Literature Collection

CONTEXT: Although the increased burden of mental health problems among patients with classic 46,XX congenital adrenal hyperplasia (CAH) is well-documented, it remains unclear if this comorbidity is attributable to the burden of living with a chronic medical condition or the potential psychosocial/sexual consequences of being born with a difference of sex development (DSD) and its associated clinical management. OBJECTIVE: To compare the prevalence of psychiatric diagnoses among patients with CAH and 3 reference groups: matched males and females from the general population, and females with type 1 diabetes mellitus (T1DM). METHODS: This was a retrospective cross-sectional study using 3 large integrated health systems. Participants included patients with CAH (n = 115), general population male and female referents (n = 1150 per group), and 66 002 female T1DM referents. RESULTS: The prevalence of depression, anxiety, personality disorders, and suicidal ideation was higher among CAH participants than in males and females from the general population, but similar to or lower than in T1DM referents. Patients with CAH were more likely to be diagnosed with neurodevelopmental disorders than both female reference groups, whereas the prevalence of elimination disorders (predominantly enuresis) and gender dysphoria was higher in the CAH cohort than in all reference groups. CONCLUSION: Females with classic CAH experience a higher burden of psychiatric illness, including anxiety and depression, than demographically similar men and women in the general population. The similar psychiatric burden between females with CAH and T1DM suggests that morbidity may be influenced by the challenges associated with managing a chronic condition. Investigating long-term mental health trajectories in this population will require longitudinal studies.

OBJECTIVES: This study estimated the prevalence, time trends, and state-level variation of same- and multiclass psychotropic polypharmacy among youths in Medicaid fee-for-service plans. METHODS: Using pharmacy records from 29 Medicaid states from 1999 to 2010, the authors constructed ten two-year cohorts of beneficiaries between ages 0 and 17 years who received at least one psychotropic to treat a mental disorder. Polypharmacy was defined as any period in which dispensed days' supply of psychotropics overlapped for more than 45 days. Same- and multiclass psychotropic polypharmacy prevalence was stratified by age and state. RESULTS: A total of 692,485 children were included across each two-year cohort. The prevalence of any-class and multiclass psychotropic polypharmacy grew steadily, from 21.2% and 18.8% in 1999-2000 to 27.3% and 24.4% in 2009-2010, respectively. The prevalence increased with older age, with highest estimates for late adolescents. For same-class psychotropic polypharmacy, a constant upward trend was noted over time, except for antidepressants. Polypharmacy increased over the decade for central nervous system stimulants, from .1% to .6%, and for alpha-agonists, from .1% to .4%. Heterogeneous prevalences of psychotropic polypharmacy were noted across states, ranging from 6.9% to 48.8% for any-class psychotropic polypharmacy, from .4% to 6.4% for same-class antidepressant polypharmacy, and from .1% to 4.6% for antipsychotics. CONCLUSIONS: The study found an overall increasing trend of psychotropic polypharmacy coupled with significant variation across the examined states. A more granular assessment that considers patient characteristics and local contextual factors is warranted.