Current Psychiatry Reports

, Volume 2, Issue 3, pp 256–263

Comorbid medical illness in psychiatric patients

  • Larry S. Goldman


Patients with psychiatric illnesses may be at higher risk for the development of certain medical problems. Those with more severe psychiatric illnesses may encounter barriers to promoting good health and to obtaining good health care when comorbid illnesses do occur. This paper reviews some of the recent literature on health care practices and health system access for the mentally ill; HIV care and its relationship to mental disorders; drug interactions between general medical drugs and psychotropics; and certain medical conditions that appear to co-occur more frequently with psychiatric disorders.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Karasu TB, Waltzman SA, Lindenmayer JP, et al.: The medical care of patients with psychiatric illnesses. Hosp Comm Psychiatry 1980, 31:463–472.Google Scholar
  2. 2.
    Simon J, Davies C, Ramsey LE: Association of panic disorder and panic attacks with hypertension. Am J Med 1999, 107:310–316.CrossRefGoogle Scholar
  3. 3.
    Felker B, Yazel JJ, Short D: Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv 1996, 47:1356–1363.PubMedGoogle Scholar
  4. 4.
    Goldman LS: Medical illness in patients with schizophrenia. J Clin Psychiatry 1999, 60(suppl 121):10–15.PubMedGoogle Scholar
  5. 5.
    Brown S: Excess mortality of schizophrenia: a meta-analysis. Br J Psychiatry 1997, 171:502–508.PubMedGoogle Scholar
  6. 6.
    Dembling BP, Chen DT, Vachon L: Life expectancy and causes of death in a population treated for serious mental illness. Psychiatr Serv 1999, 50:1036–1042.PubMedGoogle Scholar
  7. 7.
    Kamara SG, Peterson PD, Dennis JL: Prevalence of physical illnesses among psychiatric inpatients who die of natural causes. Psychiatr Serv 1998, 49:788–793.PubMedGoogle Scholar
  8. 8.
    Bark N: Deaths of psychiatric inpatients during heat waves. Psychiatr Serv 1998, 49:1088–1090.PubMedGoogle Scholar
  9. 9.
    Holmberg SK, Kane C: Health and self-care practices of persons with schizophrenia. Psychiatr Serv 1999, 50:827–829.PubMedGoogle Scholar
  10. 10.
    Steiner JL, Hoff RA, Moffett C, et al.: Preventive health care for mentally ill women. Psychiatr Serv 1998, 49:696–698.PubMedGoogle Scholar
  11. 11.
    Berren MR, Santiago JM, Zent MR, Carbone CP: Health care utilization by persons with severe and persistent mental illness. Psyhiatr Serv 1999, 50:559–561.Google Scholar
  12. 12.
    Druss BG, Bradford DW, Rosenheck RA et al.: Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA 2000, 283:506–511. This is the first paper to look for health care delivery disparities in those with medical illnesses, much the way that other studies have looked at this for women or minorities. The authors found that in a large group of Medicare recipients who suffered myocardial infarctions, those with diagnosed mental illnesses were less likely to undergo angioplasty or coronary-artery bypass grafting than those who did not carry these diagnoses. The authors speculated about potential reasons for this disparity.PubMedCrossRefGoogle Scholar
  13. 13.
    Lawrie SM, Martin K, McNeill G, et al.: General practitioners’ attitudes to psychiatric and medical illness. Psychol Med 1998, 28:1463–1467.PubMedCrossRefGoogle Scholar
  14. 14.
    Carney CP, Yates WR, Goerdt CJ, Doebbeling BN: Psychiatrists’ and internists’ knowledge and attitudes about delivery of clinical preventive medical services. Psychiatr Serv 1998, 49:1594–1600.PubMedGoogle Scholar
  15. 15.
    Sullivan G, Koegel P, Kanouse DE, et al.: HIV and people with serious mental illness: the public sector’s role in reducing HIV risk and improving care. Psychiatr Serv 1999, 50:648–652.PubMedGoogle Scholar
  16. 16.
    Brunette MF, Rosenberg SD, Goodman LA, et al.: HIV risk factors among people with severe mental illness in urban and rural areas. Psyhiatr Serv 1999, 50:556–558.Google Scholar
  17. 17.
