High Prevalence Of Psychiatric Comorbidity Research Articles

Association of Personality Traits of Alcohol-dependent Patients with Their Psychiatric Comorbidities: A Cross-sectional Study from Central Rural India

Introduction: Alcohol dependence syndrome (ADS) is a significant health problem all over the world. Alcohol-dependent individuals have a high prevalence of psychiatric comorbidities and nonadaptive personality traits that may influence the pathogenesis, treatment outcome, clinical course, and relapse of ADS. Aim: The aim of this study was to assess the personality traits and psychiatric comorbidities of alcohol-dependent patients and to determine the association of personality traits with psychiatric comorbidities in ADS. Methodology: An observational study was conducted on 100 patients of ADS from Acharya Vinoba Bhave Rural Hospital, Sawangi Wardha, Maharashtra. They were assessed through semi-structured sociodemographic pro forma, Mini-International Neuropsychiatric Interview PLUS, and 16 Personality Factor Inventory. Results: Most of the patients scored high on personality traits such as dominance (67%), warmth (56%), sensitivity (70%), social boldness (56%), openness to change (65%), vigilance (77%), and perfectionism (52%) while they scored low on factors privateness (50%) and liveliness (35%). The prevalence of psychiatric comorbidity was found to be 49%, with mood disorders (21%) being the most common diagnosis. Personality factors dominance (0.0001) and social boldness (0.042) were significantly associated with psychiatric comorbidities with P < 0.05. Conclusion: The personality traits and psychiatric comorbidity need to be addressed at the time of management to improve outcome.

Psychiatric Co-morbidity with Obsessive Compulsive Disorder

Background: Obsessive-compulsive disorder is a chronic psychiatric disorder. It is associated with substantial psychiatric comorbidity. Major Depressive disorder & mixed anxiety and depressive disorder are the most common psychiatric co-morbidities.Objective: To evaluate the psychiatric co-morbidity with obsessive-compulsive disorder.Materials and Methods: It was a descriptive and cross-sectional clinical study. It was conducted in the Outpatient Department of Psychiatry, Khwaja Yunus Ali Medical College, Sirajganj from January 2021 to December 2022. Total 100 patients were taken. All the selected patients were interviewed in detail by using ICD-10. Analysis was done according to the Statistical Package for Social Science (SPSS) for windows version 25.Results: This study shows obsessive compulsive disorder is more common in young to middle age (21 to 40 years) and mean age of onset of illness was 28.31±10.21 years. Maximum (57%) were female and 43% were male. Depressive disorder, mixed anxiety and depressive disorder were most common psychiatric comorbidity (63% and 22%) in patient with OCD followed by panic disorder in 7% patients, social phobia in 5% patients, generalized anxiety disorder in 5% patients, substance abuse in 5% patients, schizophrenia in 5% patients, bipolar affective disorder in 2% patients and tic disorder in 1% patients.Conclusion: This study demonstrates a high prevalence of psychiatric comorbidities in individuals diagnosed with OCD. The most prevalent co-occurring disorders are depressive disorder & mixed anxiety and depressive disorder. KYAMC Journal Volume: 14, No: 04, January 2024: 206-209.

A preliminary analysis of clinical characteristics of patient with alcohol use disorder and suicidal ideation

IntroductionSuicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients.ObjectivesTo analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD.MethodsThis is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European addiction severity index (EuropASI). SI was evaluated by using the item for SI in EuropASI.ResultsFrom a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside of SUD, and higher addiction severity according to the EuropASI (See table)Image:ConclusionsSI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies.REFERENCES1. Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.022. MacKillop J, et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-1 3. Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874]. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870Disclosure of InterestR. Palma-Alvarez Speakers bureau of: RFPA has received speaker honorariums from Angelini, Cassen Recordati, Exeltis, Lundbeck, MSD, Rubió, Servier, and Takeda., A. Rios-Landeo: None Declared, G. Ortega-Hernandez Speakers bureau of: GOH has received speaker honorariums from Rubió., E. Ros-Cucurull Speakers bureau of: ERC has received speaker honorariums from Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Lilly, Servier, Rovi, Juste., C. Daigre: None Declared, M. Perea-Ortueta: None Declared, L. Grau-Lopez Speakers bureau of: LGL has received fees to give talks for Janssen-Cilag, Lundbeck, Servier, Otsuka, and Pfizer., J. Ramos-Quiroga Speakers bureau of: JARQ has been on the speakers’ bureau and/or acted as consultant for Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Rubió, Uriach and Raffo.

