Cognition in Euthymic Patients with Bipolar Disorder: Do Not Forget to Account for Anxiety!

Purpose: Despite the high prevalence of anxiety disorders in BD and its known impact on cognitive performance, the presence and severity of anxious symptoms is not systematically evaluated in studies on cognition in BD. Our aim was to determine if attention and/or inhibition of cognitive interference in euthymic patients with type I Bipolar Disorder (BD-I) is affected by symptoms of anxiety. Patients and Methods: Eighty-seven euthymic BD-I patients were included. Patients with comorbidities other than Generalized Anxiety Disorder (GAD) or Panic Disorder (PD) were excluded. State anxiety was measured with the Brief Inventory of Anxious Responses and Situations (ISRA-B). Subjective cognitive performance was evaluated with the COBRA scale, attention with the Digit-Span Forward task and inhibition of cognitive interference was assessed with the StroopTest interference score. Multiple linear regression models were used to test if anxious symptoms were associated with attention or inhibition of cognitive interference, considering other known contributors for cognitive impairment. Results: Attention was unaffected by anxiety symptoms, but the overall regression for inhibition of cognitive interference was significant: years of schooling (ß=1.12, p = 0.001), cognitive complaints (ß=0.44, p = 0.008), and anxiety (ß=-0.21, p = 0.017) explained 15% of the interference score of the Stroop test (R2 = 0.15). Conclusion: Beyond residual affective symptoms, anxious symptoms seem to affect inhibition of cognitive interference. We recommend routine testing of anxiety when considering cognitive evaluations, especially when screening for cognitive deficits.

Real-world utilization pattern of dydrogesterone in 7287 Indian women with obstetric and gynecological conditions: data from multicentric, retrospective study.

Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.

Real-world utilization pattern of dydrogesterone in 7287 Indian women with obstetric and gynecological conditions: data from multicentric, retrospective study

Abstract Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.

Sleep hygiene practices in patients with major depression with comorbid insomnia, primary insomnia, and good sleepers / Prácticas de higiene de sueño en pacientes con depresión mayor con insomnio comórbido, insomnio primario y buenos durmientes

Abstract Introduction Inadequate sleep hygiene (SH) is considered factor contributing to insomnia. However, the practice of SH by depressed patients with comorbid insomnia has not been explored. Objective We aimed to compare the practice of SH between patients with major depression, comorbid insomnia, primary insomnia, and good sleepers. Method One hundred and eighty-two adult individuals participated: 62 outpatients with major depressive disorder with comorbid insomnia (MDD), 56 outpatients with primary insomnia (PI), and 64 good sleepers (GS). All participants were assessed with a structured psychiatric interview, an insomnia interview, the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Sleep Hygiene Practice Scale. We compared the practice of SH as a whole and by domains between the groups and the relation between SH practice, insomnia, and sleep quality. Results Patients with PI and MDD showed a significantly worse practice of global SH. In the comparison by SH domains, MDD and PI groups had significantly worse scores than GS in all domains. Individuals with MDD showed a significantly worse practice of sleep schedule and arousal related behaviors than PI group. Although, SH practice was significantly related with insomnia and sleep quality in the whole sample, this association remained significant only in the PI. The arousal-related behaviors domain was the main predictor of insomnia and sleep quality. Discussion and conclusion Although patients with insomnia comorbid with MDD or with PI have a worse SH practice than GS, only arousal-related behaviors and drinking/eating habits contribute significantly to insomnia severity and sleep quality.

Resumen Introducción Una inadecuada higiene de sueño (HS) se considera como un factor que contribuye al insomnio, incluido el insomnio comórbido con trastornos mentales. Sin embargo, no se ha estudiado la práctica de HS en pacientes con depresión e insomnio comórbido. Objetivo Comparar la práctica de HS entre pacientes con depresión mayor con insomnio comórbido, insomnio primario y buenos durmientes. Método Participaron 182 individuos: 62 pacientes ambulatorios con trastorno depresivo mayor con insomnio comórbido (TDM), 56 pacientes con insomnio primario (IP) y 64 buenos durmientes (BD). A todos se les realizó una entrevista psiquiátrica estructurada, una entrevista sobre insomnio, el Índice de Calidad de Sueño de Pittsburgh, el Índice de Severidad de Insomnio y la Escala de Prácticas de Higiene de Sueño. Comparamos la práctica de HS tanto global como por dominios entre los grupos, y la relación entre la práctica de HS, el insomnio y la calidad de sueño. Resultados Los pacientes con IP y con TDM mostraron una práctica global de la HS significativamente peor. En la comparación por dominios, los grupos con TDM e IP alcanzaron peores calificaciones que los BD en todos. La práctica de HS se relacionó significativamente con el insomnio y calidad de sueño en la muestra total, sin embargo, solamente en el grupo con IP se mantuvo significativa. El dominio de conductas relacionadas con el alertamiento fue el principal predictor de insomnio y calidad de sueño. Discusión y conclusión Aunque los pacientes con insomnio comórbido con TDM o con IP tienen peores hábitos de HS que los BD, solamente las conductas relacionadas con el alertamiento y los hábitos de alimentación contribuyen significativamente a la gravedad del insomnio y calidad de sueño.

