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Children with complex behavioral profiles (e.g., ASD + ADHD) may experience delays in obtaining a final diagnosis. Low-resource or underrepresented groups may be at even greater risk for delayed diagnosis. We assessed the effect of sociodemographic factors, symptom complexity and co-occurring conditions, and identifier of first symptoms on diagnostic trajectories among children aged 3-17 years diagnosed with ASD (n = 52) or ASD + ADHD (n = 352) from a nationally-representative sample. Race/ethnicity and gender disparities were evident in both groups. Race, symptom complexity, and co-occuring conditions predicted age of final diagnosis and wait time between first concern and final diagnosis, both of which were staggeringly high. Results suggest a complex influence of sociodemographic factors on the diagnostic pathway, and risk of health disparities as a function of intersectionality., Author(s): Haylie L. Miller [sup.1] [sup.2] , Morgan Thomi [sup.3] , Rita M. Patterson [sup.4] , Karabi Nandy [sup.5] [sup.6] Author Affiliations: (1) grid.214458.e, 0000000086837370, School of Kinesiology, University of [...]

Purpose: The ability to repair breakdowns in communication is an important pragmatic language skill that helps to maintain clear and meaningful interactions. Examining this ability in genetically based neurodevelopmental disabilities in which pragmatics are affected can provide important information about the precise pragmatic skills impacted across different populations and also help to identify core mechanisms underlying pragmatic impairment that may inform tailored interventions.Method: Individuals with idiopathic autism spectrum disorder (ASD-O; n = 40), fragile X syndrome with comorbid autism spectrum disorder (FXS-ASD; n = 62), FXS without ASD (FXS-O; n = 38), Down syndrome (DS; n = 43), and typical development (TD; n = 42) completed a picture description task in which an examiner prompted for clarification repeatedly to elicit communication repair attempts. Participants' response strategies were compared across diagnostic groups and by sex and examined in relationship to different cognitive abilities.Results: Relatively few group differences were observed in responses to requests for clarification overall. Males with ASD-O responded less to clarification requests than males with FXS-ASD and FXS-O, and males with FXS-ASD responded more inappropriately than males with ASD-O and DS. All male groups became less responsive to prompts for communication repair across the series of requests. Males with TD and FXS-ASD used less effective strategies than females.Conclusion: All groups showed some proficiency in repairing communication breakdowns, although individuals with ASD-O and FXS-ASD demonstrated some key areas of difficulty, highlighting the importance of considering ASD symptomatology in assessment and treatment of males with FXS. Findings also suggest that, across groups, multiple requests for clarification may lead to disengagement from the interaction. Finally, correlated skills observed across groups could implicate different underlying skills related to communication repair abilities across groups., In communicative exchanges, misunderstood messages are typically met with a request for clarification (e.g., 'what?' and 'what do you mean?'). Such requests prompt the speaker to adjust his or her [...]

Byline: Aashik. Shetty, Amrit. Nasta, Amit. Gupte, Ramen. Goel Background: Bariatric surgery leads to a significant improvement in obesity and associated comorbidities. Safe surgical outcomes are especially desirable in bariatric, [...]

In this PsychView custom video series, Debra Stultz, MD, of Stultz Sleep and Behavioral Health in Barboursville, West Virginia, and Stephen Stahl, MD, PhD, of the Neuroscience Education Institute and [...]

Comorbidity in psychopathology is a common phenomenon. However, little is known about the way in which clinicians think about comorbid cases. The Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) implies an additive model of concept combination, but studies of human cognition find that individuals often combine concepts in nonadditive ways. In this study, 70 clinicians listed symptoms for three disorders and their combinations. Participants produced nonadditive descriptions, termed overextensions, at significant rates. These results challenge the utility of the implicit additive model of the current DSM. [c] 2010 Wiley Periodicals, Inc. J Clin Psychol 66:1121-1130, 2010. Keywords: comorbidity; psychcpathology; concept formation; DSM DOI: 10.1002/jclp.20713

