scholarly journals Risk of Mental and Sleep Disorders After the Diagnosis of Adrenal Adenomas: A Population-Based Cohort Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A94-A95
Author(s):  
Sumitabh Singh ◽  
Catherine Zhang ◽  
Elizabeth Atkinson ◽  
Sara Achenbach ◽  
Andreas Ebbehoj ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Sleep Disorders ◽  
Adrenal Adenoma ◽  
Cortisol Secretion ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Increased Risk ◽  
Substance Abuse Disorders

Abstract Background: Adrenal adenomas are incidentally diagnosed in 7% of adults undergoing abdominal imaging. Mild autonomous cortisol secretion is present in 50% of adrenal adenomas, and even “nonfunctioning” adrenal adenomas demonstrate abnormal steroid profile. We aimed to 1) investigate the prevalence of mental and sleep disorders in patients with adrenal adenomas and to 2) determine the risk of mental and sleep disorders after the diagnosis of adrenal adenoma in patients compared to the referent subjects from the same population Methods: Using a medical records linkage system, we identified adult patients living in the Olmsted County, MN diagnosed with an adrenal adenoma during 1995–2017. Patients with overt hormone excess were excluded. Every patient with adenoma was matched by sex and age to a referent subject from the same population. Subjects were followed until death or end of the study. Mental health related comorbidities and sleep disorders were assessed at baseline and during follow up. Results: Our cohort included 1004 patients with adrenal adenomas and 1004 referent subjects (58% women, median age of 63 years). Patients were more likely to smoke (70% vs 54%, p <0.001) and had a higher BMI (30 kg/m2 vs 28 kg/m2, p < 0.001). Within 5 years prior to the index date (diagnosis of adenoma), and after adjusting for BMI and smoking, patients demonstrated a higher prevalence of depression (Odds ratio, OR of 1.3 (CI95% 1.1–1.6), p=0.02), anxiety (OR of 1.4 (CI95% 1.1–1.8, p=0.003), substance abuse disorders (OR of 2.4 (CI 95% 1.7–3.4), p<0.001), but not insomnia (OR of 1.2 (CI95% 0.9–1.7) and sleep related breathing disorders (OR of 1.3 (CI 95% 0.9–1.7). During follow-up, starting 1 year after the diagnosis, patients demonstrated a higher risk of new onset depression (HR of 1.9, CI95%1.5–2.4), anxiety (HR of 1.5,CI95% 1.2–1.9), schizophrenia (HR of 1.7, CI95% 1.2–2.4), and substance abuse disorders (HR of 1.6, CI95% 1.2–2.0). Risk of sleep disorders 1 year after diagnosis was also high for insomnia (HR of 1.4, CI95% 1.1–1.9), sleep-related breathing disorders (HR of 1.8, CI95% 1.4–2.3), hypersomnias of central origin (HR of 2.0, CI95%1.04–3.96), parasomnias (HR of 2.4, CI95%1.2–4.7), and sleep-related movement disorders(HR of 1.9, CI95%1.3–2.6). Conclusion: Patients with adenomas are at increased risk for mental and sleep disorders, possibly explained by the underlying subtle cortisol secretion. Further prospective studies with an in-depth characterization of both hormonal secretion and mental/sleep disorders are needed. Reversibility or improvement of mental health and sleep disorders with adrenalectomy should be investigated.

Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions

2018 ◽  
Vol 53 (9) ◽  
pp. 547-553 ◽  
Author(s):  
Daniel I Rhon ◽  
Tina A Greenlee ◽  
Bryant G Marchant ◽  
Charles Dennis Sissel ◽  
Chad E Cook
Keyword(s):  
Mental Health ◽  
Metabolic Syndrome ◽  
Substance Abuse ◽  
Chronic Pain ◽  
Sleep Disorders ◽  
Mental Health Disorders ◽  
Hip Surgery ◽  
Cardiovascular Disorders ◽  
Substance Abuse Disorders ◽  
Health Disorders

ObjectivesWe aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy.MethodsData from individuals (ages 18–50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS. Person-level data over 36 months were pulled and aggregated. Seven comorbidities related to poor outcomes from musculoskeletal disorders (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) were examined 12 months prior and 24 months after surgery. Changes in frequencies were calculated as were differences in proportions between presurgery and postsurgery.Results1870 subjects were identified (mean age 32.24 years; 55.5% men) and analysed. There were statistically significant increases (p<0.001) proportionally for all comorbidities after surgery. Relative to baseline, cases of mental health disorders rose 84%, chronic pain diagnoses increased 166%, substance abuse disorders rose 57%, cardiovascular disorders rose by 71%, metabolic syndrome cases rose 85.9%, systemic arthropathy rose 132% and sleep disorders rose 111%.ConclusionsMajor (potentially ‘hidden’) clinical comorbidities increased substantially after elective arthroscopic hip surgery when compared with preoperative status. These comorbidities appear to have been overlooked in major studies evaluating the benefits and risks of arthroscopic hip surgery.Level of evidencePrognostic, level III.

scholarly journals Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045356
Author(s):  
Nick A Francis ◽  
Beth Stuart ◽  
Matthew Knight ◽  
Rama Vancheeswaran ◽  
Charles Oliver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Clinical Deterioration ◽  
Care Services ◽  
Increased Risk ◽  
Remote Assessment ◽  
History Of

ObjectiveIdentify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DesignReal-world prospective observational study.SettingVH remote assessment service in West Hertfordshire NHS Trust, UK.ParticipantsPatients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.Main outcome measureDeath or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.Results900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).ConclusionsThese predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.

