High Rates Of Comorbid Disorders Research Articles

The clinical picture of bipolar affective disorders in children and adolescents hospitalized at the psychiatric ward in Sosnowiec.

To determine the clinical picture of bipolar affective disorders (BD) in children and adolescents hospitalized at the Clinical Ward of Developmental Age Psychiatry and Psychotherapy (DAPP) in Sosnowiec, Poland. Documentation analysis of 288 BD patients below 18 years of age. Detailed clinical and demographic data were collected and symptoms present during hospitalization were assessed. The mean age of illness onset was 13.6 ± 1.7 years. A total of 86.5% of the studied individuals received a first diagnosis different from BD/mania, and the average time until the proper diagnosis was 16.9 months. In 45.5% the first episode was depression with varied severity, in 29.2% a mixed episode and in 25.3% mania/hypomania. In 48.6% comorbid disorders were present. The most frequent reason for hospitalization was a mixed episode (47.6%). Among the symptoms, irritability was observed in over 80% of patients with mania or mixed episodes, but also in 60% of patients with depression. Suicidal thoughts were experienced by almost all the depression patients, 84.7% in the mixed episode and also 52.6% in mania/hypomania episode. Anxiety was mostly present in depression (40.7%) and mixed episode (22.6%), while moodcongruent delusions in depression and mania (around 20% of cases). Aggressive behaviours were manifested in around half of patients with mania and a mixed episode. In the studied population of children and adolescents, BD usually started with a depression episode accompanied by a high rate of comorbid disorders and in most cases there was an original misdiagnosis. Study results also point to a significant frequency of some pathological symptoms in this population.

Sex differences in frailty manifestations in patients with coronary artery disease

Aim. To analyze the differences in detection rate of prefrailty and frailty syndrome (FS) in male and female patients with multivessel coronary artery disease (CAD) undergoing elective coronary artery bypass grafting (CABG).Material and methods. The study included 387 patients admitted for elective primary CABG. Screening for prefrailty and FS in patients before surgery was performed using the questionnaire "Age is not a drawback".Results. In the age group of 45 to 59 years, 25% of females and only 6% of males had signs of FS, while 25% of women and 34% of men did not present with signs of frailty and prefrailty. Half of middle-aged women and 60% of middle-aged men had prefrailty. Between the ages of 60 and 74, only 14% of women and 24% of men were not frail. Elderly women are more likely than elderly men to present with signs of FS (p=0,040). The symptoms of prefrailty in elderly patients were detected at equal rate in men and women (59% and 60%, respectively). All senile-aged patients presented with the signs of prefrailty or FS.Conclusion. Patients with multivessel CAD present with manifestation of frailty in senile, elderly, and middle age. At the same time, middle-aged and elderly women with the higher rates of comorbid disorders require special attention.

Modular-based psychotherapy (MoBa) versus cognitive–behavioural therapy (CBT) for patients with depression, comorbidities and a history of childhood maltreatment: study protocol for a randomised controlled feasibility trial

IntroductionIn depression treatment, most patients do not reach response or remission with current psychotherapeutic approaches. Major reasons for individual non-response are interindividual heterogeneity of etiological mechanisms and pathological forms, and...

Comorbidities Associated With Attention-Deficit/Hyperactivity Disorder in Children and Adolescents at a Tertiary Care Setting.

Studies have revealed high rates of neurodevelopmental and psychiatric comorbid conditions among individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD). However, research on this topic in the Arab world has been limited. This study evaluates the medical, neurodevelopmental, and psychiatric comorbidities in children and adolescents diagnosed with ADHD in Dubai, United Arab Emirates (UAE). A total of 428 pediatric patients diagnosed with ADHD were included. Children and adolescents with ADHD had high rates of comorbid disorders. Twenty comorbid conditions were identified. More than 3 quarters of the study sample had at least 1 comorbid disorder. The most common comorbidity among children was autism spectrum disorder, and among adolescents was anxiety disorders. Comprehensive assessments are highly warranted to identify and manage associated comorbid conditions. Further research is needed in exploring the biopsychosocial factors contributing to the elevated rate of comorbidity in children and adolescents with ADHD.

