Somatic Comorbidity In Patients Research Articles

Diagnostic psychiatric and somatic comorbidity in patients with depression in the Western Balkan countries.

This paper aims to examine the frequency and significance of diagnostic comorbidity of psychiatric disorders and somatic diseases in a sample of patients with depression as well as present current psychopharmacological treatment of the patients in the sample. The subjects in this study sample were 489 patients from the four Western Balkan countries with current primary diagnosis of major depression according to ICD 10. Comorbid psychiatric disorders and non-psychiatric illnesses were noted according to ICD 10 criteria during the diagnostic interview and analysed later. Additionally, the pharmacological treatment (existing and newly introduced) for each patient was noted and analysed later. At least one comorbid psychiatric disorder was present in 72.5% of patients. The most frequent were anxiety disorders (53.6%), specifically generalized anxiety disorder (20.2%); non-organic sleep disorders (50.7%), specifically insomnia (48.4%); and sexual dysfunctions (21.4%), specifically lack of sexual desire (20.2%). Comorbidity with any non-psychiatric illness was present in 80.3% of patients. The most frequent were circulatory system diseases (55.9%), specifically hypertension (45.9%); endocrine, nutritional and metabolic disorders (51.3%), specifically hyperlipidaemia (24.0%); and other non-psychiatric disorders (60.7%), specifically low back pain (22.7%). All patients received pharmacological treatment with different medications. Most patients received monotherapy or combination therapy of antidepressants, anxiolytics, antipsychotics and antiepileptics. The most frequently used antidepressants were escitalopram, sertraline, and duloxetine. The most frequently used anxiolytics were alprazolam and diazepam, the most used antiepileptic was pregabalin, and the most used antipsychotics were olanzapine, quetiapine, and aripiprazole. The results of the study confirm the results of previous research studies about the high prevalence of psychiatric and non-psychiatric comorbidities in patients with depression that were conducted in the past. It would be important if future studies could prove the importance of those comorbidities on clinical severity, choice of treatment, and its outcome in patients with depression.

Regard des patients psychiatriques sur leur prise en charge somatique en psychiatrie : enquête et propositions

Literature's data report the existence of numerous somatic comorbidities in patients with mental diseases. In order to improve practices, HAS-labeled recommendations were written in 2015. These recommendations advocate the improvement of current practices, by integrating into the accreditation procedures of institutions the somatic management of patients including a complete somatic examination of any hospitalized patient. Outpatient follow-up is also mentioned, especially when the patient does not have a general practitioner: “the psychiatrist will naturally be in charge of managing the patient's somatic problems”. This text reminds us that psychiatry belongs to the medical world and that it is necessary to improve patient care. Nevertheless, these recommendations may come up against the usual practice of psychiatrists who do not generally carry out a somatic clinical examination. Indeed, the particularity of the French psychiatric practice is that it is rooted in the field of human sciences where subjectivity plays a major role. However, the somatic examination is in essence objectifying, leading to an ethical conflict for the psychiatrist between an adapted somatic management and an optimal psychiatric management. In order to help us in our reflection, we decided to question the patients, by focusing our work on their social representations concerning the psychiatrist and his function. The objective of our work will thus be to discuss the dilemmas resulting from these recommendations in the light of other ethical principles and to propose practical reflections on their implementation with an ethical concern by placing the patient at the center of the care system. In France or internationally, no study on the social representations that patients have of their somatic care has yet been conducted. MethodWe conducted a prospective study in the form of semi-structured interviews with a sample of 21 patients treated in a general psychiatric ward. The interview guide included four themes: definition of the doctor and the psychiatrist, the course of care in psychiatry, the relationship between patients and therapists in psychiatry, and the role of the psychiatrist in somatic care in psychiatry. The results show the ambivalence of patients who wish to receive comprehensive care without expecting psychiatrists to invest in their somatic evaluation. These representations are linked to the heritage of French psychiatry, but also to the subjective link between the patient and his psychiatrist in the psychotherapeutic framework and finally, to the position of specialist assigned to the psychiatrist treating a specific medical field. ConclusionIt is therefore the psychiatrist's ethical responsibility to question the practical implementation of his medical skills (in particular in the field of somatic comorbidities) and his psychotherapeutic skills by adapting them in a singular way to each patient according to his pathology, his degree of autonomy and his social representations in order not to be harmful on the psychic level while wanting to be beneficial on the somatic level. The psychiatrist must inform the patient of his or her competencies and limitations in terms of somatic care and of the specific somatic aspects of the patient's pathology. Finally, patients followed in psychiatry often have a lack of access to care as well as an unfavourable socio-economic level. In this context, they may have difficulty accessing the various medical specialists. Most inpatients benefit from appropriate somatic care thanks to the development of somatic care units in the institutions. Thus, we see that the will to improve the situation in the hospital has led to socio-economically favourable solutions and to the training of competent general practitioners in this field. It is necessary to continue efforts in this direction, but also in general medicine. Even if psychiatrists are aware of patients’ somatic pathologies, take them into account, and occasionally perform a somatic examination, they cannot replace a trained and competent general practitioner.

