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ObjectiveTo describe medical comorbidity in persons with Complicated Grief (CG) and to test whether medical comorbidity in individuals with CG is associated with the severity and duration of CG, after adjusting for age, sex, race, and current depressive symptoms.MethodsIn exploratory analyses, we compared data from participants in an NIMH-sponsored multisite clinical trial of CG ("HEAL": "Healing Emotions After Loss") to archival data from participants matched on age, gender, and race/ethnicity, stratified by the presence or absence of current major depression. We used the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) as a measure of medical polymorbidity. We investigated the association between CG and medical comorbidity via multiple linear regression, adjusting for sociodemographic and clinical variables, including severity of depressive symptoms.ResultsChronological age and severity of co-occurring symptoms of major depression correlated with cumulative medical polymorbidity in persons with Complicated Grief. The severity of CG and the time since loss did not correlate with global medical polymorbidity (CIRS-G score). Nor was there an interaction between severity of depressive symptoms and severity of CG symptoms in predicting global CIRS-G score. Cumulative medical comorbidity, as measured by CIRS-G scores, was greater in subjects with current major depression ("DEPRESSED") than in CG subjects, and both DEPRESSED and CG subjects had greater medical morbidity than CONTROLS.ConclusionMedical comorbidity is prevalent in Complicated Grief, associated with increasing age and co-occurring depressive symptoms but apparently not with chronicity and severity of Complicated Grief per se. This observation suggests that treating depression in the context of CG may be important to managing medical conditions in individuals with Complicated Grief to attenuate or prevent the long-term medical sequelae of CG.

Objective: Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This analysis examined the association between adherence to antihypertensive and BD medications and clinical symptoms in patients with BD and comorbid hypertension (HTN) from an ongoing trial to optimize adherence., Method: Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pillcap which captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over 1 week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms., Results: A total of 83 participants with BD and HTN were included. Adherence to BD and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than self-reported antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline; antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline., Conclusions: Adherence levels fluctuated over time and differed based on measurement method in people with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to change in self-reported adherence. BD symptom severity may indicate poor adherence in patients with BD and should be considered in treatment planning., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Author M.S.: Research grants within past 3 years: Intra-Cellular, Merck, Otsuka, Alkermes, International Society for Bipolar Disorders (ISBD), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), Patient-Centered Outcomes Research Institute (PCORI). Consultant in the past year: Alkermes, Otsuka, Janssen, Lundbeck, Teva, Neurelis. Royalties: Springer Press, Johns Hopkins University Press, Oxford Press, UpToDate.

Background: Although anxiety is highly represented in the medically ill and its occurrence has relevant clinical implications, it often remains undetected and not properly treated. This systematic review aimed to report on anxiety, either symptom or disorder, in patients who suffer from a medical illness. Methods: English-language papers reporting on anxiety in medically ill adults were evaluated. PubMed, PsycINFO, Web of Science, and Cochrane databases were systematically searched from inception to June 2021. Search term was "anxiety" combined using the Boolean "AND" operator with "medically ill/chronic illness/illness/disorder/disease." Risk of bias was assessed via the Joanna Briggs Institute (JBI) Critical Appraisal Tools—Checklist for Prevalence Studies. The PRISMA guidelines were followed. Results: Of 100,848 citations reviewed, 329 studies met inclusion criteria. Moderate or severe anxious symptoms were common among patients with cardiovascular, respiratory, central nervous system, gastrointestinal, genitourinary, endocrine, musculoskeletal system or connective tissue, dermatological diseases, cancer, AIDS and COVID-19 infections. The most common anxiety disorder was generalized anxiety disorder, observed among patients with cardiovascular, respiratory, central nervous system, dermatologic diseases, cancer, primary aldosteronism, amenorrhea, and COVID-19 infection. Panic disorder was described for cardiovascular, respiratory, dermatology diseases. Social anxiety was found for cardiovascular, respiratory, rheumatoid diseases. Specific phobias were relatively common in irritable bowel syndrome, gastroesophageal reflux, end-stage renal disease. Conclusion: Anxiety is a major challenge in medical settings. Recognition and proper assessment of anxiety in patients who suffer from a medical illness is necessary for an appropriate management. Future reviews are warranted in order also to clarify the causal and temporal relationship between anxiety and organic illness. [ABSTRACT FROM AUTHOR]

Abstract Background The global burden of anxiety and depressive symptoms become increasing, specifically accounts for high burden of morbidity among patients with medical conditions in low-income countries. The aim was to compare the level of anxiety and depressive symptoms in participants with general medical conditions and community residents in northwest Ethiopia. Methods Comparatively 2625 adults in the community and 1363 patients at health center in Mecha Demographic Surveillance and Field Research Center (MDSFRC) had interviewed. Level of anxiety and depressive symptoms was assessed by Hospital Anxiety and Depression Scale (HADS) and logistic regression analysis was employed with corresponding adjusted OR (AOR) and 95% confidence interval (CI) at p-value less than 0.05 declaration of significant. Results A higher prevalence of high-level anxiety and depressive symptoms, 12.6% with 95% CI; 11.0%, 14.0% and 10.1%, 95% CI; 8.0%, 12% were found among participants at health center compared to community residents, 6.8%, 95% CI; 7.0%, 8.0% and 5.2%, 95% CI; 4.0%, 6.0% at (p value < .0001), respectively. Social support, loss of a parent before age of 18 years, physical/verbal abuse, and having general medical conditions were significantly associated with both high-level anxiety and depressive symptoms. However, factors such as advanced age, perceived relative wealth, living alone, and having a family history of mental illness were associated with high-level of anxiety symptoms, but not with depressive symptoms. Conclusions Proportion of high-level of anxiety and depressive symptoms were found a two-fold higher in patients with medical condition than healthy residents in the community. Patients with medical illnesses should be assess for anxiety and depressive symptoms at health center.

