Psychiatric comorbidity in adult patients with idiopathic generalized epilepsy

We reviewed the medical records of 157 adult (18 years) patients with firmly diagnosed idiopathic generalized epilepsy (IGE) to investigate the extent and the type of psychiatric comorbidity and its relationship to various IGE syndromes and other epilepsy-related neurobiological factors. Forty-one patients (26.1%, 14 men and 27 women, median age: 34.0 years, range: 18-68, mean: 36.5) had comorbid mental disorders according to the 10th revision of the International Classification of Diseases (ICD-10) criteria, with four patients having a dual diagnosis. Mood disorders were the most common comorbid mental disorder (46.7%), followed by anxiety-panic disorder (26.7%). Comorbid psychiatric disorders occurred in all syndromes and in association with all seizure types, and, as in focal epilepsies, seizure control was significantly better in patients without psychiatric comorbidity (40.5% vs 19.5%, chi(2)(1)=5.873, P=0.015).     

Psychiatric comorbidity among patients with gender identity disorder

Aims: Psychiatric comorbidity and mental instability seem to be important unfavorable prognostic factors for long‐term psychosocial adjustment in gender identity disorder (GID). However, psychiatric comorbidity in patients with GID has rarely been assessed. In this study, we investigated the psychiatric comorbidity and life events of patients with GID in Japan. Methods: A total of 603 consecutive patients were evaluated independently by at least two senior psychiatrists at the GID clinic using clinical information and results of examinations. Results: Using DSM‐IV criteria, 579 patients (96.0%) were diagnosed with GID. Among the GID patients, 349 (60.3%) were the female‐to‐male (FTM) type, and 230 (39.7%) were the male‐to‐female (MTF) type. Current psychiatric comorbidity was 19.1% (44/230) among MTF patients and 12.0% (42/349) among FTM patients. The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients. Among current psychiatric diagnoses, adjustment disorder (6.7%, 38/579) and anxiety disorder (3.6%, 21/579) were relatively frequent. Mood disorder was the third most frequent (1.4%, 8/579). Conclusions: Comparison with previous reports on the psychiatric comorbidity among GID patients revealed that the majority of GID patients had no psychiatric comorbidity. GID is a diagnostic entity in its own right, not necessarily associated with severe comorbid psychological findings.     

Psychiatric comorbidity in a Brazilian sample of patients with binge-eating disorder

We compared sociodemographic characteristics and psychiatric status in obese Brazilian patients who did (n=32) and did not (n=33) meet DSM-IV criteria for binge-eating disorder (BED). The sample's mean age was 35.0 years (+/-10.5), with 92.3% of individuals being female and 41.5% having some higher education. Obese binge eaters (OBE) were significantly more likely than obese non-binge eaters to meet criteria for a current diagnosis of any axis I disorder, any mood disorder and any anxiety disorder. Specifically, OBE patients were characterized by significantly higher rates of current and lifetime histories of major depressive disorder. Similar to patients from developed countries, Brazilian patients with BED display increased rates of psychiatric comorbidity, particularly mood and anxiety disorders.     

Psychiatric comorbidity in older adults with bipolar disorder

INTRODUCTION: Comorbidity patterns and correlates among older adults with bipolar disorder (BPD) are not well understood. The aim of this analysis was to examine the prevalence of comorbid PTSD and other anxiety disorders, substance abuse and dementia in a population of 16,330 geriatric patients with BPD in a Veterans Health Administration administrative database. METHODS: Patients were identified from case registry files during Federal Fiscal Year 2001(FY01). Comorbidity groups were compared on selected clinical characteristics, inpatient and outpatient health resource use, and costs of care. RESULTS: Four thousand six hundred and sixty-eight geriatric veterans with BPD were comorbid for either substance abuse, PTSD and other anxiety disorder, or dementia (28.6% of all veterans with BPD age 60 or older). Mean age of all veterans in the four comorbidity groups was 70.0 years (+/-SD 7.2 years). Substance abuse was seen in 1,460 (8.9%) of elderly veterans with BPD, while PTSD was seen in 875 (5.4%), other anxiety disorders in 1592 (9.7%), and dementia in 741 (4.5%) of elderly veterans. Individuals with substance abuse in this elderly bipolar population are more likely to be younger, minority, unmarried and homeless compared to elderly bipolar populations with anxiety disorders or dementia. Inpatient use was greatest among geriatric veterans with BPD and dementia compared to veterans with BPD and other comorbid conditions. CONCLUSION: Clinical characteristics, health resource use and healthcare costs differ among geriatric patients with BPD and comorbid anxiety, substance abuse or dementia. Additional research is needed to better understand presentation of illness and modifiable factors that may influence outcomes.     

