Der erste Teil der vorliegenden Arbeit ist ein Review über die unterschiedlichen Studien aus den letzten zwanzig Jahren, die sich mit der Thematik: psychische Komorbidität bei (Brust-) Krebs auseinandersetzen. Die thematische Auseinandersetzung erfolgte zum Großteil in Form von Querschnittstudien. Das Fortbestehen der psychischen Komorbidität über Monate oder auch Jahre, nach dem Zeitpunkt der Diagnosestellung, ist erst in jüngster Zeit in das Blickfeld der Wissenschaft gerückt. Der zweite Teil der Arbeit beschäftigt sich mit der Untersuchung verschiedener soziodemographischer und krankheitsspezifischer Faktoren und deren Einfluß auf die psychische Komorbidität. Die untersuchte Patientinnengruppe sind Frauen mit Brustkrebs. Das verwendete Screeninginstrument ist die Hospital Anxiety and Depression Scale (HADS). Die Identifizierung der soziodemographischen und krankheitsspezifischen Faktoren, die psychische Komorbidität beeinflussen, ist ein noch junges Forschungsgebiet. Die Identifikation dieser Faktoren ist wichtig für die Erkrankten, um Chronifizierungsprozesse seelischen Leiden vorzubeugen. Das Ziel sollte sein, die psychische Komorbidität frühzeitig zu erkennen und zu behandeln. Dadurch kann die Lebensqualität der Frauen mit Brustkrebs gesteigert werden. Durch Fragebögen beispielsweise, als sekundär präventive Maßnahme, kann die psychische Komorbidität frühzeitig erkannt und therapiert werden. Ein zusätzlicher und nicht unerheblicher Aspekt ist dabei eine mögliche Kostenersparnis im Gesundheitswesen.

Abstract Research Objectives¡GThe chronic diseases of the elderly not only influence their life quality but also become a great burden of the society on the health care costs. International studies focused on the utilization of medical care resources for diabetes mellitus patients of comorbidity, such as cardiovascular disease¡Bcerebrovascular disease¡Brenal disease and hypertensive. However, systemic analyses on the medical care utilization of the diabetes patients with comorbidity have not been well-studied in Taiwan. The purposes of the study are to quantitatively analyze the relationships between the number of comorbidity and the utilization of medical are resources, and to further discuss the interference on the utilization of medical care resources among individual diseases of the comorbidity. The research questions are: What is the effect of comorbidity on the type and volume of the utilization of medical care resources? Which comorbidity pattern has the highest effect? Methods¡GBased on the databases established by the Bureau of National Health Insurance during the period of 2005 to 2006, the diabetes patients with aged 65 or older have been analyzed. The data analyses have been carried out by Chi-square test, T-test, Pearson¡¦s correlation, and Multiple Regression and Logistic regression. Result¡GOur results showed that the clinic-visiting frequencies of outpatients with a comorbidity score of 0, 1, 2 and 3 are 52, 69 , 70 and 86 times, respectively, and their expenses are NT dollars 50,505, 97,347, 83,006 and 146,954, respectively. The hospital admission frequency of inpatients with a comorbidity score of 0, 1, 2 and 3 are 2 , 3, 3 and 5 times, respectively; the length of stay are 24, 29, 27 and 60 days, respectively; and the inpatient expense are NT dollars 118,079, 174,727, 147,639 and 271,725 respectively. In addition, the logistic regression model showed that ORs for the probability of hospitalization for the patients with comorbidity scores of 1, 2 and 3 were higher than those with the comorbidity score of 0¡]OR=1.689, OR=1.597, OR=3.319¡^respectively. Conclusion¡GA clear gradient was observed between the number of comorbidities and the increased health care utilizations. Moreover, comorbidity among diabetes patients is associated with considerable consequences of health care and related costs. In addition, current single-disease approach of diabetes care should be extended to the integrated care modules, which must be generic and include comorbidity disease in order to meet the complex health care demands of diabetes patients in the future.

