Rates Of Psychiatric Comorbidity Research Articles

Prodromal Phase of Idiopathic Generalized Epilepsy: A Register-Based Case Control Study.

Idiopathic generalized epilepsy (IGE) is associated with distinct behavioral traits, symptoms of frontal lobe dysfunction, and psychiatric comorbidity. Whether psychiatric symptoms are part of the IGE endophenotype or secondary to the burden of chronic disease is unknown. In this study, we aimed at describing the sequence of appearance of psychiatric and epilepsy symptoms in patients with IGE. Inclusion criteria for this cohort study were diagnosis of IGE with age at diagnosis at 10-25 years. We created 2 mutually exclusive cohorts, 1 based on ICD-10 codes in Danish registers with a first IGE diagnosis from January 1, 2005, to December 31, 2018, and a second patient cohort treated at Odense University Hospital and the Danish Epilepsy Centre in the same period. Each case was matched with 10 age-matched, sex-matched, and geography-matched normal population controls from the Danish registers. We compared social status, health care utilization, and psychiatric diagnoses between the groups in the 5 years preceding epilepsy diagnosis, at diagnosis, and at the end of the study period using the Wilcoxon rank-sum test and confirmatory logistic regression models. We identified 1,009 patients for the register-based cohort (55.1% female; mean age at diagnosis [SD]: 15.9 [±3.8] years) and 402 patients for the hospital-based cohort (56.2% female; mean age at diagnosis [SD]: 18.3 [±7.4] years) and matched them to 10,090 and 4,020 controls, respectively. IGE cohorts and controls did not differ at birth. In the 5 years before their IGE diagnosis, register patients had an increasing number of contacts with hospitals (mean visits [SD]: cases: 8.3 [±5.6], controls: 6.6 [±4.5]) and their general practitioners (mean visits [SD]: cases: 48.7 [±26.3], controls: 45.3 [±24.5]) and received more prescriptions for psychiatric medications (prescriptions: cases: 4.2%, controls: 2.5%, p = 0.003) compared with controls. Patients had a higher rate of psychiatric comorbidity (comorbidity: cases: 26.5%, controls: 17.8%, p < 0.0001) at the end of the study than controls. Data were similar in the hospital-based cohort. Our data suggest a prodromal phase of IGE detectable approximately 5 years before the first seizure characterized by increased health care utilization and greater use of prescription medicine for psychiatric symptoms.

The Impact of Negative Emotional Dysregulation on the Outcome of Bariatric Surgery in Patients with Severe Obesity: An Observational One-Year Follow-Up Study.

Background: Psychiatric symptoms are highly prevalent in patients with severe obesity, often representing pivotal factors in the development and progression of this condition. This study examines the association between negative emotional dysregulation (NED) and weight loss following bariatric surgery. Methods: Ninety-nine patients were consecutively enrolled at the Obesity Center of the Pisa University Hospital between March 2019 and February 2021, during a routine psychiatric evaluation before bariatric surgery. Psychopathological dimensions were assessed using the Mini-International Neuropsychiatric Interview (MINI), the Reactivity, Intensity, Polarity, and Stability questionnaire in its 40-item version (RIPoSt-40), the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and the Barratt Impulsiveness Scale (BIS-11). Based on a RIPoSt-40 cut-off score of 70, subjects were divided into two groups: with (NED+) and without (NED-) NED. Results: NED+ subjects had a higher rate of psychiatric comorbidities and eating disorders than NED- patients. Of the total sample, 76 underwent bariatric surgery, and 65 of them were re-evaluated one-year after surgery. Among them, 10 of 28 NED+ subjects (37.5%) had inadequate weight loss one year after surgery compared to 5 of 37 NED- subjects (13.5%) (p = 0.035, OR 3.55, 95%, C.I. 1.05-12.03). Conclusions: Our results suggest a significant association between NED and inadequate weight loss at one-year post surgery.

