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1.
J Affect Disord ; 321: 161-166, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36272460

RESUMEN

OBJECTIVE: This study aimed to compare the differences in gray matter volumes (GMVs) of subcortical nuclei between major depressive disorder (MDD) patients with and without persistent depressive disorder (PDD) at long-term follow-up. METHODS: 114 and 94 subjects with MDD, including 48 and 41 with comorbid PDD, were enrolled to undergo high-resolution T1-weighted imaging at first (FIP) and second (three years later, SIP) investigation points, respectively. FreeSurfer was used to extract the GMVs of seven subcortical nuclei, and Generalized Estimating Equation models were employed to estimate the differences in GMVs of subcortical nuclei between the two subgroups. RESULTS: The PDD subgroup had a significantly greater depressive severity and a higher percentage of patients undergoing pharmacotherapy at the FIP as compared with the non-PDD subgroup. These differences became insignificant at the SIP. The PDD subgroup had a significantly (p < 0.003) smaller GMV in the right putamen at the SIP and in the right nucleus accumbens (NAc) at the FIP and SIP as compared with the non-PDD subgroup. After controlling for clinical variables, PDD was independently associated with smaller GMVs in the right putamen and NAc. LIMITATIONS: Imaging was not performed at baseline and pharmacotherapy was not controlled at the FIP and SIP. CONCLUSIONS: MDD with PDD was associated with smaller GMVs in the right putamen and NAc as compared with MDD without PDD. Whether the two regions are biomarkers related to a poor prognosis and the chronicity of depression requires further study.


Asunto(s)
Trastorno Depresivo Mayor , Humanos , Trastorno Depresivo Mayor/diagnóstico por imagen , Trastorno Depresivo Mayor/tratamiento farmacológico , Sustancia Gris/diagnóstico por imagen , Corteza Cerebral , Putamen/diagnóstico por imagen , Comorbilidad , Imagen por Resonancia Magnética
2.
J Affect Disord ; 321: 33-40, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36273681

RESUMEN

BACKGROUND: The associations of current and remitted bipolar disorder (BD) with health-related quality of life (HRQOL) have been under-studied, and we aim to address these gaps. METHODS: The 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized adults in the US. Using DSM-5 criteria, three groups were operationalized as: 1) adults who met criteria for BD in the past year (i.e., current BD; n = 566 unweighted); and 2) adults who met criteria for BD previously but not in the past year (i.e., BD in remission; n = 187); and 3) adults with no BD in their lifetime (n = 35,556). HRQOL and quality-adjusted life years (QALYs) were compared by these groups. Multivariable-adjusted regression analyses were used to adjust for and examine the role of covariates. RESULTS: Overall, 1.5 % of the study sample, representing 3.6 million adults nationwide, met criteria for current BD, and 0.5 %, representing 1.3 million adults, met criteria for BD in remission. Adults with current BD and BD in remission had lower mental HRQOL and QALYs, as compared to adults who never had BD. However, these differences were no longer significant when adjusted for behavioral co-morbidities (e.g., psychiatric and substance use disorders). CONCLUSION: Both current BD and BD in remission were adversely associated with HRQOL and QALYs, while these associations were not independent of behavioral co-morbidities. Because behavioral co-morbidities are common in individuals with current BD or those with BD in remission, they should be treated together to improve HRQOL.


Asunto(s)
Trastornos Relacionados con Alcohol , Trastorno Bipolar , Trastornos Relacionados con Sustancias , Humanos , Adulto , Trastorno Bipolar/epidemiología , Trastorno Bipolar/psicología , Calidad de Vida , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Comorbilidad , Trastornos Relacionados con Sustancias/epidemiología
3.
Child Adolesc Psychiatr Clin N Am ; 32(1): 57-68, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36410906

RESUMEN

Cannabis use often co-occurs with attention-deficit/hyperactivity disorder and other internalizing and externalizing disorders. Treatment planning, including pharmacologic and psychosocial interventions, for these comorbid disorders require thorough diagnostic evaluation to determine the extent of social, emotional, and behavioral impairments, severity of substance use, and motivation for change. Improved understanding of these comorbid disorders will inform treatment planning that address current symptoms and behaviors and may also prevent the development of mental health and substance use disorders in early adulthood.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Cannabis , Trastornos Relacionados con Sustancias , Adolescente , Humanos , Adulto , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Comorbilidad
4.
J Affect Disord ; 320: 340-347, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36174785

