Comorbidity of opiate dependence and mental disorders

In a 5-year-follow-up study of 350 opiate addicts in contact with a drug help system in Hamburg, 272 clients (78%) were interviewed a second time after 1 year. The objective of the study was to examine the correlation between mental disorders and drug consumption and its relationship to clients' general life situation. In the majority of the opiate addicts, a pattern of polydrug consumption was observed, but the amount of drugs consumed was clearly lower after 1 year. In the initial survey, a mental disorder according to ICD-10 could be diagnosed for 55% of the sample. Among groups formed by the severity and course of mental disorders or their symptoms, a significant correlation was observed, particularly at the time of follow-up, between the extent of drug consumption and the course of the mental disorder. Other areas, like physical health or social problems/conflicts, were also related to comorbidity (i.e., heavy drug consumption and/or mental disorder). These interrelationships should be taken into account in treatment, care and guidance to increase the prospects for successful treatment.     

Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents

We examine the lifetime comorbidity among anxiety disorders, and between anxiety disorders and other mental disorders, in a large (n = 1,507) community sample of high school students on whom extensive diagnostic data were available. Three diagnostic groups were formed: those with a lifetime anxiety disorder (n = 134); those with a nonanxiety disorder (n = 510); and those who had never met criteria for a mental disorder (n = 863). The intra-anxiety comorbidity rate was relatively low (18.7%), and was strongly associated with being female (92%). The lifetime comorbidity between anxiety and other mental disorders (primarily MDD) was substantial (73.1%) and was not associated with being female.     

Reducing risks of mental disorders.

Presents views on the prevention of mental disorders, with a focus on the reports entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research (P. J. Mrazek and R. J. Haggerty, 1994) and The Prevention of Mental Disorders: A National Research Agenda (NIMH Prevention Research Steering Committee, 1994), prepared by the Institute of Medicine (IOM) and the National Institute of Mental Health, respectively. Congress must work closely with NIMH to ensure that recommendations made by the IOM to advance the field of prevention of mental disorders are implemented. Also, the mental health community will need to be proactive with Congress to make a difference in critical decisions about financing for the treatment and prevention of mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common mental disorders, depression and public health

Common Mental Disorders (CMD), particularly depressive disorders, are problems of public health importance and it would seem appropriate to approach them from a public health point of view. In this paper only psychosocial aspects are dealt with, because biological factors are less important in the pathogenesis of CMD. Although there are significant associations between socioeconomic variables and CMD, the association between poverty and CMD seems to be one of the most robust. There is good evidence that low income is associated with CMD, and this relationship may be causal. There is therefore a possibility that changes in social and economic policy that would reduce poverty might also reduce the prevalence of CMD. Future research should try to unravel the mechanisms and causal factors that underlie these common and disabling disorders.     

Compliance with medication regimens for mental and physical disorders

Although the central nervous system (CNS) is often regarded as an immunologically privileged site, it is well established that specific CNS immunoreactivity can be generated through peripheral vaccination with CNS antigens. Dendritic cells (DC) are potent antigen presenting cells of hematopoietic origin that have emerged as a promising tool for cancer immunotherapy capable of evoking significant anti-tumor immunity when pulsed with tumor-associated peptides. To explore a role for DC-based immunization strategies for the treatment of CNS tumors, we developed a brain tumor model using the C3 sarcoma cell line which expresses the tumor-specific, major histocompatibility complex (MHC) class I-restricted peptide epitope E7(49-57). Syngeneic C57Bl/6 mice receiving intravenous (i.v.) injections of bone marrow-derived DCs pulsed with E7 peptide were effectively protected against a subsequent intracerebral challenge with C3 tumor cells. More importantly, this systemic immunization strategy was effective in a therapy model as 67% of animals (10 of 15) with established (day 7) intracerebral C3 tumors treated with 3 weekly injections of E7 peptide-pulsed DCs achieved a long-term survival (>90 days) while no control animals survived beyond day 41. In vivo depletion of CD8+ cells, but not CD4+ or asialo-GM1+ cells, abrogated the efficacy of E7 peptide-pulsed DC therapy of established tumors, indicating a pivotal role of specific CD8+ T-cell responses in mediating the anti-tumor effect. Our findings support the hypothesis that effective CNS anti-tumor immunoreactivity can be generated with DC-based tumor vaccines.     