Bilateral vestibulopathy – Loss of vestibular function and experience of emotions

ObjectiveThe vestibular system is closely connected to emotion-processing neuronal circuits. Patients with bilateral vestibulopathy (BVP), a chronic loss of vestibular function, show remarkably lower rates of psychiatric comorbidities and vertigo-related anxiety (VRA) than those with episodic vertigo/dizziness (v/d). This study aimed to evaluate whether patients with BVP differ from those with episodic v/d in terms of VRA, general anxiety, and cognitions about body and health. MethodsThis cross-sectional study involved a subsample of 202 patients with episodic v/d (i.e., vestibular migraine, vestibular paroxysmia, or Menière's disease) and 43 patients with BVP. All patients underwent standardised neurological/neurotological examinations, structured clinical interviews (SCID-I), and self-report questionnaires, such as the Vertigo Handicap Questionnaire (VHQ), Beck Anxiety Inventory (BAI), Trait Anxiety from the State-Trait-Anxiety Inventory (STAI-T), and Cognitions About Body and Health questionnaire (CABAH). Non-parametric tests were used for analysis. Due to multiple testing, the significance level was set at p ≤ .008. ResultsPatients with episodic v/d exhibited higher VRA levels than those with BVP. However, this difference was not statistically significant (p = .04; r = 0.15, small effect). Additionally, patients with BVP reported more catastrophizing cognitions (p < .001; r = 0.25, small effect) and bodily weakness (p = .003; r = 0.22, small effect) compared to those with episodic v/d. There were no differences in general anxiety levels (BAI and STAI-T) between patients with v/d and those with BVP. ConclusionPatients with episodic v/d and BVP differed in their appraisal (cognition). The difference in VRA (subjective feeling) was not statistically significant. These preliminary results are discussed using a component approach to emotions.

One-to-one peer-coaching for patients with cancer — results of a pilot study

PurposeCancer is a life threatening disease with negative impact on quality of life and psychological well-being. In international studies, one-to-one peer support and counseling have been shown to improve the psychological well-being of cancer patients. In the study presented, we developed and evaluated an innovative program of peer-coaching. In this program at the University Hospital of Freiburg, cancer survivors were trained to support peers by sharing experience.MethodsIn the project, N = 25 cancer survivors were trained to conduct supportive one-to-one conversations with acute patients or patients in aftercare. Based on a prospective observational study, patients were interviewed using questionnaires before and after the conversations. We assessed expectations and experiences with the peer-coaching as well as psychosocial parameters (PHQ9, GAD7, SSUK, NCCN-distress thermometer).ResultsA total of 52 patients had at least one contact with a peer-coach. Most of the patients attended 1–3 sessions. In total, 85 contacts pairing peer-coaches with patients were conducted. Patients showed on average a high level of distress but a low rate of psychiatric comorbidity. The supportive conversations met the patients` needs. Sharing experiences and empowerment were the most relevant benefits for the patients. Both patients and trained peers showed high satisfaction levels with the program.ConclusionOur findings support the feasibility and utility of a peer-coaching program in which trained cancer survivors, acting as peer-coaches, support other patients during or after their oncological treatment. In a further study, the efficacy of peer-coaching should be investigated based on a randomized-controlled trial.Trial registrationThe trial was registered in the German Clinical Trials Register (No. DRKS DRKS00017500) on 12.12.2019.

Gender Differences in Gambling Disorder: Results from an Italian Multicentric Study.

Although gender-specific evidence on Gambling Disorder (GD) is still limited, some studies reported specific differences, mainly in psychopathological profiles, gambling behavior patterns, and pathogenesis. In order to further examine the role of gender in GD, we conducted a multicenter investigation in a sample of Italian outpatients. One hundred-four outpatients with a diagnosis of GD based on DSM-5 criteria were consecutively recruited at two clinics based in Milan. Socio-demographic and clinical variables were collected for the whole sample and analyzed for the effect of gender. The severity of illness was assessed using the Canadian Problem Gambling Index and the Gambling Attitudes and Beliefs (GABS). Among females, a significantly higher mean age (52.23 ± 10.95 vs. 40.96 ± 15.76; p=0.005) and older age at illness onset emerged (43.5 ± 11.92 vs. 29.22 ± 14.26; p<0.001). Females showed a significantly higher rate of psychiatric comorbidities, lifetime suicide ideation, stressful events at GD onset, and positive family history for GD compared to males. A predictive effect of male gender was found for the GABS questionnaires by performing a linear regression model, with males showing a higher risk to reach higher scores compared to females (B= 11.833; t=2.177; p=0.034). Our study seems to confirm the hypotheses that gender in GD may influence psychopathological profiles, course, and comorbidity. GD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to males. Identifying specific clinical factors by gender may prompt more focus on the public health of women in relation to gambling, while still recognizing that males are at-risk of earlier gambling problems. These findings should be considered in therapeutic perspectives.

