Research Article
Ann Depress Anxiety. 2016; 3(1): 1073.
Distinction between Episodic Mood Disorder and Attention Deficit Disorder with Hyperactivity based on their Association with the Main Classes of International Classification of Disease in a Child and Adolescent Population
Chartier G1 and Cawthorpe D2*
1Department of Psychiatry, University of British Columbia, Canada
2Department of Psychiatry & Community Health Sciences, University of Calgary, Canada
*Corresponding author: David Cawthorpe, Department of Psychiatry & Community Health Sciences, University of Calgary, Canada
Received: March 25, 2016; Accepted: April 07, 2016; Published: April 12, 2016
Abstract
Background: Few studies comprehensively examine specific mental disorders in terms of associated bio-medical comorbidities with focus on the pattern of similitude and distinction. The present study compares the profile of independent classes of physical disorder for Episodic Mood Disorder (EMD), Attention-Deficit Disorder with Hyperactivity (ADHD) and all Other Mental Disorders (OMD).
Methods: Physician billing data for 235893 individuals up to 18 years old spanning sixteen fiscal years (1994-2009) in Calgary, Alberta, was compiled, permitting the examination of Odds Ratios (ORs) comparing the main classes International Classification of Diseases (ICD) within each of four groups of psychiatric disorders: EMD, ADHD, both EMD/ADHD and OMD.
Results: Each group profile was distinct: The EMD group presented Odds Ratios (OR) greater than ADHD and all other mental disorder across most ICD classes. For both sexes, ADHD and EMD differed significantly in profile across 11 independent ICD disorder classes, with an additional three classes being specific to females and one specific to males. The ADHD group ORs tended to be lower than the EMD group and the OMD group.
Conclusion: This study represents the premiere pediatric populationbased report on the patterns of main class ICD disorders associated with EMD and ADHD and OMD. In opposition with most research focusing on EMD and ADHD, the different clinical profile pattern of ICD disorders for EMD and ADHD disorders suggest an independent etiology. Profiling comorbidity represents a novel approach to understanding disease and etiology.
Keywords: Attention deficit hyperactivity disorder; Episodic mood disorder; Comorbidity; Population; Epidemiology; International classification of diseases
Abbreviations
ADHD: Attention Deficit Hyperactivity Disorder; CI: Confidence Intervals; EMD: Episodic Mood Disorder; ICD: International Classification of Diseases; OMD: Other Mental Disorders; OR: Odds Ratio
Introduction
There is overlap of the descriptive criteria underpinning the definition and diagnosis of different mental disorders. Furthermore, much research has focused on common etiology or shared liability or comorbidity of Attention Deficit Hyperactivity Disorder (ADHD), Episodic Mood Disorder (EMD) and other mental disorders in pediatric populations [1-3]. This report supports the contention that ADHD and EMD are distinct entities based on their respective physical disorder profiles.
Background
There has been debate regarding the associations and etiology of EMD and ADHD [4-12]. Research has distinguished between subtypes of chronic and episodic irritability in youngsters, however has not associated chronic and episodic irritability with particular mental disorders [13]. Others have associated early-onset chronic irritability, a feature of EMD, with ADHD [14,15]. Furthermore, studies have identified EMD to be associated with a range of child psychiatric disorders [16-18]. Overlapping symptoms can account for some observed comorbidity in studies [19], however, the application of diagnostic criteria in clinical settings may be influenced by the clinician background and orientation. For example, clinicians are influenced by the debate regarding the phenomenology of EMD, as this relates to diagnostic criteria as applied in children, in addition to its relationship to other childhood mental disorders [20]. While the improvement of diagnostic precision helps to resolve difficulties in establishing the independence of specific child disorders, another approach to understanding these differences may derive from an examination of the physical disorder profiles associated with specific childhood disorders, such as EMD and ADHD. The present study reports on the annual prevalence of EMD and ADHD, in addition to the similarities and differences in comparing the profiles of major class International Classification of Diseases (ICD) of those with EMD and ADHD in relationship to those with both EMD/ADHD and all Other Mental Disorders (OMD).