A preliminary analysis of clinical characteristics of patient with alcohol use disorder and suicidal ideation

IntroductionSuicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients.ObjectivesTo analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD.MethodsThis is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking for treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European Addiction Severity Index (EuropASI), SI was evaluated using the item for SI in EuropASI.ResultsFrom a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside from SUD, and higher addiction severity according to the EuropASI.Image:ConclusionsSI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies.REFERENCES1 Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.0212. MacKillop J, et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-13.Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874]. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870Disclosure of InterestNone Declared

Psychiatric comorbidities and prescribing tendencies of sleep medications and related medications in young people with insomnia: a United States commercial claims-based analysis.

To characterize children and youth newly diagnosed with insomnia and to describe their use of sleep and other related prescription medications. Within a commercial claims database (January 1, 2016-December 31, 2021), we identified children and youth (2-24 years) with a newly recorded insomnia diagnosis (G47.0x; F51.0x) and examined psychiatric diagnoses in the prior 6 months. We evaluated sleep and related prescription medications dispensed in the week after new insomnia diagnoses (i.e. trazodone, other antidepressants, hydroxyzine, alpha-agonists, benzodiazepines, non-benzodiazepine hypnotics "z-drugs," antipsychotics, and others). Analyses were stratified by age and psychiatric comorbidities. Among 68 698 children and 108 118 older youth (18-24 years) with a new insomnia diagnosis, three-quarters had a diagnosed comorbid psychiatric condition; anxiety disorders, depression, and ADHD were the most common. Among those without comorbid psychiatric diagnoses, 20.2% of children and 37.4% of older youth had a sleep or related medication dispensed in the following week. In children without a comorbid psychiatric diagnosis, alpha-agonists, hydroxyzine, and trazodone were the most common medications; in older youth, trazodone was the most common medication followed by hydroxyzine, z-drugs, and SSRIs. Sleep and related prescription medications were more commonly dispensed to those with psychiatric comorbidities. From 2017 to 2021, there was an increase in hydroxyzine prescriptions following a new insomnia diagnosis and decline in z-drug and benzodiazepine prescriptions. Our findings from a nationwide sample of young people with insomnia highlight the high prevalence of psychiatric comorbidities and variety of sleep and related medications they receive. Characterizing prescribing tendencies informs guideline development and future research.

P398 The Burden of Psychiatric Manifestations in Inflammatory Bowel Diseases: A Systematic Review with Meta-analysis