BackgroundAlthough anxiety is highly represented in the medically ill and its occurrence has relevant clinical implications, it often remains undetected and not properly treated. This systematic review aimed to report on anxiety, either symptom or disorder, in patients who suffer from a medical illness.MethodsEnglish-language papers reporting on anxiety in medically ill adults were evaluated. PubMed, PsycINFO, Web of Science, and Cochrane databases were systematically searched from inception to June 2021. Search term was “anxiety” combined using the Boolean “AND” operator with “medically ill/chronic illness/illness/disorder/disease.” Risk of bias was assessed via the Joanna Briggs Institute (JBI) Critical Appraisal Tools—Checklist for Prevalence Studies. The PRISMA guidelines were followed.ResultsOf 100,848 citations reviewed, 329 studies met inclusion criteria. Moderate or severe anxious symptoms were common among patients with cardiovascular, respiratory, central nervous system, gastrointestinal, genitourinary, endocrine, musculoskeletal system or connective tissue, dermatological diseases, cancer, AIDS and COVID-19 infections. The most common anxiety disorder was generalized anxiety disorder, observed among patients with cardiovascular, respiratory, central nervous system, dermatologic diseases, cancer, primary aldosteronism, amenorrhea, and COVID-19 infection. Panic disorder was described for cardiovascular, respiratory, dermatology diseases. Social anxiety was found for cardiovascular, respiratory, rheumatoid diseases. Specific phobias were relatively common in irritable bowel syndrome, gastroesophageal reflux, end-stage renal disease.ConclusionAnxiety is a major challenge in medical settings. Recognition and proper assessment of anxiety in patients who suffer from a medical illness is necessary for an appropriate management. Future reviews are warranted in order also to clarify the causal and temporal relationship between anxiety and organic illness.

Introduction: Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. Methods: Patient data were obtained from the Healthcare Cost and Utilization Project's State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). Results: Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). Conclusion: Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients' psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care. [ABSTRACT FROM AUTHOR]

Objective: Postoperative delirium has many consequences and should be prevented when possible. Non-opioid pain treatments have known delirium prevention benefits, while melatonin has promising prevention data in non-surgical populations. The incidence of postoperative delirium was retrospectively compared in patients prescribed acetaminophen with and without melatonin following orthopedic surgery., Methods: Retrospective data was analyzed in adults ≥65-years-old who were hospitalized within one health system following an orthopedic procedure. Patients receiving at least acetaminophen 1000 mg/day with and without melatonin 1 mg/day for at least 48 hours perioperatively were included. Patients were excluded if they had prior delirium, an intensive care unit placement >24 hours, or other risk factors for developing delirium to reduce confounders. The primary outcome was delirium incidence or positive CAM-ICU score. Key secondary endpoints included hospital length of stay and 30-day hospital readmission., Results: Two hundred patients were assessed, and 134 patients were included in the analysis (ie, 66 acetaminophen plus melatonin, 68 acetaminophen alone). There was a lower rate of delirium when comparing the combination vs acetaminophen alone (5% vs 25%; P = 0.001). There were no differences in 30-day readmission. Patients taking the combination had a longer length of stay than acetaminophen alone (5 vs 4 days; P = 0.04)., Conclusion: Geriatric patients taking acetaminophen plus melatonin after orthopedic surgery had a significantly lower risk of delirium than patients receiving acetaminophen alone. Using combination melatonin and acetaminophen before orthopedic surgery is a promising delirium prevention strategy and should be considered in future prospective trials., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction. The prevention of a complex phenomenon, such as suicide, requires an interdisciplinary approach that provides a comprehensive response to the care needs of people with suicidal behavior (SB). The aim of this study is to investigate the clinical and healthcare features of people presenting thoughts and/or attempts of suicide to define risk factors for recurrence. Methods. A cohort study was carried out with a 6-month follow-up. The cohort consisted of persons admitted to the emergency department of the Hospital Universitario Marqués de Valdecilla (Santander) presenting thoughts and/or attempts of suicide, throughout a 4-month recruitment period: 1-March to 30-June 2015. Sociodemographic and clinical variables were collected in the index episode and visits to the emergency department during the following 6 months. Results. 143 patients were assessed by SB, and it was possible to collect information on recurrence in 110 (average age of 43.31; range 16-84; 65% women). Twenty-one percent presented recurrence of SB: 10% attempted, 6% thoughts, and 5% both; 1 (0.7%) committed suicide; most frequently with age 30-65 years and with a history of mental illness. During follow-up, 60% consulted repeatedly in the emergency department not only for SB but also for other psychiatric or medical reasons, independently of follow-up in the mental health service. Conclusions. Recurrence of SB is common despite being followed up in the mental health service. In addition, people with SB frequently and repeatedly consult the emergency department for other psychiatric and medical reasons, suggesting that the conventional approach to comorbidity with SB is insufficient. Further studies are needed to define risk profiles and design specific interdisciplinary strategies for SB management and suicide prevention, avoiding fragmentation. This will contribute more efficiently to early identification, appropriate management and prevention of suicide recurrences and deaths. [ABSTRACT FROM AUTHOR]