Introduction: Bipolar Disorder (BD) is a chronic mental illness associated with functional decline, mortality, and significant health care costs; furthermore, specific general medical conditions have been found to occur disproportionately within BD patient populations, among them, migraine is one of the most studied. Migraine has a global prevalence of 10%, and it is a disorder with elevated direct and indirect costs, the later mostly derived from its association with mood and anxiety disorders. Specifically, the reported prevalence of migraine in the BD population ranges from 24.8% to 39.8%, rates that are considerable higher than those found in the general population. / Objective: To explore the prevalence and clinical characteristics of BD patients with and without migraine (Study 1), and to examine the psychiatric comorbidity in patients suffering from migraine (Study 2). / Methods: 323 BD patients were studied, using SADS-L and SCID as diagnostic interviews, and ill-Migraine questionnaire to assess the presence of migraine. Statistical analyses were conducted using parametric analysis and the development of log-linear models. Additionally, 102 migraine patients were interviewed using SADS-L, and the descriptive characteristics of the sample were analyzed. / Results: For Study 1, we found that 24.5% of BD patients suffer from migraine, and it is significantly associated with BD 2, suicidal behaviour, and a variety of anxiety disorders. As well, over 70% of migraine patients showed a lifetime psychiatric diagnosis, mainly within the spheres of mood and anxiety disorders; specifically, the prevalence of BD among migraine patients was 12.7%. / Conclusions: Our study highlights the high prevalence of migraine among BD patients, and the elevated prevalence of psychiatric comorbidity among migraine sufferers. The study of this comorbidity will deepen our understanding of the mechanisms that underlie both disorders and provide a better framework for the developing of molecular techniques to further analyze the molecular physiopathology of Bipolar Disorder.

Heterogeneity in children with Attention Deficit Hyperactivity Disorder (ADHD) symptoms is a well-known phenomenon. Empirically, this heterogeneity is evident in at least three different respects: expression of the two ADHD symptom domains (hyperactivity/impulsivity and inattention), neuropsychological impairments, and comorbid behavior problems. The major aim of the present thesis was to examine the heterogeneity characterizing children with ADHD symptoms to enhance our understanding by examining neuropsychological factors with regard to common and independent contributions, and specificity of the two ADHD symptom domains in relation to neuropsychological factors and comorbid behavioral problems. Particular emphasis is placed on prominent neuropsychological processes such as executive functions, state regulation and delay aversion. The present thesis is based on findings from four studies on community-based samples of children – studies involving concurrent and longitudinal designs as well as both categorical and dimensional approaches. Results provide support for the notion that executive function and state regulation, but not delay aversion, constitute independent pathways to ADHD, primarily to symptoms of inattention. However, delay aversion was shown to have an effect in combination with state regulation on both hyperactivity/impulsivity and inattention. Additionally, symptoms of hyperactivity/impulsivity and inattention have different primary correlates concerning neuropsychological factors and comorbidity. More specifically, executive function, state regulation, internalizing problems and academic achievement were specifically related to inattention but not to hyperactivity/impulsivity. Oppositional Defiant Disorder (ODD) was specifically related to hyperactivity/impulsivity, but not to inattention. The present thesis has contributed with important and new knowledge about the heterogeneity of children with ADHD symptoms concerning neuropsychological pathways, and specificity of the two ADHD symptom domains in relation to neuropsychological factors and comorbid behavioral problems. Knowledge such as this can help us understand how to identify more homogeneous ADHD subgroups, and contribute to the further development of multiple pathway models within this area of research.

Despite the established relationship between Post-Traumatic Stress Disorder (PTSD) and depression in Western cultures, research concerning the prevalence rates and relationship between the comorbid disorders in Non-Western communities remains sparse. The present study explored the relationship between PTSD and comorbid depression in citizens currently living in Ghana, West Africa. Ghanaian Nationals (n=140) completed the PTSD and demographic sections of the Structured Clinical Interview for the DSM-IV (SCID-I), as well as the Center for Epidemiological Studies Depression Scale (CES-D). Both measures were administered through interview format. Results revealed a lower prevalence rate of PTSD than expected. Further analysis demonstrated that meeting the diagnostic criteria for PTSD increased the chance of meeting the diagnostic criteria for depression, as well as increased depression scores. To confirm that the prevalence rates found in this study were reflective of actual cases of depression (not measurement error) a scale reliability analysis was conducted on the CES-D. The results of this analysis confirmed internal consistency. Results suggest that although the prevalence rate of PTSD was low, a relationship is present between the disorders in a non-Western sample. The reliability of the measures means that PTSD and depression were assessed for, but what is not certain is whether the actual construct of the disorders could occur differently in a non-Western sample, causing a different presentation of symptoms. Future research is needed to examine the Western construct of PTSD and depression to determine if there is a different presentation of symptoms not accounted for by Western measures. / Department of Psychological Science

