Cannabis use and medication nonadherence in bipolar disorder: A nationwide inpatient sample database analysis.

BACKGROUND: Medication nonadherence among bipolar disorder (BD) is often linked with comorbid substance use disorders. This study aims to investigate cannabis use disorder (CUD) association with medication noncompliance in hospitalized BD patients. METHODS: Using data on 266,303 BD hospitalizations between 2010 and 2014 from the US Nationwide Inpatient Sample database, we obtained medication noncompliance rates stratified by demographics and CUD. Logistic regression was used to evaluate factors associated with medication noncompliance. RESULTS: Overall mean age, the prevalence of CUD, and medication nonadherence were 41.58 (± 0.11) years, 15.0% and 16.1%, respectively. There were 56.6% females in the overall population. There was a significant difference in the characteristics of those in the medication nonadherence vs adherence groups, including age, sex, race, comorbid substance use, income, insurance type, hospital region, and hospital teaching status (p < 0.001). After adjusting for other variables using multivariate analysis, there remained a statistically significant association of medication nonadherence in BD hospitalization and CUD (OR 1.42, 95% CI 1.36-1.48). LIMITATION: Confounding multiple substance use could not be accounted for, and the retrospective nature of the database which includes only inpatients is prone to possible selection and reporting bias. CONCLUSION: CUD statistically predicts increased rates of medication nonadherence among patients with BD. Given the possible association of CUD with medication nonadherence among BD patients, collaborative work between general adult psychiatry and addiction services is imperative in improving the management outcome of patients with BD and comorbid CUD.

A Retrospective Analysis on Risk Factors for 30-day Readmission Rates in Patients Living With HIV and Severe Major Depression Disorder.

Background Major depression disorder (MDD) is the most common psychiatric comorbidity in patients living with HIV (PLWHIV). The prevalence rate of MDD is higher in PLWHIV in comparison to the general population. In our study, we focus specifically on the 30-day readmission rate of PLWHIV and severe major depression. Methods The Health Care Agency (HCA) databank was used to conduct a retrospective study on PLWHIV and severe MDD. Keywords such as HIV, severe MDD, CD4, viral load were used to identify the data. 30-day readmission rate is studied in PLWHIV and severe MDD (N=143). Variables such as age, sex, gender, adherence to antiretroviral medications, cluster of differentiation 4 (CD4), and viral load were studied in this population. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria were used to diagnose severe MDD in PLWHIV. An antiretroviral therapy (ART) medication list was used to analyze adherence in this population group. Geographical locations were identified using urbanization codes. Results Logistic regression analysis for the 30-day readmission rate in PLWHIV was found to be higher in the older age group (p<0.01). Caucasian population (p<0.01) and rural areas (p<0.01), ART non-adherence (p<0.05), and severe major depression were also found to be significant in this population (p<0.01). Conclusion As more patients live longer with HIV/AIDS, it gives rise to illnesses such as anxiety, depression, and cognitive impairment. Thus, it is important to identify severe depression in PLWHIV since it can have an impact on rates of hospitalization, morbidity/mortality, and the financial burden, specifically within 30-days of discharge.

Comorbid Psychiatric Aspects of Bainbridge-Ropers Syndrome.

Objective: Bainbridge-Ropers syndrome (BRPS) is a neurodevelopmental genetic disorder associated with mutations in the additional sex combs-like ASXL3 gene on chromosome 18q12.1. The objective of this study is to describe the comorbid psychiatric aspects of BRPS.Methods: A retrospective review was conducted of the electronic medical records of patients diagnosed with BRPS from 2013 to 2020 at an academic medical center. Results were deidentified and presented as frequencies and percentages.Results: Seven cases (5 White males and 2 White females) of BRPS were identified. The mean age at the time of referral was 12 years, while the mean age at diagnosis of BRPS was 7 years. Comorbid psychiatric symptoms and diagnoses associated with BRPS included global developmental delay: 6 (86%), sleep impairment: 5 (71%), autism spectrum disorder: 3 (43%), speech impairment: 2 (29%), disruptive behavior: 4 (57%), attention-deficit/hyperactivity disorder: 3 (43%), self-injurious behavior: 3 (43%), aggression: 4 (57%), and seizures: 3 (43%). All 7 patients (100%) had multiple DSM-5 diagnoses.Conclusions: These data highlight the need for awareness of the psychiatric comorbidity of BRPS. The findings also underscore the need for further research and emphasize the importance of multidisciplinary collaboration in the prompt assessment, diagnosis, and management of patients presenting with BRPS.

