Volume 38 · Number 11
NOVEMBER 2008
Clinical Implications of Epidemiologic Data for Diagnosis and Treatment of Psychiatric Comorbidity
By Sharon Samet, PhD; Deborah Hasin, PhD
The term “psychiatric comorbidity” describes the co-occurrence of two or more distinct psychiatric disorders within a specified time period. Since the early 1980s, psychiatric epidemiologic research has demonstrated that psychiatric disorders are commonly comorbid with alcohol and drug use disorders. Data from these studies provide clinicians with important information about the correlates and co-occurrence of disorders. However, the relationship of co-occurring disorders is complicated by the fact that many symptoms of psychiatric disorders also arise as the direct physiological effects of the substances. This commonality presents diagnostic challenges for clinicians and also raises questions about the documented high rates of comorbidity because this could, in part, be spurious due to misdiagnosed intoxication and withdrawal effects. Epidemiologic data have also provided some answers to these more complicated questions about comorbidity diagnosis, a central concern for clinicians who rely on accurate diagnosis to identifying the most effective treatments when patients abuse alcohol or drugs.
ABOUT THE AUTHORS
Sharon Samet, PhD, is with the NY State Psychiatric Institute, New York, New York, and Columbia University School of Social Work. Deborah Hasin, PhD, is with the NY State Psychiatric Institute, the Mailman School of Public Health, Columbia University, and Columbia University College of Physicians and Surgeons.
Address correspondence to: Sharon Samet, PhD, N.Y. State Psychiatric Institute, Unit 123, New York, NY 10032; or e-mail ss1456@columbia.edu.
Dr. Samet and Dr. Hasin have disclosed no relevant financial relationships.
EDUCATIONAL OBJECTIVES
- Summarize the epidemiologic comorbidity data from U.S. general population and treatment studies.
- Describe Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) classification of comorbidity and resulting diagnostic challenges.
- Discuss the clinical implications of the epidemiologic data.
The Role of Comorbidity in Severity and Outcome
Jan Fawcett, MD
Challenges in Comorbidity
Barbara J. Mason, PhD
Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders
Ihsan Salloum, MD, MPH;
Antoine Douaihy, MD;
Lauren Williams, MD
Anxiety Disorders with Comorbid Substance Use Disorders: Diagnostic and Treatment Considerations
Sudie E. Back, PhD;
Kathleen T. Brady, MD, PhD
Treatment of Co-occurring Depression and Substance Dependence: Using Meta-analysis to Guide Clinical Recommendations
Edward V. Nunes, MD;
Frances R. Levin, MD
Psychiatric Risk Factors for Suicide in the Alcohol-dependent Patient
Kenneth R. Conner, PsyD, MPH;
Michael S. McCloskey, PhD;
Paul R. Duberstein, PhD