RESUMEN

BACKGROUND: Although anxiety is highly prevalent in people with bipolar disorders and has deleterious impact on the course of the illness, past reviews have shown that many aspects of the topic remain under-researched. This scoping review aims to provide a comprehensive overview of the literature addressing anxiety in bipolar disorder (A-BD) between 2011 and 2020, assess if the interest in the topic has increased over the period and map the publication trends. METHODS: Three databases were systematically searched, and all articles were screened at the title/abstract and full text level based on inclusion and exclusion criteria. Of these, 1099 articles were included in the study. The annual number of articles on A-BD published between 2011 and 2020 was calculated and articles addressing it as a primary topic (n = 310) were classified into 4 categories and 11 subcategories to identify gaps in the knowledge. RESULTS: The results show no clear increase in the number of annual publications during the period and much of the available literature is of a descriptive nature. Less is known about the processes underlying the comorbidity and about treatment approaches. LIMITATIONS: Given the large scope of the research question, no quality assessment of the evidence was made. Only articles in English or French were considered. CONCLUSIONS: These results highlight the need to change the focus of research efforts to better understand and address this unique set of conditions in clinical settings.


Asunto(s)
Trastorno Bipolar , Humanos , Trastorno Bipolar/epidemiología , Trastorno Bipolar/terapia , Trastornos de Ansiedad/epidemiología , Ansiedad/epidemiología , Comorbilidad
5.
J Affect Disord ; 320: 169-177, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36179780

RESUMEN

BACKGROUND: Peripheral artery disease (PAD) is highly prevalent and associated with poor outcomes. Depression is a risk factor for adverse outcomes in patients with coronary artery disease. Despite evidence showing that depression is common in patients with PAD, less is known about its association with adverse prognostic outcomes. To address this, we conducted a systematic review and meta-analysis to summarize the association between depression and outcomes in patients with PAD. METHODS: We performed a systematic search of eight databases to January 2022 including studies that reported a risk estimate for the association of depression or depressive symptoms with all-cause mortality or major adverse limb events (MALE) in patients with PAD and pooled results in a meta-analysis. Risk of bias was assessed using ROBINS-I. RESULTS: Of the 7048 articles screened, 5 observational studies with 119,123 patients were included. A total of 16.2 % had depression or depressive symptoms. Depression was associated with a statistically significant increased risk of all-cause mortality (HR 1.24, confidence interval 1.07-1.25, p = .005). The association between depression and MALE was not significant but trended toward a positive association. LIMITATIONS: Due to lack of data, results were limited by a single study with a large sample size, overrepresentation of men, and lack of information of depression severity or treatment status. CONCLUSION: Depression or depressive symptoms are associated with a 24 % increased risk of all-cause mortality in patients with PAD. Future work should explore the mechanisms and directionality of this association and identify depression as an important comorbidity to address for patients with PAD. REGISTRATION: PROSPERO CRD 42021223694.


Asunto(s)
Enfermedad de la Arteria Coronaria , Enfermedad Arterial Periférica , Humanos , Masculino , Depresión/terapia , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/epidemiología , Enfermedad Arterial Periférica/diagnóstico , Factores de Riesgo , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/epidemiología , Comorbilidad
7.
Clin Geriatr Med ; 39(1): 1-14, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36404023

RESUMEN

Dementia spectrum disorders (DSDs) are a major cause of mortality and disability worldwide. DSDs encompass a large group of medical conditions that all ultimately lead to major functional and cognitive decline and disability. Demographic and comorbid conditions that are associated with DSDs have significant prognostic and preventive implications. In this article, we will discuss the global and regional burden of DSDs and cover key demographic and clinical conditions linked with DSDs. In the absence of disease-modifying treatments, the role of primary prevention has become more prominent. Implementation of preventive measures requires an understanding of predisposing and exacerbating factors.


