Co-morbidity

Kranzler HR, Rosenthal RN Dual diagnosis alcoholism and co-morbid psychiatric disorders. Am J Addict 12 (suppl 1) S26—S40, 2003 Kranzler HR, Tinsley JA (eds) Dual Diagnosis Substance Abuse andComorbid Medical and Psychiatric Disorders, 2nd Edition. New York, Marcel Dekker, 2004... 

People known to be at risk for anaphylaxis should wear up-to-date medical identification such as a bracelet or other jewelry, or carry an Anaphylaxis Wallet Card listing their confirmed trigger factor(s), relevant co-morbidities such as asthma, and concurrent medications [45]. 

Treatment considerations for antiretroviral-experienced patients are much more complex than for patients who are naive to therapy. Prior to changing therapy, the reasons for treatment failure should be identified. A comprehensive review of the patient s severity of disease, antiretroviral treatment history, adherence to therapy, intolerance or toxicity, concomitant drug therapies, co-morbidities, and results of current and past HIV resistance testing should be performed. If patients fail therapy due to poor adherence, the underlying reasons must be determined and addressed prior to initiation of new therapy. Reasons for poor adherence include problems with medication access, active substance abuse, depression and/or denial of the disease, and a lack of education on the importance of 100%... 

Another study with citalopram evaluated its efficacy in the treatment of social anxiety disorder along with co-morbid major depression (Schneier etal., 2003). The outpatients (n= 21) were predominantly Hispanic (76%) and from New York. Response rates for the intent-to-treat sample were 66.7% for social anxiety disorder and 76.2% for major depression. Only one subject was known to have withdrawn secondary to severe side effects. The mean dose of the medication was 37.6 mg/day and there was no placebo control. The depressive symptoms tended to improve... 

Co-morbid medical or psychiatric illness Impaired cognitive function... 

N. Sartorium, T. B. Ustun, Y. Lecrubier, et al. Depression co-morbid with anxiety results from the WHO study on psychological disorders in primary health care, Br. J Psychiatry, 169 (suppl 30), 38 (1996). 

In Parkinson s disease very few studies focus on the elderly although Parkinson s disease is significantly age-related (SBU 2003). In the studies few patients suffers mental side effects of the drugs, while in clinical practice almost half of elderly patients suffers such problems. Since the studies do not include patients with co-morbidity it does not reflect the clinical situation. In heart failure modern treatment recommendations are based on studies were the average age of the patients are 60-65 years, most of which did not even include patients over 80 (SBU 2003). 

Aging is one of the major risk factors for developing gastric ulcers because of an increased incidence of Helicobacter pylori infections and a widely spread use of non-steroidal anti-inflammatory drugs (NSAID). Co-morbidity, with the need for prophylactic medication with antiplatelet therapy, warfarin and other anticoagulants, also increases the risk of gastrointestinal bleeding and ulcerations (Murakami et al. 1968). 

Among elderly women as much as 80% suffer from involuntary voiding of the bladder, urinary incontinence (UI). In the United States approximately 12.5 million people are affected by incontinence and a European study showed a prevalence of between 12% and 22% in all ages and an increase to 30-40% in ages over 75 years (Hampel et al. 1997). Women experience UI twice as often as men. Incontinence becomes more common in old age, with existing co-morbidity of all kinds and life styles (Box 5.5). There are different forms of urinary incontinence and they differ in cause and treatment. This problem causes not only personal distress but also a considerable cost for society as a whole (Jackson 1997). Lower quality of life is often reported in people with UI and the risk increases by the withdrawal from social interaction and participation in sports and other activities. An estimated cost for the care of patients with UI in the United States was approximately 26 billion dollars in year 1995 (Wagner and Hu 1998). Other studies have come up with a calculated cost that represents two percent of the total national health budget. 

Elderly are more susceptible to adverse effects of drugs due to decreased physiologic reserves, polypharmacy and co-morbidity. Precribers should therefore always consider whether non-pharmacological treatment may be appropriate before prescribing additional drugs to elderly patients. 

Singularity of the Drug. The principle involved in the singularity method of linking a drug with an ADR is based on two assumptions Only one drug was administered, and there was no basic disease or co-morbid state that could be related to the ADR marker being used in the assessment. 

