Pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: Exploring psychosis, related risk factors, and hospital outcomes in a nationwide inpatient sample: A cross-sectional study.

OBJECTIVE: Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes. METHODS: We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018-2019). We included 3,405 pediatric inpatients (age 6-17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis. RESULTS: The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation. CONCLUSION: Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.

Exploring the relationship between vitamin D deficiency and comorbid heart disease in Americans with mood disorders: a cross-sectional nationwide study.

Objective: This study aimed to explore the relationship between vitamin D deficiency and comorbid heart disease in adult inpatients with mood disorders (depressive and bipolar disorders). Methods: A cross-sectional investigation was carried out employing the nationwide inpatient dataset, which encompassed 910,561 adult inpatients aged 18 to 50 years diagnosed with depressive and bipolar disorders. Additionally, the sample was categorized based on the presence of comorbid heart disease. We utilized a logistic regression model to assess the odds ratio (OR), pertaining to demographic features and coexisting medical conditions in relation to comorbid heart disease. Results: Comorbid heart disease was present in 1.3% of inpatients with mood disorders; they were middle-aged (mean age 42.7 years) men and White individuals. Inpatients with depressive disorder had a higher risk of comorbid heart disease (OR 1.19, 95% CI 1.15-1.24) compared to those with bipolar disorders. Inpatients with comorbid heart disease had a higher prevalence of medical and psychiatric comorbidities. The prevalence of vitamin D deficiency was 2.3% in mood disorders but higher in those with comorbid heart disease (2.9%). Vitamin D deficiency showed a notable correlation with comorbid heart disease, resulting in a 26% increased risk in the unadjusted regression model (OR 1.26, 95% CI 1.13-1.40). However, after accounting for potential confounding factors, including comorbidities, the risk did not exhibit statistical significance (OR 1.08, 95% CI 0.97-1.21). Among psychiatric comorbidities, trauma-related (OR 1.22, 95% CI 1.17-1.28) and tobacco-related (OR 1.31, 95% CI 1.26-1.37) disorders had a higher risk of association with comorbid heart disease. Conclusion: Middle-aged men with depressive disorders and from low-income families had a higher risk of developing comorbid heart disease. Trauma-related and tobacco-related disorders were associated with an increased risk by 20-30% for comorbid heart disease in inpatients with mood disorders. Vitamin D deficiency was not associated with the risk of comorbid heart disease after controlling demographics and comorbid cardiovascular risk factors.

Posttraumatic stress disorder comorbidity in patients undergoing ECT for major depressive disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is not recognized as an indication for electroconvulsive therapy (ECT). However, research indicates promise for this treatment modality. To elucidate the effects of ECT for treating PTSD, prospective research is needed. The first step in assessing the feasibility of such research is to determine if many patients being treated with ECT have comorbid PTSD. This study examined the PTSD comorbidity rates and compared demographic data among patients with major depressive disorder (MDD) who were treated with ECT vs patients with MDD who were not treated with ECT. METHODS: Data from patients with MDD were obtained from the Nationwide Inpatient Sample. RESULTS: Approximately 10% of patients undergoing ECT for MDD also had PTSD. The difference in comorbidity of PTSD in those treated with ECT vs those not treated with ECT was approximately 1%. CONCLUSIONS: Prospective naturalistic studies that examine the response of PTSD to ECT are feasible because a sizable number of patients with PTSD are receiving ECT.

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.

Electroconvulsive therapy plus lithium is associated with less cognitive impairment and drug-induced delirium in bipolar depression compared to unipolar depression.

BACKGROUND: Although major depressive disorder (MDD) and bipolar depression can present with similar symptoms, biological differences exist. One difference is the possible variance in adverse effects associated with treatment. This study examined the association of cognitive impairment and delirium in patients treated with electroconvulsive therapy (ECT) plus lithium for MDD or bipolar depression. METHODS: The Nationwide Inpatient Sample included 210 adults receiving ECT plus lithium. Descriptive statistics and a Chi-square test were used to evaluate the differences between mild cognitive impairment and drug-induced delirium for those with MDD or bipolar depression. We calculated the odds ratio (OR) for drug-induced delirium in inpatients with MDD (compared to inpatients with bipolar depression) using a binomial logistic regression model. RESULTS: Mild cognitive impairment was observed in 9.1% of patients with MDD (n = 110), compared to 0 in bipolar depression (n = 100) (P = .002). Drug-induced delirium was more prevalent in MDD (OR 1.19; 95% CI, 1.11 to 1.30). CONCLUSIONS: ECT plus lithium is associated with less cognitive impairment and drug-induced delirium in bipolar depression compared to MDD. This study may also support biological differences between the 2 types of depression.

