Epidemiologic Catchment Area Research Articles

TBI Associated With Increased Risk for Suicide, Study Finds

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessTBI Associated With Increased Risk for Suicide, Study FindsRichard KarelRichard KarelSearch for more papers by this authorPublished Online:19 Oct 2018https://doi.org/10.1176/appi.pn.2018.10a1AbstractClinicians are advised to ask patients about their history of head injuries.A Danish retrospective study of more than 34,000 people who died from suicide found that the suicide rate was nearly double among those diagnosed with traumatic brain injury (TBI) compared with those without a TBI diagnosis.iStock/majoroslThe study was conducted by psychiatric epidemiologist Trine Madsen, Ph.D., and colleagues including psychiatrist Michael Benros, M.D., Ph.D. The authors are affiliated with the Danish Research Institute of Suicide Prevention and Copenhagen University Hospital in Denmark. Benros is a senior researcher and clinician with expertise in psychiatric epidemiology.In total, the researchers assessed data on more than 7.4 million people aged 10 and older living in Denmark from 1980 to 2014. During this period, approximately 7.6 percent—nearly 568,000 people—had a medical contact for TBI. Among those with TBI, the suicide rate was 41 per 100,000 versus 20 per 100,000 for those without a TBI diagnosis.Although the incidence of post-TBI suicide was only a fraction of the total number of people who experienced TBI—0.62 percent—any factor that increases suicide risk warrants concern, commented Jennifer Coughlin, M.D., an assistant professor of psychiatry at Johns Hopkins School of Medicine. She has studied the impact of concussions on National Football League athletes using neuroimaging to evaluate the molecular changes that follow brain trauma. She noted that the study finding are consistent with prior findings.“We need to be asking our patients about history of TBI, and for those who report TBI, we need to ask about psychiatric symptoms and suicidal ideation,” Coughlin said. “These data suggest that the impact of that practice alone may be lifesaving.”“We found that the suicide rate was nearly doubled after a TBI.” —Michael Benros, M.D., Ph.D.The researchers also found that the more severe the TBI, the greater the risk of suicide, and that suicide risk was most elevated in the six months following initial medical contact for TBI. This suggests that both patients and clinicians need to be particularly focused on treatment during this critical period, said Benros.Regarding treatment, Benros said, the evidence supporting an approach specifically for post-TBI psychiatric disorders is inadequate. The absence of treatment details and the absence of data on the particular psychiatric disorders that were associated with TBI were among the study’s key limitations and represent critical areas for further research, he said.There was one paradoxical finding—in those with a pre-TBI history of either a psychiatric diagnosis or deliberate self-harm, TBI was associated with a lower risk of suicide than among those who had only a psychiatric diagnosis or had engaged in deliberate self-harm.“That finding emphasizes what we [already know]—that psychiatric illness and deliberate self-harm are the main risk factors for suicide,” said Benros. It is possible that because risk in this subpopulation is already so elevated, there may be “a ceiling effect,” he noted, and it is also possible that increased medical attention after TBI may be a protective factor for those with pre-TBI psychiatric diagnosis and history of self-harm.Jonathan Silver, M.D., is a clinical professor in the NYU School of Medicine Department of Psychiatry and the lead author of an article in the journal Brain Injury on the association between head injuries and psychiatric disorders.The Danish study highlights an important issue, said Silver, but clinicians need to remember that there is an “enormous association” between TBI and a range of serious psychiatric disorders, he told Psychiatric News. In a commentary for the New England Journal of Medicine’s “Journal Watch,” Silver wrote, “Preventing suicide is important; education of clinicians regarding assessment and treatment of common neuropsychiatric disorders in people with TBI would have even greater impact.”The study was funded by the Mental Health Services Capital Region Denmark and an unrestricted grant from the Lundbeck Foundation. ■“Association Between Traumatic Brain Injury and Risk of Suicide” can be acccessed here. “The Association Between Head Injuries and Psychiatric Disorders: Findings From the New Haven NIMH Epidemiologic Catchment Area Study” is available here. ISSUES NewArchived

Job strain and cognitive change: the Baltimore Epidemiologic Catchment Area follow-up study

ObjectivesTo investigate the association between job strain and subsequent cognitive change over approximately 11 years, using data from the population-based Baltimore Epidemiologic Catchment Area follow-up study.MethodsThe sample ranged from 555...