PTSD symptoms and comorbid mental disorders in Israeli war veterans

BACKGROUND: The purpose of this study was to investigate patterns of mental disorders co-morbid with PTSD symptoms in young Israeli men exposed to combat. METHOD: Six hundred and seventeen subjects were selected via a general population sample and evaluated in a two-phase case-identification procedure, culminating in a modified SADS-L interview, administered by psychiatrists. RESULTS: Major depressive disorder (OR = 3.2), substance use disorders (OR = 1.9) and personality disorders (OR = 3.0) occurred more frequently in men reporting symptoms of PTSD than in men who had been under fire who did not report symptoms. With the possible exception of personality disorders, comorbid disorders did not constitute risk factors for PTSD. Comorbid PTSD and RDC disorders were associated with increased help-seeking. CONCLUSIONS: The results suggest similar rates and types of PTSD comorbidity in Israeli war veterans as in veterans in the US assessed in general population studies, and are consistent with shared risk factors for PTSD and comorbid disorders.     

Sexual assault and mental disorders in a community population.

In a cross-sectional probability survey of 3,132 household adults representing two Los Angeles communities, lifetime diagnoses of nine major mental disorders were compared between those who reported that they had been sexually assaulted at some time in their lives and those who reported no sexual assault. Sexual assault predicted later onset of major depressive episodes, substance use disorders, and anxiety disorders. Those who were assaulted in childhood were more likely than those first assaulted in adulthood to report the subsequent development of a mental disorder. Demographic characteristics of gender, age, Hispanic ethnic background, and education, however, were generally unrelated to the probability of developing any specific disorder after being assaulted. Finally, major depression, drug abuse or dependence, antisocial personality, and phobia were all associated with a higher probability of subsequent sexual assault. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of mental and insomnia disorders in the general population

The co-occurrence of insomnia and mental disorders constitutes the most prevalent diagnosis pattern found in sleep disorder clinics. Yet, there remains a paucity of epidemiological information regarding comorbidity of mental disorders and sleep disorder symptomatology in the general population. The present study showed results based on a large representative French cohort (n = 5,622; 80.7% of the contacted stratified sample). A total of 997 (17.7%) individuals with insomnia complaints were identified and divided into six diagnostic categories: (1) Insomnia related to a Depressive Disorder; (2) Insomnia related to an Anxiety Disorder; (3) Depressive Disorder accompanied by insomnia symptomatology; (4) Anxiety Disorder accompanied by insomnia symptomatology; (5) Primary Insomnia; and (6) isolated insomnia symptomatology. Telephone interviews were conducted using the Sleep-Eval System. Subjects with insomnia related to a Mental Disorder have a longer history of insomnia complaints and are usually younger than those with Depressive or Anxiety Disorders accompanied by insomnia symptoms. Subjects with Insomnia related to a Depressive Disorder experienced more repercussions than any other group. A surprisingly high percentage of individuals with depressive symptomatology had sought independent medical treatment specifically for their sleep problems, which raises the unsettling possibility that many cases of depression go undetected by the general medical community. The distinct predictability of commonly undiagnosed depression leading to chronic depression speaks directly to the imperative that physicians receive additional training in this area of community mental health.     

Outdated practitioner views about family culpability and severe mental disorders

Current theories and research about the etiology and treatment of psychotic disorders increasingly point to the importance of biological factors. Accompanying this shift in the etiological literature has been an accumulation of evidence indicating the need to move away from treatment modalities that make families of people with psychotic disorders feel culpable in the causation or perpetuation of their relatives' disorders. The current study reports the development of a reliable and valid scale to assess the extent to which practitioners have made this shift. It also reports two surveys, the findings of which imply grounds for concern about what many practitioners do when working with clients with severe and persistent mental illness and their families.     

On consumer advocacy and the diagnosis of mental disorders.

This article provides a brief overview of the development of consumer and family advocacy activity during the past 40 years, mentioning the involvement of these groups in the treatment and research arenas and describing a dearth of such activities related to matters of diagnosis. In an attempt to address this relative inattention to diagnostic issues, the article continues by proffering a relative personal account and then reporting the results of a quasi-qualitative study that collected opinions about the diagnostic process from a selected sample of consumers. The results of the latter process indicate that these consumers' opinions primarily focus on issues of billing and insurance, labeling and stigma, axis issues, and multiple and/or changing diagnoses. The article concludes with guarded recommendations as to how mental health professionals can possibly improve the process of diagnosing persons with mental illnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline mental disorders in workers exposed to poisons and their prevention

Studies covered psychic state in workers exposed to poisons. The authors represent clinical and epidemiologic principles of the disorders formation, the prevalence and structure of the disorders caused by various hazards. The article necessitates up-to-date data-processing system for occupational selection, clinical, psychophysiologic, biochemical and experimental psychologic evaluation of current state in workers engaged into liquidation of chemical weapons.     

Comorbid mental disorders: Implications for treatment and sample selection.

