BACKGROUND & AIMS: :The aim of the present study was to investigate the prevalence of panic attack (PA) and panic disorder (PD) in patients with schizophrenia and detect the clinical features. Forty-nine patients with schizophrenia were included in the study. Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI), Extrapyramidal Symptom Rating Scale (ESRS) and Bandelow Panic and Agoraphobia Rating Scale were administered. Fifteen patients were found to have PA and seven patients had PD. Patients with panic symptoms had higher scores of PANSS, HDRS, CGI and ESRS. Comorbid panic symptoms in schizophrenia may be related to positive symptoms, extrapyramidal side-effects and depression.

背景与目标： : 本研究的目的是调查精神分裂症患者惊恐发作 (PA) 和恐慌症 (PD) 的患病率并检测临床特征。研究纳入了49名精神分裂症患者。采用阳性和阴性综合征量表 (PANSS)，汉密尔顿抑郁量表 (HDRS)，临床总体印象 (CGI)，锥体外系症状量表 (ESRS) 和班德洛恐慌和广场恐惧症量表。发现15名患者患有PA，7名患者患有PD。有恐慌症状的患者的PANSS，HDRS，CGI和ESRS评分较高。精神分裂症的合并症恐慌症状可能与阳性症状，锥体外系副作用和抑郁症有关。

BACKGROUND & AIMS: OBJECTIVE:To determine the influence of comorbidity on physical function in osteoarthritis (OA) consulters aged 50 years and over in family practice. METHODS:The study design linked morbidity consultations during an 18-month period to self-reported physical function status measured at the end of the period. Clinical comorbidity was compared between consulters with (n = 1026) and without (n = 8160) OA. Comorbidity was defined by morbidity counts (1-2 low, 3-4 medium,> 5 high) and by a measure of severity of individual morbidities based on chronicity. Associations between comorbidity and physical function were assessed using unconditional logistic regression, adjusting for age, sex, and socioeconomic deprivation. RESULTS:Of the 1026 OA consulters, 38 (3.7%) had an OA consultation only, 260 (25.3%) had low, 288 (28.1%) medium, and 440 (42.9%) high morbidity counts. Higher OA comorbid counts were associated with poorer physical function, after adjusting for age, sex, and socioeconomic deprivation. Associations between OA comorbidity severity and poor physical function showed estimates that were in excess of simply multiplying the individual effects of OA and comorbidity severity separately. Comorbidity, however, did not explain all of the association between OA and poor physical function. CONCLUSION:Comorbidity increases the likelihood of poor physical function in patients with OA in population-based family practice. The combined influence is greater than would be expected from the influence of either OA or the comorbid conditions alone. Treating comorbidity in patients with OA is likely to be crucial in preventing or reducing the related physical decline.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Comorbidity between mental and physical disorder conditions is the rule rather than the exception. It is estimated that 25% of adult population have mental health condition and 68% of them suffer from comorbid medical condition. Readmission rates in psychiatric patients are high and we still lack understanding potential predictors of recidivism. Physical comorbidity could be one of important risk factors for psychiatric readmission. The aim of the present study was to review the impact of physical comorbidity variables on readmission after discharge from psychiatric or general inpatient care among patients with co-occurring psychiatric and medical conditions. METHODS:A comprehensive database search from January 1990 to June 2014 was performed in the following bibliographic databases: Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. An integrative research review was conducted on 23 observational studies. RESULTS:Six studies documented physical comorbidity variables only at admission/discharge and 17 also at readmission. The main body of studies supported the hypothesis that patients with mental disorders are at increased risk of readmission if they had co-occurring medical condition. The impact of physical comorbidity variables on psychiatric readmission was most frequently studied in in patients with affective and substance use disorders (SUD). Most common physical comorbidity variables with higher probability for psychiatric readmission were associated with certain category of psychiatric diagnoses. Chronic lung conditions, hepatitis C virus infection, hypertension and number of medical diagnoses were associated with increased risk of readmission in SUD; Charlson Comorbidity Index, somatic complaints, physical health problems with serious mental illnesses (schizophrenia, schizoaffective disorder, personality disorders); not specified medical illness, somatic complaints, number of medical diagnoses, hyperthyroidism with affective disorders (depression, bipolar disorder). Co-occurring physical and mental disorders can worsen patient's course of illness leading to hospital readmission also due to non-psychiatric reasons. CONCLUSIONS:The association between physical comorbidity and psychiatric readmission is still poorly understood phenomenon. Nevertheless, that physical comorbid conditions are more common among readmitted patients than single admission patients, their association with readmission can vary according to the nature of mental disorders, characteristics of study population, applied concept of comorbidity, and study protocol.

