Psychiatric Diagnoses In Patients Research Articles

Trends in Mental Disorders in Children and Adolescents Receiving Treatment in the State Mental Health System

To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States. Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client-Level Data 2013-2021 (total number of records= 13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic, and service strata focusing on community-based programs. The analyses revealed increases in the proportion of anxiety disorders from 9.6% in 2013 to 19.2% in 2021 (adjusted odds ratio [AOR] 2.17, 95% CI 1.85-2.55, p< .001), trauma- and stressor-related disorders from 22.7% to 27.4% (AOR 1.31, 95% CI 1.09-1.57, p= .004), and depressive disorders from 13.4% to 17.0% (AOR 1.20, 95% CI 1.03-1.41, p= .04). During this same period, the proportion of bipolar disorders declined almost 8-fold from 10.0% to 1.3% (AOR 0.07, 95% CI 0.06-0.09, p< .001). The proportion of conduct disorder and oppositional defiant disorder also declined from 9.7% to 4.4% (AOR 0.42, 95% CI 0.32-0.55, p< .001) and from 11.1% to 7.8% (AOR 0.79, 95% CI 0.65-0.98, p= .03), respectively. Trends varied across sex, age, and racial/ethnic strata. The composition of childhood psychiatric diagnoses in patients within publicly funded mental health treatment settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.

The diagnosis of malingering in general hospitals in the United States: A retrospective analysis of the National Inpatient Sample

ObjectiveTo characterize the socio-demographics and comorbid medical and psychiatric diagnoses of patients in the general hospital diagnosed with malingering. MethodWe conducted a retrospective observational cohort study using data from the 2019 National Inpatient Sample, an all-payors database of acute care general hospital discharges in the United States, querying for patients aged 18 and older discharged with a diagnosis of “malingerer [conscious simulation],” ICD-10 code Z76.5. Results45,645 hospitalizations (95% CI: 43,503 to 47,787) during the study year included a discharge diagnosis of malingering. 56.1% were for male patients, and the median age was 43 years (IQR 33 to 54). Black patients represented 26.8% of the patients with a discharge diagnosis of malingering, compared to 14.9% of all patients sampled. Zip codes in the lowest household income quartile comprised 39.9% of malingering diagnoses. The top categories of primary discharge diagnoses of hospitalizations included medical (“Diabetes mellitus without complications”), psychiatric (“Depressive disorders”), and substance use (“Alcohol-related disorders”) disorders. “Sepsis, unspecified organism,” was the most common primary diagnosis. ConclusionThe striking overrepresentation of Black patients in hospitalizations with diagnosis of malingering raises concern about the roles of implicit and systemic biases in assigning this label. The disproportionate number of patients of low socioeconomic status is further suggestive of bias and disparity. Lower health literacy in these populations may result in a limited knowledge of traditional ways to meet one's needs and thus greater reliance on malingered behavior as an alternative means. Accurate description of these patients' socio-demographics and comorbid medical and psychiatric diagnoses with reliable data from large samples can lead to improved understanding of how the malingering label is applied and ultimately better patient care.

Psychiatric consequences in hospitalized patients affected by COVID-19 (RECOVER-PSY)

IntroductionCOVID-19 had a significant impact on the mental health of the affected population. Such multifactorial risk for a deterioration of mental health suggests the need to identify groups of patients with psychiatric vulnerability and to establish strategies of intervention based on scientific evidence.ObjectivesThe aim of the study was to identify psychiatric outcomes one year after recovery and possible associations between these and the clinical, anamnestic, and sociodemographic variables.MethodsThe Mini International Neuropsychiatric Interview was employed to assess current and lifetime mental illness in a cohort of 100 patients discharged between March and April 2020 from COVID-19 wards of the San Paolo Hospital in Milan, Italy. The Kendall rank correlation coefficient was administered to measure the ordinal association between clinical-demographic variables and the psychiatric diagnoses of patients. Bivariate correlation was used to explore the association between psychiatric outcomes and the sample characteristics.ResultsAlmost one third of subjects screened positive for a diagnosis of a new psychiatric disorder, and a novel onset of psychiatric morbidity did not differ significantly in patients with and without a positive history of mental illness (42 and 58%). New psychiatric disorders were grouped into stress reactions, anxiety-group disorders and mood disorders. Concerning demographic characteristics, advanced age represented a protective factor against the onset of new psychiatric disorders (rτ = -0,203, p =0,008). Despite a lower risk of contracting the infection, women in our cohort were more vulnerable to psychiatric post-Covid symptoms (rτ =0,190, p =0,029). The correlation between the onset of new psychiatric disorders and some pre-admission vulnerability factors, such as an overweight condition (rτ =0,185, p =0,026) and a positive medical history for cigarette smoking (rτ =0,203, p =0,026), were statistically significant. Moreover, subjects who reported taking a therapy to control the infection prior to hospitalization were more likely to receive a new psychiatric diagnose (rτ =0,269, p =0,005). Of note, variables related to the severity of hospitalization such as oxygenation intensity, days of hospitalization, or requirement of intensive car were not associated with new psychiatric diagnoses.ConclusionsThe onset of psychiatric disorders shows a relevant frequency in patients hospitalized for COVID-19, suggesting that mental health services should structure adequate screening and diagnosis methods. Three levels of intervention can also be expected to reduce the overall risk and burden of psychiatric morbidity: increasing awareness regarding modifiable risk factors; guaranteeing a minimal level of mental health support to patients hospitalized for COVID-19; providing personalized interventions with respect to gender and age groups.Disclosure of InterestNone Declared

