Women with posttraumatic stress disorder (PTSD) often develop alcohol use disorders (AUD) resulting from the use of alcohol to self-medicate from negative affect. Research supports the relationship between comorbid PTSD and AUD, and studies with women additionally identify the role of rumination, or excessive thinking about distress and its causes, as a precipitating aspect leading to self-medication. Female-based data is sparse, however, regarding specific thought patterns and factors which trigger the need to self-medicate with alcohol. Numerous researchers have studied the relationship between stress, anxiety, and alcohol use, although, there exists a need for qualitative studies providing thick, rich information. Applying the self-medication model and rumination theory, the purpose of this study was to use a transcendental research framework as a lens to explore and describe the phenomenon of how women with comorbid PTSD and AUD make sense of their dual disorder. Qualitative data were gathered from in-depth interviews of 12 women who participated in Alcoholics Anonymous groups in a large Southeastern city. The women collectively described their lived experience with the phenomenon as an internally-focused strategy premised on the notion of a 'Higher Power.' They reported using this strategy to manage thoughts, feelings, and behaviors which triggered negative self-assessment and the need to self-medicate with alcohol. This research contributes to the literature by offering a more detailed understanding of comorbid PTSD and AUD. Positive social change can be achieved with a better understanding of the etiology of female trauma and the factors that trigger alcohol relapse in women with PTSD.

BACKGROUND: Individuals with serious mental illness face a significant burden of disease, yet experience lower quality care across a range of services (1). Hospital readmission within 30 days of discharge is an important, if imperfect, proxy for quality of care. Factors contributing to readmission are well documented (2–5), yet successful interventions to decrease readmissions have been slow to take shape (6–9). To effectively develop and incorporate evidence-based interventions to reduce 30-day psychiatric readmissions into large, geographically diverse inpatient systems; there is a need to conduct in-depth implementation analyses to better understand the relationship between patient-, hospital-, health system-, and community-level factors and their net impact on readmissions. This research addresses this need. METHODS: Using a modified Consolidated Framework for Implementation Research (CFIR), two state-based case studies were conducted within a large U.S. hospital system. Two hospitals per state were selected-- one with a high and one with a lower readmission rate. We conducted document reviews and semi-structured interviews (N=52) with corporate, clinical and community stakeholders, using the CFIR to identify key themes within each construct. We scored and compared hospitals with lower vs. higher readmission rates. An analysis of EMR data from the hospital system contextualized case study findings. RESULTS: In one state a complex interplay of factors at all levels contributed to readmission rates in both hospitals. In the second, constructs within the inner hospital setting contribute to differences in hospital readmission rates. Facilities with high readmission rates scored lowest among CFIR constructs “Patient Needs and Resources in the Community” and “External Policies and Incentives.” CONCLUSIONS: Ours is the first known study to explore a broad range of factors that influence readmission rates among patients with serious mental illness and a range of comorbidities. Findings from two state-based case studies indicate that readmission rates are determined by multiple, interrelated factors which vary in importance based on hospital and community context and political environment. To be effective, systemic interventions to reduce readmissions must be tailored to the specific context at targeted hospitals.

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Summaries in Afrikaans and English / Text in Afrikaans / Tourettesindroom is 'n lewenslange versteuring wat gekenmerk word deur motoriese en vokale trekkings saam met moontlik ook komorbiede simptome soos aandagtekort-hiperaktiwiteitsversteuring, obsessief-kompulsiewe versteuring, aggressie en depressie. Die sindroom kom in hoe mate in Suid-Afrika voor en die pastor kan dus heel moontlik daarmee te doen kry. Die beste behandeling vir die sindroom is medikasie saam met gedrags- en gesinsterapie toegedien deur 'n multidissiplinere span. Die pastor het 'n rol om te vervul in hierdie span probleme het aangesien persone met Tourettesindroom dikwels in hulle verhoudings met God, hulleself en ander mense. Vir effektiewe pastorale berading aan sodanige persone, moet die pastor deeglike kennis he van die sindroom en die simptome daarvan, asook van sy of haar invalshoek as pastor. 'n Moontlike kernmoment van die sindroom wat deur die pastor aangespreek kan word, is die verlies aan beheer wat deur dje lyer ervaar word. Die sindroom kan as 'n verskoning gedrag en gebruik word vir negatiewe en onverantwoordelike die pastor sal die lyer dus moontlik eties moet konfronteer op 'n medemenslike wyse. / Tourette Syndrome is a lifelong disorder. Symptoms are motoric and vocalic tics with possible comorbid symptoms such as attention deficit disorder with hyperactivity, obsessive-compulsive disorder, and depression. It is frequent among South Africans and the pastor will probably be confronted with persons struggling with the syndrome. The best therapy for Tourette Syndrome is medication in conjunction with behaviour and family therapy administered by a multi-disciplinary team. Persons with Tourette Syndrome have problems maintaining relationships with God, themselves and others. The pastor therefore has a definite role to play in the team. Knowledge of the syndrome and its symptoms, and of pastoral care are essential for succesful pastoral counseling. A possible central theme of the syndrome is the loss of control experienced by the person with the syndrome. The syndrome can become an excuse for negative and irresponsible behaviour and ethical confrontation may be necessary. / Philosophy, Practical & Systematic Theology / M. Th. (Praktiese Teologie)

