With the rate of obesity on the rise worldwide, individuals with schizophrenia represent a particularly vulnerable population. The aim of this study was to assess the metabolic profile of individuals with schizophrenia in relation to dietary and physical activity habits compared to normal controls.
Dietary and physical activity habits of 130 individuals with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of schizophrenia or schizoaffective disorder were compared with 250 BMI, age, gender, and racially matched controls from the 2005-2008 National Health and Nutrition Examination Surveys (NHANES) using a 24-hour diet recall and a self report physical activity questionnaire.
Individuals with schizophrenia had significantly higher levels of glycosylated hemoglobin (HbA1c) and insulin compared to matched controls. Additionally, these individuals had an increased waist circumference and diastolic blood pressure than the comparison group. Daily caloric intake was not different between groups; however, individuals with schizophrenia consumed significantly greater amounts of sugar and fat. Individuals with schizophrenia reported engaging in moderate physical activity less frequently than the NHANES group, but there was no difference in reported vigorous physical activity.
These findings suggest that the dietary and physical activity habits of individuals with schizophrenia contribute to an adverse metabolic profile. Increased opportunities for physical activity and access to healthy foods for individuals with schizophrenia may ease the burden of disease.
obesity; schizophrenia; dietary intake; physical activity; metabolic syndrome
The metabolic syndrome (MetSyn), characterized by vascular symptoms, is strongly correlated with obesity, weight-related medical diseases and mortality, and has increased commensurately with secular increases in obesity in the U.S. Little is known about the distribution of MetSynin obese patients with binge eating disorder (BED) or its associations with different developmental trajectories of dieting, binge eating, and obesity problems. Further, inconsistencies in the limited data necessitate elucidation. This study examined the frequency and correlates of MetSyn in a consecutive series of 148 treatment-seeking obese men and women with BED assessed with structured clinical interviews. Almost half of the participants met criteria for MetSyn. Participants with MetSyn did not differ from those without MetSyn on demographic variables or disordered eating psychopathology. However, our findings suggest that MetSyn is associated with a distinct developmental trajectory, specifically a later age at BED onset and shorter BED duration. Although the findings from this study shed some light on MetSyn and its associations with developmental trajectories of eating and weight-related behaviors, notable inconsistencies characterize the limited literature. Prospective studies are needed to examine causal connections in the development of the MetSyn in relation to disordered eating in addition to excess weight.
It is unclear whether direct structured interviews are able to capture the full range of psychopathology in schizophrenia, as is required in diagnostic assessments or clinical ratings. We examined agreement between symptom ratings derived from direct patient interviews and from review of casenotes.
The study sample comprised 1021 schizophrenic subjects collected as part of the Irish Case-Control Study of Schizophrenia (ICCSS). Diagnostic interviews utilized a modified version of the Structured Clinical Interview for DSM-III-R. Symptoms were rated by the interviewer. In addition, the Casenote Rating Scale was used to rate symptoms based on medical record information. For each negative and positive symptom, we calculated the Pearson correlation between the interview and the casenote rating. Using the mean of the interview and casenote rating for each symptom, exploratory factor analysis using Varimax rotation was performed.
Three factors were extracted in factor analysis: positive, negative, and Schneiderian symptoms. The highest correlations between interview and casenote ratings were for negative symptoms, in which all symptoms were significantly correlated. Positive and Schneiderian symptoms were significantly correlated with the exception of thought insertion, thought withdrawal, voices speaking in sentences, and somatic hallucinations. Significant correlations were generally moderate (0.2–0.55)
Most schizophrenic symptoms, especially negative symptoms, can be assessed by direct interviews as the sole source of information with moderate reliability. However, the presence of some Schneiderian and possibly less prevalent positive symptoms may be difficult to determine without a review of records, which may include longitudinal observations and information from multiple observers.
schizophrenia; clinical features; structured interview; factor analysis
Research has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with BMI and eating-disorder psychopathology in BED.
Participants were 113 overweight or obese treatment seeking men and women with BED. Participants were administered semi-structural diagnostic clinical interviews and completed a battery of self-report measures.