Association between level of suicide risk, characteristics of suicide attempts, and mental disorders among suicide attempters

BackgroundPast attempted suicide is a strong predictor of future suicide risk, but the risk varies among suicide attempters. Hence, it is important to clarify distinguishing features of lifetime attempters with a high level of current suicide risk for efficient preventive management.MethodsWe compared characteristics of suicide attempts and clinical characteristics among high-, moderate-, and low-risk attempters. Among the total of 6022 participants in the Korean Epidemiologic Catchment Area study, 193 reported a suicide attempt in their lifetime, 36 of which had high, 126 moderate, and 30 low levels of current suicide risk (1 incomplete response).ResultsHigh-risk suicide attempters had more past attempts compared with moderate- and low-risk suicide attempters. Suicide attempts were closely linked to a wide range of psychiatric comorbidities regardless of degree of current level of suicide risk, but the relative risk for having at least one mental disorder was the highest in high-risk attempters. Specifically, the relative risks for depressive disorder, anxiety disorders including obsessive-compulsive disorder and post-traumatic stress disorder, and substance use disorders were higher in high-risk attempters, and relative risk for somatoform disorder was higher in low-risk attempters than others.ConclusionsOur findings indicated that special attention is required for suicide attempters with a history of repeated attempts and current mental disorders, particularly anxiety disorders.

Patterns of Health Care Service Utilization by Individuals with Mental Health Problems: a Predictive Cluster Analysis.

This study aimed at identifying and characterizing clusters of mental health service users based on various characteristics in a sample of individuals with mental health problems. Data were collected in the epidemiological catchment area of South-West Montreal, Quebec in 2011 and 2014. Among the 746 participants who reported experiencing a mental health problem (high psychological distress and/or a mental disorder), 29% had used mental health services. A Two-Step cluster analysis was carried out to generate participant profiles based on their visit to mental health professional. Four clusters were identified: 1) young males with high quality of life and social support and who were less likely to have mental health problems and to utilize mental health services; 2) older females living with a partner and having a family doctor who were less likely to have mental health problems and to utilize mental health services; 3) single females with generalized anxiety disorder and somatic illness who were more likely to utilize mental health services, and 4) depressed females with high psychological distress, low quality of life and social support who were likely to utilize mental health services. The results reinforce the importance to develop programs that target the specific needs of subgroups of people experiencing mental health problems, given their considerable heterogeneity.

Interpersonal trauma moderates the relationship between personality factors and suicidality of individuals with posttraumatic stress disorder.

Individuals with posttraumatic stress disorder (PTSD) are more prone to suicidal ideation and behavior. While those who have experienced interpersonal trauma exhibit more suicidality than those who have experienced non-interpersonal trauma, it is unclear how the traumatic effects are related to an individual’s personality characteristics. This study examined the association between interpersonal trauma and personality factors with suicidality, and elucidated the moderating role of interpersonal trauma in individuals with PTSD. The study included 6,022 participants from the Korean Epidemiologic Catchment Area Study 2011. The Korean Version of Composite International Diagnostic Interview was used for the survey, including the participants’ history of suicidality, the traumas they have experienced, and their PTSD symptoms. The 11-item version of the Big Five Inventory (BFI-11) was used to assess the participants’ personality factors. 76 individuals were diagnosed with PTSD, while 810 had been exposed to trauma but were not diagnosed with any DSM-IV mental disorder. Among the individuals with PTSD, those who had experienced interpersonal trauma were more likely to have suicidal ideation than those who had experienced non-interpersonal trauma (p = .020; odds ratio [OR] = 3.643; 95% confidence interval of OR = [1.226, 10.825]). High agreeableness and conscientiousness predicted less suicidality in those exposed to non-interpersonal trauma, while predicting more suicidality in those exposed to interpersonal trauma. Clinicians examining individuals with PTSD should pay closer attention to the trauma that they have experienced, as well as their personality factors, to provide appropriate treatment.