    Malow RM, McPherson S, Klimas N, et al.: Adherence to complex combination antiretroviral therapies by HIVpositive drug abusers. Psyhiatr Serv 1998, 49:1021–1022.Google Scholar
  18. 18.
    Walkup J, Crystal S, Sambamoorthi U: Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey. Am J Public Health 1999, 89:1101–1103.PubMedGoogle Scholar
  19. 19.
    Perretta P, Akiskal HS, Nisita C, et al.: The high prevalence of bipolar II and associated cyclothymic and hyperthymic temperaments in HIV patients. J Affect Disord 1998, 50:215–224.PubMedCrossRefGoogle Scholar
  20. 20.
    Ellen SR, Judd FK, Mijch AM, Cockram A: Secondary mania in patients with HIV infection. st NZ J Psychiatry 1999, 33:353–360.CrossRefGoogle Scholar
  21. 21.
    Mijch AM, Judd FK, Lyketsos CG, et al.: Secondary mania in HIV infection: are antiretrovirals protective? J Neuropschiatry Clin Neurosci 1999, 11:475–480.Google Scholar
  22. 22.
    Drugs for HIV infection. Med Lett 2000, 42:1-6.Google Scholar
  23. 23.
    Flexner C: HIV-protease inhibitors. New Engl J Med 1998, 1282–1292.Google Scholar
  24. 24.
    Wainberg MA, Friedland G: Public health implications of antiretroviral therapy and HIV drug resistance. JAMA 1998, 279:1977–1983. This is an important discussion about how the inadequate treatment of individual patients with HIV can lead to the development of resistant strains of HIV, threatening the health of not only that particular patient but also of others who might be infected with such resistant strains. Because the treatment armamentarium for HIV is limited and complex, treatment-resistance may equate to untreatable.PubMedCrossRefGoogle Scholar
  25. 25.
    Goldman LS. Interact: Psychotropic Drug Interactions. Washington, DC: American Psychiatric Press; 1999.Google Scholar
  26. 26.
    Ziedonis DM, Kosten TR, Glazer WM, et al.: Nicotine dependence and schizophrenia. Hosp Comm Psychiatry 1994, 45:204–206.Google Scholar
  27. 27.
    Lyons ER: A review of the effects of nicotine on schizophrenia and antipsychotic medication. Psyhiatr Serv 1999, 50:1346–1350.Google Scholar
  28. 28.
    Cassidy F, Ahearn E, Carroll BJ: Elevated frequency of diabetes mellitus in hospitalized manic-depressive patients. Am J Psychiatry 1999, 156:1417–1420. This study of a large series of patients hospitalized for manicdepressive illness found a prevalence of diabetes mellitus at about three times that seen in the general population. Those with diabetes had more psychiatric hospitalizations than those without although age of onset was the same between the two groups. The authors examine a number of hypotheses to explain this new finding.PubMedGoogle Scholar
  29. 29.
    GS, Guille C: Weight gain associated with use of psychotropic medication. J Clin Psychiatry 1999, 60(suppl 21):16–19.Google Scholar
  30. 30.
    Woodman CL, Breen K, Noyes R, et al.: The relationship between irritable bowel syndrome and psychiatric illness: a family study. Psychosomatics 1998, 39:45–54.PubMedGoogle Scholar
  31. 31.
    Masand PS, Sousou AJ, Gupta K, Kaplan DS: Irritable bowel syndrome and alcohol abuse or dependence. Am J Drug Alcohol Abuse 1998, 24:513–521.PubMedCrossRefGoogle Scholar
  32. 32.
    Epstein SA, Kay G, Clw D, et al.: Psychiatric disorders in patients with fibromyalgia: a multicenter investigation. Psychosomatics 1999, 40:57–63.,This study reports the careful psychiatric, psychologic, and functional evaluation of 73 patients at four centers who were rigorously diagnosed with the fibromyalgia syndrome. The authors conform the findings of other, smaller studies showing elevated rates of mood and anxiety disorders in this population as well as marked psychologic distress and functional impairment.PubMedGoogle Scholar
  33. 33.
    Yates WR, Gleason O: Hepatitis C and depression. Depress Anxiety 1998, 7:188–193.PubMedCrossRefGoogle Scholar
  34. 34.