Psychiatric Emergencies in Oncology Ambulatory Care Settings.

Psychiatric disorders affect 35%–47% of patients with cancer during the disease trajectory (Caruso & Breitbart, 2020; İzci et al., 2016). The most common psychiatric diagnoses in patients with cancer are depression, anxiety, and adjustment disorders (Caruso et al., 2017). Although cancer can cause emotional, psychological, and behavioral reactions, underlying medical conditions and treatment-related factors may also affect mental health (see Figure 1).

Free Papers Compiled

INTRODUCTIONErectile Dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection adequate for satisfactory sexual activity. The overall global prevalence is 13.1–71.2%. A study conducted in south India found prevalence of erectile dysfunction in 15.77%, with least in those aged 26-30 years(8.6%) and highest in those aged 51-60 years(27.6%). Emergence of erectile dysfunction may be attributed to organic or psychogenic factors, irrespective of which it often leads to psychological problems. Although ED is subjectively distressing, only a small proportion of males consider it a medical problem, and hence reported infrequently. This study tries to explore presence of co-morbid psychiatric diagnoses in patients with Erectile Dysfunction.SOURCE30 consecutive sexually active males attending the out-patient department of Urology, KIMS, Bangalore, diagnosed with erectile dysfunction were included in the study. ‘International Index of Erectile Function Questionnaire’ was used to assess severity and ‘The Mini International Neuropsychiatric Interview’ was used to assess the presence of co-morbid psychiatric disorders.RESULTS26 of the 30 study subjects had psychiatric co-morbidity, commonly anxiety spectrum disorder(46.15%), depressive spectrum disorder(38.46%) and substance use disorder(15.38%). 11 patients of the 26 had symptoms suggestive of psychiatric disorder before the onset of ED, though untreated. These were predominantly substance use disorder(4), generalized anxiety disorder(3), depressive disorder(3) and obsessive compulsive disorder(1) were seen. 15 patients developed psychological symptoms after the onset of ED, predominantly anxiety disorder(8) and depressive disorder(7). There was no association between psychiatry morbidity and socio-demographics of the patients.CONCLUSION57.6% of the study population developed psychiatric morbidity following the onset of erectile dysfunction, predominantly anxiety and depressive disorders. Since the occurrence of psychiatric morbidity is high in patients with erectile dysfunction, it is important to incorporate routine screening for the same at the outset.

Особливості психічного здоров'я громадян України в умовах епідемічної небезпеки та реформування системи охорони здоров`я на сучасному етапі

