Comorbidity, stigma and emotional perception in psychiatric disorders

Abstract

Schizophrenia is associated with significant comorbidity and mortality—patients seemingly suffer more often from type-2 diabetes mellitus, diabetogenic complications plus environmentally influenced conditions than non-schizophrenic patients. Schoepf et al. [1] in a 12-year follow-up study with 1,418 adult schizophrenic patients and 14,180 ageand gender-matched hospital controls compared whether comorbidities with somatic diseases in fact lead to higher mortality. They discovered many of them to be more prevalent plus associated with a worse outcome in the schizophrenia population, whereas these patients suffered less from hypertension, hyperlipidemia, angina and cataract than controls. In the end, except parkinsonism the hospital mortality due to comorbid physical diseases did not significantly differ from the control population. Parkinsonism, again, was significantly prevalent in deceased schizophrenic patients compared to those surviving the study period. Anyhow, the authors recommend to thoroughly monitor and manage the most prevalent comorbidities in schizophrenia. Since there is an overlap between affective and schizophrenia symptoms in a large group of patients, Wilson et al. [2] critically question the reliability and clinical utility of the diagnosis of schizoaffective disorder after finding statistically significant deviances between clinical and research diagnoses in 134 psychiatric inpatients: While the treating clinicians had diagnosed 48 of these patients with schizophrenia, 50 with schizoaffective disorder and 36 with psychotic bipolar disorder, trained research personal again using the Structured Clinical Interview of the DSM-IV-TR inclusive an explicit time threshold for criterion C diagnosed 64 patients with schizophrenia, 38 with schizoaffective disorder and 32 with psychotic bipolar disorder. The authors assume a tendency for less severe diagnoses on clinician side and advocate a more stringent criterion C for the diagnosis schizoaffective disorder to address an implicit bias in clinical practice, which in the end might affect the prevalence of the psychotic disorder diagnoses. Only few studies so far have broached the issue of disempowerment and stigma-related stress in patients with mental illness due to involuntary hospitalization. Rusch et al. [3] assessed shame and self-contempt, self-stigma, empowerment, quality of life and self-esteem in 186 seriously mentally ill persons. Self-stigma was significantly associated with higher stigma stress levels independent of psychiatric symptoms, diagnosis, age, gender or the number of involuntary hospitalizations during lifetime inducing a negative effect on quality of life and empowerment. Thus, emotional reactions and stigma as a stressor should be considered in interventions to reduce the negative effects of compulsory measures. In an fMRI study with 18 female patients with a diagnosis of borderline personality disorder and 18 healthy female controls, Scherpiet et al. [4] investigated whether not only the perception of emotional stimuli but also the mere anticipation of upcoming emotional pictures leads to emotional dysregulation associated with the disorder. Compared to controls, the patient sample showed deficient recruitment of various brain areas related to cognitiveemotional interaction already in the anticipation phase of both negative and ambiguously announced stimuli possibly adding to the emotional dysregulation and contributing to hypersensitivity toward emotional cues. Emotional perception is also subject of Schonenberg and Jusytes [5] A. Schmitt (&) P. Falkai Department of Psychiatry and Psychotherapy, LudwigMaximilians-University Munich, Nusbaumstr. 7, 80336 Munich, Germany e-mail: Andrea.Schmitt@med.uni-muenchen.de