P.0784 Cardiovascular risk factors and somatic comorbidity in patients with severe mental illness hospitalized in a long-term psychiatric rehabilitation unit

P.0784 Cardiovascular risk factors and somatic comorbidity in patients with severe mental illness hospitalized in a long-term psychiatric rehabilitation unit

Psychiatric disorders and somatic comorbidities

IntroductionPeople followed at the department of psychiatry have a high prevalence of somatic pathologies that are generally not taken optimal care of in time, which implies excess mortality rate among these patients.ObjectivesTo study somatic comorbidities in patients followed at the department of psychiatry of the regional hospital of Gabes (Tunisia).Methods We conducted a retrospective, descriptive and analytical study carried out on a clinical population who consult for the first time at the psychiatry department at the Gabes regional hospital during the period from January 1st, 2010 to December 31, 2013. Sociodemographic, clinical and therapeutic data of the patients were assessed. Data were analysed using the software SPSS (20th edition).Results The number of patients consulting for the first time at the psychiatry department during the study’s period was 1601 patients, with a mean age of 34 years and a sex ratio (M / F) of 0.96. Among these patients, 399 (24.9%) had somatic comorbidity. The most common somatic comorbidity was arterial hypertension (8.1% of patients, n=129 patients). Diabetes mellitus was ranked second with 99 patients (6.2%). The analytical study showed that depressive disorders were significantly more frequent in patients with hypertension (p<0.001), diabetes mellitus (p<0.001) and asthma (p=0.026).ConclusionsSomatic comorbidities were frequent in patients followed by the department of psychiatry. Paying attention to somatic comorbidities must be part of the evaluation of these patients in order to coordinate effectively with the somatic doctors.

Pain perception in schizophrenia: A neglected phenomenon with a great impact

IntroductionA decrease in pain sensitivity has been observed in patients with schizophrenia since the beginning of the twentieth century. This hypothesis further emerged during the last decades due to many clinical findings.ObjectivesTo study pain responsiveness in patients with schizophrenia and explore its physiopathological mechanism through a review of the literature.MethodsWe searched the Medline database with no time restrictions, and we hand searched the references of all retrieved reviews. After removing duplicates, we selected Full-text articles in both French and English languages. Keywords: “schizophrenia”, “pain”, “pain threshold”, “nociceptors”, “opioid receptors”, “opioid peptides”ResultsWe have collected 399 references, we finally included 50 Articles only. Many case reports with heterogeneous types of pain concluded that despite the high prevalence of somatic comorbidities in patients with schizophrenia, there was no significant difference in pain complaints between patients with schizophrenia and controls. There was a positive correlation between the decrease in pain sensitivity and schizophrenia. Experimental studies supported a decrease in pain perception and a high pain threshold in those patients. The neurobiological hypothesis suggested the lack of pain transmission by the dysfunctional glutamatergic system and the involvement of the opioid system. these findings have been reported in patients even before starting treatment. The psychopathology theory pointed to the impact of psychotic defenses such as denial and cleavage in the phenomenon of pain insensitivity.ConclusionsThe meticulous research of pain symptoms should be systematic in patients with schizophrenia and the hypoalgesia should be considered when dealing with somatic conditions in this specific population.