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.

Demographic and Clinical Correlates of Narcolepsy in Adolescents Hospitalized with Mood Disorders: A Nationwide Inpatient Sample (NIS) Study.

OBJECTIVES: To discern the differences in demographic, clinical comorbidities, and hospital outcomes associated with narcolepsy in adolescents hospitalized for mood disorders. METHODS: We included 639,064 adolescents hospitalized with mood disorders, that is, major depressive disorder (MDD) and bipolar disorders (BP) from the nationwide inpatient sample. About 0.04% of inpatients had comorbid narcolepsy (N = 267) and we extracted a demographically matched control group (N = 270) for comparison. RESULTS: Mood-disordered adolescents with narcolepsy had a higher prevalence of comorbid obesity (18.5% in BP,14.4% in MDD) and sleep apnea (9.3% in BP, 9.6% in MDD) compared to those without narcolepsy. Obesity and sleep apnea were significantly more prevalent in Black adolescents hospitalized for MDD and BP (P < .001). There was a higher percentage of females with BP and comorbid narcolepsy than males (59.9% vs 40.1%). In comparison, MDD and comorbid narcolepsy were observed more in males (57.1% vs 42.9%). CONCLUSIONS: Our study results suggest a significantly higher prevalence of obesity and sleep apnea comorbidity in mood-disordered adolescents with narcolepsy with an overall negative impact on hospital outcomes.

Characteristics and Correlates of Metabolic Syndrome in Adolescents with Unipolar and Bipolar Depression: Results from a Cross-National Inpatient Case-Control Study.

Abstract Objectives: To assess characteristics and correlates of metabolic syndrome (MetS) in adolescents with major depressive disorder (MDD) or bipolar disorder-depressive episode (BP-d). Methods: Case-control study, using national inpatient sample data, including adolescents (age, 12-18 years) with a primary diagnosis of MDD or BP-d. Using propensity score matching (based on age, sex, and race/ethnicity), we extracted cases with MetS (≥3 of the following conditions: obesity, diabetes, hypercholesterolemia, and hypertension) and controls without MetS. We used a multivariable logistic regression model calculating adjusted odds ratios (aORs) for potential correlates of MetS, focusing on primary mood disorders and psychiatric comorbidities. Results: In 607 age-/sex-/race/ethnicity-matched adolescents (MDD = 83.5%, BP-d = 16.5%), comparing those with (N = 332) versus without MetS (N = 275), MetS was most prevalent in later-age adolescents (mean age 16.3 years), females (58.1%), Whites (40.3%), and Blacks (31.5%). MetS was characterized by obesity (84.9% vs. 3.6%), hypertension (81% vs. 1.8%), diabetes (72.8% vs. 9.1%), and hypercholesterolemia (67.2% vs. 3.6%) (all p < 0.001). MetS was associated with a primary diagnosis of BP-d versus MDD (aOR 2.42, 95% confidence interval [CI] 1.47-3.97) and comorbid disruptive behavior disorders (DBD) (aOR 4.45, 95% CI 1.55-12.78), while comorbid substance use disorder reduced MetS risk (aOR 0.31, 95% CI 0.19-0.50). Conclusion: In adolescents with MDD or BP-d, MetS was associated with a primary BP-d diagnosis, and comorbid DBD. MetS-related parameters should be screened for early in adolescents with depression-spectrum disorders aiming to prevent the development or effects of MetS.

School Year and Suicidal Behaviors Among Youth: Insight From a National Dataset.

Objective: To compare suicidal behaviors that occur during the school year with those during school break and to examine demographic characteristics and comorbidities of the suicidal behaviors by time period.Methods: This retrospective cross-sectional analysis of a nationwide US sample included 74,385 inpatients (aged 10-18 years) who were admitted to the hospital with primary ICD-9 codes of suicidal ideation or suicide and self-inflicted injury including poisoning between January and December 2014. For this study, the sample was further subgrouped based on school year (September to May) and school break (June to August).Results: Suicidal behaviors were higher during the school year (average of 6,761/month) compared to school break (average of 4,512/month). Prevalence of suicidal behaviors was highest in October for both hospitalization and primary diagnosis of mood disorder. Among the school year cohort, the rate of suicidal behaviors was higher in youth with mood disorders (91.6% vs 90%). During school break, the suicidal behavior rate was higher for youth with disruptive behavior disorders (34.6% vs 31.5%) and comorbid alcohol (7.9% vs 5.7%) and other substance use disorders (21.7% vs 18.4%).Conclusions: Suicidal behaviors were higher (1.5 times) during the school year compared to school break. Given the finding that suicidal behaviors are higher among students with mood disorders during the school year, schools should implement universal depression and suicide screening. Youth with disruptive behavior disorders and substance use disorders are at higher risk for suicidal behaviors during school break, thus increased outreach and monitoring during extended breaks seems warranted for these high-risk youth during unstructured times.

