Psychiatric Comorbidities and Risk of Somatic Symptom Disorders in Posttraumatic Stress Disorder: A Cross-Sectional Inpatient Study.

ABSTRACT: Nearly 90% of Americans are exposed to a traumatic event at some point in their lives, and over 8% of those individuals will develop posttraumatic stress disorder (PTSD). Our study examined the demographic differences and psychiatric comorbidities in inpatients with PTSD with and without somatic symptom disorders (SSDs), using data from the Nationwide Inpatient Sample for 2018 and 2019. Our sample included 12,760 adult patients with a primary diagnosis of PTSD, which was further subdivided based on a codiagnosis of SSD. We used a logistic regression model to determine the odds ratio (OR) of association for SSD and identify demographic predictors and comorbid risk factors in inpatients with PTSD. The prevalence of SSD in inpatients with PTSD was 0.43%, and it was more commonly seen in women and Caucasians. Personality disorders (OR, 5.55; p < 0.001) and anxiety disorders (OR, 1.93; p = 0.018) were found to increase the likelihood of codiagnoses of SSD in inpatients with PTSD. These findings support the need for a systematic, modular approach that includes evidence-based interventions to treat at-risk populations.

Gender Dysphoria in Pediatric and Transitional-Aged Youth Hospitalized for Suicidal Behaviors: A Cross-National Inpatient Study.

Objective: Our study aims to demarcate the sociodemographic differences in pediatric patients hospitalized for suicidal behaviors and struggling with gender dysphoria. Additionally, we evaluated the demographic factors and comorbidities that are predictive of gender dysphoria in patients with suicidal behaviors.Methods: We included 319,430 patients (aged 6-24 years) with suicidal behaviors and a primary psychiatric diagnosis (per ICD-10 criteria) of mood disorders (depressive disorders, 75.3%; bipolar disorders, 15.9%; and other mood disorders, 8.8%) from the Nationwide Inpatient Sample (2018-2019). We compared the distributions of categorical variables using the Pearson χ2 test and continuous variables using an independent-samples t test in inpatients without versus with gender dysphoria. We used a logistic regression model to calculate the odds ratio (OR) to assess the demographic and comorbid characteristics of gender dysphoria with suicidal behaviors.Results: The prevalence of codiagnosis of gender dysphoria in inpatients hospitalized for suicidal behaviors was 1.5%. Gender dysphoria was seen in a higher proportion of adolescents (68.2%), females (73.6%), those from high-income families (51.7%), and those from metropolitan counties (88.8%). The prevalent psychiatric comorbidities in inpatients with gender dysphoria included anxiety disorders (63.6%), posttraumatic stress disorder (PTSD; 28.2%), and neurodevelopmental disorders (27.4%). Comorbidities including somatic disorders (OR = 2.30), eating disorders (OR = 1.95), obsessive-compulsive disorder (OR = 1.71), anxiety disorders (OR = 1.59), PTSD (OR = 1.32), and neurodevelopmental disorders (OR = 1.17) increased the likelihood of codiagnoses of gender dysphoria.Conclusions: There exists a high prevalence of psychiatric comorbidities in those with gender dysphoria and hospitalized for suicidal behavior. Our findings call for prompt evaluations of comorbidities of suicidal behaviors among adolescents and youth with gender dysphoria to provide a coordinated approach to suicide prevention, thereby reducing the future risk of poor health outcomes and mortality.

Cardiometabolic Comorbidity Risk in Pediatric Patients With Psychiatric Illnesses: A Case-Control Inpatient Study.

Objectives To delineate the differences in the cardiometabolic comorbidities in pediatric patients with medical versus psychiatric illnesses and to determine the risk of association between the spectrum of cardiometabolic comorbidities in pediatric patients with a broad range of psychiatric illnesses. Methods We conducted a case-control study using the nationwide inpatient sample (NIS), the largest hospital database in the United States (US) and included 179,550 pediatric patients (age 10-18 years) that were hospitalized with a primary diagnosis of psychiatric illness (N = 89,775) and pediatric patients that were hospitalized with a primary diagnosis of medical illness (N = 89,775). We used descriptive statistics and Pearson's chi-square test to delineate the differences between pediatric inpatients with medical versus psychiatric illnesses. Results The majority of pediatric patients with psychiatric illnesses were females (58%) and white (62%), with a mean age of 15 years. Cardiometabolic comorbidities were higher in patients admitted for psychiatric illness, with a higher prevalence of hypothyroidism (1.6%) and obesity (7.1%) than in those hospitalized for medical illnesses. Among all cardiometabolic comorbidities, obesity had the highest prevalence across all psychiatric illnesses, measuring eight percent in patients with disruptive behavior disorders, followed by seven percent each in anxiety, mood, and psychotic disorders. Diabetes had the lowest prevalence hovering between one and two percent for a spectrum of psychiatric illnesses. Conclusion The prevalence of cardiometabolic comorbidities is higher in pediatric inpatients with psychiatric illnesses. This calls for timely monitoring of the routine labs and early diagnosis and management of the cardiometabolic comorbidities in this at-risk population.

New-Onset Catatonia and Delirium in a COVID-Positive Patient.

Coronavirus disease (COVID-19) is a strain of coronavirus family, which was initially found in China in late 2019 and subsequently spread to rest of the world. COVID-19 has led to physical and mental health complications since its onset. In addition to the pandemic-associated social stresses, biological complications include direct viral encephalitis, autoimmune-mediated responses, medication side effects, hypoxic brain injury, and delirium, which can collectively cause varied presentations of neuropsychiatric symptoms. Neuropsychiatric complications have been reported in the acute stages of COVID-19 and post-infection period. Here we report our experience treating a patient who initially presented with a severe depressive episode and subsequently developed catatonia and delirium following hospital-acquired COVID-19 infection.

Acute Psychosis and COVID-19 Infection: Psychiatric Symptoms in Hospitalized Patients.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in various medical and psychosocial consequences globally. Respiratory infections are common among patients infected with the SARS-CoV-2 virus, the causative virus of coronavirus disease 2019 (COVID-19). However, various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported as well.  This study aimed to describe two clinical case reports of patients with no prior history of psychiatric illnesses admitted to the psychiatric inpatient unit with acute onset of psychosis. A 49-year-old woman with no past medical history and no past psychiatric history was admitted to the inpatient psychiatric unit with suicidal ideation and was noted to have acute psychosis. A 56-year-old woman with a history of hypertension with no past psychiatric history was admitted to the hospital with acute hypoxic respiratory failure secondary to COVID-19 pneumonia and was noted to have acute psychosis.  Various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported. However, the pathophysiology, direct biological effects of the disease, treatment modalities, worsening of symptoms due to various medications, and other long-term sequelae are not fully understood. Therefore, clinicians should be mindful of neuropsychiatric symptoms and conduct a detailed history and physical examination on all patients presenting with psychiatric symptoms in the context of COVID-19. It is also essential to assess for signs and symptoms of delirium in patients presenting with neuropsychiatric symptoms. Further research is needed to identify the etiology, predisposing factors, exacerbating or precipitating factors contributing to neuropsychiatric symptoms associated with infection with the SARS-CoV-2 virus. In addition, the pathophysiology contributing to these symptoms and pharmacological interventions for managing these sequelae need to be evaluated.