Medical Comorbidities In Patients Research Articles

Comorbidities of dry eye disease: a nationwide population‐based study

To investigate the comorbidities of dry eye disease in a nationwide population-based data in Taiwan. This study features a study group and a comparison group. The study group comprised 12 007 patients who sought ambulatory care for treatment of dry eye in 2005 and 2006. In total, 36 021 randomly selected patients were in the comparison group. Conditional logistic regression analyses conditioned on gender, age, monthly income and level of urbanization of the community in which the patient resided were conducted to calculate the odds ratio (OR) for each of 33 comorbidities among patients with and without dry eye disease. The regression analyses revealed that compared to patients without dry eye disease, patients with dry eye disease were more likely to have comorbidities of ischaemic heart disease (OR = 1.36), hyperlipidaemia (OR = 1.68), cardiac arrhythmias (OR = 1.55), peripheral vascular disorders (OR = 1.57), stroke (OR = 1.31), migraines (OR = 1.76), myasthenia gravis (OR = 2.85), RA (OR = 2.86), systemic lupus erythematosus (OR = 3.98), asthma (OR = 1.25), pulmonary circulation disorders (OR = 1.37), diabetes with complications (OR = 1.31), hypothyroidism (OR = 1.94), liver diseases (OR = 1.71), peptic ulcers (OR = 1.76), hepatitis B (OR = 1.64), deficiency anaemias (OR = 1.31), depression (OR = 2.11), psychoses (OR = 1.87) and solid tumours without metastasis (OR = 1.41). This study demonstrates significantly higher prevalence of medical comorbidities in patients with dry eye disease in Taiwan.

Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population-based study

ObjectiveAnkylosing spondylitis (AS) is a systemic inflammatory disease that can result in chronic pain and disability. This study aimed to analyse the prevalence and risk of medical comorbidities in patients...

Psychological correlates of medical comorbidities in patients with temporomandibular disorders

Medical comorbidities are common among patients with temporomandibular disorders (TMDs). The authors examined the relationship between the medical comorbidities in patients with TMDs and their psychological functioning. The sample consisted of 1,060 adults with TMDs, of whom 85 percent (n = 901) were female. At the time patients were evaluated at a university orofacial pain center, from 1997 through 2007, they completed medical history and psychological questionnaires. On the basis of retrospective chart reviews, the authors assessed the relationship between medical comorbidities and psychological functioning, controlling for pain severity, by using multivariate analyses of covariance. The mean total number of medical comorbidities was 3.49 (standard deviation [SD] = 2.87; range, 0-16). The authors found a linear relationship between number of medical comorbidities and overall psychological distress (t[1, 959] = 16.79, P < .001) and interference owing to pain (t[1, 1,028] = 18.03, P < .001). Patients with TMDs who have medical comorbidities may be at increased risk of experiencing poor psychological functioning. Further study is needed to investigate whether the observed relationship changes across time. The physical and psychological health of patients with TMDs may influence the course of their pain condition. When treating these patients, dentists routinely should assess not only the symptoms of their TMDs but also their general health status.

Overview of Managing Medical Comorbidities in Patients With Severe Mental Illness

Patients with severe mental disorders have increased mortality rates compared with the general population. The leading cause of death for individuals with psychotic illnesses or bipolar disorder is cardiovascular disease (CVD), which is often the result of patients' health problems associated with their psychiatric disorders, including, but not limited to, obesity, metabolic syndrome, and diabetes. Such problems occur more often and have worse outcomes in patients with serious mental illness than the general population because of a combination of factors such as inadequate access to quality care, poor lifestyle choices, and the association between some antipsychotic medications and weight gain. Coordinated somatic and psychiatric treatment, weight-neutral or weight-reducing pharmaceuticals, and behavioral weight management programs may help lessen the burden of CVD in the mental health population.