Methods
Using a population sampling frame, the unique identifiers of 238303 individuals (51% male) up to 18 years of age were selected from the regional health service registry in the Calgary health zone (Calgary, Alberta, Canada) and merged with all direct physician billings (n =10802484) from 1993-2010 for treatment of any presenting concern, resulting in 16 years of fiscal data (1994-2009). Each billing record pertains to services rendered to patients on specified dates resulting in the assignment of an ICD diagnostic code. This study employed an anonymous data set that included International Classification of Diseases (ICD) diagnoses, visit date, age at index visit, and sex.
The annual population rates of the diagnostic groupings were based on the number of unique individuals diagnosed by a physician with ADHD or EMD, or both, or any other mental disorders in any given year, denominated by the civic census of those up to 18 years of age from 1994-2009. The 16-year prevalence was based on the total number of unique individuals diagnosed denominated by a standardized base population (e.g., 2001).
The data was collapsed into four basic groups representing the dependent variables: Presence or absence of EMD (+/-EMD) or ADHD (+/-ADHD), or both EMD and ADHD (+/- BOTH) or any other mental disorder (+/-OMD). EMD did not include schizophrenia, or single or recurrent Major Depression, but included Manic Depressive Disorder, Bipolar Affective Disorder, and Affective Psychosis NOS). These three dependent variables were expressed as the odds ratios of the remaining classes of ICD disorders including V codes (independent variables) as compared to the base category, those without mental disorder. Differences were based on a comparison of overlapping and non-overlapping 95% confidence intervals. For rates, significant statistical differences between proportions in any given year were estimated by comparison of the 95% confidence intervals using the standard formula, wherein non-overlapping 95% confidence intervals represent significant differences (p < 0.05, with z set to 1.96). The sexes were examined separately.
In each case (Table 1), column a represents those without any psychiatric diagnosis or the independent main ICD class disorder, column b represents the frequency of those with the independent man ICD class disorder and without the dependent mental disorder (OMD, EMD, ADHD, both ADHD/EMD), column c represents those without the independent man ICD class disorder and with the dependent mental disorder (OMD, EMD, ADHD, both ADHD/ EMD), column d represents those with both the independent man ICD class disorder and the dependent mental disorder (OMD, EMD, ADHD, both ADHD/EMD). Calculation of the odds ratio was based on the formula OR = [(ad)/(bc)].
Group
ICD Main Class
a
b
c
d
Males
All Other
infectious-parasitic diseases
59202
41690
9227
9598
neoplasms
60630
42303
7799
8985
endocrine etc
62051
42425
6378
8863
blood-blood-forming organs
65315
47892
3114
3396
nervous system
64269
43714
4160
7574
sense organs
22683
11287
45746
40001
circulatory system
63370
43481
5059
7807
respiratory system
9955
3096
58474
48192
digestive system
46627
26592
21802
24696
genitourinary system
54373
34786
14056
16502
complications of pregnancy childbirth
67723
50490
706
798
skin subcutaneous tissue
25599
11570
42830
39718
musculoskeletal system connective tissue
37394
18140
31035
33148
congenital anomalies
64078
46416
4351
4872
perinatal conditions
63107
47258
5322
4030
symptoms signs ill-defined conditions
14686
3974
53743
47314
injury poisoning
16938
5081
51491
46207
V Codes
23441
8606
44988
42682
EMD
infectious-parasitic diseases
99576
1316
18529
296
neoplasms
101658
1275
16447
337
endocrine etc
103277
1199
14828
413
blood-blood-forming organs
111713
1494
6392
118
mental disorders
68429
1610
49676
1610
nervous system
106755
1228
11350
384
sense organs
33512
458
84593
1154
circulatory system
105651
1200
12454
412
respiratory system
12932
119
105173
1493
digestive system
72511
708
45594
904
genitourinary system
88106
1053
29999
559
complications of pregnancy childbirth
116627
1586
1478
26
skin subcutaneous tissue
