Еще о коморбидности. Конечно, когда есть явные физические проблемы, психические традиционно отодвигаются на второй план. Однако хорошо ли это прогностически?
[Ссылки доступны только зарегистрированным пользователям ]
2 June 2006
Medical comorbidities appear to be common among patients with bipolar I disorder, say researchers who note that this comorbidity can have a detrimental effect on the prognosis and outcome of the condition.
"Not only do preventing and treating medical comorbidities in bipolar patients decrease the morbidity and mortality related to physical illness, but they could also enhance psychological wellbeing and possibly improve the course of bipolar illness," report Wesley Thompson (University of Pittsburgh School of Medicine, Pennsylvania, USA) and colleagues.
The researchers studied the relationship between number of medical comorbidities in 174 patients with bipolar I disorder and their demographic and clinical characteristics.
The participants were all enrolled in the acute phase of the Pittsburgh Maintenance Therapies in Bipolar Disorder study, which compared Interpersonal and Social Rhythm Theory with an intensive clinical management approach.
A total of 160 (92%) of the patients reported some type of comorbid medical condition, such as asthma, diabetes, gastrointestinal, or thyroid dysfunction, at the start of the study. The average number of comorbidities reported was 4.2, with a maximum of 13.
Patients with a high number of medical comorbidities, at three or more, had a longer duration of both lifetime depression and lifetime inpatient depression treatment than patients with fewer to moderate medical comorbidities, at 34.2 versus 28.0 months and 1.5 versus 0.8 months, respectively. A high level of comorbidity was also associated with a higher baseline Hamilton Rating Scale for Depression (HAM-D) score than lower levels of comorbidity, at 23.2 versus 18.6 points.
Even after controlling for baseline severity of depression, medical comorbidities still predicted slower decreases in HAM-D score and mixed/cycling episodes.
"Medical illness could be influencing the outcome of bipolar disorder through several factors including its negative impact on quality of life, functioning, and psychological wellbeing," suggest Thompson et al in the Journal of Clinical Psychiatry.
"Medical comorbidities may also disrupt sleep and other circadian rhythms, thus causing or contributing to mood destabilization."
The researchers conclude: "We strongly support the development and testing of a model of care that includes interventions specifically designed for patients with bipolar disorder and that integrates medical treatment with psychiatric treatment of individuals suffering from bipolar I disorder."
Source: J Clin Psychiatry 2006; 67: 783–788
©2006 Current Medicine Group Ltd
|