Impact Of Psychiatric Comorbidity Research Articles

Prevalence and Impact of Psychiatric Co-Morbidity in Patients with Spinal Pathology in Basrah, Iraq

Background and objective: to minimize complications by proper selection of patients for surgery and to evaluate what is the impact of psychiatric co-morbidity in patients admitted to a spinal surgical unit in Basrah, Iraq. Patients and Methods: A multi-center cross-sectional prospective cohort study was conducted on 247 patients. In Basrah province. During admission complete history was taken in form of identity, complaint, past medical and surgical history, drug history, type of previous and the coming surgery and lastly special emphasis on the questioner to assess patient psychological status using the Patient Health Questioner. Somatic Anxiety Depressive Symptoms (PHQ.SADS) After one week and one-month the same questions were addressed to the patient to check the general condition,and any complications or readmission. Results: Out of the 247 patients: Eight patients refuse to be part of this study, thirty-one patients lost follow up, three patients excluded from the study due to exclusion criteria, five patients their surgery postponded because they were psychologically unstable and advised for psychiatrist consultation. 111 patients (55.5%) of the sample size were male patients. A 90 (45%) patients were at age of 38-57 years, 111 (55.5%) of the sample were male 82 patients (41%) were of moderate degree using the PHQ.SADS. 62 patients (31%) were within the severe scale PHQ.SADS.132 patients (66%) complained from radiculopathy with or without backache,192 (96%) patients discharged safely postoperatively. 41(39.4%) patients were diagnosed with lumber canal stenosis belongs to the severe group. Psychological break down occurs in 10 (5%) patients, 9 (90%) of those patients belong to severe grade category of PHQ.SADS. Conclusion: There was a strong association between pre-operative psychological conditions and post-operative complications in form of repeated visit after surgery and persistence of pain and disability.

D11. The Impact of Psychiatric Comorbidities on Outcomes and Quality of Life in Plastic Surgery Patients

D11. The Impact of Psychiatric Comorbidities on Outcomes and Quality of Life in Plastic Surgery Patients

The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysis

The burden of psychiatric symptoms in Parkinson's disease includes depression, anxiety, apathy, psychosis, and impulse control disorders. However, the relationship between psychiatric comorbidities and subsequent prognosis and neurological outcomes is not yet well understood. In this systematic review and meta-analysis, in individuals with Parkinson's disease, we aimed to characterise the association between specific psychiatric comorbidities and subsequent prognosis and neurological outcomes: cognitive impairment, death, disability, disease progression, falls or fractures and care home admission. We searched MEDLINE, Embase, PsycINFO and AMED up to 13th November 2023 for longitudinal observational studies which measured disease outcomes in people with Parkinson's disease, with and without specific psychiatric comorbidities, and a minimum of two authors extracted summary data. Studies of individuals with other parkinsonian conditions and those with outcome measures that had high overlap with psychiatric symptoms were excluded to ensure face validity. For each exposure-outcome pair, a random-effects meta-analysis was conducted based on standardised mean difference, using adjusted effect sizes-where available-in preference to unadjusted effect sizes. Study quality was assessed using the Newcastle-Ottawa Scale. Between-study heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots. PROSPERO Study registration number: CRD42022373072. There were 55 eligible studies for inclusion in meta-analysis (n=165,828). Data on participants' sex was available for 164,514, of whom 99,182 (60.3%) were male and 65,460 (39.7%) female. Study quality was mostly high (84%). Significant positive associations were found between psychosis and cognitive impairment (standardised mean difference [SMD] 0.44, [95% confidence interval [CI] 0.23-0.66], I2 30.9), psychosis and disease progression (SMD 0.46, [95% CI 0.12-0.80], I2 70.3%), depression and cognitive impairment (SMD 0.37 [95% CI 0.10-0.65], I2 27.1%), depression and disease progression (SMD 0.46 [95% CI 0.18-0.74], I2 52.2), depression and disability (SMD 0.42 [95% CI 0.25-0.60], I2 7.9%), and apathy and cognitive impairment (SMD 0.60 [95% CI 0.02-1.19], I2 27.9%). Between-study heterogeneity was moderately high. Psychosis, depression, and apathy in Parkinson's disease are all associated with at least one adverse outcome, including cognitive impairment, disease progression and disability. Whether this relationship is causal is not clear, but the mechanisms underlying these associations require exploration. Clinicians should consider these psychiatric comorbidities to be markers of a poorer prognosis in people with Parkinson's disease. Future studies should investigate the underlying mechanisms and which treatments for these comorbidities may affect Parkinson's disease outcomes. Wellcome Trust, UK National Institute for Health Research (NIHR), National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at University College London Hospitals NHS Foundation Trust, National Brain Appeal.