Social anxiety was positively and significantly correlated with shape- and weight-concerns, and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating-, shape-, and weight-concerns and overall eating-disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after co-varying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint.
Our findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape- and weight-concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating-disorder psychopathology.
Auditory hallucinations (AH) are a cardinal feature of schizophrenia spectrum disorders. They are not disease specific, however, and can occur in other conditions, including affective psychoses.
In this descriptive, cross-sectional study, we examined AH in relation to other psychotic symptoms, mood symptoms, illness severity, and functional status in 569 patients with psychosis (n=172 schizophrenia, n=153 schizoaffective disorder, n=244 bipolar disorder with psychotic features).
323 (56.7%) patients reported a lifetime history of AH (75.6% of patients with schizophrenia, 71.9% schizoaffective disorder, and 34.0% bipolar disorder). The mean score for the hallucinations item (P3) of the Positive and Negative Syndrome Scale (PANSS) in the AH group was 3.66 ± 1.79, indicating mild to moderate state hallucinations severity. AH were strongly associated with hallucinations in other sensory modalities and with the first-rank symptoms of delusions of control, thought insertion, and thought broadcasting. Multivariate analysis showed that AH were associated with lower education even after controlling for diagnosis, age, and gender. There was no association between AH and functional status as measured by the Multnomah Community Ability Scale (MCAS).
AH are associated with specific clinical features across the continuum of both schizophrenic and affective psychoses independent of DSM-IV diagnosis.
Hallucinations, auditory; Psychotic disorders; Schizophrenia; Bipolar disorder
This study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies.
We first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant.
Rates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, the majority of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group.
Our findings underscore the need to further examine the factors underlying differences between minority and non-minority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.
Substance abuse; mental disorders; co-occurring disorders; comorbidity; dual diagnosis; minorities; health disparities; CPES
Defining the pre-psychotic state in an effort to prevent illness progression, and the development of disorders such as schizophrenia, is a rapidly growing area of psychiatry. The presentation of psychotic symptoms can be influenced by culture; however there has not been any previous assessment of psychosis-risk symptoms in the continent of Africa. Our study aimed to measure the prevalence of psychosis-risk in a community sample in Nairobi, Kenya, and to evaluate the effects of key demographic variables.
A culturally modified version of the 12-item PRIME-Screen (mPRIME) was self-administered by 2,758 youth (aged 14–29) recruited through house-to-house visits in Nairobi, Kenya. The prevalence and severity of psychosis-risk items from the mPRIME, and the effects of gender and age on symptoms were evaluated. k-Means cluster analysis was used to identify symptom groups.
Depending on the mPRIME item, 1.8–19.5% of participants reported certainty of having had a psychosis-risk symptom. Overall, 45.5% reported having had any psychosis-risk symptom. Females had a significantly higher mean severity score on items evaluating persecutory ideation and auditory hallucinations. Symptom severity on five items showed a modest (R=0.09–0.13) but significant correlation with age. Cluster analysis identified four groups of participants: normative (55%), high symptom (11%), intermediate symptom (19%), and grandiose symptom (15%).
Psychosis-risk symptoms appear to be highly prevalent in Kenyan youth. Longitudinal studies are needed to determine the correlation of identified symptoms with transition to psychotic illness, as well as the associated functionality and distress, in order to develop appropriate intervention strategies.
Psychosis; Risk; Kenya; Africa; Youth; Prime screen
Obesity is associated with poorer cognitive function and impulsivity, which may contribute to binge eating disorder (BED). The objective of this study was to compare cognitive function in morbidly obese individuals with and without BED.
A total of 131 morbidly obese individuals (41 with past or present BED, 90 with no BED history) completed a computerized battery of cognitive tests including executive, memory, language, and attention.
Both groups of participants evidenced high rates of cognitive impairment, however, no significant differences emerged between persons with and without BED on cognitive testing. Comparison of persons without BED, current BED, and past BED also yielded no differences.
In the present sample, morbidly obese individuals with and without BED were clinically indistinguishable on tests of cognitive function. Our findings suggest that obesity, rather than binge eating, may be more directly related to cognition. Future studies should further examine this relationship, as it might provide greater insight into the neural mechanisms for this BED.
