Prevalence Of Comorbid Disorders Research Articles

Psychiatric Comorbidity in patients with Pediatric Bipolar Disorder - a Systematic Review.

A growing body of evidence suggests that pediatric bipolar disorder (PBD) frequently co-occurs with comorbid psychiatric disorders that may impact functioning. To review existing literature on the prevalence of psychiatric comorbidity and general functioning in patients with a primary diagnosis of PBD. We performed a systematic literature search on the PubMed, Embase and PsycInfo databases on November 16th, 2022. We included original papers on patients ≤18 years with primary PBD and any comorbid psychiatric disorder, diagnosed according to a validated diagnostic tool. Risk of bias of the individual studies was assessed using the STROBE checklist. We calculated weighted means to assess the comorbidity prevalence. The review complied with PRISMA statement guidelines. 20 studies with a total study population of 2722 patients with PBD were included (mean age=12.2 years). We found an overall high prevalence of comorbidity in patients with PBD. The most common comorbidities were attention-deficit-hyperactivity disorder (ADHD) (60%) and oppositional defiant disorder (ODD) (47%). Anxiety disorders, obsessive-compulsive disorder, conduct disorder, tic disorders and substance-related disorders affected between 13.2% and 29% of patients, while one in ten had comorbid mental retardation or autism spectrum disorder (ASD). The prevalence of comorbid disorders was lower in studies that assessed the current prevalence in patients in full or partial remission. General functioning was overall not specifically decreased in patients with comorbidity. Comorbidity across a broad range of disorders was high in children diagnosed with PBD, especially regarding ADHD, ASD, behavioural and anxiety disorders including OCD. Future original studies should assess current prevalence of comorbidities in patients with PBD who are in remission to obtain more reliable estimates of psychiatric comorbidity in this patient group. The review highlights the clinical and scientific importance of comorbidity in PBD. This article is protected by copyright. All rights reserved.

Comparing Comorbid Profile and the Pattern of Non-Psychiatric Medicine Use Between Elderly and Non-Elderly Patients with Schizophrenia

Objectives: Patients with schizophrenia receive psychiatric medications for many years, and their comorbid profile in old age remains unclear. Moreover, their pattern of non-psychiatric medicine use is of importance. Rehabilitation is crucial in patients with schizophrenia because it improves their strengths and life skills to live independently. These issues are essential in terms of polypharmacy among them, and its associated adverse effects. Methods: The present cross-sectional study investigated 131 patients with schizophrenia referring to Razi Hospital who were selected by a convenience sampling method. The subjects’ medical records were evaluated in terms of comorbid disorders and non-psychiatric medicine use patterns. Their demographic data were also collected by a separate questionnaire. Results: The frequency of schizophrenia disorder was higher in males aged ≥65 years. The comorbidity frequency of non-psychiatric disorders was significantly higher in the elderly, compared to non-elderly patients. The most prevalent comorbid disorders in the elderly were musculoskeletal, cardiovascular, and metabolic disorders; and in the non-elderly neurological, hematological, and digestive diseases. The prevalence of non-psychiatric medicine intake was significantly higher in the elderly. The prevalence of non-psychiatric medicine use in the elderly (e.g. aspirin, heart disease medications, hypertension medications, etc.) and non-elderly patients (e.g. anemia medications, antibiotics, anticonvulsants, etc.) was not similar. Discussion: In schizophrenic patients, the old age period is associated with more comorbid disorders, compared to their healthy counterparts. Such comorbid profile is similar to other patients; e.g. the most prevalent comorbidities were musculoskeletal, cardiovascular, and metabolic disorders. Polypharmacy is a medical problem in the elderly, with numerous adverse effects. The adjunct consumption of psychiatric medications with the non-psychiatric ones highlights the vital phenomena of drug interactions and associated adverse effects of polypharmacy.

Patients with overlapping diagnoses of asthma and COPD: is livestock exposure a risk factor for comorbidity and coexisting symptoms and infections?