背景与目标：

BACKGROUND & AIMS: :This article provides national data on the lack of transition preparation among youth with special health care needs, including those with emotional, behavioral, and developmental conditions. Consumer and provider transition barriers pertaining to inadequate transition support are summarized. In addition, current US transition goals are presented along with health professional recommendations on transition. The Six Core Elements of Health Care Transition, which are aligned with professional recommendations, are reviewed with practice-based lessons learned from quality improvement efforts. The article concludes with a discussion of transition evaluation needs and opportunities.

背景与目标： : 本文提供了有关具有特殊医疗保健需求的年轻人 (包括具有情感，行为和发育状况的年轻人) 缺乏过渡准备的国家数据。总结了与过渡支持不足有关的消费者和提供者过渡障碍。此外，还提出了当前的美国过渡目标以及有关过渡的卫生专业建议。卫生保健过渡的六个核心要素与专业建议相一致，并结合从质量改进工作中吸取的基于实践的经验教训进行了审查。文章最后讨论了过渡评估的需求和机会。

BACKGROUND & AIMS: :Most efforts aimed at understanding the notable heterogeneity of outcomes in multiple sclerosis (MS) have focused on disease-specific factors, such as symptoms at initial presentation, initial relapse rate, and age at symptom onset. These factors, however, explain relatively little of the heterogeneity of disease outcomes. Owing to the high prevalence of comorbidity in MS and the potential for its prevention or treatment, comorbidity is of rising interest as a factor that could explain the heterogeneity of outcomes. A rapidly growing body of evidence suggests that comorbidity adversely affects outcomes throughout the disease course in MS, including diagnostic delays from symptom onset, disability at diagnosis and subsequent progression, cognition, mortality, and health-related quality of life. Therefore, clinicians need to incorporate the prevention and management of comorbidity when treating patients with MS, but managing comorbidities in MS successfully may require the adoption of new collaborative models of care.

背景与目标： : 大多数旨在了解多发性硬化症 (MS) 结局的显着异质性的努力都集中在疾病特异性因素上，例如初始表现时的症状，初始复发率和症状发作时的年龄。然而，这些因素对疾病结局异质性的解释相对较少。由于MS中合并症的高患病率及其预防或治疗的潜力，合并症作为可以解释结果异质性的一个因素引起了人们的关注。快速增长的证据表明，合并症会对MS的整个病程产生不利影响，包括症状发作的诊断延迟，诊断时的残疾以及随后的进展，认知，死亡率和与健康相关的生活质量。因此，临床医生在治疗MS患者时需要结合合并症的预防和管理，但是成功地管理MS中的合并症可能需要采用新的协作护理模式。

BACKGROUND & AIMS: AIM:To assess the prevalence of comorbidities and measures of physical and mental health among the cancer patients and survivors compared with the general population. METHODS:Data collected by the Australian Bureau of Statistics from 2011-2012 National Health Survey were utilized for this cross-sectional study. Comparisons were made between adults aged 25 years and over with history of cancer (n = 2170) and those respondents who did not report having had a cancer (n = 11 592) using logistic regression models. Analyses were repeated according to cancer status (current cancer vs. cancer survivor). RESULTS:People with history of cancer had significantly higher odds of reporting mental and behavioral problems (overall cancer group adjusted odds ratio 1.36, 95 percent confidence interval 1.20-1.54; current cancer 2.53, 1.97-3.27; cancer survivor 1.20, 1.05-1.38), circulatory conditions (overall cancer group 1.25, 1.12-1.39; current cancer 1.38, 1.08-1.76; cancer survivor 1.22, 1.09-1.38), musculoskeletal conditions (overall cancer group 1.37, 1.24-1.52; current cancer 1.66, 1.30-2.12; cancer survivor 1.33, 1.19-1.48) and endocrine system disorders (overall cancer group 1.19, 1.06-1.34; current cancer 1.29, 1.00-1.66; cancer survivor 1.17, 1.04-1.33) compared with the noncancer group. Cancer patients and survivors were more likely to report poor health status, a higher level of distress, and a greater number of chronic conditions compared with the noncancer group. CONCLUSION:Poor health and comorbidity is more prevalent among cancer patients and survivors than the noncancer population. Our results further support the need to develop models of care that effectively address multiple chronic conditions experienced by the cancer population.