Operative Debridement of Pressure Ulcers

BackgroundInfection in severe pressure ulcers can lead to sepsis with a 6-month mortality as high as 68%.MethodsOperative records of 142 consecutive operative debridements on 60 patients in a dedicated wound healing inpatient unit were reviewed, from the Wound Electronic Medical Record, for identification of key steps in debridement technique, mortality, unexpected returns, and time to discharge following debridement.ResultsThe mean age of the patients was 73.1 years, and 45% were men. Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%). The mean initial wound area prior to debridement was 14.0 cm2, and 83% of debridements were performed on stage IV pressure ulcers. The postoperative hospital stay averaged 4.1 days. Key steps in the technique included (1) exposure of areas of undermining by excising overlying tissue; (2) removal of callus from wound edges; (3) removal of all grossly infected tissue; and (4) obtaining a biopsy of the deep tissue after debridement of all nonviable or infected tissue for culture and pathology to determine the presence of infection, fibrosis, and granulation tissue. There was one death 9 days post-debridement of a sacral ulcer and one unplanned return to the operating room for bleeding 8 days post-debridement.ConclusionsOperative debridement of pressure ulcers is safe, despite the medical co-morbidities in patients with severe pressure ulcers. Proper debridement technique may prevent sepsis and death in patients with multiple co-morbid conditions.

Sleep disturbance and medical comorbidities in patients with psoriasis, psoriatic arthritis, and controls

Sleep disturbance and medical comorbidities in patients with psoriasis, psoriatic arthritis, and controls

Medical comorbidity in patients with schizophrenia and alcohol dependence

Background Schizophrenia and alcohol dependence are major risk factors for a variety of medical problems, yet there has been little research on the medical status of patients in whom both conditions coexist. Methods We assessed the prevalence and severity of medical illness in 80 patients with schizophrenia or schizoaffective disorder and comorbid alcohol use disorders who entered a controlled trial of monitored naltrexone treatment, and analyzed the relationship between medical illness burden and demographic variables, alcohol and other substance use, and psychosis. Participants underwent physical examination, laboratory tests, medical record review and standardized assessments of medical illness burden, alcohol and other substance use, and psychosis. Nested block multiple regression analyses were used to assess the contribution to illness burden made by demographic variables, alcohol and substance use, and psychosis severity. Results 83% of participants had at least one chronic medical illness, hypertension being the most common (43%). Medical comorbidity in this cohort was more severe than for schizophrenia patients in the CATIE trial (Chwastiak, L., Rosenheck, R., McEvoy, J.P., Keefe, R.S., Swartz, M.S., Lieberman, J.A., 2006. Interrelationships of Psychiatric Symptom Severity, Medical Comorbidity, and Functioning in Schizophrenia. Psychiatr. Serv., 57(8), 1102–1109.); the prevalence of hypertension, chronic obstructive pulmonary disease, and coronary artery disease, was more than twice greater. Medical illness burden correlated with alcohol use severity, but appeared to be independent of other substance use or psychosis severity. Conclusions Patients with co-occurring alcohol use disorder may have significantly more medical illness burden than patients with schizophrenia or schizoaffective disorder alone. Interventions to reduce alcohol use may be necessary to lessen medical morbidity.

Presence of Medical Comorbidities in Patients With Infected Primary Hip or Knee Arthroplasties

Many older patients undergoing primary hip or knee joint arthroplasty surgery have multiple medical problems. In this retrospective case-control study, the authors examined the individual and cumulative effects of various types of medical comorbidities on the risk of developing prosthetic joint infection after surgery. Case and control patients were matched by age, sex, and procedure. Analysis was undertaken using crude odds ratios (ORs) and multiple logistic regression analysis. Fifty-one patients with 52 joint infections were identified. Both diabetes mellitus (OR, 3.91; P = .04) and total number of medical conditions (OR, 1.35; P = .005) were associated with higher risk of infection. This information allows the orthopedic surgeon to inform patients more fully regarding the risks of surgery, and promotes the reduction and optimization of medical comorbidities before surgery.

Inflammation and schizophrenia

Previous research has demonstrated that prenatal infections with bacterial or viral agents during pregnancy are associated with an increased risk of schizophrenia in the offspring during adulthood. Furthermore, there has been evidence linking obstetric complications to schizophrenia. In parallel, there is a separate body of evidence relating subclinical chronic inflammation and schizophrenia in individuals, usually in their adulthood, who have already developed schizophrenia. On the other hand, unequivocal experimental, epidemiological and clinical evidence has emerged during the past decade linking inflammation to the development of insulin resistance and metabolic disturbances, which are common in the schizophrenic population. Inflammation might be an important common pathophysiological process related to both schizophrenia psychopathology and metabolic disturbances seen in patients with schizophrenia. Future studies targeting proinflammatory cytokines and their molecular signaling pathways may lead to novel pharmacological intervention strategies treating both psychopathology and medical comorbidity in patients with this devastating mental illness.