BackgroundEpidemiological research on health effects of livestock exposure in population subgroups with compromised respiratory health is still limited. The present study explored the association between livestock exposure and comorbid/concurrent conditions in patients with overlapping diagnoses of asthma and COPD.MethodsElectronic health record data from 23 general practices in the Netherlands were collected from 425 patients diagnosed with both asthma and COPD, living in rural areas with high livestock density (“study area”). Data of 341 patients with the same overlapping diagnoses, living in rural areas with lower livestock density (“control areas”) were obtained from 19 general practices. First, the prevalence of comorbid disorders and symptoms/infections were compared between the study and control area. Second, the examined health outcomes were analyzed in relation to measures of individual livestock exposure.ResultsPneumonia was twice as common among patients living in areas with a high livestock density (OR 2.29, 99% CI 0.96–5.47); however, there were generally no statistically significant differences in the investigated outcomes between the study and control area. Significant associations were observed between presence of goats within 1000 m and allergic rhinitis (OR 5.71, 99% CI 1.11–29.3, p < 0.01), number of co-occurring symptoms (IRR 1.69, 99% CI 1.03–2.77, p < 0.01) and anxiety (OR 8.18, 99% 1.5–44.7, p < 0.01). Presence of cattle within 500 m was associated with pneumonia prevalence (OR 2.48, 99% CI 1.05–5.84, p < 0.01).ConclusionLivestock exposure is not associated with comorbid chronic conditions but appears to be a risk factor for symptomatic effects in patients with overlapping diagnoses of asthma and COPD.

Investigating the Associations Of Adult ADHD Symptoms, Hypersexuality, and Problematic Pornography Use Among Men and Women on a Largescale, Non-Clinical Sample

IntroductionAttention deficit hyperactivity disorder (ADHD) is one of the most prevalent comorbid disorders in hypersexuality; however, previous studies only examined the associations of ADHD and hypersexuality among men seeking treatment. Although problematic pornography use (PPU) might be considered the most frequent manifestation of hypersexuality, no previous research examined its association with ADHD symptoms. AimTo (i) examine ADHD symptoms in relation to hypersexuality and PPU and (ii) identify possible similarities and differences in relationship with hypersexuality and PPU in a large, non-clinical sample between both sexes. MethodsMulti-group structural equation modeling was conducted to investigate the hypothesized associations among adult ADHD symptoms, hypersexuality, and PPU between men and women (N = 14,043 participants; women = 4,237; mean age = 33.5 years, SD = 10.9). Main Outcome MeasuresAdult ADHD symptoms were assessed in relation to hypersexuality and PPU via self-reported measures. ResultsResults indicated that hypersexuality had positive and moderate association with problematic pornography use among women (r[14041] = .50, P < .01) and positive and strong association among men (r[14041] = .70, P < .01). ADHD symptoms had positive and moderate associations with hypersexuality in both men and women (β = .50, P < .01; β = .43; P < .01; respectively). Regarding men, ADHD symptoms had a positive, moderate association with PPU (β = .45, P < .01), whereas ADHD symptoms had a positive, but weak, association with PPU in the case of women (β = .26, P < .01). Clinical ImplicationsWhen men have high levels of hypersexuality or PPU, ADHD should be assessed as a potential comorbid disorder. With regard to women, ADHD should be assessed as a potential comorbid disorder only in the case of hypersexuality. Strength & LimitationsApplying self-report methods have possible biases that should be taken into account when interpreting the present findings. However, the present study was conducted on a large community sample and examined the differentiated role of ADHD symptoms in hypersexuality and PPU, not only in men but also in women, that has never been addressed in the literature. ConclusionADHD symptoms might play an important role in the severity of hypersexuality between both sexes, whereas ADHD symptoms might only play a stronger role in PPU among men but not women. The findings corroborate previous results that PPU may not be unambiguously considered as a subcategory of hypersexuality. In addition, potential background mechanisms behind problematic pornography use should be examined separately between men and women.Bőthe B, Koós M, Tóth-Király I, et al. Investigating the Associations Of Adult ADHD Symptoms, Hypersexuality, and Problematic Pornography Use Among Men and Women on a Largescale, Non-Clinical Sample. J Sex Med 2019;16:489–499.

Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice

Guidelines for management of chronic obstructive pulmonary disease (COPD) primarily focus on the prevention of weight loss, while overweight and obesity are highly prevalent in patients with milder stages of COPD. This cross-sectional study examines the association of overweight and obesity with the prevalence of comorbid disorders and prescribed medication for obstructive airway disease, in patients with mild to moderate COPD. Data were used from electronic health records of 380 Dutch general practices in 2014. In total, we identified 4938 patients with mild or moderate COPD based on spirometry data, and a recorded body mass index (BMI) of ≥21 kg/m2. Outcomes in overweight (BMI ≥ 25 and <30 kg/m2) and obese (BMI ≥30 kg/m2) patients with COPD were compared to those with a normal weight (BMI ≥ 21 and <25 kg/m2), by logistic multilevel analyses. Compared to COPD patients with a normal weight, positive associations were found for diabetes, osteoarthritis, and hypertension, for both overweight (OR: 1.4–1.7) and obese (OR: 2.4–3.8) patients, and for heart failure in obese patients (OR: 2.3). Osteoporosis was less prevalent in overweight (OR: 0.7) and obese (OR: 0.5) patients, and anxiety disorders in obese patients (OR: 0.5). No associations were found for coronary heart disease, stroke, sleep disturbance, depression, and pneumonia. Furthermore, obese patients were in general more often prescribed medication for obstructive airway disease compared to patients with a normal weight. The findings of this study underline the need to increase awareness in general practitioners for excess weight in patients with mild to moderate COPD.

Impact of Comorbidities Among Medicaid Enrollees With Chronic Obstructive Pulmonary Disease, United States, 2009.

IntroductionMultimorbidity, the presence of 2 or more chronic conditions, frequently affects people with chronic obstructive pulmonary disease (COPD). Many have high-cost, highly complex conditions that have a substantial impact on state Medicaid programs. We quantified the cost of Medicaid-insured patients with COPD co-diagnosed with other chronic disorders.MethodsWe used nationally representative Medicaid claims data to analyze the impact of comorbidities (other chronic conditions) on the disease burden, emergency department (ED) use, hospitalizations, and total health care costs among 291,978 adult COPD patients. We measured the prevalence of common conditions and their influence on COPD-related and non–COPD-related resource use by using the Elixhauser Comorbidity Index. Elixhauser comorbidity counts were clustered from 0 to 7 or more. We performed multivariable logistic regression to determine the odds of ED visits by Elixhauser scores adjusting for age, sex, race/ethnicity, and residence.ResultsAcute care, hospital bed days, and total Medicaid-reimbursed costs increased as the number of comorbidities increased. ED visits unrelated to COPD were more common than visits for COPD, especially in patients self-identified as black or African American (designated black). Hypertension, diabetes, affective disorders, hyperlipidemia, and asthma were the most prevalent comorbid disorders. Substance abuse, congestive heart failure, and asthma were commonly associated with ED visits for COPD. Female sex was associated with COPD-related and non–COPD-related ED visits.ConclusionComorbidities markedly increased health services use among people with COPD insured with Medicaid, although ED visits in this study were predominantly unrelated to COPD. Achieving excellence in clinical practice with optimal clinical and economic outcomes requires a whole-person approach to the patient and a multidisciplinary health care team.

