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Psychiatric comorbidity: fact or artifact?

van Loo HM, Romeijn JW - Theor Med Bioeth (2015)

Bottom Line: The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry.Current explanations focus either on classification choices or on causal ties between disorders.Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead.

View Article: PubMed Central - PubMed

Affiliation: Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands, h.van.loo@umcg.nl.

ABSTRACT
The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves two problems for psychiatric diseases: experimenter's regress and arbitrariness.

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Related in: MedlinePlus

Histogram with responses on “Have you ever suffered from…?” Answers: ANX: anxiety, worrisome period of at least 1 month; DEP: depressed mood for at least 2 weeks; INS: insomnia for at least 2 weeks; CONC: concentration problems for at least 2 weeks (* marks comorbidity with rates of 43.1 % in a to 53.9 % in b)
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Fig4: Histogram with responses on “Have you ever suffered from…?” Answers: ANX: anxiety, worrisome period of at least 1 month; DEP: depressed mood for at least 2 weeks; INS: insomnia for at least 2 weeks; CONC: concentration problems for at least 2 weeks (* marks comorbidity with rates of 43.1 % in a to 53.9 % in b)

Mentions: Two simple monothetic disorders (D1 and D2) are constructed in Fig. 4a. D1 is defined as the combination of depressed mood and insomnia (D1: DEP ∩ INS); D2 consists of the monothetic set anxiety and concentration difficulties (D2: ANX ∩ CONC). In total, 1,923 patients satisfied D1; 1,675 patients satisfied D2. Of those patients, 1,084 patients satisfied D1 and D2 and, thus, suffered from comorbidity. In Fig. 4b, D2 is adjusted in a polythetic disorder (D2′): anxiety is still a required symptom, but in addition, a patient may suffer from concentration difficulties or sleep problems or both (D2′: ANX ∩ (CONC ∪ INS)). Therefore, two extra combinations of symptoms also satisfied this diagnosis (ANX, INS and ANX, INS, DEP), of which the latter implies comorbidity of D1 and D2. As a consequence, more individuals satisfied D2, and more individuals suffered from both disorders D1 and D2. Among the individuals satisfying a disorder, the percentage of comorbid patients increased from 43 to 54 %.Fig. 4


Psychiatric comorbidity: fact or artifact?

van Loo HM, Romeijn JW - Theor Med Bioeth (2015)

Histogram with responses on “Have you ever suffered from…?” Answers: ANX: anxiety, worrisome period of at least 1 month; DEP: depressed mood for at least 2 weeks; INS: insomnia for at least 2 weeks; CONC: concentration problems for at least 2 weeks (* marks comorbidity with rates of 43.1 % in a to 53.9 % in b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4320768&req=5

Fig4: Histogram with responses on “Have you ever suffered from…?” Answers: ANX: anxiety, worrisome period of at least 1 month; DEP: depressed mood for at least 2 weeks; INS: insomnia for at least 2 weeks; CONC: concentration problems for at least 2 weeks (* marks comorbidity with rates of 43.1 % in a to 53.9 % in b)
Mentions: Two simple monothetic disorders (D1 and D2) are constructed in Fig. 4a. D1 is defined as the combination of depressed mood and insomnia (D1: DEP ∩ INS); D2 consists of the monothetic set anxiety and concentration difficulties (D2: ANX ∩ CONC). In total, 1,923 patients satisfied D1; 1,675 patients satisfied D2. Of those patients, 1,084 patients satisfied D1 and D2 and, thus, suffered from comorbidity. In Fig. 4b, D2 is adjusted in a polythetic disorder (D2′): anxiety is still a required symptom, but in addition, a patient may suffer from concentration difficulties or sleep problems or both (D2′: ANX ∩ (CONC ∪ INS)). Therefore, two extra combinations of symptoms also satisfied this diagnosis (ANX, INS and ANX, INS, DEP), of which the latter implies comorbidity of D1 and D2. As a consequence, more individuals satisfied D2, and more individuals suffered from both disorders D1 and D2. Among the individuals satisfying a disorder, the percentage of comorbid patients increased from 43 to 54 %.Fig. 4

Bottom Line: The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry.Current explanations focus either on classification choices or on causal ties between disorders.Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead.

View Article: PubMed Central - PubMed

Affiliation: Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands, h.van.loo@umcg.nl.

ABSTRACT
The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves two problems for psychiatric diseases: experimenter's regress and arbitrariness.

Show MeSH
Related in: MedlinePlus