Symptoms may be caused by an underlying disease or co-morbidity, or by a drug, rather than by an ingested substance. 

Classification Body mass index (kgjm ) Risk of co-morbidities... 

As the prevalence of obesity increases worldwide, so does the prevalence of associated co-morbidities type-2 diabetes, chronic obstructive sleep apnoea, cardiovascular disease (hyper-tension, coronary artery disease and congestive heart failure, stroke and peripheral vascular disease), fatty liver disease, various malignancies (Table 7.2), gallstones, subfertility, musculo-skeletal problems and depression. 

One of the major limitations in studies of the genetics of behavioural disorders in children arises from the overlap with other conditions. For example, nearly 50% of the patients with ADHD also have co-morbid conduct disorders. In addition, a subtype of the disorder may exist in those children in which the disorder persists into adulthood. An additional problem arises from the overlap between ADHD and bipolar disorder this has been estimated to be as high as 16%. 

Fibromyalgia, accounting for 2-4% of the general population, is a common cause of chronic pain. It has been estimated that 20-40% of such patients have co-morbid depression with a lifetime prevalence of about 70%. This raises the question whether there is a common mechanism linking pain and depression. 

The challenge consists of identifying those at high enough risk, with a substantial amount of viable myocardium, who would benefit from revascularization. The criteria for selecting such patients include symptoms, collaterals, LV function, ischemic burden, associated indications for cardiovascular surgery or co-morbidities, and the amount of viable myocardium. 

Although an effective device, widespread utilization is limited by the need for trans-septal can-nulation. Severe peripheral vascular disease is a contraindication for TandemHeart, an often present co-morbid condition. Optimal pump performance is dependent on adequate filling pressures. Any condition that leads to a decrease in left atrial filling will affect pump flow. Possible causes are as follows right sided circulatory failure pulmonary hypertension, bleeding, hypovolemia, tamponade, and arrhythmias. 

Another important consideration associated with specific diseases is co-morbidity, which often complicates chronic diseases such as diabetes or congestive cardiac disease. For example, medicines which could be perfectly safe in the early phase of type II diabetes could cause serious side effects if nephropathy develops. This could be the consequence of the impaired route of elimination or by direct effect on the damaged kidney. 

Of practical importance is the problem of prescribing to the elderly, and to those with co-morbid conditions e.g. greater risk of serious gastroduodenal reactions, high risk of exacerbating cardiac failure and development of renal failure in patients dependent on prostaglandins to maintain glomerular perfusion, dehydration, concomitant use of ACE... 

III.c.2.7. Co-morbidity. Co-morbidity or associated conditions such as hypertension, diabetes mel-litus, cardiovascular and cerebrovascular atherosclerosis, neuropathy, osteoporosis, etc., must be treated simultaneously. 

Merikangas KR, Stevens DE, Fenton B, Stolar M, O Malley S, Woods SW, Risch N (1998b) Co-morbidity and familial aggregation of alcoholism and anxiety disorders. Psychol Med 28 773-788... 

Co-morbid factors that increase the risk of NSAID-induced GI bleeding include history of ulcer disease, advanced age, poor health status, treatment with certain drugs (discussed later), long duration of NS AID therapy, smoking, and heavy alcohol use. Because of their renal effects, NSAIDs must be used with caution in... 

Kessler, R. C., P. Stang, H. U. Wittchen, M. Stein, and E. E. Walters. Lifetime Co-morbidities Between Social Phobia and Mood Disorders in the US National Comorbidity Survey. Psychological Medicine 29(3) (1999) 555-567. 

George DT, Nutt DJ, Dwyer BA, et al Alcoholism and panic disorders is the co-morbidity more than coincidence Acta Psychiatr Scand 81 97-107, 1988 George MS, Guidotti A, Rubinow D, et al CSF neuroactive steroids in affective disorders pregnenolone, progesterone, and DBl. Biol Psychiatry 35 775-780, 1994 George MS, Wassermann, EM, Williams WA Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport 6(14 1853-1856, 1995... 

To date, all antidepressants appear to be similarly effective for treating major depression, but individual patients may respond preferentially to one agent or another. In addition, these medications are significantly different from one another with regard to side effects, lethality in overdose, pharmacokinetics, and the abihty to treat co-morbid disorders. 

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