Associations between attention-deficit hyperactivity disorder genetic liability and ICD-10 medical conditions in adults: utilizing electronic health records in a Phenome-Wide Association Study

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is often comorbid with other medical conditions in adult patients. However, ADHD is extremely underdiagnosed in adults and little is known about the medical comorbidities in undiagnosed adult individuals with high ADHD liability. In this study we investigated associations between ADHD genetic liability and electronic health record (EHR)-based ICD-10 diagnoses across all diagnostic categories, in individuals without ADHD diagnosis history.

METHODS

We used data from the Estonian Biobank cohort (N = 111 261) and generated polygenic risk scores (PRS) for ADHD (PRSADHD) based on the ADHD genome-wide association study. We performed a phenome-wide association study (PheWAS) to test for associations between standardized PRSADHD and 1515 EHR-based ICD-10 diagnoses in the full and sex-stratified sample. We compared the observed significant ICD-10 associations to associations with (1) ADHD diagnosis and (2) questionnaire-based high ADHD risk analyses.

RESULTS

After Bonferroni correction (p = 3.3 × 10-5) we identified 80 medical conditions associated with PRSADHD. The strongest evidence was seen with chronic obstructive pulmonary disease (OR 1.15, CI 1.11-1.18), obesity (OR 1.13, CI 1.11-1.15), and type 2 diabetes (OR 1.11, CI 1.09-1.14). Sex-stratified analysis generally showed similar associations in males and females. Out of all identified associations, 40% and 78% were also observed using ADHD diagnosis or questionnaire-based ADHD, respectively, as the predictor.

CONCLUSIONS

Overall our findings indicate that ADHD genetic liability is associated with an increased risk of a substantial number of medical conditions in undiagnosed individuals. These results highlight the need for timely detection and improved management of ADHD symptoms in adults.

Exploring the Impact of Shame on Health-Related Quality of Life in Older Individuals

PURPOSE

To explore the relationship between shame, ageing, physical disease, and quality of life in Greek older people.

DESIGN AND METHODS

A cross-sectional design using a stratified random cluster sample of older adults from Open Care Centers for the Elderly in the region of Epirus, Greece. Data were collected using (a) the Short Form-36 Health Survey, (b) the Other As Shamer Scale, and (c) the Experience of Shame Scale. Data were analyzed using SPSS software.

RESULTS

Internal shame was positively correlated with external shame (Pearson's r(177) =, p < .01), with negative effect on the mental component in both men and women (effect on women b_W = -0.173, p_W = .004, effect on men b_M = -0.138, p_​M = .047), b = path analysis beta coefficient and with a significant negative effect on the physical health component for men. External shame was found to have a significant negative effect on women's mental health (b = -0.266, p = .002) and a nonsignificant effect on the physical health component. Age was negatively related with the physical health component in both groups (b_W = -0.392, p_W = .002 and b_M = -0.384, p_M = .003), while the presence of a bodily disease corresponded with a lower physical health component score for men (b = -4.267, p = .033).

CONCLUSION

Shame in older individuals is present in both sexes. Older males suffering from a physical disease displayed a greater decline of the health-related quality of life on physical health components, leading to greater internal shame. Older females suffering from a physical disease displayed a greater decline of health-related quality of life on mental health components, leading to greater external shame.

CLINICAL RELEVANCE

These results indicate the need for developing assessment and care plans for older individuals that incorporate in them the concept of shame as a factor in dealing with and adapting to physical disease.

Epidemiology of schizophrenia and risk factors of schizophrenia-associated aggression from 2011 to 2015

Objective To investigate the risk factors associated with aggression in patients with schizophrenia. Methods Patient clinical, behavioural, and demographic information was collected and reported online to the Beijing Mental Health Information Management System by psychiatrists. We used chi-square tests to analyse information between 2011 and 2015 to determine the prevalence and incidence of schizophrenia and the rate of aggression. We used univariate and binary logistic regression to analyse risk factors of aggressive behaviours. Results The prevalence and incidence of schizophrenia, and the proportion of cases displaying aggressive behaviour, increased considerably from 2011 to 2015. Risk of aggression was associated with non-adherence to medication (odds ratio [OR]: 2.92; 95% confidence intervals [CI]: 2.08-4.11), being unmarried (OR: 1.62; 95% CI: 1.03-2.55), having physical disease (OR: 3.26; 95% CI: 2.28-4.66), and higher positive symptom scores (OR: 2.01; 95% CI: 1.06-3.81). Physical disease was a risk factor associated with committing more than one type of aggression. Conclusion We confirmed that demographic factors, treatment-related factors, and clinical symptoms were associated with aggression in patients with schizophrenia in Beijing. A focus on improving controllable factors, including medication adherence and physical health status, might help to prevent aggressive behaviour.

The association of physical illness and self-harm resulting in hospitalisation among older people in a population-based study

OBJECTIVES

With population ageing, self-harm injuries among older people are increasing. Further examination of the association of physical illness and self-harm among older people is warranted. This research aims to identify the association of physical illness with hospitalisations following self-harm compared to non-self-harm injury among older people.