Purpose. To examine patterns of colorectal cancer (CRC) treatment and survival in relation to comorbidities (COM), functional limitations (FL), and geriatric syndromes (GS). Methods. Our study population consisted of Ohio elders diagnosed with incident invasive CRC in the period August 1999 to November 2001 and admitted to home health care (HHC) in the 30 days before or after cancer diagnosis (n = 1009). We used data from the Ohio Cancer Incidence Surveillance System, vital records, and Medicare administrative data, including the HHC Outcome and Assessment Information Set (OASIS), which includes detailed clinical data for HHC patients. Counts of COM, FL, and GS at baseline were retrieved from the OASIS. Multivariable logistic and survival models were developed to examine the association between clinical attributes and outcomes, adjusting for demographic covariates and cancer stage. Results. Comorbidities were associated with increased likelihood of surgery-only, but not with surgery + chemotherapy. Both FL and GS were associated with lower likelihood to undergo surgery-only or surgery + chemotherapy. Two or more GS was associated with disease-specific mortality (adjusted hazard ratio [AHR]: 2.71; 95% confidence interval [CI]: 1.80-4.07) and overall mortality (AHR: 2.34: 95% CI: 1.74-3.15). Two or more FL was associated with overall mortality (AHR: 1.33; 95% CI: 1.10-1.62), but not with disease-specific mortality. COM was not associated with overall mortality, but was negatively associated with disease-specific mortality at borderline level of significance (AHR: 0.78; 95% CI: 0.61-1.00). Conclusion. Our findings demonstrate the importance of accounting for FL and GS, in addition to COM, when studying cancer-related outcomes in elders. Key Words: Comorbidities--Functional limitations--Geriatric syndromes--Colorectal cancer. doi: 10.1093/gerona/glp180

Chronic neuropathic pain is a prevalent problem that eludes cure and adequate treatment. The persistence of intense and aversive symptoms, inadequacy of available treatments, and impact of such pain on [...]

Currently, an estimated 38 million individuals 65 years or older live in the United States, and more than 11 million of these individuals are 80 years or older. Older people [...]

The efficacy of drugs for neuropathic pain has been established in randomized controlled trials that have excluded patients with comorbid conditions and those taking complex medications. However, patients with neuropathic [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.04.012 Byline: G. Martinotti (a), V. Carli (b), D. Tedeschi (a), M. Di Giannantonio (c), A. Roy (d), L. Janiri (a), M. Sarchiapone (b) Keywords: Polysubstance dependence; Comorbidity; Childhood trauma; Personality; Suicidal behaviour Abstract: The study aimed to examine the clinical correlates of polysubstance dependence. Author Affiliation: (a) Institute of Psychiatry, Catholic University Medical School, Rome, Italy (b) Department of Health Sciences, University of Molise, Campobasso, Italy (c) Institute of Psychology, University 'G. D'Annunzio', Chieti, Italy (d) New Jersey VA Healthcare System, Psychiatry Service, East Orange, USA

Data from a national health survey is used to describe the prevalence, demographic correlates, and commorbidities of enuresis in a sample of U.S. children. The 12-month prevalence of enuresis is 4.45 percent and boys have this condition significantly more than girls. A strong association between enuresis and attention deficit hyperactivity disorder is found.

The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients. Index Terms: cardiovascular, depression hypertension, posttraumatic stress, PTSD, Several researchers to date have identified a relationship between posttraumatic stress disorder (PTSD) and either cardiovascular disease (CVD) or symptoms of CVD. (1-4) This evidence primarily involves retrospective examination of [...]

The purpose of the current study was to classify adolescents receiving outpatient treatment for alcohol or other drug (AOD) problems via self-reports of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. American Psychiatric Association, 1994) psychiatric symptoms, and to identify group differences in measures of proximal risk factors for sexual risk behaviors (SRBs) and self-reported SRBs. Structured interviews were administered to 300 adolescent clients (202 males, 98 females; M = 16.22 years; SD = 1.13) receiving treatment services as part of a larger National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded randomized clinical trial. Ward's method cluster analysis (Ward, 1963) was used to classify adolescents into distinct groups based on psychiatric symptom profiles. A multivariate analysis of variance was used to identify significant between-cluster differences in self-reported SRBs and proximal risk factors for SRB. Substantial heterogeneity in patterns of psychiatric symptoms was documented in this treatment sample. Membership in certain psychiatric symptom clusters was associated with several self-reported SRBs and correlated proximal risk factors. Among youth receiving AOD treatment, interventions to promote HIV/STI risk reduction may need adaptation for those with differing psychiatric profiles. Keywords: sexual risk behaviors, AOD, person-centered analysis, comorbidity, HIV