Relevance. The global pandemic caused by the prevalence of COVID-19 (SARS-Cov-2) has become a trigger for the formation of a wide range of problems in the medical, socio-psychological, and rehabilitation spheres. The frequency of neurological or psychiatric diagnosis in patients after SARS-Cov-2, in the next 6 months, was 33.62%; the frequency of first diagnosis is 25.79%, and the mental health disorders themselves are diverse and affect almost all aspects of mental functioning, significantly worsening the quality of life. In addition, the extreme burden of the healthcare system in Ukraine in the context of a prolonged socio-economic and political crisis requires immediate реформування reform. Therefore, it is important to study the peculiarities of mental health of Ukrainian citizens in the context of epidemic danger and reform of the healthcare system at the present stage. Goal. To study the peculiarities of mental health of Ukrainian citizens in the paradigm of reforming the healthcare system in conditions of epidemic danger at the present stage. Materials and methods. Subject to informed consent in compliance with the principles of Bioethics and deontology, for the period from March to September 2021, 80 people aged 20 to 80 years were examined, who suffered covid-19 in 2020-2021 in mild (Group 1) and moderate severity – Group 2 (lung damage from 25 to 60%) and did not previously have a psychiatric diagnosis. The clinical and psychopathological method and screening diagnostics were implemented in the form of a semi-structured psychopathological interview, the main purpose of which was a comprehensive assessment of the patient's mental status. The psychodiagnostic method was used using the hospital scale of anxiety and depression HADS; the quality of life questionnaire SF-36; Being Activity Mood (BAM); The scale of C. D. Spielberger – Yu.L. Khanin. Results. The most common mental and behavioral disorders (MBD) using the HADS method are analyzed. The results showed that clinically expressed anxiety occurred in 33.7% of respondents (groups 1 and 2), and its subclinical variant – in 6.3%. The dominant plot of anxiety was phobic thoughts, fears of severe or fatal consequences of a viral disease in yourself or your loved ones. Clinically expressed depression was observed in 29.7%, and subclinically – in 68%. Assessment of the quality of life according to the SF-36 questionnaire revealed clinical indicators of the average score on the "vital activity" scale – 32.0 and 43.0 in groups 1-2, respectively. According to the BAM methodology, the self-assessment of the individual indicated a low assessment of all indicators in both groups. 75% of patients on the C. D. Spielberger–Yu.L. Khanin scale had high levels of situational and personal anxiety, and 25% had moderate levels. The level of situational anxiety was 56.70±0.48, and personal anxiety – 43.86±0.34 points. The Law of Ukraine "On rehabilitation in the field of healthcare " and the resolution of the Cabinet of Ministers of Ukraine "Issues of Organization of rehabilitation in the field of healthcare" are legislative and executive innovations of the present, which differ: pronounced" patient-centricity"; stages; multi-level; multicomponent influences; a significant range of rehabilitation coverage; interdisciplinarity; consistency; organizational and informational integrity; management efficiency; modernity, innovation. That is, the implementation of this law, if the necessary funding is available, will provide rehabilitation assistance to the population of Ukraine, including in conditions of epidemic danger, at the proper level. Conclusions. Thus, according to our study, as a result of the covid-19 viral disease, there was an increase in the number of patients with MBD: adaptive, anxiety-phobic and depressive. Organizational and methodological aspects of comprehensive medical and psychological care for patients with MBD in the framework of the development of the corresponding algorithm included: unity of measures, manageability of impacts; integrality; holistic approach; continuity, etc. However, an algorithm should be developed and brought into line with the presented innovations of healthcare reform in Ukraine for the terminology and formation of rational, effective directed routing of patients with anxiety-phobic disorders in conditions of epidemic danger in order to improve and increase the level of medical and psychological care and improve their quality of life. Keywords: COVID-19 (SARS-Cov-2) pandemic, mental disorders, behavioral disorders, health system reform.

Successful Treatment of Post-COVID Symptoms With Transcranial Direct Current Stimulation.

Anxiety and depression have been the most common psychiatric diagnoses in patients following COVID-19 infection. Could transcranial direct current stimulation be an effective treatment for these post-COVID symptoms?

Long COVID and mental health.

Long COVID and mental health.