Longitudinal analysis of quality of life across the trauma spectrum.

Few longitudinal studies have examined the relationship between trauma exposure and posttraumatic stress disorder (PTSD) in relation to quality of life or have been designed to consider the relationships between trauma, PTSD diagnosis, and quality of life in terms of both global scores and specific domains. This article aims to provide an essential longitudinal examination of the effects of trauma and PTSD diagnosis on global as well as specific domains of quality of life in a Canadian sample to better understand the diagnosis and unveil possible routes of research and successful treatment methods for the future. Data were drawn from the initial two waves of the Zone d'étude en épidémiologie sociale et psychiatrique du sud-ouest de Montréal (ZEPSOM), an epidemiological catchment area study based in southwest Montréal (N = 2,433 at Wave 1 and N = 1,823 at Wave 2). PTSD diagnosis and global and subscale scores of quality of life outcomes were established by face-to-face structured interviews using standardized instruments. Outcomes were compared among 3 trauma/PTSD categories and healthy controls. This study extends previous cross-sectional findings within the catchment area by demonstrating that the effects of current PTSD diagnosis on quality of life endure with time. Specifically, the negative impact of current diagnosis of PTSD on Wave 2 quality of life is expressed through its influence on Wave 1 quality of life. Subscale findings are discussed. Research needs to focus on understanding more than just global indices of quality of life when it comes to the trauma spectrum. Additional research remains necessary to fully understand these complex relationships over time. (PsycINFO Database Record

Age of first drunkenness and risks for all-cause mortality: A 27-year follow-up from the epidemiologic catchment area study

BackgroundEarly-onset drunkenness is associated with an increased risk of developing an alcohol use disorder (AUD), which predicts excess mortality risk. Here, we estimated mortality risk for drinkers with and without early drunkenness. MethodsFor 14,848 adult participants interviewed about drinking, drunken episodes, and AUD in 1981–83 for the Epidemiologic Catchment Area in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), and Durham (North Carolina), we linked National Death Index records through 2007. ResultsCox regression modeling estimates showed excess mortality for drinkers with age of first drunkenness earlier than 15 years old (hazard ratio, HR: 1.47, 95% CI: 1.25, 1.72) and when first drunkenness occurred at or after age 15 (HR: 1.20, 95% CI: 1.11, 1.29), as compared with adults who had never been drunk. Consistent results were observed, irrespective of AUD history. That is, early drunkenness signaled excess mortality risk even in absence of AUD. ConclusionsIn a large community sample from four cities in the US, early age of onset of drunkenness predicts mortality risk. We discuss experiments to investigate the possible causal significance of this predictive association.

RETRACTED ARTICLE: Correlates, comorbidities, and suicidal tendencies of problematic game use in a national wide sample of Korean adults

BackgroundThis study aimed to investigate the prevalence, correlates, comorbidities, and suicidal tendencies of problematic game use in a nationally representative sample of Korean adults.MethodsOf the 6022 subjects who participated in the 2011 Korean Epidemiologic Catchment Area study and completed the Composite International Diagnostic Interview 2.1, 1397 game users were evaluated for problematic game use using 9-item DSM-5 proposed criteria for Internet gaming disorder. Respondents who responded “yes” to five or more of the nine DSM-5 criteria were considered as problematic game users and the reminders were considered as normal game users.Results4.0% (56/1397) of game users were classified as a problematic game user. Problematic game users were more likely to be in younger age group and live in urban area compared with normal game user. Problematic game use was positively associated with several psychiatric disorders including nicotine use disorder, depressive disorder, and anxiety disorder, but not associated with alcohol use disorder and obsessive-compulsive disorder, after adjusting for age, sex, and residential area. Problematic game use was significantly and positively associated with suicide plans, after controlling for psychiatric disorders as well as socio-demographic factors.ConclusionProblematic game use is relatively prevalent in Korean adult population and highly comorbid with other psychiatric disorders and suicidality. Therefore, preventive strategy for problematic game use is needed for game users who were more likely to be addicted such as young adults in urban area, and mental health screening and appropriate treatment are needed for individuals with problematic game use.

