Latest news with #comorbidities
Medscape
3 days ago
- Health
- Medscape
Fast Five Quiz: Multiple Sclerosis and Depression
Depression is among the most common comorbidities of multiple sclerosis (MS), leading to psychological quality-of-life issues that can further exacerbate a patient's functional capacity. The significant burden of depression in patients with MS is typically associated with neuroinflammatory processes which are directly correlated to depression severity. Understanding the relationship between depression and MS is crucial for healthcare providers, to develop effective treatment strategies that address both the neurologic and psychological aspects of the disease. What do you know about the interplay of MS and depression? Check your knowledge with this quick quiz. The prevalence of depression in the general population is approximately 13%, according to the Centers for Disease Control and Prevention (CDC). Other data indicate that it falls between 25% and 54% in patients with MS. Depression, along with other disorders such as anxiety and fatigue, are among the most common comorbidities of MS. These comorbidities further degrade quality of life in patients who are already affected by the functional disabilities caused by the diseases. A multidisciplinary approach can help to holistically manage MS to ensure that quality of life is optimized across specific healthcare needs. Learn more about guidelines for MS. A recent systematic review reported that depression symptoms do not significantly improve after smoking cessation in patients with MS, although these patients do see improvements in anxiety. The same review noted that depression is associated with a 1.3- to 2.3-fold increased prevalence in patients with MS who also smoke tobacco. Although smoking cessation is known to cause short-term mood changes, a recent cross-sectional analysis of the NHANES study found that longer duration of cessation is associated with lower risk for depression. However, the persistence of depression in former smokers with MS might be due to depression's strong association with MS, and clinicians should not assume that depression symptoms will improve when a patient quits smoking. Learn more about tobacco product use and depression. Though depression and anxiety can occur in any subtype of MS, an extensive review and meta-analysis found that both were more prevalent in progressive MS (defined by the researchers as PPMS and SPMS) compared with RRMS. In contrast, the same meta-analysis reported that patients with MS and an Expanded Disability Status Scale (EDSS) score of less than 3 had higher rates of depression compared with patients with an EDSS score of greater than 3, while the prevalence of anxiety was higher in patients with an EDSS score greater than 3 compared with an EDSS score below 3. Proinflammatory cytokines in MS have been shown to disrupt the monoaminergic system, which is a component of the pathogenesis of depression. As such, treatments that enhance monoamine neurotransmission (such as SSRIs, SNRIs, and dopaminergic psychostimulants) are indicated for use in depression and MS-associated depression. Learn more about the pathophysiology of MS. Although comorbid depression in MS often presents similarly to fatigue, several characteristics can help clinicians distinguish between the two and guide appropriate treatment. According to a recent review, patients with depression typically have better functioning in the evening while those with fatigue typically have better functioning in the morning. Other characteristics of depression tend to include hypersomnia and hopelessness; patients with fatigue usually experience insomnia and strong hopefulness for recovery. Learn more about symptom management of depression and fatigue in MS. According to a systematic review and meta-analysis assessing exercise best practices for depression in MS, programs implementing ergometer training protocols had the largest effect size. The data reviewed indicated immediate improvements in depression scores with exercise, and depression symptoms were found to improve regardless of exercise frequency, duration, or activity. This is consistent with another review that cited a range of nonpharmacologic interventions for improving depression in MS, including exercise as well as cognitive-behavioral therapy, yoga, dietary habits, and sleep hygiene. Further, data on Hatha yoga, circuit training at moderate intensity, and resistance training with active rest periods in patients with MS and depression are limited. Learn more about exercise for depression. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Medscape
20-05-2025
- Health
- Medscape
Comorbidities Tied to Emergency CRC Diagnoses
A substantial proportion of colorectal cancer (CRC) cases were diagnosed through emergency presentations, with increased odds observed among patients younger than 50 years or aged 80 years or older, those with a lower socioeconomic status, individuals who were widowed, and those with three or more comorbidities. METHODOLOGY: Emergency diagnoses of cancer are associated with poorer survival rates. Given that socioeconomic status and comorbidities can influence diagnostic pathways, evaluating these factors is vital for improving care. Researchers conducted a retrospective cohort study using data from an Italian cancer registry linked to administrative health databases to examine how comorbidities and socioeconomic status affect CRC diagnostic routes; cases were diagnosed between July 2014 and December 2020. Three mutually exclusive diagnostic routes were examined: Screening, emergency presentation, and inpatient or outpatient visits. Researchers also assessed cancer stage at diagnosis and short-term mortality. TAKEAWAY: Researchers included 14,457 patients diagnosed with CRC (74.4% with colon cancer and 25.6% with rectal cancer). D iagnostic routes were reconstructed for 97.8% of patients with colon cancer (median age, 73.1 years; 47.1% women) and 98.1% of those with rectal cancer (median age, 70.3 years; 42.8% women). Among colon cancer cases, 35.6% were diagnosed via emergency presentation, 8.4% via screening, and 22.6% during inpatient/outpatient visits. For rectal cancer, the corresponding rates were 22.6%, 9.5%, and 67.8%, respectively. Emergency diagnosis of colon cancer was more likely among patients younger than 50 years or aged 80 years or older, those in the highest deprivation socioeconomic index quintile, single or widowed individuals (vs married), and those with three or more comorbidities (vs none). Conversely, patients with three or more comorbidities were less likely to be diagnosed with colon cancer through screening than during inpatient/outpatient visits. For both colon and rectal cancers, diagnosis through emergency presentations was associated with significantly higher 30-day and 1-year mortalities than diagnosis through inpatient/outpatient visits ( P < .001 for all). IN PRACTICE: 'Tailored interventions are needed to facilitate screening, to reduce emergency cancer diagnoses, and to improve outcomes for a large number of patients with chronic conditions,' the authors wrote. SOURCE: This study was led by Flavia Pennisi, MD, School of Medicine, University Vita-Salute San Raffaele, Milan, Italy. It was published online in JAMA Network Open . LIMITATIONS: The lack of individual-level electronic health records limited access to symptom data at diagnosis, hindering the ability to differentiate between symptomatic and asymptomatic cases. This study focused on observed associations rather than causal relationships. DISCLOSURES: This study was funded by a grant and an award from Early Detection and Diagnosis Committee from Cancer Research UK. The authors reported having no conflicts of interest.