The prevalence and impact of psychiatric comorbidities on hospitalized inflammatory bowel disease patients in the United States: insights from the National Inpatient Sample from 2009-2018.

Patients with inflammatory bowel disease (IBD) are at increased risk of anxiety and mood disorders. This study examines the temporal trends and clinical impact of anxiety and mood disorder diagnoses in hospitalized IBD patients in the United States during a 10-year period. Using the National Inpatient Sample from 2009-2018, all IBD-related discharges in adults were analyzed. Primary outcomes were the prevalence and temporal trends of mood disorder and anxiety diagnoses for IBD-related admissions. The impact of the psychiatric comorbidities on clinical outcomes was also evaluated. A total of 1,718,736 IBD-related discharged were identified. A diagnosis of anxiety or a mood disorder was found to have a prevalence of 16.44% and 18.97%, respectively, amongst IBD-related admissions. The prevalence of anxiety disorders amongst hospitalized IBD patients increased significantly (from 12.13% to 20.26%), whereas the prevalence of mood disorders did not (17.46% and 18.9%). IBD admissions with psychiatric comorbidities had lower rates of IBD-related complications or mortality during hospitalization compared to IBD admissions without comorbid psychiatric diagnoses. This population, however, was more likely to experience certain comorbidities such as Clostridioides difficile, pneumonia, and venous thromboembolism, as well as a longer hospitalization. The prevalence of comorbid anxiety among hospitalized IBD patients in the United States matches or exceeds the prevalence of anxiety in the general hospitalized population. Given its association with more in-hospital complications and a longer hospital stay, it is important to further understand how psychological screening and mental health services can improve the management of hospitalized IBD patients.

Impact of Psychiatric Comorbidity on Readmissions of Sickle Cell Disease -a Nationwide Readmissions Database Study

Introduction: While advances in the management of sickle cell disease (SCD) treatment have improved outcomes, readmission rates among patients remain a significant concern. A previous study with the National Readmission Database (NRD) 2016 found that alcohol use, tobacco use, opoid use ,substance use and depression were associated with SCD readmission even though the general rate of readmission has decreased over the years. This study aims to update the literature, and further determine the predictors associated with increased readmission among individuals with SCD. Methods: Using the Nationwide Readmissions Database (NRD), we evaluated readmissions for SCD for the year 2016-2020. On the basis of International Classification of Diseases, TenthRevision, Clinical Modification (ICD-10-CM) codes, we identified SCD hospitalizations (D57.0, D57.1, D57.2, D57.4, D57.8), and comorbid conditions. Usingamultivariateregressionanalysis,weestimatedtheindependent predictors of 30-day readmissions of SCD. We used STATA® Version 18.0 Software (STATACORP, TEXAS, USA) for analysis. The p-value was set at p < 0.05 for statistical significance. Results: A total of 262,571 index admissions for adult patients with a primary diagnosis of SCD were admitted within the study period; 61,687 patients (23.6%) were readmitted within 30 days. A total of 886 and 105 deaths were reported respectively among index admissions and readmissions. Compared to index admissions, readmissions had decreased THC of 2147 U.S. dollars (95%CI: -2678 - -1615), while we found no significant change in the LOS between index admissions and readmissions. Common causes of increased rate of readmissions were SCD with mood disorder (HR=1.15, 95%CI: 1.11-1.20) , anxiety disorder (HR= 1.16, 95%CI: 1.11-1.20) and opioid use (HR=1.42, 95%CI: 1.35-1.50). Conditions associated with lower rates of readmission are Alcohol use disorder (HR 0.76, 95%CI: 0.62-0.94) and cannabis use ( HR=0.94, 95%CI: 0.88-0.99). Discussion: Our findings suggest that among individuals admitted with a primary diagnosis of SCD, having concurrent mood and anxiety disorders, and opioid use disorder increases rates of readmission. Interestingly, we observed that alcohol use disorder and cannabis use was associated with lower rates of readmission in SCD patients. Optimizing the comorbid conditions in patients with SCD may reduce readmission rates. However, further studies are required to establish the relationship between psychiatric comorbidity and healthcare resources utilization among SCD patients.

