Comorbidity In Psychiatric Disorders: A Literature Review

January 19, 2013
Psychiatric Times Editors
Volume 30, Issue 1

A list of recent articles highlighting the complexity of psychiatric and systemic illness, both in terms of overlapping clinical presentation and in the degrees to which systemic illness and psychiatric illness affect each other.

Depression in Parkinson’s disease: diagnosis and management. Latoo J, Mistry M, Dunne FJ. Br J Hosp Med (Lond). 2012;73:331-334.
Parkinson disease has a high prevalence of psychiatric comorbidity, including depression. In this review, Latoo and colleagues highlight the epidemiology, etiology, and diagnosis of depression in patients with Parkinson disease. They provide recommendations on treatment and suggest that a closer partnership between neurology and psychiatry might improve outcomes.

Factors affecting hospital stay in psychiatric patients: the role of active comorbidity. Douzenis A, Seretis D, Nika S, et al. BMC Health Serv Res. 2012;12:166.
Douzenis and colleagues looked at physical comorbidity in psychiatric inpatients using the criterion of referral to medical subspecialties. The study was made up of 200 patients with schizophrenia and 228 patients with bipolar disorder (type I or II). The most common medical comorbidity for patients with bipolar disorder was arterial hypertension; for patients with schizophrenia, it was endocrine/metabolic disease-12% of referrals were for Hashimoto thyroiditis. A positive linear trend was found between length of stay and number of referrals; the effect was greater for schizophrenia patients. The findings suggest that comorbidity that is severe enough to warrant referral is a significant determinant of hospital stay.

Effects of general medical health on Alzheimer’s progression: the Cache County Dementia Progression Study. Leoutsakos JM, Han D, Mielke MM, et al. Int Psychogeriatr. 2012;24:1561-1570.
The goal of this population-based study was to quantify the relationship of incident Alzheimer disease (AD) and to compare global comorbidity ratings with counts of comorbid conditions and medications as predictors of AD progression. The 335 participants with incident AD were followed for up to 11 years. None of the baseline medical variables (general medical health record [GMHR], comorbidities, and nonpsychiatric medications) was associated with differences in rates of decline in longitudinal linear mixed effects models. The findings indicate that it is likely that there is a dynamic relationship between medical and cognitive health. GMHR is a more sensitive measure of health than simple counts of comorbidities or medications.

Depression and epilepsy, pain and psychogenic non-epileptic seizures: clinical and therapeutic perspectives. Kanner AM, Schachter SC, Barry JJ, et al. Epilepsy Behav. 2012;24:169-181.
Is the clinical presentation of depression in people with epilepsy (PWE) unique to this neurological disorder? The high comorbidity of depression and epilepsy may be associated with the existence of common pathogenic mechanisms. Psychogenic nonepileptic seizure (PNES) disorder is often comorbid with depressive disorder. The role of depression in PNES disorder and its treatment are discussed in this article. Data on the treatment of depression in PWE are scarce; thus, clinicians have had to rely on data from patients with primary depressive disorders. A consensus strategy on the identification and treatment of depressive disorders in adult and pediatric patients with epilepsy is outlined in the article.

Epilepsy and psychiatric comorbidity: a nationally representative population-based study. Rai D, Kerr MP, McManus S, Jordanova V, et al. Epilepsia. 2012;53:1095-1103.
Rai and colleagues looked at whether the overrepresentation of comorbidities could be explained by epilepsy being a chronic medical or neurological condition, or by the confounding effect of demographic and socioeconomic factors or other health conditions. The results showed that almost one-third of the people with epilepsy had an ICD-10 anxiety or depressive disorder (compared with 1 in 6 people without epilepsy). Social phobia and agoraphobia, generalized anxiety disorder, depression, and measures of suicidality were strongly associated with epilepsy, which remained robust after accounting for potential confounders. The prevalence of psychiatric and neurodevelopmental conditions was found to be higher in people with epilepsy than in those with other nonneurological chronic conditions.