Clinical and criminal profile of internet offenders with ASD

Purpose Autism-specific characteristics have been associated with internet criminal activities. Internet and non-internet offenders differ on a series of demographic, psychological and offending variables. However, the clinical and criminal presentation of individuals with autism spectrum disorder (ASD) in forensic secure care settings has been underexplored. This paper aims to explore the profiles of internet offenders with ASD admitted to a secure psychiatric unit. Design/methodology/approach This study provides the results of a service evaluation of individuals with ASD. The demographic, clinical and criminal characteristics of a small sample of internet offenders with ASD admitted to secure care are described and discussed. Findings Internet offenders present in secure care with high rates of comorbid disorders, histories of violence and traumatic experiences, mood disorders and difficulties with relationships. Of the 24 internet offenders discussed, 18 of them committed an offence of a sexual nature involving children. Originality/value This paper highlights the potential risks for individuals with ASD in using the internet and the possible difficulties associated with detecting this because of rapid advancements in technology.

Application of a staging model in patients with obsessive-compulsive disorder: cross-sectional and follow-up results.

Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition with frequent chronic course. Staging models applied to psychiatric disorders seek to define their extent of progression at a particular time-point and differentiate early, milder clinical phenomena from those characterizing illness progression and chronicity. In OCD patients, a staging model has been recently proposed but not tested yet. This was the aim of the present study. From an overall sample of 198 OCD patients, recruited across two psychiatric clinics in Northern Italy, 70 patients on stable treatment completed a follow-up assessment ranging from 12 to 24months. At follow-up initiation, patients had been divided into four staging groups, according to the model proposed by Fontenelle and Yucel. At the end of the follow-up, patients were subdivided into three groups (no stage change, improved stage, or worsened stage) compared with statistical analyses. At the end of the follow-up, 67.1% patients showed no stage changes, 24.3% a stage improvement, and 8.6% a stage progression. Worsened patients showed higher rates of comorbid disorders and higher rates of unfavorable employment characteristics compared to the other subgroups (P<.05). Patients with worsened stage showed higher prevalence of somatic obsessions (P<.05), while patients with improved stage showed higher rates of magical thinking and violence/harm obsessions compared to other groups (P<.05). The present results provide epidemiologic and clinical correlates of the first application of a staging model in a sample of OCD patients, encouraging further studies to assess the utility of this approach in the field.

PSYCHIATRIC COMORBIDITY AND SLEEP PROBLEMS IN CHILDREN AND ADOLESCENTS WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER IN RELATION TO ATTENTION DEFICIT HYPERACTIVITY DISORDER PRESENTATION, AGE AND GENDER

Objective: This study aimed to investigate psychiatric comorbidity and sleep problems and their relationships with ADHD presentation, age and gender in a clinical sample of children and adolescents with ADHD. Material and Method: One hundred fifty-four subjects aged 6-17 were included in the study. A semi-structured diagnostic interview was conducted to screen psychiatric disorders. The Child Depression Inventory (CDI), Screen for Child Anxiety Related Emotional Disorders (SCARED) and Children’s Sleep Habits Questionnaire (CSHQ) were used to investigate internalizing difficulties and sleep problems. Results: Overall high rates of comorbid disorders (78%) and sleep problems (97%) were found. ADHD-C was significantly more frequent in males and ADHD-I was more frequent in females (p&lt;0.001). While oppositional defiant disorder (ODD), enuresis and encopresis were more frequent in subjects with ADHD-C (p&lt;0.05), generalized anxiety (GAD) and social anxiety (SAD) disorders were more frequent in subjects with ADHD-I (p&lt;0.05). Females, compared to males, had more frequent diagnoses of depression (p=0.021) and SAD (p=0.03). The majority of subjects (96.7%) scored above the cut off score of 41 in CSHQ (50.51±5.86). The ADHD-C group had significantly higher CSHQ total scores than the ADHD-I group (p&lt;0.05). There was a significant positive correlation between CSHQ total scores and the number of lifetime comorbid diagnoses (p=0.006), self-reported anxiety (p=0.009) and depressive (p=0.004) symptoms. Conclusion: Comorbidity and sleep problems may be common in young people with ADHD and may have complex reciprocal relations with several factors including ADHD presentation, age, and gender.

Trial-Based Cognitive Therapy: Efficacy of a New CBT Approach for Treating Social Anxiety Disorder with Comorbid Depression

The present study aims to evaluate the efficacy of Trial-Based Cognitive Therapy (TBCT), a new cognitive-behavioral therapy approach, for generalized social anxiety disorder (GSAD) in a population with high rates of comorbid disorders, especially depression. This two-arm randomized clinical trial included 39 adults (TBCT = 18; waitlist group = 21) diagnosed with GSAD. The TBCT group received 16 weekly sessions of individual TBCT. Symptom severity was assessed at pre- and post-treatment. Participants in the TBCT group showed reduction in social anxiety, social avoidance, and depression, all associated with a large effect size. No differences between pre- and post-treatment scores were observed in the waitlist condition. Results also showed that comorbidity significantly moderated treatment efficacy. Patients with comorbid conditions showed greater reductions in social anxiety symptoms across treatment than those with SAD only. In summary, TBCT was effective in reducing social anxiety and depressive symptoms, particularly for patients with comorbidity.

