This report presents an overview of the results of the US National Comorbidity Survey (NCS) (Kessler et al., 1994) and future directions based on these results. The NCS is a survey that was mandated by the US Congress to study the comorbidity of substance use disorders and nonsubstance psychiatric disorders in the general population of the US. (...)

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Die Organtransplantation hat sich in den letzten 20 Jahren zu einem Standardverfahren in der Therapie schwerer, anders nicht mehr behandelbarer Organerkrankungen entwickelt. In Deutschland werden jährlich etwa 3000 Transplantationen durchgeführt. Über 13 000 Menschen stehen auf der Warteliste für einen solchen Eingriff. Sowohl die Wartezeit als auch die verschiedenen Phasen nach dem Eingriff fordern erhebliche psychische Anpassungsleistungen von Patienten und Angehörigen, was häufig zu psychischen Störungen führt. Das Transplantationsgesetz von 1997 fordert daher ausdrücklich eine psychosomatische Mitbetreuung in den Transplantationszentren. Trotz dieses Therapiebedarfs fehlt es bisher an empirisch gesicherten therapeutischen Strategien. In der Transplantationsmedizin ist ein methodenübergreifender Betreuungsansatz sinnvoll. Kognitiv-verhaltenstherapeutische Therapieelemente scheinen aufgrund ihres pragmatischen und lösungsorientierten Ansatzes für diese Patientengruppe besonders geeignet. Ziel dieses Artikels ist es, auf Basis klinischer Erfahrungen und der wissenschaftlichen Literatur eine Übersicht über die unterschiedlichen Phasen der Transplantation solider Organe, ihre spezifischen Belastungen und therapeutische Strategien für Patienten und ihre Angehörigen zu geben. Der Bedarf an empirischer Forschung auf diesem Gebiet, gerade was die Wirksamkeit verhaltensmedizinischer Interventionen angeht, wird deutlich. / About 3,000 patients per year receive a transplant in Germany and some 13,000 patients are on waiting lists. Waiting period and the different stages of recovery demand special coping strategies from patients and their families. Psychological disorders are frequent before and after the transplantation and psychological risk factors are relevant for the outcome of the transplantation. Therefore special psychosomatic care for patients and their families is necessary. However, evidence based knowledge on appropriate therapeutic interventions is still scarce. In transplantation medicine, an overall approach is reasonable. Cognitive-behavioral aspects seem to be especially promising. The article describes strategies and techniques for the psychosomatic assessment of patients before transplantation and psychotherapeutic interventions for patients and their families before and after solid organ transplantation. More research on the effects of psychotherapeutic interventions in this field is necessary. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The overall aim of this thesis was to assess measurement properties of methods suitable for screening or monitoring of physical capacity and physical activity in subjects with chronic obstructive pulmonary disease (COPD), and to explore factors associated with physical activity levels. Methods: Four observational studies were conducted. Participants in studies I-III (sample sizes) (n=49, n=15, n=73) were recruited from specialist clinics, and in study IV from a population-based cohort (COPD n=470 and Non-COPD n=659). Psychometric properties of methods assessing physical capacity (study I) and physical activity (study II) were investigated in laboratory settings. Daily physical activity and clinical characteristics were assessed with objective methods (study III) and with subjective methods (study IV). Results: Physical capacity as measured by walking speed during a 30-metre walk test displayed high test-retest correlations (ICC>0.87) and small measurement error. The accuracy for step count and body positions differed between activity monitors and direct observations. In study III 92% of subjects had an activity level below what is recommended in guidelines. Forty five percent of subjects’ activity could be accounted for by clinical characteristics with lung function (22.5%), walking speed (10.1%), quadriceps strength (7.0%) and fat-free mass index (3.0%) being significant predictors. In study IV, low physical activity was significantly more prevalent in COPD subjects from GOLD grade ≥II than among Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10-4.08) and fatigue, OR 2.33 (1.31-4.13) while obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17-4.35). Conclusion: The 30 meter walk test and activity monitors are useful when assessing physical capacity and physical activity, respectively in patients with COPD. Impaired physical activity in severe COPD is related to low lung function, low walking speed, low muscle strength and altered body composition, whereas comorbidities and fatigue are linked to insufficient physical activity in patients with moderately severe COPD.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (M.S.)--Mississippi State University. Department of Psychology. / Title from title screen. Includes bibliographical references.

Source: Dissertation Abstracts International, Volume: 69-09, Section: B, page: 5301. Adviser: Eric Boerwinkle. Includes bibliographical references.