Asunto(s)
Disfunción Cognitiva , Demencia , Personas con Discapacidad , Humanos , Comorbilidad , Disfunción Cognitiva/epidemiología , Demencia/epidemiología , Demencia/terapia , Demografía
8.
Dent Clin North Am ; 67(1): 141-155, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36404075

RESUMEN

This article presents the case of a patient with persistent right-sided jaw pain with a history of multiple temporomandibular joint surgeries in the setting of persistent widespread body pain, the causes of which were fibromyalgia and osteoarthritis with multiple joint replacements, as well as psychological diagnoses of PTSD and depression. Despite extensive treatment from her orofacial pain team in combination with neurology and neurosurgery, her severe pain persisted, likely due to the consequences of untreated PTSD and depression, which led to avoidance of activities that would exacerbate her pain and thus to further disability and emotional deterioration.


Asunto(s)
Dolor Crónico , Personas con Discapacidad , Trastornos por Estrés Postraumático , Femenino , Humanos , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Dolor Facial/etiología , Dolor Crónico/complicaciones , Comorbilidad
9.
Holist Nurs Pract ; 37(1): E14-E23, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36378093

RESUMEN

Dyspnea is a common symptom and anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD). They affect individuals with COPD in a multifaceted way, causing many disabilities. Progressive relaxation exercises (PREs) are an important intervention in reducing symptoms and comorbidity. The aim of this study was to determine the effects of PREs on dyspnea and anxiety levels in individuals with COPD. A pretest-posttest randomized controlled trial was conducted at the chest diseases clinic of a university hospital in Turkey. Forty-four patients with COPD who met the inclusion criteria for participation in the study were assigned either to an intervention or a control group, with 22 patients in each group. In the intervention group, the patients performed PREs once a day for 4 weeks in addition to the standard treatment. The patients in the control group received the standard treatment. In the data collection stage of the study, questionnaire forms, namely, the Modified Borg Scale (MBS), Modified British Medical Research Council Dyspnea Scale, COPD Assessment Test (CAT), and Beck Anxiety Inventory (BAI), were used. Data were collected before (the first follow-up) and after the intervention (the second follow-up). In the second follow-up, the MBS, BAI, and CAT scores decreased significantly in the intervention group (P < .05) but showed no significant changes in the control group (P > .05). This study demonstrates that PREs can reduce dyspnea and anxiety levels in individuals with COPD.


Asunto(s)
Entrenamiento Autogénico , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Disnea/etiología , Disnea/terapia , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/terapia , Comorbilidad , Ansiedad/etiología , Ansiedad/terapia , Calidad de Vida
10.
Otolaryngol Clin North Am ; 56(1): 55-63, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36266107

RESUMEN

It is evident that sex and gender differences impact pathophysiology, disease burden, and treatment outcomes for a variety of systems and major illnesses including those affecting the unified airway. Important male-female differences in unified airway disease are driven by various intrinsic and extrinsic mechanisms including anatomic, morphometric, hormonal, genetic (and epigenetic), environmental, psycho-social, and comorbidity-related factors. This review highlights current knowledge of how patient sex influences epidemiology, diagnosis, treatment, and outcomes for diseases affecting the unified airway.


Asunto(s)
Sistema Respiratorio , Caracteres Sexuales , Femenino , Masculino , Humanos , Factores Sexuales , Comorbilidad
11.
Otolaryngol Clin North Am ; 56(1): 1-10, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36266105

RESUMEN

Upper and lower airways diseases are very common, with population prevalence of 10% to 40%. The conditions are usually interlinked and referred to as "unified airway disease" or "the united airways." Especially in phenotypes with more severe disease, type 2 immunologic endotype is often noted. Comorbid upper and lower airway diseases are usually caused by similar underlying immunologic response. Any patient with rhinitis or rhinosinusitis should have their lower respiratory tract evaluated. A multidisciplinary approach in the diagnosis and treatment of airway disease is advised, especially, for more severe phenotypes.


