McIntyre Roger S, Rosenbluth Michael, Ramasubbu Rajamannar, Bond David J, Taylor Valerie H, Beaulieu Serge, Schaffer Ayal
Mood Disorders Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Ann Clin Psychiatry. 2012 May;24(2):163-9.
Most individuals with mood disorders experience psychiatric and/or medical comorbidity. Available treatment guidelines for major depressive disorder (MDD) and bipolar disorder (BD) have focused on treating mood disorders in the absence of comorbidity. Treating comorbid conditions in patients with mood disorders requires sufficient decision support to inform appropriate treatment.
The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force sought to prepare evidence- and consensus-based recommendations on treating comorbid conditions in patients with MDD and BD by conducting a systematic and qualitative review of extant data. The relative paucity of studies in this area often required a consensus-based approach to selecting and sequencing treatments.
Several principles emerge when managing comorbidity. They include, but are not limited to: establishing the diagnosis, risk assessment, establishing the appropriate setting for treatment, chronic disease management, concurrent or sequential treatment, and measurement-based care.
Efficacy, effectiveness, and comparative effectiveness research should emphasize treatment and management of conditions comorbid with mood disorders. Clinicians are encouraged to screen and systematically monitor for comorbid conditions in all individuals with mood disorders. The common comorbidity in mood disorders raises fundamental questions about overlapping and discrete pathoetiology.
大多数患有情绪障碍的个体同时存在精神和/或躯体共病。现有的重度抑郁症（MDD）和双相情感障碍（BD）治疗指南主要关注在不存在共病的情况下治疗情绪障碍。治疗患有情绪障碍的患者的共病状况需要充分的决策支持，以便做出适当的治疗选择。
加拿大情绪与焦虑治疗网络（CANMAT）特别工作组试图通过对现有数据进行系统的定性综述，就治疗MDD和BD患者的共病状况制定基于证据和共识的建议。该领域研究相对较少，这常常需要采用基于共识的方法来选择治疗方法并确定治疗顺序。
在处理共病时出现了几个原则。这些原则包括但不限于：确立诊断、风险评估、确定适当的治疗环境、慢性病管理、同时或序贯治疗以及基于测量的护理。
疗效、有效性和比较有效性研究应强调对与情绪障碍共病的状况的治疗和管理。鼓励临床医生对所有患有情绪障碍的个体进行共病状况的筛查和系统监测。情绪障碍中常见的共病引发了关于重叠和离散病理病因的基本问题。
