Psychiatric comorbidity of smoking and nicotine dependence

Recent epidemiologic studies have revealed that comorbidity of psychiatric disorders is far more pervasive than previously suspected. Strong associations have been reported between specific substance use disorders and between any mental disorder and any substance use disorder. This report focuses on comorbidity of nicotine dependence, a substance use disorder on which little epidemiologic information is available. Data come from an epidemiologic study of approximately 1000 young adults in southeast Michigan, in which the NIMH-DIS, revised according to DSM-III-R, was used. Lifetime prevalence of nicotine dependence was 20%. Males and females with nicotine dependence had increased odds for alcohol and illicit drug disorders, major depression, and anxiety disorders, compared with nondependent smokers and nonsmokers combined. Major depression and any anxiety disorder were associated specifically with nicotine dependence. Increased odds for alcohol or illicit drug disorders were observed also in nondependent smokers, compared to nonsmokers. History of early conduct problems increased the odds for nicotine dependence among smokers. Potential mechanisms in the comorbidity of nicotine dependence are discussed.     

Turning point in the design of linkage studies of schizophrenia

Despite extensive genomic scans, linkage studies of multiplex pedigrees have been unable to produce replicable evidence of genes predisposing to schizophrenia. This indicates that it is unlikely that a single gene accounts for a majority of cases of schizophrenia, even in multiplex pedigrees. It is most likely that schizophrenia is caused by the nonlinear interaction of multiple genetic and environmental factors influencing brain development and function. This conclusion has strong implications for the design of linkage and association studies. Recently designed linkage studies involve several improvements to deal with extensive locus heterogeneity and multiplicative interaction. These improvements include much larger samples of pedigrees, systematic ascertainment and sequential extension rules, and standardized procedures at multiple sites to facilitate collaboration and replication. Future improvements are likely to require advances in the assessment of clinical and neurobiological variability in multiplex pedigrees, more systematic environmental assessment, and advances in analytic methods to deal with multiplicative interaction. Rather than focusing only on schizophrenia as one or more discrete disorders, future linkage efforts should also consider the etiology of individual clinical syndromes or dimensional components of risk that interact to cause the complex pattern of syndromal comorbidity observed within schizophrenics and their families. © 1994 Wiley-Liss, Inc.     

Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients

ObjectivesWe examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures.DesignPopulation-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR).Setting and ParticipantsPatients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443).MethodsComorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes.ResultsThe overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity.Conclusion and ImplicationsIncreasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years.     

Derivation and validation of a novel comorbidity‐based delirium risk index to predict postoperative delirium using national administrative healthcare database

ObjectiveTo derive and validate a comorbidity‐based delirium risk index (DRI) to predict postoperative delirium.Data Source/Study SettingData of 506 438 hip fracture repair surgeries from 2006 to 2016 were collected to derive DRI and perform internal validation from the Premier Healthcare Database, which provided billing information on 20‐25 percent of hospitalizations in the USA. Additionally, data of 1 130 569 knee arthroplasty surgeries were retrieved for external validation.Study DesignThirty‐six commonly seen comorbidities were evaluated by logistic regression with the outcome of postoperative delirium. The hip fracture repair surgery cohort was separated into a training dataset (60 percent) and an internal validation (40 percent) dataset. The least absolute shrinkage and selection operator (LASSO) procedure was applied for variable selection, and weights were assigned to selected comorbidities to quantify corresponding risks. The newly developed DRI was then compared to the Charlson‐Deyo Index for goodness‐of‐fit and predictive ability, using the Akaike information criterion (AIC), Bayesian information criterion (BIC), area under the ROC curve (AUC) for goodness‐of‐fit, and odds ratios for predictive performance. Additional internal validation was performed by splitting the data by four regions and in 4 randomly selected hospitals. External validation was conducted in patients with knee arthroplasty surgeries.Data CollectionHip fracture repair surgeries, knee arthroplasty surgeries, and comorbidities were identified by using ICD‐9 codes. Postoperative delirium was defined by using ICD‐9 codes and analyzing billing information for antipsychotics (specifically haloperidol, olanzapine, and quetiapine) typically recommended to treat delirium.Principal FindingsThe derived DRI includes 14 comorbidities and assigns comorbidities weights ranging from 1 to 6. The DRI outperformed the Charlson‐Deyo Comorbidity Index with better goodness‐of‐fit and predictive performance.ConclusionsDelirium risk index is a valid comorbidity index for covariate adjustment and risk prediction in the context of postoperative delirium. Future work is needed to test its performance in different patient populations and varying definitions of delirium.     

10140例肾结石患者临床合并症及相关因素分析

目的 评估肾结石患者的人口学分布和临床合并症特点并探索其相关因素,为临床防治提供依据。方法 回顾性分析2017年1月至2020年12月海军军医大学附属长海医院门诊及住院患者中影像学报告为肾结石的10140例患者。根据受累肾脏情况,分为单侧肾结石组(单侧组)及双侧肾结石组(双侧组),分析两组人群在年龄、性别、实验室检查、常见临床合并症上的差异,采用logistic回归探寻可能影响双侧肾结石形成的相关因素。结果 10140例肾结石患者的平均年龄为57.75±13.30岁,男女比例为2.25:1。其中单侧组8171例（80.6%）,双侧组1969例（19.6%）。所有肾结石患者最常见的临床合并症依次为高血压病(HT)、肿瘤、高尿酸血症、糖尿病(DM)、冠心病(CHD)、脑血管疾病。两组在年龄、性别的分布,以及HT、肿瘤、高尿酸血症、CHD的合并率方面差异有统计学意义(P<0.05);而在体重指数(BMI)、DM、脑血管疾病的合并率方面差异无统计学意义(P>0.05)。实验室检查方面,单侧组血清肌酐(Cr)、尿酸(UA)、尿pH值水平低于双侧组(P<0.05);而高密度脂蛋白胆固醇(HDL-C)水平高于双侧组(P<0.05);空腹血糖(FPG)、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平方面两组之间差异无统计学意义(P>0.05)。此外,性别(男性)、高尿酸血症可能是双侧肾结石形成的重要相关因素(P<0.05),而合并肿瘤则更倾向于表现为单侧肾结石患者(P<0.05)。结论 肾结石更多见于中年男性,代谢综合征相关疾病在肾结石的发展过程扮演了重要角色,有必要加强这些疾患的早期防治。肾结石患者肿瘤合并率高,提示两者存在关联。此外,较单侧肾结石而言,男性、合并高尿酸血症与双侧肾结石形成关系更密切,应当引起重视。     

PTSD and Comorbid Psychotic Disorder: Comparison with Veterans Diagnosed with PTSD or Psychotic Disorder

Symptoms of posttraumatic stress disorder (PTSD), psychosis, general psychopathology, role functioning, violence potential, and cognitive and emotional aspects of psychotic states were compared in three groups of veterans. Groups were defined on the basis of their DSM-IV diagnoses: Psychotic disorder and war-related PTSD, war-related PTSD without psychotic symptoms, and psychotic disorder without PTSD. Veterans with PTSD and a comorbid psychotic disorder showed significantly higher levels of positive symptoms of psychosis, general psychopathology, paranoia, and violent thoughts, feelings, and behaviors than the other two groups. These data show that patients with comorbid PTSD and psychotic disorder show levels of cognitive, emotional, and behavioral disturbance that far exceed the levels of disturbance seen in patients with PTSD without psychosis or in patients with psychotic disorder.