METHOD

A population-based cohort study of individuals aged 50+ years admitted to hospital either for a self-harm or a non-self-harm injury using linked hospital admission and mortality records during 2003-2012 in New South Wales, Australia was conducted. Logistic regression and survival plots were used to examine the association of 21 physical illnesses and mortality at 12 months by injury intent, respectively. Age-adjusted health outcomes, including length of stay, readmission and mortality were examined by injury intent.

RESULTS

There were 12,111 hospitalisations as a result of self-harm and 474,158 hospitalisations as a result of non-self-harm injury. Self-harm compared to non-self-harm hospitalised injury was associated with higher odds of mental health conditions (i.e. depression, schizophrenia, bipolar and anxiety disorders), neurological disorders (excluding dementia), other disorders of the nervous system, diabetes, chronic lower respiratory disease, liver disease, tinnitus and pain. Tinnitus, pain, malignancies and diabetes all had a higher likelihood of occurrence for self-harm compared to non-self-harm hospitalisations even after adjusting for mental health conditions, number of comorbidities and alcohol and drug dependency.

CONCLUSION

Older people who are experiencing chronic health conditions, particularly tinnitus, malignancies, diabetes and chronic pain may be at risk of self-harm. Targeted screening may assist in identifying older people at risk of self-harm.

Where are patients who have co-occurring mental and physical diseases located?

BACKGROUND

Patients with a psychiatric illness have a higher prevalence of physical diseases and thus a higher morbidity and mortality.

AIM

The main aim was to investigate where patients with co-occurring physical diseases and mental disorders (psychotic spectrum or mood) in the health and social service system are identified most frequently before admission into psychiatry. The second aim was to compare the differences in the treatment routes taken by the patients before entry into psychiatric services in all the participating countries (Denmark, Germany, Japan, Nigeria and Switzerland).

METHODOLOGY

On admission to a psychiatric service, patients diagnosed with schizophrenia, schizotypal or delusional disorders (International Classification of Diseases-10 (ICD-10) group F2) or mood (affective) disorders (ICD-10 group F3) and a co-morbid physical condition (cardiovascular disease, diabetes mellitus and overweight) were asked with which institutions or persons they had been in contact with in the previous 6 months.

RESULTS

Patients from Denmark, Germany and Switzerland with mental disorders had almost the same contact pattern. Their primary contact was to public or private psychiatry, with a contact percentage of 46%-91%; in addition, general practice was a common contact, with a margin of 41%-93%. Similar tendencies are seen in Japan despite the small sample size. With regard to general practice, this is also the case with Nigerian patients. However, religious guidance or healing was rarely sought by patients in Europe and Japan, while in Nigeria about 80% of patients with mental disorders had contacted this type of service.

CONCLUSION

Promoting prophylactic work between psychiatry and the general practice sector may be beneficial in diminishing physical conditions such as cardiovascular disease, diabetes mellitus and overweight in patients with mental disorders in European countries and Japan. In Nigeria (a low-to-middle-income country), religious guides or healers, along with general practitioners, are the most frequently contacted, and they therefore seem to be the most obvious partner to collaborate with.

The Association between Depressive Symptoms and Physical Diseases in Switzerland: A Cross-Sectional General Population Study

OBJECTIVE

To estimate the association between depressive symptoms and physical diseases in Switzerland, as respective findings might inform about future estimates of mental and physical health care costs.

METHODS

A population-based study, using data from the Swiss Health Survey collected by computer-assisted telephone interviews and additional written questionnaires during the year 2007 (n = 18,760) in Switzerland. The multistage stratified random sample included subjects aged 15 years and older, living in a private Swiss household with a telephone connection. Complete data were available for 14,348 subjects (51% of all subjects reached by telephone). Logistic regression analyses were used to estimate the associations between depressive symptoms and any physical disease, or a specific physical disease out of 13 non-communicable physical diseases assessed with a self-report checklist on common physical diseases. Analyses were adjusted for sex, age, education, occupation, and household income.

RESULTS

In the adjusted models, depressive symptoms were associated with arthrosis and arthritis [Odds Ratio (OR) = 1.79, 95% confidence interval (CI) = 1.28-2.50] and any physical disease (OR = 1.67, 95% CI = 1.33-2.10) after controlling for multiple testing.

CONCLUSION

Our findings contribute to a better understanding of the comorbidity of depressive symptoms and arthrosis and arthritis in Switzerland and might have implications for more precise future estimates of mental and physical health care costs.

Risk of suicide and suicide attempts associated with physical disorders: a population-based, balancing score-matched analysis

BACKGROUND

The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders.

METHOD

Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3:1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1-90, 91-364, ⩾ 365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923).

RESULTS

Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03-1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71-9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73).

CONCLUSIONS

People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.