Association between genital gender-affirming surgery and psychiatric comorbidities in individuals with gender incongruence.

Previous studies present mixed evidence on the relationship between psychiatric comorbidities and genital gender-affirming surgery (GGAS) in individuals with gender incongruence (GI). This research aims to investigate the psychiatric comorbidity rates post-GGAS in the GI population-namely, depressive disorders, anxiety disorders, posttraumatic stress disorders, substance abuse disorder, and suicidality. Based on the TriNetX health care database, an international database with >250 million patients, a cross-sectional study was executed comparing psychiatric comorbidity rates among cases of GI with and without GGAS. Individuals were matched for demographic and health-related variables, which included history of cardiovascular disease, diabetes, and obesity. The main focus was to establish the rates and changes in psychiatric comorbidities following GGAS. Among individuals with GI, the study identified 4061 with GGAS and 100 097 without. At 1 year post-GGAS, there was a significant decrease in depression (odds ratio [OR], 0.748; 95% CI, 0.672-0.833; P < .0001), anxiety (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), substance use disorder (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), and suicidality (OR, 0.530; 95% CI, 0.425-0.661; P < .0001), and these reductions were maintained or improved on at 5 years, including posttraumatic stress disorder (OR, 0.831; 95% CI, 0.704-0.981; P = .028). The findings indicate that GGAS may play a crucial role in diminishing psychiatric comorbidities among individuals with GI. This is the largest known study to evaluate the effect of GGAS on psychiatric comorbidities in the GI population, offering robust evidence. The reliance on the precision of CPT and ICD-10 codes for data extraction poses a limitation due to potential coding inaccuracies. The evidence suggests a significant association between GGAS and reduced psychiatric comorbidities in individuals with GI.

Comorbid Chronic Pain and Post-traumatic Stress Disorder: Current Rates and Psychiatric Comorbidities Among U.S. Military Veterans.

This study reports rates of comorbid chronic pain and post-traumatic stress disorder (PTSD) among U.S. military veterans and rates of psychiatric comorbidities among those with both chronic pain and PTSD. This study utilized National Veterans Affairs (VA) administrative data to identify all veterans treated for chronic pain or PTSD in 2023. Multivariable logistic regression models determined the likelihood of each psychiatric comorbidity for those with chronic pain and PTSD relative to those with chronic pain only and separately to those with PTSD only, after adjusting for demographic variables and all other psychiatric comorbidities. Of the 5,846,453 service users of the VA in 2023, a total of 2,091,391 (35.8%) met the criteria for chronic pain and 850,191 (14.5%) met the criteria for PTSD. Furthermore, 21.6% of those with chronic pain also had PTSD and over half (53.2%) of those with PTSD also met the criteria for chronic pain (n = 452,113). Veterans with chronic pain and PTSD were significantly more likely to be women, Black or African American, Hispanic or Latina, and urban dwelling. Veterans with chronic pain and PTSD had significantly higher rates of all selected comorbidities relative to veterans with chronic pain only. Patients with comorbid chronic pain and PTSD may benefit from tailored treatments to address the additive impact of these conditions.

Diagnosis and pharmacological management of attention deficit hyperactivity disorder in adults with and without intellectual disability: cohort study using electronic health records.