6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records

SummaryBackgroundNeurological and psychiatric sequelae of COVID-19 have been reported, but more data are needed to adequately assess the effects of COVID-19 on brain health. We aimed to provide robust estimates of incidence rates and relative risks of neurological and psychiatric diagnoses in patients in the 6 months following a COVID-19 diagnosis.MethodsFor this retrospective cohort study and time-to-event analysis, we used data obtained from the TriNetX electronic health records network (with over 81 million patients). Our primary cohort comprised patients who had a COVID-19 diagnosis; one matched control cohort included patients diagnosed with influenza, and the other matched control cohort included patients diagnosed with any respiratory tract infection including influenza in the same period. Patients with a diagnosis of COVID-19 or a positive test for SARS-CoV-2 were excluded from the control cohorts. All cohorts included patients older than 10 years who had an index event on or after Jan 20, 2020, and who were still alive on Dec 13, 2020. We estimated the incidence of 14 neurological and psychiatric outcomes in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood, and anxiety disorders (grouped and separately); substance use disorder; and insomnia. Using a Cox model, we compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory tract infections. We investigated how these estimates were affected by COVID-19 severity, as proxied by hospitalisation, intensive therapy unit (ITU) admission, and encephalopathy (delirium and related disorders). We assessed the robustness of the differences in outcomes between cohorts by repeating the analysis in different scenarios. To provide benchmarking for the incidence and risk of neurological and psychiatric sequelae, we compared our primary cohort with four cohorts of patients diagnosed in the same period with additional index events: skin infection, urolithiasis, fracture of a large bone, and pulmonary embolism.FindingsAmong 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62% (95% CI 33·17–34·07), with 12·84% (12·36–13·33) receiving their first such diagnosis. For patients who had been admitted to an ITU, the estimated incidence of a diagnosis was 46·42% (44·78–48·09) and for a first diagnosis was 25·79% (23·50–28·25). Regarding individual diagnoses of the study outcomes, the whole COVID-19 cohort had estimated incidences of 0·56% (0·50–0·63) for intracranial haemorrhage, 2·10% (1·97–2·23) for ischaemic stroke, 0·11% (0·08–0·14) for parkinsonism, 0·67% (0·59–0·75) for dementia, 17·39% (17·04–17·74) for anxiety disorder, and 1·40% (1·30–1·51) for psychotic disorder, among others. In the group with ITU admission, estimated incidences were 2·66% (2·24–3·16) for intracranial haemorrhage, 6·92% (6·17–7·76) for ischaemic stroke, 0·26% (0·15–0·45) for parkinsonism, 1·74% (1·31–2·30) for dementia, 19·15% (17·90–20·48) for anxiety disorder, and 2·77% (2·31–3·33) for psychotic disorder. Most diagnostic categories were more common in patients who had COVID-19 than in those who had influenza (hazard ratio [HR] 1·44, 95% CI 1·40–1·47, for any diagnosis; 1·78, 1·68–1·89, for any first diagnosis) and those who had other respiratory tract infections (1·16, 1·14–1·17, for any diagnosis; 1·32, 1·27–1·36, for any first diagnosis). As with incidences, HRs were higher in patients who had more severe COVID-19 (eg, those admitted to ITU compared with those who were not: 1·58, 1·50–1·67, for any diagnosis; 2·87, 2·45–3·35, for any first diagnosis). Results were robust to various sensitivity analyses and benchmarking against the four additional index health events.InterpretationOur study provides evidence for substantial neurological and psychiatric morbidity in the 6 months after COVID-19 infection. Risks were greatest in, but not limited to, patients who had severe COVID-19. This information could help in service planning and identification of research priorities. Complementary study designs, including prospective cohorts, are needed to corroborate and explain these findings.FundingNational Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.

Family history of mood disorders and concomitant psychopathology in patients with depression

IntroductionA family history (FH) of mood disorders is an important clinical feature that affects the risk of depression and its clinical manifestations during the course of the disease.ObjectivesTo assess the impact of FH in patients with depression on the presence of concomitant psychiatric disorders.MethodsThis cross-sectional study included 172 patients with depression (64.5% women; age - 40,87±15,86 years). The M.I.N.I. was conducted to verify the diagnosis of psychiatric disorders. FH is based on indirect reports of patients.ResultsThe most prevalent concomitant psychiatric diagnoses in patients with depression were generalized anxiety disorder (GAD; 26,2%), panic disorder (24,4%) and social anxiety disorder (13,4%). FH was recorded in 52 (30.2%) patients with depression. Patients with depression and FH more often had concomitant GAD (with FH - 20 (38,5%), without FH - 25 (20,8%); p=0.016). Women with depression and FH showed a higher rate of early onset (before age 18) of depression (with FH - 10 (32,3%), without FH - 10 (12,5%); p=0.015). Men with depression and FH more often had concomitant GAD (with FH - 10 (47,6%), without FH - 8 (20%); p=0.025). Logistic regression revealed that FH was associated with GAD in patients with depression (p=0.019).ConclusionsFH of mood disorders in patients with depression is associated with specific concomitant psychopathology. Further genetic studies are needed to explain this comorbidity.