Medication-overuse headache

Medication-overuse headache affects 1 to 2 percent of the population. Any kind of painkiller, if taken regularly at least 10 days per month can cause medication-overuse headache, and therefore the possibility of this headache has to be raised whenever a patient with a preexistent headache notices a significant increase in headache frequency during a period of frequent painkiller consumption. Medication-overuse headache is most prevalent in females between 40 and 50 years of age. Its main risk factors are smokig, obesity, depression, and anxiety. The pathomechanism of medication-overuse headache is complex, with a probable genetic propensity and other biological (neurochemical and neurophysiological), as well as psychological and behavioural factors (such as anticipatory anxiety, catastrophisation of pain and consequentially a compulsive painkiller use) contributing to its genesis. The prerequisite of successful treatment is the withdrawal of the overused substance, other necessary elements of the therapy include the treatment of withdrawal symptoms including rebound headache, the introduction of an effective preventative therapy, taking into consideration the highly prevalent comorbid disorders as well, and the education and psychological support of patients. As the relapse rate can be as high as 30 to 40% regardless of effective treatment, the prevention of medication-overuse headache is of paramount importance, and the role of general practitioners can hardly be overstated.

Functional impairment in adolescents and young adults with emerging mood disorders.

Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multiple domains. However, little is known about impaired functioning in youth with mood disorders. To examine the prevalence of objective, subjective and observer-rated disability in a large, representative sample of young people with a primary mood disorder. Individuals aged 16-25 years presenting to youth mental health services for the first time with a primary mood disorder participated in a systematic diagnostic and clinical assessment. Impairment was assessed using objective (unemployment or disability payments), observer- (Social and Occupational Functioning Assessment Scale; SOFAS) and self-rated measures (role functioning according to the Brief Disability Questionnaire). Of 1241 participants (83% unipolar; 56% female), at least 30% were functionally impaired on the objective, self-rated and/or observer-rated measures, with 16% impaired according to all three criteria. Even when current distress levels were taken into account, daily use of cannabis and/or nicotine were significantly associated with impairment, with odds ratios (OR) ranging from about 1.5 to 3.0. Comorbid anxiety disorders were related to lower SOFAS scores (OR = 2-5). Levels of disability were significant, even in those presenting for mental healthcare for the first time. Functional impairment did not differ between unipolar and bipolar cases, but some evidence suggested that females with bipolar disorder were particularly disabled. The prevalence of comorbid disorders (50%) and polysubstance use (28%) and their association with disability indicate that more meaningful indicators of mood episode outcomes should focus on functional rather than symptom-specific measures. The association between functioning and nicotine use requires further exploration.

Neurobiology of Comorbid Substance Use Disorders in Mental Illness: A Closer Look at the Underlying Commonalities between Cannabis and Schizophrenia

The high rate of cannabis use disorders (CUDs) among patients with schizophrenia is well established. The implications of this comorbidity are extensive and include symptom exacerbation, frequent relapses leading to hospitalization and an overall worsening of prognosis. Therefore, a greater understanding of why cannabis use and schizophrenia frequently present in the same individual is critical. In this article, we propose that common neurobiological pathways and substrates independently contribute to the predisposition of developing these disorders. Dysregulation of the endocannabinoid system, as well as abnormalities in neurophysiology, neurocognition, genetics, and brain morphology may contribute to this comorbidity. Future studies are needed to confirm these commonalities between CUDs and schizophrenia, given that better understanding of their etiology may guide integrated treatment interventions and the development of prevention strategies for these prevalent comorbid disorders.

A cross-sectional analysis of patient characteristics and practice patterns in the management of bipolar disorder across Turkey