Although obsessive-compulsive disorder (OCD) is typically described as a chronic condition, relatively little is known about the naturalistic, longitudinal course of the disorder. The purpose of the current study was to examine the probability of OCD remission and recurrence as well as to explore demographic and clinical predictors of remission.
This study uses data from the Harvard/Brown Anxiety Disorders Research Program, which is a prospective, naturalistic, longitudinal study of anxiety disorders. Diagnoses were established by means of a clinical interview at study intake. One hundred thirteen Harvard/Brown Anxiety Disorders Research Program participants with OCD were included in the study; all had a history of at least 1 other anxiety disorder. Assessments were conducted at 6-month and/or annual intervals during 15 years of follow-up.
Survival analyses showed that the probability of OCD remission was .16 at year 1, .25 at year 5, .31 at year 10, and .42 at year 15. For those who remitted from OCD, the probability of recurrence was .07 at year 1, .15 by year 3, and by year 5, it reached .25 and remained at .25 through year 15. In predictors of course, those who were married and those without comorbid major depressive disorder (MDD) were more likely to remit from OCD. By year 15, 51% of those without MDD remitted from OCD compared to only 20% of those with MDD.
In the short term, OCD appears to have a chronic course with low rates of remission. However, in the long term, a fair number of people recover from the disorder, and, for those who experience remission from OCD, the probability of recurrence is fairly low.
While genetic epidemiological studies demonstrate a substantial degree of genetic predisposition for Attention-Deficit/Hyperactivity Disorder (ADHD), they also suggest that the genetics are complex and may differ between populations or ethnic groups.
This study describes the phenomenology of siblings with Attention-Deficit/Hyperactivity Disorder (ADHD) from the genetically-isolated population of the Central Valley of Costa Rica.
Rates of DSM-IV defined ADHD subtypes and co-morbid conditions were calculated in a sample of 157 ADHD-affected children (probands and siblings) recruited for genetic studies using standardized approaches. Sib-sib comparisons and logistic regressions were conducted to identify significant patterns of concordance.
Combined type ADHD (69.5%) was the most common subtype among probands, followed by the inattentive (27.4%), and hyperactive-impulsive (3.2%) subtypes. Anxiety disorders were prevalent (55.9%), as were disruptive behavior disorders (30.9%), and Tourette's disorder (17.0%). Probands and siblings showed high sib-sib concordance for anxiety disorders.
ADHD in Costa Rica is similar in clinical and demographic characteristics to ADHD seen in other parts of the world, although the rates of co-occurring psychiatric disorders differ somewhat from those previously reported in Latin American samples. Comorbid anxiety is prevalent, with high rates of sib-sib concordance, and may represent a distinct, homogeneous subgroup suitable for genetic studies.
ADHD; Psychiatric; Genetics; International; Co-morbidity; Sib-pairs
This study examined interrelationships between cigarette smoking for weight control and eating disorder symptoms in a community sample of adult female smokers.
Participants were 107 female smokers who completed a battery of questionnaires, including the Eating Disorder Examination – Questionnaire (EDE-Q). Key items measured weight-control smoking, including smoking to prevent overeating, smoking to undo the effects of overeating, and smoking to feel less hungry. Smokers who endorsed smoking in an attempt to control weight were compared to those who denied such behaviors on EDE-Q scores and frequency of binge eating and purging.
A substantial proportion of participants reported weight-control smoking. Participants who endorsed weight-control smoking reported elevations on eating disorder symptoms as measured by the EDE-Q. Compensatory smoking was related to the frequency of binge eating.
The findings have implications for clinicians working with eating disorder patients; for some individuals, cigarette smoking may be used as an attempt to compensate for overeating.
