Psychiatric Comorbidities in Neurologic Hospitalizations in Portugal: A Nationwide Retrospective Observational Study

Authors

  • Manuel Gonçalves-Pinho *Shared first co-authorship. CINTESIS@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Psychiatry and Mental Health. Unidade Local de Saúde do Tâmega e Sousa. Penafiel. https://orcid.org/0000-0001-6098-429X
  • Bárbara Martins *Shared first co-authorship. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Neurology. Unidade Local de Saúde de São João. Porto.
  • Andreia Costa Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Neurology. Unidade Local de Saúde de São João. Porto.
  • João Pedro Ribeiro Department of Psychiatry and Mental Health. Unidade Local de Saúde do Tâmega e Sousa. Penafiel.
  • Alberto Freitas CINTESIS@RISE, MEDCIDS. Faculdade de Medicina. Universidade do Porto. Porto.
  • Elsa Azevedo Department of Neurology. Unidade Local de Saúde de São João. Porto; UnIC@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto.
  • Lia Fernandes CINTESIS@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Psychiatry Service. Unidade Local de Saúde de São João. Porto.

DOI:

https://doi.org/10.20344/amp.20969

Keywords:

Comorbidity, Hospitalization, Mental Disorders, Nervous System Diseases

Abstract

Introduction: Psychiatric comorbidities have a significant impact on patients’ quality of life and often go undetected in neurologic practice. The aim of this study was to describe and characterize psychiatric comorbidities among patients hospitalized due to a neurologic disorder in mainland Portugal.
Methods: A retrospective observational study was performed by analyzing hospitalization with a primary diagnosis of neurologic disorder defined as categories 76, 77, 79 - 85, 95, 109 of the Clinical Classification Software for International Classification of Diseases, Ninth Revision, Clinical Modification, occurring between 2008 and 2015 in adult patients (≥ 18 years of age). Psychiatric comorbidities were determined as the presence of a secondary
diagnosis belonging to the Clinical Classification Software categories 650 to 670.
Results: A total of 294 806 hospitalization episodes with a primary diagnosis of a neurologic disorder were recorded in adult patients between 2008 - 2015 in Portuguese public hospitals. Approximately 26.9% (n = 79 442) of the episodes had a recorded psychiatric comorbidity (22.1%; 32.2%, female versus male hospitalizations). Patients with registered psychiatric comorbidities were younger (66.2 ± 16.2 vs 68.6 ± 17.2 with no psychiatric comorbidities, p < 0.001), presented lower all-cause in-hospital mortality rates, and significantly longer mean hospital stays. ‘Delirium, dementia, amnestic and other cognitive disorders’ were recorded in 7.4% (n = 21 965) of the hospitalizations, followed by alcohol-related disorders in 6.5% (n = 19 302) and mood disorders in 6.1% (n = 18 079). Epilepsy/seizures were the neurologic disorders with the highest proportion of recorded psychiatric comorbidities (39.9%).
Conclusion: Psychiatric comorbidities were recorded in more than a quarter of the hospitalizations with a primary diagnosis of a Neurologic disorder. Psychiatric comorbidities varied among neurological disorders and were associated with different demographic and clinical features.

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References

Moreira D, Oliveira E, Coelho F, Ferraz H, Francisco S, Borges V, et al. What can be expected to be seen in a neurology ward? Elevenyear experience in a Brazilian university hospital. Arq Neuropsiquiatr. 2021;79:478-82.

Earl J, Pop O, Jefferies K, Agrawal N. Impact of neuropsychiatry screening in neurological in-patients: comparison with routine clinical practice. Acta Neuropsychiatr. 2011;23:297-301.

Weichert I. The prevalence and impact of psychiatric comorbidity in inpatients admitted to a district general hospital in England: a 1-week cross-sectional study. J R Coll Physicians Edinb. 2019;49:237-44.

Bressi SK, Marcus SC, Solomon PL. The impact of psychiatric comorbidity on general hospital length of stay. Psychiatr Q. 2006;77:203-9.

Wolff J, Heister T, Normann C, Kaier K. Hospital costs associated with psychiatric comorbidities: a retrospective study. BMC Health Serv Res. 2018;18:67.

