Adolescents' Perceptions of Living With Co-Existing ADHD and Medical Disorder in Denmark.

AIM: The study aim was to explore adolescents' with co-existing ADHD and medical disorder (MD) perceptions of everyday life and support from parents and healthcare professionals. DESIGN AND METHODS: In this qualitative study, 10 adolescents aged 13-17 years diagnosed with ADHD and a MD were included from a general pediatric hospital clinic and a child and adolescent psychiatric hospital clinic. Data obtained through semi-structured interviews were analyzed using thematic analysis. RESULTS: The adolescents' perceptions were categorized into four themes: 1) ADHD perceived as part of the adolescent's self-understanding - yet with daily frustrations, 2) MD perceived as an interruption in everyday life, 3) ADHD and MD - an overlooked dual task, and 4) the need for supportive relationships in navigating ADHD and MD. CONCLUSION: Living with co-existing ADHD and MD is a complex dual task, as ADHD and MD interfere with each other in everyday life. However, the adolescents overlook the dual task as they believe their difficulties would be resolved if the MD was eliminated. Moreover, supportive relationships are essential in navigating the complexities in living with co-existing ADHD and MD. Nevertheless, the adolescents take a passive role in the encounters with the healthcare professionals, whereas they are more active in encounters with peers, parents and teachers. PRACTICE IMPLICATIONS: Healthcare professionals treating and caring for adolescents with co-existing ADHD and MD need interventions facilitating patient involvement in a patient-centered approach to support both adolescents and healthcare professionals in recognizing the dual task of having co-existing ADHD and MD.

The Irrelevance of Harm for a Theory of Disease.

Normativism holds that there is a close conceptual link between disease and disvalue. We challenge normativism by advancing an argument against a popular normativist theory, Jerome Wakefield's harmful dysfunction account. Wakefield maintains that medical disorders are breakdowns (dysfunctions) in evolved mechanisms that cause significant harm to the organism. We argue that Wakefield's account is not a promising way to distinguish between disease and health because being harmful is neither necessary nor sufficient for a dysfunction to be a disorder. Counterexamples to the harmful dysfunction account are considered, such as mild infections, perceptual deficits, and beneficial illnesses. Then we consider two ways of amending the harmful dysfunction account to address these cases and argue that the proposed amendments raise even more serious problems for this account. These problems apply generally to any normativist theory and raise doubts about the entire normative approach to the philosophy of health and disease.

Harm as a Necessary Component of the Concept of Medical Disorder: Reply to Muckler and Taylor.

Wakefield's harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction (failure of biologically designed functioning) and a value (harm) component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction's harmfulness is best understood in dispositional terms.

Pathways Between Combat Stress and Physical Health Among Portuguese War Veterans.

In this study, I explored the experience of both physical and psychological chronic illnesses among a sample of Portuguese war veterans. Twenty suffered from chronic posttraumatic stress disorder (PTSD; unrecovered) and 20 had remission from PTSD (recovered), and all participants suffered from a chronic physician-diagnosed medical disorder. Two semistructured interviews were conducted. Analysis of the interviews was conducted using the Thematic and Categorical Analysis. Unrecovered participants reported higher moral injury, discrepancy between pre- and postwar identity, medication side effects, and lower repertoire of coping strategies, and verbalized that treatment care plan triggers posttraumatic symptoms. Recovered participants reported stronger moral repair, sense of continuity between pre- and postwar identity, and wider repertoire of coping strategies, well-being. Veterans' adjustment to chronic physician-diagnosed medical disorders is related to the accommodation of war traumatic experiences within existing self-schemas to restore a sense of continuity between veterans' pre- and postwar identity.

The biostatistical theory versus the harmful dysfunction analysis, part 1: is part-dysfunction a sufficient condition for medical disorder?

Christopher Boorse's biostatistical theory of medical disorder claims that biological part-dysfunction (i.e., failure of an internal mechanism to perform its biological function), a factual criterion, is both necessary and sufficient for disorder. Jerome Wakefield's harmful dysfunction analysis of medical disorder agrees that part-dysfunction is necessary but rejects the sufficiency claim, maintaining that disorder also requires that the part-dysfunction causes harm to the individual, a value criterion. In this paper, I present two considerations against the sufficiency claim. First, I analyze Boorse's central argument for the sufficiency claim, the "pathologist argument," which takes pathologists' intuitions about pathology as determinative of medical disorder and conclude that it begs the question and fails to support the sufficiency claim. Second, I present four counterexamples from the medical literature in which salient part-dysfunctions are considered nondisorders, including healthy disease carriers, HIV-positive status, benign mutations, and situs inversus totalis, thus falsifying the sufficiency claim and supporting the harm criterion.

Physical activity, suicidal ideation, suicide attempt and death among individuals with mental or other medical disorders: A systematic review of observational studies.