A number of recent studies using factor analytic methods find that the structure of psychopathology reflects broad internalizing and externalizing dimensions, with the internalizing dimension being further divided into fear and distress disorders. While these variable-centered studies have provided important insights into the structure of psychopathology, they provide limited information about the classification of individual cases. The present study examines patterns of lifetime internalizing and externalizing psychopathology in participants from the Oregon Adolescent Depression Project using latent class analysis, which classifies individuals rather than variables. A four class solution best fit the data. The largest class (62.5%) included individuals with relatively little psychopathology; one class (16.4%) was largely characterized by internalizing disorders; one class (16.9%) was largely characterized by externalizing disorders; and the final class (4.2%) was characterized by both internalizing and externalizing disorders. The validity of the classes was further examined using data on psychiatric morbidity, temperament, and family aggregation of psychopathology. Classes differed on indices of positive, negative, and disinhibited temperament in ways that were consistent with theoretical predictions. Patterns of familial aggregation of psychopathology demonstrated relative specificity of transmission of different disorders. Overall, the findings support conclusions from studies of dimensional models of internalizing and externalizing disorders, and extend them to person-centered approaches to classification.
psychopathology; structure; personality; latent class analysis
Posttraumatic stress disorder (PTSD) and other Axis I comorbidity among women with substance use disorders (SUD) appear similarly prevalent and are associated with comparable negative clinical profiles and treatment outcomes. The relative contribution of comorbid PTSD versus other Axis I psychiatric disorders to clinical characteristics is largely unexamined, however, despite theory and empirical data indicating that PTSD and substance use disorders may have a unique relationship that confers specific risk for clinical severity and poor treatment outcome. In a sample of pregnant, opioid and/or cocaine dependent women entering substance abuse treatment, women with PTSD (SUD-PTSD; n=23) were compared to those with other Axis I comorbidity (SUD-PSY; n=45) and those without Axis I comorbidity (SUD-Only; n=37). Data were collected via face-to-face interviews and urinalysis drug assays. While the study groups had similar substance use severity, the SUD-PTSD group was more likely to report suicidality, aggression and psychosocial impairment than both the SUD-PSY and SUD-Only groups. Findings indicate treatment considerations for substance dependent women with PTSD are broader and more severe than those with other Axis I conditions or substance dependence alone.
posttraumatic stress disorder; women; substance use disorders; dual diagnosis; treatment indicators
The aim of the present study was to examine overweight bulimia nervosa (BN) in a community sample of women. Volunteers (N=1,964) completed self-report questionnaires of weight, binge eating, purging, and cognitive features. Participants were classified as overweight (BMI>=25) or normal weight (BMI<25). Rates of BN within the overweight and normal weight classes did not differ (6.4% vs.7.9%). Of the 131 participants identified as BN, 64% (n=84) were classified as overweight BN (OBN) and 36% (n=47) as normal weight BN. The OBN group had a greater proportion of ethnic minorities, and reported significantly less restraint than the normal weight BN group. Otherwise, the two groups reported similarly, even in terms of purging and depression. In summary, rates of BN did not differ between overweight and normal weight women. Among BN participants, the majority (two-thirds) were overweight. Differences in ethnicity and restraint, but little else, were found between overweight and normal weight BN. Findings from the present study should serve to increase awareness of the weight range and ethnic diversity of BN, and highlight the need to address weight and cultural sensitivity in the identification and treatment of eating disorders.
obesity; binge eating; bulimia nervosa; eating disorders; prevalence
To examine, among hospital employees exposed to an outbreak of severe acute respiratory syndrome (SARS), post-outbreak levels of depressive symptoms, and the relationship between those depressive symptom levels and the types of outbreak event exposures experienced.
In 2006, randomly selected employees (n = 549) of a hospital in Beijing were surveyed concerning their exposures to the city’s 2003 SARS outbreak, and the ways in which the outbreak had affected their mental health. Subjects were assessed on sociodemographic factors, on types of exposure to the outbreak, and on symptoms of post-traumatic stress disorder (PTSD) and depression.
The results of multinomial regression analyses showed that, with other relevant factors controlled for, being single, having been quarantined during the outbreak, having been exposed to other traumatic events prior to SARS, and perceived SARS-related risk level during the outbreak were found to increase the odds of having a high level of depressive symptoms three years later. Altruistic acceptance of risk during the outbreak was found to decrease the odds of high post-outbreak depressive symptom levels.