Asunto(s)
Asma , Rinitis , Sinusitis , Humanos , Asma/diagnóstico , Asma/epidemiología , Asma/terapia , Rinitis/diagnóstico , Rinitis/epidemiología , Rinitis/terapia , Sinusitis/diagnóstico , Sinusitis/epidemiología , Sinusitis/terapia , Sistema Respiratorio , Comorbilidad
12.
J Affect Disord ; 320: 544-551, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36209777

RESUMEN

BACKGROUND: Evidence on the association of low physical activity (PA) with depression or anxiety is well established. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low- and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged ≥18 years from 46 LMICs. METHODS: Cross-sectional, community-based data were analyzed from the World Health Survey (WHS). Multivariable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category. RESULTS: 237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12-1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23-1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52-2.01). CONCLUSION: Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.


Asunto(s)
Depresión , Países en Desarrollo , Humanos , Adulto , Femenino , Adolescente , Masculino , Depresión/epidemiología , Estudios Transversales , Ejercicio Físico , Comorbilidad , Prevalencia
13.
Artículo en Inglés | MEDLINE | ID: mdl-36029929

RESUMEN

Sleep disturbances are strongly linked with mental diseases such as substance use disorder (SUD) or schizophrenia (SZ) which can have a detrimental impact on quality of life (QOL), especially when both disorders are comorbid (dual disorder). In absence of studies about both circadian characteristics and QOL in patients with SUD and comorbid SZ (SUD + SZ), we examined a sample of 155 male under treatment, 75 with SUD + SZ and 80 only with SUD. Circadian functioning was evaluated by chronotype, social jet-lag and sleep quality (using the Pittsburgh Sleep Quality Index, PSQI), while the QOL was obtained by the World Health Organization's Quality of Life Questionnaire (WHOQOL)-BREF. SUD + SZ patients were more evening type than SUD, and this chronotype was linked to polydrug use in total sample and SUD + SZ group. We observed that the comorbidity did not lead to worse sleep quality in the SUD and SUD + SZ patients. QOL was poorer in SUD + SZ patients, who showed a negative association of Physical health, Psychological health and Social relationship with suicide attempts and severity of SZ. Lastly, patients with worse QOL also reported poorer sleep quality suggesting that treatment could include circadian adjustments along with a focused approach to lifestyle improvement.


Asunto(s)
Trastornos Psicóticos , Esquizofrenia , Trastornos Relacionados con Sustancias , Humanos , Masculino , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Calidad de Vida , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Comorbilidad
16.
Int J Oncol ; 62(1)2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36416345

RESUMEN

Epidemiological and retrospective clinical studies on cancer outcomes frequently adjust for patients' comorbid conditions. Despite the existence of multiple comorbidity indices, the Charlson comorbidity index (CCI) is the most frequently applied. Indices are developed in specific settings and the extent of alignment between the development setting and subsequent study is unclear. The present study provides a contemporaneous snapshot of comorbidity indices used in retrospective observational cancer studies and the extent to which cancer type(s), data source(s) and outcome(s) matched the studies in which the indices were developed. A systematic literature search in PubMed identified retrospective, observational studies on outcomes in patients with cancer published between March 2015 and March 2020. Information including the cancer type, data source and outcome were extracted and compared to those used in the validation study of the comorbidity index used. Of 158 papers reviewed, 79 used the CCI, either alone or in combination with other indices. The cancer type matched to that used in the validation study of the comorbidity index in 16 of the 115 studies using an established index, whilst the data source matched in 27 studies and outcome in only two. Justification was rarely provided for index choice (15 of the 115 studies). It may be concluded that, while the CCI remains the dominant comorbidity index, it may not always align to key elements of the study design in terms of cancer type, data source and outcome. A range of indices exists and identification of the most appropriate measure has the potential to improve adjustment for comorbidity. The present study provided information about the indices used in included studies and encourages future studies to consider which comorbidity index offers the best alignment with the study population, data source and question addressed.