36844
325
81261
1287
musculoskeletal system connective tissue
55111
423
62994
1189
congenital anomalies
108992
1502
9113
110
perinatal conditions
108786
1579
9319
33
symptoms signs ill-defined conditions
18576
84
99529
1528
injury poisoning
21928
91
96177
1521
V Codes
31760
287
86345
1325
ADHD
infectious-parasitic diseases
88998
11894
15657
3168
neoplasms
90147
12786
14508
2276
endocrine etc
91843
12633
12812
2429
blood-blood-forming organs
99104
14103
5551
959
mental disorders
68429
15023
36226
15062
nervous system
94994
12989
9661
2073
sense organs
31381
2589
73274
12473
circulatory system
93685
13166
10970
1896
respiratory system
12191
860
92464
14202
digestive system
65336
7883
39319
7179
genitourinary system
79084
10075
25571
4987
complications of pregnancy childbirth
103406
14807
1249
255
skin subcutaneous tissue
33610
3559
71045
11503
musculoskeletal system connective tissue
49452
6082
55203
8980
congenital anomalies
97093
13401
7562
1661
perinatal conditions
96884
13481
7771
1581
symptoms signs ill-defined conditions
17489
1171
87166
13891
injury poisoning
20484
1535
84171
13527
V Codes
29999
2048
74656
13014
BOTH
infectious-parasitic diseases
100892
515
18825
159
neoplasms
102933
519
16784
155
endocrine etc
104476
482
15241
192
blood-blood-forming organs
113207
630
6510
44
Table 1: Cell counts used to calculate Odds Ratios.
nervous system
107983
498
11734
176
sense organs
33970
129
85747
545
circulatory system
106851
500
12866
174
respiratory system
13051
28
106666
646
digestive system
73219
280
46498
394
genitourinary system
89159
415
30558
259
complications of pregnancy childbirth
118213
658
1504
16
skin subcutaneous tissue
37169
105
82548
569
musculoskeletal system connective tissue
55534
187
64183
487
congenital anomalies
110494
613
9223
61
perinatal conditions
110365
645
9352
29
symptoms signs ill-defined conditions
18660
25
101057
649
injury poisoning
22019
29
97698
645
V Codes
32047
59
87670
615
Females
All Other
infectious-parasitic diseases
45488
42559
9945
18184
neoplasms
47654
44371
7779
16372
endocrine etc
49030
44244
6403
16499
blood-blood-forming organs
51688
52110
3745
8633
nervous system
50799
46762
4634
13981
sense organs
17225
11872
38208
48871
circulatory system
51261
48802
4172
11941
respiratory system
7592
2293
47841
58450
digestive system
37540
27400
17893
33343
genitourinary system
29220
10961
26213
49782
complications of pregnancy childbirth
49492
38024
5941
22719
skin subcutaneous tissue
19312
9964
36121
50779
musculoskeletal system connective tissue
30550
16425
24883
44318
congenital anomalies
52441
56046
2992
4697
perinatal conditions
51459
54879
3974
5864
symptoms signs ill-defined conditions
10588
2427
44845
58316
injury poisoning
17765
6645
37668
54098
V Codes
12929
2572
42504
58171
EMD
infectious-parasitic diseases
86549
1498
27286
843
neoplasms
90470
1555
23365
786
endocrine etc
91931
1343
21904
998
blood-blood-forming organs
101936
1862
11899
479
mental disorders
55433
2339
58402
2339
nervous system
96090
1471
17745
870
sense organs
28688
409
85147
1932
circulatory system
98431
1632
15404
709
respiratory system
9827
58
104008
2283
digestive system
64201
739
49634
1602
genitourinary system
39999
182
73836
2159
complications of pregnancy childbirth
86372
1144
27463
1197
skin subcutaneous tissue
29012
264
84823
2077
musculoskeletal system connective tissue
46570
405
67265
1936
congenital anomalies
106333
2154
7502
187
perinatal conditions
104254
2084
9581
257
symptoms signs ill-defined conditions
12969
46
100866
2295
injury poisoning
24274
136
89561
2205
V Codes
15450
51
98385
2290
ADHD
infectious-parasitic diseases
84148
3899
26224
1905
neoplasms
87438
4587
22934
1217
endocrine etc
88915
4359
21457
1445
blood-blood-forming organs
98667
5131
11705
673
mental disorders
55433
5795
54939
5804
nervous system
92963
4598
17409
1206
sense organs
28339
758
82033
5046
circulatory system
95146
4917
15226
887
respiratory system
9658
227
100714
5577
digestive system
62317
2623
48055
3181
genitourinary system
38589
1592
71783
4212
complications of pregnancy childbirth
83121
4395
27251
1409
Table 1 (1of2): Cell counts used to calculate Odds Ratios.