Policy makers and mental health professionals working to prepare for potential disease outbreaks should be aware that the experience of being quarantined can, in some cases, lead to long-term adverse mental health consequences.
The objective of this exploratory pilot study was to examine autonomic reactivity and hypothalamic pituitary adrenal axis dysregulation in spouses of highly exposed survivors of the 1995 Oklahoma City bombing.
This study compared psychiatric diagnoses and biological stress markers (physiological reactivity and cortisol measures) in spouses of bombing survivors and matched community participants. Spouses were recruited through bombing survivors who participated in prior studies. Individuals with medical illnesses and those taking psychotropic medications that would confound biological stress measures were excluded. The final sample included 15 spouses and 15 community participants. The primary outcome measures were psychiatric diagnoses assessed with the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Biological stress markers were physiological reactivity and recovery in heart rate and blood pressure responses to a trauma interview and cortisol (morning, afternoon, and diurnal variation).
Compared to the community participants, spouses evidenced greater reactivity in heart rate, systolic blood pressure, and diastolic blood pressure; delayed recovery in systolic blood pressure; and higher afternoon salivary cortisol.
The results support the need for further research in this area to clarify post-disaster effects on biological stress measures in the spouses of survivors and the potential significance of these effects and to address the needs of this important population which may be overlooked in recovery efforts.
Treatments for obese patients with binge eating disorder (BED) typically report modest weight losses despite substantial reductions in binge eating. Although the limited weight losses represent a limitation of existing treatments, an improved understanding of weight trajectories prior to treatment may provide a valuable context for interpreting such findings. The current study examined the weight trajectories of obese patients in the year prior to enrollment in primary care treatment for BED. Participants were a consecutive series of 68 obese patients with BED recruited from primary care centers. Doctoral-level clinicians administered structured clinical interviews to assess participants’ weight history and eating behaviors. Participants also completed a self-report measure assessing eating and weight. Overall, participants reported a mean weight gain of 9.5 pounds in the past year although this overall average comprised remarkable heterogeneity in patterns of weight changes, which ranged from losing 40 pounds to gaining 62 pounds. The majority of participants (65%) gained weight, averaging 22.5 pounds. Weight gain was associated with more frequent binge eating episodes and overeating at various times. The majority of obese patients with BED who present to treatment in a primary care setting reported having gained substantial amounts of weight during the previous year. Such weight trajectory findings suggest that the modest amounts of weight losses typically reported by treatment studies for this specific patient group may be more positive than previously thought. Specifically, although the weight losses typically produced by treatments aimed at reducing binge eating appear modest they could be reinterpreted as potentially positive outcomes given that the treatments might be interrupting the course of recent and large weight gains.
A number of studies have suggested that negative emotionality and negative affect intensity play key roles in the development and maintenance of borderline personality disorder (BPD). However, more recent research indicates that one’s response to affective discomfort may be an even more important variable in the pathogenesis of BPD than either negative emotionality or negative affect intensity per se. As such, the current study aimed to empirically test the moderating role of two well-validated laboratory measures of the ability to tolerate psychological distress (distress tolerance) in the relationship of negative emotionality and negative affect intensity with BPD levels a sample of 186 adult men and women drawn from the community and from an urban substance use center. Results provide laboratory-based evidence for a moderating effect of distress tolerance on the relationship of negative emotionality and negative affect intensity with levels of BPD. Specifically, the two former variables were related to levels of BPD among those with low distress tolerance. The current results add support to existing developmental frameworks of BPD, and suggest the importance of modifying one’s response to affective distress along with levels of negative emotionality in treatment settings.
Borderline Personality Disorder; Distress Tolerance; Affect Intensity; Negative Emotionality
This paper examines temporal relationships between negative emotions and pain in a cohort of 33 patients with chronic musculoskeletal pain enrolled in a telephone-based relapse prevention program [Therapeutic Interactive Voice Response (TIVR)], following 11 weeks of group Cognitive Behavioral Therapy (CBT). Patients were asked to make daily reports to the TIVR system for four months following CBT. Patients’ daily reports were analyzed with path analysis to examine temporal relationships between three emotion variables (anger, sadness and stress) and two pain variables (pain and pain control).
