Carga de comorbilidad en pacientes adultos con trastorno psiquiátrico ingresados en un hospital general 2012-2018

Abstract

Introduction and objectivePeople with mental disorders are at higher risk of developing organic pathologies than the general population. It is estimated that 25% of the adult population suffers from a mental disorder and 68% of them suffer from a comorbid disease. The aim of this work is to estimate the relationship between severe somatic comorbidity and mental disorders. MethodsBetween 2012 and 2018 we studied the somatic comorbidity of patients admitted to the Hospital [University Hospital of Mostoles] with a diagnosis of mental disorder ICD-10 using the Charlson-Quan index. Results5073 patients had a diagnosis of mental disorder. Of these, 1490 (29.4%) had a somatic disease of known impact and prognostic significance (Charlson-Quan index equal to or greater than 1), different among the groups of mental disorders (organic mental disorder 78.3%, substance use disorder 38.9%, schizophrenia spectrum disorders “non-schizophrenia psychosis” 21.9%, common mental disorder “anxiety-depression” 19.7% and schizophrenia 19.0%). The distribution by sex and age of psychiatric diagnoses was not homogeneous. In schizophrenia, the majority were male (64.5%), while in the rest of the diagnostic categories, women predominated. Organic mental disorders had a higher proportion of people over 65 years of age (77.9%), compared to the rest of the categories, which were mostly between 35 and 65 years of age. The most frequent somatic diseases in the sample are: chronic lung disease (14%), diabetes with chronic complications (11.3%), hemiplejía/paraplejía (11.3%), any malignancy (7.5%) and mild liver disease (5.7%).The occurrence of somatic comorbidity throughout the life cycle is different in the mental disorder groups, with 4 patterns observed. Substance use disorders have the earliest onset of severe somatic comorbidity. Schizophrenia and schizophrenia spectrum disorders “non-schizophrenia psychosis” have an intermediate onset and a very sharp increase in morbidity rate. Common mental disorders initiate severe comorbidity later and more progressively. Organic mental disorders are those with the latest onset of morbidity, above 60 years of age, and rapidly become more complicated. ConclusionsThis study provides an estimate of the prevalence and characteristics of somatic illness in hospitalized patients with mental illness in a general hospital. Mental illness is associated with a substantial burden of physical comorbidities that appear at different evolutionary moments according to the diagnostic group of mental illness.