Brain-derived neurotrophic factor, depressive symptoms and somatic comorbidity in patients with coronary heart disease.

Depression and coronary heart disease (CHD) are highly comorbid conditions. Brain-derived neurotrophic factor (BDNF) plays an important role in cardiovascular processes. Depressed patients typically show decreased BDNF concentrations. We analysed the relationship between BDNF and depression in a sample of patients with CHD and additionally distinguished between cognitive-affective and somatic depression symptoms. We also investigated whether BDNF was associated with somatic comorbidity burden, acute coronary syndrome (ACS) or congestive heart failure (CHF). The following variables were assessed for 225 hospitalised patients with CHD: BDNF concentrations, depression [Patient Health Questionnaire-9 (PHQ-9)], somatic comorbidity (Charlson Comorbidity Index), CHF, ACS, platelet count, smoking status and antidepressant treatment. Regression models revealed that BDNF was not associated with severity of depression. Although depressed patients (PHQ-9 score >7) had significantly lower BDNF concentrations compared to non-depressed patients (p = 0.04), this was not statistically significant after controlling for confounders (p = 0.15). Cognitive-affective symptoms and somatic comorbidity burden each closely missed a statistically significant association with BDNF concentrations (p = 0.08, p = 0.06, respectively). BDNF was reduced in patients with CHF (p = 0.02). There was no covariate-adjusted, significant association between BDNF and ACS. Serum BDNF concentrations are associated with cardiovascular dysfunction. Somatic comorbidities should be considered when investigating the relationship between depression and BDNF.

Potencjalne niedodiagnozowanie współchorobowości somatycznej u pacjentów chorych na schizofrenię i zaburzenia afektywne dwubiegunowe

Introduction. Patients treated for schizophrenia and for bipolar affective disorder have a potentially higher risk of developing chronic somatic diseases compared to the general population. Aim. This is to compare the prevalence of somatic co-morbidity in patients with schizophrenia, patients with bipolar affective disorder (BD) and available data on the prevalence of somatic diseases in the general Polish population. Material and methods. Archival data of 527 (F = 249) patients with a diagnosis of schizophrenia, aged 42.56 ± 14.25 (M ± SD), and 155 (F = 82) patients with BD, aged 48.05 ± 14.45 (M ± SD), hospitalized in psychiatric hospital in Central Poland in 2019 were analyzed. Results. Majority of patients with schizophrenia and with BD had no registered somatic co-morbidity (80.6 and 67.7%, respectively); most common group of coexisting somatic diseases in both subgroups of patients were diseases of circulatory system (11.0 and 22.6%, respectively); and the most common disease was primary hypertension (10.4 and 20.6%, respectively). In men in the 7th decade of life, diseases of the circulatory system were significantly more common in patients with BD than in those with schizophrenia (p = 0.004). The prevalence of somatic diseases in both subgroups of patients turned out to be lower than their prevalence in the general population. Conclusions. Somatic co-morbidity in patients with BP and with schizophrenia is potentially underdiagnosed. Possible reasons of this finding were carefully discussed.

Obstetric complications in bipolar disorder: The role of mental health disorders in the risk of caesarean section

Background: Women with Bipolar Disorder (BD) during pregnancy present a negative impact on them and their babies’ health. Caesarean Section (C-Section) is an intervention to reduce complications associated with childbirth, but it also has risks, including maternal infections, anaesthetic and psychological complications. There are few studies that analyse the C-Section rates in women with BD compared to the general population. Methods: A case–control study was conducted in a general university hospital. 100 pregnant women with BD matched with 100 controls without psychiatric illness who were attending the same hospital at delivery. We compared obstetrical outcomes during pregnancy, Pre/During Labour, onset of labour and mode of delivery specifying the type of C-Section. Results: Rate of C-Section was significantly higher in BD group compared to the control group (OR=2, 95% CI 1,4–1,6). Case group had more somatic illness (SI) without treatment (P<, 001). BD (P=,021), primiparity (P=, 003), obstetric complications during pregnancy (P<, 001), obstetric complications during labour (P<,001), and SI with and without treatment (P<,001 and P=,007, respectively) were higher in women that required C- section. Conclusion: Women with Bipolar Disorder have near two-fold increased risk of C-section than women without Bipolar Disorder of similar age, gestational age and parity. Somatic illness was more prevalent in BD group that required C-section and this relation probably is related to high probability of having somatic comorbidities in patients with BD.

