The Journal of Clinical Psychiatry最新文献

{"title":"Bad Dreams and Nightmares Preceding Suicidal Behaviors.","authors":"Pierre A Geoffroy,&nbsp;Rodolphe Borand,&nbsp;Marine Ambar Akkaoui,&nbsp;Séverine Yung,&nbsp;Yasmine Atoui,&nbsp;Emeline Fontenoy,&nbsp;Julia Maruani,&nbsp;Michel Lejoyeux","doi":"10.4088/JCP.22m14448","DOIUrl":"https://doi.org/10.4088/JCP.22m14448","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Nightmares seem to predict suicidal behaviors, and the aim of this study is to explore the chronology and trajectories of alterations in dream contents before a suicidal crisis, distinguishing 3 different experiences: bad dreams, nightmares, and suicidal scenarios during dreams.</p><p><p><b><i>Methods:</i></b> This naturalistic study included individuals hospitalized between January 2021 and May 2021 in a psychiatric post-emergency room unit for suicidal crisis (thoughts and attempts).</p><p><p><b><i>Results:</i></b> The study observed that 80% (n = 32/40) of patients had altered dreams (AD) before the suicidal crisis, including 27 (67.5%) with bad dreams, 21 (52.5%) with nightmares (bad dreams that awaken the sleeper), and 9 (22.5%) with suicidal scenarios during dreams. No differences were observed between the AD group versus patients with no altered dreams (ND) regarding sociodemographic characteristics. We observed a progression of dream content alterations: bad dreams appear 111 days (4 months) before the suicidal crisis, then nightmares appear 87.3 days before (3 months), and suicidal scenarios during dreams were reported 45.2 days before (1.5 months). For the AD and ND populations in suicidal crisis, 80% had at least 1 subtype of dream alterations, 40% had bad dreams and nightmares, and 17.5% had all 3 subtypes. The AD group, compared to the ND group, had significantly more family history of insomnia (<i>P</i> = .046). Almost all patients (97.5%) had depressive symptoms (Montgomery-Asberg Depression Rating Scale [MADRS] score ≥ 7; 82.5% had moderate to severe symptoms, MADRS ≥ 20), 60% had insomnia (Insomnia Severity Index > 14), 92.5% had altered sleep quality (Pittsburgh Sleep Quality Index > 5), and 57.5% reported sleepiness (Epworth Sleepiness Scale > 10).</p><p><p><b><i>Conclusions:</i></b> Dream alterations and their progression can be readily assessed and may help to better identify prodromal signs of suicidal behaviors.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40721145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Operationalizing Executive Function Deficits in Adults With ADHD Using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A).","authors":"Joseph Biederman,&nbsp;Maura L DiSalvo,&nbsp;Chloe R Hutt Vater,&nbsp;K Yvonne Woodworth,&nbsp;Stephen V Faraone","doi":"10.4088/JCP.22m14530","DOIUrl":"https://doi.org/10.4088/JCP.22m14530","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Although group findings document that executive function deficits (EFDs) contribute to the morbidity associated with adult attention-deficit/hyperactivity disorder (ADHD), it is unclear whether easy-to-use assessment methods can aid in the identification of EFDs at the individual level. The aim of the present study was to assess whether the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), a well-standardized, self-report instrument that assesses behavioral concomitants of EFDs, can serve that purpose.</p><p><p><b><i>Methods:</i></b> 1,090 consecutively referred 18- to 55-year-old adults of both sexes who were clinically referred for the evaluation and treatment of ADHD between June 2016 and December 2021 completed a battery of scales assessing several non-overlapping domains of functioning. Because the BRIEF Global Executive Composite (GEC) offers a single point summary of all other BRIEF-A scales, we used receiver operator characteristic (ROC) curves to identify the optimal cutoff on the BRIEF-A GEC to categorize patients as having executive dysfunction.