Given the high prevalence of hepatitis C virus (HCV) infection among drug users, HCV testing is critical in this population. While many drug treatment programs offer HCV testing, patients often do not utilize this essential program-facilitated service. Summarizing data collected in semi-structured interviews and surveys with patients in 25 programs, this paper identifies barriers and facilitators to being tested for HCV through the program. Barriers include the patient's belief that she/he is not HCV infected, fear of needles, fear of obtaining a positive HCV test result, fear of disclosure of such a result, and fear of inappropriate or disrespectful treatment during the testing process. In addition, 38% of HCV sero-unaware or sero-negative patients completing the survey did not know that HCV testing was offered through their programs. Salient facilitators for those tested through their programs include support from staff in explaining the importance of testing and help in understanding and coping with test results.

The new paradigm of recovery has highlighted the importance of positive social relationships, but little is known about their role in recovery among homeless individuals with serious mental illness and comorbid substance abuse. This study used within- and across-case analyses of longitudinal data from qualitative interviews with 41 dually diagnosed individuals entering residential programs to exit homelessness and receive needed services. Thematic findings include (a) 'loner talk' and the need for privacy; (b) family ties as 'good news, bad news'; (c) when it comes to a partner, other things come first; and (d) in search of positive people. Analyses of change in individual trajectories revealed that stronger social relationships did not coincide exactly with positive outcomes. Although positive life changes were gradual, negative changes could be precipitous. Social relationships were threatened by concentrated disadvantage, that is, a lack of social and economic currency. Findings are discussed with implications for improving services for the most vulnerable individuals who stand to benefit from the era of recovery. Keywords: serious mental illness, substance abuse, social relationships, recovery

Repeat offenders for DUI are routinely mandated to undergo alcohol treatment. These individuals have been shown to have high rates of co-occurring psychiatric disorders, which can be important for the conduct and outcomes of alcohol treatment. The extent to which treatment providers are aware of these disorders and modify treatment accordingly is unknown. As part of a larger study to investigate the impact of sanction conditions on probation outcomes, we screened 233 patients for psychiatric conditions and compared the findings with the psychiatric conditions identified during mandatory treatment by independent treatment providers. Adjusted rates of underdiagnosis were commonly high: 97.2% of bipolar disorder cases, 67.5% of major depression cases, 100% of obsessive-compulsive disorder cases, and 37.3% of drug use disorder cases remained undiagnosed during treatment. Rates of overdiagnosis were low for all disorders, with the exception of drug use disorders. These rates of underdiagnosis represent missed opportunities to improve treatment outcomes among repeat DUI offenders. Keywords: DUI/DWI; Psychiatric comorbidity; Treatment; Underdiagnosis

This article presents lifetime and 12-month prevalence rates and comorbidity for posttraumatic stress disorder (PTSD) among a sample of 428 homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwesteru cities of various populations. About one-third (35.5%) of the runaways met lifetime criteria for PTSD and 16.1% met 12-month criteria for the disorder. More than 90% of the adolescents who met criteria for PTSD met criteria for at least one of the other four diagnoses. Multivariate analyses indicated that correlates of PTSD were age of adolescent, being female, having experienced serious physical abuse and/or sexual abuse from an adult caretaker, and having been assaulted or injured by weapon when on the street. The multiplicative interaction between sexual abuse by caretaker and sexual assault when the adolescents were on their own was statistically significant, indicating that rape victims were highly likely to meet criteria for PTSD regardless of early sexual abuse. At very high levels of early sexual abuse, the probability of meeting criteria for PTSD converges with that for sexual assault victims. Keywords: homeless adolescents; runaways; victimization; posttraumatic stress

Objective: Decreased brain volumes in prefrontal, limbic and parietal areas have been found in women with borderline personality disorder (BPD). Recent models suggest impaired structural and functional connectivity in this [...]

