The prevalence of migraine in patients with bipolar and unipolar affective disorders

There is a well-known association between migraine and affective disorders, but the information is sparse concerning the prevalence of migraine in subgroups of the affective disorders. The present study was undertaken to investigate the prevalence of migraine in unipolar depressive, bipolar I and bipolar II disorders. Patients with major affective disorders (n = 62), consecutively admitted to an open psychiatric ward, were examined with a semi-structured interview based on DSM-IV diagnostic criteria, combined with separate criteria for affective temperaments. Diagnosis of unipolar and bipolar I disorders followed the DSM-IV criteria, while bipolar II disorder encompassed patients with either discrete hypomanic episodes or a cyclothymic temperament. Migraine was diagnosed according to IHS-criteria. Symptoms of migraine were found to be common in these patients, both in those with unipolar depression (46% prevalence of migraine) and in those with bipolar disorders (44% prevalence). Among the bipolar patients there was, however, a striking difference between the two diagnostic subgroups, with a prevalence of 77% in the bipolar II group compared with 14% in the bipolar I group (P = 0.001). These results support the contention that bipolar I and II are biologically separate disorders and point to the possibility of using the association of bipolar II disorder with migraine to study both the pathophysiology and the genetics of this affective disorder.     

Comorbidity of psychiatric and behavioral disorders in pediatric migraine

OBJECTIVE: To determine whether behavioral and psychiatric disorders occur more frequently in school-age children with migraine headache. To also elucidate treatment response related to comorbid psychiatric or behavioral diagnosis. BACKGROUND: Recurrent migraine headaches are common in school-age children. Concurrent behavioral or psychiatric diagnoses could significantly impact headache frequency, severity, and response to treatment. METHODS: Healthy children from 6 to 17 years of age presenting to our headache clinic with migraine headache according to International Headache Society (IHS) criteria were identified. Parents/guardians were asked to complete the Child Symptom Inventory, 4th edition (CSI-4) after written informed consent. Children with positive rating scales underwent psychological interviews for confirmatory diagnosis. Results were compared to controls. Headache patients were assigned our usual treatment paradigm. Response regarding headache frequency was assessed at 3 months. RESULTS: A total of 47 patients were diagnosed with migraine headaches. The mean age was 10.55 years. Thirty controls were identified. After completing the CSI-4 and confirmatory psychological interview, 14 of 47 headache patients fulfilled Diagnostic and Statistical Manual (DSM-4) criteria for a psychiatric or behavioral disorder. Oppositional defiant disorder (ODD) was significantly represented among children with migraine compared to the control group of children. Headache patients improved significantly post-treatment regarding their headache frequencies regardless of comorbid psychiatric or behavioral disorder. No significant differences were noted between boys and girls regarding diagnoses or treatment outcome. CONCLUSION: ODD was a significant comorbidity in our headache population. Although families complained of significant behavioral symptomatology in their children, most of these symptoms did not qualify their children for a psychiatric diagnosis and may be related to the stressors of headache on social/school disruption.     

The role of estrogen in migraine: a review and hypothesis

The epidemiological, clinical and basic science evidence for a role of estrogen in migraine is reviewed. The hypothesis is put forward that estrogen exerts its influence by modulating sympathetic control of the cerebral vasculature.     

The role of psychotherapy in treating psychiatric disorders

Psychotherapy has shifted from long-term to short-term approaches, which have been found to be effective for the treatment of specific psychiatric disorders. These psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been found useful in presenting an educational framework for disorders and the treatment rationale for intervention programs. Short-term and maintenance empirical data support the effectiveness of using behavior therapy and CBT as adjunctive interventions with medications for bipolar I disorder and schizophrenia. In major randomized clinical trials, psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been shown to be effective as primary treatments (treatments of choice) for the major psychiatric problems of obsessive-compulsive disorder, panic disorder, and major depression as well as several other psychiatric disorders. The combination of psychotherapy and psychotropic medications is not always additive for acute treatment effects or especially for the maintenance of treatment effects so that the combination of psychotherapy and medications is not the most effective treatment for all psychiatric disorders. Badly needed, additional randomized controlled trials of psychotherapy, medications, and their combinations are under way in large, NIMH-supported studies of the treatment of several psychiatric disorders.     