</p><p><p><b><i>Results:</i></b> We averaged the optimal BRIEF-A GEC cut-points from the ROC curve analyses to categorize patients with (N = 480; 44%) and without (N = 610; 56%) EFDs (BRIEF-A GEC score ≥ 70 or < 70, respectively). Adults with ADHD with EFDs had significantly more severe ADHD symptoms (ADHD Self-Report Scale scores ≥ 24: 94% vs 41%, <i>P</i> < .001); higher levels of psychopathology (Adult Self Report Total Problems T-scores ≥ 64: 75% vs 19%, <i>P</i> < .001), emotional dysregulation (69% vs 23%, <i>P</i> < .001), mind wandering (84% vs 48%, <i>P</i> < .001), and symptoms of autism (Social Responsiveness Scale T-scores ≥ 66: 24% vs 3%, <i>P</i> < .001); and worse quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire mean scores: 44.4 ± 8.2 vs 51.9 ± 8.5, <i>P</i> = .001) compared to those without EFDs. There were no major differences in outcomes by age, sex, or race.</p><p><p><b><i>Conclusions:</i></b> The BRIEF-A helped identify a sizeable minority of adults with ADHD with behavioral concomitants of EFDs that added substantial morbidity and disability beyond that expected by having ADHD alone.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40702741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Concomitant Benzodiazepines on the Antidepressant Effects of Ketamine: Findings From the RAPID Intravenous Ketamine Study.","authors":"Anna Feeney,&nbsp;Bettina B Hoeppner,&nbsp;Marlene P Freeman,&nbsp;Martina Flynn,&nbsp;Dan V Iosifescu,&nbsp;Madhukar H Trivedi,&nbsp;Gerard Sanacora,&nbsp;Sanjay J Mathew,&nbsp;Charles DeBattista,&nbsp;Dawn F Ionescu,&nbsp;Cristina Cusin,&nbsp;George I Papakostas,&nbsp;Manish K Jha,&nbsp;Maurizio Fava","doi":"10.4088/JCP.22m14491","DOIUrl":"https://doi.org/10.4088/JCP.22m14491","url":null,"abstract":"Objective: Ketamine is a novel and rapidly acting treatment for major depressive disorder (MDD). Benzodiazepines are commonly coprescribed with antidepressants in MDD. This study sought to examine data from a randomized clinical trial that compared a single infusion of intravenous (IV) ketamine to midazolam placebo in treatment-resistant depression (DSM-IV-TR MDD) and to assess whether the use of concomitant oral benzodiazepines differentially affected treatment response to ketamine versus midazolam. Methods: This trial ran from December 2015 to December 2016. Subjects who were taking oral benzodiazepines (n = 44) were compared to those who were not (n = 55). A significant treatment-by-benzodiazepine effect could be interpreted as a possible moderator of differential treatment response to ketamine versus midazolam. Benzodiazepine use was examined as both a binary and a continuous predictor, to assess the impact of dosage. Results: Benzodiazepine users did not differ from non-users on the original study's primary outcome measure, score on the 6-item Hamilton Depression Rating Scale (HDRS-6), at baseline, but the former had more severe anxiety. When oral benzodiazepine use was modeled as a binary predictor, benzodiazepine use did not impact differential treatment response. However, when benzodiazepine dosage was considered, there was a significant impact of benzodiazepine use on differential treatment response. Oral benzodiazepines significantly impacted HDRS-6 (P = .018) and Clinical Global Impressions-Severity of Illness scale (CGI-S; P = .008) scores at day 1 (24 hours post treatment); effects were nonsignificant for all day 3 outcomes. Among ketamine subjects, higher doses of benzodiazepines were associated with less improvement in depression scores at day 1. Conclusions: Concomitant oral benzodiazepines at higher doses may attenuate the antidepressant effects of IV ketamine at day 1 but not day 3 post-infusion. Trial Registration: ClinicalTrials.gov identifier: NCT01920555.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating PTSD and Alcohol Use Disorder: Concurrent Cognitive Processing Therapy and Psychopharmacology.","authors":"Rachel Zack Ishikawa,&nbsp;Rachel Steere,&nbsp;Nkechi Conteh,&nbsp;Margaret A Cramer,&nbsp;Vinod Rao,&nbsp;Susan Sprich,&nbsp;Jonah N Cohen","doi":"10.4088/JCP.22ct14636","DOIUrl":"https://doi.org/10.4088/JCP.22ct14636","url":null,"abstract":"<p><p>Comorbidity is common with posttraumatic stress disorder, and alcohol use disorder (AUD) is among the most common co-occurring disorders. When viewed through the lens of avoidance behaviors, AUD can shape an individual's response to