Autoimmune Diseases and Psychotic Disorders.

The notion of immunological pathways playing a role in the etiology of a subset of psychotic disorders has received increased interest in the last decades. One of the findings that has spiked interest herein, is an apparent link between autoimmune diseases and psychotic disorders. This is supported by genetic findings associating immune-related genetic markers with schizophrenia and clinical studies finding increased levels of inflammatory markers in patients with psychosis. Several large-scale epidemiologic studies have found positive associations between autoimmune diseases and psychosis. Particularly, autoimmune diseases as multiple sclerosis and lupus are known to have higher frequencies of neuropsychiatric symptoms, including psychosis, compared to healthy controls. Cross sectional studies have found higher prevalence of psychiatric diagnoses among those with autoimmune diseases, and longitudinal studies have shown bidirectional associations between several autoimmune diseases and increased risks associated with schizophrenia. Moreover, a family history of autoimmune diseases has been shown to be associated with an increased risk of psychotic disorders and vice versa. In this review we will summarize the epidemiologic evidence on associations between autoimmune diseases and psychosis. Possible mechanisms accountable for the association will be discussed, amongst others the probable role of shared genetic risk factors, the impact of infections on both autoimmunity and the development of psychotic disorders, and the potential role of the microbiome. We discuss the findings on and influence of autoantibodies and dysregulation of T- and B-cells in both disease categories, and why further research hereon is needed. In addition to the potential importance of autoimmunity in etiological mechanisms of psychotic disorders, the association also brings important attention to somatic comorbidity in patients with psychotic disorders.

Nine deaths among 29 patients with severe mental illness identified with high mortality using SSEPP

Purpose: It is an established consensus that patients suffering from Severe Mental Illness (SMI) often have somatic comorbidities and a shortened life expectancy. In this study, we examine to what extent previously unknown comorbidities can be revealed if patients suffering from SMI are examined by a specialist in general medicine using the new clinical tool of Systematic Somatic Examinations of Psychiatric Patients (SSEPP).Methods: SSEPP is a detailed, in-depth questioning and clinical evaluation performed by a specialist in General medicine. A total of 112 patients were recruited from asylums for patients suffering from chronic and severe psychiatric disorders in the Copenhagen area. Diagnosis within SMI led to 106 patients included. 6 patients had no SMI diagnosis and were excluded. Four years later, deaths in the cohort were registered.Results: Ninety percent of examined patients were found to have previously unknown indications for medical treatment. Nine deaths occurred among the examined patients during follow-up. All deaths happened among the 29 patients identified with high expected risk of ischemic manifestation (31%, p < .0001).Conclusions: In this study, SSEPP is shown to be capable of: Identifying previously unknown and/or undertreated somatic comorbidity in patients with SMI. Identifying the patients with the highest risk of ischemic manifestation with a score of 9 deaths/29 patients. This is statistically significant (p < .0001). This study suggests that patients with SMI in every psychiatric ward be systematically examined for somatic comorbidity by GPs especially trained with tools like SSEPP.

Factors Affecting the Management of Somatic Comorbidity in Tunisian Patients with Schizophrenia.

Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the sociodemographic and clinical factors correlating with somatic comorbidities in patients with schizophrenia to facilitate screening and prevention. It was a retrospective descriptive study of 78 schizophrenia patients in clinical remission and followed in outpatient psychiatry. In addition to the acquired records, other data were provided by the clinical and biological examinations performed for each patient. The evaluation of the therapeutic adherence was carried out using the Drug Attitude Inventory (DAI).Seventy-six patients (97.4%) had somatic comorbidities with a mean of 3.83 (± 1.81). This number increased significantly in males, older patients, couples, urban patients, and those receiving a combination therapy. According to a multivariate study, the four predictors of an increased risk of comorbidities were age, use of psychoactive substances, waist size and therapeutic adherence.Our findings focus on somatic comorbidities risk in schizophrenia patients, requiring particular vigilance in their follow-up, and suggest some modifiable clinical factors that might be a preferred target for reducing or preventing the occurrence of such disorders.

Cardiovascular and metabolic comorbidities in patients with Alzheimer's disease and vascular dementia compared to a psychiatric control cohort

Multimorbidity in dementia is associated with an increased risk of complications and a higher need for care. Having knowledge of cardiovascular and metabolic comorbidities is crucial when making decisions about diagnostic procedures and therapies. We compared the prevalence of comorbidities in hospitalized patients with Alzheimer's disease (AD), vascular dementia, and psychiatric diseases other than dementia. Additionally, we compared clinically relevant health-care indicators (length of hospital stay, rate of re-hospitalization) between these groups. We used information from a database of treatment-relevant indicators from psychiatric and psychosomatic hospitals throughout Germany. This database contains routinely recorded data collected from 85 German hospitals from 2011 to 2015. In total, 14 411 AD cases, 7156 vascular dementia cases, and 34 534 cases involving non-demented psychiatric patients (used as controls) were included. To analyze comorbidities and health-care indicators, χ2 tests and t-tests were used. Diabetes mellitus, lipoprotein disorders, coronary artery diseases, cardiac arrhythmia and insufficiency, and atherosclerosis were significantly more prevalent in patients with vascular dementia than in those with AD and psychiatric controls. Hypertension and coronary artery diseases were less frequently associated with AD than with non-demented psychiatric controls (P < 0.001). Additionally, dementia patients with cardiovascular or metabolic diseases exhibited longer hospital stays (+ 1.4 days, P < 0.001) and were more often re-hospitalized within 3 weeks (P < 0.001) and 1 year (P < 0.001) compared to dementia patients without these comorbidities. Awareness of somatic comorbidities in patients with dementia is crucial to avoid complications during inpatient treatment. The occurrence of comorbid disorders was associated with longer and more frequent hospital stays, which potentially lead to higher health-care costs. Further studies should evaluate the causative association between somatic comorbidities and inpatient costs in dementia patients.

English

Purpose: To assess the impact of somatic comorbidities on stigma and the quality of life of Bulgarian patients with refractory epilepsy. Methods: We have studied 92 adult patients with refractory epilepsy, without cognitive impairment, progressive somatic, neurological disease or recent seizures. All participants fulfilled a 3-item stigma scale and QOLIE-89 questionnaire. Results: The study participants (61.96% men) had a mean disease duration 42.34 ± 1.28 years. Seventy three patients (77.17%) had focal epilepsy, 21 (22.83%) had generalized epilepsy. The etiology of the greatest percentage of participants (39.13%) was unknown, 35.87% had symptomatic epilepsy. We found stigmatization in 43.48% of the patients, 29.35% of them were severely stigmatized. There were concomitant somatic diseases in 40.22% of patients, in 16.31% - from more than one system. We proved that somatic comorbidities did not have influence on the overall score of QOLIE-89 P > 0.05 (F = 2.64) and on perceived stigma P > 0.05 (2 = 2.36). Conclusion: Somatic comorbidities in patients with refractory epilepsy do not correlate negatively with perceived stigma and does not influence the overall score of their quality of life.

P-39ORGANIC COMORBIDITY IN PATIENTS WITH ALCOHOL ABUSE OR DEPENDENCE TREATED IN AN OUTPATIENT CLINIC

Objectives of the study. To examine the prevalence of somatic comorbidity in patients with Alcohol Abuse or Dependence and analyze other sociodemographic and clinical variables associated to comorbidity. Methods. Retrospective descriptive study of psychiatric outpatients diagnosed of Alcohol Abuse or Dependence, treated in a Mental Health Unit …

The relationship of health-related quality of life and treatment outcome during inpatient treatment of depression.

