Comorbidity
A co-morbidity is another diagnostic definable disease or syndrome , in addition to a basic disease is present (index disease). The term translated means concomitant disease , the English term is comorbidity .
It can be one, several or any number of additional disturbance images. This is why we also speak of double or multiple diagnoses. If a patient has a large number of additional diagnoses , this is referred to as multimorbidity . Comorbidities can, but do not have to be causally related to the underlying disease in the sense of a secondary disease. Examples of comorbidity include: B. a patient with Alzheimer's disease who also has gout symptoms or if prostate cancer occurs at the same time as diabetes mellitus .
Comorbidity principle
The Komorbiditätsprinzip makes the relationships between the individual syndromes of epidemiological observation accessible.
Comorbidities occur more frequently with increasing age . In 40% of patients with colon cancer, five or more comorbidities can be diagnosed. It is crucial that when treating a disease, the presence of other diseases is taken into account, as these can have a decisive influence on the success of the treatment or overall survival and the overall well-being of the patient is in the foreground.
In psychiatry
Multiple diagnoses often occur, especially in the area of psychological disorders according to DSM-5 . It has been shown that in the case of problematic substance use (or addiction disorders ), depression , anxiety and panic disorder and dysthymia can often be detected. Here, too, it is again true that no statement is made as to whether and how which disorder is responsible for the occurrence of the others. It goes so far as to emphasize that the (frequent) neglect of these facts, because of their devastating consequences, borders on medical malpractice . The simultaneous occurrence of physical and mental illnesses leads to poorer treatment results, worsens the prognosis of the individual illnesses and has a considerable influence on the overall quality of life .
Assignment problem
A particular difficulty in determining comorbidities is the question of which additional findings are assessed as symptoms and which disease or diseases they are assigned to, if applicable.
Temporal sequence
The underlying diseases and their comorbidities can develop at different times. The order of the diseases is described in different hypotheses. The underlying disease is seen as the disease that is the focus of the current treatment. All other illnesses are considered comorbidities. In the following , this will be considered using the underlying disease chronic back pain and the comorbidity depression .
Antecedent hypothesis
The antecedent hypothesis assumes that depression developed first and then chronic back pain.
Consequence hypothesis
In the context of the consequence hypothesis, it is assumed that the depression only appeared after the chronic back pain.
Scar hypothesis
The Scar hypothesis is based on the vulnerability-stress model . The occurrence of comorbid depression is attributed to an earlier depressive episode that occurred before chronic back pain, which is responsible for an increased likelihood of a new depressive episode.
literature
- Michael Höfler: Statistics in the Epidemiology of Mental Disorders , Springer, Berlin 2004, ISBN 3-540-20387-7 , p. 21.
Individual evidence
- ↑ U. Wedding u. a .: Urooncology , Springer, 2009, ISBN 3-642-01381-3 , section Urooncology in older patients, p. 275, here online
- ↑ R. Yancik, MN Wesley, LA Ries, RJ Havlik, S. Long, BK Edwards, JW Yates: Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. In: Cancer . Volume 82, Number 11, June 1998, pp. 2123-2134, PMID 9610691 .
- ↑ Kathlen T. Brady, Sudie E. Back, Shelly F. Greenfield (ed.): Women & Addiction - A Comprehensive Handbook. The Guilford Press, New York / London 2009.
- ↑ Disorders associated with psychotropic substances . In: BJ Connemann, J. Kassubek: Comorbidity of depressive disorders. Neurology 2004; 23: 6.
- ^ Adam J. Gordon: Physical Illness and Drugs of Abuse, A Review of the Evidence. Cambridge University Press, 2010.
- ↑ David A. Fishbain, Robert Cutler, Hubert L. Rosomoff, Renee Steele Rosomoff: Chronic Pain-Associated Depression: Antecedent or Consequence of Chronic Pain? A review . In: The Clinical Journal of Pain . tape 13 , no. 2 , p. 116-137 , doi : 10.1097 / 00002508-199706000-00006 ( wkhealth.com [accessed January 6, 2017]).