Objective: Bipolar disorder (BD) is one of the leading causes of disability among medical and psychiatric disorders associated with prevalent, chronic, severe and highly disabling characteristics. This study was designed to identify clinical characteristics and practice patterns in the management of outpatients with BD across Turkey. Methods: This multi-center cross-sectional study involving 1001 patients diagnosed with using DSM-IV criteria was conducted prospectively at 31 outpatient psychiatry clinics for 12 months. Patient demographics, clinical features, family history, comorbid psychiatric disorders, and the treatment modalities were assessed by means of semi-structured questionnaire. Results: Age at the onset of symptoms was 26.7±9.8 years, age at diagnosis was 28.9±10.4 years, and the time interval between them was 2.2 (4.7) years. Misdiagnosis prior to current diagnosis was evident in 40.3% of bipolar patients. The most common type of first episode was mania (57.1%) and depression (34.5%). Comorbid psychiatric illness was identified in 12.0% of patients. Only 10% of patients were receiving monotherapy. The most commonly prescribed drugs for depressive, manic and mixed episodes were lithium, sodium valproate and quetiapine, respectively. Conclusion: The time interval between onset of symptoms and the initial diagnosis in Turkish sample was quite shorter than reported in the literature. The misdiagnosis rate in the present study and recent studies were similar. A low comorbidity rate appears to indicate a lower prevalence of comorbid disorders in BD in Turkish sample. Lithium, sodium valproate and atypical antipsychotics were more commonly used drugs in the treatment of BD in Turkey.

Komorbide psychiatrische Störungen und Differenzialdiagnostik bei nicht-intelligenzgeminderten Erwachsenen mit Autismus-Spektrum-Störung

Autism spectrum conditions (ASC) without intellectual disability are often diagnosed late in life. Little is known about co-occurring psychiatric disorders and differential diagnosis of ASC in adulthood, particularly with regard to personality disorders. What kind of comorbid psychiatric disorders occur in ASC? Which are the most prevalent differential diagnoses in a sample of patients who seek autism specific clinical diagnostics? 118 adults who were referred with a presumed diagnosis of autistic disorder, were diagnosed with autism specific instruments and the prevalence of further psychiatric disorders was investigated. 59 (50%) fulfilled the criteria of ASC. 36% of the individuals with ASC fulfilled also criteria for a DSM-IV axis-I psychiatric disorder. Affective disorders (24%) and social phobia (14%) were the most prevalent comorbid disorders. The most frequent differential diagnoses were depression, social phobia, paranoid, avoidant and narcissistic personality disorder.

Functional Impairment and Occupational Outcome in Adults With ADHD

Objective: ADHD is associated with poor functional outcomes. The objectives were to investigate the prevalence of functional impairment and occupational status in a clinically referred sample of adults with ADHD and explore factors predicting occupational outcome. Method: A sample of 149 adults with a confirmed diagnosis of ADHD participated in the present study. Cross-sectional data were collected from the participant’s medical records and from self-report questionnaires. A multiple regression model was applied to identify possible predictors of occupational outcome. Results: Only 22.2% had ordinary work as their source of income, compared with 72% in the general population. The most prevalent comorbid disorders were lifetime depression (37.8%), substance abuse (28.1%), and alcohol abuse (23.3%). Age at first treatment with central stimulants and inattentiveness negatively predicted occupational outcome. Conclusion: Adult ADHD was associated with lower educational attainment and lower level of employment. Later age of first central stimulant treatment and higher inattentiveness ratings were associated with lower level of employment.

Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta‐analysis of population surveys

This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers. A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies. Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution. Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates.

Sociodemographic characteristics and comorbidity in panic disorder patients / Panik bozukluğu hastalarında sosyodemografik özellikler ve komorbidite

Aim: The aim of the present study is to investigate the sociodemographic characteristics and the frequency of comorbid Axis I diagnosis in panic disorder (PD) patients.Method: 77 patients who referrred to the psychiatry outpatient clinic of Vakif Gureba Training and Research Hospital and Sisli Etfal Training and Research Hospital and who were diagnosed with panic disorder according to DSM-IV diagnostic criteria were included in the study. Comorbid psychiatric diagnoses were evaluated by SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders). Results: Fifty six of the patients (72.7%) were female, and 21 (27.3%) were male. Mean age was 35.53±12.25. Among patients, 37.7% had Axis I psychiatric disorder diagnosis in their family histories. In 93% of the patients, a psychiatric comorbidity was diagnosed along with panic disorder. The most common Axis I comorbidity was major depression (47.2%). Discussion: Although the number of female patients was higher when compared to other studies, female/male ratio was determined to be lower. The rate of major depression was compatible with the literature, while comorbidity rates for generalized anxiety disorder and social anxiety disorder (SAD) were found to be lower than the groups in similar literature. SAD comorbidity rate in PD patients with agoraphobia was found to be significantly higher than the PD group without agoraphobia. Conclusion: Nearly half of the PD patients had major depression, while in patients with comorbid agoraphobia, prevalence of comorbid disorders, particularly of SAD, was shown to increase.