Examination of anxiety, hostility and psychiatric disorders in patients with migraine and tension-type headache

The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate anxiety, depression, hostility and psychological symptoms in patients with migraine and tension-type headache (TTH) and to compare the results with healthy controls. Seventy-five subjects with migraine and 55 subjects with TTH (according to the criteria of the International Headache Society classification) and a control group including 73 healthy subjects were studied. The Buss-Durkee Hostility Inventory, Brief Symptom Inventory, State-trait Anxiety Inventory, Trait form were administered to the subjects. Compared with healthy controls, the patients with headache had significantly higher scores on measures of anxiety, depression and hostility and lower scores on psychological symptoms. The present results indicate the need to distinguish the unique dimensions of anxiety, depression and hostility that should be assessed in the population with headaches.     

Understanding the causes and prevention of menstrual migraine: the role of estrogen

Menstruation increases the risk of migraine in susceptible women. In a subpopulation of women with menstrual migraine, headaches occurring in association with onset of menses may be more severe and of longer duration than headaches experienced by the same woman at other times of her menstrual cycle. Although menstrual migraines share many clinical characteristics of other types of migraines, their occurrence is predictable provided that the patient has regular menstrual cycles. Therefore, short-term prevention regimens can be considered for women whose headaches are not adequately managed with acute therapies.     

Comorbidity between psychiatric disorders and chronic pain

The term comorbidity refers to the coexistence of an index disease with another clinical entity. Comorbidity between chronic pain and psychiatric pathology as delineated on Axis I and II of the Diagnostic and Statistical Manual of Mental Disorders is reviewed here.The literature indicates that this type of comorbidity is common in chronic pain patients (CPPs).The most common groups of comorbid psychiatric disorders found within CPPs are affective disorders, substance-related disorders, and personality disorders. A number of other psychiatric disorder comorbidities should also be present within CPPs, but these have not yet been researched. Finally, the importance of psychiatric comorbidities to chronic pain treatment is discussed.     

The role of comorbidities in cardioprotection

Cardioprotective strategies such as pre- and postconditioning result in a robust reduction in infarct size in young, healthy male animals. However, there are data suggesting that the protection is diminished in animals with comorbidities such as hypertension, hypercholesterolemia, and diabetes. It is important to understand at a mechanistic level the reasons for these differences. The effects of sex and diseases need to be considered in design of cardioprotective interventions in animal studies and clinical trials.     

Differentiating between post-Vietnam syndrome and preexisting psychiatric disorders

The scientific literature and the news media have suggested that the symptoms of post-Vietnam syndrome are being overlooked by society and mental health workers. The literature relating to psychiatric problems in Vietnam combat troops and veterans was confusing, and reporting of the posttraumatic stress syndrome was slow. However, the Veterans Administration accepts the diagnostic entity of posttraumatic stress disorder as potentially compensable. We report a case that demonstrates many of the complex issues faced when treating a Vietnam combat veteran. We believe the time has come for a large-scale study of Vietnam veterans to identify the risk factors involved in postwar psychiatric problems.     

Associations between psychiatric disorders and menstrual cycle characteristics

An understanding of the relationship between psychiatric disorders and menstrual characteristics is important to the assessment and care of women. Menstrual cycle regularity and length have significant associations with specific current and lifetime psychiatric disorders. The purpose of this study was to investigate whether psychiatric disorders are associated with menstrual cycle length or regularity. The sample included 628 pregnant Medicaid-eligible women from Women, Infants, and Children's Supplemental Nutrition Program sites in five counties in rural Missouri and the city of St. Louis. Women were assessed for current (12-month) and lifetime psychiatric disorders with the Diagnostic Interview Schedule IV. Menstrual length and regularity were assessed by self-report. Analyses consisted of logistic regression while controlling for race. Independent of the effects of race, (a) women who reported irregular cycles were less than half as likely to have a current anxiety disorder as those that reported regular cycles, and (b) women with shorter cycles (相似文献   