Disorders from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) were assessed in a birth cohort of 961 young adults. Comorbid cases exceeded single-disordered cases in chronic history of mental illness, use of treatments, physical health problems, functional interference in daily life, and impaired adaptation across domains such as work, education, health, and social-support networks. Single-disorder cases were also more impaired than nondisordered cases, but comorbid cases were the most severely impaired. Our findings suggest that (a) samples that underrepresent comorbidity (pure single-disorder cases or student samples) will underestimate effect sizes for relations between a disorder and its correlates, whereas samples that overrepresent comorbidity (clinical or adjudicated samples) will overestimate effect sizes, (b) comorbidity is accompanied by complications that challenge treatment planning, compliance, and coordination of service delivery, and (c) comorbidity is associated with physical, educational, and economic problems that make it a broad societal concern. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of mental disorders and psychosocial impairments in adolescents and young adults

Graves' disease is the predominant cause of hyperthyroidism in the pediatric age group. Other disorders must be recognized, however, because adequate management relies on a precise diagnosis. Careful monitoring of the thyroid status is required during this active phase of growth and development.     

Exposure to styrene and mortality from nervous system diseases and mental disorders

Chronic low-dose exposure to solvents has been associated in epidemiologic studies with chronic neurotoxicity, but the evidence is not consistent. Styrene causes acute disturbances in the central and peripheral nervous systems. To determine if exposure to styrene may contribute to chronic diseases of the central nervous system, the authors examined mortality from nervous system diseases, mental disorders, and suicide in relation to styrene exposure in an international historical cohort study. The cohort involved 35,443 workers employed during 1945-1991 in the reinforced plastics industry, where high exposures to styrene occur. Indicators of exposure were reconstructed through job histories and environmental and biologic monitoring data. Poisson regression was used for internal comparisons. Mortality from diseases of the central nervous system (27 deaths) increased with time since first exposure, duration of exposure, average level of exposure, and cumulative exposure to styrene. A quadratic model described best the dose-response shape for cumulative exposure and duration of exposure with the highest risks at around 300 ppm-years and 5 years, respectively, and a subsequent decrease in risk in the highest exposure categories. Mortality from epilepsy increased monotonically with all styrene exposure indicators, while associations for degenerative diseases of the central nervous system were generally weaker. Mortality from mental disorders and suicide decreased with increasing duration of exposure and cumulative exposure, while there was no trend with time since first exposure and average exposure to styrene. These findings suggest that, in addition to the known acute effects, exposure to styrene may contribute to chronic diseases of the central nervous system.     

Psychological prognosis of outcome in the mental disorders.

"A review of the literature on the use of psychological tests for prognosis revealed an extreme amount of variation and contradiction in the indices considered prognostic. In an attempt to partially explain these contradictions, the factor of chronicity was investigated in psychotics." The criteria for a good prognostic study are set forth. 85-item bibliography. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emergency pediatric EEG in mental confusion, behavioral disorders and vigilance disorders: a retrospective study]

In the present study we investigated the effects of acute treatment with acetyl-L-carnitine (50 mg/kg, i.v. 90 min before the sodium cyanide injection) on a sodium cyanide-induced behavioral deficit in the Morris water escape task. In a first experiment the spatial discrimination performance of the rats was found to be dose-dependently impaired after an i.c.v. injection of sodium cyanide (2.5 and 5.0 microg). Acute treatment with acetyl-L-carnitine was found to increase the behavioral deficit after sodium cyanide. These findings were replicated in a second experiment. Based on these results it can be argued that an acute administration of acetyl-L-carnitine appears to potentiate a sodium cyanide-induced behavioral deficit. An additional in vitro experiment with rat brain synaptosomes showed clear effects of administered sodium cyanide on the energy-dependent incorporation of inositol into phosphoinositides and on the ATP concentration. In vitro acetyl-L-carnitine administration had no effect on the sodium cyanide-induced energy depletion. The negative behavioral findings are in contrast with our previously found protective effect of chronic treatment with acetyl-L-carnitine (via drinking water) on the sodium cyanide-induced behavioral deficit. Since chronic acetyl-L-carnitine treatment has no effect on the phosphoinositide metabolism it was suggested that acetyl-L-carnitine may act via the formation of an ATP-independent reservoir of activated acyl groups. Thus, fatty acids as acylated derivatives can be used for reacylation processes during an acute period of energy depletion. However, we have no clear explanation for the discrepancy in behavioral results between the chronic vs acute treatment of acetyl-L-carnitine at present. Further research is needed to characterize the mechanism of action of acetyl-L-carnitine in relation to sodium cyanide.