Psychiatric symptoms and quality of life in systemic sclerosis. Mura G, Bhat KM, Pisano A, et al. Clin Pract Epidemiol Ment Health. 2012;8:30-35.
The aim of Mura and colleagues was to define the amount of impairment of quality of life (QoL) in patients with systemic sclerosis (SSc) and how much of this is due to depressive or other psychiatric symptoms. Psychiatric symptoms are frequent in patients with SSc, but pain, fatigue, disability, and body changes do not appear to explain the high prevalence of psychiatric comorbidity in SSc. The high rate of depression seems to strictly correlate with poor QoL, and this finding needs more research to establish the cause of such a correlation.

Prevalence of psychiatric disorders in patients with diabetes types 1 and 2. de Ornelas Maia AC, Braga Ade A, Brouwers A, et al. Compr Psychiatry. 2012;53:1169-1173.
The Mini International Neuropsychiatric Interview was used to identify psychiatric disorders in 100 patients with type 1 diabetes mellitus and 100 patients with type 2 diabetes mellitus. Eighty-five patients (42.5%) were found to have at least 1 psychiatric disorder: generalized anxiety disorder (21%), dysthymia (15%), social phobia (7%), current depression (5.5%), lifelong depression (3.5%), panic disorder (2.5%), and risk of suicide (2%). Dysthymia, current depression, and panic disorder were more prevalent in patients with type 1 diabetes mellitus. The high prevalence of psychiatric disorders in diabetic patients indicates the need to consider mental issues when performing a diagnostic evaluation of patients.

Psychiatric and neuropsychological manifestations of systemic lupus erythematosus. Fietta P, Fietta P, Delsante G. Acta Biomed. 2011;82:97-114.
Psychiatric/neuropsychological syndromes are frequent and challenging manifestations of systemic lupus erythematosus (SLE) in both adults and children. Ischemia (due to disease-related vascular injury or cerebral vasospasm) and inflammatory/immunopathological mechanisms appear to be the main pathogenic factors. There are no standardized treatment guidelines; however, therapeutic recommendations have been proposed. Because of the high prevalence of psychiatric syndromes and significant risk of suicide in patients with SLE, systematic assessment to provide prompt diagnosis and adequate care should be a critical part of the evaluation protocol.

Pretransplant psychiatric and substance use comorbidity inpatients with cholangiocarcinoma who received a liver transplant. Schneekloth TD, Jowsey SG, Biernacka JM, et al. Psychosomatics. 2012;53:116-122.
Pretransplant psychopathology and substance use disorders in liver transplant recipients were assessed to better characterize patients with cholangiocarcinoma. The records of 143 liver transplant recipients (26 of whom had cholangiocarcinoma) who completed pretransplant psychological screening between 2000 and 2004 were retrospectively reviewed. The results showed that 35% had a pretransplant psychiatric diagnosis, 35% had a substance use disorder, and 43% were current or former smokers. The two groups did not differ significantly in the likelihood of having a psychiatric disorder or smoking history; however, the cholangiocarcinoma group was less likely to have an alcohol use disorder or any substance use disorder.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and select comorbid medical conditions.Ramasubbu R, Taylor VH, Samaan Z, et al. Ann Clin Psychiatry. 2012;24:91-109.
To help understand the bidirectional relationship and to provide an evidence-based framework to guide the treatment of mood disorders that are comorbid with medical illness, the authors looked at the links between mood disorders and several common medical conditions and evaluated the efficacy and safety of pharmacological and psychosocial treatments. They focused on cardiovascular disease, cerebrovascular disease, cancer, HIV infection, hepatitis C, migraine, multiple sclerosis, epilepsy, and osteoporosis. Their findings suggest that depression is often comorbid with medical disorders, and it is treatable. Failure to treat depression in medically ill patients may have a negative effect on medical outcomes.

The CANMAT task force recommendations for the management of patients with mood disorders and comorbid medical conditions: diagnostic, assessment, and treatment principles. Ramasubbu R, Beaulieu S, Taylor VH, et al. Ann Clin Psychiatry. 2012;24:82-90.
The authors describe the complex interactions between medical illness and mood disorders and provide an approach for clinical diagnosis and management of the comorbidities. Evidence from epidemiological, clinical, and biological studies suggests that the relationship between medical illness and mood disorders is bidirectional. Furthermore, evidence shows that there are shared and specific etiological factors that link these conditions.