Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
Eur Arch Psychiatry Clin Neurosci. 2011 Oct;261(7):489-508. doi: 10.1007/s00406-011-0196-4. Epub 2011 Feb 18.
The presence of comorbidity in major psychoses (e.g., schizophrenia and psychotic subtypes of bipolar disorder and major depressive disorder) seems to be the rule rather than the exception in both DSM-IV and ICD-10. Examining comorbidity in major psychoses, however, requires an investigation into the different levels of comorbidity (either full-blown and subsyndromal) which should be analyzed in both psychopathological and medical fields. On one hand, the high prevalence of psychiatric comorbidity in major psychoses may be the result of the current nosographic systems. On the other hand, it may stem from a common neurobiological substrate. In fact, comorbid psychopathological conditions may share a biological vulnerability, given that dysfunction in specific brain areas may be responsible for different symptoms and syndromes. The high rates of comorbidity in major psychoses require targeted pharmacological treatments in order to effectively act on both the primary diagnosis and comorbid conditions. Nevertheless, few controlled trials in comorbid major psychoses had been carried out and treatment recommendations in this field have mostly an empirical basis. The aim of the present article is to provide a comprehensive and updated overview in relation to epidemiological and clinical issues of comorbidity in major psychoses.
在 DSM-IV 和 ICD-10 中，主要精神病（例如精神分裂症和双相情感障碍及重性抑郁障碍的精神病亚型）合并症的存在似乎是常态而非例外。然而，检查主要精神病的合并症需要调查不同程度的合并症（无论是完全和亚综合征），应在精神病理学和医学领域进行分析。一方面，主要精神病中精神科合并症的高患病率可能是当前分类系统的结果。另一方面，它可能源于共同的神经生物学基础。事实上，合并的精神病理学状况可能具有共同的生物学脆弱性，因为特定脑区的功能障碍可能导致不同的症状和综合征。主要精神病中的高合并症率需要有针对性的药物治疗，以便能够有效地针对主要诊断和合并症进行治疗。然而，针对合并主要精神病的对照试验很少，该领域的治疗建议主要基于经验。本文的目的是提供与主要精神病合并症的流行病学和临床问题相关的全面和最新概述。
