Sex-role traits and the comorbidity of symptoms of disordered eating and problem drinking

The symptoms of problem drinking and disordered eating were studied independently in relation to sex-role traits and also for evidence of comorbidity in a student sample of 217 women. The participants completed surveys that assessed positive and negative sex-role traits, reported drinking levels, alcohol dependence, problem drinking, bulimic symptoms, dietary restraint, and drive for thinness. Eating symptoms were related to both the negative and positive traits of Femininity, but self-descriptions involving negative traits (passivity, dependence, unassertiveness, etc.) showed the strongest relationship. High scores on identification with the traits typically labelled as Masculinity were related to drinking but there was an important difference between drinking per se (which was related to Positive Masculinity) and drinking found to be associated with drinking problems, which was related to Negative Masculinity (aggression, showing-off, rudeness, etc.). Feminine traits were also related to drinking. Low identification with the traits of Negative Femininity was associated with non-problem drinking, whereas low identification with the traits of Positive Femininity were associated with problem-related drinking. Young women who displayed comorbid symptoms described themselves by a high identification with the traits of both Negative Masculinity and Negative Femininity. It was argued that comorbidity reveals a more extreme form of the sex-role conflict previously described in relation to disordered control over both eating and drinking when considered independently.

Depression : an important comorbidity with metabolic syndrome in a general population

OBJECTIVE—There is a recognized association among depression, diabetes, and cardiovascular disease. The aim of this study was to examine in a sample representative of the general population whether depression, anxiety, and psychological distress are associated with metabolic syndrome and its components.

RESEARCH DESIGN AND METHODS—Three cross-sectional surveys including clinical health measures were completed in rural regions of Australia during 2004–2006. A stratified random sample (n = 1,690, response rate 48%) of men and women aged 25–84 years was selected from the electoral roll. Metabolic syndrome was defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (NCEP ATP III), and International Diabetes Federation (IDF) criteria. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale and psychological distress by the Kessler 10 measure.

RESULTS—Metabolic syndrome was associated with depression but not psychological distress or anxiety. Participants with the metabolic syndrome had higher scores for depression (n = 409, mean score 3.41, 95% CI 3.12–3.70) than individuals without the metabolic syndrome (n = 936, mean 2.95, 95% CI 2.76–3.13). This association was also present in 338 participants with the metabolic syndrome and without diabetes (mean score 3.37, 95% CI 3.06–3.68). Large waist circumference and low HDL cholesterol showed significant and independent associations with depression.

CONCLUSIONS—Our results show an association between metabolic syndrome and depression in a heterogeneous sample. The presence of depression in individuals with the metabolic syndrome has implications for clinical management.

Ankylosing spondylitis patients commencing biologic therapy have high baseline levels of comorbidity: a report from the Australian Rheumatology Association Database

Aims: To compare the baseline characteristics of a population-based cohort of patients with ankylosing spondylitis (AS) commencing biological therapy to the reported characteristics of bDMARD randomised controlled trials (RCTs) participants.
Methods: Descriptive analysis of AS participants in the Australian Rheumatology Association Database (ARAD) who were commencing bDMARD therapy.
Results: Up to December 2008, 389 patients with AS were enrolled in ARAD. 354 (91.0%) had taken bDMARDs at some time, and 198 (55.9%) completed their entry questionnaire prior to or within 6 months of commencing bDMARDs. 131 (66.1%) had at least one comorbid condition, and 24 (6.8%) had a previous malignancy (15 nonmelanoma skin, 4 melanoma, 2 prostate, 1 breast, cervix, and bowel). Compared with RCT participants, ARAD participants were older, had longer disease duration and higher baseline disease activity.
Conclusions: AS patients commencing bDMARDs in routine care are significantly different to RCT participants and have significant baseline comorbidities.

Parent management training, comorbidity, and treatment of children with oppositional defiant disorder

This study found that Parent Management Training was a successful treatment for promary school aged children who were referred to a mental health clinic and diagnosed with Oppositional Defiant Disorder. The positive outcome was not affected by the child having comorbid disorders. These findings have relevance to the clinical field.

Health service systems and comorbidity: stepping up to the mark

Clients with co-occurring substance use and mental health disorders are not well served in traditional health care systems where specialist services offer segregated interventions and the client is left to negotiate required treatment across both systems. In recent years, policy change guiding the treatment of dual diagnosis in the United States, United Kingdom, Australia and elsewhere has triggered the development of diverse models of treatment, each of which function at different points on a continuum from serial to fully integrated care. This paper outlines key models and provides examples, while considering their potential for appropriately addressing the needs of this client group. Consideration is given to the benefits of an interaction between stepped care and the chosen model, as a means of enhancing care efficiency while retaining the focus on positive outcomes.

Comorbidity of cardiovascular disease, diabetes and chronic kidney disease in Australia

This is the first report of a projected series regarding the comorbidity of cardiovascular disease (CVD), diabetes and chronic kidney disease (CKD) in Australia. Comorbidity refers to any two or more of these diseases that occur in one person at the same time. The questions to be answered in this report include: 1. How many Australians have comorbidity of CVD, diabetes and CKD? 2. What is the proportion of hospitalisations with these comorbidities? 3. How much do these comorbidities contribute to deaths? 4. What is the magnitude of comorbidity in the context of each individual disease? 5. Are there differences in the distribution of these comorbidities among age groups and sexes?