As expected, same-day correlations were significant between emotion variables and both pain and pain control. The lagged associations revealed unidirectional relationships between pain and next-day emotions: increased pain predicted higher reports of sadness the following day (p<0.05). Conversely, increased pain control predicted decreased sadness and anger the following day (p<0.05). Unlike some previous studies, this study did not reveal that an increase of negative emotions predicted increased next-day pain.
We speculate that CBT treatment followed by the relapse prevention program teaches patients how to modulate negative emotions such that they no longer have a negative impact on next-day pain perception. The clinical implications of our findings are discussed.
daily diary; chronic pain; emotions; Interactive Voice Response; pain control
To examine the significance of parental histories of SUD in the expression of binge eating disorder (BED) and associated functioning.
Participants were 127 overweight patients with BED assessed using diagnostic interviews. Participants were administered a structured psychiatric history interview about their parents (N=250) and completed a battery of questionnaires assessing current and historical eating and weight variables and associated psychological functioning (depression and self-esteem).
BED patients with a parental history of SUD were significantly more likely to start binge eating before dieting, had a significantly earlier age at BED onset, and reported less time between binge eating onset and meeting diagnostic criteria for BED than patients without a parental history of SUD. In terms of psychiatric comorbidity, BED patients with a parental history of SUD were significantly more likely to meet criteria for a mood disorder. A parental history of SUD was not significantly associated with variability in current levels of binge eating, eating disorder psychopathology, or psychological functioning.
Our findings suggest that a parental history of SUD is associated with certain distinct trajectories in the development of binge-eating (earlier binge onset predating dieting onset) and with elevated rates of comorbidity with mood disorders in patients with BED.
To compare weight-based attitudes in obese Latino adults with and without binge eating disorder (BED), and examine whether these attitudes are related to indices of eating disorder psychopathology and psychological functioning.
Participants were a consecutive series of 79 monolingual Spanish-speaking-only obese Latinos (65 females, 14 males) participating in a randomized placebo-controlled trial performed at a Hispanic community mental health center. Participants were categorized as meeting criteria for BED (N=40) or obese non-binge-eating controls (NBO) (N=39) based on diagnostic and semi-structured interviews administered by fully-bilingual research-clinicians trained specifically for this study.
Analyses revealed that negative attitudes towards obesity did not differ significantly between the BED and NBO groups nor were they correlated with the intensity of eating disorder psychopathology (e.g., levels of weight and shape concerns). Overall, the levels of negative attitudes towards obesity in this latino/a group are similar to those reported previously for samples of English-speaking primarily white obese persons.
These findings suggest that it may be obesity per se - rather than ED psychopathology or body image - that heightens vulnerability to negative weight-based attitudes.
weight bias; stigma; binge eating; obesity; latino
To quantify the effect of comorbid alcohol and drug use disorders on premature death, as reflected by the manner of death (suicide and other unnatural death versus natural death) and the age at death, among decedents with unipolar and bipolar disorders.
This study is based on the U.S. Multiple Cause of Death (MCD) public-use data files for 1999–2006.Secondary data analysis was conducted comparing decedents with unipolar/bipolar disorders and decedents with all other causes of death, based on the death records of 19,052,468 decedents in the MCD data files who died at age 15 and older. Poisson regression models were used to derive prevalence ratios (PRs) to assess the effect of comorbid substance use disorders on the risks for being an unnatural death among mood disorder deaths. Multiple-cause life table analysis and mean age at death were used to quantify the effect of comorbid substance use disorders on premature mortality among mood disorder deaths.
Prevalence of comorbid substance use disorders was higher among unipolar and bipolar disorder deaths than that among all other deaths. Among unipolar and bipolar disorder deaths, comorbid substance use disorders were associated with elevated risks for suicide and other unnatural death in both males and females (prevalence ratios ranging 1.49–9.46, p<.05). They also were associated with reductions in mean ages at death (ranging 11.7–33.8 years, p<.05). In general, these effects were much stronger for drug use disorders than for alcohol use disorders. Both substance use disorders had stronger effects on suicide among females, whereas their effects on other unnatural deaths were stronger among males.