Abstract Background Psychiatric manifestation in individuals with inflammatory bowel disease (IBD) has been the subject of extensive research, but uncertainties remain regarding its precise magnitude, its impact on intestinal disease, and the whole burden of psychiatric manifestations.This systematic review aims to synthesize available evidence on the prevalence and impact of psychiatric disorders in patients with IBD. Methods A systematic search of PubMed/MEDLINE, EMBASE, and SCOPUS databases was performed to identify relevant studies published between January 2010 and January 2023. Cross-sectional, case-control, cohort, registry, and population studies that addressed the prevalence of depression, anxiety, bipolar disorder, and schizophrenia in patients with IBDs and that met the specific inclusion criteria were selected. A meta-analysis to assess the strength of association between IBD and selected psychiatric disorders was also performed. Data extraction and quality assessment were performed. Results The search yielded a total of 3209 articles. 193 met the inclusion criteria, but only 26 studies provided the complete data for the analysis (Table 1). Overall, the prevalence of psychiatric comorbidities was found to be significantly higher in IBD compared with the general population. The analysis revealed a moderate but significant association between IBD and depression, with a pooled odds ratio (OR) of 1.42 (95%CI 1.33-1.52). (Fig.1) Also, anxiety emerged as a prevalent comorbidity in IBD with a pooled OR of 1.3 (95%CI =1.22-1.44). Evidence on the relationship between bipolar disorders and IBD was limited and mixed, with a pooled OR of 1.64 (95%CI=1.20-2.24), despite a substantial heterogeneity (I2=94.01%). Only three studies examined the association between schizophrenia and IBD, providing widely heterogeneous results, with an inconclusive OR (p= 0,73), estimated at 0.93 (95%CI=0.62-1.39). Conclusion This systematic review with meta-analysis highlights that patients with IBD, both CD and UC, frequently experience psychiatric comorbidities such as depression, anxiety, bipolar disorders, and, to a lesser extent, schizophrenia. These disorders are more prevalent in IBD patients than in the general population. Depression and anxiety are particularly prevalent. Bipolar disorder is still an underexplored area in the context of IBD. Data on the relationship between schizophrenia and IBD is sparse and inconclusive and requires further research. Given the high prevalence of psychiatric comorbidities in IBD patients, the results of this systematic review underscore the need for a deeper understanding of these associations and early identification and tailored interventions for mental health in patients with IBD to improve their quality of life.

A Study of Psychiatric Co-morbidities, Anxiety, Depression and Quality of Life in Patients of Chronic Obstructive Pulmonary Disease

ABSTRACT Aim: To study psychiatric co-morbidities, anxiety, depression, and quality of life in patients of chronic obstructive pulmonary disease (COPD). Materials and Methods: A cross-sectional, case-control study was conducted on 122 cases of COPD and equal number of age- and sex-matched controls in a tertiary care hospital. They were assessed with the Mini-International Neuropsychiatric Interview (MINI), depression, anxiety stress scale-42 (DASS-42), St. George Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT). Results: COPD patients and control subjects were matched with respect to age, sex, education, employment, domicile, and socioeconomic status. Psychiatric disorders were diagnosed in 56% of cases and 14% of controls. Major depressive disorder, alcohol dependence, and anxiety disorders were the most common psychiatric diagnoses. There was significantly higher prevalence of smoking in cases with COPD compared to control subjects suicidality was present in two patients. The mean scores on depression, anxiety, and stress on DASS-42 of COPD patients were significantly higher than normal controls. On the CAT majority of the COPD patients belonged to the high-impact group followed by the very high-impact group. Mean scores on the SGRQ were in the range expected in COPD patients. A multiple regression analysis revealed that significant predictors of SGRQ scores were age, gender, economic status, domicile, alcohol habits, depression, anxiety, and stress. Conclusion: COPD patients have a significantly higher prevalence of psychiatric co-morbidities compared to healthy controls. Common psychiatric disorders were major depression, alcohol dependence, and anxiety disorders along with smoking.

Clinical characterization of coexisting ADHD symptoms in a sample of adults with cyclothymia: A preliminary observational study

BackgroundCyclothymia seems to be often associated with coexisting ADHD symptoms, although this comorbidity is understudied. Emotional dysregulation is a core symptom of both conditions. MethodsAdult subjects with cyclothymia were consecutively enrolled at the outpatient service of the Second Psychiatry Unit of the Pisa University Hospital (Italy). Screening for ADHD was performed using the Adult ADHD Self-Report Scale (ASRS). We analyzed differences in sociodemographic and clinical characteristics between subjects with and without ADHD symptomatology. ResultsOf the total sample of 107 subjects, 43 % screened positive for ADHD. ADHD+ subjects were significantly younger than ADHD- subjects, had a lower level of education, a higher prevalence of psychiatric comorbidity, and a more frequent family history for ADHD and alcohol use disorder. In addition, ADHD+ subjects scored higher than ADHD- subjects on the affective instability, negative emotionality, and emotional impulsivity subscales of the RIPoSt-40 questionnaire, as well as on the 40‐item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40) total score. They also showed a stronger association with the cyclothymic and depressive subscales of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) scale. Limitationsthe small sample size, the cross-sectional nature of the study, the use of self-report questionnaires, and the use of a screening test to assess comorbidity with ADHD symptomatology. ConclusionsADHD symptomatology is very common in cyclothymic individuals, and emotional dysregulation blurs the diagnostic boundaries between the two disorders. Several clinical features suggest the need for systematic evaluation of ADHD in patients with cyclothymic disorder.

