Lifetime Psychiatric Comorbidity Research Articles

Characterization of Bipolar Disorder I and II: Clinical Features, Comorbidities, and Pharmacological Pattern.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides precise diagnostic criteria to differentiate between bipolar disorder (BD) type I and II; nevertheless, it can be challenging to come up with the right diagnosis. The aim of this study is to evaluate the sociodemographic differences, clinical features, comorbidities, and pharmacological pattern between patients with BD type I and II. A total of 680 patients with BD type I and II were consecutively recruited to our psychiatry department. A semi-structured interview was used to collect several information. Patients with BD type I were mostly males, single, with a lower current age, and unemployed compared to patients with BD type II. Furthermore, patients with BD type I showed an earlier age at onset and a significant higher prevalence of psychotic and residual symptoms, a higher number of hospitalizations, and involuntary admissions. On the other hand, patients with BD type II were associated with a significant higher prevalence of lifetime suicide attempts, psychiatric comorbidities, and use of alcohol. Finally, antidepressant drugs were prescribed more often to patients with BD type II, while antipsychotics and mood stabilizers were mostly prescribed in patients with BD type I. the differentiation of the 2 nosologic bipolar diagnosis is in line with the current scientific interest, confirming the existence of a markedly different profile between BD type I and II. This differentiation could reduce the heterogeneity of bipolar presentation in research, optimize clinical assessment, and increase the interest in developing more precise and individualized therapeutic strategies, also implementing psychosocial therapies.

Intentional Self-Harm and Death by Suicide in Body Dysmorphic Disorder: A Nationwide Cohort Study

BackgroundBody dysmorphic disorder (BDD) is thought to be associated with considerable suicide risk. This nationwide cohort study quantified the risks of intentional self-harm—including nonsuicidal self-injuries and suicide attempts—and death by suicide in BDD. MethodsIndividuals with a validated ICD-10 diagnosis of BDD in the Swedish National Patient Register, registered between January 1, 1997, and December 31, 2020, were matched with 10 unexposed individuals (i.e., without BDD) from the general population on birth year, sex, and county of residence. Conditional Poisson regression models estimated incidence rate ratios and 95% CIs for intentional self-harm. Stratified Cox proportional hazards models estimated hazard ratios and 95% CIs for death by suicide. Models adjusted for sociodemographic variables and lifetime psychiatric comorbidities. ResultsAmong 2833 individuals with BDD and 28,330 unexposed matched individuals, 466 (16.45%) and 1071 (3.78%), respectively, had at least 1 record of intentional self-harm during the study period (incidence rate ratio = 3.37; 95% CI, 3.02–3.76). In the BDD group, about two-thirds (n = 314; 67%) had their first recorded self-harm event before their first BDD diagnosis. A total of 17 (0.60%) individuals with BDD and 27 (0.10%) unexposed individuals died by suicide (hazard ratio = 3.47; 95% CI, 1.76–6.85). All results remained robust to additional adjustment for lifetime psychiatric comorbidities. A higher proportion of individuals with BDD who died by suicide had at least 1 previous record of intentional self-harm compared with unexposed individuals (52.94% vs. 22.22%; p = .036). ConclusionsBDD was associated with a 3-fold increased risk of intentional self-harm and death by suicide.

Early-onset obsessive-compulsive disorder: sociodemographic and clinical characterization of a large outpatient cohort