distressing trauma reminders by dulling the emotional response and promoting disengagement from the traumatic memory. Over time, this response strengthens posttraumatic distress by reinforcing the belief that traumatic memories and their emotional responses are themselves dangerous and intolerable. In turn, this belief may impede treatment progress. Concurrent trauma-focused therapy and AUD treatment can serve to establish more adaptive coping strategies. Reducing reliance on alcohol for coping while engaging safely and effectively with trauma memories allows the individual to process the memories, build tolerance to emotional distress, and ultimately reframe maladaptive trauma-related beliefs and decrease the intensity of reactions. This case presents concurrent psychopharmacology and cognitive processing therapy for co-occurring posttraumatic stress disorder and AUD. We explore how alcohol use, and emotional avoidance more broadly, become targets for change.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Suvorexant and Lemborexant for the Prevention of Delirium in Adult Critically Ill Patients at an Advanced Critical Care Center: A Single-Center, Retrospective, Observational Study.","authors":"Ayaka Matsuoka,&nbsp;Shuko Tobita,&nbsp;Rintaro Sogawa,&nbsp;Kota Shinada,&nbsp;Toru Murakawa-Hirachi,&nbsp;Chisato Shimanoe,&nbsp;Akira Monji,&nbsp;Yoshito Mizoguchi,&nbsp;Toru Miike,&nbsp;Yuichiro Sakamoto","doi":"10.4088/JCP.22m14471","DOIUrl":"https://doi.org/10.4088/JCP.22m14471","url":null,"abstract":"<p><p><b><i>Objective:</i></b> There is limited evidence for the efficacy of the novel dual orexin receptor antagonists (DORAs) suvorexant and lemborexant in preventing delirium. We examined the efficacy of DORAs in preventing delirium in critically ill patients at an advanced emergency and critical care center.</p><p><p><b><i>Methods:</i></b> In this retrospective observational study, patients 18 years of age or older admitted to the emergency center between July 2018 and November 2021 with hospitalization duration of at least 72 h were included. Kaplan-Meier curves were plotted and log rank tests were performed to compare between patients with and without DORA treatment. Cox regression analyses adjusting for factors associated with delirium risk were also performed.</p><p><p><b><i>Results:</i></b> Of the 633 enrolled patients, 82 were treated with suvorexant and 41 with lemborexant. Cox regression analysis showed that, without adjustment, the hazard ratios (95% CIs) for the development of delirium were 0.56 (0.36-0.86) for patients treated with suvorexant and 0.26 (0.11-0.62) for those treated with lemborexant. After adjustment for delirium risk factors, the hazard ratios (95% CIs) remained low at 0.34 (0.20-0.58) for suvorexant and 0.21 (0.08-0.52) for lemborexant.</p><p><p><b><i>Conclusions:</i></b> Both suvorexant and lemborexant may be effective in preventing delirium in critically ill adult patients in an advanced critical care center.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bipolar Disorder and Premenstrual Dysphoric Disorder: Comorbidity Conundrum.","authors":"Teri Pearlstein","doi":"10.4088/JCP.22com14573","DOIUrl":"https://doi.org/10.4088/JCP.22com14573","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40432138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Premenstrual Dysphoric Disorder With Bipolar Disorder: A Systematic Review.","authors":"Verinder Sharma,&nbsp;Dwight Mazmanian,&nbsp;Heidi Eccles","doi":"10.4088/JCP.22r14416","DOIUrl":"https://doi.org/10.4088/JCP.22r14416","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Since depression represents the most predominant mood polarity in bipolar disorder (BD), the prevalence rates of a diagnosis of premenstrual dysphoric disorder (PMDD) in women with BD and those of a diagnosis of BD in women with PMDD deserve systematic review.</p><p><p><b><i>Data Sources:</i></b> A systematic search of PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Reviews databases was carried out on November 19, 2021, using the terms [late luteal phase disorder OR premenstrual dysphoric disorder] AND comorbidity AND bipolar disorder. Articles from 1987-2021 were searched. Case studies, intervention studies, reviews, and systematic analyses were excluded.