Electroconvulsive Treatment Utilization for Inpatient Management of Catatonia in Adolescents With Schizophrenia Spectrum Disorders.

OBJECTIVE: The aim of this study was to determine rates of electroconvulsive therapy (ECT) use for catatonia in schizophrenia spectrum disorders, stratified by patient demographics and hospital characteristics, and its impact on inpatient length of stay and cost. METHODS: We found 155 adolescents (aged 12-18 years) with principal discharge diagnosis of schizophrenia spectrum disorders with catatonia from the National Inpatient Sample. They were subgrouped into ECT (n = 20) and non-ECT (n = 135) groups. We used descriptive statistics to evaluate the utilization of ECT for catatonia and independent-sample t test for continuous variables with statistical significance at P ≤ 0.05. RESULTS: The overall utilization rate of ECT in adolescents for catatonia was 12.9%. A high rate of ECT use was evident for Whites (30.8%) compared with the other race/ethnicities and also was seen in private health insurance beneficiaries (20%). The rate of ECT use varied by the region, with highest for the Northeast (20%), followed by the South (18.2%), and the West (14.3%). Adolescent inpatients with catatonia in public and teaching type, and large bed-size hospitals were more likely to receive ECT than their counterparts. The mean number of ECT sessions required during the inpatient stay was 5.2 (range, 1-15), and the mean number of days from admission to initial ECT was 2.5 (range, 0-6). CONCLUSIONS: Electroconvulsive therapy is used for approximately only 13% of adolescents with catatonia when comorbid schizophrenia spectrum disorders are present, suggesting that many patients may not get evidence-based treatment. Future studies in this area are needed.

Cannabis Use is an Independent Risk Factor for Manic Episode: A Report from 380,265 Bipolar Inpatients.

OBJECTIVES: To evaluate the odds for bipolar disorder (BP) mania and depression-related hospitalization due to cannabis use disorders (CUD). METHODS: We conducted a cross-sectional study using the national inpatient sample (NIS), and included adult BP hospitalizations sub-grouped by manic (N = 209,785) versus depressive episodes (N = 170480). A logistic regression model was used to evaluate adjusted odds ratio (aOR) of association between CUD and BP-mania-related hospitalizations and was adjusted for demographics confounders, psychiatric comorbidities and other substance use disorders (SUD). RESULTS: Comorbidities were less prevalent in BP mania compared to BP depression: anxiety disorders (22.7% vs. 35.3%), PTSD (8.7% vs. 14.3%), and personality disorders (15.4% vs. 20.5%). Among SUD, methamphetamine (aOR 1.27, 95%CI 1.22 - 1.32) and CUD (aOR 1.53, 95%CI 1.50 - 1.56) had increased odds for hospitalization for BP mania. CONCLUSION: CUD increases the odds for hospitalization for BP manic episode by 53%. Due to the rising prevalence of cannabis use among patients with BP it is important to provide substance use counseling/psychoeducation and discourage cannabis use among youth to prevent long-term adverse consequences.

Real-world effectiveness of long-acting injectable antipsychotics to reduce 90-day and annual readmission in psychotic disorders: insights from a state psychiatric hospital.

BACKGROUND: To evaluate the effectiveness of long-acting injectable antipsychotics (LAI-a) in reducing the 90-day and annual readmission rates in schizophrenia inpatients. METHODS: We conducted a cross-sectional study and included 180 adult patients with psychotic disorders discharged from 2018 to 2019 at a state psychiatric hospital. Descriptive statistics were used to measure the differences between the readmit and nonreadmit cohorts. Logistic regression model was used to measure the odds ratio (OR) for 90-day and annual readmission and was controlled for potential readmission risk factors. RESULTS: A lower proportion of patients receiving LAI-a were readmitted within 90-day (28.6%) and 1-year (32.4%) periods. Patients receiving LAI-a had lower odds of association for 90-day (OR 0.36, 95% confidence intervals [CI] 0.139-0.921) and annual (OR 0.35, 95% CI 0.131-0.954) readmissions compared to those discharged on oral antipsychotics. A higher proportion of inpatients who received fluphenazine LAI had 90-day (25%) and annual (18.2%) readmissions compared to other LAI-a. CONCLUSION: Utilization of LAI-a in patients with psychotic disorders can decrease both 90-day and annual psychiatric readmissions by 64% to 65%. Physicians should prefer LAI-a to reduce the readmission rate and improve the quality of life, and decrease the healthcare-related financial burden.