Health-related quality of life (HRQoL) is important for long-term social functioning. It is considerably reduced in patients with depression. We studied the impact of HRQoL on treatment outcome in patients with unipolar depression. Furthermore, we analysed factors associated with HRQoL in inpatients with unipolar depression. One hundred and eighty patients suffering from major depressive disorder were evaluated during their inpatient treatment by assessing admission and discharge depression severity and their HRQoL, using the Medical Outcomes Study 12-item Short Form (SF-12). Baseline and treatment variables associated with HRQoL were examined by regression analysis. Primary outcome measures were the Hamilton Rating Scale and the Beck Depression Inventory. HRQoL improved significantly during inpatient treatment. Lower HRQoL outcomes were strongly associated with higher age, somatic comorbidities, a recurrent depressive disorder and stronger depressive symptoms at admission. Additionally, patients with a complex treatment situation (high number of medications, antidepressant switch) showed stronger impairment of HRQoL. Personality disorders and additional psychotherapy did not predict HRQoL. The inpatient treatment resulted in an increase of the SF-12 scores, although to a lower extent than depressive symptoms. Several factors negatively influence HRQoL, such as the presence of somatic and axis I psychiatric comorbiditites and a recurrent or severe depressive episode. Targeting somatic comorbidities in patients with unipolar depression seem to play an important role for HRQoL.

Affections somatiques chez les patients en psychiatrie : étude transversale sur 24 mois

Somatic comorbidities in patients suffering from severe psychiatric disorders have become an important issue in the overall care of these patients. They aggravate the prognosis for both diseases, and complicate the therapeutic management and impact upon the vital prognosis. We illustrate through this work the experience of the psychiatric unit at the University Hospital Center (UHC) Hassan II of Fez (Morocco) in the detection and treatment of the somatic comorbidities among patients with serious psychiatric disorders through consultation or hospitalization from January 2010 to December 2011. ObjectivesTo provide insight into the nature of organic pathology observed in the psychiatric domain. To study the various interactions between the psychiatric diseases and the somatic comorbidities and to compare them between in- and out-patients. MethodsWe conducted a cross-sectional study of patients attending the emergency room and those hospitalized in our department of psychiatry, these patients show clinical signs in favor of an organic pathology, they were then transferred for opinion to other medical and surgical units in the UHC of Fez, on a 24-month period from January 2010 to December 2011. The information gathering was done based on a standard clinical information sheet with 23 items. ResultsOver a period of 24 months, 80 patients were included in our study. The most common reasons for requests for advice from medical and surgical services were: the suspicion of an organic cause of the psychiatric symptoms in 35% of cases, and the presence of a sign of an organic disease in 22%. Medical and surgical services most requested were: emergency department and the neurology department in 30% of cases each. The relationship between the psychiatric disorder and the somatic disease was comorbidity in 32% of cases, a side effect of psychotropic drugs in 24% of cases and a psychiatric manifestation of an organic disease in 13% of cases. Somatic comorbidities were essentially: infections in 45% of cases and trauma in 20% of cases. Side effects of psychotropic drugs were predominantly neurological in 32% of cases. ConclusionSomatic comorbidities in patients hospitalized or in consultation in psychiatric hospitals are very common, often unrecognized and their management can be difficult and complex.

Affections somatiques chez les patients en psychiatrie : étude transversale sur 24 mois