Association of psoriasis with depression, anxiety, and suicidality: A bidirectional two-sample Mendelian randomization study.

Psoriasis is a chronic, refractory inflammatory skin disease, with a high prevalence of psychiatric comorbidities, including depression, anxiety, and even suicidality, which may in turn initiate or exacerbate skin inflammation. However, the causal relationships between these comorbidities remain unclear. To investigate the cause-effect relationships between psoriasis and mental disorders including depression, anxiety, and suicidality, we conducted a bidirectional two-sample Mendelian randomization (MR) study utilizing summary statistics from the most comprehensive genome-wide association studies of psoriasis (n = 306 123), broad depression (n = 500 199), major depressive disorder (n = 173 005), anxiety (n = 17 310), and suicide attempts (n = 50 264). Using the random-effects inverse-variance weighted method as primary method, the forward MR analyses indicated that psoriasis was significantly associated with higher odds of broad depression (odds ratio [OR] 1.030, 95% confidence interval [CI] 1.010-1.051, P = 0.003) and suggestively associated with an increased risk of major depressive disorder (OR 1.054, 95% CI 1.002-1.109, P = 0.040), but not with the risk of anxiety (P = 0.160) or suicide attempts (P = 0.648). In reverse MR analyses, significant causal impact of broad depression (OR 1.363, 95% CI 1.103-1.684, P = 0.004) and major depressive disorder (OR 1.890, 95% CI 1.285-2.781, P = 0.001), but not anxiety (P = 0.787) and suicide attempts (P = 0.961) on psoriasis risk was observed. In addition, the results of primary analysis are consistent across sensitivity analyses, albeit the MR-Egger regression model produced wide CIs and negative results in several analyses. In conclusion, this MR study indicates a bidirectional causal relationship between psoriasis and depression that was previously unrecognized, which highlights the significance of screening for depression in psoriasis patients and initiating appropriate interventions. Further studies are required to elucidate the pathophysiology of the bidirectional causal relationship between these two conditions.

Distinctive electro-clinical, neuroimaging and histopathological features of temporal encephaloceles associated to epilepsy.

Encephaloceles (ENCs) may cause clinical complications, including drug-resistant epilepsy that can be cured with epilepsy surgery. We describe clinical, diagnostic, and neuropathological findings of 12 patients with temporal ENC and epilepsy evaluated for surgery and compare them with a control group of 26 temporal lobe epilepsy (TLE) patients. Six patients had unilateral and 6 bilateral temporal ENCs. Compared to TLEs, ENCs showed i) later epilepsy onset, ii) higher prevalence of psychiatric comorbidities, iii) no history of febrile convulsions, and iv) ictal semiology differences. Seven patients had MRI signs of gliosis, and 9 of intracranial hypertension. Interictal EEG analysis in ENCs demonstrated significant differences with controls: prominent activity in the beta/gamma frequency bands in frontal regions, interictal short sequences of low-voltage fast activity, and less frequent and more localized interictal epileptiform discharges. Ictal EEG patterns analyzed in 9 ENCs showed delayed and slower contralateral spread compared to TLEs. All ENCs that underwent surgery (7 lobectomies and 1 lesionectomy) are in Engel class I. Neuropathological examination revealed 4 patterns: herniated brain fragments, focal layer I distortion, white matter septa extending into the cortex, and altered gyral profile. The described peculiarities might help clinicians to suspect the presence of largely underdiagnosed ENCs.

Increased Frequency of Self-Reported Obsessive-Compulsive Symptoms in Patients with Functional Movement Disorders.