IntroductionObsessive-compulsive disorder (OCD) is a prevalent and disabling condition characterized by a wide variety of phenotypic expressions. Several studies have reinforced the hypothesis of OCD heterogeneity by proposing subtypes based on predominant symptomatology (Mataix-Cols et al., 2005), course (Tukel et al., 2007), and comorbidities (Mahasuar et al., 2011). Early-onset OCD could be considered a neurodevelopmental subtype of OCD, with evidence of distinct neurocircuits supporting disease progression (Park et al., 2022).ObjectivesThe aim of the present study is to evaluate the sociodemographic and clinical differences between the early-onset and late-onset subtypes in a large patient cohort.MethodsTwo hundred and eighty patients diagnosed with OCD were consecutively recruited from the OCD Tertiary Clinic at Luigi Sacco University Hospital in Milan. Sociodemographic and clinical variables were analyzed for the entire sample and compared between the two subgroups (EO: early-onset, age <18 years [40%]; LO: late-onset, age ≥ 18 years [60%]).ResultsThe EO group showed a higher frequency of male gender (65.5% vs 34.5%, p< .001, see Figure 1a), a higher presence of lifetime psychiatric comorbidities (75.7% vs 24.3%, p =.025), and higher rates of Tic and Tourette disorders (7.2% vs 0%, p=.006) compared to the LO group. Additionally, in the EO subgroup, a longer duration of untreated illness was observed (9.05 ± 10.0 vs 5 ± 7.17; p<.001, see Figure 1b), along with a lower presence of insight (33.3% vs. 66.7%, p =.024). No significant differences emerged in the Yale-Brown Obsessive-Compulsive Scale scores between the groups.Image:Image 2:ConclusionsThe early-onset OCD subtype highlights a more severe psychopathological profile compared to the late-onset group. Exploring distinct manifestations and developmental trajectories of OCD can contribute to a better definition of homogeneous subtypes, useful for studying risk factors and defining targeted therapeutic strategies for treatment.Disclosure of InterestB. Benatti Speakers bureau of: Angelini, Lundbeck, Janssen, Rovi, N. Girone: None Declared, M. Vismara: None Declared, C. Bucca: None Declared, B. Dell’Osso Grant / Research support from: Angelini, Lundbeck, Janssen, Pfizer, Otzuka, Neuraxpharm, and Livanova, Speakers bureau of: Angelini, Lundbeck, Janssen, Pfizer, Otzuka, Neuraxpharm, and Livanova.

All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis

Hypochondriasis, also known as health anxiety disorder, is a prevalent, yet underdiagnosed psychiatric disorder characterized by persistent preoccupation about having serious and progressive physical disorders. The risk of mortality among individuals with hypochondriasis is unknown. To investigate all-cause and cause-specific mortality among a large cohort of individuals with hypochondriasis. This Swedish nationwide matched-cohort study included 4129 individuals with a validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of hypochondriasis assigned between January 1, 1997, and December 31, 2020, and 41 290 demographically matched individuals without hypochondriasis. Individuals with diagnoses of dysmorphophobia (body dysmorphic disorder) assigned during the same period were excluded from the cohort. Statistical analyses were conducted between May 5 and September 27, 2023. Validated ICD-10 diagnoses of hypochondriasis in the National Patient Register. All-cause and cause-specific mortality in the Cause of Death Register. Covariates included birth year, sex, county of residence, country of birth (Sweden vs abroad), latest recorded education, civil status, family income, and lifetime psychiatric comorbidities. Stratified Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs of all-cause and cause-specific mortality. Of the 4129 individuals with hypochondriasis (2342 women [56.7%]; median age at first diagnosis, 34.5 years [IQR, 26.3-46.1 years]) and 41 290 demographically matched individuals without hypochondriasis (23 420 women [56.7%]; median age at matching, 34.5 years [IQR, 26.4-46.2 years]) in the study, 268 individuals with hypochondriasis and 1761 individuals without hypochondriasis died during the study period, corresponding to crude mortality rates of 8.5 and 5.5 per 1000 person-years, respectively. In models adjusted for sociodemographic variables, an increased rate of all-cause mortality was observed among individuals with hypochondriasis compared with individuals without hypochondriasis (HR, 1.69; 95% CI, 1.47-1.93). An increased rate was observed for both natural (HR, 1.60; 95% CI, 1.38-1.85) and unnatural (HR, 2.43; 95% CI, 1.61-3.68) causes of death. Most deaths from unnatural causes were attributed to suicide (HR, 4.14; 95% CI, 2.44-7.03). The results were generally robust to additional adjustment for lifetime psychiatric disorders. This cohort study suggests that individuals with hypochondriasis have an increased risk of death from both natural and unnatural causes, particularly suicide, compared with individuals from the general population without hypochondriasis. Improved detection and access to evidence-based care should be prioritized.

Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project

ObjectiveSex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. MethodsThis Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. ResultsRegarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. ConclusionOur findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.

Episodic obsessive-compulsive disorder and bipolar spectrum disorder: new evidence from a large Italian OCD sample

Objectives Obsessive-Compulsive Disorder (OCD) has been considered to be a chronic illness; however, some authors described a subtype of OCD characterised by symptom-free periods of time: Episodic-OCD (E-OCD). Only few studies focussed on this subtype of the disorder. The objectives of this research were to study the association between the episodic course of the disorder and lifetime psychiatric comorbidities and to investigate socio-demographic and other clinical features correlated to the episodic course. Methods The sample is composed of adult OCD patients. The course was defined episodic when at least one circumscribed symptom-free interval of at least 6 months was present. The sample was divided into two subgroups: Episodic-OCD and Chronic-OCD. Differences between groups were analysed with Student’s t-test, χ2 tests, Fisher test and multivariate logistic regression. Results Data regarding 585 individuals were collected. 14.2% (N = 83) of our sample had an episodic course. Bipolar I comorbid disorder, abrupt onset, lower severity of illness and lower rates of repeating compulsions were associated with the likelihood of having an E-OCD. Conclusions Our findings confirm that a significant proportion of OCD patients have an episodic course and that E-OCD could represent a specific endophenotype.

Psychiatric comorbidity as a prospective predictor of long-term weight and psychosocial outcomes after bariatric surgery

ObjectivesPsychiatric comorbidity is common among the bariatric population although the prognostic significance of psychiatric comorbidity on outcomes is uncertain. This prospective study examined differences in weight and psychosocial functioning outcomes based on lifetime and current (post-surgical) psychiatric comorbidity. MethodsParticipants were 140 adults in a RCT for loss-of-control (LOC)-eating approximately six months post-bariatric surgery. Two structured interviews were administered: the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV) to assess LOC-eating and eating-disorder psychopathology, and the Mini International Neuropsychiatric Interview (MINI) to assess lifetime and current (post-surgical) psychiatric disorders. The EDE-BSV and Beck Depression Inventory (BDI-II) were repeated at post-treatment and 24-month follow-ups. ResultsLifetime (75.7%) and current/post-surgical (25%) psychiatric diagnoses were common. Groups with and without psychiatric comorbidity did not differ significantly in weight loss outcomes at any timepoint but psychiatric comorbidity was associated significantly with greater LOC-eating, eating-disorder psychopathology, and depression. ConclusionsAmong participants with LOC-eating post-bariatric surgery, lifetime and post-surgical psychiatric comorbidity was not associated with acute or longer-term weight outcomes but predicted poorer psychosocial functioning. Findings challenge prevailing views that psychiatric comorbidity is related to poorer longer-term weight outcomes following bariatric surgery but highlight its clinical significance as it is associated with broad psychosocial difficulties.

Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder.

Suicidal ideation (SI) is a risk factor for suicidal behaviour. To ascertain the clinical correlates and prognostic impact of severe SI, we analysed 249 outpatients with major depressive disorder (MDD) and suicidal thoughts included in the COmbining Medications to Enhance Depression outcome (CO-MED) trial. Patients with severe SI (36%) were younger at disease onset ( P = 0.0033), more severely depressed ( P = 0.0029), had more lifetime suicidal behaviour ( P < 0.0001) and psychiatric comorbidities (panic disorder: P = 0.0025; post-traumatic stress disorder: P = 0.0216), and a history of childhood maltreatment (neglect: P = 0.0054; emotional abuse: P = 0.0230; physical abuse: P = 0.0076; sexual abuse: P = 0.0016) than those experiencing low-moderate SI. After controlling for depression score, severe SI was positively correlated with lifetime suicidal behaviour (OR [95% CI]: 1.26 [1.12-1.41]), panic disorder (1.05 [1.00-1.12]), and childhood maltreatment (neglect: 1.93 [1.13-3.30]; physical abuse: 2.00 [1.11-3.69]; sexual abuse: 2.13 [1.17-3.88]), and inversely correlated with age of onset (0.97 [0.95-0.99]) and sleep-onset insomnia (0.76 [0.61-0.96]). Finally, the occurrence of serious lifetime suicidal behaviour was predicted by SI severity (2.18 [1.11-4.27]), bipolar score (1.36 [1.02-1.81]), and childhood sexual abuse (2.35 [1.09-5.05]). These results emphasise the importance of assessing childhood maltreatment and bipolar liability in MDD to estimate suicidal behaviour risk.

