Comorbidities

Question 1

What are comorbidities?

Answer 1

Comorbidity is defined as any co-occurring chronic condition in addition to the index disease

Feinstein et al. (1970)

Question 2

Is psychosis more common in ppl with Psychosis?

Answer 2

Yes, they have ~26% higher prevalence rate of 1+ physical health comorbidity

Question 3

What is a dual diagnosis?

Answer 3

Dual diagnosis commonly refers to the co-occurrence of substance use in severe mental disorders (schizophrenia, schizophrenia spectrum disorders, bipolar mood disorders and depressive disorders)

• 41% of individuals with schizophrenia spectrum disorders and 33% with bipolar mood disorders have co-occurring substance use disorders.

Question 4

What to consider when choosing antidepressants?

Answer 4

Patient preference
Previous treatment response
Tolerability and likely side effects of a specific drug (sometimes sexual dysfunction; excessive swelling; eye infections)
Low lethality in overdose if history or likelihood of overdose
Concurrent medical conditions or other drugs
Family history of differential response

Question 5

How long to treat depression for?

Answer 5

There is a high risk of relapse in the first 6 months
Assess patients for risk factors for relapse:
- presence of residual symptoms
- number of previous episodes
- severity, duration and degree of treatment resistance in the most recent episode

Continue treatment at the acute treatment dose after full remission:
Low risk: (first episode, no risk factors) at least 6-9 months

Any risk factors: at least 1 year

High risk: (e.g. >5 episodes and/or 2 episodes in last few years) at least 2 years or longer term treatment considered