Scott G, Beauchamp-Lebrón AM, Rosa-Jiménez AA, Hernández-Justiniano JG, Ramos-Lucca A, Asencio-Toro G, et al. Commonly diagnosed mental disorders in a general hospital system. Int J Ment Health Syst. 2021;15:61.

Al-Atram AA. Prevalence and Patterns of psychiatric co-morbidity among adult medical inpatients: a cross-sectional study. Kuwait Med J. 2018;50:410-6.

van Niekerk M, Walker J, Hobbs H, Magill N, Toynbee M, Steward B, et al. The prevalence of psychiatric disorders in general hospital inpatients: a systematic umbrella review. J Acad Consult Liaison Psychiatry. 2022;63:567-78.

Dawood S, Poole N, Fung R, Agrawal N. Neurologists’ detection and recognition of mental disorder in a tertiary in-patient neurological unit. B J Psych Bull. 2018;42:19-23.

de Jonge P, Huyse FJ, Herzog T, Lobo A, Malt U, Opmeer BC, et al. Referral pattern of neurological patients to psychiatric consultationliaison services in 33 European hospitals. Gen Hosp Psychiatry. 2001;23:152-7.

Alsaadi T, Kassie S, Mohamed Ali O, Mozahem K, Al Fardan S, Ahmed AM. Psychiatric comorbidity in neurological disorders: towards a multidisciplinary approach to illness management in the United Arab Emirates. Front Psychiatry. 2019;10:263.

Görgülü Ü, Gürhan N, Yalçın Akman Y, Altay K, Polat Ü, Özen Ş, et al. Comorbid psychiatric disorders in some common neurological diseases. Med J SDU. 2022;29:75-83.

Medeiros GC, Turkel S, Brownlowe K, Cummings T Jr., Quinn D, Roy D. When mind meets the brain: essentials of well-coordinated management of psychiatric disorders in neurological diseases. J Acad Consult Liaison Psychiatry. 2021;62:270-84.

Kim J, Kim Y, Bae JS, Lee JH, Song HK. Concomitant psychiatric symptoms in neurological outpatients. Int J Environ Res Public Health. 2019;16:860.

Jefferies K, Owino A, Rickards H, Agrawal N. Psychiatric disorders in inpatients on a neurology ward: estimate of prevalence and usefulness of screening questionnaires. J Neurol Neurosurg Psychiatry. 2007;78:414-6.

Bridges KW, Goldberg DP. Psychiatric illness in inpatients with neurological disorders: patients’ views on discussion of emotional problems with neurologists. Br Med J. 1984;289:656-8.

Swinkels WA, Kuyk J, de Graaf EH, van Dyck R, Spinhoven P. Prevalence of psychopathology in dutch epilepsy inpatients: a comparative study. Epilepsy Behav. 2001;2:441-7.

Wood R, Wand AP. The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. J Psychosom Res. 2014;76:175-92.

Douglas MR, Peake D, Sturman SG, Sivaguru A, Clarke CE, Nicholl DJ. The inpatient neurology consultation service: value and cost. Clin Med. 2011;11:215-7.

Instituto Nacional de Estatística. Estatísticas da Saúde 2015. Lisboa: INE; 2019.

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130-9.

Gurgu RS, Ciobanu AM, Danasel RI, Panea CA. Psychiatric comorbidities in adult patients with epilepsy (A systematic review). Exp Ther Med. 2021;22:909.

Baldin E, Hesdorffer DC, Caplan R, Berg AT. Psychiatric disorders and suicidal behavior in neurotypical young adults with childhood-onset epilepsy. Epilepsia. 2015;56:1623-8.

Labudda K, Illies D, Bien CG, Neuner F. Interictal dysphoric disorder: further doubts about its epilepsy-specificity and its independency from common psychiatric disorders. Epilepsy Res. 2018;141:13-8.

Konishi R, Kanemoto K. Psychosis rarely occurs in patients with lateonset focal epilepsy. Epilepsy Behav. 2020;111:107295.

Hamerle M, Ghaeni L, Kowski A, Weissinger F, Holtkamp M. Alcohol use and alcohol-related seizures in patients with epilepsy. Front Neurol. 2018;9:401.

Guo Y, Du P, Guo L, Lin X, He B, Yu L. Alcohol use among patients with epilepsy in western China. A hospital-based study. Epilepsy Behav. 2021;124:108302.