Mental health of perpetrators of intimate partner violence

PurposeIntimate partner violence (IPV) represents a widespread social and public health problem. Researchers have been shown association between IPV and mental health problems. The purpose of this paper is to present a review of the literature on relationship between wide ranges of mental health problems.Design/methodology/approachResearch papers related to mental health problems among IPV perpetrators and published in leading academic journals in UK and abroad from 1987 to 2017 were identified and reviewed.FindingsAlthough there were some equivocal findings, the authors found that most of the available research suggests that there is a variety of psychological health problems among IPV perpetrators. Specifically, there was evidence of a significant relationship between anger problems, anxiety, depression, suicidal behaviour, personality disorders, alcoholism or problem gambling and perpetration of IPV. Results from analysed studies identified high rates of co-morbid disorders in IPV perpetrators.Practical implicationsThe findings highlight the need for treatment services to undertake screening and assessment of wide range of psychological difficulties to be able to provide best treatment approaches.Originality/valueTo the best of our knowledge, this is the first systematic review that has included studies evaluating various psychological health problems among perpetrators of IPV.

Comorbid psychiatric disorders in a clinical sample of adults with ADHD, and associations with education, work and social characteristics: a cross-sectional study

ObjectivesAdults with attention-deficit hyperactive disorder (ADHD) report high rates of comorbid disorders, educational and occupational failure, and family instability. The aim of this study was to examine the prevalence of...

Attention-deficit/hyperactivity disorder (ADHD) in adult psychiatry: Data on 12-month prevalence, risk factors and comorbidity

To examine the 12-month prevalence, risk factors, and comorbidity of ADHD in a collective of adult psychiatric patients admitted to an open general ward in a psychiatric hospital in Schleswig-Holstein (Germany) over a period of one year (n = 166). The 12-month prevalence of ADHD was 59.0 % (severe symptomatology: 33.1 %), high rates of comorbid disorders (92.9 % depression, 5.1 % bipolar disorder, 28.6 % anxiety disorder, 30.6 % emotional unstable (Borderline) personality disorder, 31.6 % avoidant personality disorder, 18.4 % dependent personality disorder, 25.5 % combined personality disorder, 10.2 % obsessive-compulsive personality disorder, 26.5 % PTSD, 25.5 % restless legs syndrome, 24.5 % adiposity, 11.2 % eating disorder, 45.9 % learning difficulty, 51.0 % nicotine dependency, 4.1 % alcohol dependency, 7.1 % illegal substance dependency), risk factors for ADHD, a high genetic risk (72.4 %) and problems in psychosocial functioning. Because of the high prevalence of ADHD in hospitalized psychiatric patients, it is mandatory to examine these for the presence of ADHD using questionnaires and identify comorbid diseases.

5.51 Examining the Clinical Profile of Adolescents With Bipolar Disorder Who Have Attempted Suicide

The suicide rate among people with bipolar disorder (BD) is 10-fold greater than the general population, and early onset of illness is associated with an increased risk for suicide attempts (SA) in adults. Up to one third of youth with BD have a history of SA, which is associated with higher rates of comorbid disorders, self-injurious behavior (SIB), psychiatric hospitalization, and a family history of suicide attempts. This study sought to expand on previous research on this important topic.

Medical and Psychiatric Comorbidities in Korean Children and Adolescents with Attention-Deficit/Hyperactivity Disorder.

ObjectiveAttention-deficit/hyperactivity disorder (ADHD) is associated with a high rate of comorbid disorders. We aimed to investigate the medical and psychiatric comorbidities of Korean children and adolescents with ADHD.MethodsData were obtained from Korean National Health Insurance Review and Assessment Service-National Patient Sample (HI-RA-NPS) for 2011. We included 2,140 (mean age, 10.9±3.1 years; boys, 1,710) and 219,410 (non-ADHD; mean age, 12.4±3.7 years; boys, 113,704) children and adolescents with and without ADHD, respectively. We compared medical and psychiatric comorbidities between the groups, and performed weighted logistic regression analyses to obtain odds ratios (ORs) and 95% confidence intervals (CIs).ResultsMost medical comorbidities were more likely in patients with ADHD and included nervous system disease (OR, 2.59; 95% CI, 2.52–2.66); endocrine, nutritional, and metabolic disease (OR, 2.09; 95% CI, 2.04–2.15); and congenital malformations, deformations, and chromosomal abnormalities (OR, 2.00; 95% CI, 1.90–2.11). Oppositional defiant disorder and conduct disorder were more prevalent in patients with ADHD (OR, 81.88; 95% CI, 79.00–84.86), followed by learning (OR, 75.61; 95% CI, 69.69–82.04), and depressive disorders (OR, 55.76; 95% CI, 54.44–57.11).ConclusionOur results suggest that Korean children and adolescents with ADHD are more likely to suffer medical and psychiatric comorbidities than those without ADHD.