S128. IMPACT OF COMORBIDITIES ON SURVIVAL ESTIMATE FOR PATIENTS WITH MENTAL DISORDERS

BackgroundA systematic review, including 203 studies, estimated that people with mental disorders have a mortality rate 2.2 times higher than the general population or control samples; the majority of these studies were conducted in developed countries. A possibility that underlies this excess mortality is that mental disorders increase the risk for communicable and non-communicable diseases and unintentional and intentional injuries. On the other hand, many health conditions increase the risk of mental disorders, and this comorbidity compromises the search for health care and may also impact survival estimates.We investigated the main causes of mortality in patients with mental disorders and the most prevalent psychiatric diagnoses involved, as well as the impact of communicable and non-communicable comorbidities on the survival estimates of these patients in a Brazilian cohort.MethodsWe evaluated 3,011 patients hospitalized due to mental disorders, over 18 years old, included in a web-based system of mental health information (SISAM-13). The SISAM-13 database is composed, in addition to sociodemographic data, of comorbidities such as hypertension, diabetes, infectious disease, trauma, respiratory problems, sequelae of cerebrovascular accident and epilepsy. This cohort was registered between April 2011 and November 2016. Information on mortality was conducted in collaboration with the SEADE, the center of São Paulo State Government in production of socioeconomic and health data, and December 2016 was the final point of the survival time. Diagnosis and mortality cause were coded according to ICD-10. The Kaplan-Meier method was used to estimate the survival function. Differences between groups were assessed with the log-rank test.ResultsIn total, 568 (26.2%) of valid cases presented comorbidities, and 124 patients (4.1%) died. The most prevalent causes of death were related to external causes (24.2%), and respiratory (17.7%), circulatory (11.3%) and digestive (8.1%) diseases. The presence of comorbidity decreased patients’ life expectancy: the median survival estimate for patients with comorbidities was 77.9 years (95% CI, 74.9 to 79.5 years), while for those without comorbidity was 80.8 years (95% CI, 78.9 to 83.2 years); X2(1) = 4.202; p = 0.040. The three most prevalent diagnoses were mental disorders due to substance use (40.7%), affective disorders (22.7%) and psychotic disorders (20.0%). The average survival estimate was lower among patients with substance use disorder (69.2 years; 95% CI, 66.4 to 72.0 years) compared to affective disorders (78.7 years; 95% CI, 76.6 to 80.8 years) and psychoses (80.3 years; 95% CI, 78.0 to 82.7 years); X2(2) = 30.807; p <0.001. No differences were observed in the interaction between the most prevalent diagnoses and presence of comorbidities.DiscussionThis study is the first of our knowledge to explore life estimates related to comorbidities and the most prevalent psychiatric diagnoses in patients living in a low- and middle-income country (LAMIC). In this sense, it was found that having comorbidity reduced life expectancy, independently of the psychiatric diagnosis; and among the most prevalent disorders, those related to psychoactive substance use presented the lowest life expectancy. These findings suggest the need for a comprehensive view of the psychiatric patient with comorbidities, as well as the urgency of public health policies directed at psychoactive substance users given the high prevalence and low life expectancy in this group of patients.

Psychiatric Comorbidities in Non-psychogenic Chronic Itch, a US-based Study

Research suggests that itch and psychiatric diseases are intimately related. In efforts to examine the prevalence of psychiatric diagnoses in patients with chronic itch not due to psychogenic causes, we conducted a retrospective chart review of 502 adult patients diagnosed with chronic itch in an outpatient dermatology clinic specializing in itch and assessed these patients for a co-existing psychiatric disease. Psychiatric disease was identified and recorded based on ICD-10 codes made at any point in time which were recorded in the patient’s electronic medical chart, which includes all medical department visits at the University of Miami. Fifty-five out of 502 (10.9%) patients were found to have a comorbid psychiatric diagnosis based on ICD-10 codes. The most common psychiatric diagnoses were anxiety disorders (45.5%), followed by major depressive disorder (36.4%). There was no significant association of any specific type of itch to a particular psychiatric disorder. No unique itch characteristics were noted in patients with underlying psychiatric diagnoses.

