Medical Comorbidity in Schizophrenia

Abstract

The extent and consequences of medical comorbidity in patients with schizophrenia are generally underrecognized. Patients with comorbid conditions are usually excluded from research studies, although they probably represent the majority of individuals with schizophrenia. Elderly patients are especially likely to have comorbid disorders. In this article, we review selected literature on medical comorbidity in schizophrenia, including physical illnesses, substance use, cognitive impairment, sensory deficits, and iatrogenic comorbidity. Data from the University of California, San Diego Clinical Research Center on late-life psychosis are also presented. Older schizophrenia patients report fewer comorbid physical illnesses than healthy comparison subjects, but their illnesses tend to be more severe. These results suggest that schizophrenia patients may receive less than adequate health care. Substance abuse is more common in patients with schizophrenia than in the general population and may exacerbate psychiatric symptoms in these patients. Although generalized cognitive impairment is associated with schizophrenia, the main contributors to dementia in older patients are more likely to be comorbid neurological and other physical disorders, substance abuse, and medication side effects. Iatrogenic comorbidity results primarily from the use of neuroleptic (e.g., tardive dyskinesia) and anticholinergic (e.g., confusion) medications. Clinical and research recommendations are made for management of comorbidity in schizophrenia.

Search Activity Concept: Relationship between Behavior, Health and Brain Functions

“…On the one hand, it was shown that older patients with schizophrenia had significantly lower physical co-morbidity compared to patients with major depression (Lacro, Jeste, 1994;Adams & Ball, 2000); older schizophrenia patients report even fewer co-morbid physical illnesses than healthy comparison subjects (Jeste et al, 1996). Of course, it can be only a sign of the decreased attention to the physical symptoms, because illnesses in schizophrenic patients, if present, tend to be more severe (Jeste et al, 1996). However, it was shown (Goldman, 1999) that patients with schizophrenia are at decreased risk for certain disorders, such as rheumatoid arthritis and allergies.…”

Cardiac side effects of psychiatric drugs

“…Use of medical care often decreases after the onset of a psychiatric disorder (Jeste et al, 1996), and even when patients are engaged in healthcare services, rates of undiagnosed physical illnesses are often high . Other patient characteristics may also contribute to poor detection and diagnosis of physical illness such as impaired ability to verbalise concerns (Lieberman and Coburn, 1986;Massad et al, 1990), poor insight into illness (Massad et al, 1990), denial of illness (Goldman, 1999) or an unwillingness to consult a doctor other than their psychiatrist.…”

Diabète chez le patient souffrant de schizophrénie et vieillissement

“…Il existe une prévalence importante de DT2 chez les patients souffrant de schizophrénie et cette prévalence semble augmenter avec l'avancée en âge de ces patients [8,11,14]. Cette prévalence augmentée précéderait même l'utilisation généralisée des nouveaux neuroleptiques et serait indépendante du traitement [5,14].…”