Background: Despite an abundance of questionnaire data, the prevalence of clinically significant and medically unexplained pain syndromes in the general population has rarely been examined with a rigid personal-interview methodology. Objective To examine the prevalence of pain syndromes and DSM-IV pain disorder in the general population and the association with other mental disorders, as well as effects on disability and health-care utilization. Methods: Analyses were based on a community sample of 4.181 participants 18–65 years old; diagnostic variables were assessed with a standardized diagnostic interview (M-CIDI). Results: The 12-month prevalence for DSM-IV pain disorder in the general population was 8.1%; more than 53% showed concurrent anxiety and mood disorders. Subjects with pain disorder revealed significantly poorer quality of life, greater disability, and higher health-care utilization rates compared to cases with pain below the diagnostic threshold. The majority had more than one type of pain, with excessive headache being the most frequent type. Conclusions: Even when stringent diagnostic criteria are used, pain disorder ranks among the most prevalent conditions in the community. The joint effects of high prevalence in all age groups, substantial disability, and increased health services utilization result in a substantial total burden, exceeding that of depression and anxiety.

Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory disease of hair follicles, characterized by subcutaneous inflammatory nodules and abscesses, typically on the axillary, genitofemoral, and perianal skin. Symptoms of HS, such as foul-smelling discharge from the inflamed lesions, pain, and disease location in sensitive areas, markedly diminish patients’ quality of life. Smoking and obesity are associated with HS, which also has several common comorbidities. While there is a growing body of evidence of somatic comorbidities in HS, psychiatric comorbidities have received less attention. Furthermore, literature on comorbidities in young patients with HS is scarce, and no systematic evaluation of mortality in HS has yet been undertaken. This study aimed to clarify the associations between HS and mental disorders, to explore both somatic and psychiatric comorbidities of HS in children and adolescents, and to determine the life expectancy and cause-specific risks of death in patients with HS. The study population comprised over 4300 cases with HS diagnosed in Finnish hospitals between 1987 and 2014. Age- and sex-matched patients with psoriasis and melanocytic nevi served as controls. Patient data were obtained from the statutory Finnish Care Register for Health Care. Information on dates and causes of death of the cases and controls were acquired from Statistics Finland. This study showed a heavy psychiatric disease burden in patients with HS. The prevalence rates and risks of all studied psychiatric comorbidities were higher in the HS than in the control groups. This was also evident in children and adolescents with HS, not only in adults. Furthermore, younger patients also had elevated risks for many somatic disorders including inflammatory bowel and joint diseases. Remarkably, the mean age at death in the HS group was only 60.5 years. The most common causes for death in the order of likelihood were: cardiovascular diseases, neoplasms, ‘accidents, suicides or violence’ and alcohol-related diseases. Suicide risk was elevated in women with HS. HS patients should be cautiously monitored for possible somatic and psychiatric comorbidities. It is clear that these patients require effective, comprehensive and multidisciplinary care to improve their quality of life and prevent premature death. / Tiivistelmä Hidradenitis suppurativa (HS) on krooninen tulehduksellinen karvatuppien sairaus, joka heikentää elämänlaatua merkittävästi. Kivuliaat kyhmyt ja paiseet sekä vuotavat käytävät, jotka sijaitsevat useimmiten kainaloissa, nivusissa, genitaalialueella ja pakaravaossa, ovat sen tyypillisimpiä ilmenemismuotoja. HS-potilailla on moninaisia terveysongelmia, joita ovat mm. tupakointi, lihavuus ja suurentunut riski useisiin somaattisiin sairauksiin. Tutkimustieto HS-potilaiden psykiatrisista sairauksista on kuitenkin vähäistä eikä liitännäissairauksista lapsilla ole juuri lainkaan tietoa. Tämän lisäksi HS-potilaiden kuolemansyitä tai eliniänodotetta ei ole perusteellisesti