Physical Comorbidity Flashcards
What is mental-physical comorbidity?
Co-occurrence of mental disorders and physical disorders at greater than chance level.
(If you have a mental disorder, you are more likely to develop a physical disease than someone without a mental disorder history & vice versa.)
Describe when mental-physical comorbidity may occur.
Concurrent: both conditions evident at the same time or the second arises soon after the first.
Occur over the lifetime: someone with recurrent depression in early to mid adulthood developing heart disease later in life.
What are the causal mechanisms from physical diseases to mental disorders?
Via psychological mechanisms (especially if the condition is life threatening, condition causes pain, major lifestyle changes and restrictions, changes to relationships)
Via medications
Via biological mechanisms
Discuss the psychological effects of cancer.
Fear: of death, of the cancer coming back (hypervigilance)
Sense of hopelessness, loss of control, “betrayal”
Stress of the treatment & side effects
Stress of interaction with others - being avoided, treated as if dying
How are medications a mechanism for physical disease leading to mental disorders?
Interferon (some cancers, hep C) –> depression
Some ARVs for HIV –> suicidality, mania, paranoia
Describe the biological mechanisms causing physical disease to lead to mental disorders.
The disease causes changes in the brain that then cause depression.
E.g. “vascular depression” (inflammation and ischemia) and “Parkinsonian depression”
Summary of findings on mental-physical comorbidity.
A wide range of mental disorders are associated with increased likelihood of developing a wide range of physical conditions.
The greater the number of mental dx someone experiences, the greater the odds of subsequent physical disease.
The earlier the onset of mental dx the greater the likelihood of subsequent physical ill-health.
Name the causal mechanisms from mental disorders to physical conditions.
Via lifestyle behaviours
Via biological pathways
Via medications
Describe how lifestyle behaviours cause physical disorders to stem from mental disorders.
People with mental disorders are more likely to smoke, drink alcohol excessively, eat poorly, get less exercise and sleep.
Describe the biological pathways mechanism causing physical disease to stem from mental disorders.
Stress response: HPA (hypothalamic pituitary adrenal) and SNS axes hyperactivity
Inflammation
Mental disorders now viewed by some as aging accelerants
How do medications cause mental disorders to cause physical disorders?
Antipsychotics - obestity and metabolic syndrome
How do medications cause mental disorders to cause physical disorders?
Antipsychotics - obesity and metabolic syndrome
Discuss the clinical implications of mental-physical comorbidity in mental health patients.
Need to assess lifestyle and physical disease biomarkers.
This needs to start when the patient is still relatively young.
- the pathogenesis of chronic physical conditions starts early in life
- bad health habits are harder to break the longer they go on
Mental health patients die 10-15 yrs earlier than those without mental disorders
Discuss the clinical implications of mental-physical comorbidity in medical patients where the primary focus is on the physical disease.
Need to be aware that conditions which involve pain, disability, threat to life, changes to lifestyle etc. can provoke psychological distress or mental disorders
People with a past history of mental health problems are most vulnerable
What are the disadvantages of mental disorder comorbidity?
Greatly decrease treatment adherence
Make treatment more complicated
Increase suffering