There are a million suicide deaths in the world annually, and 75% of these occur in low- and middle-income countries (LMICs). However, there are limited resources to prevent suicidal deaths in those regions. The aim was to assess the prevalence of suicidal behavior and associated factors among patients visiting for medical care at a health center and residents in the community. A comparative study was employed by interviewing 2,625 residents in the community and 1,363 patients at the health center about suicidal behavior in northwest Ethiopia, from March 2017 to February 2018. Logistic analysis was employed with adjusted odds ratios and 95% confidence interval (CI) and with p -value < 0.05. The total prevalence of suicidal behavior (ideation, plan, and attempt) was found to be 5.6% (with 95% CI range 5–6%). It was found to be 4.4% with 95% CI range 4–5% in residents and 7.9% with 95% CI range 6–9% in patients. Female sex, depressive symptoms, physical/verbal abuse, and feeling stigmatized were identified as a risk factors for suicidal behavior, whereas a healthy lifestyle, such as eating regular meals of fruits and vegetables, doing physical exercise regularly, and having public health insurance were identified as protective risk factors for suicidal behavior even after adjusting for being a patient or not. The proportion of suicidal behavior was double in patients compared with residents. Suicidal behavior should be assessed in patients who visit for medical help and integration of mental health service within the primary health care system is recommended, especially in low-income countries. [ABSTRACT FROM AUTHOR]

There are a million suicide deaths in the world annually, and 75% of these occur in low- and middle-income countries (LMICs). However, there are limited resources to prevent suicidal deaths in those regions. The aim was to assess the prevalence of suicidal behavior and associated factors among patients visiting for medical care at a health center and residents in the community. A comparative study was employed by interviewing 2,625 residents in the community and 1,363 patients at the health center about suicidal behavior in northwest Ethiopia, from March 2017 to February 2018. Logistic analysis was employed with adjusted odds ratios and 95% confidence interval (CI) and with p-value < 0.05. The total prevalence of suicidal behavior (ideation, plan, and attempt) was found to be 5.6% (with 95% CI range 5–6%). It was found to be 4.4% with 95% CI range 4–5% in residents and 7.9% with 95% CI range 6–9% in patients. Female sex, depressive symptoms, physical/verbal abuse, and feeling stigmatized were identified as a risk factors for suicidal behavior, whereas a healthy lifestyle, such as eating regular meals of fruits and vegetables, doing physical exercise regularly, and having public health insurance were identified as protective risk factors for suicidal behavior even after adjusting for being a patient or not. The proportion of suicidal behavior was double in patients compared with residents. Suicidal behavior should be assessed in patients who visit for medical help and integration of mental health service within the primary health care system is recommended, especially in low-income countries.

Methods: A systematic analysis was performed of the medical specialization academic programs of 20 different countries to establish which medical specialties take into account mental health issues in the specialty curricular design and which mental health content these programs address. The criteria that were explored in the educational programs include: 1) name of the medical specialties that take into account mental health content in curriculum design, 2) name of the mental health issues addressed by these programs. After independent review and data extraction, paired investigators compared the findings and reached consensus on all discrepancies before the final presentation of the data. Descriptive statistics evaluated the frequency of the data presented. Results: Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs. In four countries: Bangladesh, Serbia, the Netherlands and France, 50%of all graduate specialty training programs include mental health content. In ten countries: Germany, Sweden, the United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel and Spain, between 20% and 49% of all graduate specialty training programs include mental health content. In six countries - Brazil, Chile, Colombia, Croatia, Kenya, and the United States-less than 20% of all graduate specialty training programs include mental health content. Discussion: The proposal that we have made in this article should be taken into account by decision-makers, in order to complement the different postgraduate training programs with mental health issues that are frequently present with other physical symptoms. It is not our intention that the different specialists know how to treat psychiatric comorbidities, but rather pay attention to their existence and implications in the diagnosis, evolution and prognosis of many other diseases. The current fragmentation of medicine into ever finer specialties makes the management of comorbidity ever more difficult: a reorientation of post- graduate training might improve the situation. [ABSTRACT FROM AUTHOR]