背景与目标：

BACKGROUND & AIMS: :The results of recent community epidemiological research are reviewed, documenting that major depressive disorder (MDD) is a highly prevalent, persistent, and often seriously impairing disorder, and that bipolar disorder (BPD) is less prevalent but more persistent and more impairing than MDD. The higher persistence and severity of BPD results in a substantial proportion of all seriously impairing depressive episodes being due to threshold or subthreshold BPD rather than to MDD. Although the percentage of people with mood disorders in treatment has increased substantially since the early 1990s, a majority of cases remain either untreated or undertreated. An especially serious concern is the misdiagnosis of depressive episodes due to BPD as due to MDD because the majority of depression treatment involves medication provided by primary care doctors in the absence of psychotherapy. The article closes with a discussion of future directions for research.

背景与目标： : 回顾了最近的社区流行病学研究的结果，记录了重性抑郁症 (MDD) 是一种高度流行，持续且经常严重损害的疾病，双相情感障碍 (BPD) 的患病率较低，但比MDD更持久和更具损害。BPD的较高持久性和严重程度导致所有严重损害抑郁发作的很大一部分是由于阈值或阈值以下的BPD而不是MDD引起的。尽管自20世纪90年代初以来，接受治疗的情绪障碍患者的比例已大大增加，但大多数病例仍未得到治疗或治疗不足。一个特别严重的问题是由于BPD和MDD导致的抑郁发作的误诊，因为大多数抑郁症治疗涉及初级保健医生在没有心理治疗的情况下提供的药物。本文最后讨论了未来的研究方向。

BACKGROUND & AIMS: BACKGROUND:Data are presented on the general population prevalences, correlates, comorbidities, and impairments associated with DSM-III-R phobias. METHODS:Analysis is based on the National Comorbidity Survey. Phobias were assessed with a revised version of the Composite International Diagnostic Interview. RESULTS:Lifetime (and 30-day) prevalence estimates are 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple phobia, and 13.3% (and 4.5%) for social phobia. Increasing lifetime prevalences are found in recent cohorts. Earlier median ages at illness onset are found for simple (15 years of age) and social (16 years of age) phobias than for agoraphobia (29 years of age). Phobias are highly comorbid. Most comorbid simple and social phobias are temporally primary, while most comorbid agoraphobia is temporally secondary. Comorbid phobias are generally more severe than pure phobias. Despite evidence of role impairment in phobia, only a minority of individuals with phobia ever seek professional treatment. CONCLUSIONS:Phobias are common, increasingly prevalent, often associated with serious role impairment, and usually go untreated. Focused research is needed to investigate barriers to help seeking.

背景与目标：

BACKGROUND & AIMS: :Hierarchical models of psychopathology based on substantial numbers of lifetime diagnostic categories have not been sufficiently evaluated, even though such models have relevance for theories of disorder etiology, course, or prognosis. In this research, a hierarchical component model of 16 Axis I disorders is derived, and model elements are evaluated in terms of their ability to demonstrate distinct associations with several clinically-relevant variables. Participants were 816 randomly selected adolescents from the community who were repeatedly assessed for psychiatric disorders and associated risk and protective factors over a 14-year period. First-degree relatives were also interviewed to establish their lifetime psychiatric history. Patterns of lifetime comorbidity among 16 psychiatric disorders were described at five levels of organization. In addition to the broadest level that accounted for the most variance in disorder covariation, evidence was obtained at successive levels in the hierarchy for internalizing and externalizing broad-band domains that could be subdivided into more refined clusters. The validity and potential utility of the resultant hierarchical model were further supported by distinct associations that components at each level had with exposure to childhood adversities, psychiatric disorders among first-degree relatives, and psychosocial functioning at ~age 30. A large number of DSM Axis I disorders can be described within broad-band internalizing and externalizing domains, and further differentiation within these domains is possible and likely useful for some purposes. Implications of this research for conceptualizing relations among psychiatric disorders are discussed.