A cross-sectional study about associations between personality characteristics and mental health service utilization in a Korean national community sample of adults with psychiatric disorders

BackgroundPersonality traits are not only associated with psychiatric symptoms, but also with treatment seeking behavior. Our purpose was to examine the relationship between mental health service utilization and personality characteristics in a nationwide community sample of Korean adults.MethodOf the 6022 subjects aged 18–74 years who participated in the Korean Epidemiologic Catchment Area study, 1544 (25.6%) with a lifetime diagnosis of any DSM-IV psychiatric disorder were analyzed. Diagnostic assessments were based on the Composite International Diagnostic Interview and personality constructs were measured by Big Five Personality Inventory-10.ResultsOf the 1544 participants, 275 (17.8%) had used mental health services. Multivariate analyses revealed positive associations between mental health service utilization and both neuroticism and openness, and an inverse association between mental health service utilization and agreeableness.ConclusionsThese findings suggest that specific personality traits may have a role in treatment-seeking behaviors for mental health problems independent of the psychiatric disorder.

Epidemiology of bipolar spectrum disorder: Results from the general population survey of South Korea

IntroductionPatients with subthreshold bipolar disorder (sub-BP) experience severe clinical courses and functional impairments, which are comparable to those with bipolar I and II disorders (BP-I and -II). Nevertheless, lifetime prevalence, socioeconomic correlates and diagnostic overlaps of bipolar spectrum disorder (BPS) have not yet been estimated in the general population of South Korean adults.AimsThis study aimed to estimate the lifetime prevalence, correlates and diagnostic comorbidities of BPS using a validated screening instrument in the nationwide general population of South Korea.MethodsA total of 3013 adults among the 2011 Korean Epidemiologic Catchment Area survey (KECA-2011) completed face-to-face interviews using the Korean versions of the composite international diagnostic interview 2.1 and mood disorder questionnaire (K-CIDI and K-MDQ).ResultsThe lifetime prevalence of BPS in the South Korean adults was measured to be 4.3% (95% CI 2.6–6.9). Nearly 80% of the subjects with BPS were codiagnosed with other DSM-IV nonpsychotic mental disorders: 35.4% (95% CI 24.2–48.5) for major depression and dysthymic disorder, 35.1% (95% CI 27.7–43.3) for anxiety disorders and 51.9% (95% CI 40.5–63.1) for alcohol and nicotine use disorders. Younger age (18–34 years) was the only sociodemographic predictor of BPS positivity (P = 0.014) and the diagnostic overlap patterns were different between men and women.ConclusionsPositivity for BPS was estimated to be much greater than the prevalence of DSM-IV BP in South Korea. Most of the respondents with BPS were diagnosed with other major mental disorders and this might be related with mis and/or underdiagnosis of clinically relevant Sub-BP.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Costs of substance use disorders from claims data for Medicare recipients from a population-based sample

Medicare spending is projected to increase over the next decade, including for substance use disorders (SUD). Our objective was to determine whether SUDs are associated with higher six-year Medicare costs (1999–2004) among participants in the Baltimore Epidemiologic Catchment Area (ECA) Study. Medicare claims data for the years 1999–2004 from the Centers for Medicare and Medicaid Services were linked to four waves of data from the Baltimore ECA cohort collected between 1981 and 2005 (n=566). A generalized linear model with a log link and gamma distribution was used to examine direct Medicare costs associated with SUD status. Medicare recipients with no history of SUD had mean six-year costs of $42,576. Those with a history of SUD based on both Baltimore ECA and Medicare data, or based on Medicare claims data alone, had significantly higher costs ($98,754 and $64,876, respectively). A history of SUD based solely on Baltimore ECA data alone had lower average costs ($25,491). Findings indicate that Medicare costs differ by source of SUD diagnosis when comparing treatment versus survey data. This may have future implications for projecting Medicare costs among SUD individuals as healthcare coverage expands under the Affordable Care Act.