Previous research has suggested that depressive disorders are common in youth and are associated with many negative outcomes. As a result, understanding how to treat depression effectively is very important. It is unclear; however, what factors predict treatment success or failure for depressed youth. Researchers are starting to investigate whether comorbid anxiety is a possible moderator of treatment outcome for youth with depression. Studies of the relation between comorbid anxiety and treatment outcome have produced mixed findings and have almost exclusively focused on older depressed adolescents. There is also limited research exploring whether parent intervention moderates the effect of comorbid anxiety on treatment outcome in depressed youth. This study focused on investigating the relation between comorbid anxiety and treatment outcome in a sample of 84 depressed female early adolescents who received either group cognitive behavioral therapy (CBT) or group CBT plus a parent intervention. The addition of parent intervention was explored as a moderator of the relation between anxiety and treatment outcome. Treatment outcome was measured by changes in depression severity and global functioning during treatment. The depression severity and global functioning scores of depressed girls with comorbid anxiety were also compared to depressed girls without comorbid anxiety prior to treatment to determine whether the first group of girls entered treatment with a different level of psychopathology. Participants and their primary caregivers were administered a semi-structured diagnostic interview which was used as a measure of depression severity, global functioning, anxiety severity, and to determine whether participants met diagnostic criteria for depressive and anxiety diagnoses. The results of this study suggested that depressed youth with comorbid anxiety or higher anxiety severity started out treatment with higher depression severity and lower functioning. Results also suggested that comorbid anxiety was not related to negative treatment outcome and that youth with comorbid anxiety actually experienced larger reductions in depression severity over the course of treatment than youth without comorbid anxiety. Parent intervention did not significantly moderate the effect of comorbid anxiety on treatment outcome. The study’s limitations, implications of the results, and recommendations for future research were discussed. / text

A chart review of Veterans with (1) Tinnitus Only, (2) Tinnitus + Anxiety/Depression, and (3) Tinnitus + post-traumatic stress disorder was conducted to determine the prevalence of comorbid health conditions. Patients with comorbid mental health conditions also were likely to suffer from additional comorbid health conditions (e.g., insomnia, etc).

Les comorbidités de l'autisme constituent une composante essentielle de son hétérogénéité clinique et étiologique. Nous faisons l'hypothèse qu'elles sont un meilleur indice étiologique que la clinique comportementale du syndrome autistique. Notre première étude explore ainsi les premiers signes d'inquiétude spontanée des parents d'enfants autistes, à partir de 459 questionnaires ouverts. Elle indique que ceux-Ci repèrent très précocement un ensemble de symptômes non spécifiques des interactions sociales qui devraient être inclus dans la description d'un phénotype autistique complexe. La seconde étude liste l'ensemble des facteurs de risque pré, péri, néonatals auxquels on assigne un effet significatif, bien que modéré, sur l'autisme. La troisième étude a permis de réaliser un descriptif détaillé de l'ensemble des causes majeures, dans un échantillon clinique épidémiologique de 183 enfants présentant un autisme typique. Les 36 diagnostics génétiques retrouvés représentent 58% de l'ensemble des causes ce qui laisse proportion significative de troubles neurodéveloppementaux d'origine environnementale ou cryptogènique. La plupart des diagnostics sont rares et reflètent bien l'hétérogénéité étiologique de l'autisme, sans qu'il soit exclu que certaines causes ne convergent vers des mécanismes physiopathologiques communs. Les différences cliniques, génétiques et environnementales que nous identifions entre un autisme syndromique (avec comorbidités) et non syndromique valident l'hypothèse que les comorbidités contribuent à distinguer les étiologies et fournissent des informations pratiques sur le pronostique, une thérapeutique ciblée ou un diagnostic plus précoce. / Successive definitions of autism did not reduce the extent of its clinical heterogeneity. This limits progress in understanding its etiological basis and the implementation of targeted therapeutic strategies. Comorbid disorders with autism are a complex issue because their frequency is one of the core features of clinical heterogeneity. We hypothesize that they are a better etiological clue than behavioral clinical syndromes. Our first study explores the initial instinctive concerns of parents of autistic children based on 459 open-Labelled questionnaires. Parents identify a set of symptoms comorbid to autism at a very early stage in their child's development The second study lists all the pre, peri and neonatal risk factors which have a significant, although moderate, effect on autism. .The third study lists in great detail all of the major causes of autism in a clinical epidemiological sample of 183 children with a typical autism. The 36 genetic diagnoses represent 58% of all causes which leaves a significant proportion of neurodevelopmental disorders of environmental or cryptogenic origin. The clinical, genetic and environmental differences that we identified between a non-Syndromic and syndromic autism (with comorbidities) validate the hypothesis that comorbidities are linked to a more general dysfunction and contribute to distinguishing the etiologies and provide practical information on the prognosis. A dimensional approach which includes comorbid disorders is prone to establish a fine-Grained taxonomy that point to distinct etiopathological processes.