</p><p><p><b><i>Study Selection:</i></b> All studies that included a diagnosis of PMDD and BD were included.</p><p><p><b><i>Data Extraction:</i></b> The selected articles were reviewed to extract data using a data extraction form developed for this study.</p><p><p><b><i>Results:</i></b> A total of 5 studies were included in the review. Extant literature, although limited, suggests that PMDD is more common among women with BD than in the general population. Similarly, BD is more common among women with PMDD than in the general population. The proportion of people with PMDD and diagnosed with BD ranged from 10% to 15%. Conversely, the proportion of people with BD who received a diagnosis of PMDD ranged from 27% to 76%.</p><p><p><b><i>Conclusions:</i></b> Only a small number of relevant studies were available, and the findings from these were limited by the failure to employ prospective monitoring of symptoms-perhaps the most important feature necessary for confirming PMDD and differentiating it from premenstrual exacerbation of BD. Given the important clinical and heuristic implications, prospective studies are needed to clarify the relationship between the two disorders in order to improve their detection, diagnosis, and treatment.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40432139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Ketamine Augmentation to Monoamine Oxidase Inhibitors in Treatment-Resistant Depression: A Systematic Literature Review and Case Series.","authors":"Jolien K E Veraart,&nbsp;Sanne Y Smith-Apeldoorn,&nbsp;Mats Kutscher,&nbsp;Maurice Vischjager,&nbsp;Annemarie van der Meij,&nbsp;Jeanine Kamphuis,&nbsp;Robert A Schoevers","doi":"10.4088/JCP.21m14267","DOIUrl":"https://doi.org/10.4088/JCP.21m14267","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Ketamine is increasingly prescribed for treatment-resistant depression (TRD), often as add-on to regular antidepressants. Augmentation of ketamine to monoamine oxidase inhibitors (MAOIs) is advised against, as this practice might increase blood pressure or cause serotonin syndrome. Despite the potential relevance for patients, little is known about actual side effects of combined use. We summarize literature on the safety and add results of our case series.</p><p><p><b><i>Evidence Review:</i></b> PubMed and Embase were searched from inception to July 2021 for English-language articles describing concomitant use of ketamine and MAOIs. The search strategy included terms for \"ketamine\" AND \"monoamine oxidase inhibitor\" including generic and brand names. Additionally, we describe the safety of twice weekly oral esketamine administration over the course of 5 weeks to 9 months in 8 TRD patients using MAOIs.</p><p><p><b><i>Findings:</i></b> After deduplication, we screened 138 articles and assessed 43 full texts. Twelve studies were included with a total of 39 patients receiving ketamine and MAOIs. Blood pressure and heart rate increased in multiple cases, though this was deemed clinically insignificant in all but 1 patient. No signs of hypertensive crisis or serotonin syndrome were observed. In our case series, we observed minor elevations in blood pressure and heart rate and no serious adverse events.</p><p><p><b><i>Conclusions and Relevance:</i></b> The results suggest that combined use of MAOIs and esketamine is less prone to severe side effects than presumed. The investigated sample size was small, and prescribed doses of MAOIs were relatively low. Further research is required before definite conclusions about the safety of this combination can be drawn.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40453039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overlapping Patterns of Suicide Attempts and Non-suicidal Self-Injuries in Adults: A Prospective Clinical Cohort Study.","authors":"Margda Waern,&nbsp;Lotta Strömsten,&nbsp;Stefan Wiktorsson,&nbsp;Bo Runeson,&nbsp;Ellinor S Renberg","doi":"10.4088/JCP.21m14330","DOIUrl":"https://doi.org/10.4088/JCP.21m14330","url":null,"abstract":"<p><p><b><i>Objective:</i></b> An overlap of non-suicidal self-injuries (NSSIs) and suicide attempts (SAs) is observed in young cohorts, but there are few robust prospective studies for adults. We compared 1-year outcomes in adults with different self-harm patterns: NSSI only, NSSI + SA, and SA only.