Psychiatric comorbidity in the evolution from migraine to medication overuse headache.

We set out to study the role of psychiatric comorbidity in the evolution of migraine to medication overuse headache (MOH) by a comparative study of 41 migraineurs (MIG) and 41 patients suffering from MOH deriving from migraine. There was an excess risk of suffering from mood disorders [odds ratio (OR) = 4.5, 95% confidence interval (CI) 1.5, 13.5], anxiety (OR = 5, 95% CI 1.2, 10.7) and disorders associated with the use of psychoactive substances other than analgesics (OR = 7.6, 95% CI 2.2, 26.0) in MOH compared with MIG. Retrospective study of the order of occurrence of disorders showed that in the MOH group, psychiatric disorders occurred significantly more often before the transformation from migraine into MOH than after. There was no crossed-family transmission between MOH and psychiatric disorders, except for substance-related disorders. MOH patients have a greater risk of suffering from anxiety and depression, and these disorders may be a risk factor for the evolution of migraine into MOH. Moreover, MOH patients have a greater risk of suffering from substance-related disorders than MIG sufferers. This could be due to the fact that MOH is part of the spectrum of addictive disorders.

Effects of cannabis and psychosis vulnerability in daily life: an experience sampling test study.

BACKGROUND: Epidemiological findings suggest that cannabis use is a risk factor for the emergence of psychosis, and that the induction of psychotic symptoms in the context of cannabis use may be associated with a pre-existing vulnerability for psychosis. This study investigated in a non-clinical population the interaction between cannabis use and psychosis vulnerability in their effects on psychotic experiences in daily life. METHOD: Subjects (N = 79) with high or low levels of cannabis use were selected among a sample of 685 undergraduate university students. Experience sampling method (ESM) was used to collect information on substance use and psychotic experiences in daily life. Vulnerability to develop psychosis was measured using a clinical interview assessing the level of psychotic symptoms. Statistical analyses were performed using multilevel linear random regression models. RESULTS: The acute effects of cannabis are modified by the subject's level of vulnerability for psychosis. Subjects with high vulnerability for psychosis are more likely to report unusual perceptions as well as feelings of thought influence than subjects with low vulnerability for psychosis, and they are less likely to experience enhanced feelings of pleasure associated with cannabis. There is no evidence that use of cannabis is increased following occurrence of psychotic experiences as would be expected by the self-medication model. CONCLUSION: Cannabis use interacts with psychosis vulnerability in their effects on experience of psychosis in daily life. The public health impact of the widespread use of cannabis may be considerable.

Mood and alcohol consumption: an experience sampling test of the self-medication hypothesis.

In this investigation the authors applied the experience sampling method to prospectively test the self-medication hypothesis. In vivo reports gathered in the context of daily life demonstrated that nervousness was the only negative mood state to predict increases in alcohol consumption later in the course of the day. Further examination of this within-person relationship demonstrated that men were more likely to consume alcohol when nervous than were women, but this association was unrelated to family history of alcoholism, problem drinking patterns, or trait anxiety and depression. Consistent with the self-medication hypothesis, cross-sectional analyses also confirmed that alcohol consumption was generally associated with lower levels of nervousness; this effect varied by several demographic and clinical variables. These findings are discussed in terms of the diversity of reasons for alcohol consumption and their potential for explaining problem drinking.

The comorbidity of depression and substance use disorders.

Depression and substance use disorders are highly prevalent in the general population and often co-occur within the same individual. This association is most commonly explained either by a causal relationship or a shared etiologic factor underlying both disorders. In light of these mechanisms of association, this article summarizes evidence from clinical, epidemiologic, and genetic epidemiologic studies. Details of a large family study designed to addresses key methodological and conceptual issues identified in the review are also presented. The association of alcoholism with depression is likely to be attributable to causal factors rather than a shared etiology, but the scarcity of information for other classes of substance use disorders precludes similar conclusions regarding their association with depression. The lack of unidirectional and consistent patterns of association for depression and substance use disorders indicates that multiple mechanisms of comorbidity are likely to be simultaneously active in this population.