Social anxiety disorder comorbidity in patients with bipolar disorder: a clinical replication

BACKGROUND: The authors investigated frequency, clinical correlates and onset temporal relationship of social anxiety disorder (SAD) in adult patients with a diagnosis of bipolar I disorder. METHODS: Subjects were 189 patients whose diagnoses were assessed by the Structured Clinical Interview for DSM-III-R-Patient Version. RESULTS: Twenty-four patients (12.7%) met DSM-III-R criteria for lifetime SAD; of these, 19 (10.1% of entire sample) had SAD within the last month. Significantly more bipolar patients with comorbid SAD also had substance use disorders compared to those without. On the HSCL-90, levels of interpersonal sensitivity, obsessiveness, phobic anxiety and paranoid ideation were significantly higher in bipolar patients with SAD than in those without. Bipolar patients with comorbid SAD recalled separation anxiety problems (school refusal) more frequently during childhood than those without. Lifetime SAD comorbidity was associated with an earlier age at onset of syndromal bipolar disorder. Pre-existing OCD tended to delay the onset of bipolarity. CONCLUSIONS: Social anxiety disorder comorbidity is not rare among patients with bipolar disorder and is likely to affect age of onset and phenomenology of bipolar disorder. These findings may influence treatment planning and the possibility of discovering a pathophysiological relationship between SAD and bipolarity.     

Symptomatology and comorbidity of generalized anxiety disorder in children and adolescents.

This study investigated the symptomatology and comorbidity of generalized anxiety disorder (GAD) in a clinically referred sample of Italian children and adolescents as a function of age and gender. The sample consisted of 58 subjects (19 children and 39 adolescents), 23 males and 35 females screened from consecutively referred children and adolescents. This sample was divided into two groups of younger children (19 subjects, eight males and 11 females aged 7 to 12 years; mean age, 9.6) and adolescents (39 subjects, 15 males and 24 females aged 12 to 18 years; mean age, 14.9). Feelings of tension, apprehension, the need for reassurance, irritability, negative self-image, and physical complaints were reported in more than 70% of the subjects. Differences in the symptomatic profile between males and females were not significant. Children and adolescents did not show significant differences in the number of symptoms. The need for reassurance was significantly more frequent in children, and brooding was more frequent in adolescents. Other anxiety disorders were commonly comorbid with GAD. More than half of the patients with GAD showed a concurrent depressive disorder; no differences were found for comorbidity between children and adolescents, except for higher rates of separation anxiety disorder in children.     

Psychiatric comorbidity in gender identity disorder

OBJECTIVE: Despite being recognized as an important prognostic factor for the outcome in gender identity disorder (GID), psychiatric comorbidity has rarely been assessed by means of standardized diagnostic instruments. The aim of this study was to assess current and lifetime psychiatric comorbidity in patients with GID. METHODS: A cross-sectional sample of 31 patients who were treated for GID was assessed by the structured clinical interview for Axis I and II (SCID-I/II) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders. CONCLUSIONS: Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.     

EEG sleep studies in patients with generalized anxiety disorder

Sleep polygraphic recordings were performed during 3 consecutive nights in 12 inpatients with generalized anxiety disorder (GAD) in comparison with age- and sex-matched groups of patients with major depressive disorder (MDD) and normal subjects. GAD patients differed significantly from those with MDD. A lower number of awakenings and stage shifts in night 1 and the mean of the 3 nights and a shorter rapid eye movement (REM) duration in night 1 but longer REM latency in the mean of the 3 nights were observed in GAD in comparison to MDD. GAD patients also showed a significantly longer sleep onset latency and shorter duration of total sleep time and Stage 2 than control subjects. Electroencephalographic sleep recordings, as well as other laboratory tests, may help the clinician to differentiate anxiety from depressive disorders.     

