative outcomes of depression in older adults demonstrate that geriatric depression is a serious medical condition that not only affects mood but can also lead to functional and cognitive decline. Advances in neuroimaging technology have demonstrated structural and functional changes in the brains of older depressed patients. With the advent of brain banks in neuropsychiatry, we are now seeing postmortem neuroanatomical studies that seek to extend findings from clinical practice and from neuroimaging research. Clinicians should become more aware of advances in detection of depression, the effect of psychiatric comorbidities, the poor mood and cognitive outcomes associated with late-life depression and should keep abreast of recent neuroimaging and neuroanatomical findings.

Challenges and Opportunities in the Treatment of Adolescents with Substance Use Disorder and Suicidal Behavior

Many youth who present for substance abuse treatment report co-occurring sui-cidality. Therefore, it is important to learn about the characteristics of this population and effective treatment strategies. The purpose of this paper is to provide an overview of some of the key issues that arise when treating youth with substance abuse and co-occurring suicidality and to offer recommendations on how to approach these areas. Specifically, we discuss the potential utility of an integrated approach to treatment, and provide an overview of the characteristics of this treatment population, motivational and treatment engagement issues, the clinical management of suicidality in the context of treatment, and the effect of psychiatric comorbidity on treatment needs. We then discuss school, family, and peer issues that may arise as well as special considerations for the use of urine drug screens with this population. We conclude with recommendations for future treatment development research in this very important area.

Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity

Depression is highly co-morbid with both psychiatric and chronic somatic disease. These types of co-morbidity have been shown to exert opposite effects on underdiagnosis of depression by general practitioners (GPs). However, past research has not addressed their combined effect on underdiagnosis of depression. Co-morbidity data on 191 depressed primary-care patients selected by a two-stage sampling procedure were analysed. Diagnoses of major depression and/or dysthymia in the last 12 months were assessed using a standardized psychiatric interview (CIDI) and compared with depression diagnoses registered by GPs in patient contacts during the same period. Presence of psychiatric and chronic somatic co-morbidity was determined using the CIDI and contact registration, respectively. Regression analysis showed a significant interaction effect between psychiatric and chronic somatic co-morbidity on GPs' diagnosis of depression, while taking into account the effects of sociodemographic variables, depression severity and number of GP contacts. Subsequent stratified analysis revealed that in patients without chronic somatic co-morbidity, a lower educational level, a less severe depression, and fewer GP contacts all significantly increased the likelihood of not being diagnosed as depressed. In contrast, in patients with chronic somatic co-morbidity, only having no psychiatric co-morbidity significantly decreased the likelihood of receiving a depression diagnosis. Our results indicate that the effects of psychiatric co-morbidity and other factors on underdiagnosis of depression by GPs differ between depressed patients with and without chronic somatic co-morbidity. Efforts to improve depression diagnosis by GPs seem to require different strategies for depressed patients with and without chronic somatic co-morbidity.

Psychiatric comorbidity in medical inpatients - prevalence and effect on the length of stay

In the course of a year the prevalence of psychiatric comorbidity as well as the effect of psychiatric comorbidity on the length of stay on two internal medical wards we investigated. When examined by separate methods, the prevalence of psychiatric comorbidity reached 36 % (ICD-10 diagnosis) in a sample of 511 medical inpatients of a university hospital. The study shows that patients with psychiatric comorbidity have a significantly longer length of stay - up to 8.2 days compared with inpatients with mere internal diagnosis. This association was not influenced by the length and the severity of the illness. The findings lead to the conclusion that psychiatric comorbidity is a central contributor to one of the most important factors of medical costs - the length of stay.

Pharmacologic Treatment of Generalized Anxiety Disorder

GAD is a severe, chronic, and distressing illness that often requires long-term management. Considerable progress has been made in the ability to help these patients. New antidepressants, such as venlafaxine, and the SSRIs provide an important treatment alternative to "traditional" anxiollytic treatments, which include the benzodiazepines, buspirone, and the TCAs; however, comparative efficacy and the effects of psychiatric comorbidity, long-term treatment, and relapse prevention are areas requiring further investigation.

Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder.

The effect of comorbid reading or arithmetic learning disabilities (LDs) on neuropsychological function in attention-deficit/hyperactivity disorder (ADHD) was studied. Participants were young males diagnosed with ADHD, with and without LD, and non-ADHD, non-LD male controls of similar age. LD was defined by combined regression-based and low-achievement classifications. Analyses adjusted for the effect of psychiatric comorbidity, age, and socioeconomic status on neuropsychological function. Children who had both ADHD and LD were significantly more impaired on both executive and nonexecutive functions than ADHD children without LD. Neuropsychological performance was most impaired in ADHD with combined arithmetic and reading disability. These data indicate that comorbid LD, especially arithmetic disability, significantly increases the severity of executive function impairment in ADHD.

The effects of psychiatric comorbidity on response to an HIV prevention intervention

Drug abusers with psychiatric comorbidity are at high risk for becoming exposed to HIV. To address this compelling public health issue, our randomized HIV prevention study compares the effectiveness of the NIDA standard HIV testing and counseling protocol to a four session, peer-delivered, educational intervention for out-of-treatment cocaine users with and without antisocial personality disorder (ASPD) and major depression. Among the 966 out-of-treatment cocaine users who have completed the 3 month follow-up, all groups, regardless of assignment to standard vs. peer-delivered intervention or psychiatric status, improved significantly in: crack cocaine use, injection drug use, number of IDU sex partners and overall number of sex partners, but not in condom use. Nevertheless, when stratified by psychiatric status, ASPD was associated with significantly less improvement in crack cocaine use ( P=0.04) and with a trend for less improvement in having multiple sex partners and having IDU sex partners ( P=0.06 and 0.08, respectively). ASPD status was not associated with change in injection drug use or condom use. Depression was associated with a trend ( P=0.07) for greater improvement in crack cocaine use but not in any of the other behaviors. When examining the standard and peer intervention groups separately, no consistent differences in the association of psychiatric comorbidity with outcome were discerned between the two groups. We conclude that persons with ASPD and depression respond well to standard HIV prevention interventions, but these psychiatric disorders respectively attenuate and enhance response somewhat. Behavioral interventions tailored for persons with these conditions may be indicated if long-term change in HIV risk behaviors is to be achieved.

Psychological and Behavioral Factors Affecting Medical Conditions and DSM-IV: An Overview

As part of the process of reevaluating the category Psychological Factors Affecting Physical Condition (PFAPC) for possible revisions in DSM-IV, a coordinated review of the literature was conducted to document the extent of empirical evidence that exists for an association between psychological factors affecting the onset, exacerbation, course, and outcome of medical disorders. In this introduction and overview, the authors discuss the methodology and purpose of the reviews, as well as the reasons for considering revisions in the PFAPC category. Relevant historical concepts in psychosomatic medicine are briefly reviewed, and an argument is made that the general scope of the PFAPC category should be broadened in DSM-IV to include behaviorally related factors of major public health concern, as well as the effects of psychiatric comorbidity on medical outcome.