828-P: The Impact of Diabetes and Depression Status on Weight Loss Outcomes in Mexican Patients with Severe Obesity

Background: There is a well-known association between type 2 diabetes (T2DM) and depression, including inferior outcomes in weight loss treatments. However, obesity guidelines do not address psychiatric interventions during such programs. Objective: We assessed the impact of T2DM in outcomes (weight loss, psychiatric diagnoses and quality of life) of a six-month public obesity program that incorporated a psychiatric intervention for patients with severe obesity. Methods: Retrospective analysis of the registry of the behavioral obesity program at Instituto Nacional de Ciencias Médicas y Nutrición in Mexico City after implementation of a psychiatric intervention that includes diagnosis by a single psychiatrist with the DSMV criteria, psychoeducation, psychopharmacological prescription and/or psychotherapy accordingly. We determined weight loss, frequency of psychiatric diagnoses (depression, anxiety, binge eating disorder [BED]), and quality of life according with T2DM diagnosis. Results: We included 329 subjects (66% women aged 43.7±12.2 years, initial BMI of 44.2±9.6 kg/m2). The frequency of psychiatric diagnoses in patients with and without T2DM was: Depression 43% and 32% (p=0.05), anxiety 25% and 24% (p=0.42), and BED 32% and 32% (p=0.50). Baseline quality of life (QoL) was lower in patients with T2DM than in those without it (p&amp;lt;0.001), and both were prescribed a pharmacological treatment similarly. Subjects with T2DM were prescribed an obesity drug more often (p=0.004) but lost similar weight (p=0.07). Patients with T2DM had higher depression remission, to similar frequency at the end (p=0.42), and QoL improved significantly (p=0.02), but remained lower than in subjects without T2DM (p&amp;lt;0.001). Conclusion: In subjects with severe obesity and T2DM, pharmacological obesity treatment and a psychiatric intervention and were beneficial for weight loss and depression control. Improvement in QoL might require additional T2DM interventions. Disclosure M. Rodriguez Flores: None. S. Stephano Z.: None. M. Rabasa: None. J. Montoya: None. C. Velez: None. E. Garcia: None.

The effect of attention deficit/hyperactivity disorder and other psychiatric disorders on the treatment of pediatric diabetes mellitus.

Psychiatric diagnoses of patients with type 1 diabetes mellitus (T1DM), the severity of attention deficit/hyperactivity disorder (ADHD) symptoms of the patients and their primary caregivers, and the effects of these factors on treatment were investigated. Sixty-one patients with T1DM were included in the study along with their parents. Psychiatric diagnoses of the patients were determined using a semistructured psychiatric interview, and their depression and ADHD symptom severities were evaluated with self-report scales. The ADHD symptom severities of the parents were evaluated using self-report scales. The relationships among the psychiatric symptoms and the hemoglobin A1c (HbA1c), fasting blood glucose (FBG), and postprandial blood glucose (PBG) levels of the patients were investigated. HbA1c levels were found to correlate with the hyperactivity levels of children and the number of diagnoses they had. FBG and PBG values of patients diagnosed with ADHD were found to be higher than in those who did not have ADHD. HbA1c, FBG, and PBG values of the patients who had any disruptive behavior disorder were found to be higher than in those who did not. ADHD total scores, gender (being female), having diagnoses of ADHD or depression were found to be predictive of HbA1c levels according to the regression analyses. No relationship between the clinical findings of the children and their parents' ADHD levels was found. The findings of this study implicate that children with T1DM should be evaluated in terms of ADHD which could have negative effects on the treatment.

Psychiatric diagnoses in patients with renal transplantation or dialysis made due to end stage renal disease

Objective: End stage renal disease (ESRD) is a growing public health problem. Many studies reported that psychiatric morbidities and disability of patients with ESRD are high and that transplantation is more psychologically advantageous than dialysis. We aimed to determine the risk factors affecting the psychiatric diagnosis of the patients who underwent renal transplantation and dialysis due to ESRD in our study. Methods: Forty-eight trans-plant recipients and 42 patients on maintenance receiving dialysis who have been followed up by Nephrology Unit of Ataturk University Medical Faculty and 43 healthy volunteers were included in the study. All subjects were assessed with Sociodemographic-Clinical Data Form, State and Trait Anxiety Inventory (STAI I-II), Hospital Anxiety Depression Scales (HADS) and the validated Turkish versions of Structured Clinical Interview for the DSM-IV (SCID-I). Results: No statistically significant difference was found between the three groups in terms of age, gender, educational status, marital status and income status. In dialysis patients, the absence of active work experi-ence was higher than the other two groups. When the averages of the scale scores of the groups were compared, it was seen that the STAI-II, HAD anxiety averages were higher in the dialysis group than the other two groups. For transplant and dialysis groups it was detected that there was a positive correlation between KBY duration and STAI I-II, and dialysis duration and HADS scores. When the distribution of psychiatric disorders was examined in the groups according to SCID, the rate of depressive disorder in dialysis group was higher than in both groups. Discus-sion: In this study, it was found that depression was common in patients undergoing dialysis, and transplant patients had similar depression rates with the controls. It should be given priority to the diagnosis and treatment of depres- sion as a risk factor that may affect the long-term general medical conditions of the patients with dialysis or kidney transplantation in addition to the biological evaluation.