Associations of depression status and hopelessness with blood pressure: a 24-year follow-up study

Hypertension is estimated to cause 12.8% of all deaths worldwide. Both literature and well-supported cognitive models indicate that hopelessness predicts depressive symptoms. This study aimed to test whether high levels of hopelessness are associated with increased blood pressure, as well as whether depression acts as a mediator between hopelessness and blood pressure. Data from the original 24-year longitudinal Baltimore Epidemiologic Catchment Area Study (ECA) were analyzed via linear regression (N = 917; 60.3% female; 62.9% European American; mean age = 42.96 years, SD = 16.94). Hopelessness was found to have a significant direct relationship with systolic blood pressure (SBP, p < .05), but not with diastolic blood pressure (DBP, p > .05); while depression had no significant direct relationship with SBP or with DBP. Overall, findings indicated that hopelessness has a significant relationship with SBP. Limitations and implications are discussed.

Prevalence and Psychiatric Comorbidities of Internet Addiction in a Nationwide Sample of Korean Adults.

The goal of the study was to examine the prevalence and psychiatric comorbidities of Internet addiction in a nationwide sample of Korean adults. Among a total of 6,022 participants involved in Korean Epidemiological Catchment Area study in 2011, 3,723 Internet users were assessed for their Internet addiction using Young's 8-item Diagnostic Questionnaire. The results showed that of the 3,723 Internet users, 39 (1.0%) had Internet addiction. Addicted Internet users were younger, more likely to be males and unemployed compared to non-addicted Internet users. Internet addiction was associated with alcohol and nicotine use disorders, depressive disorders, and anxiety disorder after controlling for age, gender, and occupational status. Internet addiction was associated with suicidal plans even after controlling for psychiatric disorders and socio-demographic factors. This study showed that Internet addiction is highly associated with variety of different psychiatric disorders and suicidal plans. Therefore, clinicians should carefully evaluate them when treating addicted Internet users.

Employment Status and Mental Health: Mediating Roles of Social Support and Coping Strategies.

Although it has been established that unemployment and underemployment increase distress and depression, the psychological mechanisms involved are not very clear. This study examines the roles of social support and coping strategies as mediators of the association between employment status and mental health, as well as gender and age differences as moderators. Residents from the epidemiological catchment area of south-west Montreal responded to a randomized household survey for adults in 2009. A follow-up was conducted based on participants' employment status 2 and 4years later. ANOVAs tests were computed with SPSS to evaluate group differences, and structural equation modeling was performed with AMOS to test mediation effects. At baseline, among participants between 18 and 64years old (n=2325), 14.3% were unemployed/not studying, 14.4% worked part-time, and 56.5% worked full-time. Employment status was found to significantly affect depression among those under 45years old (chi-square=23.4, p<0.001). Results showed a negative association of full-time employment with depression, which was fully mediated by social support, less coping with drugs/medication, and less distress. A negative association with full-time employment was also noted with distress, which was partially mediated by increased social support, coping with alcohol, and less coping with drugs/medication. The total indirect effect suggests that full-time employees generally have more resources and do not tend to use avoidance strategies like coping with drugs/medication, resulting in less distress (β=-0.05; p<0.01) and depression (β=-0.028; p<0.01). Results suggest that optimal impact on mental health could be attained when increasing employment, namely full-time employment, in communities.

Assessing trauma and posttraumatic stress disorder: Single, open-ended question versus list-based inventory.