selvitetty. Tällä tutkimuksella haluttiin määrittää psykiatristen sairauksien riski HS-potilailla ja selvittää sekä somaattisten että psykiatristen liitännäissairauksien todennäköisyyttä lapsuudessa ja nuoruudessa. Tarkoituksena oli myös tutkia, mihin sairauksiin HS-potilailla on suurentunut riski kuolla ja minkä ikäisinä he menehtyvät. Terveyden ja hyvinvoinnin laitoksen hoitoilmoitusjärjestelmästä etsittiin tiedot kaikista Suomen sairaaloissa vuosina 1987–2014 diagnosoiduista HS-tapauksisista (N=4381). Liitännäissairauksien tutkimista varten verrokeiksi valittiin psoriaasi- tai luomidiagnoosin saaneet henkilöt, jotka kaltaistettiin iän ja sukupuolen mukaan. Kuolintiedot menehtyneistä tutkimuspotilaista saatiin Tilastokeskukselta. HS-potilailla havaittiin selkeästi suurentunut psykiatristen sairauksien riski niin aikuisena kuin myös jo alle 18 vuoden iässä. Lisäksi monien somaattisten sairauksien, esim. tulehduksellisten suoli- ja nivelsairauksien, riski oli suurentunut lapsuudessa. HS-potilaiden todettiin menehtyvän huomattavan nuorella iällä, sillä heidän keskimääräinen elinikänsä oli vain 60,5 vuotta. Yleisimmät kuolinsyyt olivat sydän- ja verisuonitaudit, kasvaimet, ’onnettomuudet, itsemurhat ja väkivalta’ sekä alkoholiin liittyvät kuolemat. Itsemurhariski havaittiin suurentuneeksi naisilla. Tämän tutkimuksen perusteella HS-potilailla on runsaasti psykiatrisia liitännäissairauksia. Sekä somaattisten että psykiatristen sairauksien riski onkin pidettävä mielessä aina HS-potilaita hoidettaessa. Tehokas, kokonaisvaltainen ja moniammatillinen hoito on tärkeää potilaiden elämänlaadun parantamiseksi ja ennenaikaisen kuoleman ehkäisemiseksi.

<p>Uvod: Hronični subduralni hematom (HSDH) je učestala i nezanemarljiva traumatska/netraumatska intrakranijalna lezija, naročito kod pacijenata starije životne dobi. Simptomi pacijenata sa HSDH su raznovrsni i često pogre&scaron;no protumačeni i lečeni. Zbog navedenih činjenica, HSDH predstavlja veliki izazov u dijagnostici i terapiji. Različiti autori ističu značaj radiolo&scaron;kih parametara tokom dijagnostike ovog oboljenja i povezanost sa kliničkom slikom I neurolo&scaron;kim statusom pacijenta, pa je ovo istraživanje bilo usmereno u preciznoj evaluaciji pomenutih parametara, njihovoj prediktivnoj vrednosti i uticaju na prognozu ishoda lečenja. Cilj: Generalni cilj istraživanja je bio da se ispita učestalost pacijenata sa hroničnim subduralnim hematomom na teritoriji Vojvodine u periodu od tri godine; da se analizira starosna dob pacijenata, polna distribucija oboljenja, uticaj komorbiditeta ili faktora rizika na nastanak HSDH; prisustvo ili odsustvo traume koja je doprinela nastanku HSDH, vremenski interval od traume do pojave simpotoma ili znakova bolesti i da se omogući praćenje efekta terapije pacijenata sa ovim oboljenjem. Specifični ciljevi su obuhvatili: 1. Da se utvrde parametri kompjuterizovane tomografije koji imaju prediktivni značaj u pozitivnom ishodu lečenja pacijenata sa hroničnim subduralnim hematomom. 2. Da se utvrde klinički parametri koji imaju prediktivni značaj u pozitivnom ishodu lečenja pacijenata sa hroničnim subduralnim hematomom. 3. Da se dobije model sa najvećom specifično&scaron;ću i senzitivno&scaron;ću za predikciju ishoda lečenja, kombinacijom kliničkih i parametrara kompjuterizovane tomografije kod pacijenata sa hroničnim subduralnim hematomom. Materijal i metode: Istraživanje je obavljeno kao prospektivna trogodi&scaron;nja studija u periodu od aprila 2010. do aprila 2013. godine u Kliničkom Centru Vojvodine- Centru za radiologiju i Klinici za neurohirurgiju i obuvatila je 83 pacijenata sa dijagnozom hroničnog subduralnog hematoma. Svi ispitanici su dijagnostikovani upotrebom kompjuterizovane tomografije glave (CT) i lečeni na Klinici za neurohirurgiju KCV. Izvori podataka su celokupna medicinska dokumentacija svakog pacijenta od perioda prve hospitalizacije do njihovog otpusta, a uključuje i podatke vezane za subjektivni osećaj o zdravstvenom stanju koje su pacijenti usmeno izneli &scaron;est meseci nakon hospitalnog otpusta. Rezultati: Rezultati istraživanja pokazuju da je Glasgow Coma Scala (GCS) tj. nivo svesti pacijenta na hospitalnom prijemu jedini parametar sa visokom prediktivnom vredno&scaron;ću za klinički ishod lečenja pacijenata sa HSDH procenjen preko Glasgow Outcome Scale (GOS). Preostali radiolo&scaron;ki i klinički parametri (&scaron;irina hematoma, pomeraj mediosagitalne