Comorbidity

Binge eating disorder is more common than anorexia and bulimia combined, according to a national survey, but many physicians are unaware of the problem. The guidance and evidence discussed here highlight the key issues in recognizing and managing the disorder.

Attention-deficit/hyperactivity disorder (ADHD) is often underappreciated and inadequately treated in adults. Long thought to be a disorder of childhood, ADHD is now believed to persist into adulthood in approximately half of all cases.

What is comorbidity? Psychiatric comorbidity refers to the occurrence of 2 or more mental or substance use disorders within a certain period. Research shows that comorbidity of substance use and other psychiatric disorders is common and often worsens the prognosis for each disorder.

This study determined the prevalence of at-risk drinking in a psychiatric emergency service (PES) and compared the characteristics and functioning of at-risk drinkers with schizophrenia or bipolar disorder with those of at-risk drinkers with depression or anxiety disorders. Of the adult patients who entered the PES and met study criteria, 148 had schizophrenia or bipolar disorder and 242 had depression or anxiety.

Panic disorder occurs in about 1 in 5 individuals who have bipolar disorder. Anxiety amplifies the distress caused by depression and mania, but pharmacological approaches are tricky and under-studied. Frequent comorbidity and evidence of a possible genetic relationship of bipolar and panic disorders are suggestive of a causal relationship between the 2. Thus, it may be fruitful to look more closely at evidence for common biological abnormalities in both disorders to find a pathophysiological mechanism that links mania, depression, and panic attacks. Mood episodes and panic attacks can both be modeled as the result of deficits in amygdala-mediated emotional conditioning. From this model, some insight may be gained for potentially helpful treatment strategies for the 2 disorders when they occur together.

According to the Centers for Disease Control and Prevention (CDC), there are approximately 50,000 violent deaths each year in the United States. Until recently, there were no comprehensive data available to the public regarding these deaths. It was with this in mind that the National Violent Death Reporting System (NVDRS) was created, not only to provide statistics of reported violent deaths, but also to educate and possibly prevent more violent deaths from occurring.

Generalized anxiety disorder (GAD) is characterized by excessive or unrealistic anxiety and worries about life circumstances. In the general population, the prevalence of GAD is 2% to 5%. It is the most frequent anxiety disorder seen in primary care, where 22% of patients complain of anxiety problems.1 DSM-IV lists 6 somatic symptoms associated with GAD: restlessness, increased fatigability, difficulty in concentrating, irritability, muscle tension, and sleep disturbance. These symptoms may present with hyperarousal, hypervigilance, and heightened muscle tension; autonomic symptoms are milder than in other anxiety disorders and can be absent.

Posttraumatic stress disorder (PTSD) is a severe and often chronic anxiety disorder that can develop following exposure to an event involving actual or perceived threat to the life or physical integrity of oneself or another person. Epidemiological studies such as the National Comorbidity Survey1 estimate that more than half the population of the United States has experienced one or more traumatic events and that 8% of the population has met criteria for lifetime PTSD. Thus, trauma and PTSD are significant mental health problems.

Delirium is a disorder that lies at the interface of psychiatry and medicine. It is an acute organic syndrome caused by an underlying medical condition and is defined clinically by disturbances in cognitive function, attention, and level of consciousness.1 Delirium is considered a syndrome because of the constellation of signs and symptoms associated with the disorder, coupled with a wide variety of potential etiologies.

Pathological gambling (PG) is characterized by persistent and recurrent maladaptive patterns of gambling behavior (eg, a preoccupation with gambling, the inability to control gambling behavior, lying to loved ones, illegal acts, and impaired social and occupational functioning).1 With past-year prevalence rates similar to those of schizophrenia and bipolar disorder,2 it is apparent that PG has become a significant public health issue. The aim of this article, therefore, is to introduce clinicians to the assessment and treatment of PG with the hope that early interventions will reduce the considerable personal and social costs associated with the disorder.

Early findings from a national study are shedding light on differences in the type and prevalence of mental disorders in US-born and immigrant Latinos, as well as differences among Latinos from various countries of origin.

Persons with childhood-onset schizophrenia appear to have the poorest outcome among those in whom schizophrenia is diagnosed.

The Metabolic Syndrome and Schizophrenia: Clinical Research Update

Persons who have anxiety disorders commonly self-medicate with alcohol and other drugs, a recent survey confirmed. The results were published in the November 2006 issue of The Journal of Nervous and Mental Disease.

Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.

Intermittent explosive disorder (IED) is not yet on the radar screens of many psychiatrists, but it is more prevalent than panic disorder and warrants extensive research and attention, 2 experts on IED said recently.

The prevalence of substance use disorders in patients with schizophrenia is greater than the rate observed in the general population, with a dramatic increase since the 1970s. Several theories exist to explain the high rate of comorbidity. The "self-medication" hypothesis suggests that persons may abuse substances to treat underlying psychotic symptoms or adverse effects of medications commonly used to treat schizophrenia.

Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.

More than 1 in 20 adults nationwide suffer from compulsive buying, according to a telephone survey of 2500 adults. And contrary to popular opinion, “compulsive buying appears to be almost as common in men as in women,” according to Lorrin M. Koran, MD, first author of a recently published prevalence study of compulsive buying behavior in the United States. Six percent of women and 5.5% of men in the study reported symptoms considered to be consistent with compulsive buying disorder.

Despite the accepted validity of Hispanic as a distinct demographic and cultural category, we have only fragmentary evidence and scarce guidelines regarding the treatment of mentally ill Hispanic Americans. This article provides a brief review of the topics with the most clinical relevance to diagnosis and treatment of mental disorders in Hispanic Americans.

The skin is the largest organ of the body and functions as a social, psychological, and metabolically active biologic interface between the individual and the environment.

Certainly, with the advent of the atypicals, it has become almost too easy to forget about doing an Abnormal Involuntary Movement Scale (AIMS) checklist. Given the time and reimbursement constraints of current psychiatric practice, however, it is close to impossible to find time for clinical rating scales.

That depression, anxiety, sleep disorders, and other neuropsychological conditions are often associated with chronic pain isn't news to most neurologists. But physicians who do not specialize in pain management are largely unaware of a growing body of research suggesting that the race (a genetic classification) or ethnicity (a cultural classification) of a patient with chronic pain may determine the patient's risk of neuropsychological symptoms.

Office management of attention-deficit/hyperactivity disorder (ADHD) differs in many important ways from ADHD management conducted in a research environment. In clinical trials, treatments and eligible patients are selected in advance by committees, patients are randomized to different management strategies, and both clinicians and pa tients are blinded to the treatments.

Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.

Although studies now suggest that some psychotropic medication regimens have a somewhat higher success rate than the one-third rule would have predicted, psychiatrists are still left with the problem of why it is that only one third to one half of patients who are treated get better, and why fewer still sustain that improvement over time

In the era of Google and PubMed, a medical reference book finds itself in a precarious position. Is there a role for a bundled, unchangeable hard copy of data that may become outdated in the near (and more easily accessed) future?

Despite the progressive increase in the number of available antidepressants, many patients with depression continue to be symptomatic.

If done properly, the assessment of alcohol and substance use disorders in the emergency department (ED) or psychiatric emergency service can be the first step toward recovery.