Functional movement disorders (FMD) are associated with a high prevalence of psychiatric comorbidities. To assess the frequency of obsessive-compulsive symptoms (OCS) in FMD. A total of 167 consecutive patients with clinically definite FMD (mean age = 44.4 years, standard deviation [SD] = 12.0, 119 females) and 145 healthy controls (mean age = 43.2 years, SD = 11.8, 103 females) completed the Obsessive-Compulsive Inventory-Revised (OCI-R), which is a widely used tool for assessing OCS. The cutoff score ≥21 is indicative of clinically significant obsessive-compulsive disorder (OCD). Motor symptom severity was assessed using the Simplified FMD Rating Scale (S-FMDRS). All subjects completed questionnaires for depression, anxiety, pain, fatigue, cognitive complaints, health-related quality of life, and childhood trauma. Personality traits were assessed using the Big Five questionnaire. FMD patients had higher mean OCI-R score and higher proportion of individuals with OCI-R ≥ 21 42%, 95% confidence interval (CI) = (30.2, 54.6) versus 16%, 95% CI = (8.2, 28.2) in controls, P < 0.001. Patients had higher scores in three domains: checking, ordering, and obsessing (P < 0.001). FMD patients with OCI-R score ≥21 had higher depression, anxiety, cognitive complaints, and lower quality of life compared to those with score <21 (P < 0.001). No correlation between OCI-R and S-FMDRS scores was found. FMD patients reported higher rates of OCS compared to controls, along with higher rates of non-motor symptoms and lower quality of life. This finding may have clinical implications and raises the possibility of shared risk factors and common pathophysiological mechanisms in FMD and OCD.

Psychiatric comorbidities in patients suffering from systemic lupus erythematosus admitted to a tertiary care hospital in Northern India.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multiorgan involvement presenting with a myriad of symptoms, including neuropsychiatric symptoms. Although many studies have evaluated screening questionnaires based psychiatric morbidity, very few studies have used contemporary diagnostic criteria. This study aimed to evaluate the prevalence of psychiatric disorders in patients with SLE admitted to a tertiary care hospital. A total of 79 patients diagnosed with SLE for at least for 1year, who were not in delirium were assessed by a qualified psychiatrist for psychiatric morbidity as per the International Classification of Diseases, 10th Revision (ICD-10) criteria. Additionally, these patients were assessed on Patient Health Questionnaire-9 (PHQ-9) item version, Patient Health Questionnaire-15 (PHQ-15) item version, Generalized Anxiety Disorder-7 item scale and Montreal Cognitive Assessment (MoCA). 51% (n = 40) of the participants were diagnosed with a psychiatric diagnosis, with depressive disorders being the most common, seen in 36.7% (n = 29) of the participants. Additionally, 10% (n = 8) participants were diagnosed with adjustment disorder and 2.5% (n = 2) were diagnosed with anxiety (not otherwise specified). Only one patient was diagnosed with organic psychosis. On PHQ-9, 39.8% (n = 33) were diagnosed with depression. 44.3% (n = 35) expressed death wishes and/or suicidal ideations. On PHQ-15, 17.7% (n = 14) of the participants scored for severe somatic distress (score >15). On GAD-7, 55.7% (n = 44) screened positive for anxiety symptoms, but only 7.6% (n = ) had a score of 15 or more to indicate severe anxiety. Nearly half (n = 43; 52%) of the participants also had cognitive impairment as assessed on MoCA, with 13.3% (n = 11) of the participants having scores indicating severe dementia. Patients with SLE have a high prevalence of psychiatric comorbidities and should be routinely screened for psychiatric morbidity. They should be appropriately treated, to improve the overall treatment outcomes.

Mental Illnesses in Inflammatory Bowel Diseases: mens sana in corpore sano.