Examining the significance of age of onset in persons with lifetime anorexia nervosa: Comparing child, adolescent, and emerging adult onsets in nationally representative U.S. study.

This study compared sociodemographic and clinical profiles of adult patients with lifetime DSM-5-defined anorexia nervosa (AN) categorized by age-of-onset using data from U.S. national sample of adults. Study included 216 participants from Third National Epidemiological Survey Alcohol and Related Conditions (NESARC-III) who met criteria for lifetime AN based on structured diagnostic interviews (AUDADIS-5) with age-of-onset prior to age 25. Of the 216 participants, 30 were categorized as child-onset (<15 years old), 104 adolescent-onset (15-18 years of age), and 82 "emerging-adult" (19-24 years of age); the three groups were compared on their clinical characteristics. Among participants with lifetime diagnoses of AN with onsets earlier than 25 years, adjusted prevalence rates for the three groups were: 11.8% (SE=2.04; child-onset), 39.6% (SE=2.69; adolescent-onset), and 48.6% (SE=2.67; emerging-adult). Child-onset group reported more frequent adverse childhood experiences (ACEs), lowest BMI, longest episode-duration, was least likely to attend college, and had highest rate of lifetime psychiatric comorbidity. Child-onset group had earliest age of help-seeking and were most likely to have been hospitalized. Group differences persisted in analyses adjusting for sociodemographic characteristics and duration of AN episode. Our findings, based on a nationally representative sample of U.S. adults with lifetime diagnoses of AN, suggest that those with child-onset had more severe AN, greater life difficulties, and greater lifetime psychiatric comorbidity. Findings emphasize the importance of earlier recognition and rapid referral to effective treatments.

Are Maternal Personality Traits an Etiological Factor in Adolescents with Functional Chest Pain?

BackgroundIn the etiology of functional chest pain (FCP), parental personality traits are worth considering in the context of the biopsychosocial model. The αlpha factor sub-dimension of the five-factor personality model (5FPM) includes agreeableness, conscientiousness, and neuroticism. There is increasing evidence that this dimension may be related to psychosomatic diseases. It was aimed to investigate how maternal personality traits affect adolescents with FCP. The hypothesis was determined that adolescents diagnosed with FCP can have lower quality of life and be more depressive/anxious and their mothers can have factor-α personality traits and be more depressive/anxious. MethodsThe sample of this single-center, cross-sectional, case-control study consisted of 25 adolescents with FCP and their parents. The control group consisted of 35 age and sex matched healthy adolescents and their parents. Psychopathology was screened using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) and psychiatric comorbidities were excluded. The Child Depression Inventory (CDI), the Spielberger State-Trait Anxiety Inventory (STAI), and KINDL forms were completed by the adolescents. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Five-Factor Personality Inventory short form (FFPI) were completed by the parents. ResultsMothers of adolescents with FCP scored significantly higher compared with mothers of healthy controls in agreeableness and conscientiousness and scored significantly lower in neuroticism. Higher levels of mothers’ neuroticism scores were associated with higher CDI and STAI-1 scores in FCP group. Agreeableness (Exp (B) = 10.097; p = .004; confidence interval [CI] = 2.049-49.745) and conscientiousness (Exp (B) = 16.414; p = .011; CI = 1.902-141.682) were statiscally significant in regression model. ConclusionsThis study showed for the first time that mother's alpha factor personality traits may be one of the factors that contribute to the presence of FCP.

Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder.

Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the 'gender paradox' and 'delayed-onset pathway' hypotheses of female CD. As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9-18 years), compared to 864 sex- and age-matched typically developing controls. Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the 'gender paradox' hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the 'delayed-onset pathway' hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology. Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the 'gender paradox' and 'delayed-onset pathway' hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.

The forbidden thoughts dimension and psychiatric comorbidities in a large sample of OCD patients: A possible link to bipolar I comorbid disorder

ObjectiveMany theoretical models have been proposed to identify groups of patients affected by Obsessive Compulsive Disorder (OCD) and the most studied model categorized OCD into different classes according to symptom dimensions. The aims of this study were to evaluate the association between the lifetime presence of Forbidden Thoughts (FT) symptoms and lifetime psychiatric comorbidities and to examine socio-demographic and other clinical features related to the lifetime presence of FT in a large naturalistic sample. MethodsThe sample is composed of adult OCD patients from a tertiary center. The sample was divided into two subgroups according to the lifetime presence/absence of the FT. Differences between groups were analyzed with Student's t-test and χ2 tests. Subsequently we performed multivariate logistic regression. Results and conclusionsData regarding 601 subjects were collected. The 65.9% Experienced lifetime FT. Higher level of education, lower age at symptoms onset, abrupt onset type and bipolar I comorbid disorder were associated with the likelihood of having FT. Our findings confirm a high prevalence of the FT dimension and suggest that OCD with aggressive, sexual, religious obsessions could represent a specific endophenotype of this disorder. The specific relation between FT and comorbid bipolar disorder type I seems particularly interesting.

Independent effects of entering recovery as a young versus older adult on long-term functioning and quality of life: Results from a U.S. national study of recovering persons

BackgroundFor physical health conditions, earlier intervention typically results in better prognoses and improved quality of life (QoL). Despite some evidence that early intervention yields better subsequent functioning too for behavioral health conditions like alcohol and other drug (AOD) disorders, less is known. This study examined the relationship between the life-stage at which individuals entered AOD recovery, demographic and clinical correlates, and its relationship to a variety of indices of current functioning, QoL and well-being. MethodNationally representative sample of U.S. adults who resolved an AOD problem (Weighted N = 1844). Structured regression analyses tested whether life-stage at which individuals entered recovery (i.e., as a young [18−30yrs,n = 746] vs. older [>30yrs,n = 1098] adult), was associated with current QoL, happiness, self-esteem, distress, and recovery capital, independent of confounders. Sensitivity analyses investigated effects during the first 5-years of recovery. ResultsYoung adult recovery entry was independently associated with current employment, younger age of onset for primary substance, primary substance other than alcohol, and less lifetime psychiatric comorbidity. In fully-adjusted models examining indices of functioning, no association was found between life-stage at recovery entry and current self-esteem, happiness, or distress, but an association was found between young adult recovery entry and better current functioning and QoL. This effect was even more pronounced during the first 5-years of recovery. ConclusionIrrespective of current age, duration of recovery, and clinical markers of impairment, entering recovery as a young, versus older, adult, is associated with better subsequent QoL - an advantage that appears even more discernable early in recovery.

Lifetime Psychiatric Comorbidity and Diagnostic Trajectories in an Italian Psychiatric Sample.

ObjectiveComorbidity in psychiatric patients has been widely examined in the literature, enucleating the role in misinterpretation of symptom’s root in a multi-disease background, as well as the impact on the quality of life, outcome, and health-care effects. This research aimed to examine, in an Italian population of psychiatric patients, the diagnostic continuum in the context of lifetime psychiatric comorbidity, assessing possible differences related to the onset disorder.MethodA retrospective analysis of medical records of 458 subjects, in which various psychiatric diagnoses were represented and categorized in 16 nosographic classes, was conducted.ResultsResults showed that “Bipolar disorder” (22.06%) was the most frequent diagnosis, “Eating disorder” had the earliest age onset (Mean age years = 16 ± 1.41), and “Schizophrenia” showed the longest disease duration (Mean years = 24.20±12.76). Moreover, 54,4% of the final sample presented at least one psychiatric comorbidity in disease history, while “Other personality disorders” was the most comorbidity-associated diagnosis, representing 29% of all the cases with more than 3 past diagnoses. Heterotypic transition was observed in fairly all considered onset diagnoses, exception made for “Schizophrenia” with 75% of the subjects showing homotypic progression.ConclusionsOur results suggest a tendency to make multiple diagnoses over psychiatric patients' lifetime in the majority of cases, often escaping from the original onset nosographic domain. More generally, our findings agree with a broad consensus that describes psychiatric symptomatic dimensions rather overlapped and correlated with each other, leading to a more transdiagnostic clinical approach.