This study is among the first to provide population mortality-based evidence to further establish comorbid substance use disorder as one of the key risk factors for premature death among individuals with unipolar or bipolar disorders in the United States. Clinicians need to be aware of the potentially lethal risk associated with these comorbid conditions.
Comorbidity poses a major challenge to conventional methods of diagnostic classification. While dimensional models of psychopathology have shed some light on this issue, the reason for inter-relationships among dimensions is unclear. The current study attempted to utilize an alternative approach to characterizing patterns of comorbidity among common mental disorders by modeling them instead as clusters by using latent class analysis.
Latent class analyses (LCA) of DSM diagnoses from two nationally representative epidemiological samples – the National Comorbidity Survey (NCS) and National Comorbidity Survey – Replication (NCS-R) datasets were undertaken.
Within each dataset, LCA yielded five latent classes exhibiting distinctive profiles of diagnostic comorbidity: a fear class (all phobias and panic disorder); a distress class (depression, generalized anxiety disorder, dysthymia); an externalizing class (alcohol and drug dependence, conduct disorder); a multimorbid class (highly elevated rates of all disorders); and a few disorders class (very low probability of all disorders). While some disorders were relatively specific to certain classes, others (major depression, PTSD, social phobia) appeared to be evident across all classes. Profiles for the five classes were highly similar across the two samples. When bipolar I disorder was added to the LCA models, in both samples, it occurred almost exclusively in the multimorbid class.
Comorbidity among mental disorders in the general population appears to occur in a finite number of distinct patterns. This finding has important implications for efforts to refine existing diagnostic classification schemes, as well as for research directed at elucidating the etiology of mental disorders.
Association between poor cognition and symptom clusters including depressive ideation (e.g., guilt) and vegetative symptoms in the absence of dysphoria (nondysphoric depression - NDD) has been suggested in the elderly. The current study examined associations between NDD and pre-morbid and concurrent cognitive functioning in younger adults at high risk for psychopathology. NDD and depressed subjects were expected to show poorer pre-morbid and current cognition than non-depressed participants.
Subjects were adoptees enrolled in the Iowa Adoption Study . NDD subjects were compared with non-depressed comparison subjects and with subjects with dysphoric depression (DD) on measures of pre-morbid cognition (estimated by standardized school achievement test scores) and concurrent cognition (intelligence, attention, memory, executive abilities).
NDD and DD showed lower pre-morbid cognition and executive functioning, while DD showed lower verbal and performance IQ compared to non-depressed subjects. The size of the comparison between NDD and non-depressed subjects for pre-morbid cognition was double that between DD and non-depressed subjects. No significant differences in cognition were found between NDD and DD. These effects were no longer significant after controlling for pre-morbid cognition.
Poorer pre-morbid cognition and executive functions in NDD (and the absence of current cognitive differences compared with DD) suggest that NDD may be a condition of clinical interest. Because poor cognition is a known correlate of alexithymia, these results (including their magnitude) are consistent with the view that NDD may be a paradoxical presentation of depression in persons with limited ability to be aware and verbally report emotions.
Previous research suggests that many preschoolers meet criteria for psychiatric diagnoses; still, relatively little is known about preschool mental health, particularly emotional problems, in the community. The present study investigates the rates of parent-reported DSM-IV disorders in a large community sample of preschoolers using the Preschool Age Psychiatric Assessment (PAPA). 541 parents were interviewed with the PAPA. Of the children, 27.4% met criteria for a PAPA/DSM-IV diagnosis; 9.2% met criteria for two or more diagnoses. Oppositional defiant disorder (ODD) (9.4%), specific phobia (9.1%), and separation anxiety disorder (5.4%) were the most common diagnoses; depression (1.8%), selective mutism (1.5%), and panic disorder (0.2%) were least common. In addition, there was significant comorbidity/covariation between depression, anxiety, and ODD, and between ODD and attention deficit hyperactivity disorder (odds ratios: 1.81-18.44; p < .05). The stability and clinical significance of diagnoses and patterns of comorbidity must be elucidated in future research.