Trauma exposure is a precursor to a diagnosis of posttraumatic stress disorder (PTSD). A dearth of empirical evidence exists on the impact of different measurement practices on estimates of trauma exposure and PTSD within representative epidemiological samples. In the present study, we examined differences in reported trauma exposure and rates of PTSD using single, open-ended question versus list-based trauma assessments in a general community sample. Using data from the third wave of the Montreal epidemiological catchment area study (N = 1029), participants were interviewed in person by a lay interviewer about lifetime history of trauma exposure and PTSD. Prevalence rates of trauma exposure and PTSD diagnosis using single, open-ended question and list-based assessment were compared using a within-subject design. A single, open-ended question versus list-based trauma assessment yielded trauma-exposure rates of 61%, 95% CI [57.8, 63.8] and 78%, 95% CI [75.2, 80.3], respectively. Conditional rates of lifetime PTSD decreased from 6.7%, 95% CI [5.8, 9.4] to 6%, 95% CI [4.4, 7.7], respectively. Increases in trauma exposure were more pronounced in women (33.7%) than men (21.5%), as well as in the younger stratum of study participants (15-24 years old; 36.1%). Underestimation of PTSD using a single, open-ended question assessment was minimal, although all missing cases were women. Our results lend support to the importance of using comprehensive assessments of exposure to potentially traumatic events when conducting epidemiological research, especially when reporting conditional rates of PTSD. Previous research may have underestimated the prevalence of trauma exposure, particularly among young women. (PsycINFO Database Record

Place and Posttraumatic Stress Disorder.

Research on traumatic stress has focused largely on individual risk factors. A more thorough understanding of risk factors may require investigation of the contribution of neighborhood context, such as the associations between perceived neighbourhood disorder and social cohesion with reported trauma exposure (yes/no) and posttraumatic stress disorder (PTSD) diagnostic status (past-year PTSD, remitted). To examine these associations, we used a cross-sectional analysis of an epidemiological catchment area survey (N = 2,433). Visible cues, indicating a lack of order and social control in the community (neighbourhood disorder), were associated with increased trauma exposure (adjusted odds ratio [AOR] = 1.21, 95% confidence interval [CI] [1.12, 1.31]). For trauma-exposed individuals, neighbourhood disorder was associated with greater odds of lifetime PTSD (AOR = 1.38, 95% CI [1.10, 1.75]), and the willingness of residents who realize common values to intervene for the common good (social cohesion), was associated with lower likelihood of past-year PTSD (AOR = 0.64, 95% CI [0.42, 0.97]). For participants with a lifetime diagnosis of PTSD (including past-year), increased social cohesion was associated with higher odds of remission (AOR = 2.59, 95% CI [1.55, 4.30]). Environmental contexts play a role in the development and progression of PTSD. As such, traumatic stress outcomes may be better understood through a perspective that integrates individual and contextual risk factors.

Lifetime prevalence, sociodemographic correlates, and diagnostic overlaps of bipolar spectrum disorder in the general population of South Korea

BackgroundPatients with subthreshold bipolar disorder (Sub-BP) experience severe clinical courses and functional impairments which are comparable to those with bipolar I and II disorders (BP-I and -II). Nevertheless, lifetime prevalence, socioeconomic correlates and diagnostic overlaps of bipolar spectrum disorder (BPS) have not yet been estimated in the general population of South Korean adults. MethodsA total of 3013 adults among the 2011 Korean Epidemiologic Catchment Area survey (KECA-2011) completed face-to-face interviews using the Korean versions of the Composite International Diagnostic Interview 2.1 and Mood Disorder Questionnaire (K-CIDI and K-MDQ). ResultsThe lifetime prevalence of BPS in the South Korean adults was measured to be 4.3% (95% CI 2.6–6.9). Nearly 80% of the subjects with BPS were co-diagnosed with other DSM-IV non-psychotic mental disorders: 35.4% (95% CI 24.2–48.5) for major depression and dysthymic disorder, 35.1% (95% CI 27.7–43.3) for anxiety disorders, and 51.9% (95% CI 40.5–63.1) for alcohol and nicotine use disorders. Younger age (18–34 years) was the only sociodemographic predictor of BPS positivity (P=0.014), and the diagnostic overlap patterns were different between men and women. LimitationsThe prevalence of BPS and other mental disorders could have been influenced by recall bias due to the retrospective nature of this study. ConclusionsPositivity for BPS was estimated to be much greater than the prevalence of DSM-IV BP in South Korea. Most of the respondents with BPS were diagnosed with other major mental disorders and this might be related with mis- and/or under-diagnosis of clinically relevant Sub-BP.