Modelos neuropsicobiológicos para estudo da dor e das emoções / Neuropsychobiological models for the study of pain and emotions / Modelos neuropsicológicos para el estudio del dolor y las emociones

Dor é uma experiência pessoal e subjetiva que pode apenas ser sentida pelo sofredor. A dor aguda tem a finalidade de avisar o indivíduo que algo está errado. Contudo, a dor crônica (DC) é um problema global de saúde, que afeta a qualidade de vida e torna o indivíduo parcial ou totalmente incapacitado. A pesquisa básica utiliza diversos modelos animais para o estudo da dor aguda ou crônica, bem como para o estudo das principais comorbidades oriundas de sua cronificação como a ansiedade e a depressão. Esta revisão aborda os modelos animais mais comumente utilizados neste contexto.

Pain is a personal and subjective experience that can only be felt by the sufferer. Acute pain is intended to warn the individual that something is wrong. However, chronic pain (CP) is a global health problem, affecting the quality of life and making the individual parts or disabled. Basic research uses several animal models for the study of acute or chronic pain, as well as for the study of the main comorbidities arising from their chronicity, such as anxiety and depression. This review focuses on the animal models most commonly used in this context.

El dolor es una experiencia personal y subjetiva que solo puede sentir la víctima. El dolor agudo está destinado a advertir al individuo que algo está mal. Sin embargo, el dolor crónico (EC) es un problema de salud global, que afecta la calidad de vida y hace que el individuo esté parcial o totalmente discapacitado. La investigación básica utiliza varios modelos animales para el estudio del dolor agudo o crónico, así como para el estudio de las principales comorbilidades resultantes de su cronicidad, como la ansiedad y la depresión. Esta revisión se centra en los modelos animales más utilizados en este contexto.

The Unhappy Mental Health Triad: Comorbid Severe Mental Illnesses, Personality Disorders, and Substance Use Disorders in Prison Populations.

BACKGROUND: Information on the comorbidity of mental health problems in prison populations is scarce. The aim of the present study was to assess the prevalence of comorbidities at intake to prison between three diagnostic groups: severe mental illnesses (SMIs), personality disorders (PDs), and substance use disorders (SUDs). The co-occurrence of those disorders in prison populations may require the integration of differential treatment approaches and novel treatment trials. METHODS: A consecutive sample of N = 427 (229 male and 198 female) individuals committed to imprisonment in Santiago de Chile was assessed with the Mini Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV (module for borderline personality disorders) on arrival at prison. Diagnoses were a priori grouped as SMI including psychosis, bipolar disorder and major depression, PD including borderline and antisocial PD and SUD including alcohol and drug abuse or dependence. Sex stratified multivariate binary logistic regression analyses were conducted to assess sociodemographic, criminal and treatment characteristics of individuals with at least one diagnosis from each of the three diagnostic groups. RESULTS: The triad of SMI, PD, and SUD was present in n = 138 (32.3%; 95% IC: 28.0-36.9) study participants, n = 105 (45.9%; 95% CI: 39.4-52.4) of the men and n = 33 (16.7%; 95% CI: 12.1-22.6) of the women. Among those with the disorder triad, n = 129 (30.2%; 95% CI: 26.0-34.8) had major depression, PD and SUD; n = 54 (12.6%; 95% CI: 9.8-16.2) had psychosis, PD and SUD. The disorder triad was more common in men (OR = 4.86; 95% IC: 2.63-8.95), younger age (OR = 0.94; 95% CI: 0.91-0.97), and participants with lower educational levels (OR = 1.69; 95% CI: 1.01-2.82). The disorder triad was significantly associated with previous incarcerations (OR 2.60; 95% CI: 1.55-4.34) and histories of psychiatric hospitalizations (OR 2.82; 95% CI: 1.27-6.28). DISCUSSION: The complex triad of disorders from different diagnostic groups is common in prison populations, especially among young men. Successful treatment interventions may have the potential to break a cycle of repeat institutionalization in prisons and psychiatric institutions.

Psychopathological Comorbid Symptoms in Animal Hoarding Disorder.