Food and Development: Children and Adolescents with Neurodevelopmental and Comorbid Eating Disorders-A Case Series.

The impact of psychiatric comorbidities in the diagnosis and treatment of feeding and eating disorders (FEDs) represents an emerging research topic. The current literature, nonetheless, lacks studies investigating the developmental paths of individuals with FEDs and comorbid neurodevelopmental disorders (NDDs). Here, we report 11 cases of children and adolescents with comorbid FEDs and NDDs, as assessed along the neuropsychological, psychopathological, and nutritional developmental pathways. The onset of FED-related psychopathology was preceded, sometimes undiagnosed, by altered neurodevelopmental features leading to specific NDD diagnoses (autism spectrum disorder-ASD; attention-deficit/hyperactivity disorder-ADHD; specific learning disorder-SLD). NDDs appeared to influence the diagnoses and treatments of FEDs, frequently with an impact on socio-relational and emotional premorbid features, and on the possibility to receive and attend FED-targeted treatments. Further studies should longitudinally contribute to assessing the experiences of care and neurodevelopmental pathways of children with FEDs and specific NDD comorbidities.

The Impact of Psychiatric Comorbidities on Outcomes in Palliative and End-of-Life Care: A Systematic Review (FR223D)

The Impact of Psychiatric Comorbidities on Outcomes in Palliative and End-of-Life Care: A Systematic Review (FR223D)

The impact of psychiatric comorbidities on emergency general surgical patients’ outcomes

BackgroundPsychiatric disorders are increasingly prevalent. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with a number of worsening outcomes in hospitalised patients in general. The relationship between a wide range of psychiatric comorbidities and acute surgical presentations has not been studied to date. Study designThe Hospital In-Patient Enquiry (HIPE) system and prospectively maintained eHandover were used to identify all surgical emergency admissions to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), and procedures undergone were recorded over a 12-months period. Subgroup analyses examining LoS variation in surgical presentation types were performed. Results1028 admissions occurred over this one year period, amongst 995 patients, the presence of psychiatric comorbidities increased the mean LoS by 1.9 days (p = 0.002). Comorbid depression, dementia, and intellectual disability conferred a significant increase in LoS by 2.4 days, 2.8 days and 6.7 days respectively. Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = 0.019), skin and soft tissue infections (2.5 days, p = 0.040), bowel obstruction (4.3 days, p = 0.047), and medical disorders (18.6 days, p = 0.010). No significant difference was observed in mortality and readmission rates. ConclusionPsychiatric comorbidities significantly impact length of hospital stay and discharge planning in surgical inpatients. Greater awareness of this can facilitate better care delivery for this population to reduce the LoS and subsequent economic burden on the healthcare system.

Pre-Existing Anxiety and Depression in Injured Older Adults: An Under-Recognized Comorbidity With Major Health Implications.