Background: The global burden of anxiety and depressive symptoms become increasing, specifically accounts for high burden of morbidity among patients with medical conditions in low-income countries. The aim was to compare the level of anxiety and depressive symptoms in participants with general medical conditions and community residents in northwest Ethiopia. Methods: Comparatively 2625 adults in the community and 1363 patients at health center in Mecha Demographic Surveillance and Field Research Center (MDSFRC) had interviewed. Level of anxiety and depressive symptoms was assessed by Hospital Anxiety and Depression Scale (HADS) and logistic regression analysis was employed with corresponding adjusted OR (AOR) and 95% confidence interval (CI) at p-value less than 0.05 declaration of significant. Results: A higher prevalence of high-level anxiety and depressive symptoms, 12.6% with 95% CI; 11.0%, 14.0% and 10.1%, 95% CI; 8.0%, 12% were found among participants at health center compared to community residents, 6.8%, 95% CI; 7.0%, 8.0% and 5.2%, 95% CI; 4.0%, 6.0% at (p value <.0001), respectively. Social support, loss of a parent before age of 18 years, physical/verbal abuse, and having general medical conditions were significantly associated with both high-level anxiety and depressive symptoms. However, factors such as advanced age, perceived relative wealth, living alone, and having a family history of mental illness were associated with high-level of anxiety symptoms, but not with depressive symptoms. Conclusions: Proportion of high-level of anxiety and depressive symptoms were found a two-fold higher in patients with medical condition than healthy residents in the community. Patients with medical illnesses should be assess for anxiety and depressive symptoms at health center. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmada şizofreni hastalarının fiziksel hastalık eş tanı profillerinin çıkarılması amaçlanmıştır. Fiziksel hastalıkların sosyodemografik verilere ve klinik özelliklere göre farklılıklar gösterip göstermediğinin tanımlanması planlanmıştır. Gereç ve Yöntem: Çalışmaya Çukurova Üniversitesi Tıp Fakültesi Balcalı Hastanesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı’nda ve Adana Doktor Ekrem Tok Ruh Sağlığı ve Hastalıkları Hastanesi’nde tedavi görmekte olan şizofreni hastaları alındı. Görüşmeler tek bir görüşmeci tarafından 30-45 dakikada gerçekleştirildi. Görüşme sırasında sosyodemografik veri formu, fiziksel hastalıklar listesi ve mevcut fiziksel hastalık listesi görüşmeci tarafından dolduruldu. Bulgular: Çalışmamıza 537 hasta katılmıştır. Hastaların 219'u (%40,8) kadın, 318'i (%59,2) erkektir. Hastaların yaş ortalaması 38,50 ±12,21'dir. Hastaların 495'inde (%92,2) herhangi bir fiziksel hastalık olduğu saptanmıştır. Bu hastalıklardan en sık görüleni 458 (%85,3) hastayla ağız-diş sağlığı problemleridir. Daha sonra ise obezite gelmektedir (170 hasta, %31,7). 3. sıklıkta gözlenen hastalık diyabet olup 50 (%9,3) hastada bulunmuştur. Ardından ise hipertansiyon ve hiperlipidemi gelmektedir (her ikisi de 39 hastada saptanmıştır, %7,3). Sonuç: Elde ettiğimiz bulgular şizofreni hastalarının büyük çoğunluğunun bir fiziksel hastalık eş tanısı olduğunu göstermiştir. Şizofreni hastalarının genel tıbbi durumu ilgilendiren hastalıklarına karşı özenli olmamaları nedeniyle bir kısım hastalıklarının tanısının atlandığı da düşünülünce bu oranların çok daha yüksek olduğu sonucuna varılabilir. Bazı hastalıkların sıklıklarının şizofreni hastalarında arttığına da dikkat edilirse şizofreni hastalarının en önemli ölüm sebeplerinden olan fiziksel hastalık eş tanılarının etkin şekilde tanılanması ve tedavi edilmesi gerekliliği kanaatine varılmıştır.

ObjectiveTo evaluate the effects of medical comorbidity on anxiety treatment outcomes.MethodsData were analyzed from 1004 primary care patients enrolled in a trial of a collaborative care intervention for anxiety. Linear-mixed models accounting for baseline characteristics were used to evaluate the effects of overall medical comorbidity (two or more chronic medical conditions [CMCs] versus fewer than two CMCs) and specific CMCs (migraine, asthma, and gastrointestinal disease) on anxiety treatment outcomes at 6, 12, and 18 months.ResultsAt baseline, patients with two or more CMCs (n = 582; 58.0%) reported more severe anxiety symptoms (10.5 [95% confidence interval {CI} = 10.1-10.9] versus 9.5 [95% CI = 9.0-10.0], p = .003) and anxiety-related disability (17.6 [95% CI = 17.0-18.2] versus 16.0 [95% CI = 15.3-16.7], p = .001). However, their clinical improvement was comparable to that of patients with one or zero CMCs (predicted change in anxiety symptoms = -3.9 versus -4.1 at 6 months, -4.6 versus -4.4 at 12 months, -4.9 versus -5.0 at 18 months; predicted change in anxiety-related disability = -6.4 versus -6.9 at 6 months, -6.9 versus -7.3 at 12 months, -7.3 versus -7.5 at 18 months). The only specific CMC with a detrimental effect was migraine, which was associated with less improvement in anxiety symptoms at 18 months (predicted change = -4.1 versus -5.3).ConclusionsEffectiveness of the anxiety intervention was not significantly affected by the presence of multiple CMCs; however, patients with migraine displayed less improvement at long-term follow-up. Trial Registration ClinicalTrials.com Identifier: NCT00347269.

Background: Atrial fibrillation (AF) secondary to non-cardiac surgery and medical illness is common and, although often transient, is associated with an increased risk of stroke and mortality. This pilot study tested the feasibility of self-monitoring to detect recurrent AF in this setting and the frequency with which it occurred. Methods: Patients with new secondary AF after non-cardiac surgery or medical illness that reverted to sinus rhythm before discharge were recruited in three tertiary hospitals in Australia. Participants performed self-monitoring for AF recurrence using a Handheld single-lead ECG device 3–4 times/day for 4-weeks. Results: From 16,454 admissions, 224 (1.4%) secondary AF cases were identified. Of these, 94 were eligible, and 29 agreed to participate in self-monitoring (66% male; median age 67 years). Self-monitoring was feasible and acceptable to participants in this setting. Self-monitoring identified AF recurrence in 10 participants (34%; 95% CI, 18% −54%), with recurrence occurring ≤ 9 days following discharge in 9/10 participants. Only 4 participants (40%) reported associated palpitations with recurrence. Six participants (60%) with recurrence had a CHA2DS2-VA score ≥ 2, suggesting a potential indication for oral anticoagulation. Conclusions: Approximately 1 in 3 patients with transient secondary AF will have recurrent AF within nine days of discharge. These recurrent episodes are often asymptomatic but can be detected promptly using patient self-monitoring, which was feasible and acceptable. Future research is warranted to further investigate the incidence of secondary AF, the rate of recurrence after discharge and its prognosis, and whether use of oral anticoagulation can reduce stroke in this setting.