The main goal of this research is to describe the psychopathological symptoms comorbid to animal hoarding disorder. This is a cross-sectional study with a sample of a 33 individuals sample diagnosed with animal hoarding disorder. For data collection, a Sociodemographic Data questionnaire and a Semi-Structured Clinical Interview were used, based on the DSM-5 Level 1 Cross-Cutting Symptom Measure. The sample consisted of 24 women (72.7%) and 9 men (27.30%), with a prevalence of 64% of the elderly. The mean number of self-reported animals per residence was 41.12 (DP = 24.41), totaling 1357 animals: 915 (68%) dogs, 382 (28%) cats, and 50 (4%) ducks. The results indicated animal hoarding disorder the comorbid psychopathological symptoms of depression (36%), anxiety (36%), memory deficits (27%), mania (21%) and obsessive-compulsive disorder (18%). The analyses revealed a higher occurrence of these symptoms among participants who had hoarded animals for over 20 years.

Comorbid personality disorders and their impact on severe dissociative experiences in Mexican patients with borderline personality disorder.

Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences. Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES). Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n = 263) and depressive (81.3%, n = 257). The mean BEST and DES total score were 43.3 (SD = 11.4, range 15-69) and 28.6 (SD = 19.8, range 0-98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences. Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.

El efecto de algunos factores sociodemográficos y psicosociales en los síntomas de ansiedad que presenta una muestra de personas con diabetes mellitus tipo 2 en una comunidad del área Oeste de Puerto Rico / The effect of some socio-demographic and psychosocial factors on anxiety symptoms in a sample of type 2 diabetes mellitus patients in a community in the western region of Puerto Rico / O efeito de alguns fatores sociodemográficos e psicossociais nos sintomas de ansiedade que tem um grupo de pacientes com diabetes mellitus tipo 2 em uma comunidade da área oeste do Porto Rico

Resumen Introducción Este estudio pretende hacer un análisis de cómo y por qué la diabetes mellitus tipo 2 afecta psicológicamente a los pacientes. No obstante, somos conscientes del amplio espectro de condiciones mentales que puede desencadenar el padecimiento de esta condición y hemos decidido enfocar esta investigación en la relación existente entre este tipo de diabetes y la ansiedad comórbida. Materiales y Métodos Estudio descriptivo correlacional de corte transversal. Se utilizó un cuestionario semiestructurado y validado internacionalmente para medir la ansiedad y el análisis estadístico de regresión múltiple. Resultados Nuestra muestra estuvo compuesta por sesentaicinco pacientes diagnosticados con la condición en el área oeste de Puerto Rico. Los resultados revelaron que la edad (p = .014) y la actividad física (p = .031) tienen efectos significativos sobre los síntomas de ansiedad. Discusión La ansiedad en pacientes de diabetes mellitus tipo 2 pudiera estar influenciada por otras variables intervinientes y moderadoras. Conclusiones Los profesionales de enfermería al momento de controlar los síntomas de ansiedad en el paciente diabético debe considerar la importancia del entorno y el contexto cultural y psicosocial en la atención del cuidado holístico.

Abstract Introduction This study aims to analyze how and why type 2 diabetes mellitus affects patients psychologically. However, we are aware of the broad spectrum of mental conditions that can trigger this condition and have decided to focus this research on the relationship between this type of diabetes and comorbid anxiety. Materials and Methods A descriptive, correlational, cross-sectional study was conducted. A semi-structured and internationally validated questionnaire was used to measure anxiety and statistical multiple regression analysis. Results Our sample was composed of sixty-five patients diagnosed with this condition in the western area of Puerto Rico. The results revealed that age (p =.014) and physical activity (p =.031) have significant effects on anxiety symptoms. Discussion Anxiety in type 2 diabetes mellitus patients may be influenced by other intervening and moderating variables. Conclusions Nursing professionals in managing anxiety symptoms in the diabetic patient should consider the importance of the environment and the cultural and psychosocial context in the holistic care.

Resumo Introdução Esta pesquisa pretende fazer uma análise de como e porque a diabetes mellitus tipo 2 afeta psicologicamente os pacientes. No entanto, somos conscientes do amplo espectro de condições mentais que podem ser desencadeadas por esta doença, por isso decidimos abordar nesta pesquisa a relação entre ela e a comorbidade na ansiedade. Materiais e Métodos Pesquisa descritiva correlacional de tipo transversal. Foi utilizado um questionário semiestruturado e validado internacionalmente para medir a ansiedade e a análise estatística de regressão múltipla. Resultados Nossa amostra esteve constituída por sessenta e cinco pacientes com o diagnóstico da condição exposta anteriormente na área oeste do Porto Rico. Os resultados revelaram que a idade (p= .014) e a atividade física .031) têm efeitos significativos em relação aos sintomas de ansiedade. Discussão A ansiedade em pacientes com diabetes mellitus tipo 2 poderia ser influenciada por outras variantes que intervêm e que a moderam. Conclusões Os profissionais da enfermagem, quando controlam os sintomas de ansiedade no paciente diabético, devem levar em conta a importância do entorno e do contexto cultural e psicossocial quando o paciente estiver recebendo um cuidado holístico.