Postpartum Depression Risk following Prenatal Diagnosis of Major Fetal Structural Anomalies

2021 ◽  
Author(s):  
Christina L. Herrera ◽  
John J. Byrne ◽  
David B. Nelson ◽  
Rachel C. Schell ◽  
Jodi S. Dashe
Keyword(s):  
Mental Health ◽  
Prenatal Diagnosis ◽  
Postpartum Depression ◽  
Depressive Disorder ◽  
Structural Anomaly ◽  
Depression Risk ◽  
Organ Systems ◽  
Increased Risk ◽  
Structural Anomalies

Objectives Our primary objective was to evaluate how prenatal diagnosis of a major fetal structural anomaly and resulting pregnancy outcome affected postpartum depression risk, as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Secondary objectives were to review the rate of mental health follow-up and subsequent diagnosis of postpartum depression in screen-positive women. Study Design Singleton pregnancies with prenatal diagnosis of one or more major fetal structural anomalies were ascertained from prospectively maintained databases that included perinatal outcomes and subsequent EPDS responses from January 2010 to May 2018. EPDS scores of 13 or higher were considered positive and prompted referral for mental health follow-up, which was verified by medical record review. Statistical analyses were performed using Student's t-test, χ2, and odds ratios (ORs) with p < 0.05 considered significant. Results A total of 1,306 women had a prenatal diagnosis of one or more major fetal structural anomalies, 896 (68%) also had a postpartum EPDS screening, and 82 (9.2%) screened positive. Positive EPDS screening was more common with anomalies of multiple organ systems (16.5 vs 7.8%, p = 0.002) and aneuploidy (17.1 vs 9.3%, p = 0.02). Pregnancies complicated by fetal death, neonatal death, and termination for anomaly were significantly more likely to screen positive than those with neonatal survival to discharge (OR, 3.1 [95% confidence interval [CI], 1.6–6.2], 3.0 [95% CI, 1.5–5.8], and 4.4 [95% CI, 2.1–8.9], respectively, p ≤ 0.002). Of the 35 (43%) screen-positive women who attended follow-up appointments with mental health providers, 18 (51%) were diagnosed with a depressive disorder, accounting overall for 22% of those with a positive EPDS screen. Conclusion Among women with a prenatal diagnosis of a major fetal structural anomaly, those experiencing a perinatal loss or pregnancy termination have an increased risk of positive EPDS screen result compared with who have a neonate surviving to discharge. A depressive disorder was diagnosed postpartum in 22% of these women with a positive EPDS screen. Our findings highlight the mental health needs in this vulnerable population. Key Points

Substance Abuse Co-Occurrence with Mental Health Issues

2021 ◽  
pp. 262-283
Author(s):  
Kirstin Painter ◽  
Maria Scannapieco
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Intervention Strategy ◽  
Screening Tools ◽  
Health Issues ◽  
Emotional Symptoms ◽  
Family Issues ◽  
Substance Abuse Disorders ◽  
Abused Drugs ◽  
Alcohol And Other Drugs

Substance abuse, including the use of alcohol and other drugs, is one of the most prevalent disorders among adolescents and young adults, co-occurring with many other psychiatric and mental health disorders. Some use of alcohol and drugs can be expected during adolescence; however, it is necessary to use screening tools to differentiate between misuse of drugs and alcohol and substance abuse. Some brief and comprehensive screening instruments are mentioned in this chapter for future reference. General indicators of substance abuse disorders such as physical and emotional symptoms, family issues, and social problems are explored, and the chapter discusses some of the most commonly abused drugs. Emphasis is put on incorporating treatments of substance abuse with treatments of mental illness for a more comprehensive intervention strategy for people with co-occurring disorders.

Psychiatric Disability in Ontario

1996 ◽  
Vol 41 (9) ◽  
pp. 564-571 ◽  
Author(s):  
Paula Goering ◽  
Elizabeth Lin ◽  
Dugal Campbell ◽  
Michael H Boyle ◽  
David R Offord
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Psychiatric Disorder ◽  
Affective Disorders ◽  
Community Sample ◽  
Psychiatric Disability ◽  
Life Domains ◽  
Economic Costs ◽  
Substance Abuse Disorders ◽  
Service Need

Objective To describe the disability associated with psychiatric disorder in a community sample in order to refine estimates of service need and identify subgroups with greater priority for intervention. Method Disability is conceptualized broadly as performance difficulties, troubled relationships, and dissatisfaction in various life domains. Data from the Mental Health Supplement are used to compare disability between those with and without disorder and among various subtypes of disorder. Results Although the majority of those with disorder do not report disability, their difficulties with functioning are far greater than for the rest of the population. Those with comorbid or affective disorders typically have more disability than those with anxiety or substance abuse disorders. Conclusions Society needs to recognize the high human and economic costs associated with the prevalence of psychiatric disorder. Assessments of service need and decisions about priorities should take both disorder and disability into consideration.

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