Comorbidity
‘Comorbidity’ is a term introduced by Feinstein to refer to the coexistence of two essentially independent and distinct disorders. According to this early concept, there exists an ‘index’ or ‘primary’ disorder and a comorbid separate second disorder which
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‘Comorbidity’ is a term introduced by Feinstein to refer to the coexistence of two essentially independent and distinct disorders. According to this early concept, there exists an ‘index’ or ‘primary’ disorder and a comorbid separate second disorder which potentially affects the selection of treatment and the prognosis of the index one (Feinstein 1970). Comorbidity may be due to chance or to ascertainment bias (Berkson’s bias); however, the consistent pattern of comorbidity concerning several disorders (e.g. comorbid anxiety and depression) makes unlikely the suggestion it is happening by chance (Kessler et al. 2007). According to some authors, the conceptual overlapping especially between mood and anxiety disorders and the overlapping of symptoms might produce an ‘artefactual comorbidity’ (Maj 2005). Most authors and textbooks clearly suggest that comorbidity, both with mental as well as with somatic diseases, is the rule rather than the exception in BD. Many go even further and suggest that the clinical picture of BD is grossly complicated because of comorbidity. In terms of official classification systems, this complex picture is reflected by the finding that most BD patients suffer from more than two distinct ‘comorbid’ mental disorders. The literature is conclusive concerning the overall high rate of comorbidity and its adverse effect on overall outcome of the patients; however, it is rather inconclusive concerning certain diseases and specific rates. This is because of differences in study samples (e.g. inpatients, outpatients, epidemiological samples, registered and insured which by definition might suffer from a less severe form, etc.) and assessment methods. General population epidemiological studies often use trained lay interviewers, while clinical studies often utilize only highly experienced researchers. Thus, there is an unsolved riddle in place: Clinical samples are more reliably evaluated, but they might include patients with more severe form of the illness and higher comorbidity, while general population samples have problematic assessment, almost always with the use of structured interviews and thus an artificial inflation of rates, because of false allocation or multiple allocation of the same symptom.
© Springer-Verlag Berlin Heidelberg 2015 K.N. Fountoulakis, Bipolar Disorder: An Evidence-Based Guide to Manic Depression, DOI 10.1007/978-3-642-37216-2_10
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Comorbidity
This chapter will deal with mental and medical comorbidity in adult BD patients with the exception of personality disorders, alcohol and substance abuse as well as behavioural addictions (e.g. gambling, Internet addiction, etc.). Also, this chapter will not cover the issue of comorbidity in children, adolescents and the elderly. These topics will be covered in especially dedicated chapters of this book. Treatment of comorbid disorders will be covered in the chapters specifically dedicated to treatment options. In general, with the exception of substance use disorders, medical and psychiatric comorbidity is more
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