12-month prevalence and concomitants of DSM-IV depression and anxiety disorders in two violence-prone cities in Brazil.

BACKGROUND: Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15-75) in two violence-prone cities. METHODS: The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15-75) in São Paulo (N = 2536) and Rio de Janeiro (N = 1208), yielded 12-month prevalence of violent events experienced, and DSM-IV diagnoses of depression and anxiety, which were classified into mutually exclusive groups: 1) no anxiety/depression; 2) anxiety only; 3) depression only; 4) comorbid anxiety/depression. Weighted analyses estimated 12-month prevalence, multinomial logistic regression compared the demographic characteristics of the diagnosis groups, and association with experienced violence. RESULTS: Twelve-month prevalence of anxiety alone, depression alone, and comorbid anxiety/depression was 12.7% (of whom 24.9% were also depressed), 4.9% (of whom 46.2% had anxiety), and 4.2% respectively for São Paulo; and 12.1% (18.2% of whom were depressed), 4.6% (37.0% with anxiety), and 2.7% respectively for Rio de Janeiro. All conditions were approximately twice as prevalent in women than in men in both cities. In São Paulo, comorbidity was associated with age under 60, depression alone was more prevalent among 30-59 year olds, but in 23-29 year-olds in Rio de Janeiro. Exposure to violence increased the odds of anxiety, depression, and their comorbidity. With rare exception, marital status, education, and race/ethnicity were not associated with anxiety, depression, or their comorbidity. LIMITATIONS: Cross-sectional design. CONCLUSIONS: Prevalence rates for all conditions were high, and particularly associated with exposure to violence. Means to ameliorate violence, and its mental health effects, particularly for women, are needed.

Co-morbid Non-communicable Diseases and Associated Health Service Use in African and Caribbean Immigrants with HIV.

We sought to characterize non-communicable disease (NCD)-related and overall health service use among African and Caribbean immigrants living with HIV between April 1, 2010 and March 31, 2013. We conducted two population-based analyses using Ontario's linked administrative health databases. We studied 1525 persons with HIV originally from Africa and the Caribbean. Compared with non-immigrants with HIV (n = 11,931), African and Caribbean immigrants had lower rates of hospital admissions, emergency department visits and non-HIV specific ambulatory care visits, and higher rates of health service use for hypertension and diabetes. Compared with HIV-negative individuals from these regions (n = 228,925), African and Caribbean immigrants with HIV had higher rates of health service use for chronic obstructive pulmonary disease [rate ratio (RR) 1.78; 95% confidence interval (CI) 1.36-2.34] and malignancy (RR 1.20; 95% CI 1.19-1.43), and greater frequency of hospitalizations for mental health illness (RR 3.33; 95% CI 2.44-4.56), diabetes (RR 1.37; 95% CI 1.09-1.71) and hypertension (RR 1.85; 95% CI 1.46-2.34). African and Caribbean immigrants with HIV have higher rates of health service use for certain NCDs than non-immigrants with HIV. The evaluation of health services for African and Caribbean immigrants with HIV should include indicators of NCD care that disproportionately affect this population.

IDO chronic immune activation and tryptophan metabolic pathway: A potential pathophysiological link between depression and obesity.

Obesity and depression are among the most pressing health problems in the contemporary world. Obesity and depression share a bidirectional relationship, whereby each condition increases the risk of the other. By inference, shared pathways may underpin the comorbidity between obesity and depression. Activation of cell-mediated immunity (CMI) is a key factor in the pathophysiology of depression. CMI cytokines, including IFN-γ, TNFα and IL-1ß, induce the catabolism of tryptophan (TRY) by stimulating indoleamine 2,3-dioxygenase (IDO) resulting in the synthesis of kynurenine (KYN) and other tryptophan catabolites (TRYCATs). In the CNS, TRYCATs have been related to oxidative damage, inflammation, mitochondrial dysfunction, cytotoxicity, excitotoxicity, neurotoxicity and lowered neuroplasticity. The pathophysiology of obesity is also associated with a state of aberrant inflammation that activates aryl hydrocarbon receptor (AHR), a pathway involved in the detection of intracellular or environmental changes as well as with increases in the production of TRYCATs, being KYN an agonists of AHR. Both AHR and TRYCATS are involved in obesity and related metabolic disorders. These changes in the TRYCAT pathway may contribute to the onset of neuropsychiatric symptoms in obesity. This paper reviews the role of immune activation, IDO stimulation and increased TRYCAT production in the pathophysiology of depression and obesity. Here we suggest that increased synthesis of detrimental TRYCATs is implicated in comorbid obesity and depression and is a new drug target to treat both diseases.