Characteristics of patients who had deep brain stimulation for treatment-resistant depression from among 116,890 inpatients with major depressive disorder.

BACKGROUND: The aims of this study were to evaluate the characteristics of patients and the pattern and rate of use of deep brain stimulation (DBS) for major depressive disorder (MDD) in the United States. METHODS: Data from the 2012-2014 Nationwide Inpatient Sample (NIS) included 116,890 patients. Patient variables included age, gender, race, median household income, insurance, primary diagnosis, primary procedure, length of stay, and total cost. Hospital variables included ownership, location, teaching status, bed size, and geographic region. RESULTS: Patients who received DBS for MDD were primarily high- income White females with private insurance. The mean age was 49.1 years (SD 7.85). The length of inpatient stay was 1 to 1.6 days. Total cost was highest in the West and lowest in the Northeast. Deep brain stimulation was mostly used by private nonprofit urban teaching hospitals in the South region of the United States. CONCLUSIONS: Deep brain stimulation was used in .03% of the total inpatient population with a primary diagnosis of MDD. If efficacy is established in definitive trials, DBS could fill a need for patients with treatment-resistant depression who do not respond to standard therapeutics or electro-convulsive therapy.

Second-Generation Antipsychotics in Management of Acute Pediatric Bipolar Depression: A Systematic Review and Meta-analysis.

Objectives: To evaluate the efficacy in reduction of depressive symptoms, and safety and tolerability of second-generation antipsychotics (SGAs) to manage pediatric bipolar depression (PBD). Methods: We conducted a systematic review for randomized clinical trials (RCTs) for PBD in MEDLINE, Scopus, and EMBASE. Four (quetiapine: 2, lurasidone: 1, olanzapine-fluoxetine combination [OFC]: 1) out of 569 studies met the criteria for inclusion in meta-analysis. RevMan was used for statistical analysis, and the mean difference (MD) between mean children's depression rating scale-revised (CDRS-R) score was used to measure treatment difference between SGA and placebo. Results: Lurasidone displayed a significant reduction in depressive symptoms (MD -5.70, 95% confidence interval [CI] -8.67 to -2.73) in PBD, followed by OFC (MD -5.00, 95% CI -8.64 to -1.36) and quetiapine (MD -2.30, 95% CI -6.80 to 2.20; MD 1.00, 95% CI -9.88 to 11.88). The response was significantly higher for lurasidone (59.5% vs. 36.5%; p < 0.001) and OFC (78.2% vs. 59.2%, p = 0.003) compared with placebo. There was no statistically significant MD in treatment and response rates between quetiapine and placebo in all RCTs. The weighted mean CDRS-R total score difference was -4.58 (95% CI -6.59 to -2.56) and overall effect was significant (p < 0.00001). Importantly, the p value for heterogeneity was 0.46, which indicated that there was no heterogeneity between outcomes of the studies. The number needed to treat (NNT) for lurasidone was 4.3, followed by OFC (NNT = 5.3) and quetiapine (NNT = 12.5; NNT = 25). Conclusion: Our findings showed lurasidone and OFC were more efficacious than placebo for acute depressive episodes in PBD. RCTs of treatments for PBD remain scarce pressing the need for more research.

Cannabis use disorder and increased risk of arrhythmia-related hospitalization in young adults.

BACKGROUND AND OBJECTIVES: Recent observations indicate that cannabis use can result in cardiovascular complications including arrhythmias. We studied the relationship between cannabis use disorder (CUD) and arrhythmia hospitalization. METHODS: We conducted a retrospective analysis of the Nationwide Inpatient Sample (2010-2014). Patients (age 15-54) with a primary diagnosis for arrhythmia (N = 570,556) were compared with non-arrhythmia (N = 67,662,082) inpatients for odds ratio (OR) of CUD by the logistic regression model, adjusted for demographics and comorbid risk factors. RESULTS: The incidence of CUD in arrhythmia inpatients was 2.6%. Among cannabis users, the most prevalent arrhythmia was atrial fibrillation (42%), followed by other arrhythmias (24%) and atrial flutter (8%). Patients with CUD were younger (15-24 years, OR: 4.23), male (OR: 1.70), and African American (OR: 2.70). CUD was associated with higher odds of arrhythmia hospitalization in the young population, 1.28 times in 15-24 years (95% confidence interval [CI]: 1.229-1.346) and 1.52 times in 25-34 years (95% CI: 1.469-1.578). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: With the growing legalization in the United States, there is an increased use of medicinal/recreational cannabis. This is the first national study to our knowledge that found that CUD is associated with a 47%-52% increased likelihood of arrhythmia hospitalization in the younger population and the risk of association was controlled for potential confounders including other substances. The fact that atrial fibrillation is the most prevalent arrhythmia is of special concern since it can result in stroke and other embolic events. Physicians need to familiarize themselves with cannabis abuse or dependence as a risk factor for arrhythmia.