Access to abstract permanently restricted to Ball State community only. / Access to thesis permanently restricted to Ball State community only. / Department of Educational Psychology

Attention-Deficit/Hyperactivity Disorder (ADHD) is comorbid with a range of other disorders in clinical and community samples, including anxiety disorders. The outcomes of the Multimodal Treatment Studies of ADHD (MTA Cooperative Group, 1999) highlight the importance of this comorbidity, as children with anxiety responded differently to treatments than did children with ADHD only. At present there are few tested theoretical explanations of the etiological processes and developmental trajectories associated with their co-occurrence. The aim of this research was to put forward and examine different explanations for the comorbidity of these two disorders in children according to the framework provided by Lilienfeld (2003). This was achieved by examining the covariation of ADHD symptoms and anxiety symptoms in a community sample of 499 children aged 8-13. Dimensional assessments of psychopathology were conducted via self-report questionnaires given to children, parents and teachers. The results were analysed via structural equation modelling approaches using AMOS (Arbuckle, 2003). Consistent with the hypotheses, positive associations at Time 1 between ADHD and anxiety symptoms were linked with inattention symptoms and were particularly pronounced for girls. The concurrent positive associations observed at each time period could not be completely accounted for by overlapping symptoms across measures or by method covariance explanations. The link between ADHD and anxiety symptoms could be explained by a common factor in reporting whereby ADHD and anxiety symptoms were both associated with noncompliance and negative affect for parents' reports, and negative affect for children???s' reports. Despite the concurrent associations, there was no support for the hypothesis that ADHD symptoms predicted the development of anxiety symptoms over time, nor the alternative hypothesis that anxiety symptoms predicted the development of ADHD symptoms over time, when the stability of symptoms across time was taken into account. It was concluded that ADHD symptoms (particularly inattention) and anxiety symptoms are covarying phenomena that are linked with common features of an irritable temperament and disruptive behaviour. Future research should investigate the role of these common factors in treatment outcome and cognitive research, which has previously found differences between ADHD children with and without anxiety.

Suicide attempts and opioid dependence are important clinical issues, as both are associated with a high degree of psychiatric morbidity and elevated risk of mortality. Research has identified a number of risk factors for suicide attempts among the general population, and to a lesser extent, among heroin users. Due to a lack of case-control studies, however, it is still not known to what extent opioid dependence per se is a risk factor for suicide attempts. This thesis comprised the first study to directly examine whether opioid dependence is a unique risk factor of suicide attempts. This thesis examined suicide attempts, associated risk factors, and related comorbidity among an opioid-dependent case group and a non-opioid-dependent control group. A structured interview was used to collect data from 726 opioid-dependent cases and 399 non-opioid-dependent controls. This thesis identified a number of important findings. Firstly, although opioid-dependent individuals were more likely to report lifetime suicide attempts compared to controls, the risk factors were largely the same for both groups. It appeared that opioid-dependent individuals were characterised by a higher likelihood of the same risk factors for suicide attempts, rather than having different risks. Cases appeared to be at increased risk of suicide attempts because of increased levels of multiple risk factors. Secondly, borderline personality disorder (BPD) and impulsivity were identified as important risk markers for suicidal behaviour, especially among opioid-dependent individuals. The study concluded that the treatment of BPD should be prioritised among this group. Third, self-mutilation was identified as a clinically significant problem in its own right, however, when combined with a history of attempted suicide, the psychological dysfunction observed was found to be very high. Fourth, non-fatal opioid overdose and suicide attempts were found to be distinct behaviours. The risk factors for each were completely different. While drug-related risks were associated with non-fatal overdose, the risk markers for suicide attempts were related to the presence of psychological disorders. This thesis has highlighted important areas of concern for clinical interventions as well as for future research to explore. Considering this is the first study of its kind, future research should focus on its replication.

Thesis (M.S.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 89 pages. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.