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Comorbid Psychiatric Disorders (comorbid + psychiatric_disorders)
Selected AbstractsBrief communication: A randomized study of iterative hypothesis testing in undergraduate psychiatric educationACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010K. G. Kahl Kahl KG, Alte C, Sipos V, Kordon A, Hohagen F, Schweiger U. A randomized study of iterative hypothesis testing in undergraduate psychiatric education. Objective:, Iterative hypothesis testing (IHT) or related strategies of diagnostic decision making have been taught in many curricula for medical students but not in psychiatry. We therefore asked whether the addition of training in IHT may add to the quality of the psychiatry course. Method:, Seventy-two medical students were randomized to four weeks problem-based learning or to IHT. Knowledge and skills of the students were tested using a multiple choice exam and simulated patients. Results:, Iterative hypothesis testing-trained students recognized more diagnostic items and more often identified comorbid psychiatric disorders and acute suicidal tendencies. Acquisition of general psychiatric knowledge and global satisfaction with the course were similar in both groups. Conclusion:, We conclude that teaching IHT to medical students may enhance their clinical ability to recognize complex disease patterns. Further studies are required concerning the enhancement of clinical skills in the psychiatric specialty. [source] Patterns of comorbidity in panic disorder and major depression: findings from a nonreferred sampleDEPRESSION AND ANXIETY, Issue 2 2005Joseph Biederman M.D. Abstract Previous findings in referred adult samples document major depression as having important moderating effects on the patterns of comorbidity for panic disorder and major depression. This study evaluated whether these patterns of comorbidity are moderated by referral bias. Panic disorder (PD) and major depression (MD) were used to predict the risk for comorbid psychiatric disorders and functional outcomes using data from a large sample of adults who had not been ascertained on the basis of clinical referral (N=1,031). Participants were comprehensively assessed with structured diagnostic interview methodology to evaluate childhood and adult comorbid psychiatric disorders. PD increased the risk for anxiety disorders, independently of MD. MD increased the risk for mania, antisocial personality disorder, psychoactive substance use disorder, disruptive behavior disorders, overanxious disorder, social phobia, and generalized anxiety disorder, independently of PD. These results extend to nonreferred samples' previously reported findings documenting that MD has important moderating effects on patterns of comorbidity for PD and indicate that patterns of comorbidity for PD are not due to referral bias. Depression and Anxiety 21:55,60, 2005. © 2005 Wiley-Liss, Inc. [source] Cognitive functioning in substance abuse and dependence: a population-based study of young adultsADDICTION, Issue 9 2009Antti Latvala ABSTRACT Aims To investigate whether substance use disorders (SUDs) are associated with verbal intellectual ability, psychomotor processing speed, verbal and visual working memory, executive function and verbal learning in young adults, and to study the associations of SUD characteristics with cognitive performance. Participants A population-based sample (n = 466) of young Finnish adults aged 21,35 years. Measurements Diagnostic assessment was based on all available information from a structured psychiatric interview (SCID-I) and in- and out-patient medical records. Established neuropsychological tests were used in the cognitive assessment. Confounding factors included in the analyses were comorbid psychiatric disorders and risk factors for SUDs, representing behavioural and affective factors, parental factors, early initiation of substance use and education-related factors. Findings Adjusted for age and gender, life-time DSM-IV SUD was associated with poorer verbal intellectual ability, as measured with the Wechsler Adult Intelligence Scale,Revised (WAIS-R) vocabulary subtest, and slower psychomotor processing, as measured with the WAIS-R digit symbol subtest. Poorer verbal intellectual ability was accounted for by parental and own low basic education, whereas the association with slower psychomotor processing remained after adjustment for SUD risk factors. Poorer verbal intellectual ability was related to substance abuse rather than dependence. Other SUD characteristics were not associated with cognition. Conclusions Poorer verbal intellectual ability and less efficient psychomotor processing are associated with life-time alcohol and other substance use disorders in young adulthood. Poorer verbal intellectual ability seems to be related to parental and own low basic education, whereas slower psychomotor processing is associated with SUD independently of risk factors. [source] Effects of alcoholism severity and smoking on executive