Medical comorbidities in patients with recurrent depressive disorder

Medical comorbidities in patients with recurrent depressive disorder

Clinical Management After Bariatric Surgery: Value of a Multidisciplinary Approach

Comprehensive and collaborative longitudinal care is essential for optimal outcomes after bariatric surgery. This approach is important to manage the many potential surgical and medical comorbidities in patients who undergo bariatric surgery. Medical management programs require prompt and often frequent adjustment as the nutritional program changes and as weight loss occurs. Familiarity with the recommended nutritional program, monitoring and treatment of potential vitamin and mineral deficiencies, effects of weight loss on medical comorbid conditions, and common postoperative surgical issues should allow clinicians to provide excellent care. Patients must understand the importance of regularly scheduled medical follow-up to minimize potentially serious medical and surgical complications. Because the long-term success of bariatric surgery relies on patients' ability to make sustained lifestyle changes in nutrition and physical activity, we highlight the role of these 2 modalities in their overall care. Our guidelines are based on clinical studies, when available, combined with our extensive clinical experience. We present our multidisciplinary approach to postoperative care that is provided after bariatric surgery and that builds on our presurgical evaluation.

Prevalence and Clinical Correlates of Medical Comorbidities in Patients With Bipolar I Disorder

We studied the relationship between number of medical comorbidities in patients with bipolar I disorder and their demographic and clinical characteristics. Data were from 174 patients in the acute phase of the Pittsburgh Maintenance Therapies in Bipolar Disorder (MTBD) study, a randomized controlled trial comparing Interpersonal and Social Rhythm Therapy to an intensive clinical management approach for individuals with a lifetime diagnosis of bipolar I disorder or schizoaffective disorder, manic type, according to Research Diagnostic Criteria, who were receiving adjunctive protocol-driven pharmacotherapy. Patients entered the MTBD study from 1991 to 2000. We examined the acute-phase Hamilton Rating Scale for Depression (HAM-D) and Bech-Rafaelsen Mania Scale scores, demographics, clinical history, and medical comorbidities. Patients with a high number of medical comorbidities had longer duration of both lifetime depression (p = .02) and lifetime inpatient depression treatment (p = .04), had higher baseline HAM-D score (p = .01), and were more likely to be treated for a depressed clinical state during the acute phase of the MTBD study (p = .05). Moreover, higher severity of baseline medical comorbidities predicted slower decreases in HAM-D score among depressed (p = .004) and mixed/cycling (p = .003) patients even after controlling for baseline HAM-D score. Medical illness is correlated with several indicators of poorer prognosis and outcome in bipolar I disorder. Not only do preventing and treating medical comorbidities in bipolar patients decrease the morbidity and mortality related to physical illness, but they could also enhance psychological well-being and possibly improve the course of bipolar illness. Identification of characteristics in bipolar I patients that are correlated to increased risk for medical comorbidities is a fundamental step in understanding the nature of the relationship between bipolar disorder and medical illness.

The burden of general medical conditions in patients with bipolar disorder

We reviewed the current literature on medical comorbidity burden in bipolar disorder. Overall, current studies suggest that numerous medical conditions may occur disproportionately within bipolar disorder patient populations, including hypertension, hyperlipidemia, and hepatitis C infection. In addition, the determinants of increased burden of medical comorbidity in patients with bipolar disorder include metabolic-related factors, health care access barriers, and patient behavioral and treatment factors. Overall, interventions specifically designed to reduce the burden of medical comorbidity in bipolar disorder are needed, especially those that emphasize changes at the health system level to facilitate coordination of medical and psychiatric care.

Antihypertensive Medication Adherence and Blood Pressure Control in Patients With Psychotic Disorders Compared to Persons Without Psychiatric Illness

The authors compared antihypertensive medication adherence and blood pressure control among middle-aged and older outpatients with schizophrenia and related those with psychotic disorders versus persons without any psychiatric illness. A total of 178 subjects were included in the investigation (89 patients with a psychotic disorder and 89 randomly selected, age-matched comparison subjects). Although the two groups had similar antihypertensive medication adherence, the patients with a psychotic disorder were significantly less likely to have had controlled blood pressure during the 1-year study period. The results highlight the need for clinicians to monitor closely the management of medical comorbidity in patients with schizophrenia and related disorders.

Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction

Background Depression is common in patients with acute myocardial infarction (AMI) and is associated with adverse health outcomes. However, the extent to which clinical depression is related to comorbid medical conditions is unknown. This study examined the degree of association between clinical depression and medical comorbidity in patients hospitalized with AMI. Methods Two thousand four hundred and eighty-one depressed or socially isolated patients with AMI were enrolled, as part of the National Heart, Lung, and Blood Institute-sponsored Enhancing Recovery in Coronary Heart Disease clinical trial. A structured interview was used to diagnose major and minor depression and dysthymia; severity of depression was measured by the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Level of social support was measured by the ENRICHD Social Support Instrument. A modified version of the Charlson Comorbidity Index was used to measure the cumulative burden of medical comorbidity. Results The adjusted odds ratios (ORs) for having major depression increased linearly with medical comorbidity (ORs 1.6, 2.2, 2.7 for each increasing medical comorbidity category). This relationship remained after adjusting for coronary heart disease severity (ORs 1.4, 1.7, 1.9, P < .001). The relationship between severity of depression and medical comorbidity was also maintained after excluding somatic symptoms of depression (F = 21.5, P < .0001). Conclusions Patients with AMI and clinical depression have significantly greater levels of medical comorbidity than nondepressed, socially isolated patients. Further research is needed to determine whether comorbid medical illness contributes to the more frequent rehospitalizations and increased risk of mortality associated with depression.

Comorbid conditions in schizophrenia

Psychiatric syndromes, including depression, obsessive-compulsive disorder, panic, and substance use disorders, co-occur with schizophrenia at significant rates. These syndromes interact with schizophrenia symptoms in clinically meaningful ways, and can be associated with adverse outcomes such as suicide, long-term disability, medication nonadherence, and frequent hospitalization. Data to inform treatment of co-occurring syndromes are largely anecdotal, and further studies are required to understand better the risks and benefits of treatment options. Weight gain and disturbances of glucose and lipid metabolism are emerging as significant medical comorbidities in patients treated with new-generation antipsychotic agents, and preventive interventions are urgently needed.

The General Medical Health Rating: a bedside global rating of medical comorbidity in patients with dementia.

Dementia is a serious public health problem. General medical comorbidity is common in dementia patients and critical to their care. However, little is known about medical comorbidity in these patients, and there are no straightforward bedside global rating scales for the seriousness of comorbid medical illness. This paper describes the development and measurement properties of the General Medical Health Rating (GHMR), a rapid global rating scale of medical comorbidity in dementia patients. Interrater reliability, concurrent validity, and predictive validity of the GMHR are reported. An outpatient dementia clinic, assisted living, and nursing home. A total of 819 consecutive dementia clinic outpatients and 180 consecutive admissions to Copper Ridge, a long-term care residence for people with dementia, were included in the study. GMHR was found to be highly reliable (weighted kappa = .91). Across all stages and types of dementia, GMHR ratings were correlated with number of comorbid medical conditions, number of medications being taken for comorbid conditions, and with activity of daily living impairment, even after adjustment for severity of dementia. GMHR ratings were also a strong predictor of falls and of mortality in long-term care residents after adjustment for age and severity of dementia. GMHR is a reliable, valid, global bedside measure of severity of general medical comorbidity for patients with dementia that can be used for clinical and research purposes.

Medical comorbidity in schizophrenia.

The extent and consequences of medical comorbidity in patients with schizophrenia are generally underrecognized. Patients with comorbid conditions are usually excluded from research studies, although they probably represent the majority of individuals with schizophrenia. Elderly patients are especially likely to have comorbid disorders. In this article, we review selected literature on medical comorbidity in schizophrenia, including physical illnesses, substance use, cognitive impairment, sensory deficits, and iatrogenic comorbidity. Data from the University of California, San Diego Clinical Research Center on late-life psychosis are also presented. Older schizophrenia patients report fewer comorbid physical illnesses than healthy comparison subjects, but their illnesses tend to be more severe. These results suggest that schizophrenia patients may receive less than adequate health care. Substance abuse is more common in patients with schizophrenia than in the general population and may exacerbate psychiatric symptoms in these patients. Although generalized cognitive impairment is associated with schizophrenia, the main contributors to dementia in older patients are more likely to be comorbid neurological and other physical disorders, substance abuse, and medication side effects. Iatrogenic comorbidity results primarily from the use of neuroleptic (e.g., tardive dyskinesia) and anticholinergic (e.g., confusion) medications. Clinical and research recommendations are made for management of comorbidity in schizophrenia.