skin subcutaneous tissue
28271
1005
82101
4799
musculoskeletal system connective tissue
45073
1902
65299
3902
congenital anomalies
103241
5246
7131
558
perinatal conditions
101156
5182
9216
622
symptoms signs ill-defined conditions
12761
254
97611
5550
injury poisoning
23800
610
86572
5194
V Codes
15189
312
95183
5492
BOTH
infectious-parasitic diseases
88047
229
28129
171
neoplasms
92025
295
24151
105
endocrine etc
93274
223
22902
177
blood-blood-forming organs
103798
324
12378
76
nervous system
97561
257
18615
143
sense organs
29097
41
87079
359
circulatory system
100063
293
16113
107
respiratory system
9885
9
106291
391
digestive system
64940
104
51236
296
genitourinary system
40181
39
75995
361
complications of pregnancy childbirth
87516
239
28660
161
skin subcutaneous tissue
29276
45
86900
355
musculoskeletal system connective tissue
46975
83
69201
317
congenital anomalies
108487
356
7689
44
perinatal conditions
106338
365
9838
35
symptoms signs ill-defined conditions
13015
6
103161
394
injury poisoning
24410
15
91766
385
V Codes
15501
7
100675
393
Table 1 (1of3): Cell counts used to calculate Odds Ratios.
Results
The sample included 116176 females and 119717 males with a total of 10802484 visits with physician-assigned diagnoses for 3490912 unique patient-diagnoses (50% male). On average individuals had 15 diagnoses (median 13; 90th percentile 21; range 1-89). Thirty-two percent had at least one mental disorder over 16 fiscal years from 1993-2009 [21]. For females, the prevalence rates were 1.2% for EMD 4.5% ADHD and 0.25% for Both EMD/ADHD. For males, the prevalence rates were 0.92% for EMD 12%, ADHD and 0.38% for Both EMD/ADHD.
The EMD diagnoses represented 2866 individuals (44% male) of mean age 15.6 years. EMD diagnoses were made primarily by psychiatrists (58%), followed by general practitioners (30%) and other specialties (12%). The EMD first diagnosis date was assigned by general practitioners 248 days on average before the EMD first diagnosis date assigned by psychiatrists and 397 days in the median.
The mean age was 10.7 years (22486 individuals, 73% male) among those having a diagnosis of ADHD. ADHD diagnoses were made primarily by pediatricians (45%), followed by general practitioners (43%) and by psychiatrists (11%) and the remaining 1% by other specialties. The ADHD first diagnosis date was assigned by general practitioners 98 days on average before the ADHD first diagnosis date assigned by psychiatrists and 132 days in the median.
The mean age was 14.8 years for 865 individuals (61% male) among those having a diagnosis of ADHD and EMD. Where both diagnoses co-occurred, diagnoses were made primarily by pediatricians (1.3%), followed by general practitioners (25%) and by psychiatrists (63%) and the remaining 10.7% by other specialties.
Table 2 shows the annual rates per 100,000 of EMD and ADHD for those up to the age of 18 years. The rate of ADHD is less consistent from year to year and two to four times higher than the rate of EMD in the population in various years.The population rate for episodic mood disorder and ADHD are relatively stable (Table 2). Compared to males, the 16-year prevalence rate of EMD is higher for females (132%) and for each year. The 16-year prevalence rate of ADHD is less for females (38%) and for each year, as is the rate for both EMD/ ADHD (66%).