Seizures, Nonepileptic Events, Trauma, Anxiety, or All of the Above.

Psychiatric Comorbidity and Traumatic Brain Injury Attribution in Patients With Psychogenic Nonepileptic or Epileptic Seizures: A Multicenter Study of US Veterans Salinsky M, Rutecki P, Parko K, Goy E, Storzbach D, O’Neil M, Binder L, Joos S. Epilepsia. 2018. Epub ahead of print. https://doi.org/10.1111/epi.14542 Objective: To determine the frequency and severity of psychiatric disorders and attribution of seizures to traumatic brain injury (TBI) in veterans with verified psychogenic nonepileptic seizures (PNES) versus epileptic seizures (ES). Methods: We studied 333 consecutive admissions to the monitoring units of 3 Veterans Administration epilepsy centers. All patients underwent continuous video-electroencephalographic recording to define definite PNES or ES. Evaluations included the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, posttraumatic stress disorder (PTSD) Checklist, Beck Depression Inventory II, and Patient Seizure Etiology Questionnaire. Interviews and questionnaires were completed prior to final seizure type diagnosis and patient debriefing. The primary outcome measure was a comparison of Axis I psychiatric diagnoses in patients diagnosed with PNES versus ES. Results: A total of 81 patients were diagnosed with PNES and 70 with ES. Posttraumatic stress disorder was the most frequent Axis I diagnosis in veterans with PNES (64% vs 13% of those with ES; P < .001). Posttraumatic stress disorder was common regardless of deployment to a war theater or combat exposure. Mood, substance abuse, and anxiety disorders were also more common in the PNES group. Traumatic brain injury was cited as a likely cause of seizures by 47% of veterans with PNES versus 25% of those with ES (P = .01). Posttraumatic stress disorder and attribution of seizures to TBI were found in 30% of veterans with PNES versus 3% of those with ES (P < .001). Significance: In veterans referred for inpatient seizure evaluation, PTSD was strongly associated with a diagnosis of PNES versus ES. The association of PNES with PTSD, attribution of seizures to TBI, or both, may prompt early consideration of PNES.

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery.

The impact of well-controlled or historical psychiatric diagnoses in patients seeking bariatric surgery (BS) on perioperative outcomes is unclear. The primary objective of this study was to determine the impact of psychiatric diagnoses on hospital length of stay (LOS), 30-day readmission rates after BS, and post-operative weight loss outcomes. Patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) from 2014 to 2016 at a single academic institution were retrospectively reviewed. Baseline demographic data and psychiatric history including depression, anxiety, and/or bipolar disorder (DAB) were obtained from the electronic medical record. Hospital LOS, 30-day readmissions, and % excess body weight loss (%EBWL) were obtained on all patients and compared between DAB patients and those without any psychiatric history. During the study period, 354 patients were reviewed, of which 78% were female; 60% underwent LSG. The mean preoperative BMI was 48.9 ± 8.4m/kg2. Major depression was the leading diagnosis (42%), and 13% had both depression and anxiety. The 30-day readmission rate was significantly higher than the control (10.5% vs. 3.7%, p = 0.02). Mean hospital LOS and the incidence of long hospital LOS (≥ 4days) was not different between the groups, although within LSG patients, the incidence of long hospital LOS trended towards being higher for DAB patients (9.2% vs. 4%, p = 0.10). Patients with depression and anxiety had a higher incidence of long LOS (23.4% vs. 9.2%, p < 0.005). While 6-month %EBWL was significantly lower for DAB patients (41% vs. 46%, p = 0.004), 1-year weight loss outcomes were not different, even when adjusting for surgical procedure. Patients with baseline or historical DAB had significantly higher early readmission rates, and those with multiple diagnoses were associated with a hospital LOS ≥ 4 days. Future studies should focus on elucidating the impact of psychiatric diagnoses on these quality metrics.

Psychiatric comorbidity and traumatic brain injury attribution in patients with psychogenic nonepileptic or epileptic seizures: A multicenter study of US veterans.