Clinical characteristics and comorbidity associated with female gender in obsessive-compulsive disorder

IntroductionObsessive-compulsive disorder (OCD) is a heterogeneous condition characterized by largely variable phenotypic expressions. Previous findings suggested that gender may be a relevant factor in mediating this heterogeneity. The present study aimed at exploring gender differences in a large clinical sample of Italian OCD patients. MethodsSocio-demographic and clinical variables of a sample of 229 consecutive OCD outpatients were included in a common database. Patients were assessed through structured clinical interviews, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale. ResultsFemale OCD patients were more likely than males to have lifetime psychiatric comorbidities (72.6% vs 56.9%; p < 0.05), poly-comorbidities being twice as high compared to males. The female group also showed a significant later onset of symptoms (63.7% vs 44.8%; p < 0.005) and a higher age at first treatment (30.98 ± 13.1 years vs 27.81 ± 11.3; p < 0.005). Moreover, the female subgroup presented higher rates of cleaning and washing compulsions, compared to the male subgroup (28.7% vs 12.6% in the male group; p < 0.005). ConclusionsThe current study supports the notion that OCD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to male patients. These findings should be considered in epidemiologic and therapeutic perspectives.

Smoking, obesity, and their co-occurrence in the U.S. military veterans: results from the national health and resilience in veterans study

Background: Smoking and obesity are major public health concerns, though little is known about the mental and physical health burden of co-occurring obesity and smoking.Methods: Using a nationally representative sample of U.S. military veterans, we examined the prevalence of mental and physical co-morbidities, physical and mental functioning, and quality of life between obese only; smoking only; and obese smokers.Results: Among current smokers, 31.7% were obese; among obese veterans, 16.4% were current smokers; and in the total sample, 5.4% were obese and current smokers. Relative to the obese-only group, obese smokers were more likely to be younger, male, non-white, non-married, unemployed and VA–served, and have lower household incomes. These also reported higher levels of perceived stress and trauma and were more likely to endorsed current suicidal ideation and lifetime suicide attempts (odds ratio [OR]=2.0), medical (2.3<=OR<=3.9) and psychiatric (1.5<=OR<=2.9) comorbidities, and lower overall health status and quality of life. Compared to the smoking-only group, obese smokers were more likely to endorse current suicidal ideation (OR=2.0) and nicotine dependence (OR=1.5), and reported poorer physical health and overall quality of life. Analyses were adjusted for sociodemographic and military characteristics.Limitations: The cross-sectional study design precludes causal inference.Conclusions: These findings suggest that co-occurring obesity and smoking is associated with substantial mental and physical health burden in U.S. veterans. Collectively, they underscore the importance of multicomponent interventions targeting, obesity, smoking, and co-occurring issues, such as trauma and internalizing disorders, in this population.