Is chronic periodontitis premature in systemic lupus erythematosus patients?

The aim of this study was to compare the frequency and severity of chronic periodontitis (CP) in systemic lupus erythematosus (SLE) patients with individuals without rheumatic diseases. Seventy-five patients with SLE were compared to 75 individuals without rheumatic diseases (control group) matched for age, educational level, and income. The activity of SLE was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000. Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus evaluated SLE-related damage. Dental evaluation included measuring plaque index and parameters of periodontal disease (probing depth, clinical attachment level, and bleeding on probing). Fifty-one (68 %) SLE patients and 42 (56 %) control individuals had CP (p = 0.13). Periodontal status was similar in both groups. Considering only individuals with CP, SLE patients were younger than controls (40.7 ± 9.8 versus 46.14 ± 12.5 years of age, p = 0.02). CP was not associated with activity or therapeutics in SLE patients. Severity of periodontal parameters was similar in SLE patients and control subjects; however, CP occurred earlier in SLE patients.

Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample.

BACKGROUND: Obsessive-compulsive disorder (OCD) has a heterogeneous and complex phenomenological picture, characterized by different symptom dimensions and comorbid psychiatric disorders, which frequently co-occur or are replaced by others over the illness course. To date, very few studies have investigated the associations between specific OCD symptom dimensions and comorbid disorders. METHODS: Cross-sectional, multicenter clinical study with 1001 well-characterized OCD patients recruited within the Brazilian Research Consortium on Obsessive-Compulsive and Related Disorders. The primary instruments were the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses between symptom dimensions and comorbidities were followed by logistic regression. RESULTS: The most common comorbidities among participants (56.8% females) were major depression (56.4%), social phobia (34.6%), generalized anxiety disorder (34.3%), and specific phobia (31.4%). The aggressive dimension was independently associated with posttraumatic stress disorder (PTSD), separation anxiety disorder, any impulse-control disorder and skin picking; the sexual-religious dimension was associated with mood disorders, panic disorder/agoraphobia, social phobia, separation anxiety disorder, non-paraphilic sexual disorder, any somatoform disorder, body dysmorphic disorder and tic disorders; the contamination-cleaning dimension was related to hypochondriasis; and the hoarding dimension was associated with depressive disorders, specific phobia, PTSD, impulse control disorders (compulsive buying, skin picking, internet use), ADHD and tic disorders. The symmetry-ordering dimension was not independently associated with any comorbidity. LIMITATIONS: Cross-sectional design; participants from only tertiary mental health services; personality disorders not investigated. CONCLUSIONS: Different OCD dimensions presented some specific associations with comorbid disorders, which may influence treatment seeking behaviors and response, and be suggestive of different underlying pathogenic mechanisms.

Espondilodiscitis: análisis de 19 casos internados en un hospital de tercer nivel / Spondylodiscitis: analiysis of 19 inpatients at a referral hospital in Rosario, Argentina

Introducción: la espondilitis representa un desafío diagnóstico, ya que el dolor lumbar, su principal manifestación clínica, constituyeun motivo de consulta muy frecuente en la práctica cotidiana y carece de especificidad. Por lo tanto, resulta indispensablemantener una elevada sospecha clínica. Objetivo: Analizar las características clínicas, analíticas, microbiológicas e imagenológicas,el tratamiento, la evolución y los factores pronósticos de pacientes internados por espondilodiscitis en el Hospital Provincial delCentenario, desde enero de 2011 a marzo de 2015, excluyéndose los casos postquirúrquicos. Resultados: Se analizaron 19 pacientescon una edad media 48±11 años, 63% varones. Se identificaron como comorbilidades: diabetes (37%), obesidad (16%), etilismo(21%), insuficiencia renal crónica en hemodiálisis (16%), HIV (11%), adicción EV (11%). Los gérmenes más frecuentes fueron losestafilococos (52%). Al ingreso el 94% presentó dolor, 73% fiebre y 36% foco neurológico. La media de tiempo de evolución desíntomas hasta ingreso fue 62±80 días (rango 4-360 días). La velocidad de eritrosedimentación fue elevada en todos los pacientes,y sólo 37% presentaban leucocitosis. La vancomicina fue el antibiótico más utilizado. El 37% de los pacientes presentaba infeccióndiseminada. La mortalidad fue del 26%. Los pacientes que tuvieron un tiempo de evolución al ingreso mayor a 25 días presentaronpeor evolución (colecciones, foco neurológico o muerte) (p<0,05). Conclusiones: en esta serie, la asociación de la consulta tardíacon la mala evolución destaca la importancia de considerar las pautas de alarma en centros de atención primaria para posibilitar undiagnóstico más temprano.