Asunto(s)
Neoplasias , Humanos , Estudios Retrospectivos , Comorbilidad , Neoplasias/epidemiología
17.
Braz. j. oral sci ; 21: e227017, jan.-dez. 2022. ilus
Artículo en Inglés | LILACS, BBO - Odontología | ID: biblio-1393192

RESUMEN

During COVID-19 pandemic, fulminant deep fungal infection started emerging in India, known as Mucormycosis. This type of mucormycosis was termed as COVID-19 associated mucormycosis (CAM). These patients had previous history of COVID-19 infection. Such cases were mainly reported in immunocompromised patients such as patients with poorly controlled diabetes and chronic renal diseases etc. Rhinomaxillary mucormycosis is an aggressive, fulminant, fatal deep fungal infection of head and neck region. Early diagnosis and prompt treatment can reduce the mortality and morbidity associated with the disease; hence we present case series of rhinomaxillary mucormycosis to create awareness amongst dental surgeons


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anciano , Signos y Síntomas , Comorbilidad , Infecciones Fúngicas Invasoras/diagnóstico , COVID-19 , Mucorales , Mucormicosis/epidemiología , Micosis/diagnóstico
18.
Compr Psychiatry ; 119: 152353, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36341748

RESUMEN

Obsessive-compulsive disorder (OCD) is frequent and often disabling. Yet, correct diagnosis and appropriate treatment implementation are usually delayed, with undesirable consequences. In this paper we review the rationale for early intervention in OCD and provide recommendations for early intervention services. Two scenarios are discussed, i.e., subclinical (prodromal) obsessive-compulsive symptoms (OCS) and full-blown OCD. Although the typical patient with OCD reports a long history of subclinical OCS, longitudinal studies suggest most individuals with OCS in the community do not convert to full-blown OCD. Thus, research on "at risk" phenotypes for OCD and how they should incorporate different risk factors (e.g., polygenic risk scores) are badly needed. For this specific scenario, preventative treatments that are cheap, well tolerated and highly scalable (e.g., lifestyle interventions) are of major interest. On the other hand, increasing evidence suggests OCD to be a progressive disorder and the severity and duration of illness to be associated with both biological changes and increased clinical complexity, including greater number of physical and psychiatric comorbidities, increased family accommodation and worse treatment response. Therefore, prompt identification and early treatment implementation for full-blown OCD are also critical for ethical, clinical and therapeutic reasons. Based on the existing findings, we argue that, regardless of focusing on subclinical OCS or clinical OCD, early intervention services need to target a childhood age group. In addition to delivering well established treatments to people with full-blown OCD early on their illness, early intervention services also need to provide psychoeducation for patients, families and teachers.


Asunto(s)
Trastorno Obsesivo Compulsivo , Humanos , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/terapia , Trastorno Obsesivo Compulsivo/epidemiología , Comorbilidad
19.
Rev Med Suisse ; 18(802): 2048-2052, 2022 Nov 02.
Artículo en Francés | MEDLINE | ID: mdl-36326221

RESUMEN

How to apply treatment recommendations from various knowledgeable specialist societies concerning the very complex patient? Within a population weakened by the cumulative effect of comorbidities, loss of autonomy aggravated by geriatric syndromes and biological changes linked to aging which interact with the pharmacokinetics and pharmacodynamics of drugs, there is fertile soil for the advent of adverse conditions linked to simultaneously prescribing multiple treatments. Our aim is to analyze various clinical reasoning tools permitting an appropriate drug prescription while considering the state of health, life expectancy and time to benefit with the aim of reducing iatrogenesis.


Comment mettre en pratique les recommandations de prise en charge médicamenteuse suggérées par les différentes sociétés savantes de spécialistes face à un patient âgé non robuste ? Dans une population fragilisée par le cumul des comorbidités, les handicaps liés aux syndromes gériatriques et les modifications biologiques liées au vieillissement, le terrain est fertile pour la survenue d'effets indésirables lors de la prescription simultanée de plusieurs médicaments. Nous analysons dans cet article divers aides au raisonnement clinique menant à la prescription d'une médication adaptée aux objectifs partagés avec le patient, en tenant compte de l'état de santé, de l'espérance de vie et du temps nécessaire au bénéfice escompté de la prescription, afin de pallier toute iatrogénie.


Asunto(s)
Prescripciones de Medicamentos , Polifarmacia , Humanos , Anciano , Síndrome , Comorbilidad , Envejecimiento , Evaluación Geriátrica
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