Occurrence and Clinical Correlates of Psychiatric Comorbidity in Patients With Psychotic Disorders
J Clin Psychiatry 1998;59(2):60-68
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Background: The aim of this study was to explore
patterns and clinical correlates of psychiatric comorbidity in
patients with schizophrenia spectrum disorders and mood spectrum
disorders with psychotic features.
Method: Ninety-six consecutively hospitalized
patients with current psychotic symptoms were recruited and
included in this study. Index episode psychotic diagnosis and
psychiatric comorbidity were assessed using the Structured
Clinical Interview for DSM-III-R-Patient Version (SCID-P).
Psychopathology was assessed by the SCID-P, Brief Psychiatric
Rating Scale, Scale for the Assessment of Negative Symptoms, and
Hopkins Symptom Checklist. Awareness of illness was assessed with
the Scale to Assess Unawareness of Mental Disorders.
Results: The total lifetime prevalence of
psychiatric comorbidity in the entire cohort was 57.3% (58.1% in
schizophrenia spectrum disorders and 56.9% in mood spectrum
psychoses). Overall, panic disorder (24%), obsessive-compulsive
disorder (24%), social phobia (17.7%), substance abuse (11.5%),
alcohol abuse (10.4%), and simple phobia (7.3%) were the most
frequent comorbidities. Within the group of mood spectrum
disorders, negative symptoms were found to be more frequent among
patients with psychiatric comorbidity than among those without
comorbidity, while such a difference was not detected within the
group of schizophrenia spectrum disorders. Social phobia,
substance abuse disorder, and panic disorder comorbidity showed
the greatest association with psychotic features. An association
between earlier age at first hospitalization and comorbidity was
found only in patients with unipolar psychotic depression.
Patient self-reported psychopathology was more severe in
schizophrenia spectrum patients with comorbidity than in those
without, while such a difference was less pronounced in mood
Conclusion: These findings suggest that
psychiatric comorbidity is a relevant phenomenon in psychoses and
is likely to negatively affect the phenomenology of psychotic
illness. Further studies in larger psychotic populations are
needed to gain more insight into the clinical and therapeutic
implications of psychiatric comorbidity in psychoses.