
- Psychiatric Times Vol 29 No 1
- Volume 29
- Issue 1
Introduction: The Integrated Approach to Addressing Comorbidities-Part 1
These articles illustrate the variety and complexity of problems associated with comorbidity in psychiatric disorder.
It is increasingly appreciated that comorbidity in psychiatric illness is an important consideration in clinical practice; it has also become a topic of research interest. Many recent articles highlight 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.
When one speaks of psychiatric comorbidity, 2 constructs come to mind. The first is psychiatric illness that is comorbid with systemic medical illness. Whether the onset of the psychiatric illness is temporally associated with the systemic illness, whether the psychiatric illness comorbidity can be explained by the patient not coping well with the systemic illness, or whether both are referable to a common source is often elusive and ambiguous. What matters is that the patient has 2 (or more) medical problems (that affect different organ systems) that need to be addressed by evidence-based clinical interventions in an integrated approach.
The other “psychiatric comorbidity” refers to more than one psychiatric illness in the same patient. Examples include dementia with episodic delirium, depression with concurrent substance abuse, and personality disorder comorbid with PTSD. Indeed, for some particularly complex psychiatric patients, one may speak of “trimorbidity” (eg, mood disorder, personality disorder, and substance abuse), even in the absence of significant systemic illness. Of course, physicians are quite familiar with patients who are “multiply comorbid” on 2 dimensions (ie, 2 or more chronic systemic illnesses and 2 or more psychiatric illnesses) simultaneously.
The semantics of all of this can be daunting and less than precise. What is important, for psychiatrists and other specialty physicians, is to be vigilant for comorbidity within the category of psychiatric illness and to look for psychiatric and systemic comorbidity simultaneously. Care for these various conditions should be integrated and balanced, so that various medical interventions do not work at cross purposes. Comorbidity can serve as the illnesses’ “substrate” that encourages the patient’s various specialty physicians to thoughtfully collaborate and complement their respective interventions.
The authors of this Special Report-which will appear in this issue and also in February and which can now be read online at www.psychiatrictimes.com-have chosen a compelling series of topics. In her article,
These articles illustrate the variety and complexity of problems associated with comorbidity in psychiatric disorder. We hope that physicians who daily face the challenges of often multiple psychiatric illnesses in patients with significant comorbidity will find these articles useful.
Articles in this issue
over 13 years ago
Chronic Disease Self-Management Programs in Psychiatryover 13 years ago
Educating Patients About Bipolar Disordersover 13 years ago
Introduction: Patient Education as Treatment Foundationalmost 14 years ago
Treatment of Insomnia in Anxiety Disordersalmost 14 years ago
Anesthesia Advances Add to Safety of ECTalmost 14 years ago
The “Pseudocommando” Mass Murderer: A Blaze of Vaingloryalmost 14 years ago
Unfavorable Changes to Medicare Pay Loom for Psychiatristsalmost 14 years ago
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