背景与目标： : 基于大量终生诊断类别的心理病理学分层模型尚未得到充分评估，即使此类模型与疾病病因，病程或预后理论相关。在这项研究中，得出了16轴I疾病的分层成分模型，并根据模型元素证明其与几个临床相关变量的独特关联的能力来评估模型元素。参与者是816随机选择的来自社区的青少年，他们在14年的时间内反复评估了精神疾病以及相关的风险和保护因素。还采访了一级亲戚，以确定他们的终生精神病史。在五个组织级别上描述了16种精神疾病的终生合并症模式。除了在无序协变中占最大方差的最广泛水平外，还在层次结构中的连续水平上获得了证据，用于内部化和外部化宽带域，这些域可以细分为更精细的簇。所得分层模型的有效性和潜在效用得到了不同的关联的进一步支持，这些关联是每个级别的组成部分与儿童时期的逆境，一级亲属的精神疾病以及30岁时的心理社会功能有关。可以在宽带内在化和外在化域中描述大量的DSM轴I疾病，并且在这些域中进一步区分是可能的，并且可能对某些目的有用。讨论了这项研究对精神疾病之间的概念化关系的意义。

BACKGROUND & AIMS: BACKGROUND:Most family studies of psychiatric disorders examine one syndrome at a time, and identify probands in clinical rather than epidemiological settings.

METHOD:In the National Comorbidity Survey, 5877 respondents were asked about the history of five psychiatric disorders in their parents: major depression (MD), generalised anxiety disorder (GAD), antisocial personality disorder (ASP), alcohol abuse/dependence (AAD) and drug abuse/dependence (DAD).

RESULTS:Significant familial aggregation was seen for all disorders. Controlling for other disorders produced only modest reductions in the odds ratios for MD, GAD and AAD and larger reductions for ASP and DAD. The familial transmission of these disorders can be explained by underlying vulnerabilities to internalising and to externalising disorders transmitted across generations with moderate fidelity.

CONCLUSIONS:Familial aggregation of common psychiatric and substance use disorders is substantial in epidemiologic samples. The examined environmental adversities account for little of the observed parent-offspring transmission of these conditions.

背景与目标： 背景 : 大多数精神疾病的家庭研究一次检查一种综合征，并在临床而不是流行病学环境中识别先证者。
方法 : 在国家合并症调查中，5877受访者被问及父母中五种精神疾病的病史: 重度抑郁症 (MD)，广泛焦虑症 (GAD)，反社会人格障碍 (ASP)，酒精滥用/依赖 (AAD) 和药物滥用/依赖 (DAD)。
结果 : 所有疾病均可见明显的家族聚集。控制其他疾病仅使MD，GAD和AAD的优势比适度降低，而ASP和DAD的优势比降低幅度更大。这些疾病的家族传播可以通过适度保真度跨代传播的内在和外在疾病的潜在脆弱性来解释。
结论 : 常见的精神病和物质使用疾病的家族聚集在流行病学样本中很大。所检查的环境逆境几乎没有在这些条件下观察到的父母-后代传播中占很小。

BACKGROUND & AIMS: BACKGROUND:A growing number of studies have shown the impact of psychological comorbidities on gastro-oesophageal reflux disease (GERD) patients' symptom reports and healthcare-seeking behaviour. AIM:To review the reported relationship between GERD and psychological comorbidity. METHODS:Review of the literature on GERD and psychological comorbidity. RESULTS:Psychological comorbidity is common among GERD patients and appears to afflict all GERD phenotypes. Sexual and physical abuse is also common in GERD patients. Stress enhances perception of oesophageal acid exposure. Treatment for GERD, especially in those who are not responsive to antireflux treatment, may require further evaluation for psychological comorbidity. CONCLUSIONS:Psychological comorbidity is very common in GERD patients and is likely to play an important role in response, or failure of response, to proton pump inhibitor treatment.

背景与目标：

BACKGROUND & AIMS: :The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.

背景与目标： 临床文献越来越多地表明，心血管危险因素和心血管疾病 (CVD) 在创伤后应激障碍 (PTSD) 患者中更为常见。抑郁症也有心血管疾病的风险，通常与创伤后应激障碍并存。迄今为止的研究尚未确定PTSD是否与除与合并症抑郁症相关的风险之外的其他CVD风险相关。作者在美国国家合并症调查的数据中研究了终生PTSD和抑郁症与高血压的关系。他们将参与者分为4个互斥的诊断组 :( 1) PTSD病史和无抑郁史，(2) PTSD和抑郁史，(3) 抑郁史和无PTSD病史，以及 (4) 无精神障碍史。PTSD，无抑郁和PTSD加抑郁组的高血压患病率高于仅抑郁组和无精神障碍组。PTSD似乎与高血压有关，而与抑郁症无关。这可能部分解释了PTSD患者CVD发生率的升高。