INTRODUÇÃO: Os termos múltiplas comorbidades e multimorbidade são crescentes na literatura médica, trazendo e traduzindo uma nova forma de avaliar e cuidar de pacientes graves que acumulam doenças crônicas. Estudos apontam piores prognósticos para o transtorno bipolar (TB) quando associado à comorbidades específicas. Entretanto, fatores correlacionados ao número total de transtornos associados, e não a cada transtorno de forma específica, ainda não foram investigados no TB. OBJETIVOS: A finalidade deste estudo é avaliar diferentes aspectos relacionados à presença de múltiplas comorbidades psiquiátricas de Eixo I ao longo da vida em amostra de pacientes com TB. MÉTODO: Uma amostra de 294 pacientes bipolares foi investigada. Os diagnósticos de TB e das comorbidades psiquiátricas foram confirmados através entrevista clínica estruturada para transtornos de Eixo I (SCID-I) do DSM-IV. Um protocolo padrão do PROTAHBI foi aplicado para a obtenção de dados sócio-demográficos e variáveis clínicas. Os níveis de funcionamento, a qualidade de vida (QV), assim como, a presença de sintomas depressivos, ansiosos e maníacos foram avaliados através de instrumentos específicos validados na literatura. Múltiplas comorbidades foram consideradas presentes quando três ou mais diagnósticos psiquiátricos, adicionais ao TB, eram constatados. LIMITAÇÕES: Comorbidades com transtornos de Eixo II e III não foram investigadas neste estudo. RESULTADOS: A prevalência ao longo da vida para pelo menos uma comorbidade foi de 68.8% (n = 203), para duas ou três foi de 34.2% (n = 101) e para múltiplas comorbidades foi de 34.6% (n = 102). Na análise comparativa para as variáveis clínicas, diferenças correlacionadas ao número total de comorbidades foram detectadas. Um significativo impacto negativo foi verificado na avaliação do funcionamento e na QV dos pacientes com múltiplas comorbidades. CONCLUSÕES: A presença de múltiplas comorbidades psiquiátricas de Eixo I ocorre em cerca de um terço dos pacientes bipolares e revela uma maior gravidade e complexidade ao transtorno, independentemente de quais transtornos específicos co-ocorram. Questões acerca de sua adequada contemplação nos critérios de classificação diagnóstica e guidelines de tratamento também foram suscitadas. / BACKGROUND: The concepts multiple comorbidities and multimorbidity are growing in relevance in medical literature, enabling a new perspective to understand and treat patients with severe and cumulative chronic diseases. Studies report worse prognoses of bipolar disorder (BD) when associated with specific comorbidities. However, factors underlying co-occurring rather than single disorders have not been analyzed yet. OBJECTIVES: The present study aims at assessing the impact of psychiatric multiple comorbidities with Axis I disorder on bipolar patients. METHODS: A sample of 294 bipolar patients was examined. BD and comorbidities diagnoses were confirmed by means of Structured Clinical Interview for DSM-IV Axis I disorders. A PROTAHBI standard protocol provided the access for the social-demographic data and clinical variables. Levels of functioning and quality of live as well as the presence of depressive, anxiety and manic symptoms were evaluated by means of proper instruments validated in medical literature. Multiple comorbidities were considered when three or more comorbid psychiatric diagnoses were verified. LIMITATIONS: Axis II and III comorbidities were not considered in this investigation. RESULTS: Lifetime prevalence of any comorbidity was 68.8% (n = 203), of one or two comorbidities was 34.2% (n = 101), and of multiples comorbidities was 34.6% (n = 102). ). In the comparative analysis of clinical variables, some differences between the groups were detected. A significant negative impact was verified when assessing functioning and quality of life of patients with multiple comorbidities. CONCLUSIONS: The presence of Axis I psychiatric comorbidities was found in one third of the bipolar patients and revealed a more severe and complex disorder, regardless of which particular disorders may co-occur. Concerns were raised about whether current medical classification systems and practice guidelines are properly addressing this issue.