Females
Males
Year
EMD
ADHD
Both EMD/ADHD
EMD
ADHD
Both EMD/ADHD
16 yr
1210
4530
253
920
11938
384
1994
42
234
6
34
604
10
1995
81
341
9
40
947
9
1996
93
423
7
51
930
15
1997
76
330
6
48
914
16
1998
75
342
7
39
828
12
1999
65
323
14
56
800
18
2000
80
284
14
52
694
20
2001
76
274
16
65
697
21
2002
75
257
10
60
682
31
2003
51
230
9
39
690
15
2004
81
273
24
70
725
30
2005
87
299
23
64
745
26
2006
93
249
23
73
696
34
2007
84
243
25
67
671
34
2008
92
210
28
80
627
40
2009
64
213
21
66
589
34
Table 2: Annual rates per 100,000 of EMD and ADHD for males and females combined in the population.
Table 3 shows the odds ratios and 95% confidence intervals by sex and main ICD class for each dependent group category is rank ordered from the highest to the lowest odds ratio bison for the category with the highest value which in each case was the column containing the group with both ADHD/EMD.
Group
ICD Main Class
Any Other MD
EMD
ADHD
BOTH EMD/ADHD
Males
injury poisoning
2.99
[2.89 3.09]
3.81
[3.08 4.71]
2.14
[2.03 2.27]
5.01
[3.45 7.27]
symptoms signs ill-defined conditions
3.25
[3.13 3.38]
3.4
[2.72 4.23]
2.38
[2.24 2.53]
4.79
[3.21 7.15]
V Codes
2.58
[2.51 2.66]
1.7
[1.49 1.93]
2.55
[2.43 2.68]
3.81
[2.92 4.98]
nervous system
2.68
[2.57 2.79]
2.94
[2.62 3.3]
1.57
[1.49 1.65]
3.25
[2.74 3.87]
circulatory system
2.25
[2.17 2.33]
2.91
[2.6 3.26]
1.23
[1.17 1.3]
2.89
[2.43 3.44]
respiratory system
2.65
[2.54 2.76]
1.54
[1.28 1.86]
2.18
[2.03 2.34]
2.82
[1.93 4.12]
endocrine etc
2.03
[1.96 2.1]
2.4
[2.14 2.69]
1.38
[1.31 1.44]
2.73
[2.31 3.23]
skin subcutaneous tissue
2.05
[2 2.11]
1.8
[1.59 2.03]
1.53
[1.47 1.59]
2.44
[1.98 3.01]
musculoskeletal system connective tissue
2.2
[2.15 2.25]
2.46
[2.2 2.75]
1.32
[1.28 1.37]
2.25
[1.9 2.67]
digestive system
1.99
[1.94 2.03]
2.03
[1.84 2.24]
1.51
[1.46 1.57]
2.22
[1.9 2.58]
complications of pregnancy childbirth
1.52
[1.37 1.68]
1.29
[0.88 1.91]
1.43
[1.24 1.63]
1.91
[1.16 3.15]
neoplasms
1.65
[1.6 1.71]
1.63
[1.45 1.84]
1.11
[1.05 1.16]
1.83
[1.53 2.19]
genitourinary system
1.84
[1.79 1.88]
1.56
[1.41 1.73]
1.53
[1.48 1.59]
1.82
[1.56 2.13]
sense organs
1.76
[1.71 1.8]
1
[0.9 1.11]
2.06
[1.97 2.16]
1.67
[1.38 2.03]
infectious-parasitic diseases
1.48
[1.43 1.52]
1.21
[1.06 1.37]
1.51
[1.45 1.58]
1.65
[1.38 1.98]
blood-blood-forming organs
1.49
[1.41 1.56]
1.38
[1.14 1.67]
1.21
[1.13 1.3]
1.21
[0.89 1.65]
congenital anomalies
1.55
[1.48 1.61]
0.88
[0.72 1.06]
1.59
[1.5 1.68]
1.19
[0.92 1.55]
perinatal conditions
1.01
[0.97 1.06]
0.24
[0.17 0.34]
1.46
[1.38 1.55]
0.53
[0.37 0.77]
Female
V Codes
6.88
[6.58 7.19]
7.05
[5.34 9.31]
2.81
[2.5 3.15]
8.64
[4.09 18.26]
symptoms signs ill-defined conditions
5.67
[5.42 5.94]
6.41
[4.79 8.59]
2.86
[2.52 3.24]
8.28
[3.7 18.56]
injury poisoning
3.84
[3.72 3.96]
4.39
[3.69 5.23]
2.34
[2.15 2.55]
6.83
[4.08 11.44]
genitourinary system
5.06
[4.93 5.2]
6.43
[5.52 7.48]
1.42
[1.34 1.51]
4.89
[3.52 6.81]
respiratory system
4.05
[3.85 4.25]