Introduction: Spondylodiscitis represents a diagnostic challenge since the main clinical manifestation, low back pain, is very frequent andnonspecific, and often impedes a timely diagnosis. Clinical suspicion is essential. Objective: to analyze the clinical, analytical, microbiological,and radiological features, as well as outcome and prognostics factors, in patients with spondylodiscitis admitted to the Hospital Provincialdel Centenario (Rosario, Argentina), from January 2011 to March 2015. Postsurgical cases were excluded. Results: Nineteen patients wereincluded. Mean age was 48±11 years, 63% were males. We identified the following comorbid diseases: diabetes (37%), obesity (16%),alcoholism (21%), hemodialysis-dependent chronic kidney disease (16%), HIV (11%), intravenous drug abuse (11%). The most frequentcausative organism was Staphylococcus sp. (52%). Upon admission 94% of patients presented pain, 73% fever, and 36% neurologicalinvolvement. The average time from the onset of symptoms to diagnosis was 62±80 days (range 4-360). The erythrocyte sedimentation ratewas raised in all the patients, and only 37% had leukocytosis. Vancomycin was the most frequently prescribed antibiotic. Disseminatedinfection was present in 37% of patients. The mortality rate was 26%. Patients with a time lag to diagnosis higher than 25 days had worseoutcome (suppurative collections, neurological involvement, or death) compared to those with earlier diagnosis (p <0.05). Conclusions:The association of late consultation with poor outcome in this study emphasizes the importance of educating the general population toencourage attendance to medical centers. Physicians in primary care settings must be trained to identify pain pattern, and incorporateclinical perspectives capable of recognizing a defined syndrome at first contact, in other to achieve a better outcome.Key words: Spondylodiscitis, comorbid conditions, diagnostic delay, outcome.

Insomnia current diagnosis: an appraisal / Diagnóstico atual de insônia: uma apreciação

Chronic insomnia is the most common sleep disorder in adults andits diagnosis is fundamental for adequate clinical management. The aim of this paper is to present recently published definitions of insomnia according to current international classifications, such as the International Classification of Sleep Disorders - Third Edition and the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition. For the first time, these classifications are congruent related to thei rdiagnostic criteria; both present insomnia as a distinct disorder and divide it into acute, chronic and other. This emphasizes the necessityof a specific insomnia approach. Furthermore, it is necessary torecognize those insomniacs with physiological hyperarousal, whichmay be identified by objective measures (short total sleep time, forinstance). These patients may have poorer outcome, as they are athigher risk of developing cardiometabolic conditions and neurocognitive impairment. Diagnosis is primarily made on a clinical basis (anamnesis and physical examination), while sleep diaries and questionnaires (such as Insomnia Severity Index) can help evaluate these patients. Objective measures, such as polysomnography, arenot required in most cases, except when suspicion of another sleep disorder arises.

A insônia crônica é o transtorno do sono mais comum em adultos,e seu diagnóstico é fundamental para o manejo clínico adequado.O principal objetivo deste trabalho é apresentar, em relação à insônia,as definições publicadas recentemente segundo as novas classificações internacionais, como a Classificação Internacional de Distúrbios do Sono - Terceira Edição e o Manual Diagnóstico e Estatístico de Transtornos Mentais - Quinta Edição. Pela primeira vez, essas classificações são congruentes a respeito de seus critérios diagnósticos,pois ambas apresentam a insônia como uma doença em si ea dividem em aguda, crônica e outras. Isso enfatiza a necessidade de uma abordagem específica da insônia. Além do mais, é necessário reconhecer os insones com estado fisiológico de hiper alerta que podem ser identificados por medidas objetivas (tempo total de sono curto, por exemplo). Esses pacientes podem ter pior prognóstico, por causa do maior risco de desenvolver condições cardiometabólicas e comprometimento neurocognitivo. O diagnóstico da insônia é feito principalmente com base em dados clínicos (anamnese e exame físico),e o uso de diário de sono e questionários (tais como o Índice de Gravidade de Insônia) pode ajudar na avaliação desses pacientes.Análises objetivas, como aquelas obtidas pela polissonografia, não são rotineiramente necessárias na maioria dos casos, exceto quando há a suspeita de outro distúrbio do sono.

Comorbidity ascertainment from the ESRD Medical Evidence Report and Medicare claims around dialysis initiation: a comparison using US Renal Data System data.