linije, denzitet hematoma, starost pacijenta) nemaju visoku prediktivnu vrednost za klinički ishod pacijenata sa hroničnim subduralnim hematomom. Zaključak: Na osnovu grupe analiziranih pacijenata sa HSDH nije bilo moguće napraviti optimalan model za predikciju ishoda lečenja kombinujući radiolo&scaron;ke i kliničke parametre. Pojedinačno posmatrani radiolo&scaron;ki parametri nisu imali visoku prediktivnu vrednost za ishod lečenja pacijenata sa HSDH. Izolovan klinički parametar- GCS- je jedini visoko prediktivni faktor za ishod lečenja pacijenata sa HSDH. Kombinacija kliničkih i radiolo&scaron;kih parametara daje visoku vrednost predviđanja kliničkog ishoda lečenja, ali samo zahvaljujući izrazito visokoj prediktivnoj vrednosti GCS. Iz svega navedenog, kompjuterizovana tomografija (CT) ima veliki značaj u ranoj dijagnostici i praćenju terapije pacijenata sa HSDH, ali CT parametri ponaosob nemaju značaj u predviđanju ishoda lečenja.</p> / <p>Introduction: Chronic subdural hematoma (CSDH) is common traumatic/no traumatic intracranial lesion, especially in older patients. Symptomatology of this disease is variable and often is misdiagnosed and treated with specially challenges in diagnostic and therapy. Different authors pointed on importance of radiological parameters during diagnostic of this disease and connections with clinic and neurological status in patients with chronic subdural hematoma (CSDH), so this thesis was directed to evaluate radiological and clinical parameters of CSDHs and to show their predictive values and their significance on patient&rsquo;s outcome. Aim: General aim of this thesis was to examine frequency of patients with chronic subdural hematoma in Vojvodina, during the period of three years, to analyze the age of population with CSDHs, the gender distribution, an impact of comorbidity or risk factors for patients with CSDHs, the presence or absence of trauma which has contributed to CSDH, to determine time interval from trauma to appearance of symptoms and signs of disease, monitoring the effect of therapy. Specific aims were: 1. To determine clinical parameters with a positive predictive significance on patients outcome 2. To determine radiological parameters with a positive predictive significance on patients outcome 3. To determine optimal prognostic model with high specificity and sensitivity, using combination of radiological and clinical parameters for positive prediction outcome. Material and methods: The study was performed as three-year prospective study from April 2010 to April 2013 in Clinical Centre of Vojvodina, Centre for Radiology and Clinic of Neurosurgery and includes 83 patients with chronic subdural hematoma. All patients were diagnosed using computed tomography of the brain (CT scan) and all were treated in Clinic of Neurosurgery (KCV). Data sources included the medical records of each patient from the time of first hospitalization to period of their discharge and included data related to the subjective feeling of the health that patients verbally present six months after hospital discharge. Results: The results showed that the Glasgow Coma Scale (GCS) - a level of consciousness of the patient on the hospital admission was the only parameter with a high predictive value for clinical outcome of patients with CSDH assessed through Glasgow Outcome Scale (GOS). Other evaluated radiological and clinical parameters (width of the CSDH, mediosagital line displacement, a density of the CSDH, the age of the patient) did not have high predictive values for the clinical outcome in patients with chronic subdural hematoma. Conclusion: Based on the analyzed group of patients with CSDH it was not possible to make optimal predictive model for outcome by combining radiological and clinical parameters. Radiographic parameters did not have high predictive values for treatment outcome in patients with CSDH. Glasgow Coma Scale (GCS) is the only highly predictive factor for treatment outcome in patients with CSDH. The combination of clinical and radiological parameters gives high predictive value for clinical outcome, but only because of extremely high predictive value of GCS. Therefore, computed tomography (CT) is of great importance in early diagnosis and therapy monitoring of patients with CSDH, but CT parameters did not have the high predictive values for the patient&rsquo;s clinical outcome.</p>

No description available.