Attention deficit hyperactivity disorder (ADHD) is increasingly diagnosed in adults. People with intellectual disability have higher rates of ADHD yet there is little evidence on the presentation and pharmacological treatment of ADHD in this population or how this differs from the general population. Retrospective cohort study using data from electronic health records. Adults with intellectual disability newly diagnosed with ADHD between 2007 and 2022 were matched to adults with ADHD without intellectual disability and their clinical features and treatments were compared. A total of 159 adults with ADHD and intellectual disability and 648 adults with ADHD without intellectual disability formed the dataset. Adults with intellectual disability had higher rates of psychiatric co-morbidity and spent more time under mental health services than those without intellectual disability. They were more likely to have recorded agitation, aggression, hostility, and mood instability, and less likely to have poor concentration recorded in the 12 months prior to the diagnosis of ADHD. Following diagnosis, people with intellectual disability were significantly less likely to be prescribed any medication for ADHD than controls without intellectual disability (adjusted odds ratio 0.60, 95% confidence interval 0.38-0.91), and were less likely to be prescribed stimulants (27.7% v 46.0%, p < 0.001). The presence of behaviors that challenge in adults with intellectual disability may indicate co-occurring ADHD. Further work to define the safety and efficacy of medication for ADHD in adults with intellectual disability is needed to understand differences in prescription rates and to avoid inequities in care outcomes.

Medical students’ attitudes towards well-being and welfare: a systematic review protocol

IntroductionMedical education poses serious stressors on medical students, as they report overall higher rates of psychiatric comorbidities compared with students enrolled in other university-level courses. The high rates of poor...

Prevalence and associated factors of psychiatric comorbidities in epilepsy in the Casablanca-Settat region of Morocco: A cross-sectional study.

To determine the estimated prevalence of anxiety, depression, and anxiety-depression syndrome (ADS) and to identify the associated factors in Moroccan people with epilepsy (PWE). A cross-sectional study was conducted among adult PWE (June 2021-December 2022) in the Casablanca-Settat region. PWE were interviewed by completing a questionnaire collecting sociodemographic and clinical data. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Out of 21 points, a score ≥8 is in favor of considerable anxiety/depression symptoms and a sum of the two scores ≥15 indicates the presence of ADS. Data were analyzed using Statistical Package for Social Sciences (SPSS) 21.0. p-values ≤0.05 were considered statistically significant and logistic regression was performed to determine the associated factors. Among 294 PWE, the median age was 39 years (interquartile range [IQR]: 25.75-54.00). The median anxiety, depression, and ADS scores were 8 (IQR: 5.00-10.00), 7 (IQR: 4.00-10.00), and 15 (IQR: 10.00-20.00), respectively. Anxiety, depression, and ADS were revealed in 51.4%, 44.9%, and 51.0% of PWE, respectively. Depression was the only predictor for anxiety (aOR = 24.20; 95%CI: 12.45-47.01). Antiseizure polytherapy (aOR = 3.35; 95%CI: 1.72-6.54) and anxiety (aOR = 24.04; 95%CI: 12.12-47.67) were the factors associated with depression. The risk of ADS was increased by female gender (aOR = 2.83; 95%CI: 1.68-4.78), antiseizure polytherapy (aOR = 2.75; 95%CI: 1.62-4.65), structural epilepsy (aOR = 1.73; 95%CI: 1.01-2.94), and the presence of concomitant conditions with epilepsy (aOR = 1.96; 95%CI: 1.16-3.31). Our study reports high psychiatric comorbidity prevalence in epilepsy, which supports the bidirectional link hypothesis. Associated factors found are important in the prognosis and prevention. The neural mechanisms underlying epilepsy tend to expose PWE to psychiatric disorders. Our study aims to quantify the rate of psychiatric comorbidities and their predictive factors in Moroccan PWE. The estimated prevalences of significant symptoms of anxiety, depression, and ADS were 51.4%, 44.9%, and 51.0%, respectively. Depression was the predictor of anxiety. Antiseizure polymedication and anxiety were the associated factors with depression. The risk of SAD was increased by female gender, antiseizure polymedication, structural epilepsy, and concomitant diseases with epilepsy. Our results are important for considering the psychiatric aspect of PWE and improving their care and quality of life.