BACKGROUND: The end-stage renal disease Medical Evidence Report serves as a source of comorbid condition data for risk adjustment of quality metrics. We sought to compare comorbid condition data in the Medical Evidence Report around dialysis therapy initiation with diagnosis codes in Medicare claims. STUDY DESIGN: Observational cohort study using US Renal Data System data. SETTING & PARTICIPANTS: Medicare-enrolled elderly (≥66 years) patients who initiated maintenance dialysis therapy July 1 to December 31, 2007, 2008, or 2009. INDEX TESTS: 12 comorbid conditions ascertained from claims during the 6 months before dialysis therapy initiation, the Medical Evidence Report, and claims during the 3 months after dialysis therapy initiation. REFERENCE TEST: None. RESULTS: Comorbid condition prevalence according to claims before dialysis therapy initiation generally exceeded prevalence according to the Medical Evidence Report. The κ statistics for comorbid condition designations other than diabetes ranged from 0.06 to 0.43. Discordance of designations was associated with age, race, sex, and end-stage renal disease Network. During 23,930 patient-years of follow-up from 4 to 12 months after dialysis therapy initiation (8,930 deaths), designations from claims during the 3 months after initiation better discriminated risk of death than designations from the Medical Evidence Report (C statistics of 0.674 vs 0.616). Between the Medical Evidence Report and claims, standardized mortality ratios changed by >10% for more than half the dialysis facilities. LIMITATIONS: Neither the Medical Evidence Report nor diagnosis codes in claims constitute a gold standard of comorbid condition data; results may not apply to nonelderly patients or patients without Medicare coverage. CONCLUSIONS: Discordance of comorbid condition designations from the Medical Evidence Report and claims around dialysis therapy initiation was substantial and significantly associated with patient characteristics, including location. These patterns may engender bias in risk-adjusted quality metrics. In lieu of the Medical Evidence Report, claims during the 3 months after dialysis therapy initiation may constitute a useful source of comorbid condition data.

Artroplastía de hombro en el medio privado: Análisis de las variables demográficas y de comorbilidad en una muestra de 120 pacientes / Shoulder arthroplasty in the private practice: Analysis of demographics and comorbid conditions in a sample of 120 patients

Objetivo: Describir las variables demográficas de una serie de casos de artroplastía de hombro operadas en un solo hospital y por un solo equipo quirúrgico. Material y métodos: Se incluyeron 120 artroplastías de hombro de Enero de 2006 a Noviembre del 2014 obteniéndose las variables de edad, género, diagnóstico de base, tipo de prótesis utilizada, comorbilidades, lado afectado, ocupación, tiempo de evolución y cirugías previas. Resultados: 66% de los casos fueron mujeres y 34% hombres, el promedio de edad fue de 66 años y el diagnóstico más frecuente fue la artropatía por desgarro del manguito rotador (30%). La prótesis total de anatomía reversa se realizó en 51% de los casos, seguida por la hemiprótesis en 38%. 70% de la población fue originario del D.F. La hipertensión arterial se presentó en 23% los casos. 36% de los casos tenía antecedentes de cirugías previas. En 40% de los casos la ocupación fue trabajo en el hogar. Conclusión: La artroplastía de hombro es un procedimiento que se realiza con un alto volumen en este centro hospitalario. Nuestra serie reporta un número significativo de casos en donde las variables demográficas obtenidas pueden representar un panorama inicial en la artroplastía de hombro en pacientes mexicanos, y presentar el perfil del paciente candidato a este procedimiento al no contar con registros previos.

Objective: To describe the demographics in a series of shoulder arthroplasty cases operated in a single hospital and by the same surgical team. Material and methods: 120 shoulder arthroplasties performed between January 2006 and November 2014 were included. The following variables were analyzed: age, gender, baseline diagnosis, type of prosthesis used, comorbid conditions, involved side, occupation, follow-up time, and surgical history. Results: Females accounted for 66% and males 34%; mean age was 66 years and the most frequent diagnosis was arthropathy resulting from rotator cuff tear (30%). The reverse total shoulder prosthesis was used in 51% of cases, followed by the hemiprosthesis in 38%. Seventy per cent of patients were from the Federal District. Arterial hypertension occurred in 23% of cases; 36% of cases had undergone prior surgery; 40% of cases worked at home. Conclusion: Shoulder arthroplasty is a procedure frequently performed at this hospital. Our case series reports a significant number of cases in which the demographics may give us an overview of shoulder arthroplasty in Mexican patients and describe the characteristics of patients eligible for this procedure, as there are no other registries available.