Les objectifs généraux de cette thèse visaient d'une part à déterminer si les enfants et adolescents abusés sexuellement consultaient et étaient davantage hospitalisés pour des problèmes de santé génito-urinaire que la population pédiatrique générale et d'autre part, à explorer ce qui pouvait expliquer cette différence le cas échéant. La thèse visait également à pallier les lacunes des études antérieures pour la plupart rétrospectives, transversales et conduites principalement auprès de filles, grâce à une méthodologie prospective et de cas-contrôle apparié en ayant recours aux diagnostics médicaux documentés dans les banques administratives publiques du Québec (RAMQ, MSSS) entre les années 1996 et 2013. Dans le premier article, à partir d'un échantillon de 882 enfants (1-18 ans) dont l'agression sexuelle a été corroborée et 882 enfants de la population générale appariés selon l'âge, le sexe et la région sociosanitaire, les résultats du modèle linéaire généralisé indiquent que les filles victimes d'agression sexuelle recevaient plus de diagnostics pour des problèmes de santé urinaire (RR: 2,1) et génitale (RR: 1,4), mais qu'aucune différence n'a été décelée pour les infections transmises sexuellement (ITS). Chez les garçons, ceux ayant été victimes d'agression sexuelle recevaient un nombre équivalent de diagnostics pour les problèmes de santé génitale et urinaire et les données étaient insuffisantes pour conduire des analyses et comparer les taux d'ITS. Selon le type de problèmes de santé analysé (santé génitale, urinaire ou ITS), les filles victimes d'agression sexuelle et celles de la population générale consultaient entre 2,5 et 11 fois en lien avec des diagnostics de troubles génito-urinaires comparativement aux garçons victimes ou ceux de la population générale. Les résultats de cette étude démontrent que l'agression sexuelle à l'enfance est associée à davantage de problèmes de santé urinaire et génitale chez les filles, mais pas chez les garçons. Des efforts de prévention et d'intervention précoce pour une bonne santé génito-urinaire chez les filles victimes d'agression sexuelle pourraient prévenir l'aggravation et la chronicisation de ces problèmes de santé à l'âge adulte. Le deuxième article quant à lui testait un modèle théorique biopsychologique selon lequel une plus grande détresse psychologique (mesurée par la comorbidité des troubles psychiatriques) expliquerait en partie l'effet de l'agression sexuelle sur le nombre accru de diagnostics génito-urinaires chez les filles. Les résultats issus des analyses de médiation conduites auprès de 661 filles victimes d'agression sexuelle et 661 filles de la population générale indiquent qu'après avoir contrôlé le statut socio-économique, le nombre d'années de données médicales et le nombre de diagnostics génito-urinaires/psychiatriques reçus avant la date de signalement de l'agression sexuelle, une plus grande comorbidité psychiatrique expliquait 23% de la relation entre l'agression sexuelle à l'enfance et le nombre de diagnostics urinaires et 62% de la relation entre l'agression sexuelle à l'enfance et le nombre de diagnostics génitaux. Ces résultats indiquent que plus les filles consultent après le signalement de l’agression sexuelle pour un grand nombre de troubles psychiatriques distincts (comorbidité) et plus leur risque de consulter ultérieurement pour des problèmes génito-urinaires est augmenté. Ainsi, cette conclusion suggère que l'émergence de problèmes de santé génito-urinaire des années après l'agression sexuelle pourrait être prévenue chez les filles en prenant soin directement de leur détresse psychologique. / The general objectives of this thesis were first, to determine whether children and adolescents who were sexually abused consulted or were hospitalized more often for genitourinary health problems than the general pediatric population and second, to explore what could explain this difference if any. This thesis also aimed to overcome limitations of previous studies who were retrospective, cross-sectionnal and conducted among girls for the majority, via a prospective matched-cohort design and medical diagnoses documented in Quebec's public administrative banks (RAMQ, MSSS) between 1996 and 2013. In the first article, using a sample of 882 children (1-18 years) with a substantiated report of sexual abuse and 882 children from the general population matched by age, sex and geographic area, the results of the generalized linear mixed model indicated that abused girls received more diagnoses for urinary (RR: 2.1) and genital (RR: 