</p><p><p><b><i>Methods:</i></b> 793 patients (67% women) consecutively presenting with NSSI (17%) or SA (83%) at 3 Swedish hospitals took part in face-to-face interviews. Past and current self-harm was characterized by the Columbia-Suicide Severity Rating Scale. Clinical records and national register data were employed to determine 1-year outcomes.</p><p><p><b><i>Results:</i></b> At inclusion, over half of the participants had engaged in both NSSI and SA; 41% had SA only and 5%, NSSI only. During follow-up, non-fatal SAs were observed in approximately one-third of the total group (n = 269). Suicides occurred in 2% of those with NSSI + SA; the same proportion was seen in the SA only group. No suicides were observed in those with NSSI only. In a multiple logistic regression analysis, the NSSI + SA pattern was associated with a more than 3-fold risk of subsequent fatal/non-fatal suicidal behavior compared to \"pure\" NSSI; risk was not elevated in those with \"pure\" SA. Neither sex nor age group predicted subsequent suicidal behavior.</p><p><p><b><i>Conclusions:</i></b> Switching between behaviors with and without suicidal intent was common in this adult clinical cohort. Risk of subsequent suicidal behavior was tripled in the combined group. Clinicians who assess adults with NSSI must evaluate not only current but also previous episodes when assessing future risk of suicidal behavior.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40453040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Major Depressive Disorder on Comorbidities: A Systematic Literature Review.","authors":"Alix M Arnaud,&nbsp;Teri S Brister,&nbsp;Ken Duckworth,&nbsp;Phyllis Foxworth,&nbsp;Tonya Fulwider,&nbsp;Ellison D Suthoff,&nbsp;Brian Werneburg,&nbsp;Izabela Aleksanderek,&nbsp;Marcia L Reinhart","doi":"10.4088/JCP.21r14328","DOIUrl":"https://doi.org/10.4088/JCP.21r14328","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To summarize the breadth of data exploring the relationship between major depressive disorder (MDD) and both the incidence and the disease course of a range of comorbidities.</p><p><p><b><i>Data Sources:</i></b> The authors searched MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and several prespecified congresses. Searches included terms related to MDD and several comorbidity categories, restricted to those published in the English language from 2005 onward.</p><p><p><b><i>Study Selection:</i></b> Eligibility criteria included observational studies within North America and Europe that examined the covariate-adjusted impact of MDD on the risk and/or severity of comorbidities. A total of 6,811 articles were initially identified for screening.</p><p><p><b><i>Data Extraction</i></b>: Two investigators extracted data and assessed study quality.</p><p><p><b><i>Results:</i></b> In total, 199 articles were included. Depression was significantly (<i>P</i> < .05) associated with an increased incidence of dementia and Alzheimer's disease as well as cognitive decline in individuals with existing disease; increased incidence and worsening of cardiovascular disease/events (although mixed results were found for stroke); worsening of metabolic syndrome; increased incidence of diabetes, particularly among men, and worsening of existing diabetes; increased incidence of obesity, particularly among women; increased incidence and worsening of certain autoimmune diseases; increased incidence and severity of HIV/AIDS; and increased incidence of drug abuse and severity of both alcohol and drug abuse.</p><p><p><b><i>Conclusions:</i></b> The presence of MDD was identified as a risk factor for both the development and the worsening of a range of comorbidities. These results highlight the importance of addressing depression early in its course and the need for integrating mental and general health care.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40574837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}