neurocognitive functionADDICTION, Issue 1 2009Jennifer M. Glass ABSTRACT Aims Neurocognitive deficits in chronic alcoholic men are well documented. Impairments include memory, visual,spatial processing, problem solving and executive function. The cause of impairment could include direct effects of alcohol toxicity, pre-existing cognitive deficits that predispose towards substance abuse, comorbid psychiatric disorders and abuse of substances other than alcohol. Cigarette smoking occurs at higher rates in alcoholism and has been linked to poor cognitive performance, yet the effects of smoking on cognitive function in alcoholism are often ignored. We examined whether chronic alcoholism and chronic smoking have effects on executive function. Methods Alcoholism and smoking were examined in a community-recruited sample of alcoholic and non-alcoholic men (n = 240) using standard neuropsychological and reaction-time measures of executive function. Alcoholism was measured as the average level of alcoholism diagnoses across the study duration (12 years). Smoking was measured in pack-years. Results Both alcoholism and smoking were correlated negatively with a composite executive function score. For component measures, alcoholism was correlated negatively with a broad range of measures, whereas smoking was correlated negatively with measures that emphasize response speed. In regression analyses, both smoking and alcoholism were significant predictors of executive function composite. However, when IQ is included in the regression analyses, alcoholism severity is no longer significant. Conclusions Both smoking and alcoholism were related to executive function. However, the effect of alcoholism was not independent of IQ, suggesting a generalized effect, perhaps affecting a wide range of cognitive abilities of which executive function is a component. On the other hand, the effect of smoking on measures relying on response speed were independent of IQ, suggesting a more specific processing speed deficit associated with chronic smoking. [source] Are there subgroups of bulimia nervosa based on comorbid psychiatric disorders?INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 1 2005Alexis E. Duncan MPH Abstract Objective The current study sought to determine whether there are subtypes of bulimia nervosa (BN) differentiated by comorbid psychiatric disorders. Method Data on comorbid psychiatric diagnoses in female relatives of probands and controls in the Collaborative Study of the Genetics of Alcoholism (COGA) who met criteria for BN (as outlined in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were analyzed using latent class analysis. Resulting latent classes were compared on a variety of variables related to impulsive behaviors and psychological functioning. Results The best-fitting solution, a two-class model, yielded one class (72%) characterized by substance dependence, depression, antisocial personality disorder (ASPD), and anxiety disorders, and another characterized by depression. The highly comorbid class had more suicidality, more daily smokers, sought help for emotional problems, and had lower Global Assessment of Functioning (GAF) scores compared with those in the comorbid depression only class. Discussion Latent class findings suggest the existence of two classes of BN differentiated by substance dependence, impulsive behaviors, and poorer psychological functioning. © 2004 by Wiley Periodicals, Inc. [source] Chronic fatigue syndrome and fibromyalgia: Clinical assessment and treatmentJOURNAL OF CLINICAL PSYCHOLOGY, Issue 4 2001Fred Friedberg Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are closely related illnesses of uncertain etiology. This article reviews the research literature on these biobehavioral conditions, with an emphasis on explanatory models, clinical evaluation of comorbid psychiatric disorders, assessment of stress factors, pharmacologic and alternative therapies, and cognitive-behavioral treatment studies. Furthermore, clinical protocols suitable for professional practice are presented based on an integration of the authors' clinical observations with published data. The article concludes with the recognition that mental health professionals can offer substantial help to these patients. © 2001 John Wiley & Sons, Inc. J Clin Psychol 57: 433,455, 2001 [source] Alcohol-Related Disorders in Beijing, China: Prevalence, Socio-Demographic Correlates, and Unmet Need for TreatmentALCOHOLISM, Issue 6 2009Yu-Tao Xiang Background:, The study aimed to determine the prevalence of alcohol use, episodic heavy drinking, and alcohol dependence and their socio-demographic correlates in Beijing, China. Methods:, A total of 5,926 subjects were randomly selected in Beijing and interviewed using the Composite International Diagnostic Interview (CIDI 1.0). Data on basic socio-demographic and current major medical conditions were also collected. Results:, The 12-month prevalence of alcohol use and episodic heavy drinking were 32.5 and 13.8%, respectively. The 