A growing body of research has demonstrated the potential role for physical activity as an intervention across mental and other medical disorders. However, the association between physical activity and suicidal ideation, attempts, and deaths has not been systematically appraised in clinical samples. We conducted a PRISMA 2020-compliant systematic review searching MEDLINE, EMBASE, and PsycINFO for observational studies investigating the influence of physical activity on suicidal behavior up to December 6, 2023. Of 116 eligible full-text studies, seven (n = 141691) were included. Depression was the most frequently studied mental condition (43%, k = 3), followed by chronic pain as the most common other medical condition (29%, k = 2). Two case-control studies examined suicide attempts and found an association between physical activity and a reduced frequency of such attempts. However, in studies examining suicidal ideation (k = 3) or suicide deaths (k = 2), no consistent associations with physical activity were observed. Overall, our systematic review found that physical activity may be linked to a lower frequency of suicide attempts in non-prospective studies involving individuals with mental disorders.

How to adapt orthodontic treatment for a patient with a general pathology? Review of the literature based on six scenarios that challenge the practitioner / Comment adapter le traitement orthodontique chez un patient porteur d'une pathologie générale ? Revue de la littérature à partir de six situations qui questionnent le praticien

Introduction: The democratization of access to orthodontic treatments and the development of orthodontics in adults lead more and more practitioners to take care of patients with various general pathologies. The aim of this literature review was to specify the recommendations governing orthodontic treatment in six specific situations: diabetes, patient at risk of endocarditis, haemophilia, osteopetrosis, epidermolysis bullosa and treatment with growth hormone. Material and Method: A review of the literature was carried out according to the PRISMA method from the PubMed database. The keywords used were, for diabetes: diabetic, diabetus mellitus, for infective endocarditis: endocarditis, for hemophilia : hemophilia, bleeding disorder, for the use of growth hormone: growth hormone, for epidermolysis bullosa: epidermolysis bullosa and for osteopetrosis: osteopetrosis, associated with the request « orthodontic ¼ or « tooth movement ¼. Results and Conclusion: None of these situations constituted an absolute contraindication to orthodontic treatment. However, if surgical procedures with potential for complications were necessary, a compromise should then be discussed in order to provide the best benefit/risk balance for patients.

Introduction: La démocratisation de l'accès aux traitements orthodontiques et le développement de l'orthodontie chez l'adulte amène de plus en plus les praticiens à prendre en charge des patients atteints de pathologies générales diverses. Le but de la présente revue de littérature était de préciser les recommandations encadrant les traitements orthodontiques dans six situations particulières : diabète, patient à risque d'endocardite, hémophilie, ostéopétrose, épidermolyse bulleuse et traitement par l'hormone de croissance. Matériel et méthode: Une revue de la littérature a été réalisée selon la méthode PRISMA à partir de la base de données PubMed. Les mots-clés utilisés étaient, pour le diabète : diabetic, diabetus mellitus, pour l'endocardite infectieuse : endocarditis, pour l'hémophilie : hemophilia, bleeding disorder, pour l'utilisation de l'hormone de croissance : growth hormone, pour les épidermolyses bulleuses : epidermolysis bullosa et pour l'ostéopétrose : osteopetrosis, associés à la requête « orthodontic ¼ ou « tooth movement ¼. Résultats et conclusion: Aucune de ces situations ne constituait une contre-indication absolue à un traitement orthodontique. Toutefois, si des actes chirurgicaux à potentiel de complications étaient nécessaires, un compromis devait alors être discuté afin d'apporter la meilleure balance bénéfice / risque pour les patients.

Values in mental and medical disorder concepts: Their presence is not the point, being aware of them is.

BACKGROUND: Both in medicine and in psychiatry, it's essential to find a general definition for medical and mental disorders. For this we have to analyze the concepts behind these definitions. In this article, we intend to review the proximity between the concepts of mental and medical disorders regarding the presence of values, and to propose a way to deal with the different kinds of values that might be present. METHODS: The method used in this paper was a conceptual review/analysis. RESULTS: Regarding the concept of medical disorder, it has resorted to different sub-concepts such as dysfunction and harm (distress disability). The concept of dysfunction, apparently being less value-laden, has been prioritized in relation to the harm component although several authors have already proved that implicitly and explicitly this concept is value laden. In medical-surgical disorder it is very unlikely to find any diagnostic information that includes moral values. In this type of disorder, the values in question are universally non-moral: pain, disability, distress (or risk for these) and risk of death. On the other hand, in several mental disorders, moral values have often been included in their diagnostic criteria. CONCLUSION: It is concluded that values are present in the main concepts that have been used to define medical or mental disorder. What is essential is to understand what is descriptive and what is value and to try to avoid moral values in this context.

Medical disorder, harm, and damage.

Jerome Wakefield's harmful dysfunction analysis (HDA) of medical disorder is an influential hybrid of naturalist and normative theories. In order to conclude that a condition is a disorder, according to the HDA, one must determine both that it results from a failure of a physical or psychological mechanism to perform its natural function and that it is harmful. In a recent issue of this journal, I argued that the HDA entails implausible judgments about which disorders there are and how they are individuated. The same arguments apply to other views that incorporate a harm criterion. More recently, David G. Limbaugh has modified the HDA by providing a novel account of the way in which a disorder must be harmful. Here, I briefly review the relevant issues and then critically assess Limbaugh's account. I argue in the end that Limbaugh's revisions do not succeed in making accounts like the HDA more attractive.