Illness burden and medical comorbidity in the systematic treatment enhancement program for bipolar disorder

Objective:  Coexisting chronic medical conditions are common in bipolar disorder. Here, we report the prevalence and correlates of medical comorbidity in patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). We were particularly interested in associations between variables reflecting illness chronicity and burden with comorbid medical conditions.

Method:  We used intake data from the open-label component of the STEP-BD. History of medical comorbidity was obtained from the affective disorders evaluation, and its presence was the outcome of interest. The sample size in analyses varied from 3399 to 3534. We used multiple Poisson regression to obtain prevalence ratios.

Results:  The prevalence of any medical comorbidity in the sample was 58.8%. In addition to demographic variable, several clinical characteristics were associated with the frequency of medical comorbidity. Having more than 10 previous mood episodes, childhood onset, smoking, lifetime comorbidity with anxiety, and substance use disorders were independently associated with having a medical comorbidity in the final multivariate model.

Conclusion:  The results presented here reveal strong associations between variables related to illness chronicity and medical burden in bipolar disorder. This lends further support to recent multidimensional models incorporating medical morbidity as a core feature of bipolar disorder.

Hoarding in attention deficit hyperactivity disorder: Understanding the comorbidity

Abstract
Hoarding disorder has a frequent co-occurrence with attention-deficit/hyperactivity disorder (ADHD). An accurate understanding of the comorbidity between hoarding disorder and ADHD remains unclear but is essential to inform appropriate assessment, prevention and treatment approaches. This paper will provide a review of potential comorbidity models and aetiological mechanisms implicated in both disorders in order to inform understanding of the nature of the comorbidity between hoarding disorder and ADHD. A correlated liabilities model is identified that implicates genetic, neurological, and executive functioning factors in the development and maintenance of hoarding symptoms in individuals with ADHD.

Motivational interviewing to explore culturally and linguistically diverse people's comorbidity medication self-efficacy

Aims and objectives: To examine the perceptions of a group of culturally and linguistically diverse participants with the comorbidities of diabetes, chronic kidney disease and cardiovascular disease to determine factors that influence their medication self-efficacy through the use of motivational interviewing. Background: These comorbidities are a global public health problem and their self-management is more difficult for culturally and linguistically diverse populations living in English-speaking communities. Few interventions have been tested in culturally and linguistically diverse people to improve their medication self-efficacy. Design: A series of motivational interviewing telephone calls were conducted in the intervention arm of a randomised controlled trial using interpreter services. Methods: Patients with these comorbidities aged ≥18 years of age whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatient clinics of two Australian metropolitan hospitals in 2009. Results: The average age of the 26 participants was 73·5 years. The fortnightly calls averaged 9·5 minutes. Thematic analysis revealed three core themes which were attitudes towards medication, having to take medication and impediments to chronic illness medication self-efficacy. A lack of knowledge about medications impeded confidence necessary for optimal disease self-management. Participants had limited access to resources to help them understand their medications. Conclusion: This work has highlighted communication gaps and barriers affecting medication self-efficacy in this group. Culturally sensitive interventions are required to ensure people of culturally and linguistically diverse backgrounds have the appropriate skills to self-manage their complex medical conditions. Relevance to clinical practice: Helping people to take their medications as prescribed is a key role for nurses to serve and protect the well-being of our increasingly multicultural communities. The use of interpreters in motivational interviewing requires careful planning and adequate resources for optimal outcomes.

Comorbidity between depression and inflammatory bowel disease explained by immune-inflammatory, oxidative, and nitrosative stress; tryptophan catabolite; and gut–brain pathways

The nature of depression has recently been reconceptualized, being conceived as the clinical expression of activated immune-inflammatory, oxidative, and nitrosative stress (IO&NS) pathways, including tryptophan catabolite (TRYCAT), autoimmune, and gut–brain pathways. IO&NS pathways are similarly integral to the pathogenesis of inflammatory bowel disease (IBD). The increased depression prevalence in IBD associates with a lower quality of life and increased morbidity in IBD, highlighting the role of depression in modulating the pathophysiology of IBD.This review covers data within such a wider conceptualization that better explains the heightened co-occurrence of IBD and depression. Common IO&NS underpinning between both disorders is evidenced by increased pro-inflammatory cytokine levels, eg, interleukin-1 (IL-1) and tumor necrosis factor-α, IL-6 trans-signalling; Th-1- and Th-17-like responses; neopterin and soluble IL-2 receptor levels; positive acute phase reactants (haptoglobin and C-reactive protein); lowered levels of negative acute phase reactants (albumin, transferrin, zinc) and anti-inflammatory cytokines (IL-10 and transforming growth factor-β); increased O&NS with damage to lipids, proteinsm and DNA; increased production of nitric oxide (NO) and inducible NO synthase; lowered plasma tryptophan but increased TRYCAT levels; autoimmune responses; and increased bacterial translocation. As such, heightened IO&NS processes in depression overlap with the biological underpinnings of IBD, potentially explaining their increased co-occurrence. This supports the perspective that there is a spectrum of IO&NS disorders that includes depression, both as an emergent comorbidity and as a contributor to IO&NS processes. Such a frame of reference has treatment implications for IBD when “comorbid” with depression.