    Zisook S, Peterkin J, Goggin KJ, et al.: Treatment of major depression in HIV-seropositive men. J Clin Psychiatry 1998, 59:217–224.PubMedGoogle Scholar
  35. 35.
    Markowitz JC, Kocsis JH, Fishman B, et al.: Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry 1998, 55:452–457. This was a large study of men and women with HIV and depression to examine the effects of various forms of psychotherapy and of imipramine. Imipramine, when combined with either interpersonal or supportive psychotherapy, yielded better outcomes than supportive or cognitive-behavioral psychotherapy alone. There were many subjects who did not complete the study, some becse of adverse drug effects, but also many for non-drug-related reasons.PubMedCrossRefGoogle Scholar
  36. 36.
    Elliott AJ, Uldall KK, Bergam K, et al.: Randomized placebo-controlled trial of paroxetine versus imipramine in depressed HIV-positive outpatients. Am J Psychiatry 1998, 155:367–372.PubMedGoogle Scholar
  37. 37.
    Lee MR, Cohen L, Hadley SW, Goodwin FK: Cognitivebehavioral group therapy with medication for depressed gay men with AIDS or symptomatic HIV infection. Psychiatr Serv 1999, 50:948–952.PubMedGoogle Scholar
  38. 38.
    Rabkin JG, Wagner GJ, Rabkin R: Fluoxetine treatment for depression in patients with HIV and AIDS: a randomized, placebo-controlled trial. Am J Psychiatry 1999, 156:101–107.PubMedGoogle Scholar
  39. 39.
    Elliott AJ, Russo J, Bergam K, et al.: Antidepressant efficacy in HIV-seropositive outpatients with major depressive disorder: an open trial of nefazodone. J Clin Psychiatry 1999, 60:226–231.PubMedCrossRefGoogle Scholar
  40. 40.
    Ferrando SJ, Rabkin JG, de Morre GM, Rabkin R: Antidepressant treatment of depression in HIV-seropositive women. J Clin Psychiatry 1999, 60:741–746.PubMedCrossRefGoogle Scholar
  41. 41.
    Amprenavir: a new HIV protease inhibitor. Med Lett 1999, 41:64–66.Google Scholar
  42. 42.
    Lane H-Y, Chang W-H, Chou JC-Y: Seizure during risperidone treatment in an elderly woman treated with concomitant medications. J Clin Psychiatry 1998, 59:81–82.PubMedGoogle Scholar
  43. 43.
    Zaleplon for insomnia. Med Lett 1999, 41:93–94.Google Scholar
  44. 44.
    Shader RI, Greenblatt DJ: The reappearance of a monoamine oxidase inhibitor (isocarboxazid). J Clin Psychopharmacol 1999, 19:105–106.PubMedCrossRefGoogle Scholar
  45. 45.
    Lamberg TS, Kivisto KT, Neuvonen PJ: Effects of verapamil and diltiazem on the pharmacokinetics and pharmacodynamics of buspirone. Clin Pharmacol Ther 1998, 63:640–645.PubMedCrossRefGoogle Scholar
  46. 46.
    Magnuson TM, Keller BK, Burke WJ: Extrapyramidal side effects in a patient treated with risperidone plus donepezil. Am J Psychiatry 1998, 155:1458–1459.PubMedGoogle Scholar
  47. 47.
    Kivisto KT, Lamberg TS, Kantola T, et al.: Plasma buspirone concentrations are greatly increased by erythromycin and itraconazole. Clin Pharmacol Ther 1997, 62:348–354.PubMedCrossRefGoogle Scholar
  48. 48.
    Gillette DW: Desipramine and ibuprofen. J Am Acad Child Adolesc Psychiatry 1998, 37:1129.PubMedCrossRefGoogle Scholar
  49. 49.
    Franco-Bronson K, Gajwani P: Hypotension associated with intravenous haloperidol and imipenem. J Clin Psychopharmacol 1999, 19:480–481.PubMedCrossRefGoogle Scholar
  50. 50.
    Yasui N, Kondo T, Otani K, et al.: Effects of itraconazole on the steady-state plasma concentrations of haloperidol and its reduced metabolite in schizophrenic patients: in vivo evidence of the involvement of CYP3A4 for haloperidol metabolism. J Clin Psychopharmacol 1999, 19:149–154.PubMedCrossRefGoogle Scholar
  51. 51.