Psychiatric Comorbidity and Hoarding Symptoms in African Americans With Obsessive-Compulsive Disorder

This study investigated comorbidity and hoarding symptoms in a sample of African American adults with obsessive-compulsive disorder ( N = 75). For lifetime disorders, 87.9% of participants had at least one other comorbid condition. The most prevalent comorbidities were mood disorders (67.1%), anxiety disorders (51.4%), and substance abuse disorders (38.0%). There was low comorbidity with eating disorders, as only 4.1% had binge-eating disorder and none met criteria for anorexia or bulimia nervosa. In terms of gender differences, females were more likely to have posttraumatic stress disorder and males were more likely to have a comorbid alcohol use disorder. Over half of the participants had hoarding compulsions (56.0%) as indicated by the Yale-Brown Obsessive-Compulsive Scale. Individuals with hoarding compulsions were more likely to have comorbid anxiety-related disorders than those without, and experienced greater indecisiveness, pathological slowness, and doubting; they also had less education and earning power than those without these behaviors. African Americans with obsessive-compulsive disorder tend to have high rates of comorbid disorders, with patterns that resemble findings in non-Hispanic White populations.

Socioeconomic status and intelligence quotient as predictors of psychiatric disorders in children and adolescents with high-functioning autism spectrum disorder and in their siblings.

Previous studies have shown high rates of comorbid disorders in children and adolescents with autism spectrum disorder, but failed to compare them with general population and few of them have identified predictors of comorbidity. This study compared the rates of psychiatric disorders in 50 children and adolescents with autism spectrum disorder, 24 of their siblings, 32 controls from general population and 22 of their siblings. Children and adolescent with autism spectrum disorder and their siblings had higher rates of attention deficit and hyperactivity disorder compared to controls. Lower socioeconomic status and intelligence quotient were the main risk factors. The contribution of socioeconomic status and intelligence quotient to increase the risk of developing comorbidity in autism spectrum disorder and psychopathology in their siblings deserves further study.

Association of attention-deficit/hyperactivity disorder with gambling disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a frequent mental disorder with childhood onset and high persistence into adulthood. There is much evidence that ADHD increases the risk for the development of other psychiatric disorders and functional problems in several domains of everyday life. In this study, the association of ADHD with gambling disorder (GD) was investigated. 163 adult subjects suffering from GD were examined for childhood and current ADHD according to DSM-5 as well as co-morbid psychiatric disorders. Moreover, characteristics of gambling behavior have been evaluated. The prevalence of lifetime ADHD was 28.8%, with 25.2% of the study population presenting ADHD as a full syndrome according to DSM-5. The prevalence of co-morbid substance use disorders and adjustment disorders and cluster B personality disorders was higher in GD patients with current ADHD than in the group without. Also, an increased rate of suicide attempts was detected in gamblers with ADHD. In contrast with gamblers without ADHD, those with ADHD were reported to spend more time with gambling, a sedative effect of gambling and a faster development of GD. The high prevalence of ADHD in patients with GD indicates that childhood ADHD is a risk factor for the development of GD in later life. Moreover, treatment of patients with GD and ADHD is complicated by a high rate of co-morbid disorders. Regarding therapeutic approaches, it should be considered that functional aspects of gambling differ in GD patients with and without ADHD.

Characterizing the daily life, needs, and priorities of adults with autism spectrum disorder from Interactive Autism Network data.