D150. Gender Affirming Surgery and Reduced Rates of Psychiatric Co-morbidities in Patients with Gender Dysphoria

D150. Gender Affirming Surgery and Reduced Rates of Psychiatric Co-morbidities in Patients with Gender Dysphoria

Attention deficit hyperactivity disorder (ADHD) syndrome across ages

AbstractAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that significantly impacts various aspects of life, including school, work, family, and social relationships. The disorder has a prevalence of 6–7% in children and 4–5% in adults and commonly manifests before the age of 12. Symptoms can be categorised into two groups: attention deficit; and hyperactivity/impulsivity. As individuals age, hyperactivity symptoms generally decrease, while attention deficit symptoms exhibit less change. Attention deficit hyperactivity disorder is associated with numerous adverse outcomes, such as comorbid psychiatric disorders, academic difficulties, accidents, injuries, and increased economic burdens on society and individuals. Children and adults with ADHD have a high rate of psychiatric comorbidity, including learning disorders, autism spectrum disorder, anxiety disorders, mood disorders, tic disorders, adolescent substance abuse, and antisocial personality disorder in adulthood. Timely detection, enhanced intervention strategies, and consistent care may alleviate the clinical and economic burden of ADHD.

Skin picking disorder in the elderly- What is the available evidence?

Introduction Excoriation disorder (ExD) is a pathology recognized by DSM-5, and it is considered a part of the obsessive-compulsive spectrum. ExD is associated with a high rate of psychiatric comorbidity (e.g., depression, ADHD, substance use disorders, etc.).ObjectivesThe main objective of this review was to explore the available evidence to support the diagnosis and treatment of skin picking in elderly population.MethodsA literature review of the available sources reporting on ExD in elderly patients, realized by searching three electronic databases (PubMed, Cochrane, Clarivate/Web of Science) but also the grey literature. All papers published between January 1990 and July 2023, including the terms “excoriation disorder”, “compulsive skin picking”, “dermatillomania” and “elderly” or “old-age patients” were reviewed.Results The information about ExD was extracted almost exclusively from reports on elderly patients with neurocognitive disorders. Tactile hallucinations, delusions of contamination, social isolation and focusing on own bodily sensations, and organic causes- dehydration, allergies, renal insufficiency, hepatic and pancreatic diseases, as well as toxic causes- e.g., adverse events of certain drugs should be investigated in elderly patients exhibiting signs of ExD. A differential diagnosis is very important in this population in order to find the most adequate treatment. Behavioral treatments, serotonergic antidepressants, and glutamatergic modulators have been explored in patients with ExD, although specific trials for elderly patients with this disorder are still lacking. However, case reports support the utility of several serotonergic antidepressants in the elderly.ConclusionsExD is a less explored disorder in the elderly, where an extensive differential diagnosis and screening for somatic/psychiatric comorbidities are needed. Trials exploring the potential treatments for ExD in old-age patients are also required for evidence-based case management.Disclosure of InterestNone Declared

Sex differences in neonatal outcomes following prenatal opioid exposure.

The impact of the opioid epidemic on pregnant people and children is a growing public health crisis. Understanding how opioids affect the developing brain during pregnancy and postnatally remains a critical area of investigation. Biological sex plays a crucial role in all physiologic processes, with the potential for a significant impact on neonatal outcomes, including those infants with opioid exposure. Here, we aim to explore current literature on the effect of sex on neonatal outcomes following prenatal opioid exposure. Sex differences in adults with opioid use disorder have been well studied, including increased mortality among males and higher rates of psychiatric comorbidities and likelihood of relapse in females. However, such differences are not yet well understood in neonates. Emerging clinical data suggest sex-specific effects in infants with prenatal opioid exposure on the expression of genes related to feeding regulation and reward signaling pathways. Increased susceptibility to white matter injury has also been noted in female infants following prenatal opioid exposure. Understanding the impact of sex as a biological variable on neonatal outcomes following prenatal opioid exposure is paramount to improving the health and well-being of infants, children, and adults impacted by the opioid epidemic.