INTRODUÇÃO: Os termos múltiplas comorbidades e multimorbidade são crescentes na literatura médica, trazendo e traduzindo uma nova forma de avaliar e cuidar de pacientes graves que acumulam doenças crônicas. Estudos apontam piores prognósticos para o transtorno bipolar (TB) quando associado à comorbidades específicas. Entretanto, fatores correlacionados ao número total de transtornos associados, e não a cada transtorno de forma específica, ainda não foram investigados no TB. OBJETIVOS: A finalidade deste estudo é avaliar diferentes aspectos relacionados à presença de múltiplas comorbidades psiquiátricas de Eixo I ao longo da vida em amostra de pacientes com TB. MÉTODO: Uma amostra de 294 pacientes bipolares foi investigada. Os diagnósticos de TB e das comorbidades psiquiátricas foram confirmados através entrevista clínica estruturada para transtornos de Eixo I (SCID-I) do DSM-IV. Um protocolo padrão do PROTAHBI foi aplicado para a obtenção de dados sócio-demográficos e variáveis clínicas. Os níveis de funcionamento, a qualidade de vida (QV), assim como, a presença de sintomas depressivos, ansiosos e maníacos foram avaliados através de instrumentos específicos validados na literatura. Múltiplas comorbidades foram consideradas presentes quando três ou mais diagnósticos psiquiátricos, adicionais ao TB, eram constatados. LIMITAÇÕES: Comorbidades com transtornos de Eixo II e III não foram investigadas neste estudo. RESULTADOS: A prevalência ao longo da vida para pelo menos uma comorbidade foi de 68.8% (n = 203), para duas ou três foi de 34.2% (n = 101) e para múltiplas comorbidades foi de 34.6% (n = 102). Na análise comparativa para as variáveis clínicas, diferenças correlacionadas ao número total de comorbidades foram detectadas. Um significativo impacto negativo foi verificado na avaliação do funcionamento e na QV dos pacientes com múltiplas comorbidades. CONCLUSÕES: A presença de múltiplas comorbidades psiquiátricas de Eixo I ocorre em cerca de um terço dos pacientes bipolares e revela uma maior gravidade e complexidade ao transtorno, independentemente de quais transtornos específicos co-ocorram. Questões acerca de sua adequada contemplação nos critérios de classificação diagnóstica e guidelines de tratamento também foram suscitadas. / BACKGROUND: The concepts multiple comorbidities and multimorbidity are growing in relevance in medical literature, enabling a new perspective to understand and treat patients with severe and cumulative chronic diseases. Studies report worse prognoses of bipolar disorder (BD) when associated with specific comorbidities. However, factors underlying co-occurring rather than single disorders have not been analyzed yet. OBJECTIVES: The present study aims at assessing the impact of psychiatric multiple comorbidities with Axis I disorder on bipolar patients. METHODS: A sample of 294 bipolar patients was examined. BD and comorbidities diagnoses were confirmed by means of Structured Clinical Interview for DSM-IV Axis I disorders. A PROTAHBI standard protocol provided the access for the social-demographic data and clinical variables. Levels of functioning and quality of live as well as the presence of depressive, anxiety and manic symptoms were evaluated by means of proper instruments validated in medical literature. Multiple comorbidities were considered when three or more comorbid psychiatric diagnoses were verified. LIMITATIONS: Axis II and III comorbidities were not considered in this investigation. RESULTS: Lifetime prevalence of any comorbidity was 68.8% (n = 203), of one or two comorbidities was 34.2% (n = 101), and of multiples comorbidities was 34.6% (n = 102). ). In the comparative analysis of clinical variables, some differences between the groups were detected. A significant negative impact was verified when assessing functioning and quality of life of patients with multiple comorbidities. CONCLUSIONS: The presence of Axis I psychiatric comorbidities was found in one third of the bipolar patients and revealed a more severe and complex disorder, regardless of which particular disorders may co-occur. Concerns were raised about whether current medical classification systems and practice guidelines are properly addressing this issue.

Introduction: Eating disorders are serious psychiatric disorders that often require specialized care. Associated psychiatric comorbidity is frequent, with the most common comorbid conditions being anxiety and mood disorders. Eriksbergsgården in Örebro is one of Sweden’s specialized eating disorder treatment units.Aim: Primary aims were to describe clinical characteristics of the adult patient group at Eriksbergsgården and to evaluate treatment outcome and patient satisfaction at the one-year follow-up. An additional aim was to examine if factors such as psychiatric comorbidity affected treatment outcome.Methods: This study used data from Riksät and Stepwise, two large-scale Swedish registers for eating disorder treatment. Data for this study was registered into Stepwise and Riksät at Eriksbergsgården between August 2010 and December 2017 and 489 adult patients of both genders constituted the study group. Patient characteristics and DSM-IV axis I psychiatric comorbidity were assessed at the initial evaluation. At the one-year follow-up, treatment outcome and patient satisfaction were evaluated.Results: The most common diagnoses in this patient material were eating disorder not otherwise specified, 56.6 %, followed by bulimia nervosa, 26.4 %. At the initial evaluation, 62.0 % of the patients suffered from psychiatric comorbidity. Of the patients with initial comorbidity, 43.3 % were recovered at the one-year follow-up, compared to 62.8 % of the patients with no initial comorbidity, p=0.021.Conclusion: Our results confirm the previously known fact that psychiatric comorbidity among eating disorder patients is common. Also, the results identify psychiatric comorbidity as a possible factor to have negative effect on the treatment outcome.