3.72
[2.86 4.83]
2.36
[2.06 2.69]
4.04
[2.09 7.83]
digestive system
2.55
[2.49 2.61]
2.8
[2.57 3.06]
1.57
[1.49 1.66]
3.61
[2.88 4.51]
endocrine etc
2.86
[2.77 2.95]
3.12
[2.87 3.39]
1.37
[1.29 1.46]
3.23
[2.65 3.94]
sense organs
1.86
[1.81 1.91]
1.59
[1.43 1.77]
2.3
[2.13 2.49]
2.93
[2.12 4.04]
nervous system
3.28
[3.16 3.4]
3.2
[2.94 3.49]
1.4
[1.31 1.5]
2.92
[2.38 3.58]
skin subcutaneous tissue
2.72
[2.65 2.8]
2.69
[2.37 3.06]
1.64
[1.53 1.76]
2.66
[1.95 3.63]
musculoskeletal system connective tissue
3.31
[3.23 3.39]
3.31
[2.97 3.69]
1.42
[1.34 1.5]
2.59
[2.04 3.3]
infectious-parasitic diseases
1.95
[1.9 2.01]
1.78
[1.64 1.94]
1.57
[1.48 1.66]
2.34
[1.92 2.85]
circulatory system
3.01
[2.9 3.12]
2.78
[2.54 3.04]
1.13
[1.05 1.21]
2.27
[1.82 2.83]
complications of pregnancy childbirth
4.98
[4.82 5.14]
3.29
[3.03 3.57]
0.98
[0.92 1.04]
2.06
[1.68 2.51]
blood-blood-forming organs
2.29
[2.2 2.38]
2.2
[1.99 2.44]
1.11
[1.02 1.2]
1.97
[1.53 2.53]
congenital anomalies
1.47
[1.4 1.54]
1.23
[1.06 1.43]
1.54
[1.41 1.69]
1.74
[1.27 2.39]
neoplasms
2.26
[2.19 2.33]
1.96
[1.79 2.14]
1.01
[0.95 1.08]
1.36
[1.08 1.7]
perinatal conditions
1.38
[1.33 1.44]
1.34
[1.18 1.53]
1.32
[1.21 1.44]
1.04
[0.73 1.47]
Table 3: Odds ratios for males and females [with 95% CIs] for each condition.
For males with both ADHD/EMD, the main ICD class disorders injury poisoning, symptoms signs ill-defined conditions, V Codes, nervous system, circulatory system and respiratory system ranked highest. For females with both ADHD/EMD, V Codes, symptoms signs ill-defined conditions, injury poisoning, genitourinary system, respiratory system, digestive system, endocrine etc, sense organs, nervous system, skin subcutaneous tissue and musculoskeletal system connective tissue were the highest ranking main ICD class disorders.
Tables 4 summarizes the significant differences in the OR distributions for males and females comparing groups based on direction (TRUE/FALSE) and significance (with “+” representing non-overlapping 95%CIs and “-” representing non-significance). The constellations of ORs denoted as TRUE or FALSE satisfying the condition in the column header, being in each case with the independent class of ICD disorder being greater than or less than another dependent category of OR category. For both male and females, ADHD is significantly different from EMD across the following ICD main disorder classes: blood and blood-forming organs, circulatory system, and digestive system, endocrine, genitourinary system, musculoskeletal system connective tissue, neoplasms, nervous system, respiratory system, skin subcutaneous tissue, symptoms signs ill-defined conditions. For females, ADHD is significantly different from EMD across the following ICD main disorder classes: sense organs, perinatal conditions, congenital anomalies. For males, ADHD is significantly different from EMD across the ICD main disorder class injury and poisoning.