Young offenders internationally have a higher incidence of mental health problems compared with adolescents in the general population. Mental health issues, particularly comorbid presentations, affect the response to and outcome of rehabilitation and hence recidivism of offending. Most information on the mental health of young offenders has derived from studies of incarcerated young offenders, potentially a more disturbed sample of young people than the majority of young offenders who are placed on community orders. Our study investigated young offenders serving community-based orders (n = 800); the sample comprised almost 29% of the available population. Approximately 40% had at least one score in the severe range for psychopathology as assessed by the Adolescent Psychopathology Scale-Short Form (APS-SF) and 17% reported at least one comorbid condition. Twenty-six percent (26%) and 19% of young offenders scored in the severe range on the Substance Abuse and Conduct Disorder scales respectively and 8% scored in the severe range on both scales. Eighteen percent (18.5%; n = 145) had scores in the severe range for Substance Abuse and at least one other subscale (excluding Conduct Disorder); 10.8% (n = 85) had scores in the severe range for Conduct Disorder and at least one other subscale (excluding Substance Abuse); and 2.7% (n = 21) had scores in the severe range for at least two scales excluding Substance Abuse and Conduct Disorder. Young women reported between two and four times greater internalizing pathology and self-harm behavior than young men; however, young women were more characterized by externalizing disorders and anger than they were by depression or anxiety. Notwithstanding, high/very high levels of psychological distress were reported (25%) on the Kessler-10. This sample also reported high rates of child abuse and neglect on the Childhood Trauma Questionnaire and these experiences were associated with more severe externalizing pathology. In the year prior to the study, 8% of the sample had considered suicide, 5% had attempted suicide and 16% had considered or attempted other forms of self-harm. Although as a group the sample revealed high levels of behavioral disturbance and high needs for treatment, a low number reported engagement in any treatment. Recommendations for early intervention as well as tertiary treatment programs are considered. doi: 10.1300/J076v45n01_10 KEYWORDS Juvenile offenders, mental health, child abuse, conduct disorders and substance misuse, rehabilitation

Byline: Elson M. Bihm (1,2), William J. Lammers (1) Keywords: Mental retardation; anxiety; depression; comorbidity; dual diagnosis; cognitions Abstract: We assessed depression, anxiety, and relevant cognitions in persons with mental retardation by administering modified versions of the Reynolds Child Depression Scale, the Beck Anxiety Inventory, the Automatic Thoughts Questionnaire, and the Cognitions Checklist to 46 persons with borderline to moderate mental retardation. Consistent with research with other groups, self-reports of depression and anxiety were highly correlated (r = .74) in these individuals, and cognitions were strong predictors of negative affect. Subscales measuring cognitions related to depression and anxiety were also highly related, limiting the 'cognitive-specificity' hypothesis. Hierarchical multiple regression analyses offered mixed support for cognitive-specificity. We discuss the implications of these findings for the cognitive and affective assessment of persons with intellectual limitations. Author Affiliation: (1) University of Central Arkansas, Conway, Arkansas (2) Department of Psychology and Counseling, University of Central Arkansas, Conway, AR, 72035 Article History: Registration Date: 05/10/2004

This study identified comorbidity (coexistence of substance abuse and mental health diagnoses) rates and characteristics among 104 clients in a substance abuse treatment setting. To identify commonly collected intake variables that can be used for early identification of drug users with coexisting mental health concerns, participants completed a demographics questionnaire, brief symptom inventory, behavior and symptom identification scale (BASIS-32), and a drug and alcohol assessment. Results revealed a comorbidity rate of 45% and significant relationships between comorbidity and the following variables: absence of prior treatment, greater rates of unemployment, poorer physical health, poorer functioning in a variety of areas, greater symptom severity regarding drug use, poorer mental health, and greater rates of homelessness. Of these, the first four variables were the most powerful predictors of comorbidity. It can be concluded that unemployment without looking for work, difficulties relating to self and others, not having received prior outpatient treatment, and having poorer physical health can signal the possible presence of coexisting mental health problems. Implications for early detection and subsequent treatment planning are discussed. Key Words: Comorbidity; Dual diagnosis; Mental health; Assessment; Mental illness, RECOGNIZING COMORBIDITY AMONG DRUG USERS IN TREATMENT The co-occurrence of substance use and other psychiatric disorders has been labeled in a variety of ways, including comorbidity, dual diagnosis, and 'mentally [...]

Findings from a comorbidity case study emphasize the complexities surrounding differential diagnosis of anorexia nervosa, depression, anxiety, psychosis and mental retardation. Data were obtained from a 22-year-old woman with borderline mental retardation, schizoaffective disorder and anorexia nervosa.

Axis I comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. We evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of cognitive-behavioral group treatment and at follow-up, to be more severely impaired than those with no comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential rates of improvement of social anxiety disorder. Keywords: Social phobia; Social anxiety disorder; Comorbidity; Treatment outcome