Little is known about the prevalence and impact of psychiatric comorbidities on early postinjury depression and anxiety in nonneurologically injured older adults. This was a retrospective post-hoc analysis of data from the Trauma Medical Home, a multicenter randomized controlled trial (R01AG052493-01A1) that explored the effect of a collaborative care model on postinjury recovery for older adults compared to usual care. Nearly half of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9. Forty-one percent of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) had greater odds of at least mild depression at the time of hospital discharge after traumatic injury. Anxiety and depression are prevalent in the older adult trauma population, and affect women disproportionately. A dual diagnosis of depression and anxiety is particularly morbid. Mental illness must be considered and addressed with the same importance as other medical diagnoses in patients with injuries.

Psychiatric comorbidities among adult patients with disorders of gut-brain interaction: Prevalence and relationships to treatment outcomes.

Little is known about the impact of psychiatric comorbidity on pharmacologic treatment outcomes, including neuromodulators (medications targeting the gut-brain axis), among adult patients with disorders of gut-brain interaction (DGBI). Accordingly, we aimed to examine associations between psychiatric comorbidity and DGBI pharmacologic treatment outcomes. In a retrospective study of consecutively referred new patients (N=410; ages 18-90; 73% female) to a tertiary neurogastroenterology clinic in 2016 with follow-up through 2018, relationships between psychiatric illness (any psychiatric illness, anxiety disorders, depressive disorders) and pharmacologic treatment selection (any medication, neuromodulating medication) and treatment outcomes, respectively, were examined using multivariable logistic regression, adjusting for demographics, gastrointestinal (GI) diagnoses, and pre-existing neuromodulator use. Anxiety disorders (35%) were the most common psychiatric comorbidity, followed by depressive disorders (29%). Patients with anxiety disorders were more likely to be prescribed a neuromodulator by their gastroenterologist (OR=1.72 [95% CI 1.10-2.75]) yet less likely to respond to neuromodulators (OR=0.43 [0.21-0.90]) or any GI medication (OR=0.24 [0.12-0.50]) in fully adjusted analyses. In contrast, depressive disorders were not associated with neuromodulator prescription or response. Anxiety disorders are common among patients with DGBI and significantly reduce the likelihood of GI pharmacologic treatment response to any medication prescribed, including neuromodulators.

Abstract 11760: Depression Paradox for In-Hospital Cardiovascular Outcomes in Obstructive Sleep Apnea - A National Population-Level Analysis

Background: ​​Depression is a frequently encountered comorbidity in patients with Obstructive Sleep Apnea (OSA), with a higher prevalence than the general population. However, there is limited data on the impact of psychiatric comorbidities on the outcomes of OSA. Methods: We identified OSA hospitalizations using the National Inpatient Sample (2018) and relevant ICD-10 codes. After propensity score matching, demographics and comorbidities were compared between the two groups of OSA with (OSA-D+) vs without depression (OSA-D-). The odds of in-hospital outcomes between them were analysed using multivariable regression analyses. Results: Of the 2169730 OSA hospitalizations, 20.1% had comorbid depression. Matched cohorts included 846150 admissions in both groups - OSA-D+ and OSA-D-.The OSA-D+ cohort often consisted of younger (median age, 64 vs 65); females (55.5% vs 55.2%) with both cohorts predominantly including white, Medicare enrollees. The OSA-D+ cohort had significantly higher rates (all p<0.001) of comorbidities such as Hypertension (68.6% vs 64.6%); Diabetes (48.4% vs 47.4%); Hyperlipidemia (59.2% vs 53.5%); Congestive Heart Failure (21.7% vs 20.6%); Peripheral Vascular Disease (6.7% vs 6.3%); Anemia (22.4% vs 19.7%); Smoking (44.6% vs 41.8%); Substance abuse, prior MI,TIA/Stroke and Venous Thromboembolism compared to the OSA-D- group. Paradoxically, there was decreased all-cause mortality (OR:0.79, 95%CI 0.73-0.86), major adverse cardiac and cerebrovascular events (OR:0.83, 95%CI 0.80-0.87), acute MI (OR:0.80, 95%CI 0.76-0.85), dysrhythmia/AF (OR:0.81, 95%CI 0.79-0.83) and cardiac arrest including VF (OR:0.65, 95%CI 0.73-0.82) in the OSA-D+ cohort cohort during hospitalization (p<0.001). Conclusion: Despite having more comorbidities, OSA patients with depression were found to have better in-hospital outcomes. Further studies are required for a conclusive reason for this paradoxical effect of co-morbid depression.