The expression of cognitive vulnerabilities for depression in daily life: a French-American study.

This prospective study provided a direct comparison of French and American samples concerning a cognitive diathesis for depression. Using the Experience Sampling Method and identical measures across sites, subjects were signaled five times daily by electronic devices to provide in vivo reports of negative events, attributions, and depressed moods. After controlling for effects associating clinical and demographic variables, and despite differences attributable to national origin, attributional style emerged as a highly significant predictor of the numerous specific attributions made to negative events within the course of daily life. However, consistent with the cognitive mediation hypothesis, attributional style did not directly explain depression levels. The results are discussed in terms of the predictive power of cognitive and personality assessments in understanding the day-to-day experience of depression.

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology.

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.

The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities.

The comorbidity of alcoholism with anxiety and depressive disorders was examined in four epidemiologic investigations from diverse geographic sites. Despite variability in lifetime prevalence rates for these disorders, there was strong cross-site consistency in the magnitude and specific patterns of comorbidity. Individuals with alcohol abuse or dependence generally experienced a twofold to threefold increased risk of anxiety and depressive disorders. Phobic conditions typically preceded the onset of alcoholism, but no systematic pattern was observed for panic or depressive disorders. Considerable heterogeneity was also observed concerning the impact of comorbid conditions on symptoms of the index disorder. While the presence of comorbid anxiety or depressive disorders was consistently associated with moderate increases in the symptoms of alcohol abuse or dependence, alcoholism was associated with large increases in the number of depressive symptoms and little or no increase in phobic symptoms. The findings are discussed in terms of the self-medication hypothesis and the etiologic heterogeneity of these forms of comorbidity in the general population.

Preparing for community violence: mood and behavioral correlates of the second Rodney King verdicts.

This prospective investigation applied the Experience Sampling Method to examine the mood and behavioral responses of individuals facing the risk of community violence (in anticipation of the second Rodney King verdicts). Threatened participants experienced more negative affect and were less stable in behavioral involvement than individuals not under threat. Threatened participants also avoided social contact except for well-known individuals, and were more likely to be traveling than nonthreatened participants. Social contact with family or close friends and being at home (one's own home or the home of familiar individuals) were associated with large reductions in negative affect for those at risk for urban violence. The findings are discussed in terms of risk factors for trauma following community-wide stressors.

Psychopathology and temperament in parents and offspring: results of a family study.

BACKGROUND: Although research on the association between temperament and psychopathology has received renewed interest, few investigations have addressed the issues of psychiatric comorbidity or the role of temperament across the life span. The present investigation employed a family study/high-risk design to examine the specificity of associations between temperamental traits and psychiatric disorders in both children and adults. METHODS: The sample was composed of 244 probands and 82 children (ages 7-17) from the Yale Family Study of Comorbidity of Substance Abuse and Anxiety. Psychiatric disorders were assessed using structured diagnostic interviews administered by clinicians, and temperament was measured using the Dimensions of Temperament Survey. RESULTS: In both adults and children, anxiety and depression were generally associated with low scores on adaptability and approach/withdrawal, while externalizing or substance use disorders were associated with low attention scores and higher activity. However, psychiatric comorbidity was associated with the manifestation of both clusters of temperamental traits and far greater impairment and clinical severity. Some temperamental characteristics in children also demonstrated specificity of association with parental psychiatric disorder. LIMITATIONS: This investigation was limited to the analysis of cross-sectional data and was unable to separate genetic from other familial risk factors. CONCLUSIONS: The results suggest that temperament remains associated with psychopathology across the life span and may reflect diverse familial influences. Clinical intervention and prevention efforts may benefit from focusing on individuals at higher risk for psychiatric disorder through parental psychopathology or the expression of temperament problems in childhood.