1.4) health problems, but no difference was found for sexually transmitted infections (STIs). Among the boys, those who have been sexually abused received an equivalent number of diagnoses for genital or urinary health problems and there were insufficient data to conduct analyses and compare STIs rates. Depending on the genitourinary health problem, sexually abused girls and those from the general population received between 2.5 and 11 times more diagnoses than abused boys or those from the general population. The results of this study indicate that childhood sexual abuse is associated with more urinary and genital health problems in girls, but not in boys. Prevention and early intervention efforts for a good genitourinary health among girls victim of sexual abuse could prevent the aggravation and chronicisation of these health problems in adulthood. The second article tested a theoretical psychobiological model according to which greater psychological distress (as measured by psychiatric comorbidity) would partly explain the effect of sexual abuse on the increased number of genitourinary diagnoses among girls. Results form mediation analyses conducted with 661 sexually abused girls and 661 girls from the general population indicated that after controlling for socio-economic level, number of years of medical data and genitourinary/psychiatric diagnostics prior sexual abuse report date, greater psychiatric comorbidity explained 23% of the relationship between child sexual abuse and the number of urinary diagnoses and 62% of the relationship between child sexual abuse and the number of genital diagnoses. These results indicate that the more girls consult after the report of sexual abuse for a large number of distinct psychiatric conditions (comorbidity), the greater their risk to consult later for genitourinary health problems. Thus, this conclusion suggests that the emergence of genitourinary health problems years after the sexual abuse could be prevented among girls by taking direct care of their psychological distress.

Hintergrund. In klinischen und epidemiologischen Untersuchungen wurden retrospektiv Assoziationen zwischen Angst- und Alkoholstörungen bestätigt. Bei Personen, die von beiden Störungen betroffen waren, fand man restrospektiv meist einen früheren Beginn der Angststörungen im Vergleich zu den Alkoholstörungen, was kausal im Sinne der Selbstmedikationshypothese interpretiert wurde. Diese konnte bisher nicht eindeutig bestätigt werden. Zur Aufklärung notwendige prospektive Untersuchungen, die Angststörungen auf diagnostischer Ebene erfassen, zwischen verschiedenen Angststörungen unterscheiden und sich auf Jugendliche beziehen, fehlen bisher. Fragestellung. Die Bedeutung von Angststörungen für die Entwicklung von erhöhtem Alkoholkonsum und Alkoholstörungen bei Jugendlichen und jungen Erwachsenen. Methodik. Die Analysen basieren auf den Daten der prospektiv-longitudinalen EDSP-Studie (Follow-Up: insg. 4 Jahre) mit einer epidemiologischen, repräsentativen Stichprobe von 3021 Personen im Alter zwischen 14 und 24 Jahre zu T0 aus München und Umland. Zur Erhebung von DSM-IV-Diagnosen wurde das M-CIDI verwendet. Ergebnisse. Primäre Panikstörungen, Panikattacken und Soziale Phobie erwiesen sich prospektiv als spezifische Prädiktoren für Beginn und Aufrechterhaltung von Alkoholproblemen. Umgekehrt waren Alkoholprobleme mit einem erhöhten Risiko für den Beginn von Sozialer Phobie und GAS assoziiert. Bezüglich DSM-IV Diagnosekriterien fanden sich phobische Ängste sowie Episoden intensiver Angst als Risikofaktoren für den Beginn von Alkoholproblemen. Vermeidungsverhalten war mit einem verminderten Risiko für nachfolgende Alkoholprobleme verbunden. Schlussfolgerungen. Maßnahmen zur Prävention von Alkoholproblemen können sich zielgruppenorientiert an Jugendliche mit Sozialer Phobie und Paniksymptomatik richten. Bei Patienten, die sich wegen Alkoholproblemen in Behandlung begeben, ist eine umfassende Diagnostik zur Identifikation zusätzlicher Angststörungen ratsam. / Background. Many clinical and epidemiological studies have documented significant cross-sectional comorbidities between anxiety disorders and alcohol use disorders. Analysis of retrospective age-of-onset reports suggests that the anxiety disorders often start earlier than the alcohol disorders. These data have often been interpreted in terms of a self-medication-model implying a causal mechanism. Overall, in former studies this model couldn't definitely be proofed. Prospective studies that follow a sample of adolescents into adulthood