Given the differences in the pharmacological and clinical effects of antidepressants, criteria for their differential choice in the treatment of depression associated with comorbid medical illnesses are suggested. Based on these criteria and general rules of clinical pharmacology, principles of antidepressant treatment in patients with comorbid medical illnesses aimed to optimize the therapeutic process and to prevent treatment resistance are developed.

Management of treatment-resistant depression is one of the most important problems in modern psychiatry. Comorbidity of depression with medical diseases is one of the predisposing factors for the development of treatment resistance due to various mechanisms, including genetic, endocrine, neuroimmune, pharmacogenic, psychosocial, etc. Along with the efforts to reduce the negative effects of the above-mentioned mechanisms (limited by currently available therapeutic options), optimization of antidepressant treatment with regards to existing comorbid medical problems is important for prevention of treatment resistance development.

Depression is widely reported in patients with physical illness, but its prevalence varies in studies and differs from one disease to another. In patients with depression, severity of symptoms may be different in various medical conditions and responses to treatment. We aimed to systematically (a) compare the prevalence of depression between medical illness patients and mentally healthy subjects, (b) assess whether there is an independent association between medical illness and depression, (c) identify associated factors used in interventions (d) and review the relationship between depression and baseline disease severity and treatment outcomes. We studied 24 researches that had examined medical illness and depression in Mazandaran province, Iran. The prevalence of possible depression in patients with physical illness ranged from 13.1 to 67.4%, depending on diagnostic methods and sensitivity of various depression scales. Depression was found to have a negative influence on the outcomes of physical illness and treatment response. The significant outbreak of mental disorders, especially depression in patients with physical illness, and the negative impact of mental disorders on the control and treatment of diseases call for regular psychiatric counseling.

Background: A caregiver is an individual who provides assistance and assumes the responsibility for the physical and emotional needs of another individual who is incapable of self-care. Caregiver burden is a universal phenomenon and more than half of the caregivers experience burden in their role as caregivers. There is a paucity of studies to understand the burden and coping strategies of caregivers in chronic psychiatric illness and chronic medical illnesses, especially in the Indian scenario. Aims and Objectives: (i) To compare the caregiver burden in chronic psychiatric illness and chronic medical illness (ii) To compare the caregiver efficacy in chronic psychiatric illness and chronic medical illness. Materials and Methods: The study sample included caregivers of inpatients admitted in a tertiary care hospital in South India. A total of 120 caregivers were included in the study with 60 caregivers from psychiatric ward and medicine ward, respectively. The caregivers were then assessed using the Caregiver Burden Scale and the Revised Caregiver Self-efficacy Scale Results and Conclusion: We found that majority of the caregivers were first-degree relatives and women constituted a major part of the caregiver group. Caregiver burden was significantly higher in psychiatric illnesses compared to medical illnesses. Caregiver efficacy was similar in both study groups. Interventions to reduce caregiver burden and to improve caregiver efficacy should be implemented to ensure optimal management of both patient and caregiver.

Aim: The association between various physical illnesses and schizophrenia spectrum disorder (SSD) is well‐established. However, the role of gender remains unclear. The present study explored the gender‐based differences in the prevalence and early onset of chronic physical multimorbidities (CPM) in patients with SSD and the general population (GEP). Methods: We recruited 329 SSD patients and 837 GEP controls in this nested cross‐sectional study. The primary outcome was the prevalence of the chronic physical multimorbidities, especially in the youngest age group (<35 years). Results: Women with SSD had more than double the odds for having CPM than men (OR = 2.47; 95% CI 1.35‐4.50), while the gender‐related burden of chronic diseases in controls was nearly the same (OR = 0.89; 95% CI 0.65‐1.22). Furthermore, the prevalence of chronic disease in younger women patients was significantly higher than in controls (P =.002), while younger men did not seem to experience this increased comorbidity burden. Conclusions: This study suggests that women with SSD are at increased physical comorbidity risk compared to men, particularly early in the course of psychiatric illness. Tailored and individualized treatment plans must consider this, aiming to deliver holistic care and effective treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: More studies are needed on how depressive symptoms in stroke patients can impact outcomes. We evaluated the relationship between depression symptom severity and motor outcomes in a cohort of patients with motor impairment from ischemic stroke. Method: We enrolled consecutive ischemic stroke patients without a clinical diagnosis of depression who presented to a single-center urban academic referral hospital. The Patient Health Questionnaire-9 (PHQ-9) scale was used to measure depression symptom severity at three months. Three assessments of motor function were collected at stroke onset and three months: Fugl-Meyer upper extremity (FM-UE), Motricity Index, and Action Research Arm Test (ARAT). We assessed the association between three-month severity on PHQ-9 scores with the outcome measures using univariable and multivariable linear regression models. Results: Fifty-seven patients (mean age 67.8 ± 17.0 years; 50.9% male; 59.6% Caucasian) were included in the final analysis. Mean (standard deviation) outcome scores at three months were PHQ-9: 6.39 (5), Motricity Index: 86.93 (30.04), FM-UE: 52.67 (17.83), and ARAT: 43.77 (20.03). After adjusting for age, initial National Institute of Health Stroke Scale, and if patient discharged after hospitalization on a selective serotonin reuptake inhibitor, sex, and baseline motor outcome, we found that for every point increase in PHQ-9, the Motricity Index decreased by 0.82 points (p = 0.02) and the FM-UE decreased by 0.77 points (p = 0.049). Conclusion: Depressive symptoms are common in the stroke population. Depressive symptoms after stroke are associated with multiple types of motor impairments. We need better understanding of the biologic and psychologic aspects of depression involved in stroke recovery. [ABSTRACT FROM AUTHOR]