Prediction of Post-Traumatic Stress Symptoms via Comorbid Disorders and other Social and School Problems in Earthquake Exposed Turkish Adolescents / Predicción de síntomas de estrés post-traumático por trastornos comórbidos y otros problemas sociales y escolares en adolescentes expuestos a un terremoto en Turquía

On May 3rd, 2003, a strong earthquake hit the eastern part of Turkey at 03:27 a.m. and lasted 20 seconds. It destroyed a regional boarding school killing 83 students and 1 teacher. Disaster-exposed children are at risk for a variety of mental health, social, and academic problems. This research was designed to investigate the extent of comorbidity among adolescent earthquake survivors. One hundred and ninety-one adolescents were given the Child Post Traumatic Stress Reaction Index and the Behavior Assessment Systems one year after the earthquake. The adolescents were divided into PTSD (Post Traumatic Stress Disorder) positive and non PTSD groups. Multivariate ANOVAs were then conducted to test group and gender differences on the BASC subscales. Correlation analysis revealed some significant associations between the CPTSD RI and BASC subscales. Multiple stepwise regression analysis was used to predict the contribution of each of the BASC SRP A subscales. Depression was the strongest contributor, accounting for 23% of the total variance. The next most significant contributing variable was atypicality, at 6%. This was followed by sensation-seeking, with a 4% variance. Finally attitude to school added another 2% to the prediction for PTSD. These four variables, together, explained 35% of the variance in the CPTSD RI total score (r.585, r²=.35 p<.05). Those variables also correlated with the CPTSD RI subscales of re-experiencing, avoidance and hyperarousal. Cross- cultural implications were also discussed in reference to the disaster and other disorders.

El 3 de mayo de 2003 un fuerte terremoto de 20 segundos golpeó Turquía del este a las 3:27 de la madrugada, éste destruyó un internado regional en donde 83 estudiantes y 1 maestro fallecieron. Los niños expuestos a desastres están en riesgo sufrir una variedad de dificultades con respecto a su salud mental, así como problemas sociales y académicos. El propósito de este estudio fue evaluar el grado de comorbilidad entre los adolescentes sobrevivientes al terremoto. Un año después de la catástrofe 191 adolescentes completaron el Índice de Reacción de Desorden de Estrés Postraumático en Niños CPTSD y el Sistema de Evaluación de Conducta BASC. Estos adolescentes fueron divididos en grupos de PTSD (Desorden de Estrés Postraumático) positivo y grupos que no presentaban PTSD. De esta manera, se llevaron a cabo análisis de varianza ANOVA para probar las diferencias de grupo y de género en las subescalas BASC (Sistema de Evaluación de Conducta para Niños). El análisis de correlación reveló algunas asociaciones significativas entre el CPTSD RI y las subescalas BASC. Múltiples análisis de regresión stepwise (paso a paso) fueron utilizados para predecir la contribución de cada una de las subescalas BASC SRP A. La depresión fue el mayor contribuyente, lo que representa el 23% de la varianza total. La siguiente variable que contribuye significativamente fue atípica al 6%. Esto fue seguido por la búsqueda de sensaciones, con una variación del 4%. Por último, la actitud hacia la escuela añadió un 2% a la predicción para el PTSD. Estas cuatro variables juntas explicaron el 35% de la varianza de la puntuación total del CPTSD RI (r.585, r²=.35 p<.05). Estas variables también se correlacionan con las subescalas de RI CPTSD de re-experimentación, evitación e hiperexcitación. Las implicaciones transculturales también fueron discutidas en referencia a la catástrofe y otros trastornos.

Mirtazapine in Comorbid Major Depression and Alcohol Use Disorder: A Long-Term Follow-Up Study.

BACKGROUND/OBJECTIVE: To date, pharmacotherapy trials of depressed alcoholics (MDD/AUD) have focused on SSRI medications, with disappointing results, so effective treatments for that comorbid population are lacking. Mirtazapine is an FDA-approved medication for treating MDD with a unique pharmacological profile whose efficacy may exceed that of SSRIs. Results from our recent open label study suggest robust acute phase efficacy for mirtazapine for decreasing both the depression and the drinking of that population. However, to date, no studies have evaluated the longer-term efficacy of mirtazapine in that population. We now report findings from a first long-term (two-year) naturalistic follow-up evaluation involving subjects from the acute phase trial. We hypothesized that the improvements would persist at follow-up. METHODS: An eight-week open label study of mirtazapine and motivation therapy was conducted involving persons 18 to 55 years of age with DSM-IV diagnoses of comorbid MDD/AD. Two years after entry into the acute phase study, a long-term evaluation was conducted using the same instruments that had been used at baseline to assess whether the improvements seen during the acute phase trial had persisted. RESULTS: Ten of the twelve patients who entered the acute phase study participated in the follow-up study. The large magnitude improvements (p<.01) in depressive symptoms (BDI), drinking (TLFB), and sleep disturbance (HDRS) persisted at the follow-up evaluation. Two of the subjects demonstrated MDD on structured interview at follow-up, while all ten had demonstrated MDD at baseline. Six of the ten used antidepressants during the follow-up period. At baseline, three were employed, while at follow-up seven were employed. CONCLUSIONS: These findings suggest long-term efficacy for mirtazapine for decreasing the drinking and depression of depressed alcoholics. Double-blind, placebo-controlled studies are warranted to clarify the efficacy of mirtazapine in depressed alcoholics.