Attention Test Improvements from a Cluster Randomized Controlled Trial of Caregiver Training for HIV-Exposed/Uninfected Ugandan Preschool Children.

OBJECTIVE: To report vigilance attention outcomes from a cluster randomized controlled trial of early childhood development caregiver training for perinatally HIV-exposed/uninfected preschool-age children in rural Uganda. The Early Childhood Vigilance Test (ECVT) provides a webcam recording of proportion of time a child views an animation periodically moving across a computer screen. STUDY DESIGN: Sixty mothers/caregivers received biweekly year-long training sessions of the Mediational Intervention for Sensitizing Caregivers (MISC), and 59 mothers received biweekly training about nutrition, hygiene, and health care. Children were tested for attention at baseline, 6 months, and 12 months with the ECVT, in terms of proportion of time spent viewing a 6-minute animation of animals greeting the child and moving across the computer monitor screen. Time viewing the animation were scored by trained observers using ProCoder program for webcam scoring of proportion of time the child faced the animation. Mixed-effects modeling was used to compare ECVT outcomes for the 2 intervention groups. RESULTS: Unadjusted and adjusted (for age, sex, height, and ECVT at baseline) group differences on ECVT significantly favored the MISC arm at 6 months (P = .03; 95% CI (0.01, 0.11), effect size = 0.46) but not at 12 months. Both groups made significant gains in sustained attention across the year-long intervention (P = .021) with no significant interaction effects between time and treatment arms or sex. CONCLUSIONS: Caregiver early childhood development training enhanced attention in at-risk Ugandan children, which can be foundational to improved working memory and learning, and perhaps related to previous language benefits reported for this cohort. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00889395.

HIV-Associated Neurocognitive Disorder (HAND): Relative Risk Factors.

This chapter will address the issue of risk for HIV-associated neurocognitive disorder (HAND), focusing on HIV-associated dementia (HAD), among persons living with HIV in relationship to the risk for other dementias. Advances in effective antiretroviral therapy (ART) have led to an increase in the prevalence of older persons surviving with HIV - in addition to older persons who become infected by HIV later in life. Hence, HIV is no longer a disease of younger persons, and additional attention has been brought to bear against the plight of older persons living with HIV - not only as it pertains to treatment but also to prevention. The additional risk caused by aging among older persons living with HIV is complex to asses, and HIV infection is a research area that requires a robust approach to multiple other factors causing neurocognitive impairment with older age. The long-term and potentially neurotoxic exposure to ART and the deleterious consequences of chronic infection with HIV and its associated neuro-inflammation have been described for health. This aids in the understanding of dementia risk factors in this patient population, but the comorbidities (HIV- and non-HIV-associated) occurring among older persons living with HIV must also be addressed to properly assess the overall impact on dementia risk in this group. This need also warrants our examination of the risk factors for other dementias (and comorbid dementias) in persons living with HIV versus the general population through the assessment and quantification of modifiable and non-modifiable risk factors identified as major contributors toward dementia.

Infant sleep problems and childhood overweight: Effects of three definitions of sleep problems.

UNLABELLED: Sleep problems have been defined using a variety of definitions. No study has assessed the longitudinal association between infant sleep problems and childhood overweight or obesity using existing definitions of sleep problems. This study used longitudinal data (n = 895) from the multi-site Study of Early Child Care and Youth Development (SECCYD) to investigate the effects of infant sleep problems on childhood weight status in Grade 6. Infants with sleep problems in Phase I (1991) and with complete data through Phase III (2004) of SECCYD were included. Sleep problems were assessed using maternal reports of night wakings and duration of a waking episode. Sleep problems were defined using Richman (1981), Lozoff et al. (1985), and Zuckerman et al. (1987) definitions. Multinomial logistic regression was used to examine the association between sleep problems during infancy and childhood weight status in Grade 6 while controlling for birth weight, race, sex, breastfeeding, maternal poverty, family structure, and maternal education. After adjusting for all covariates, children with a history of sleep problems were found to be overweight in Grade 6 using Zukerman et al. (Odds ratio (OR) = 1.68; 95% confidence interval (CI): 1.11-2.55) and Richman (OR = 1.76; 95% CI: 1.05-2.97) definitions, but not using Lozoff et al. DEFINITION: Infant sleep problems were not found to be associated with being obese. The study found differential effects of infant sleep problems on childhood overweight in Grade 6 per different definitions of sleep problems. Findings highlight the need to construct a single definition of infant sleep problems.