Unwell medical students and trainees may pose significant medical risks to the patients and ethical challenge for colleagues, clinical supervisors and governing institutions. Medical students who suffer from medical or psychological illnesses, which directly affect their function, may deem hazardous for the safety of the patients. Fitness to practice is crucial element in decision-making, to prevent potential fatal consequences of students' action. We presented a case of a determined medical student who was diagnosed with epilepsy, complicated with unresolved post-traumatic stress symptoms from his dark teenager years. He struggled academically during his training as a doctor. There are many ethical questions regarding his fitness to practice at this stage and the need for supportive measures following the completion of his medical training. Maintaining his individual confidentiality and rights are discussed here, tailoring to the potential benefits and harms. Managing ethically challenged and sick medical students involve compassion, non-stigmatised and sound moral judgement in order to resolve future shortcomings according to Malaysian context. [ABSTRACT FROM AUTHOR]

Family caregivers can be at risk for emotional, mental, and physical health problems. The purpose of this study was to determine if brief mindfulness training was effective in reducing stress levels of family caregivers and to compare the ways that this treatment is studied. Family caregivers (N = 12) were randomly assigned to 5 hours of mindfulness training either all in one day ("all day" treatment) or in weekly installments of 75 minutes over 4 weeks ("4-week" treatment). In both groups, family caregivers experienced increased mindfulness and stress reduction. Implications and recommendations for group leaders are offered in this article. [ABSTRACT FROM AUTHOR]

Abstract Background Childhood maltreatment (abuse and neglect) can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood. Emerging evidence suggests that a history of childhood maltreatment is linked to the comorbidity between medical illnesses and mood disorders. However, existing studies on bipolar disorder have not yet explored the specific influence of child neglect and have not included comparisons with individuals without mood disorders (controls). This study aimed to extend the existing literature by examining the differential influence of child abuse and child neglect on medical morbidity in a sample of bipolar cases and controls. Methods The study included 72 participants with bipolar disorder and 354 psychiatrically healthy controls (average age of both groups was 48 years), who completed the Childhood Trauma Questionnaire, and were interviewed regarding various medical disorders. Results A history of any type of childhood maltreatment was significantly associated with a diagnosis of any medical illness (adjusted OR = 6.28, 95% confidence intervals 1.70–23.12, p = 0.006) and an increased number of medical illnesses (adjusted OR = 3.77, 95% confidence intervals 1.34–10.57, p = 0.012) among adults with bipolar disorder. Exposure to child abuse was more strongly associated with medical disorders than child neglect. No association between childhood maltreatment and medical morbidity was detected among controls. Conclusions To summarise, individuals with bipolar disorder who reported experiencing maltreatment during childhood, especially abuse, were at increased risk of suffering from medical illnesses and warrant greater clinical attention.

This paper and its second part (Sanz & García-Vera, 2017) analyze the veracity of ten ideas about depression and its treatment that are defended in media widely available on the Internet or in some prestigious clinical practice guidelines or manuals of psychopathology or psychiatry. These ideas hinder patients’ access to appropriate treatment for their depression and favor the medicalization of this treatment over the use of psychotherapy. In this first paper, four ideas about the nature of depression are contrasted with the results of the scientific literature. A review of this literature indicates that, contrary to these ideas: a) depression is considered a mental disorder, not a mental illness; b) the existence of a biological cause is simply a hypothesis, not a reality proven empirically in an unequivocal manner; c) negative life events increase the risk of depression whereas extraversion and optimism diminish it, and d) there are small but not insignificant rates of malingered depression in both legalforensic and ordinary clinical settings. The results of this review are discussed in the context of the reliability of the health information on the Internet.

