5/14: Mental/physical co-morbidity in adults

Expand on how medications prescribed for physical conditions can lead people with physical conditions to develop mental disorders

- Interferon (for some cancers, hep C) → depression - Some anti-retroviral for HIV → suicidality, mania, paranoia

Summarise the key findings from the World Mental Health Survey's study on mental-physical comorbidity

- Wide range of mental disorders are associated with ↑ likelihood (risk) of developing a wide range of physical conditions - ↑ number of mental dx someone experiences = ↑ odds of subsequent physical disease - The earlier the onset of mental dx, the greater the likelihood of subsequent physical ill-health

Expand on how psychological mechanisms can lead people with physical conditions to develop mental disorders

- occurs via shock, anxiety, distress - Increased chance if condition is life threatening or causes pain/disability/major lifestyle change and restrictions/changes to relationships

When/how can mental-physical comorbidity manifest?

1. Concurrently: both conditions occur at the same time or 2nd arises soon after 1st. Seen by Dr 2. Over lifetime

Expand on how biological pathways can lead people with mental disorders to develop physical conditions

1. Stress response (chronic stress during disorder): SNS and HPA pathways hyperactivity → if chronic, deleterious effect on body systems 2. Inflammation 3. Mental disorders now viewed by some as 'aging accelerants'

By which mechanisms can people with mental disorders develop physical conditions?

1. via lifestyle behaviours 2.via medications 3. via biological pathways

By which mechanisms can people with physical conditions develop mental disorders?

1. via psychological mechanisms (common) 2.via medications prescribed for physical condition 3. via biological mechanisms

Expand on how medications can lead people with mental disorders to develop physical conditions

Antipsychotics → obesity and metabolic syndrome

What is meant by mental-physical comorbidity?

Co-occurrence of mental disorders and physical disorders in same person at greater than chance level. - regardless of chronological order or casual pathway - complex and bi-directional - can be 2 mental or 2 physical disorders If you have mental disorder, you are more likely to develop a physical disease than someone without a mental disorder (and vice versa).

Expand on how biological mechanisms can lead people with physical conditions to develop mental disorders

Disease causes changes in brain → depression. - vascular depression (inflammation and ischemia due to narrowing of blood vessels in brain, degenerative) - 'Parkinsonian depression' (could be due to psychological depression when first diagnosed, followed by Parkinson form) Both have atypical depression presentation

Mechanisms for mental disorder leading to development of physical conditions is well understood - t/f?

False

What are the clinical implications fo mental-physical comorbidity in mental health patients?

GPs/collaborating physicians need to assess lifestyle and physical disease biomarkers (cholesterol etc.) Start when patient is still relatively young because new research has shown the pathogenesis of chronic physical conditions starts early in life AND bad health habits are harder to break the longer they go on Not happening currently (only in psychotic patients due to known drug side effects) → "scandal of premature mortality" (mental health patients die 10-15 years earlier than those w/o mental disorder)

What type of time frame often applies to physical conditions which develop as a result of mental disorders?

Long term Mental disorders start early in life, chronic physical disease occurs later

What are the clinical implications fo mental-physical comorbidity in medical patients?

Need to be aware that conditions involving pain, disability, threat to life, changes to lifestyle can provoke psychological distress or mental disorders. - People w past history of mental health problems are most vulnerable - Mental disorder comorbidity can: ↓ treatment adherence, make treatment more complicated, ↑ suffering

Expand on how lifestyle factors can lead people with mental disorders to develop physical conditions

People w/ mental disorders are more likely to smoke, drink alcohol excessively, eat poorly, get less exercise and sleep Relationship still occurs in results when these factors are considered as potential confounders, suggests a biological basis

Use cancer as an example to explain how psychological mechanisms can lead to the development of mental disorder in people with physical conditions

Stress, fear, anxiety, distress - Fear of death, cancer coming back (hypervigilance) - Sense of hopelessness, loss of control, 'betrayal' (body has let them down) - Stress of treatment and its side effects - Stress of interactions with others (being avoided, treated as if dying) EXAMINABLE