Comorbidity between mood and substance-related disorders: A systematic review and meta-analysis

Background and Objectives: Evidence indicates that mood disorders often co-occur with substance-related disorders. However, pooling comorbidity estimates can be challenging due to heterogeneity in diagnostic criteria and in the overall study design. The aim of this study was to systematically review and, where appropriate, meta-analyse estimates related to the pairwise comorbidity between mood disorders and substance-related disorders, after sorting these estimates by various study designs. Methods: We searched PubMed (MEDLINE), Embase, CINAHL and Web of Science for publications between 1980 and 2017 regardless of geographical location and language. We meta-analysed estimates from original articles in 4 broadly defined mood and 35 substance-related disorders. Results: After multiple eligibility steps, we included 120 studies for quantitative analysis. In general, regardless of variations in diagnosis type, temporal order or use of adjustments, there was substantial comorbidity between mood and substance-related disorders. We found a sixfold elevated risk between broadly defined mood disorder and drug dependence (odds ratio = 5.7) and fivefold risk between depression and cannabis dependence (odds ratio = 4.9) while the highest pooled estimate, based on period prevalence risk, was found between broadly defined dysthymic disorder and drug dependence (odds ratio = 11.3). Based on 56 separate meta-analyses, all pooled odds ratios were above 1, and 46 were significantly greater than 1 (i.e. the 95% confidence intervals did not include 1). Conclusion: This review found robust and consistent evidence of an increased risk of comorbidity between many combinations of mood and substance-related disorders. We also identified a number of under-researched mood and substance-related disorders, suitable for future scrutiny. This review reinforces the need for clinicians to remain vigilant in order to promptly identify and treat these common types of comorbidity.

Coronavirus disease 2019 and its impact on psychosocial aspects amongst infertile couples: An overview

Following the outbreak of the coronavirus pandemic, there has been an unforeseen pressure and stress to the already burdened health-care systems. This necessitated an urgent need to reallocate the health-care resources and prompted immediate suspension and postponement of non-emergent health-care services including infertility treatments. This pandemic brought additional stress to the couples seeking infertility treatment and resulted in an indefinite time lag to their treatment thereby adding to the psychological distress among this vulnerable population. The coronavirus disease 2019 (COVID-19) has also predisposed them to various psychiatric disorders by affecting their mental, reproductive, and relationship status. These included emotional disorders ranging from frustration, depression, anxiety, hopelessness, and guilt, feelings of worthlessness in life to psychiatric disorders such as generalized anxiety disorder, major depressive disorder, and dysthymic disorder. The social isolation imposed grave psychological consequences and lead to an unpredicted change in attitudes and beliefs of such infertile couples. The implication of the loss of employment has further dwelled on their financial constraints and made this population even more labile. Thus, the current time has brought forth some unique and unexpected challenges and emotional turmoil that needs due recognition and prompt professional support. Furthermore, it is high time to review our health-care policies and hence restart infertility services striking a balance between the safety of both patient and health-care professionals amidst this pandemic while helping these unfortunate couples achieve parenthood. The resumption of infertility services post-COVID-19 has challenges of its own. The clinician and the paramedical staff had to undergo specific training to adapt to the new norms of workplace while minimizing in person interactions and exposure risk.

Simulation study to demonstrate biases created by diagnostic criteria of mental illnesses: major depressive episodes, dysthymia, and manic episodes

ObjectivesComposite diagnostic criteria alone are likely to create and introduce biases into diagnoses that subsequently have poor relationships with input symptoms. This study aims to understand the relationships between the diagnoses and the input symptoms, as well as the magnitudes of biases created by diagnostic criteria and introduced into the diagnoses of mental illnesses with large disease burdens (major depressive episodes, dysthymic disorder, and manic episodes).SettingsGeneral psychiatric care.ParticipantsWithout real-world data available to the public, 100 000 subjects were simulated and the input symptoms were assigned based on the assumed prevalence rates (0.05, 0.1, 0.3, 0.5 and 0.7) and correlations between symptoms (0, 0.1, 0.4, 0.7 and 0.9). The input symptoms were extracted from the diagnostic criteria. The diagnostic criteria were transformed into mathematical equations to demonstrate the sources of biases and convert the input symptoms into diagnoses.Primary and secondary outcomesThe relationships between the input symptoms and diagnoses were interpreted using forward stepwise linear regressions. Biases due to data censoring or categorisation introduced into the intermediate variables, and the three diagnoses were measured.ResultsThe prevalence rates of the diagnoses were lower than those of the input symptoms and proportional to the assumed prevalence rates and the correlations between the input symptoms. Certain input or bias variables consistently explained the diagnoses better than the others. Except for 0 correlations and 0.7 prevalence rates of the input symptoms for the diagnosis of dysthymic disorder, the input symptoms could not fully explain the diagnoses.ConclusionsThere are biases created due to composite diagnostic criteria and introduced into the diagnoses. The design of the diagnostic criteria determines the prevalence of the diagnoses and the relationships between the input symptoms, the diagnoses, and the biases. The importance of the input symptoms has been distorted largely by the diagnostic criteria.