Neuroactive steroid levels in patients with generalized anxiety disorder

Serum levels of allopregnanolone, pregnenolone sulfate, and dehydroepiandrosterone sulfate were measured in 8 male patients with generalized anxiety disorder (GAD) and 8 healthy control subjects. Results suggest that patients with GAD have significantly lower levels of pregnenolone sulfate than control subjects.     

Noradrenergic function in generalized anxiety disorder: effects of yohimbine in healthy subjects and patients with generalized anxiety disorder

There is extensive preclinical and clinical support for the hypothesis that hyperactivity of noradrenergic neuronal systems is related to the pathophysiology of some forms of human anxiety. In the present investigation, the behavioral, biochemical, and cardiovascular responses to the alpha 2-adrenergic receptor antagonist, yohimbine, was determined in 20 patients with generalized anxiety disorder (GAD) and 20 healthy subjects. The responses to yohimbine were generally similar in the two groups except there was a trend for the yohimbine-induced increase in plasma 3-methoxy-4-hydroxyphenylglycol to be less in the GAD patients. These findings contrast with previous studies of the effects of yohimbine in panic disorder patients and, thereby, support a neurobiological distinction between these two disorders.     

Psychiatric comorbidity among children with gender identity disorder

OBJECTIVE: To investigate the prevalence and type of comorbidity in children with gender identity disorder (GID). METHOD: The Diagnostic Interview Schedule for Children-Parent version was used to assess psychopathology according to the DSM in two groups of children. The first group consisted of 120 Dutch children (age range 4-11 years) who were referred to a gender identity clinic between 1998 and 2004 (GID group) and the second group consisted of 47 Dutch children who were referred to an attention-deficit/hyperactivity disorder (ADHD) clinic between 1998 and 2004 (ADHD group; 100% response rate for both groups). RESULTS: Fifty-two percent of the children diagnosed with GID had one or more diagnoses other than GID. As expected, more internalizing (37%) than externalizing (23%) psychopathology was present in both boys and girls. Furthermore, the odds ratios of having internalizing or externalizing comorbidity were 1.28 and 1.39 times higher, respectively, in the clinical comparison group (ADHD group) than in the GID group. Finally, 31% of the children with GID suffered from an anxiety disorder. CONCLUSIONS: The results of this categorical diagnostic study show that children with GID are at risk for developing co-occurring problems. Because 69% of the children do not have an anxiety disorder, a full-blown anxiety disorder does not seem to be a necessary condition for the development of GID. Clinicians working with children with GID should be aware of the risk for co-occurring psychiatric problems and must realize that externalizing comorbidity, if present, can make a child with GID more vulnerable to social ostracism.     

Cortical surface anatomy in pediatric patients with generalized anxiety disorder

BackgroundIt is established that pediatric patients with generalized anxiety disorder (GAD) exhibit functional abnormalities and altered gray matter volumes in neural structures that subserve emotional processing, yet there are no data regarding the surface anatomy of the cerebral cortex in youth with GAD.MethodsUsing an automated surface-based approach (FreeSurfer), cortical thickness was assessed node-by-node over the entire cerebral cortex in adolescents with GAD and no co-occurring major depressive disorder (n = 13) and healthy subjects (n = 19).ResultsCompared with healthy adolescents, youth with GAD exhibited increased cortical thickness in the right inferolateral and ventromedial prefrontal cortex (i.e., inferior frontal gyrus), the left inferior and middle temporal cortex as well as the right lateral occipital cortex. No relationships were observed between cortical thickness and the severity of anxiety symptoms in the significant regions that were identified in the vertex-wise analysis.ConclusionsThese findings suggest that, in adolescents with GAD, abnormalities in cortical thickness are present in an ensemble of regions responsible for fear learning, fear extinction, reflective functioning (e.g., mentalization), and regulation of the amygdala.     

