Comorbid
— Co-morbid —
Comorbidity
co·mor·bid
- existing simultaneously with and usually independently of another
medical condition
In
medicine and in psychiatry, comorbid refers to:
•
The presence of one or more disorders (or diseases) in addition to
a primary disease or disorder.
•
The effect of such additional disorders or diseases.
In
Tourette Syndrome:
•
The most common associated symptoms in Tourette Syndrome are obsessions
and compulsions; i.e. Obsessive Compulsive Disorder (OCD).
•
Hyperactivity, distractibility, impulsivity, and mood lability are
also relatively common; i.e. Attention Deficit Hyperactivity Disorder
(ADHD), or without hyperactivity (ADD).
Comorbidity
in medicine
In medicine,
comorbidity describes the effect of all other diseases an individual
patient might have other than the primary disease of interest. There
is currently no accepted way to quantify such comorbidity.
Many tests attempt
to standardize the “weight” or value of comorbid conditions,
whether they are secondary or tertiary illnesses. Each test attempts
to consolidate each individual comorbid condition into a single, predictive
variable that measures mortality or other outcomes. Researchers have
"validated" such tests because of their predictive value,
but no one test is as yet recognized as a standard.
Charlson
Index
The Charlson
Index is a comorbidity measure created by Charlson and her colleagues
and first published in 1987. The Index consisted of a list of 19 diagnoses
obtained by medical chart review. The Index assigns a numerical value
or "weight" from 1 to 6. The final score is simply the sum
of weighted values. The Deyo-Charlson and Romano-Charlson methods
theoretically improve upon the Charlson Index by assigning sets of
5-digit ICD-9-CM diagnoses. The Romano method is also called the Dartmouth-Manitoba
score. As reported by Schneeweis et al. (2004), "These 2 scores
differ only modestly in the ICD-9-CM codes mapping the conditions
of the Charlson Index." For the D’Hoore implementation
of the Charlson comorbidity index, the first 3 digits of the ICD-9
as described in D’Hoore et al. were used. The Ghali adaptation
of the Charlson Index was calculated with the reduced set of diagnoses
and new weights that improved prediction of in-hospital mortality
in coronary aretery bypass graft patients.
DRG
Patients
who are more seriously ill tend to require more hospital resources
than patients who are less seriously ill, even though they are admitted
to the hospital for the same reason. Recognizing this, the DRG grouper
manual splits certain DRGs based on the presence of secondary diagnoses
for specific complications or comorbidities (CC).
Comorbidity
in psychiatry
In psychiatry,
comorbidity refers to the presence of more than one mental disorder
occurring in an individual at the same time. On the DSM Axis I, Major
Depressive Disorder is a very common comorbid disorder. The Axis II
personality disorders are often criticized because their comorbidity
rates are excessively high, approaching 60% in some cases, indicating
to critics the possibility that these categories of mental illness
are too imprecisely distinguished to be usefully valid for diagnostic
purposes and, thus, for deciding how treatment resources should be
allocated.