Correlates of violent suicide attempts in patients with bipolar disorder

BackgroundSuicide is one of the leading causes of death in bipolar disorder (BD); violent suicide attempts are associated with the highest level of lethality. We aimed to evaluate factors related to the risk of violent suicide in a large naturalistic sample of patients with BD; in addition, we analyzed the rates of lifetime suicide attempts and the variables associated with suicidal behavior. MethodsWe recruited 847 patients with BD. Patients were grouped according to whether they had a lifetime history of suicide attempts and, among suicide attempters, subjects who had used a violent suicide method were compared with those who had attempted suicide with a nonviolent method. Comparisons were performed using χ2 tests for categorical variables and ANOVA for continuous variables. Logistic regression (LogReg) was used to identify explanatory variables associated with violent suicide attempts (dependent variable). ResultsTwo hundred and two patients (24%) had a lifetime history of suicide attempts. Subjects with at least one lifetime suicide attempt showed longer duration of illness (22.4±14.1 years vs 19.9±14.2 years: p 0.028), more lifetime hypomanic episodes (3.3±4.3 vs 2.3±3.1: p0.001), more lifetime depressive episodes (6.0±4.4 vs 4.7±4.1: p<0.001), higher rates of lifetime psychiatric comorbidities (50.0% vs 41.3%: p 0.029), higher rates of lifetime medical comorbidities (58.0% vs 48.9%: p 0.028) and higher rates of reduced HDL cholesterol (46.2% vs 36.7%: p 0.030). Among suicide attempters, fifty-two patients (30.6%) attempted suicide with a violent method. We found more men in the group of violent suicide attempters than in the group of nonviolent suicide attempters (65% vs 28%; p: <0.001). Moreover subjects with previous violent attempts showed higher mean values of weight (80.5±18.3 vs 69.4±14.7: p<0.001), body mass index (27.8±5.6 vs 25.2±4.7: p<0.003) and waist circumference (98.7±18.5 vs 92.4±14.3: p 0.032). The LogReg analysis confirmed the association of violent attempts with male gender (p: <0.001; Phi: 0.35) and higher waist circumference (p: <0.001; Cohen’s d: 0.39). LimitationsIn our research we analyzed lifetime suicide attempts, but the sample does not include completed suicides, meaning that we are unable to test whether the results are generalizable to suicide deaths. Moreover, some relevant variables, such as medical comorbidities/metabolic parameters at the time of suicide attempts and previous medication, were not collected. Another limitation concerns the heterogeneity of recruited patients in terms of clinical characteristics (e.g.: medical conditions, drug treatments), with potential confounding factors. ConclusionsThe present study confirms the association between male gender and violent suicide and suggests a correlation between obesity and the use of violent suicide methods. The relationship between obesity and suicidal behaviour is worthy of interest and deserves to be explored by further studies.

Relationship between symptom severity, psychiatric comorbidity, social/occupational impairment, and suicidality in hoarding disorder

Social and occupational functioning deficits contribute to overall disability in hoarding disorder (HD), and psychiatric symptoms are likely strong contributors. In turn, social/occupational impairment and psychiatric illness are known to contribute to suicidality. However, few studies have examined the relationship between these factors. We examined these relationships in 313 treatment seeking individuals with HD, measuring hoarding severity with the Saving Inventory, Revised and functional impairment with the Activities of Daily Living for Hoarding Disorder (ADL-H). We created a composite social/occupational function variable assessing employment, cohabitation, and marriage. A path analysis was used to assess the relationship between social functioning, occupational functioning, hoarding related functional impairment in activities of daily living, hoarding severity, psychiatric burden, and suicidality in HD. At least one lifetime psychiatric comorbidity was noted in 61% of participants. High rates of unemployment, living alone, never marrying or being divorced/separated, and lifetime suicide attempts were present. Hoarding severity and hoarding-related functional impairment were associated with social/occupational impairment, and, along with psychiatric burden, with suicidality in this population. These findings suggest that thorough psychiatric evaluation and assessment of suicidality is warranted for those with HD, and that hoarding-related functional impairment is closely related to measures of real-world social functioning.