Parent- and child-reported anxiety disorders differentiating major depressive disorder and dysthymic disorder in children and adolescents

Objective: To date, specific parent- and child-defined anxiety disorders associated with dysthymic disorder (DD; DSM-5 persistent depressive disorder equivalent) with and without major depressive disorder (MDD) have not been investigated in children and adolescents. Method: In a cross-sectional study, we compared point prevalence rates of parent- and child-reported anxiety disorders in DD alone ( N = 154), MDD alone ( N = 29), comorbid DD and MDD ( N = 130) and anxiety disorders alone ( N = 126) groups. Results: DD alone and MDD alone did not differ with respect to comorbid anxiety disorders from parent and child reports, while parent-reported panic disorder (PD) was significantly increased in the DD and MDD group compared to the other three groups as was child-reported post-traumatic stress disorder (PTSD) compared to the MDD alone and anxiety disorders alone groups. In contrast, specific phobia (SpPh) was significantly increased in the anxiety disorders alone group compared to the DD and MDD group. Conclusion: The findings suggest that specific fear-related anxiety disorders, especially parent-reported PD and child-reported PTSD, may aid the early recognition of DD and MDD.

Cytokine profile and antibodies to neurotransmitters during comorbid depression and alcohol dependence in women

Цель исследования - сравнительный анализ содержания про- и противовоспалительных цитокинов и аутоантител к нейромедиаторам дофамину, норадреналину, серотонину, глутамату и ГАМК в сыворотке крови пациенток с алкогольной зависимостью и депрессией разной степени тяжести. Методика. Клиническое обследование и создание банка биологического материала выполнены на базе отделений аффективных расстройств и аддиктивных состояний и лаборатории клинической психонейроиммунологии и нейробиологии НИИ психического здоровья Томского НИМЦ РАН. Исследована сыворотка крови 52 женщин в возрасте 40-55 лет: 17 условно здоровых лиц, и 35 пациенток с аффективными и аддиктивными расстройствами. В соответствии с МКБ-10 у 6 пациенток диагностирован синдром зависимости от алкоголя (F10.2). У 29 пациенток диагностирована депрессия разной степени тяжести. В подгруппу легкой депрессии (сумма баллов по шкале Гамильтона HDRS до 16 баллов включительно) вошли 13 пациенток: 5 с депрессивным эпизодом легкой степени F32.0 и 8 с дистимией F34.1. В подгруппу умеренной депрессии (сумма баллов по шкале Гамильтона выше 16 баллов) вошли 16 пациенток: 7 с депрессивным эпизодом средней степени F32.1 и 9 с рекуррентной депрессией F33.1. Антитела к нейромедиаторам дофамину, норадреналину, серотонину, глутамату и ГАМК в сыворотке крови определяли методом твердофазного иммуноферментного анализа на полистироловых планшетах, активированных соответствующими тест-антигенами. Интерлейкины в сыворотке крови определяли методом иммуноферментного анализа с использованием тест-систем производства ООО Цитокин (Санкт-Петербург). Определяли баланс провоспалительных цитокинов - интерлейкинов (ИЛ 1β, ИЛ 6) и противовоспалительных - ИЛ 10. Результаты. Уровень аутоантител к нейромедиаторам связан с тяжестью депрессии. При легкой депрессии отличия от контрольного уровня незначительны. При умеренной депрессии повышен уровень антител к серотонину, глутамату и ГАМК. Спектр антител при алкоголизме сходен с таковым при умеренной депрессии. Можно предполагать, что данные паттерны отражают коморбидное течение депрессии и аддикции. Соотношение содержания провоспалительного (ИЛ 6) и противовоспалительного (ИЛ 10) цитокинов в сыворотке крови при алкоголизме незначительно отличалось от контрольного уровня, в то время как при отягощении депрессии это соотношение существенно повышалось и у 20% обследованных в явной форме указывало на преобладание воспаления над компенсаторными процессами. Заключение. Феномен нейровоспаления не является достаточным для понимания нейроиммунных механизмов коморбидной патологии. Иммунорегуляция нейромедиаторного обмена является новым источником информации о нейроиммунном дисбалансе при сочетанных расстройствах. Aim. Comparative analysis of concentrations of pro- and anti-inflammatory cytokines and autoantibodies to the neurotransmitters dopamine, norepinephrine, 5-hydroxytryptamine, glutamate, and GABA in the blood serum of female patients with alcohol dependence and depression of different severity. Methods. Clinical examination and creation of a bank of biological material were performed at the Departments of Affective Disorders and Addictive Conditions and the Laboratory of Clinical Psychoneuroimmunology and Neurobiology of the Mental Health Institute, Tomsk Scientific Research Center of the Russian Academy of Sciences. Blood serum of 52 women aged 40-55 years was studied, including 17 conditionally healthy individuals, and 35 patients with affective and addictive disorders. In accordance with ICD-10, 6 patients were diagnosed with alcohol dependence syndrome (F10.2), and 29 patients were diagnosed with depression of different severity. The subgroup of mild depression with a Hamilton Depression Rating Scale (HDRS) score <16 included 13 patients (5 with a mild depressive episode F32.0 and 8 with dysthymic disorder F34.1). The subgroup of moderate depression with a total HDRS score >16 included 16 patients (7 with a moderate depressive episode F32.1 and 9 with recurrent depression F33.1). Serum antibodies to the neurotransmitters dopamine (DA), norepinephrine (NA), 5-hydroxytryptamine (5-HT), glutamate (GLU), and GABA were determined by enzyme-linked immunosorbent assay (ELISA) on polystyrene plates activated with the respective test antigens. Serum interleukins (IL) were measured using ELISA test systems. The balance of pro-inflammatory (IL 1β and IL 6) and anti-inflammatory (IL 10) cytokines was determined. Statistical analysis was performed with the φ Fisher criteria, and data were graphically presented as mean values. Results. Concentrations of autoantibodies to neurotransmitters were related with the severity of depression. In mild depression, differences from the control values were negligible. In moderate depression, levels of antibodies to 5-hydroxytryptamine, glutamate, and GABA were increased. In alcohol dependence, the array of antibodies was similar to that in moderate depression. These patterns apparently reflect the comorbid course of depression and addiction. The ratio of pro-inflammatory (IL 6) to anti-inflammatory (IL 10) cytokine serum concentrations in alcohol dependence was slightly different from the control ratio. At the same time in more severe depression, this ratio significantly increased and clearly indicated prevalence of inflammation over compensatory processes in 20% of the patients. Conclusion. The phenomenon of neuroinflammation is not sufficient to understand neuroimmune mechanisms of the comorbid pathology. Immunoregulation of neurotransmitter metabolism is a new source of information about neuroimmune imbalance in combined disorders.

