An epidemiologic and clinical overview of medical and psychopathological comorbidities in major psychoses

  • A. Carlo Altamura
  • Marta Serati
  • Alessandra Albano
  • Riccardo A. Paoli
  • Ira D. Glick
  • Bernardo Dell’Osso
Original Paper


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.


Comorbidity Major psychoses (MPs) Schizophrenia (SK) Bipolar disorder (BD) Psychotic major depressive disorder (pMDD) 



Major psychoses


Substance use disorder




Bipolar disorder


Psychotic major depressive disorder


Obsessive compulsive disorder


Post-traumatic stress disorder


Social phobia


Panic disorder


Generalized anxiety disorder



Lucio Oldani, MD, and Mariacarlotta Palazzo, MD, contributed to the development of the present article.

Conflict of interests

Authors do not have any conflict of interest with the content of the present article.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • A. Carlo Altamura
    • 1
  • Marta Serati
    • 1
  • Alessandra Albano
    • 1
  • Riccardo A. Paoli
    • 1
  • Ira D. Glick
    • 2
  • Bernardo Dell’Osso
    • 1
  1. 1.Department of PsychiatryUniversity of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Department of PsychiatryStanford University, Stanford University School of MedicineStanfordUSA

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