DESCRIPTIVE PHENOMENOLOGY OF DEPRESSIVE AND ANXIOUS SYMPTOMS IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER

. The obsessive-compulsive disorder (OCD) is characterized by specific symptoms (obsessions and compulsions), but it also presents significant depressive and anxious symptoms. Some life-time psychiatric comorbidities collaborate to different psychopathological presentations of OCD and interfere even in response to conventional treatments. Especially depressive disorders, as other anxiety disorders, have high prevalence in patients with OCD, reaching near 70% for major depressive disorder and 37% for social anxiety disorder. Mathis et al. (2013) evaluated the age of onset of OCD and several comorbid disorders and found that both depression and anxiety disorders (except separation anxiety) occur temporally after the emergence of OCS, leading to understand such depressive and anxious symptoms as secondary to the OCS. In light of this, our research aim to investigate aspects of the descriptive phenomenology of the depressive and anxious symptoms in 1,001 patients with OCD. Method: We conducted a factor analysis with the items of the Beck Depression Inventory and of the Beck Anxiety Inventory for the development of specific depressive-anxious factors that are present in OCD as a unique disorder. Thereafter, for each of the six symptoms dimensions of the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) (aggressive, sexual/religious, symmetry/ordering/arrangement, contamination/cleaning/washing, hoarding and miscellaneous dimensions), it was carried out other six specific factor analysis with the same depressive and anxious Beck's instruments symptoms, generating, meanwhile, specific depressive-anxious factors for each of the six DYBOCS dimensions. To facilitate the understanding of the factor analysis, the depressive-anxious factors were grouped in four general factors: emotional, cognitive, autonomic (or somatic) and behavioral aspects. Results: The factorial analysis results in five factors that describe the depressive-anxious factors present in OCD as a unique disorder (low functionality on patient’s occupation, irritability and sexual dysfunction, tremors, lack of appetite, and low self-esteem and guilty). Other fourteen depressive-anxious factors were specifically related to the six DY-BOCS dimensions, especially for sexual/religious dimension, which the cognitive factor was not related to, while for the other dimensions, cognitive aspects were always important. Conclusion: Depressive-anxious specific factors found in our study described different psychopathological aspects of OCD patients, depending on the OCS predominant content. Sexual/religious dimension seems to be different from the other DY-BOCS dimension according to the depressive-anxious factors presentation. As the specific depressive-anxious symptoms may interfere in cognitive, emotional, behavioral and autonomic aspects of OCD patients, it is quite reasonable to argue that they may contribute to the refractoriness of some cases, turning available conventional treatments obsolete or insufficient. The results of this study extend the load of evidence that OCD is a heterogeneous disorder. This heterogeneity is not only in its nuclear symptomatic presentations, but also in terms of its secondary depressive and anxious issues. It is also suggestible that each group of patients (depending on the OCS or depressive-anxious presentation) may require an individualized therapeutic approach, which targets the main features of each OCS dimension.

The clinical anatomy of fibromyalgia.

Fibromyalgia is a disorder characterized by pain and a spectrum of psychological comorbidities, rendering treatment difficult, and often a financial burden. Findings regarding diagnosis, prevalence, comorbidities, and potential pathophysiological links are discussed herein. Fibromyalgia is a complex disorder and there are specific criteria that patients must meet for diagnosis, including scores on fibromyalgia questionnaires, commonalities of age, gender, menopause status, sleep disturbances, and mood symptoms. The close relationship between fibromyalgia and other chronic disorders should alert the physician to explore for comorbid illnesses. In this review of the clinical anatomy of fibromyalgia, we review new studies that could be significant for the current use of clinical interventions for patients with symptoms. Using standard search engines, the clinical anatomy of fibromyalgia is investigated and many related studies are mentioned herein. Fibromyalgia is considered a prototypical central chronic pain syndrome and is associated with widespread pain that fluctuates spontaneously. There is also substantial lifetime psychiatric comorbidity in individuals with fibromyalgia, resulting in a low health-related quality of life. These results have important clinical and theoretical implications, including the possibility that fibromyalgia could share underlying pathophysiological links with some psychiatric disorders. This reveals that patients with fibromyalgia have findings compatible with tissue injury pain, the pain mechanisms involving both the primary afferent neuron and the nociceptive systems in the central nervous system. (1) There is a relationship between fibromyalgia and chronic disorders. This should alert the physician to explore for comorbid illnesses. (2) There is substantial lifetime psychiatric comorbidity resulting in a low health-related quality of life. (3) Patients with fibromyalgia have findings compatible with tissue injury pain Clin. Anat. 31:387-391, 2018. © 2018 Wiley Periodicals, Inc.