Max Karukivi,1,2 Kirsi-Maria Haapasalo-Pesu3 1Unit of Adolescent Psychiatry, Satakunta Hospital District, Pori, Finland; 2Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland; 3Psychiatric Care Division, Satakunta Hospital District, Harjavalta, Finland Background: Adolescence is a developmentally sensitive stage, during which a medical illness may have an effect on individual development, and vice versa. Chronic medical illnesses in adolescents have been associated with psychiatric symptoms. The aim of the present register-based pilot study was to assess whether, and to what extent, different medical diagnoses predict subsequent use of mental health services among adolescents. Methods: The study material comprised data on visits to a pediatric clinic by 12- to 16-year-old adolescent patients over a period of 5 years. Altogether, 10,154 visits by 1,781 patients were identified. The associations of the medical diagnoses with a subsequent visit to the adolescent psychiatry clinic were analyzed using logistic regression. Results: During the follow-up period, 299 patients (16.8%) visited or contacted the adolescent psychiatry clinic at least once. Of various diagnoses, the highest odds ratios (ORs) were observed for diabetes mellitus (OR=4.07, p

Background: Limited studies have explored the impact of arthritis, other medical illnesses on morale in the elderly. Our study is aim to assess the association between arthritis and morale among Chinese nonagenarians and centenarians. Methods: This work was conducted as a cross-sectional study. The presence of arthritis, other medical illnesses was based on the subjects' report of diagnoses as told by their doctors and medical records from the investigation. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to measure morale. Low morale was defined as PGCMS score

Objective: Hereditary angioedema is a serious disease with unpredictable attacks. It has an impact on patients' health-related quality of life. This study aimed to assess the quality of life of the hereditary angioedema patients and to investigate the relationship between quality of life and demographic, clinical, laboratory, and psychiatric parameters. Method: A semistructured face-to-face interview, Hamilton depression rating scale, and Hamilton anxiety rating scale were performed by a psychiatrist. Participants completed Medical Outcomes Study Short Form-36, Revised Form of the Multidimensional Scale of Perceived Social Support, Anxiety Sensitivity Index-3, and Adult Separation Anxiety Questionnaire. Patients' complement results were recorded, and clinical data obtained by interview were cross-checked from patients' files. Results: In 33 hereditary angioedema patients, subscales of the Study Short Form-36, except for physical functioning, vitality, and mental health were significantly lower compared with population norms. Quality of life scores were found to be correlated with depression, anxiety, anxiety sensitivity, separation anxiety, perceived social support, perceived discrimination, perceived limitation, treatment naïve C1-Inhibitor function, and C1q level. Physical role functioning scores were better in the patients using attenuated androgens (p = 0.006, t = −3.027). Hereditary angioedema contributed to the marital problems and childbearing decisions of the patients. Conclusion: Hereditary angioedema results in significant impairment in quality of life of the patients and has an impact on family life and life style of the patients. In case of depressive and/or anxiety symptoms, patients should be referred to psychiatrists for better quality of life. Higher levels of C1-inhibitor function and C1q seem to correlate with better quality of life; these needs to be further studied. [ABSTRACT FROM AUTHOR]

Since long back, homosexuality was the major subject of research for various Psychologists and Physicians and after the various research carried out in the field of behavioral, medical, and social sciences, it is matter of subject for various psychologists and physicians either homosexuality is a medical disability or it is cause of social development. Moreover, the scientist has envisaged that the classification of homosexuality is neither a cause of medical illness nor deficiencies of psychological development. Most of scientist has emphases on the matter and tried to describe the issue on based of various researches and studies. [ABSTRACT FROM AUTHOR]

Introduction: Concomitant obesity and chronic medical illness is a significant health problem in Malaysia and worldwide. The comorbid psychological impact in obese patients is associated with a social stigma and low self-esteem. The aim of this study was to determine the prevalence and the factors associated with depression, anxiety and stress in obese patients with chronic medical illnesses attending an outpatient clinic. Methods: This was a cross-sectional study among obese patients with chronic medical illnesses presenting at the Universiti Sains Malaysia Hospital outpatient clinic. A total of 274 patients were involved. The 21-item Depression, Anxiety and Stress Scale questionnaire was used, and the results were evaluated using single and multiple logistic regression analyses. Results: The prevalences of depression, anxiety and stress among the obese patients with chronic medical illnesses were 13.9%, 23.4% and 10.9%, respectively. Younger age [p=0.003, adjusted odds ratio (AOR),1.0; 95%confidence interval (CI),0.91-0.98], unemployed employment(p=0.013, AOR,3.7;95% CI,1.32-10.09) and smoking (p=0.022, AOR,3.2; 95% CI,1.18-8.55) were associated with depression. No formal education (p=0.011, AOR,5.7; 95%CI,1.49-21.89), high body mass index (p=0.029, AOR,1.1;95% CI,1.01-1.13) and family history of psychiatric illness (p=0.018, AOR,5.1; 95% CI,1.33-19.56) were associated with anxiety. Stress was strongly associated with females (p=0.004, AOR,5.0; 95% CI,1.70-15.13) and smoking(p=0.002, AOR,6.5; 95% CI,2.03-20.7). Conclusion: Interestingly, younger age group was associated with depression. Current smokers, no education, family history of psychiatric illness and female sex were significantly associated with anxiety and stress. This notifies new emerging knowledge on factors associated with obese patients that would empower the development of effective preventive strategies for it. [ABSTRACT FROM AUTHOR]