Condition of gorup comparsion (+ = p < .05. - = ns)
ICD Main Class
ADHD<Any OTHER
ADHD<EMD
ADHD<BOTH
EMD>Any OTHER
EMD>BOTH
BOTH>Any OTHER
Female
injury poisoning
FALSE-
FALSE-
TRUE+
FALSE-
FALSE-
TRUE+
V Codes
FALSE-
FALSE-
TRUE+
FALSE-
FALSE-
TRUE+
infectious-parasitic diseases
TRUE-
TRUE-
TRUE-
FALSE-
FALSE-
TRUE-
complications of pregnancy childbirth
TRUE-
TRUE+
FALSE-
TRUE+
TRUE+
FALSE-
respiratory system
TRUE+
FALSE-
TRUE-
FALSE-
FALSE-
TRUE-
circulatory system
TRUE+
FALSE-
TRUE+
FALSE-
FALSE-
FALSE-
neoplasms
TRUE+
TRUE-
TRUE-
FALSE-
FALSE-
FALSE-
congenital anomalies
TRUE+
TRUE-
TRUE-
FALSE-
TRUE-
FALSE-
perinatal conditions
TRUE+
TRUE+
FALSE-
TRUE+
TRUE+
FALSE-
nervous system
TRUE+
TRUE+
TRUE-
TRUE+
TRUE+
FALSE-
endocrine etc
TRUE+
TRUE+
TRUE+
FALSE-
FALSE-
FALSE-
sense organs
TRUE+
TRUE+
TRUE+
FALSE-
FALSE-
FALSE-
digestive system
TRUE+
TRUE+
TRUE+
TRUE-
FALSE-
TRUE-
skin subcutaneous tissue
TRUE+
TRUE+
TRUE+
FALSE-
FALSE-
TRUE-
musculoskeletal system connective tissue
TRUE+
TRUE+
TRUE+
FALSE-
FALSE-
TRUE-
genitourinary system
TRUE+
TRUE+
TRUE+
TRUE+
FALSE-
TRUE+
symptoms signs ill-defined conditions
TRUE+
TRUE+
TRUE+
TRUE+
FALSE-
TRUE+
blood-blood-forming organs
TRUE+
TRUE+
TRUE+
TRUE+
TRUE+
FALSE-
Male
sense organs
FALSE-
FALSE-
FALSE-
FALSE-
FALSE-
FALSE-
congenital anomalies
FALSE-
FALSE-
FALSE-
FALSE-
FALSE-
FALSE-
perinatal conditions
FALSE-
FALSE-
FALSE-
FALSE-
FALSE-
FALSE-
infectious-parasitic diseases
FALSE-
FALSE-
TRUE-
FALSE-
FALSE-
TRUE-
complications of pregnancy childbirth
TRUE-
FALSE-
TRUE-
FALSE-
FALSE-
TRUE-
V Codes
TRUE-
FALSE-
TRUE+
FALSE-
FALSE-
TRUE+
respiratory system
TRUE+
FALSE-
TRUE-
FALSE-
FALSE-
TRUE-
blood-blood-forming organs
TRUE+
TRUE-
FALSE-
FALSE-
TRUE-
FALSE-
genitourinary system
TRUE+
TRUE-
TRUE-
FALSE-
FALSE-
FALSE-
skin subcutaneous tissue
TRUE+
TRUE-
TRUE+
FALSE-
FALSE-
TRUE-
neoplasms
TRUE+
TRUE+
TRUE+
FALSE-
FALSE-
TRUE-
nervous system
TRUE+
TRUE+
TRUE+
TRUE-
FALSE-
TRUE-
digestive system
TRUE+
TRUE+
TRUE+
TRUE-
FALSE-
TRUE-
musculoskeletal system connective tissue
TRUE+
TRUE+
TRUE+
TRUE-
TRUE-
TRUE-
symptoms signs ill-defined conditions
TRUE+
TRUE+
TRUE+
TRUE-
FALSE-
TRUE-
injury poisoning
TRUE+
TRUE+
TRUE+
TRUE-
FALSE-
TRUE+
endocrine etc
TRUE+
TRUE+
TRUE+
TRUE+
FALSE-
TRUE+
circulatory system
TRUE+
TRUE+
TRUE+
TRUE+
TRUE-
TRUE+
Table 4: Summary of Significant differences for females and males.