Patel V, Jaisoorya TV, Kamble NL, Yadav R, Kandavel T, Pal P, et al. Prevalence and correlates of psychiatric comorbidity and multimorbidity in Parkinson’s disease and atypical parkinsonian syndromes. J Geriatr Psychiatry Neurol. 2023;36:155-63.

Elefante C, Brancati GE, Bacciardi S, Mazzucchi S, Del Prete E, Palermo G, et al. Prevalence and clinical correlates of comorbid anxiety and panic disorders in patients with parkinson’s disease. J Clin Med. 2021;10:2302.

Lee Y, Chang YY, Chen YF, Lin TK, Hung CF, Chiou YJ, et al. Prevalence and risk factors of depression between patients with parkinson’s disease and their caregivers: a one-year prospective study. Healthcare. 2022;10:1305.

Han JW, Ahn YD, Kim WS, Shin CM, Jeong SJ, Song YS, et al. Psychiatric manifestation in patients with Parkinson’s disease. J Korean Med Sci. 2018;33:e300.

Martins V, Temótio J, Murta I. Comorbilidades psiquiátricas associadas às cefaleias: a experiência da consulta de ligação. Acta Med Port. 2015;28:44-50.

Dresler T, Caratozzolo S, Guldolf K, Huhn JI, Loiacono C, Niiberg-Pikksööt T, et al. Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications. J Headache Pain. 2019;20:51.

Anttila V, Bulik-Sullivan B, Finucane HK, Walters RK, Bras J, Duncan L, et al. Analysis of shared heritability in common disorders of the brain. Science. 2018;360:eaap8757.

Breslau N, Davis GC, Andreski P. Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults. Psychiatry Res. 1991;37:11-23.

Hamelsky SW, Lipton RB. Psychiatric comorbidity of migraine. Headache. 2006;46:1327-33.

Ligthart L, Nyholt DR, Penninx BW, Boomsma DI. The shared genetics of migraine and anxious depression. Headache. 2010;50:1549-60.

Schur EA, Noonan C, Buchwald D, Goldberg J, Afari N. A twin study of depression and migraine: evidence for a shared genetic vulnerability. Headache. 2009;49:1493-502.

Hamel E. Serotonin and migraine: biology and clinical implications. Cephalalgia. 2007;27:1293-300.

Marino E, Fanny B, Lorenzi C, Pirovano A, Franchini L, Colombo C, et al. Genetic bases of comorbidity between mood disorders and migraine: possible role of serotonin transporter gene. Neurol Sci. 2010;31:387-91.

Jürgens TP, Gaul C, Lindwurm A, Dresler T, Paelecke-Habermann Y, Schmidt-Wilcke T, et al. Impairment in episodic and chronic cluster headache. Cephalalgia. 2011;31:671-82.

Costa A, Leston JA, Cavallini A, Nappi G. Cluster headache and periodic affective illness: common chronobiological features. Funct Neurol. 1998;13:263-72.

Pedroso VS, Brunoni AR, Vieira ÉL, Jorge RE, Lauterbach EC, Teixeira AL. Early psychiatric morbidity in a Brazilian sample of acute ischemic stroke patients. Clinics. 2018;73:e55.

Hoyer C, Schmidt HL, Kranaster L, Alonso A. Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke. Neuropsychiatr Dis Treat. 2019;15:1823-31.

Chemerinski E, Robinson RG. The neuropsychiatry of stroke. Psychosomatics. 2000;41:5-14.

Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2014;9:1017-25.

Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016;173:221-31.

Aström M. Generalized anxiety disorder in stroke patients. A 3-year longitudinal study. Stroke. 1996;27:270-5.

Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8:1006-18.

McKay KA, Tremlett H, Fisk JD, Zhang T, Patten SB, Kastrukoff L, et al. Psychiatric comorbidity is associated with disability progression in multiple sclerosis. Neurology. 2018;90:e1316-23.

Published

2024-06-03

How to Cite

1.
Gonçalves-Pinho M, Martins B, Costa A, Ribeiro JP, Freitas A, Azevedo E, Fernandes L. Psychiatric Comorbidities in Neurologic Hospitalizations in Portugal: A Nationwide Retrospective Observational Study. Acta Med Port [Internet]. 2024 Jun. 3 [cited 2024 Jun. 30];37(6):455-66. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/20969

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