Somatic comorbidities in patients suffering from severe psychiatric disorders have become an important issue in the overall care of these patients. They aggravate the prognosis for both diseases, and complicate the therapeutic management and impact upon the vital prognosis. We illustrate through this work the experience of the psychiatric unit at the University Hospital Center (UHC) Hassan II of Fez (Morocco) in the detection and treatment of the somatic comorbidities among patients with serious psychiatric disorders through consultation or hospitalization from January 2010 to December 2011. ObjectivesTo provide insight into the nature of organic pathology observed in the psychiatric domain. To study the various interactions between the psychiatric diseases and the somatic comorbidities and to compare them between in- and out-patients. MethodsWe conducted a cross-sectional study of patients attending the emergency room and those hospitalized in our department of psychiatry, these patients show clinical signs in favor of an organic pathology, they were then transferred for opinion to other medical and surgical units in the UHC of Fez, on a 24-month period from January 2010 to December 2011. The information gathering was done based on a standard clinical information sheet with 23 items. ResultsOver a period of 24months, 80 patients were included in our study. The most common reasons for requests for advice from medical and surgical services were: the suspicion of an organic cause of the psychiatric symptoms in 35% of cases, and the presence of a sign of an organic disease in 22%. Medical and surgical services most requested were: emergency department and the neurology department in 30% of cases each. The relationship between the psychiatric disorder and the somatic disease was comorbidity in 32% of cases, a side effect of psychotropic drugs in 24% of cases and a psychiatric manifestation of an organic disease in 13% of cases. Somatic comorbidities were essentially: infections in 45% of cases and trauma in 20% of cases. Side effects of psychotropic drugs were predominantly neurological in 32% of cases. ConclusionSomatic comorbidities in patients hospitalized or in consultation in psychiatric hospitals are very common, often unrecognized and their management can be difficult and complex.

Somatic comorbidity, metabolic syndrome, cardiovascular risk, and CRP in patients with recurrent depressive disorders

AimTo investigate the association between depression, metabolic syndrome (MBS), somatic, particularly cardiovascular comorbidity, and low-grade chronic inflammation assessed using C-reactive protein (CRP).MethodsThis cross-sectional study included 76 patients with recurrent depressive disorder (RDD) and 72 non-depressed medical staff controls from the Department of Psychiatry, University Hospital Center Zagreb between January 2011 and June 2012.ResultsSeventy-five percent of patients had somatic comorbidity. The most common comorbid conditions were cardiovascular disorders (46.1%), locomotor system diseases (35.5%), carcinoma (15.8%), thyroid diseases (9.2%), and diabetes (9.2%). MTB was more common in RDD patients (31.6%) than in controls (23.6%), but the difference was not significant. Elevated CRP was found to be significantly more frequent in patients with recurrent depressive disorders (RDD) (35.5%; χ2 test, P = 0.001, Cramer V = 0.29) than in controls (12.5%) and was associated with lowered high-density lipoprotein and overweight/obesity.ConclusionWe found some intriguing links between stress, depression, metabolic syndrome, and low grade inflammation, which may be relevant for the prevalence of somatic comorbidity in patients with RDD, but further studies are needed to confirm our results.

The prevalence of late‐life mania: a review

Since there is a worldwide steady increase in the number of individuals living longer and an expected increase in the number of older adults who will be diagnosed with bipolar disorder, there is a growing need to better understand late-life mania. We provide in this review a report of published studies focusing on the prevalence of late-life mania in the community and in senior psychiatric care facilities. We conducted a search of PubMed and Psychinfo databases using combinations of the keywords bipolar, manic/a, manic depression, elderly, and older including English-language reports presenting quantitative data on the prevalence of mania in adults over the age of 50years. Eighteen out of 188 potentially eligible studies met our inclusion criteria, with most studies focusing on psychiatric inpatient samples. The overall prevalence of late-life mania was estimated to be 6.0% in the reported 1,519 older psychiatric inpatients. In elderly inpatients with bipolar disorder, the mean prevalence of late-onset mania was 44.2%. For other relevant care facilities, no firm conclusions could be drawn. Late-life mania is not rare in older psychiatric inpatients and late-onset mania is associated with increased somatic comorbidity in patients aged 50years and older. Several hypotheses regarding the relationship between somatic illness and late-life mania in the elderly have been proposed and studies on this relationship and the prevalence of late-life mania in different senior psychiatric care facilities deserve specific attention in future research projects.

OP0099 Somatic Comorbidity in Patients with Chronic Widespread Pain in an Outpatient Secondary Care Center for Rheumatology and Rehabilitation in the Netherlands

BackgroundComorbidity, defined as one or more additional disease(s) among patients with an index-disease, can affect the treatment and the prognosis of the index disease.1,2 Although numerous studies address the prevalence...