Background and aims: Inflammatory bowel diseases (IBD) are chronic disorders associated with a reduced quality of life, and patients often also suffer from psychiatric comorbidities. Overall, both mood and cognitive disorders are prevalent in chronic organic diseases, especially in the case of a strong immune component, such as rheumatoid arthritis, multiple sclerosis, and cancer. Divergent data regarding the true incidence and prevalence of mental disorders in patients with IBD are available. We aimed to review the current evidence on the topic and the burden of mental illness in IBD patients, the role of the brain-gut axis in their co-existence, and its implication in an integrated clinical management. Methods: PubMed was searched to identify relevant studies investigating the gut-brain interactions and the incidence and prevalence of psychiatric disorders, especially of depression, anxiety, and cognitive dysfunction in the IBD population. Results: Among IBD patients, there is a high prevalence of psychiatric comorbidities, especially of anxiety and depression. Approximately 20-30% of IBD patients are affected by mood disorders and/or present with anxiety symptoms. Furthermore, it has been observed that the prevalence of mental illnesses increases in patients with active intestinal disease. Psychiatric comorbidities continue to be under-diagnosed in IBD patients and remain an unresolved issue in the management of these patients. Conclusions: Psychiatric illnesses co-occurring in IBD patients deserve acknowledgment from IBD specialists. These comorbidities highly impact the management of IBD patients and should be studied as an adjunctive therapeutic target.

Gender Dysphoria in Pediatric and Transitional-Aged Youth Hospitalized for Suicidal Behaviors

Objective: Our study aims to demarcate the sociodemographic differences in pediatric patients hospitalized for suicidal behaviors and struggling with gender dysphoria. Additionally, we evaluated the demographic factors and comorbidities that are predictive of gender dysphoria in patients with suicidal behaviors. Methods: We included 319,430 patients (aged 6–24 years) with suicidal behaviors and a primary psychiatric diagnosis (per ICD-10 criteria) of mood disorders (depressive disorders, 75.3%; bipolar disorders, 15.9%; and other mood disorders, 8.8%) from the Nationwide Inpatient Sample (2018–2019). We compared the distributions of categorical variables using the Pearson χ2 test and continuous variables using an independent-samples t test in inpatients without versus with gender dysphoria. We used a logistic regression model to calculate the odds ratio (OR) to assess the demographic and comorbid characteristics of gender dysphoria with suicidal behaviors. Results: The prevalence of codiagnosis of gender dysphoria in inpatients hospitalized for suicidal behaviors was 1.5%. Gender dysphoria was seen in a higher proportion of adolescents (68.2%), females (73.6%), those from high-income families (51.7%), and those from metropolitan counties (88.8%). The prevalent psychiatric comorbidities in inpatients with gender dysphoria included anxiety disorders (63.6%), posttraumatic stress disorder (PTSD; 28.2%), and neurodevelopmental disorders (27.4%). Comorbidities including somatic disorders (OR = 2.30), eating disorders (OR = 1.95), obsessive-compulsive disorder (OR = 1.71), anxiety disorders (OR = 1.59), PTSD (OR = 1.32), and neurodevelopmental disorders (OR = 1.17) increased the likelihood of codiagnoses of gender dysphoria. Conclusions: There exists a high prevalence of psychiatric comorbidities in those with gender dysphoria and hospitalized for suicidal behavior. Our findings call for prompt evaluations of comorbidities of suicidal behaviors among adolescents and youth with gender dysphoria to provide a coordinated approach to suicide prevention, thereby reducing the future risk of poor health outcomes and mortality.

Psychiatric comorbidities in patients with conversion disorder – A longitudinal study

ABSTRACT Background: The word conversion refers to the substitution of a somatic symptom for a repressed idea. The conversion disorder indicates the absence of organic disease or disproportionately small disease compared with the complaint. Methodology: Ninety-six patients of conversion were screened for psychiatric comorbidities and followed up for a period of 6 months. Results: There was significant number of different psychiatric illnesses among the patients and positive correlation also with duration of illness in subsequent follow-ups. Conclusion: Our study highlights the significantly high prevalence of psychiatric comorbidities in patients of conversion disorder in first and follow-up visits with major depressive disorder being the most common one. The propensity to wait for comorbid psychiatric symptoms in conversion disorder to become florid might be unproductive. Early intervention can forestall progression into potentially chronic psychiatric illness.