To determine the frequency and severity of psychiatric disorders and attribution of seizures to traumatic brain injury (TBI) in veterans with verified psychogenic nonepileptic seizures (PNES) versus epileptic seizures (ES). We studied 333 consecutive admissions to the monitoring units of three Veterans Administration epilepsy centers. All patients underwent continuous video-electroencephalographic recording to define definite PNES or ES. Evaluations included the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, PTSD Checklist, Beck Depression Inventory II, and Patient Seizure Etiology Questionnaire. Interviews and questionnaires were completed prior to final seizure type diagnosis and patient debriefing. The primary outcome measure was a comparison of Axis I psychiatric diagnoses in patients diagnosed with PNES versus ES. A total of 81 patients were diagnosed with PNES, and 70 with ES. PTSD was the most frequent Axis I diagnosis in veterans with PNES (64%, vs 13% of those with ES; P<0.001). Posttraumatic stress disorder (PTSD) was common regardless of deployment to a war theater or combat exposure. Mood, substance abuse, and anxiety disorders were also more common in the PNES group. TBI was cited as a likely cause of seizures by 47% of veterans with PNES versus 25% of those with ES (P=0.01). PTSD and attribution of seizures to TBI were found in 30% of veterans with PNES versus 3% of those with ES (P<0.001). In veterans referred for inpatient seizure evaluation, PTSD was strongly associated with a diagnosis of PNES versus ES. The association of PNES with PTSD, attribution of seizures to TBI, or both, may prompt early consideration of PNES.

La psychiatrie de liaison au Centre Hospitalier Universitaire Mohammed VI d’Oujda, Maroc : étude transversale sur dix mois

In Morocco, liaison psychiatry is a relatively new activity and is not currently recognized as a psychiatric sub-specialty. However, several university psychiatric teams have started this activity in a more or less structured manner (Fès, Casablanca, Rabat and Oujda). ObjectivesThe objective of this study is to describe the development and organization of the psychiatric liaison activity in the psychiatry department of the Mohamed VI University Hospital Center in Oujda and to evaluate it from a preliminary study. Through this study, we evaluated the reasons for psychiatric consults, requesting services and the most frequent psychiatric disorders. MethodsThis is a cross-sectional descriptive and analytical primary study over a period of 10 months between May 2016 and February 2017. The study recruited 60 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fès. The psychiatric assessment was based on a psychiatric interview using DSM-5 diagnostic criteria. The data were collected by a certified psychiatrist using a medical psychiatric record. ResultsDuring this study, 17 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (28%), gastroenterology (13%), and nephrology (11%). Depressive symptoms (54%) and assessment of suicidal behavior (19%) were the most common motivations for psychiatric consultations. Depressive disorder (58%) and adjustment disorder (18.7%) were the most frequent psychiatric diagnoses in patients from medical and surgical departments. ConclusionPsychiatry liaison is an activity in full evolution in Morocco, the structuring and organization of this activity is paramount, given its clinical, pedagogical, research and even economic interest.

Psychiatric diagnoses and their influencing factors in patients complaining of sleep problems: A study of a psychiatric consultation-liaison service.

Objective This study aimed to identify misdiagnosed or undiagnosed psychiatric disorders and the factors associated with these disorders in patients with sleep problems who are referred to a consultation-liaison service. Method Records of all inpatients receiving a consultation from the Psychiatry Department between January and December 2016 were retrospectively reviewed. Psychiatric diagnoses were analyzed using descriptive statistics, and the factors associated with the risk of these disorders in patients with sleep problems were determined by multiple logistic regression analysis. Results Of the 331 referral patients whose referral reason was simply having trouble in sleeping, only 97 patients were diagnosed with primary sleep disorder after consultation. The recognition rate of psychiatric disorders in inpatients with sleep problems among nonpsychiatric physicians was 29.3%. Anxiety (107, 45.7%) was the most common psychiatric diagnosis in patients with sleep problems followed by organic mental disorder (83, 35.5%), depression (37, 15.8%), and other mental disorders (8, 3.4%). Multiple logistic regression analysis revealed that a course >1 month (OR = 3.656, 95% CI = 2.171-6.156, p = 0.000) and sleep-wake rhythm disturbances (OR = 25.008, 95% CI = 5.826-107.341, p = 0.000) were associated with increased risks of psychiatric disorders. Conclusions The study showed that recognition rate of psychiatric disorders in inpatients with sleep problems was very low. A course >1 month and sleep-wake rhythm disturbances were associated with increased risks of disorders and could be used as indicators by nonpsychiatric physicians to improve diagnoses.