Using online survey data from a large sample of adults with autism spectrum disorder and legal guardians, we first report outcomes across a variety of contexts for participants with a wide range of functioning, and second, summarize these stakeholders' priorities for future research. The sample included n = 255 self-reporting adults with autism spectrum disorder aged 18-71 years (M = 38.5 years, standard deviation = 13.1 years) and n = 143 adults with autism spectrum disorder aged 18-58 years (M = 25.0 years, standard deviation = 8.2 years) whose information was provided by legal guardians. Although the self-reporting subsample had much higher rates of employment, marriage/partnership, and independent living than are typically seen in autism spectrum disorder outcome studies, they remained underemployed and had strikingly high rates of comorbid disorders. Data on both descriptive outcomes and rated priorities converged across subsamples to indicate the need for more adult research on life skills, treatments, co-occurring conditions, and vocational and educational opportunities. Stakeholders also placed priority on improving public services, health care access, and above all, public acceptance of adults with autism spectrum disorder. Findings must be interpreted in light of the self-reporting subsample's significant proportion of females and of later-diagnosed individuals. This study underscores the need for lifespan research; initiatives will benefit from incorporating information from the unique perspectives of adults with autism spectrum disorder and their families.

Clinical and sociodemographic characteristics of hospitalized psychiatric patients with intellectual disability

Objectives:Intellectual disability (ID) is a critical healthcare and social issue that requires more effective and efficient programmes to enhance the health, independence, and quality of life for these patients; this requires accurate assessment of the clinical and socio-demographic characteristics of both paediatric and adult patients with ID seeking medical treatment. However, little data regarding this are available in several countries, including Turkey.Methods:All patients with ID hospitalized between January 2012 and June 2012 because of any psychiatric complaint were enrolled. Data for this cross-sectional study were collected by retrospectively reviewing medical records. Case severity was determined on the basis of Wechsler Adult Intelligence Scale or Wechsler Intelligence Scale for Children conducted once patients were stabilized.Results:In total, 84 patients were included (mean age: 23·85±9·71 years; 28 females, 56 males). The most commonly reported symptoms during recent hospitalization in the study period were aggression or excitation (77·4%), disruptive behaviour (71·4%), sleep disturbances (38·1%), hallucinations (33·3%), and delusions (25·0%). The most common comorbidity was disruptive behaviour disorder ‘not otherwise specified’ (31·0%).Conclusions:Behavioural problems are common in hospitalized patients with intellectual disabilities, presenting unique challenges for diagnosis and treatment. The generally high rate of comorbid disorders ‘not otherwise specified’ suggests significant problems in accurate diagnosis of various psychiatric illnesses in this patient group.

Relationship of Obsessive-Compulsive Disorder to Age-Related Comorbidity in Children and Adolescents With Tourette Syndrome

Attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are the 2 most frequent psychiatric disorders co-occurring with Tourette syndrome (TS). Both usually cause greater impairment in psychosocial functioning than the tics themselves. In a previous study, we examined the relationship of attention-deficit/hyperactivity disorder to other comorbid conditions in TS. The relationship of OCD to other comorbidities in TS still remains unclear and is the focus of the present study. Pearson's χ tests and logistic regressions (year-wise) were used to examine a cross-sectional sample of children and adolescents (n = 5060) diagnosed with TS, taken from the Tourette Syndrome International Database Consortium. We explored the relationship of OCD to other comorbid conditions in TS across different age groups. In children (ages 5-10 y) with TS, higher rates of comorbidities were found in the presence compared with the absence of OCD. Adolescents (ages 11-17 y) with TS + OCD showed higher rates of internalizing (i.e., anxiety and mood) disorders when compared with those with TS - OCD. A year-wise increase of coexisting mood disorders was found for subjects with TS with and without OCD. Overall, children and adolescents with TS + OCD showed higher rates of comorbid disorders compared with those with TS - OCD. This underlines the necessity for a comprehensive assessment of additional comorbidities even if the 2 disorders (TS + OCD) have already been diagnosed.

Phenotypic and measurement influences on heritability estimates in childhood ADHD

Twin studies described a strongly heritable component of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. However, findings varied considerably between studies. In addition, ADHD presents with a high rate of comorbid disorders and associated psychopathology. Therefore, this literature review reports findings from population-based twin studies regarding the influence of subtypes, assessment instruments, rater effects, sex differences, and comorbidity rates on ADHD heritability estimates. In addition, genetic effects on the persistence of ADHD are discussed. By reviewing relevant factors influencing heritability estimates more homogeneous subtypes relevant for molecular genetic studies can be elicited. A systematic search of population-based twin studies in ADHD was performed, using the databases PubMed and PsycInfo. Results of family studies were added in case insufficient or contradictory findings were obtained in twin studies. Heritability estimates were strongly influenced by rater effects and assessment instruments. Inattentive and hyperactive-impulsive symptoms were likely influenced by common as well as specific genetic risk factors. Besides persistent ADHD, ADHD accompanied by symptoms of conduct or antisocial personality disorder might be another strongly genetically determined subtype, however, family environmental risk factors have also been established for this pattern of comorbidity.