Adolescence et schizophrénie

Whilst early onset schizophrenias are rare all studies show a clear increase in the incidence and prevalence of the disorder from the age of 15 onwards. The clinical picture in adolescence is similar to that described in adults although the diagnosis of schizophrenia at this age is still difficult, as the disorder shares many common symptoms with the affective psychoses (particularly with bipolar disorder). Some clinical features, the premorbid history and past family history can help with the differential diagnosis in this situation. Studies on the fate of schizophrenic adolescents show that the disorder has particularly harmful consequences on the individuals’ development and psychosocial adaptation. The risk of suicide or accidental death are highlighted. This may be partly explained by the progressive deterioration of cognitive function seen, with the progression and the prevalence of co-morbid disorders (conduct disorders, substance abuse). Paradoxically there are few objective data available as yet about the efficacy of the different treatment strategies offered ; medical and psychotherapeutic, behavioural or psychosocial. Whilst early intervention programmes for adolescents at high risk of schizophrenia have been introduced, their utility and efficacy remain to be shown.

Comorbid psychiatric disorders in substance dependence patients: A control study

Background:The purpose of this study was to investigate the comorbidity of mental disorders among a random sample of substance dependence patients from a psychiatric inpatients department and the general population.Materials and Methods:Comprehensive data was collected from inpatients with substance abuse/dependence and comorbidity of mental disorders at the Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS) and from normal controls from the general population during the period January 2007 to May 2007.Results:The results show that the most prevalent comorbid disorders in substance dependence patients and substance abusers were depressive disorders.Conclusions:The majority of substance dependence patients suffered from comorbid mental disorders. Comorbidity needs to be taken into account when analyzing the relationship between substance dependence and depression and in planning treatment strategies for comorbid conditions.

Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples?

The authors review sample composition and enrollment data for 34 studies cited in the International Society for Traumatic Stress Studies (ISTSS) 2000 Practice Guidelines as meeting the Level A U.S. Agency for Health Care Policy and Research (AHCPR) classification for treatment of adult posttraumatic stress disorder (PTSD), and compare data from more recent research. Findings reveal that many published reports omitted vital data including exclusion criteria and rates, demographics, and trauma exposure history. Moreover, severe comorbid psychopathology, a common feature of treatment-seeking individuals with PTSD, emerged as the predominant reason for exclusion across studies. Subsequently published studies exhibited improved reporting of sample characteristics and demonstrated comparable outcomes despite inclusion of more diverse trauma exposure samples. Findings indicate the need for future efficacy research to adopt more comprehensive reporting requirements and to test the applicability of validated treatments to individuals suffering from as yet unstudied combinations of PTSD and prevalent comorbid disorders.

Comorbidity of drug abuse treatment

Research has suggested that comorbidity, the concurrence of substance abuse disorders with other psychiatric disorders, may have prognostic value and important implications for the treatment of substance abuse. Knowledge of the prevalence of comorbid disorder is important because it will enable treatment services to be appropriately configured and designed for clinical drug treatment populations. The form and duration of comorbidity may be influenced by a variety of factors, which include the class of drug being abused, the duration of drug use, the individual sensitivity to drug effects, and whether the drug effects are acute or due to withdrawal or residual conditions. This paper addresses three important scientific questions: (1) What is the prevalence of comorbid disorders in a drug abuser population? (2) What is the stability of psychiatric diagnoses in a drug abuser population? (3) Does the existence of a comorbid disorder influence the outcome of drug abuse treatment?