Clozapine-Induced Constipation: A Case Report and Review of Current Management Guidelines.

Clozapine is a second-generation antipsychotic recommended after the failure of two or more antipsychotics for treatment-resistant schizophrenia. Clozapine proved to also decrease recurrent suicidal behaviors in schizophrenia spectrum disorders. Yet, physicians often use clozapine as a last resort despite its proven efficacy due to its side effect profile. A noted side effect of clozapine is agranulocytosis, which requires a weekly complete blood count with differentials. Clozapine's anticholinergic activity causes colonic hypomotility, leading to constipation, and only a few studies examined clozapine-induced constipation (CIC). Few of the reported complications of CIC include bowel obstruction or bowel perforation due to fecal impaction. Herein we document a case report of CIC and also conducted a review of published case reports examining the complexity and management of CIC. CIC is a critical condition if unresolved as it can lead to mortality. Future directions and guidelines should be developed for early diagnosis and treatment for CIC, which will provide reassurance and directions for both the physicians and patients.

Eating Disorders and Suicidal Behaviors in Adolescents with Major Depression: Insights from the US Hospitals.

OBJECTIVE: To evaluate the odds of association between suicidal ideation and/or attempt with comorbid eating disorders in adolescents with major depressive disorder (MDD). METHODS: We conducted a cross-sectional study and included 122,020 adolescents with a primary diagnosis of MDD from the nationwide inpatient sample (NIS, 2012-2014). They were sub-grouped by a comorbid diagnosis of eating disorders (N = 1675). We calculated the adjusted odds ratio (aOR) using a logistic regression model with demographic confounders for associations of eating disorders with suicidal ideation and attempt. RESULTS: Suicidal ideations were seen in a higher proportion of adolescents with eating disorders (46.3% vs. 14.2% in those without eating disorders). On the contrary, a low proportion of adolescents with eating disorders had suicidal attempts (0.9% vs. 39.4% in those without eating disorders). Overall, eating disorders were associated with higher odds for suicidal ideations (aOR 5.36, 95% CI 4.82-5.97) compared to those without eating disorders, but with lower odds of suicidal attempt (aOR 0.02, 95% CI 0.01-0.03). CONCLUSIONS: Adolescents with MDD and comorbid eating disorders had five-times increased odds of suicidal ideations but lower odds of a suicide attempt. Self-harm/injurious behaviors are early signs of suicidal ideations in these patients. A collaborative care model is required for the screening, early diagnosis, and management of adolescents with eating disorders to improve their quality of life.

Assessing medical students' knowledge in differentiating the diagnosis and treatment of unipolar vs bipolar depression.

BACKGROUND: Depression is one of the leading causes of premature death and disability. However, both unipolar and bipolar depression are underdiagnosed and undertreated. The aims of this study were to assess medical students' level of confidence in and knowledge of diagnosing and treating depression before and after completing a psychiatry clerkship, and their knowledge of differentiating unipolar vs bipolar depression. METHODS: Third-year medical students at Augusta University (Georgia, USA) completed an online questionnaire to assess confidence in and knowledge of diagnosing and treating unipolar and bipolar depression. RESULTS: Students who completed a psychiatry clerkship were statistically significantly more comfortable/confident with diagnosing (P < .0001) and treating (P < .0001) unipolar depression. Regarding bipolar depression, 73% of students who completed a psychiatry clerkship correctly diagnosed bipolar disorder, vs 59% of students who did not complete a psychiatry clerkship. This difference was not statistically significant (P = .181). CONCLUSIONS: Students who completed a psychiatry clerkship were more confident in diagnosing and treating unipolar depression compared with those who did not complete a psychiatry clerkship. However, there was no statistically significant difference between students who had completed a psychiatry clerkship and those who had not completed a psychiatry clerkship in making the correct diagnosis of bipolar depression. Neither group had a very high rate of correct diagnosis.