Psychiatric comorbidity in the Baltimore ECA follow-up study: the matrix approach.

Psychiatric comorbidity is defined as the joint occurrence of two or more mental or substance use disorders. Widespread psychiatric comorbidity has been reported in treatment and population-based studies. The aim of this study was to measure the extent and impact of psychiatric comorbidity in a cohort of the Baltimore Epidemiologic Catchment Area study. We examined the comorbidity burden of 16 mental disorders in a cohort of 847 participants using both established and novel analytical approaches The Comorbidity to Diagnosis Inflation Ratio (CDIR), is a statistical instrument that quantifies impact of pairwise comorbid associations, both on the whole sample, as well as on each specific disorder. Most anxiety disorders had substantial co-occurrence with each other, as well as with Major Depressive Disorder (MDD). In addition, mood disorders had a high degree of comorbidity with Alcohol Dependence (AD). The CDIR for the whole sample was 1.32, indicating a ratio of 132 comorbidities per 100 diagnoses. The conditions with high sample prevalence were relatively less comorbid than the low prevalence conditions. Obsessive Compulsive Disorder had a comorbidity burden that was 89% greater than the overall sample. Anxiety disorders are highly interrelated, as well as highly comorbid with depression. The comorbidity phenomenon is linked to the differential prevalence of the analyzed conditions. Comorbidity frequency (most prevalent comorbid condition) appears mutually exclusive to comorbidity burden (most widely interrelated condition). While AD and MDD were the most frequently diagnosed disorders; low prevalence conditions as OCD and GAD were the most widely interrelated.

S517 Comorbid Psychiatric Conditions Are Associated With Increased Risk of Gastrointestinal Symptoms Following Successful Fecal Microbiota Transplantation for Clostridioides difficile Infection

Introduction: Fecal microbiota transplantation (FMT) is recommended forprevention of recurrent Clostridioides difficile infection (CDI). Our group has shown that irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have been associated with gastrointestinal symptoms following FMT. Additionally, psychiatric comorbidities (PC) are associated with functional gastrointestinal disorders. The impact of PC on gastrointestinal symptoms after FMT is unclear. Methods: This is a retrospective cohort study of patients who underwent successful FMT for recurrent CDI defined as absence of diarrhea or negative CDI testing 8 weeks following FMT. Data regarding CDI and psychiatric history were collected. Patients were assessed after FMT for CDI cure and gastrointestinal symptoms (abdominal pain, bloating, flatulence, loose stools, and constipation). The primary outcome was association of PC with any gastrointestinal symptom and secondary outcome was association of PC with the symptom of greatest significance on univariate analysis. Multivariate logistic regression with a priori dependent variables of IBS and IBD was performed for each outcome with a Bonferroni-adjusted P-value threshold of 0.025 for multiple hypothesis testing. Results: 158 patients who underwent a successful FMT were identified. PC were present in 31 (20%) patients, including anxiety (n=12), depression (n=11), bipolar disorder (n=1), post-traumatic stress disorder (n=2), or multiple diagnoses (n=5). Of these, 30 (96%) were prescribed psychotropic medication at time of FMT, 25 (80.7%) were female, and the median (IQR) age was 59 (40-73). No significant differences were present among clinical factors between patients with and without PC. On univariate analysis, patients with PC experienced any gastrointestinal symptom (67.7% vs 44.1%, P=0.02), abdominal pain (25.8% vs 4.7%, p < 0.001), and bloating (12.9% vs 3.2%, p = 0.03) at higher rates post FMT. Adjusted for pre-existing IBS and IBD, patients with PC were more likely to have any gastrointestinal symptoms (OR 2.67, 95% CI: 1.14-6.28), or just abdominal pain (OR 9.01, 95% CI: 2.48-32.71) following FMT. Conclusion: Gastrointestinal symptoms may develop following recurrent CDI even after cure is achieved with FMT. We find that PC are significantly associated with the presence of gastrointestinal symptoms such as abdominal pain following successful FMT. Patients should be assessed pre-FMT for PC so appropriate counseling can be performed.Table 1.: Predictors of Having Bloating in the Past Seven Days (N=88,969) Note: Data are presented as n (% of row). The logistic regression model adjusted for all variables listed in the table, as well as age, gender, race/ethnicity, BMI, education level, marital status, employment status, total household income, tobacco use, alcohol use, US region, insurance status, COVID positive status, self-reported comorbidities diagnosed by physician (GI cancer, celiac disease, cirrhosis, Crohn's disease, diabetes, diverticulitis, endometriosis, fibromyalgia, gastroenteritis, gastroparesis, HIV, multiple sclerosis, pancreatitis, Parkinson's disease, peptic ulcer disease, thyroid disease). 'a' Symptoms in the past seven days