    Lilja JJ, Kivisto KT, Neuvonen PJ: Grapefruit juice-simvastatin interaction. Clin Pharmacol Ther 1998, 64:477–483.PubMedCrossRefGoogle Scholar
  52. 52.
    Wines JD, Weiss RD: Opioid withdrawal during risperidone therapy. J Clin Psychopharmacol 1999, 19:265–267.PubMedCrossRefGoogle Scholar
  53. 53.
    Grozinger M, Hartter S, Hiemke C, et al.: Oxybutinin enhances the metabolism of clomipramine and dextromethorphan possibly by induction of a cytochrome P450 isoenzyme. J Clin Psychopharmacol 1999, 19:287–289.PubMedCrossRefGoogle Scholar
  54. 54.
    Lane H-Y, Su K-P, Chang W-H, et al.: Elevated plasma clozapine concentrations after phenobarbital discontinuation. J Clin Psychiatry 1998, 59:131–133.PubMedGoogle Scholar
  55. 55.
    Quetiapine for schizophrenia. Med Lett 1997, 39:117–118.Google Scholar
  56. 56.
    Yatham LN, Lint D, Lam RW, et al.: Adverse effects of pindolol gmentation in patients with bipolar depression. J Clin Psychopharmacol 1999, 19:383–384.PubMedCrossRefGoogle Scholar
  57. 57.
    Pramipexole and ropinirole for Parkinson’s disease. Med Lett 1997, 39:110.Google Scholar
  58. 58.
    Joos AAB, Frank UG, Kaschka WP: Pharmacokinetic interaction of clozapine and rifampicin in a forensic patient with an atypical mycobacterial infection. J Clin Psychopharm 1998, 18:83–85.CrossRefGoogle Scholar
  59. 59.
    Lamberg TJ, Kivisto KT, Neuvonen PJ: Concentration and effects of buspirone are considerably reduced by rifampicin. Br J Clin Pharmacol 1998, 45:381–385.PubMedCrossRefGoogle Scholar
  60. 60.
    Drugs for HIV infection. Med Lett 1997, 39:116.Google Scholar
  61. 61.
    Greenblatt DJ, von Moltke LL, Daily JP, et al.: Extensive impairment of triazolam and alprazolam clearance by short-term low-dose ritonavir: the clinical dilemma of concurrent inhibition and induction. J Clin Psychopharmacol 1999, 19:293–295.PubMedCrossRefGoogle Scholar
  62. 62.
    Sibutramine for obesity. Med Lett 1998, 40:32.Google Scholar
  63. 63.
    Lilja JJ, Kivisto KT, Neuvonen PJ: Grapefruit juice-simvastatin interaction. Clin Pharmacol Ther 1998, 64:477–483.PubMedCrossRefGoogle Scholar
  64. 64.
    Becquemont L, Raguene I, Le Bot MA, et al.: Influence of CYP1A2 inhibitor fluvoxamine on tacrine pharmacokinetics in humans. Clin Pharmacol Ther 1997, 61:619–627.PubMedCrossRefGoogle Scholar
  65. 65.
    Campo JV, Smith C, Perel JM: Tacrolimus toxicity associated with antidepressant treatment [abstract]. Psychosomatics 1999, 40:137–138.Google Scholar
  66. 66.
    Tiagabine for epilepsy. Med Lett 1998, 40:45-46.Google Scholar
  67. 67.
    Tolcapone for Parkinson’s Disease. Med Lett 1998, 40:60–61.Google Scholar
  68. 68.
    New triptans and other drugs for migraine. Med Lett 1998, 40:97–100.Google Scholar
  69. 69.
    Joffe RT, Sokolov STH: Co-administration of fluoxetine and sumatriptan: the Canadian experience. Acta Psychiatr Scans 1997, 95:551–552.CrossRefGoogle Scholar
  70. 70.
    Rogers T, deLeon J, Atcher D: Possible interaction between warfarin and quetiapine. J Clin Psychopharmacol 1999, 19:382–383.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Larry S. Goldman
    • 1
  1. 1.Department of PsychiatryUniversity of ChicagoChicagoUSA

Personalised recommendations