Unraveling the Complex Nexus of Chronic Spontaneous Urticaria: Immunological, Infectious and Psychosomatic Dimensions

Chronic Spontaneous Urticaria (CSU) is a complex dermatologic allergic condition characterized by unknown origins, frequent relapses, and resistance to therapy, contributing to a substantial psychosocial burden. Stressful experiences appear to coincide with CSU onset and exacerbation, suggesting a psychosomatic element within a psychoneuroimmunological framework. The condition significantly impairs patients’ quality of life, disrupting daily activities and exhibiting a high prevalence of psychiatric comorbidities. Recent theories propose autoantibodies activating mast cells as a potential key factor in CSU development. Psychological stress is considered both a trigger for CSU onset and a factor influencing the disease course and therapy effectiveness. Although the skin’s response mechanisms to psychological stress are not fully understood, inflammatory mediators, neuropeptides, and neurotransmitters are believed to play a role. Chronic Spontaneous Urticaria (CSU) is estimated to impact 0.5–1% of the global population at any given time, making up approximately two-thirds of all Chronic Urticaria (CU) cases. Among individuals with CSU/CIU, it is suggested that 33–67% experience both itchy welts and deeper skin swelling, while 29–65% solely have itchy welts, and 1–13% exclusively experience deeper skin swelling. Despite extensive research on the clinical aspects and origin of CSU/CIU in the last decade, the comprehensive understanding of the humanistic and economic implications of CSU/CIU remains unclear, especially for those with an inadequate response to initial treatment strategies. Research indicates that infections act as a facilitating factor for CSU initiation and perpetuation, with stress potentially necessary for the expression of the CSU phenotype. Detection and treatment of hidden infections have shown improvements in CSU patients, reinforcing the association between infections and CSU. A comprehensive, multidisciplinary approach that considers biological, psychological, and social aspects is emphasized for effective urticaria treatment. Current research underscores the significant psychological impact of CSU, particularly for individuals with more severe forms or those diagnosed with chronic autoimmune urticarial.

Methylation of the serotonin reuptake transporter gene and non-motor symptoms in dystonia patients

BackgroundDystonia is a rare movement disorder, in which patients suffer from involuntary twisting movements or abnormal posturing. Next to these motor symptoms, patients have a high prevalence of psychiatric comorbidity, suggesting a role for serotonin in its pathophysiology. This study investigates the percentage of DNA methylation of the gene encoding for the serotonin reuptake transporter (SLC6A4) in dystonia patients and the associations between methylation levels and presence and severity of psychiatric symptoms.MethodsPatients with cervical dystonia (n = 49), myoclonus dystonia (n = 41) and dopa-responsive dystonia (DRD) (n = 27) and a group of healthy controls (n = 56) were included. Psychiatric comorbidity was evaluated with validated questionnaires. Methylation levels of 20 CpG sites situated 69 to 213 base pairs upstream of the start codon of SLC6A4 were investigated. Methylation in dystonia patients was compared to healthy controls, correcting for age, and correlated with psychiatric comorbidity.ResultsBootstrapped quantile regression analysis showed that being a dystonia patient compared to a healthy control significantly explains the methylation level at two CpG sites (CpG 24: pseudo-R2 = 0.05, p = 0.04, CpG 32: pseudo-R2 = 0.14, p = 0.03). Subgroup analysis revealed that being a DRD patient significantly explained a part of the variance of methylation levels at two CpG sites (CpG 21: pseudo-R2 = 0.03, p = 0.00, CpG 24: pseudo-R2 = 0.06, p = 0.03). Regression analysis showed that methylation level at CpG 38 significantly explained a small proportion of the variance of severity score for anxiety (R2 = 0.07, p = 0.04) and having a diagnosis of depression (Nagelkerke R2: 0.11, p = 0.00). Genotype of the 5-HTTLPR polymorphism had no additional effect on these associations.ConclusionsThis study showed an association between percentage of methylation at several specific sites of the promoter region of SLCA64 and (dopa-responsive) dystonia patients compared to healthy controls. Furthermore, methylation levels were associated with severity of anxiety and presence of a depressive disorder in the dystonia group. This study suggests alterations in the serotonergic metabolism in dystonia patients, and its relation with the non-motor symptoms.