13.3 The Impact of Psychiatric Comorbidities in Transition of Care for Adolescents with Epilepsy

Transition from pediatric to adult care is important for patients with special health care needs, who overall have greater mental health needs. This study explores transition perceptions among parents of children and youths with epilepsy (CYEs). We examined correlations between parental responses on the Transition Readiness Assessment Questionnaire (TRAQ) and chart data. The main hypothesis is that mental illness comorbidities relate to less confidence in preparing for transition. The secondary hypothesis is that other comorbidities and care utilization also relate to perceived difficulty with transition. Thirty-five parents of CYEs aged 12 to 22 years in the Cleveland Clinic system completed TRAQ in 2020 and 2021. TRAQ items assess the importance of and confidence about transition. Demographic information (age, gender, race, insurance), number of emergency department (ED) visits and inpatient stays within 1 year of completing the survey, number of medical, mental illness, and neurological comorbidities, and number of antiepileptic drugs (AEDs) prescribed were extracted from electronic medical records. Spearman’s Rho test was performed between these variables and ratings on transition items using SAS 9.4. The average age of CYEs was 16.89 years, 45.7% were female, 74.3% were White, 17.1% were Black or multiracial, 65.8% held private insurance, and 34.3% were publicly insured. CYEs had an average of 1.63 mental illness, 1.89 medical, and 1.26 neurological comorbidities. On the TRAQ survey confidence item, the average rating was 4.57 out of 10. There was a significant moderate negative association between transition confidence and the number of mental illness comorbidities (rs[33] = –0.37; p < 0.03). No statistically significant correlation was found between transition confidence and number of medical or neurological comorbidities, ED visits, inpatient stays, or AEDs. Our main hypothesis was supported: mental illness comorbidities were significantly associated with less confidence in transition ability. The findings highlight the importance of identifying and managing mental illness comorbidities in CYEs. The limitations of the study include the small sample size and the lack of a standardized and normalized transition scale. Further work is needed to assess the transition perceptions of CYEs themselves.