The psychiatric disorders of midlife

The midlife phase of adult development, once viewed as a period of stagnation and involution, is now seen as a time with the potential for significant psychologic growth and development. The concept that women's psychologic health and physical health are closely tied to her reproductive function is coming under close scrutiny. The menopause is only one variable, along with other biologic, psychologic, and sociocultural stressors, that increases the individual woman's vulnerability to several psychiatric disorders. Careful attention to the patient's presenting symptoms and the specific diagnostic criteria for psychiatric illnesses allows for accurate diagnosis and treatment and avoids the pitfall of attributing these symptoms to the "menopausal syndrome."     

Links between drug and alcohol misuse and psychiatric disorders

Substance use is common in a wide range of psychiatric disorders. Psychiatric disorder can increase the risks of such use developing into a substance use disorder. Conversely, substance use disorders are frequently accompanied by psychiatric symptoms. In some people such symptoms indicate formal psychiatric disorder. Whatever the causes, comorbidity may complicate treatment and resolution of both disorders, often presenting as a vicious circle that is difficult to break.     

The impact of psychiatric comorbidities on readmissions for diabetes in youth

OBJECTIVE: Comorbid psychiatric disorders have been associated with poorer disease outcomes in diabetic youth. Less is known, however, about the relationship between psychiatric disorders and repeat hospitalizations for youth with diabetes. RESEARCH DESIGN AND METHODS: We performed a retrospective cohort study using data from the Pediatric Health Information System, which included detailed discharge data from 37 non-competing children's hospitals in the U.S. Using logistic regression, we examined whether the presence of coded diagnoses for internalizing or externalizing disorders at an index hospitalization for diabetes was associated with increased risk for rehospitalization during follow-up (duration of follow-up ranged from 3 to 24 months). The analysis was stratified by age-groups, and we controlled for potential confounders including sex, age, race/ethnicity, type 1 versus type 2 diabetes, Medicaid status, intensive care unit utilization, length of stay during index admission, and duration of follow-up. RESULTS: Among adolescents aged 13-18, internalizing disorders were associated with significantly increased odds of rehospitalization (odds ratio 1.79 [95% CI 1.27-2.52]); the point estimate for externalizing disorders was similar, but the finding was not statistically significant at the alpha = 0.05 level (1.74 [0.96-3.15]). No significant association between psychiatric diagnoses and odds of repeat hospitalization was observed in diabetic children aged 5-12 years. CONCLUSIONS: Internalizing disorders are associated with increases in repeat hospitalizations for diabetes among adolescents. Future research is needed to explore the reasons for this finding, such as degree to which treatment nonadherence mediates this relationship and whether appropriate treatment of internalizing disorders results in improved diabetes outcomes and decreased readmissions.     

The migraine cycle: patient burden of migraine during and between migraine attacks

Migraine is a neurologic disorder characterized by a cycle of attacks, including headache, separated by attack-free periods. Increasingly, episodic migraine is recognized as a disorder that may escalate to chronic migraine, with a frequency of 15 or more attacks per month. Migraine exacts a toll on the quality of life (QoL) of affected individuals, their families, and their workplace. Migraine adversely affects a patient's QoL during an attack, but also has an impact between attacks. This interictal burden on the patient manifests itself as worry in anticipation of the next painful attack and concern over its possible adverse impact on future plans or activities. The high prevalence of migraine, 12% in industrialized countries and approximately 28 million people in the United States, is considered a low estimate. Patients with disruptive migraines frequently overuse self-prescribed medications or may postpone a visit to a physician, which delays accurate diagnosis and appropriate treatment for migraine. Consequently, migraine remains underdiagnosed and undertreated. An extensive literature search of migraine reviewed its associated disability and reduced QoL during, and especially between, attacks. Assessment tools to evaluate the interictal burden on QoL, and to help in migraine diagnosis and patient-physician communication, are readily available. Nevertheless, patients with frequent and recurring migraines, who suffer a reduced QoL, continue to be underrecognized and undertreated. This segment of the migraine population could benefit from preventive therapy.