Frequency of anemia in chronic psychiatry patients

PURPOSE

Anemia could cause psychiatric symptoms such as cognitive function disorders and depression or could deteriorate an existing psychiatric condition when it is untreated. The objective of this study is to scrutinize the frequency of anemia in chronic psychiatric patients and the clinical and sociodemographic factors that could affect this frequency.

METHODS

All inpatients in our clinic who satisfied the study criteria and received treatment between April 2014 and April 2015 were included in this cross-sectional study. Sociodemographic data for 378 patients included in the study and hemoglobin (Hb) and hematocrit values observed during their admission to the hospital were recorded in the forms. Male patients with an Hb level of <13 g/dL and nonpregnant female patients with an Hb level of <12 g/dL were considered as anemic.

FINDINGS

Axis 1 diagnoses demonstrated that 172 patients had depressive disorder, 51 patients had bipolar disorder, 54 patients had psychotic disorder, 33 patients had conversion disorder, 19 patients had obsessive-compulsive disorder, 25 patients had generalized anxiety disorder, and 24 patients had other psychiatric conditions. It was also determined that 25.4% of the patients suffered from anemia. Thirty-five percent of females and 10% of males were considered as anemic. The frequency of anemia was the highest among psychotic disorder patients (35%), followed by generalized anxiety disorder patients (32%), and obsessive-compulsive disorder patients (26%). Anemia was diagnosed in 22% of depressive disorder patients, 25% of bipolar disorder patients, and 24% of conversion disorder patients.

RESULTS

The prevalence of anemia among chronic psychiatry patients is more frequent than the general population. Thus, the study concluded that it would be beneficial to consider the physical symptoms and to conduct the required examinations to determine anemia among this patient group.

Utilization of mental health services by minority urban adults: psychosocial predictors

Although most mental disorders have their first onset by young adulthood, there are few longitudinal studies of these problems and related help-seeking behavior. The present study examined some early and current predictors of the use of mental health services among African-American and Puerto Rican participants in their mid-30s. The 674 participants (52.8 % African Americans, 47.2 % Puerto Ricans; 60.1 % women) in this study were first seen in 1990 when the participants attended schools serving the East Harlem area of New York City. A structural equation model controlling for the participants' gender, educational level in emerging adulthood, and age at the most recent data collection showed significant standardized pathways from both ethnicity (β = -0.28; z = -4.82; p < 0.001) and psychological symptoms (β = 0.15; z = 2.41; p < 0.05), both measured in emerging adulthood, to smoking in the early 30s. That, in turn, was associated with certain physical diseases and symptoms (i.e., respiratory) in the mid-30s (β = 0.16; z = 2.59; p < 0.05). These physical diseases and symptoms had a cross-sectional association with family financial difficulty in the mid-30s (β = 0.21; z = 4.53; p < 0.001), which in turn also had a cross-sectional association with psychiatric disorders (β = 0.30; z = 5.30; p < 0.001). Psychiatric disorders had a cross-sectional association with mental health services utilization (β = 0.65; z = 13.25; p < 0.001). Additional pathways from the other domains to mental health services utilization in the mid-30s were also supported by the mediating role of psychiatric disorders. Results obtained from this research offer theoretical and practical information regarding the processes leading to the use of mental health services.

Physical diseases among persons with obsessive compulsive symptoms and disorder: a general population study

PURPOSE

This study aimed at evaluating the comorbidity between DSM-IV obsessive compulsive disorder (OCD) and subthreshold forms and physical diseases in the general population as well as disability associated with comorbidity.

METHODS

We used data from the 1998 German Mental Health Survey, a representative survey of the German population. Mental disorders and physical diseases of 4181 subjects (aged 18-65) were cross-sectionally assessed. Mental disorders were diagnosed using the M-CIDI/DIA-X interview. Physical diseases were assessed through a self-report questionnaire and a standardized medical interview. We created three groups of obsessive-compulsive symptoms: (1) no obsessive compulsive symptoms (n = 3,571); (2) obsessive compulsive symptoms (OCS, n = 371; endorsement of OCS (either obsession or compulsion) without fulfilling any core DSM-IV criteria); (3) subthreshold OCD/OCD (n = 239; fulfilling either some or all of the core DSM-IV criteria).

RESULTS

In comparison to subjects without OCS, subjects with subthreshold OCD/OCD showed higher prevalence rates of migraine headaches (OR 1.7; 95% CI 1.1-2.5) and respiratory diseases (OR 1.7; 95% CI 1.03-2.7); subjects with OCS showed higher prevalence rates of allergies (OR 1.6; 95% CI 1.1-2.8), migraine headaches (OR 1.9; 95% CI 1.4-2.7) and thyroid disorders (OR 1.4; 95% CI 1.01-2.0). Subjects with both OCS and physical disease reported the highest number of days of disability due to physical or psychological problems during the past 30 days compared to subjects with only OCS, only physical disease or neither of them.

CONCLUSIONS

OCD and subthreshold forms are associated with higher comorbidity rates with specific physical diseases and higher disability than subjects without OCS. Possible etiological pathways should be evaluated in future studies and clinicians in primary care should be aware of these associations.