Adolescent vs. adult onset of a first episode psychosis: Impact on remission of positive and negative symptoms

ObjectiveAdolescent-onset psychosis has traditionally been characterized as a more severe form of psychosis with a poorer prognosis. However, it is still unclear if patients with an adolescent-onset have worse symptom remission outcomes. Symptom remission is the principal clinical outcome known to predict quality of life and social functioning in the long term. The goal of this study is to clarify the influence of age of onset of psychosis on symptom remission in a sample of first-episode psychosis patients. MethodA total of 246 first-episode psychosis patients were recruited from a specialized early intervention program serving a defined epidemiological catchment area. Age of onset of psychosis (adolescence vs. adulthood) was used as the main predictor, and duration of untreated psychosis (DUP), baseline symptoms, baseline functioning, substance abuse diagnosis, medication adherence and gender were used as covariates in hierarchical regression models predicting the following positive and negative symptom remission outcomes: maximum continuous months in remission and early remission (i.e., occurring in the first three months of follow-up). ResultsAfter controlling for other variables, onset of psychosis in adulthood and shorter DUP predicted early remission of positive symptoms. This effect was stronger in patients with a diagnosis of a schizophrenia-spectrum disorder. Remission of negative symptoms did not depend on age of onset, and was only predicted by baseline negative symptoms. ConclusionPatients with onset of psychosis during adulthood are more likely to achieve early positive symptom remission than those with adolescent onset. This effect might be stronger in patients with a diagnosis of a schizophrenia-spectrum disorder.

Mental health and drug

IntroductionBipolar disorder (BD) is often associated with various comorbidities. It is substance use disorders (SUD) one of the most frequent comorbidities.The ECA study (Epidemiologic Catchment Area) observed a prevalence over the life of the 56, 1% for any TUS in the total sample of patients with bipolar disorder. In subjects with bipolar I disorder prevalence was 60.7%, and those of type II 48.1.In the OMS study conducted in America, Europe and Asia, the results confirm the high rates of disorders in patients diagnosed with bipolar disorder regardless of the country of study.CaseThis is a male, 32, who came first to the Provincial Drug Addiction Service of Huelva in 2009 for cocaine, cannabis and alcohol.In his personal history, he relates a convulsive episode at 14 years and one manic episode associated with consumption of cocaine in 2002 which began to be treated by a team of Mental Health and Provincial Center for Addictions.He entered twice in a therapeutic community in 2009 for treatment for their disorder dependence on cocaine, alcohol and cannabis.It has required admission to the Unit Hospitalization twice in 2012, with the discharge diagnosis of manic episode secondary to drug consumption.ConclusionsMost epidemiological studies in recent decades note the high prevalence of comorbidity BD + SUD.BD-SUD comorbidity is particularly complex because each disorder affects the evolution of the other and they are frequently multiple comorbidities. In addition, it implies a worse clinical and functional outcome as well as poorer therapeutic response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Poster Number: NR 6 - Stressful Life Events and Cognitive Decline: Sex Differences in the Baltimore Epidemiologic Catchment Area Follow-Up

Poster Number: NR 6 - Stressful Life Events and Cognitive Decline: Sex Differences in the Baltimore Epidemiologic Catchment Area Follow-Up