9.4 Impact of Psychiatric Comorbidities on Hospital Course in Pediatric Inpatients With HIV Infection

9.4 Impact of Psychiatric Comorbidities on Hospital Course in Pediatric Inpatients With HIV Infection

Impact of psychiatric comorbidities on emergency surgical patients’ outcomes

AimsPsychiatric disorders are increasingly prevalent and present as a comorbidity in many hospitalized patients. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with worsened inpatient outcomes. Emergency surgical admissions and the impact of CPC on their outcomes has not been studied in Ireland to date. This study aims to provide a comprehensive analyses of the relationship between a wide range of psychiatric comorbidities and surgical presentations.MethodThe Hospital In-Patient Enquiry (HIPE) and prospectively maintained electronic patient records were used to identify all surgical emergency admissions between 31st August 2019 and 1st September 2020 to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), discharge destination, and surgical interventions were recorded. Subgroup analyses were performed examining LoS variation in the type of surgical presentation. Physical comorbidities were scored using the Charlson Comorbidity Index (CCI). Statistical calculations were performed using SPSS.ResultA total of 995 admissions were recorded. The presence of CPC increased the overall mean LoS by 1.9 days (p = .002). This trend was observed in both operative and conservative management. Significant increase in LoS was noted in patients with a comorbid depression (2.4 days, p = .003), dementia (2.8 days, p = .019), and intellectual disability (6.7 days, p = .007). Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = .019), skin and soft tissue infections (2.5 days, p = .040), bowel obstruction (4.3 days, p = .047), and medical disorders (18.6 days, p = .010). The odds of nursing home or convalescence as a discharge destination was 2.44 (95% CI: 1.37–4.35, p = 0.002) in patients with CPC and the odds of self-discharge against medical advice in this population was 4.89 (95% CI: 1.43–16.70, p = 0.005). No significant difference was observed in mortality and readmission rates.ConclusionPsychiatric comorbidities significantly impact length of hospital stay and influence discharge planning in surgical inpatients. Greater vigilance is required in providing care for patients with psychiatric comorbidities, particularly those with depression, dementia and intellectual disability. Better optimisation of facilities and a more personalised approach to patients with CPC are required to improve inpatient outcomes and resource allocation.

Concurrent diagnosis of anxiety increases postoperative length of stay among patients receiving esophagectomy for esophageal cancer

Psychiatric comorbidities disproportionately affect patients with cancer. While identified risk factors for prolonged length of stay (LOS) after esophagectomy are primarily medical comorbidities, the impact of psychiatric comorbidities on perioperative outcomes is unclear. We hypothesized that psychiatric comorbidities would prolong LOS in patients with esophageal cancer. The 2016 National Inpatient Sample (NIS) was used to identify patients with esophageal cancer receiving esophagectomy. Concurrent psychiatric illness was categorized using Clinical Classifications Software Refined for ICD-10, creating 34 psychiatric diagnosis groups (PDGs). Only PDGs with >1% prevalence in the cohort were included in the analysis. The outcome of interest was hospital LOS. Bivariable testing was performed to determine the association of PDGs and demographic factors on LOS using rank sum test. Multivariable regression analysis was performed using backward selection from bivariable testing (α≤0.05). We identified 1,730 patients who underwent esophagectomy for esophageal cancer in the 2016 NIS. The median LOS was 8 days (IQR 5-12). In bivariable testing, a concurrent diagnosis of anxiety was the only PDG associated with LOS (9 days (IQR 6-14) with anxiety diagnosis vs 8 days (IQR 5-12) with no anxiety diagnosis, p=0.022). Multivariable modeling showed an independent association between anxiety diagnosis and increased LOS (OR 4.82 (1.25-25.23), p=0.022). Anxiety was not associated with increased hospital cost or in-hospital mortality. This analysis demonstrates an independent effect of anxiety prolonging postoperative LOS after esophagectomy in the United States. These findings may influence perioperative care, patient expectations, and resource allocation. This article is protected by copyright. All rights reserved.

Psychiatric Comorbidities in Functional Movement Disorders: A Retrospective Cohort Study