Aim of the present study was to evaluate executive functions (EF) such as inhibition, planning, working memory, set-shifting in children with Attention Deficit / Hyperactivity Disorder (ADHD) via comparison of three ADHD subtype groups (ADHD-I, ADHD-C and ADHD-Comorbid) and a normal control group. Participants consist of 147 children. Total of 111 children were assigned into the ADHD groups of the study. Thirty seven children (5 girl and 32 boys) were assigned into the ADHD-Inattentive group, thirty seven children (6 girls and 31 boys) were assigned into the ADHD-Combined group / and thirty seven children (4 girls and 33 boys) were classified as ADHD-Comorbide group (ADHD-C with Oppositional Defiant Disorder consists of 4 girls and 31 boys, and/or Conduct Disorders consists of 2 boys). Thirty six children (6 girls and 30 boys / age range: 7- 12) were assigned as control group by matching with the ADHD groups according to the WISC-R Full Scale IQ score, sex and age. Conner&rsquo / s Parental and Teacher Rating Scales, Child Behavior Check List and Wechsler Intelligence Scale Revised, Tower of London Test, Wisconsin Card Sorting Test, Stroop Color Word Test, Cancellation Task, Trail Making Test, California Verbal List Test for Children, Verbal Fluency Test, Continuous Performance Test, Go-No-Go Task and Bender-Gestalt Test were used for the assessment of children. The data were analyzed by one-way within subject ANOVA for all dependent variables measured by the assessment tools. Additionally discriminant function analyses were conducted to determine the variables that differentiate the three ADHD groups and control group. Outcome of study indicated that subjects in ADHD-Comorbid group had more severe Executive Function (EF) deficits than subjects in ADHD-I and ADHD-C group. The findings were discussed in the light of the literature.

Summaries in Afrikaans and English / Text in Afrikaans / Tourettesindroom is 'n lewenslange versteuring wat gekenmerk word deur motoriese en vokale trekkings saam met moontlik ook komorbiede simptome soos aandagtekort-hiperaktiwiteitsversteuring, obsessief-kompulsiewe versteuring, aggressie en depressie. Die sindroom kom in hoe mate in Suid-Afrika voor en die pastor kan dus heel moontlik daarmee te doen kry. Die beste behandeling vir die sindroom is medikasie saam met gedrags- en gesinsterapie toegedien deur 'n multidissiplinere span. Die pastor het 'n rol om te vervul in hierdie span probleme het aangesien persone met Tourettesindroom dikwels in hulle verhoudings met God, hulleself en ander mense. Vir effektiewe pastorale berading aan sodanige persone, moet die pastor deeglike kennis he van die sindroom en die simptome daarvan, asook van sy of haar invalshoek as pastor. 'n Moontlike kernmoment van die sindroom wat deur die pastor aangespreek kan word, is die verlies aan beheer wat deur dje lyer ervaar word. Die sindroom kan as 'n verskoning gedrag en gebruik word vir negatiewe en onverantwoordelike die pastor sal die lyer dus moontlik eties moet konfronteer op 'n medemenslike wyse. / Tourette Syndrome is a lifelong disorder. Symptoms are motoric and vocalic tics with possible comorbid symptoms such as attention deficit disorder with hyperactivity, obsessive-compulsive disorder, and depression. It is frequent among South Africans and the pastor will probably be confronted with persons struggling with the syndrome. The best therapy for Tourette Syndrome is medication in conjunction with behaviour and family therapy administered by a multi-disciplinary team. Persons with Tourette Syndrome have problems maintaining relationships with God, themselves and others. The pastor therefore has a definite role to play in the team. Knowledge of the syndrome and its symptoms, and of pastoral care are essential for succesful pastoral counseling. A possible central theme of the syndrome is the loss of control experienced by the person with the syndrome. The syndrome can become an excuse for negative and irresponsible behaviour and ethical confrontation may be necessary. / Philosophy, Practical and Systematic Theology / M. Th. (Praktiese Teologie)

No description available.