How different definition criteria may predict clinical outcome in treatment resistant depression: Results from a prospective real-world study

Management of treatment-resistant depression (TRD) remains a major public health challenge, also due to the lack of a consensus around TRD definition. We investigated the impact of different definitions of TRD on identifying patients with distinct features in terms of baseline characteristics, treatment strategies, and clinical outcome. We conducted a prospective naturalistic study on 538 depressed inpatients. Patients were screened for treatment resistance by two TRD definitions: looser criteria (lTRD) and stricter criteria (sTRD). We compared baseline characteristics, treatment and clinical outcome between the TRD groups and their non-TRD counterparts. 52.97 % of patients were identified as lTRD, only 28.81 % met the criteria for sTRD. sTRD patients showed lower rates of remission and slower symptom reduction compared to non-TRD patients and received more challenging treatments. Surprisingly, patients identified as sTRD also exhibited lower rates of psychiatric comorbidities, including personality disorders, substance abuse, or alcohol misuse. Stricter TRD criteria identify patients with worse clinical outcomes. Looser criteria may lead to overdiagnosis and over treatment. Clinical features known to be possible risk factors for TRD, as psychiatric comorbidities, showed to be more suggestive of a “difficult to manage” depression rather than a proper TRD.

Randomized controlled trial investigating web-based, therapist delivered eye movement desensitization and reprocessing for adults with suicidal ideation.

Promising preliminary evidence suggests that EMDR may reduce suicidal ideation (SI) when used to treat Major Depressive Disorder, Posttraumatic Stress Disorder, and trauma symptoms in the context of acute mental health crises. EMDR has never been tested specifically for treating SI, and there is a lack of data regarding the safety and effectiveness of web-based, therapist-delivered EMDR in populations with known SI. The primary objective of this study was to investigate the impact of web-based, therapist-delivered EMDR, targeting experiences associated with suicidal thinking. Secondary objectives included examining the effect of EMDR treatment on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation, as well as safety and attrition. This randomized control trial (ClinicalTrials.gov ID number: NCT04181047) assigned adult outpatients reporting SI to either a web-based EMDR intervention or a treatment as usual (TAU) group. TAU included primary and mental health services available within the Canadian public health system. Participants in the EMDR group received up to 12 web-based EMDR desensitization sessions, delivered twice weekly during the COVID-19 pandemic (2021-2023). The Health Research Ethics Board at the University of Alberta approved the protocol prior to initiation of data collection for this study (protocol ID number: Pro00090989). Forty-two adult outpatients received either EMDR (n=20) or TAU (n=22). Participants reported a high prevalence of early onset and chronic SI, and there was a high rate of psychiatric comorbidity. In the EMDR group, median SI, depression, anxiety, and posttraumatic symptom scale scores decreased from baseline to the four month follow-up. In the TAU group, only the median SI and posttraumatic symptom scale scores decreased from baseline to four month follow up. Although sample size precludes direct comparison, there were numerically fewer adverse events and fewer dropouts in the EMDR group relative to the TAU group. Study results provide promising preliminary evidence that web-based EMDR may be a viable delivery approach to address SI. In this complex population, a short treatment course was associated with reductions of SI and other symptoms across multiple diagnostic categories. Further investigation is warranted to verify and extend these results. https://clinicaltrials.gov/study/NCT04181047?id=NCT04181047&rank=1, identifier NCT04181047.

Idiopathic Generalized Epilepsy: Misunderstandings, Challenges, and Opportunities

The idiopathic generalized epilepsies (IGE) make up a fifth of all epilepsies, but <1% of epilepsy research. This skew reflects misperceptions: diagnosis is straightforward, pathophysiology is understood, seizures are easily controlled, epilepsy is outgrown, morbidity and mortality are low, and surgical interventions are impossible. Emerging evidence reveals that patients with IGE may go undiagnosed or misdiagnosed with focal epilepsy if EEG or semiology have asymmetric or focal features. Genetic, electrophysiologic, and neuroimaging studies provide insights into pathophysiology, including overlaps and differences from focal epilepsies. IGE can begin in adulthood and patients have chronic and drug-resistant seizures. Neuromodulatory interventions for drug-resistant IGE are emerging. Rates of psychiatric and other comorbidities, including sudden unexpected death in epilepsy, parallel those in focal epilepsy. IGE is an understudied spectrum for which our diagnostic sensitivity and specificity, scientific understanding, and therapies remain inadequate.