Functional movement disorders (FMD) are characterized by abnormal movements and motor symptoms incongruent with a known structural neurologic cause. While psychological stressors have long been considered an important risk factor for developing FMD, little is known about the impact of psychiatric comorbidities on disease manifestations or complexity. To compare characteristics of FMD patients with co-occurring mood and trauma-related psychiatric conditions to FMD patients without psychiatric conditions. We performed a retrospective cohort study of patients seen in the University of Colorado Health system between January 1, 2015 and December 31, 2019. Patients were included if they had a diagnosis of FMD, determined by ICD-10 coding and ≥1 phenomenology-related diagnostic code (tremor, gait disturbances, ataxia, spasms, and weakness), and at least one encounter with a neurology specialist. Fisher's exact and unpaired t-tests were used to compare demographics, healthcare utilization, and phenomenologies of patients with psychiatric conditions to those with none. Our review identified 551 patients with a diagnosis of FMD who met inclusion criteria. Patients with psychiatric conditions (N=417, 75.7%) had increased five-year healthcare utilization (mean emergency room encounters 9.9 vs. 3.5, P=0.0001) and more prevalent non-epileptic seizures (18.2% vs. 7.5%, P=0.001). Suicidal ideation (8.4%) and self-harm (4.1%) were only observed amongst patients with comorbid psychiatric conditions. Patients with FMD and comorbid psychiatric conditions require more healthcare resources and have greater disease complexity than patients without psychiatric illness. This may have implications for treatment of patients without comorbid psychiatric conditions who may benefit from targeted physiotherapy alone.

Electronic Mental Health Screening in a Pediatric Heart Failure and Transplant Clinic.

Adults with heart failure and transplant are at increased risk for psychiatric comorbidities. The prevalence and impact of psychiatric comorbidities have not been well studied in pediatric heart failure and transplant. This quality improvement project sought to evaluate the feasibility of utilizing electronic mental health screening measures during pediatric heart failure and transplant clinics and to explore the prevalence and severity of self-reported depressive, anxiety, and suicidal ideation symptoms. Patients aged 11years and older who presented to a pediatric heart failure and transplant clinic were administered the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Medical chart review and a survey were used to examine additional variables of interest. There were no significant differences in moderate and severe mental health symptoms between gender, medical diagnoses, or those with recent hospitalizations. Pediatric patients with heart failure or transplant reported higher prevalence of anxiety and depressive symptoms, and similar suicidal ideation compared to the general adolescent population. Moreover, rates of depression and anxiety symptoms as well as suicidal ideation were comparable to pediatric patients with diabetes, lupus, inflammatory bowel disease, and cystic fibrosis. Results suggest electronic mental health screening is feasible for use during outpatient cardiology clinic visits and provides valuable mental health information.

Impact of Psychiatric Comorbidities on Surgical Outcomes for Non-Small Cell Lung Cancer

BackgroundPsychiatric comorbidities (PCs) have been associated with poor surgical outcomes in several malignancies. However, the impact of PCs on surgical outcomes for non-small cell lung cancer (NSCLC) remains largely unknown. MethodsNSCLC patients who underwent pulmonary resection at a single institution between 2006 and 2017 were included. Presence of preoperative PCs was identified by documented diagnostic codes. Demographic, histopathologic, perioperative, and survival data were analyzed. Categorical variables were compared using the χ2 or Fisher exact test. Overall and disease-free survival was analyzed using Kaplan-Meier method. Univariable and multivariable logistic regression analyses were performed for 30-day readmission. ResultsAmong 2907 patients, PCs were present preoperatively in 180 (6%), including anxiety, 130 (72%); depression, 52 (29%); adjustment disorder, 28 (16%); alcohol abuse, 16 (9%); sleep disorder, 8 (4%); and schizophrenia, 3 (2%). Patients with PCs were younger, with fewer cardiovascular complications. There were no differences in length of stay. However, PCs led to increased 30-day readmission (12% vs 6%, P = .004). Reasons for readmission did not differ between groups (P = .679). Multivariable analysis showed PCs independently predicted 30-day readmission (odds ratio, 2.00; P = .005). Importantly, there were no differences in 30- or 90-day mortality (P = .495 and P = .748, respectively), overall survival (P = .439), or disease-free survival (P = .924). ConclusionsNSCLC patients with and without PCs experienced similar perioperative and long-term outcomes, suggesting that individuals should not be denied surgical care on the basis of such comorbidities. However, further research should seek to identify reasons for increased risk of readmission for patients with PCs and validate these findings in other settings.