BACKGROUND & AIMS: OBJECTIVE:To report nationally representative findings on the prevalence, correlates, psychiatric comorbidity and treatment of DSM-IV Cannabis Use and Cannabis Use Disorders in Australia. METHOD:The 2007 National Survey of Mental Health and Wellbeing was a nationally representative household survey of 8841 Australians (16-85 years) that assessed symptoms of the most prevalent DSM-IV mental disorders. RESULTS:Prevalence of lifetime and 12-month cannabis use was 18% and 6%; prevalence of lifetime and 12-month cannabis use disorder was 6% and 1%. The conditional prevalence (proportion of ever users who met criteria for a disorder) of lifetime and 12-month cannabis use disorder was 32.2% and 14.3%. Current cannabis use disorders were more common in males (OR 2.0) and younger users (OR 4.6). Strong associations were observed between current cannabis use disorders and alcohol use disorders (OR 3.6) and current affective disorders (OR 3.0). Only 36.2% of those with current cannabis use disorders sought any treatment. CONCLUSIONS:The prevalence of cannabis use disorders in the Australian population is comparable with that in the USA. Current cannabis use disorders are highly concentrated in young Australians who have high levels of comorbidity. The low rates of treatment seeking warrant attention in treatment and prevention strategies.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Depression is frequently accompanied by other mental disorders and various somatic diseases; however, previous comorbidity studies often relied on self-reported data and have not simultaneously assessed the entire spectrum of mental and somatic diagnoses. The aim is to provide a complete picture of mental and somatic comorbidity of depression in routine outpatient care in a high income country with a relatively well equipped health care system. METHODS:Using ambulatory claims data covering 87% of the German population (age 15+), we designed a cross-sectional study by identifying persons diagnosed with mild, moderate and severe depression in 2017 (N = 6.3 million) and a control group matched 4:1 on sex, 5-year age group and region of residence (N = 25.2 million). Stratified by severity, we calculated the prevalence of 202 diagnosis groups included in the ICD-10 in persons with depression as compared to matched controls using prevalence ratios (PR). RESULTS:Nearly all mental disorders were at least twice as prevalent in persons with depression relative to controls, showing a dose-response relationship with depression severity. Irrespective of severity, the three most prevalent somatic comorbid diagnosis groups were 'other dorsopathies' (M50-M54), 'hypertensive diseases' (I10-I15) and 'metabolic disorders' (E70-E90), exhibiting PRs in moderate depression of 1.56, 1.23 and 1.33, respectively. Strong associations were revealed with diseases of the central nervous system (i.e. multiple sclerosis) and several neurological diseases, among them sleep disorders, migraine and epilepsy, most of them exhibiting at least 2- to 3-fold higher prevalences in depression relative to controls. Utilization of health care was higher among depression cases compared to controls. CONCLUSIONS:The present study based on data from nearly the complete adolescent and adult population in Germany comprehensively illustrates the comorbidity status of persons diagnosed with depression as coded in routine health care. Our study should contribute to increasing the awareness of the strong interconnection of depression with all other mental and the vast majority of somatic diseases. Our findings underscore clinical and health-economic relevance and the necessity of systematically addressing the high comorbidity of depression and somatic as well as other mental diseases through prevention, early identification and adequate management of depressive symptoms.

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BACKGROUND & AIMS: UNLABELLED:This cross-sectional study examines the relation between obesity and self-reported pain (moderate or severe pain occurring at least monthly) in a general population sample of adults in the southeastern United States (N = 3637). Results of the study suggest that obese adults (body mass index [BMI] >30) are more likely to experience pain than their normal-weight and underweight counterparts. Respondents classified as class I obese (BMI of 30 to 34.9) were 1.762 times as likely as the underweight and normal weight participants to report severe pain. Class II obese respondents (BMI of 35 to 39.9) were 1.888 times as likely to experience severe pain. Those respondents categorized as class III obese were most likely to report severe pain--2.297 times as likely as the underweight and normal-weight respondents. Analyses demonstrated a similar trend for respondents reporting moderate to severe pain. Adults who are obese are also more likely to report experiencing pain in multiple locations. This study complements clinical research that links pain and obesity and extends it into a general population. Because this is a cross-sectional study, further research is needed to discern causal explanations for the relation between self-reported pain and obesity. PERSPECTIVE:This article provides a population-level depiction of the positive relation between obesity and self-reported pain, which complements clinical research on the topic. It may prompt future research to shape interventions and treatment for both pain and obesity.

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