Pre-existing medical disorders as risk factors for preeclampsia: an exploratory case-control study.

Objective: We sought to explore pre-existing medical disorders as risk factors for preeclampsia as thoroughly as possible. Methods: A case-control design. A group of 1,652 patients were identified as the preeclampsia group, and another randomly selected 4,500 patients were identified as the non-preeclampsia group. Results: Mature ovarian teratoma (adjusted odds ratio [OR] 7.69, 95% CI 1.58-37.53), uterine fibroids (adjusted OR 2.24, 95% CI 1.28-3.92) and pregestational hypothyroidism (adjusted OR 5.17, 95% CI 2.43-11.00), were significantly correlated with preeclampsia. Conclusions: Mature ovarian teratoma, uterine fibroids and pregestational hypothyroidism may also contribute to the incidence of preeclampsia.

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis.

OBJECTIVE: Collaborative care (CC) improves depressive symptoms in people with comorbid depressive disorder in chronic medical conditions, but its effect on physical symptoms has not yet systematically been reviewed. This study aims to do so. METHODS: Systematic review and meta-analysis was conducted using PubMed, the Cochrane Library, and the European and US Clinical Trial Registers. Eligible studies included randomized controlled trials (RCTs) of CC compared to care as usual (CAU), in primary care and general hospital setting, reporting on physical and depressive symptoms as outcomes. Overall treatment effects were estimated for illness burden, physical outcomes and depression, respectively. RESULTS: Twenty RCTs were included, with N=4774 patients. The overall effect size of CC versus CAU for illness burden was OR 1.64 (95%CI 1.47;1.83), d=0.27 (95%CI 0.21;0.33). Best physical outcomes in CC were found for hypertension with comorbiddepression. Overall, depression outcomes were better for CC than for CAU. Moderator analyses did not yield statistically significant differences. CONCLUSIONS: CC is more effective than CAU in terms of illness burden, physical outcomes and depression, in patients with comorbid depression in chronic medical conditions. More research covering multiple medical conditions is needed. PROTOCOL REGISTRATION NUMBER: The protocol for this systematic review and meta-analysis has been registered at the International Prospective Register of Systematic Reviews (PROSPERO) on February 19th 2016: http://www.crd.york.ac.uk/PROSPERO/DisplayPDF.php?ID=CRD42016035553.

Harm and the concept of medical disorder.

According to Jerome Wakefield's harmful dysfunction analysis (HDA) of medical disorder, the inability of some internal part or mechanism to perform its natural function is necessary, but not sufficient, for disorder. HDA also requires that the part dysfunction be harmful to the individual. I consider several problems for HDA's harm criterion in this article. Other accounts on which harm is necessary for disorder will suffer from all or almost all of these problems. Comparative accounts of harm imply that one is harmed when one is made worse off, that is, worse off than one otherwise would have been. Non-comparative accounts imply that one is harmed when one is put into some kind of condition or state that is, in some way, bad in itself. I argue that whether harm is construed comparatively or non-comparatively, HDA's harm criterion is problematic. I tentatively conclude that an analysis of medical disorder should not make use of the concept of harm.

Depression during pregnancy in women with a medical disorder: risk factors and perinatal outcomes

BACKGROUND: Approximately one-fifth of women present depression during pregnancy and puerperium, and almost 13 percent of pregnant women experience a major depressive disorder. OBJECTIVE: The aim of this study was to identify risk factors for depression among pregnant women with a medical disorder and to evaluate the influence of depression on perinatal outcomes. METHODS: Three hundred and twenty-six pregnant women with a medical disorder were interviewed. A semistructured interview was conducted for each participant using a questionnaire that had been developed previously. Major depression was diagnosed using the Portuguese version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). The medical records of the participants were thoroughly reviewed to evaluate the perinatal results. RESULTS: Major depressive disorder was diagnosed in 29 cases (9.0 percent). The prevalence of major depression was as follows: 7.1 percent for preeclampsia or chronic hypertension, 12.1 percent for cardiac disorder, 7.1 percent for diabetes mellitus, 6.3 percent for maternal anemia, 8.3 percent for collagenosis and 12.5 percent for a high risk of premature delivery. An univariate analysis showed a significant positive correlation between an average household income below minimum wage and a PRIME-MD diagnosis of major depression. A multiple regression analysis identified unplanned pregnancy as an independent predictor of major depression (86.2 percent in the group with a diagnosis of major depression by PRIME-MD vs. 68.4 percent in the group without major depression). A comparison between women who presented major depression and those who did not revealed no significant differences in the perinatal results (i.e., preterm delivery, birth weight and low Apgar scores). CONCLUSION: In the present study, unplanned pregnancy in women with a medical disorder was identified as a risk factor for major depression during gestation. Major depression during pregnancy in women with a medical disorder should be routinely investigated using specific methods.