12-month and lifetime prevalence of alcohol dependence were 1.7 and 4.3%, respectively. Age above 24 years, male sex, being married and employed, low education level (junior high school, primary school or illiterate), rural residence, and having comorbid psychiatric disorders were all significantly associated with a higher likelihood of alcohol-related disorders. Only 2.4% of the subjects with alcohol dependence were receiving treatment, and a mere 1.4% had sought treatment from mental health professionals. Conclusions:, Nationwide surveys are urgently needed to further explore the prevalence of alcohol-related disorders in China. [source] Psychiatric Comorbidity in Long-Term Abstinent Alcoholic IndividualsALCOHOLISM, Issue 5 2007Victoria Di Sclafani Background: A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder? Methods: Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS). Results: Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse. Conclusions: Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both. [source] Polysomnography in patients with post-traumatic stress disorderPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2010Sinan Yetkin MD Aims:, The purpose of the present study was to investigate sleep structure in post-traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. Methods:, Sleep patterns of 24 non-medicated male PTSD patients and 16 age- and sex-matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD-only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. Results:, Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. Conclusions:, PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD. [source] Acute effects of methylphenidate on performance during the Test of Variables of Attention in children with attention deficit/hyperactivity disorderPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2007YU-SHU HUANG md Abstract This study attempted to determine the acute effects of methylphenidate (MPH) on cognitive performance using the Test of Variables of Attention (TOVA) in children with attention deficit/hyperactivity disorder (ADHD). The study subjects comprised 57 children diagnosed with ADHD aged 6,13 years. Diagnoses of ADHD and other comorbid psychiatric disorders were based on Diagnostic and Statistical Manual of Mental Disorders-fourth edition criteria following a standard interview with the Schedule for Affective Disorder and Schizophrenia for School-Age Children, epidemiologic version. The subjects' performance on the TOVA was compared before and 1 h after administration of MPH. After administration of MPH, commission scores, response time and ADHD scores improved significantly, however, there were no significant changes in omission scores, response time variability or response sensitivity. The authors concluded that administration of one dose of MPH (0.5,1.0 mg/kg) produced more effects on impulsivity than on attention deficiency in children with ADHD, and that the second half section of the TOVA could be more sensitive than the first half in determining the acute effects of MPH therapy in children with ADHD. However, the effects of different MPH doses on the TOVA results need further investigation. [source] The epidemiology of substance misuse and comorbid psychiatric disordersACTA NEUROPSYCHIATRICA, Issue 1 2004Mohammed T Abou-Saleh The common co-occurrence of substance misuse and other psychiatric disorders and their intricate relationships have led to major community-based epidemiological studies in the US which showed high rates of current and lifetime comorbidity. Moreover, studies of clinical populations conducted in North America, Europe and Australia, showed even higher rates of comorbidity. The aetology of this comorbidity has also been investigated and important models have emerged with findings that inform its assessment and treatment. Future epidemiological studies should focus on the study of concurrent conditions rather than lifetime ones using research diagnostic instruments with high reliability providing information on a number of key outcomes. [source] Psychopharmacology of substance misuse and comorbid psychiatric disordersACTA NEUROPSYCHIATRICA, Issue 1 2004M. T. Abou-Saleh The common occurrence of comorbid substance misuse and other psychiatric disorders has challenged the diagnostic and therapeutic skills of professionals concerned with the care of patients with these dual disorders. Combined pharmacological and psychological treatment approaches have evolved empirically drawing upon standard treatments with emphasis on psychosocial approaches to substance misuse for psychotic disorders and pharmacological approaches for mood disorders. Advances in the biology of both disorders have started to inform their psychopharmacology. The specific role of atypical antipscychotics is highlighted. Further studies of the biology of comorbidity will impact the use of effective pharmaceuticals such as clozapine with dual effects on schizophrenia and substance misuse. [source] | |||||||||||||