Discussion
The relationship between mental and physical disorders in children and adults and overall prevalence rates in this population are well-described [21-23]. Compared to males, the female rates for EMD were higher and lower for ADHD and for both EMD/ ADHD, respectively. The sex difference in the rates of these disorders indicates an independent etiology for EMD and ADHD and supports the concept of these disorders being distinct diagnostic entities. That the rates for those with both EMD/ADHD were lower and intermediate in comparison of the sexes does not provide evidence of the combination being a distinct diagnostic entity.
In particular, children with mental disorders suffer physical disorders twice as frequently as those who do not [22], however, the profiles for those with EMD and ADHD were different from all other mental disorders, and distinct from one another. The profile of physical disorders distinguished EMD and ADHD. Furthermore, in terms of the independent ICD physical disorder classes, the Odds Ratio (OR) for EMD was greater than most of both the ADHD and the OMD groups. This primary finding indicated a distinct clinical pattern, suggesting a different independent etiology for EMD and ADHD. If the two entities had a similar pathophysiology, one would expect to find much more similitude between the aggregates of diseases than observed for each disorder. In opposition, the OR showed a wide disparity between the two diagnostic categories suggesting that they are distinct disorders. The further support of this distinction is found in the different annual and cumulative prevalence rates of ADHD and EMD. For ADHD and EMD to have a common etiology, one would expect more similar prevalence rates, in addition to similar physical disorder profiles.
A primary limitation of the study is the diagnostic precision or the reliability and validity of physician diagnosis. Diagnostic precision necessarily affects results at some level in terms of false positive and negative rates. Diagnoses within each category suffer more or less equally from this problem to the extent that a random distribution of more or less accurate diagnoses based on physician expertise would arise in the data.
Further, the main ICD class diagnostic groupings combine diagnoses providing a general approach to illustrate the relationship between the dependent variables. As a result, more specific diagnosisrelated associations may well be masked. Detailed analysis of all unique diagnoses may eventually be warranted to provide more information about etiology, especially in relation to the temporal order of diagnoses.
Another issue worthy of consideration, beyond the scope of this current paper, is a full description of the epidemiology and physical disorder profiles of those who have both EMD and ADHD. It may be that there is yet another etiological dimension within the continuum of mental disorders that may be conceptualized and examined as a discrete entity. More research is required to examine whether or not this is the case or if the combination of ADHD and EMD represents, in terms of physical disorder profiles, the intensity of having two discrete concurrent disorders. The present paper does not provide evidence in support of the contention that the combination of ADHD and EMD represents a novel diagnostic entity.
Notwithstanding the limitations, understanding the relationships between comorbid disorders in a population, as presented in this paper, is a novel approach to comparative disease study. The presented results illustrate the potential to understand the complex nature of clinical profiles associated with a given disease state in that it reveals key aspects potentially related to etiological and prognostic comorbidity. Future work will focus on clinical pathways.
Main Formula: Odds Ratio: OR = [(ad)/(bc)].
P values based on comparison of 95% confidence intervals, where p < 0.05 is based on non-overlapping 95% confidence intervals.
Funding Source: The original work from which this study derived was in part funded by the Norlien (Palix) Foundation. This study was conducted under Ethics ID-REB15-1057.
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Download PDFCitation:Chartier G and Cawthorpe D. Distinction between Episodic Mood Disorder and Attention Deficit Disorder with Hyperactivity based on their Association with the Main Classes of International Classification of Disease in a Child and Adolescent Population. Ann Depress Anxiety. 2016; 3(1): 1073. ISSN : 2381-8883