个案管理模式在广泛性焦虑障碍患者中的应用

目的探讨个案管理模式对广泛性焦虑障碍患者生活质量及临床结局的影响。方法选取来自四川省精神卫生中心心身疾病科且符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)广泛性焦虑障碍(GAD)诊断标准的120例住院患者,随机分为个案管理组和对照组各60例,两组均采用原有抗焦虑药物和日常心理治疗,个案管理组还进行个案管理干预。于干预前、干预后1、2、4、8、12、24、48周采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、临床疗效总评量表(CGI)和幸福指数量表(Index of Well-being)进行评定。结果两组服药依从性、复发率、满意度比较差异均有统计学意义(P均0.05);治疗后两组HAMA、HAMD、CGI评分均较基线期低,差异有统计学意义(P0.01);在治疗及随访期间,个案管理组HAMA、HAMD、CGI及总体幸福感评分均较对照组低,差异有统计学意义(P均0.05)。结论对GAD在药物治疗及一般心理支持治疗基础上实施个案管理服务48周后患者的焦虑、抑郁症状缓解更明显,服药依从性更好,复发率更低、生活质量更好,患者对治疗的满意度提高。     

Multiple anxiety disorder comorbidity in patients with mood spectrum disorders with psychotic features

OBJECTIVE: The authors investigated frequencies and clinical correlates of multiple associations of panic disorder, obsessive-compulsive disorder (OCD), and social phobia in patients with severe mood disorders. METHOD: Subjects were 77 consecutively hospitalized adults with psychotic symptoms and with a diagnosis of bipolar I disorder, major depression, or schizoaffective disorder, bipolar type. Principal diagnosis and comorbidity were assessed by the Structured Clinical Interview for DSM-III-R-Patient Version. RESULTS: Of the entire cohort, 33.8% had a single anxiety disorder and 14.3% had two or three comorbid diagnoses. Patients with multiple comorbidity had significantly higher scores on the Brief Psychiatric Rating Scale and SCL-90 and abused stimulants more frequently than did those without anxiety disorders. CONCLUSIONS: Multiple associations of panic disorder, OCD, and social phobia are not rare among patients with affective psychoses and are likely to be associated with more severe psychopathology than is found in patients without anxiety disorders.     

广泛性焦虑障碍患者风险决策特点

目的 探讨广泛性焦虑障碍(General anxiety disorder, GAD)患者在风险明确情境下的决策功能。方法 采用骰子博弈测试(Game of dice test, GDT)评估首次诊断为GAD的21例患者及性别、年龄、受教育年限相匹配的20例健康对照者风险明确情境下的决策功能,同时进行神经心理学量表测评。结果 GAD组风险选项次数(4.14±2.61)与健康对照组(6.55±4.56)比较有明显差异(t=-2.087,P<0.05);GAD组非风险选项次数(13.86±2.61)与健康对照组(11.45±4.56)比较也存在明显差异(t=2.087,P<0.05);2组负反馈利用率无明显差异(P>0.05);GAD组数字符号编码测验(Symbol digit modalities, SDMT)测验成绩(49.29±17.85)明显较健康对照组(59.4±17.67)差(z=-1.971,P=0.049)。结论 GAD患者在风险明确情境下决策更倾向于风险规避,且对负面损失的敏感度与健康对照组比较无明显差异;GAD患者注意力和信息处理速度能力较健康个体差。     

Psychiatric comorbidity in patients with spasmodic torticollis

Several studies have reported raised levels of psychopathology based on self-rating scales in patients with spasmodic torticollis. Recent publications have also proposed that psychopathology, especially symptoms of depression, might be a reaction to dystonia or constitute a nonspecific reaction pattern. To determine the actual frequency of psychiatric disorders, we evaluated 44 patients with spasmodic torticollis (20 female, 24 male; mean age 43.6 years, sd 10.4) using the standard instrument for psychiatric diagnosis in the DSM-III-R (Structured Clinical Interview Schedule, SCID). The SCID permits retrospective diagnosis for most of the major psychiatric disorders, including the time before onset of dystonia. SCID criteria for at least one psychiatric disorder were fulfilled in 65.9% of patients, including both lifetime and current diagnosis. The most frequent diagnostic categories were panic disorder with or without agoraphobia (29.5%), major depressive disorder (25%), substance abuse (13.6%), and obsessive compulsive disorders (6.8%) were diagnosed less frequently. The patient-recalled onset of psychiatric symptoms preceded onset of torticollis symptoms in 43.2% of those investigated.