Aim: Whether some diseases are related to the occurrence of synchronous colorectal carcinoma (sCRC) is unknown. Investigating the risk factors and presentation of sCRC could aid in the treatment of patients with colorectal cancer (CRC). The prognosis of sCRC compared with that of solitary CRC remains unclear. Methods: A total of 17 093 CRC patients were recruited between 1st January 1995 and 31th December 2016. The risk factors of sCRC development were assessed using univariate and multivariate logistic regression. The effect of sCRC on survival was analysed using the multivariate Cox regression model. Results: The prevalence of sCRC was 5.6% in this study. The independent risk factors of sCRC development were advanced age (P < 0.001), male sex (P < 0.001), hereditary cancer (P < 0.001), hypertension (P < 0.001) and liver cirrhosis (P = 0.024). Compared with solitary CRC, a higher number of patients with sCRC presented with an abnormal carcinoembryonic antigen (CEA) level (P = 0.011), anaemia (P < 0.001) and hypoalbuminemia (P < 0.001). Multivariate analysis revealed that sCRC was a significant factor for poor survival in patients at TNM Stage I [hazard ratio (HR) = 1.86; P < 0.001], Stage II (HR = 1.65; P < 0.001) and Stage III (HR = 1.40; P < 0.001). Conclusions: In addition to hypertension and liver cirrhosis, other risk factors for sCRC were identified in this study. The prognosis of patients with sCRC was significantly worse than that of those with solitary CRC through TNM Stages I to III. Anaemia, abnormal CEA and hypoalbuminemia were more commonly seen in patients with sCRC. [ABSTRACT FROM AUTHOR]

Background:The main reasons for admission to the medical wards in high -income countries are non communicable diseases While communicable diseases are the main reasons for admission to the medical wards in low and middle income countries. However, the reasons for admission are changing from communicable diseases to non-communicable diseases in some low and middle income countries. Objective: To assess the frequency and the pattern of medical diseases for patients admitted to the medical wards of Sulaimani Teaching Hospital during the year 2015. Patients and Methods: A retrospective study was conducted in Sulaimani Teaching Hospital for 26700 medical records of the patients who were admitted to the medical wards during the year 2015 (started from 1st January to 31th December), All the patients that had been admitted to the medical wards of Sulaimani Teaching Hospital during the year 2015 were referred from medical emergency department and outpatient clinics in addition to the private clinics. The data were obtained from medical records of the patients in statistic unit of the hospital. The variables involved in the study included age of the patients, gender, residency and final diagnosis. Results: This study included 26700 patients that have been admitted to Sulaimani Teaching Hospital, 14853 (55.62%) were females and 11847(44.38%) were males. Most admitted age groups were between 51- 60 years (18.16%) followed by 61-70 years (17.52%) ,71 years and more (16.58%) , 41-50 years (14.92%) ,21-30 years (13.36%) , 31-40 years (12.79%) while the least admitted age group was less than 20 years (6.67%), 62.85% of the patients were from urban areas and 37.15% were from rural areas. Gastroenteritis was the most common medical illness (6.45%), followed by CerebroVascular Accidant CVA (6.27%),Chronic Obstructive Pulmonary Disease COPD (5.52%),Hypertension HT (4.25%),Diabetes Mellitus DM (4.23%),Bronchial Asthma (2.80%),Heart Failure HF (2.60%),Pneumonia (2.28%),Urinary Tract Infection UTI(1,92%),Anaemia (1.86%) ,Miscellaneous diseases(35.78%) and finally the diseases that not diagnosed (26.04%).The highest number of admissions were in Summer comprising (26.96%) of all admissions followed by in Autumn (25,10%) then in Spring (24,34%) and the lowest in Winter comprising (23.60%) of all admissions.The highest number of admission were in July comprising (9.42%) of all admissions followed by June(8.87%), October(8.72%),August(8.68%),May(8.43%),September(8.36%) December(8.30%),April(8.15%),November(8.02%),January(7.97%),March(7.76%) and the lowest in February(7.32%) of all admissions. Conclusion: The commonest age group for admission is 51-60 year. Admission rate more common in females than in males and it is more common in Summer than in Winter. There is a seasonal variation in the hospital admission. The non-communicable diseases represent the main causes for medical admission than the communicable diseases. [ABSTRACT FROM AUTHOR]

Acutely ill medical patients are at risk of venous thromboembolism (VTE) and VTE-related mortality during hospitalization and posthospital discharge, but widespread adoption of extended thromboprophylaxis has not occurred. We analyzed a subpopulation within the MAGELLAN study of extended thromboprophylaxis with rivaroxaban to reevaluate the benefit risk profile. We identified 5 risk factors for major and fatal bleeding after a clinical analysis of the MAGELLAN study and analyzed efficacy and safety with these patients excluded (n = 1551). Risk factors included: active cancer, dual antiplatelet therapy at baseline, bronchiectasis/pulmonary cavitation, gastroduodenal ulcer, or bleeding within 3 months before randomization. We evaluated efficacy, safety, and benefit risk using clinically comparable endpoints in the subpopulation. At day 10, rivaroxaban was noninferior to enoxaparin (relative risk [RR] = 0.82, 95% confidence interval [CI] = 0.58-1.15) and at day 35 rivaroxaban was significantly better than enoxaparin/placebo (RR = 0.68, 95% CI = 0.53-0.88) in reducing VTE and VTE-related death. Major bleeding was reduced at day 10 (RR = 2.18, 95% CI = 1.07-4.44 vs 1.19, 95% CI = 0.54-2.65) and at day 35 (2.87, 95% CI = 1.60-5.15 vs 1.48, 95% CI = 0.77-2.84) for MAGELLAN versus this subpopulation, respectively. The benefit risk profile was favorable in this subpopulation treated for 35 days, with the number needed to treat ranging from 55 to 481 and number needed to harm from 455 to 1067 for all pairwise evaluations. Five exclusionary criteria defined a subpopulation of acutely ill medical patients with a positive benefit risk profile for in-hospital and extended thromboprophylaxis with rivaroxaban. [ABSTRACT FROM AUTHOR]