Guselkumab for the treatment of severe plaque psoriasis in a schizophrenia patient.

A wide range of comorbid conditions are associated with psoriasis, many studies have drawn attention to a higher prevalence of psychiatric comorbidities in psoriatic population. Herein, we present a case of a Caucasian 44-years-old man suffering from a severe schizophrenia, who received guselkumab (a human monoclonal antibody targeting the p40 subunit of IL-23) for the treatment of a moderate-to-severe plaque type psoriasis. After 3 months, the patient reached complete resolution of psoriasis without any side effects, maintained at 6 months follow up visit. Some studies have highlighted the hypothesis that an hyperactivation of immune response appears to be one of the main mechanisms underlying the increased risk of this association. In particular, the axis il-17/il-23 plays a central role in the pathogenesis of this disease. Further research will be needed to assess whether anti-IL23 drugs could be a more suitable therapeutic option in psoriatic patients with schizophrenia.

Disease Characteristics and Psychiatric Comorbidities in Adolescents with Anorexia Nervosa Hospitalized During COVID-19 Pandemic

Since the beginning of COVID-19 pandemic, an increase in new diagnoses and pediatric hospital admission for anorexia nervosa (AN) or atypical AN in adolescents have been reported, suggesting an adverse effect of COVID-19 on youth mental health. We hypothesized possible differences in prevalence of hospitalization and/or disease severity, related to socio-economic status and/or ethnicity. Retrospectively, patients were divided into two subgroups and compared according to the date of first hospital admission: "pre SARS-COV2 era" group (n. 45, 8th March 2016-8th March 2020) and "SARS-COV2 era" group (n. 43, 9th March 2020-8th March 2022). During the two years of the SARS-COV2 era, we reported an increase in hospital admission incidence more than doubled respect to the "pre-SARS-COV2 era". The "SARS-COV2 era group" showed a more rapid weight loss (p = 0.005), a minor duration of weight loss from lifetime maximum to admission (p = 0.019) and needed most frequently treatments with intravenous fluids (p < 0.0001), oral dietetic supplements (p <0.001) and enteral nutrition by nasogastric tube (p = 0.002). The same group presented higher prevalence of psychiatric comorbidities (63% vs. 22%, p < 0.0001) and required most frequently treatments with psychotropic drugs (56% vs. 24%, p = 0.002). We found higher family socioeconomic status (SES) in our patients with AN in both the periods and we did not find a shift in social class distribution over time. Our study confirms a significant increase in incidence of hospitalization and of psychiatric comorbidity in the pediatric population with AN during the second year of COVID-19 pandemic, regardless of SES or ethnic background. Further studies are needed to understand potential mechanisms that during COVID-19 pandemic trigger eating disorder symptoms.

Pharmacological strategies for post-traumatic stress disorder (PTSD): From animal to clinical studies

Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition with a critical familiar, personal, and social impact. Patients diagnosed with PTSD show various symptoms, including anxiety, depression, psychotic episodes, and sleep disturbances, complicating their therapeutic management. Only sertraline and paroxetine, two selective serotonin reuptake inhibitors, are approved by different international agencies to treat PTSD. In addition, these drugs are generally combined with psychotherapy to achieve positive results. However, these pharmacological strategies present limited efficacy. Nearly half of the PTSD patients do not experience remission of symptoms, possibly due to the high prevalence of psychiatric comorbidities. Therefore, in clinical practice, other off-label medications are common, even though the effectiveness of these drugs needs to be further investigated. In this line, antipsychotics, antiepileptics, adrenergic blockers, benzodiazepines, and other emerging pharmacological agents have aroused interest as potential therapeutic tools to improve some specific symptoms of PTSD. Thus, this review is focused on the most widely used drugs for the pharmacological treatment of PTSD with a translational approach, including clinical and preclinical studies, to emphasize the need to develop safer and more effective medications.This article is part of the Special Issue on ‘Fear, anxiety and PTSD’.