assessing different anxiety disorders on an diagnostic level are needed to confirm these associations. Methods. Baseline and four-year-follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the M-CIDI. Results. While in retrospective analyses strong associations between nearly all anxiety disorders and alcohol problems, especially harmful use and dependence, were found, prospective analyses showed that only primary panic disorder, panic attack and social phobia are specific predictors of subsequent onset and persistence of alcohol problems. Contrary, primary alcohol problems were related to subsequent onset of social phobia and GAD. Considering the different DSM-IV-criteria, phobic anxiety as well as episodes of intensive anxiety were found to be risk factors for the following onset of alcohol problems. Avoidance behavior was associated with a lower risk for subsequent alcohol problems. Conclusions. Alcohol prevention programs could be directed to target groups with social phobia and panic. Patients with alcohol problems should carefully be screened for comorbid anxiety disorders. In order to prevent relapses the treating of social phobia and panic should be part of the therapy with comorbid alcohol patients.

Although the problem of patients with dual diagnoses is not new, it has only been in the last few years that their unique and complex problems have begun to be addressed. This recognition coincides with society's concern regarding the magnitude of substance abuse problems in general. Currently, treatment consists of integrating concepts from substance abuse and mental health fields. This integration may improve the therapeutic outcome for these patients. As more experience is gained in this specialty, it is hoped that new treatment concepts will evolve that will more powerfully address the interactive aspect of substance abuse and psychiatric disorders.

The aim of this qualitative study was to explore hospital-counselors view on collaboration in thedischarge-process from inpatient psychiatric care regarding individuals with comorbidity in form ofserious mental illness and substance abuse. Six hospital-counselors from different psychiatric in-patient wards in Stockholms county participated in the study. All participants had a degree in socialwork and five of them had earlier experience working in the municipality as social workers. Theresearch process was conducted using qualitative interviews, further applying a systemic view oncollaboration which consisted of three levels: structural-, organizational- and individual, which wasbased on the core concepts of integrated care and person-centered care. The results showed that thehospital-counselors acted as a “link” between the health care, municipality, and patient duringcollaboration. Collaboration itself was described as a process involving different actors andorganizations within the two main principal sectors. The complexity of the differences in economicinterests, view on support needs and responsibilities regarding treatment and further care seemed to becentral aspects influencing collaboration. Although the results largely confirm previous research, it hasbrought attention to specific claims on what facilitates collaboration and what undermines it.

This study is an exploration, through ethnographic and auto-ethnographic inquiry, of the personal world, gambling experiences and underlying biopsychosocial vulnerabilities of three individual case studies - one male and two females - each representing a different sub-type of pathological gambler. It comprises the integration and implementation of a psycho-structural stage matching model to explore comorbidity and identify certain biopsychosocial manifestations in the respective stages of pathological gambling. Long term treatment strategies were identified and patient treatment matching was explored. Further, it comprises my personal relationship and therapeutic treatment of these sub-types of gamblers over a period of one year and longer. In this study it is hypothesized that formulating appropriate matching long term treatment strategies should be based on the stage of change, the phase in the psycho-structural model, as well as the gambler's underlying vulnerability. From this a comprehensive gambling disposition profile can be completed with proper intervention matching approaches. A number of other hypotheses emerged from this study that could provide valuable information and serve as a guideline to those working with pathological gamblers. / Psychology / D.Phil.

No description available.