Effectiveness and moderators of individual cognitive behavioral therapy versus treatment as usual in clinically depressed adolescents: a randomized controlled trial

We examined if manualized cognitive behavioral therapy (CBT) was more effective than Treatment As Usual (TAU) for clinically depressed adolescents within routine care. This multisite Randomized controlled trail included 88 clinically depressed adolescents (aged 12–21 years) randomly assigned to CBT or TAU. Multiple assessments (pre-, post treatment and six-month follow-up) were done using semi-structured interviews, questionnaires and ratings and multiple informants. The primary outcome was depressive or dysthymic disorder based on the KSADS. Completers, CBT (n = 19) and TAU (n = 26), showed a significant reduction of affective diagnoses at post treatment (76% versus 76%) and after six months (90% versus 79%). Intention-to-treat analyses on depressive symptoms showed that 41.6% within CBT and 31.8% within the TAU condition was below clinical cut-off at post treatment and after six-months, respectively 61.4% and 47.7%. No significant differences in self-reported depressive symptoms between CBT and TAU were found. No prediction or moderation effects were found for age, gender, child/parent educational level, suicidal criteria, comorbidity, and severity of depression. We conclude that CBT did not outperform TAU in clinical practice in the Netherlands. Both treatments were found to be suitable to treat clinically referred depressed adolescents. CBT needs further improvement to decrease symptom levels below the clinical cut-off at post treatment.

Analysis of Mental Health Diseases Trends using BeGraph Software in Spanish Healthcare Centers (Preprint)

BACKGROUND In the era of Big Data, networks are becoming a popular factor in field of data analysis. The networks are part of the main structure of BeGraph software, which is a 3D visualization application dedicated to the analysis of complex networks. OBJECTIVE The main objective of this research is to visually analyze tendencies of Mental Health diseases in a region of Spain through the Begraph software, in order to make the most appropriate health-related decisions in each case. METHODS For the development of the study, a database was used with 13531 records of patients with Mental Health disorders of three acute medical units from different healthcare complexes in a region of Spain. For the analysis, BeGraph software is applied, a web-based 3D visualization tool that allows the exploration and analysis of data through complex networks. RESULTS The results obtained with the BeGraph software allow us to determine the main disease detected in each of the healthcare complexes to be evaluated: 6.5% of income at the University Clinic of Valladolid with unspecified paranoid schizophrenia, 9.61% of admissions in the Zamora Hospital with chronic paranoid schizophrenia with acute exacerbation and 8.84% of income in the Rio Hortega Hospital in Valladolid with dysthymic disorder. CONCLUSIONS The data analysis obtained allows us to focus on the main diseases detected in the healthcare complexes to be evaluated, in order to analyse the behaviour of disorder and help in the diagnosis and treatment.