By: Jacqueline Meaney, PharmD Candidate c/o 2015, University at Buffalo: School of Pharmacy and Pharmaceutical Sciences

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Psychiatric disorders are common in the United States, as nearly half of all Americans will meet the criteria for an anxiety disorder, mood disorder, impulse-control disorder or substance abuse disorder at some point in their lifetime. It is estimated that 26.2% of adults in the United States suffer from a psychiatric disorder in any given year. In addition, mental disorders are the leading cause of disability in the United States, and many people suffer from multiple psychiatric disorders at one time.^1-3

Psychiatric disorders are currently diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).⁴ A psychiatric disorder is defined as a pattern of behavioral and psychological symptoms that impair a person’s ability to function or increases their risk of pain, disability, or death. Psychiatric disorders include eating disorders, anxiety disorders, autism spectrum disorder, mood disorders, attention deficit hyperactivity disorder (ADHD), and personality disorders. People often suffer from multiple psychiatric disorders at a time, as 45% of people with any mental disorder meet the criteria for two or more mental disorders, with disease severity being directly related to comorbidity. If left untreated, mental disorders can result in negative consequences; 90% of people who commit suicide have a mental disorder, most commonly a substance abuse disorder or a depressive disorder. ^5-7

Mood disorders affect 9.5% of adults in the United States each year.^{1, 2} Mood disorders include major depressive disorder (MDD), dysthymic disorder, bipolar disorder, and schizophrenia. MDD is the leading cause of disability in the United States for people aged 15 to 44 and is more common in women than in men.^{3, 8, 9} Dysthymic disorder involves a chronic mild depression that persists for at least two years and affects 1.5% of Americans aged 18 years and older.^{1, 2} Bipolar disorder affects 2.6% of adult Americans, while schizophrenia affects 1.1% of adult Americans.^9-11 Major depressive disorder, dysthymic disorder, and bipolar disorder all have an average age of onset between 25 and 32 years of age, while schizophrenia is often diagnosed in the late teens or early twenties.¹²

Anxiety disorders are another common type of psychiatric disorder, with 18.1% of American adults experiencing an anxiety disorder each year. Anxiety disorders include panic disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and various phobias. The majority of patients who have one anxiety disorder will also have a second anxiety disorder, and the age of onset is typically in the early twenties.^{1, 2, 8}

Eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder, which respectively affect 0.6%, 1% and 2.8% of adult Americans at some point during their lifetime. Women are three times as likely as men to develop anorexia nervosa or bulimia nervosa and are 75% more likely to develop binge-eating disorder.¹⁴ The mortality rate for eating disorders in the United States is 0.56% per year.^{14, 15}

Autism is a pervasive developmental disorder that is part of a group of disorders known as autism spectrum disorders. These disorders vary in severity, with autism being the most debilitating form of the disorder. Autism generally develops early in childhood and is four times more common in males than in females. However, females with autism tend to have a more severe disorder than males.^{16, 17}

Personality disorders include antisocial personality disorder, avoidant personality disorder, and borderline personality disorder, among others. Antisocial personality disorder is a mental disorder in which a person tends to treat others with indifference, and often seeks to manipulate or antagonize others. People with antisocial personality disorder often become criminals and rarely show guilt or remorse for crimes committed. In contrast, avoidant personality disorder is a mental condition in which a person tends to feel overly shy, inferior, inadequate, or sensitive to rejection. Borderline personality disorder is characterized by unpredictable emotions and impulsive actions that lead to chaotic relationships with others. Personality disorders tend to represent patterns of behavior that substantially deviate from the expectations of the individual’s culture and negatively affect the person’s day-to-day life. Among adult Americans, 9.1% have a diagnosable personality disorder.¹⁸

Although there are many guidelines currently available for the treatment of these disorders, there is a constant need for new clinical trials that can re-evaluate the safety and efficacy of various treatment strategies, especially when compared to new or alternative options. A running understanding of the safety and efficacy of psychiatric treatment strategies could help health care providers better select an appropriate treatment approach for patients with psychiatric disorders.

 

SOURCES:

1. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005; 62(6):617-27.
2. U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005.
3. Deaths and DALYS 2004: WHO.int. Annex tables. 2015. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf. Accessed January 26, 2015.
4. American Psychiatric Association. Diagnostic and Statistical Manual on Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.
5. WISQARS (Web-based Injury Statistics Query and Reporting System). Cdc.gov. 2015. Available at: http://www.cdc.gov/injury/wisqars/index.html. Accessed January 25, 2015.
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7. Kochanek KD, Murphy SL, Anderson RN, et al. Deaths: final data for 2002. National Vital Statistics Reports. 2004; 53(5):1-115.
8. Kessler RC, Berglund PA, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005; 62(6):593-602.
9. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association. 2003; 289(23):3095-105.
10. Weissman MM, Bland RC, Canino GJ, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine. 1999; 29(1): 9-17.
11. Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry. 1993; 50(2):85-94.
12. Robins LN, Regier DA. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.
13. Dohrenwend BP, Turner JB, Turse NA, et al. The psychological risk of Vietnam for U.S. veterans: A revisit with new data and methods. Science. 2006; 313(5789):979-982.
14. Hudson JI, Hiripi E, Pope HG, et al. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007; 61:348-58.
15. Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry. 1995; 152(7):1073-4.
16. Centers for Disease Control and Prevention (CDC). Prevalence of Autism Spectrum Disorders―Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR Surveillance Summaries. 2009; 58(SS-10)
17. Fombonne E. Epidemiology of autism and related conditions. In: Volkmar FR, ed. Autism and pervasive developmental disorders. Cambridge, England: Cambridge University Press. 1998; 32-63.
18. Lenzenweger MF, Lane MC, Loranger AW, et al. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 2007; 62(6), 553-564.

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