Recognition and management of children and adolescents with conduct disorder: a real-world data study from four western countries

BackgroundConduct disorders (CD) are among the most frequent psychiatric disorders in children and adolescents, with an estimated worldwide prevalence in the community of 2–4%. Evidence-based psychological outpatient treatment leads to significant improvement in about two-thirds of cases. However, there seems to be considerable variation in rates of CD diagnoses and implementation of evidence-based interventions between nations. The aim of this study was to compare administrative prevalence and treatment patterns for CD in children and adolescents seen in health care systems across four Western countries (Denmark, Germany, Norway, and the USA).MethodsCross-sectional observational study using healthcare data to identify children and adolescents (aged 0–19 years) with an ICD-10 code for CD within the calendar year 2018. Within each country’s study population, the prevalence of CD, psychiatric comorbidity, psychopharmacological treatment, and psychiatric hospitalisation was calculated.ResultsThe prevalence of diagnosed CD differed 31-fold between countries: 0.1% (Denmark), 0.3% (Norway), 1.1% (USA) and 3.1% (Germany), with a male/female ratio of 2.0–2.5:1. The rate of psychiatric comorbidity ranged from 69.7 to 86.1%, with attention-deficit/hyperactivity disorder being most common. Between 4.0% (Germany) and 12.2% (USA) of youths with a CD diagnosis were prescribed antipsychotic medication, and 1.2% (Norway) to 12.5% (Germany) underwent psychiatric hospitalisation.ConclusionRecognition and characteristics of youths diagnosed with CD varied greatly by country. In some countries, the administrative prevalence of diagnosed CD was markedly lower than the average estimated worldwide prevalence. This variation might reflect country-specific differences in CD prevalence, referral thresholds for mental health care, diagnostic tradition, and international variation in service organisation, CD recognition, and availability of treatment offers for youths with CD. The rather high rates of antipsychotic prescription and hospitalisation in some countries are remarkable, due to the lack of evidence for these therapeutic approaches. These findings stress the need of prioritising evidence-based treatment options in CD. Future research should focus on possible reasons for inter-country variation in recognition and management of CD, and also address possible differences in patient-level outcomes.

Psychiatric Comorbidities in Women Veterans with Epilepsy.

Background: Women Veterans with epilepsy (WVE) may have unique psychiatric comorbidities that affect presentation, treatment, and outcomes. This large, nationally representative study of Veterans Health Administration (VHA) patients explores sex differences in psychiatric diagnoses and treatment to better characterize WVE. Methods: This study included a retrospective cohort design utilizing VHA Corporate Data Warehouse administrative data. Data from 58,525 Veterans with epilepsy (8.5% women) were obtained. Psychiatric diagnoses and treatment were analyzed, with comparisons between men with epilepsy and WVE. Secondary analyses included further exploration of select gynecological conditions. Results: WVE had higher psychiatric burden than men, as evidenced by higher rates of nearly all psychiatric diagnoses, including depression (59.1% vs. 38.9%; χ2 = 771.6), posttraumatic stress disorder (42.0% vs. 26.5%; χ2 = 549.1), and anxiety disorder (44.9% vs. 24.5%; χ2 = 977.7), as well as higher use of psychotropic medication prescriptions (2.3 vs. 1.4 average number of psychotropics prescribed). Furthermore, higher percentages of women versus men utilized the emergency room for psychiatric purposes (11.7% vs. 6.9%; χ2 = 153.06) and were hospitalized with psychiatric diagnoses (9.8% vs. 6.1%; χ2 = 100.95). Discussion: Veterans with epilepsy represent a unique group with high rates of psychiatric comorbidity. These results suggest that among Veterans, men and women with epilepsy have differing psychiatric comorbidities, leading to disparate health care needs. Based on this study's findings, WVE may require a different approach to care with an increased focus on specialized psychiatric treatment for WVE.

AUD in perspective.

Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.