Psychiatric aspects of chronic physical disease

Chronic physical diseases are the main cause of disability throughout the world. Much of this disability arises from co-morbid mental health complications. The two are likely to co-exist; indeed, over 50% of working age adults with mental ill health also have physical ill health and this rises to 95% in those over 79 years. This co-morbidity adversely influences outcomes by worsening disability, quality of life and mortality. It is recognized that the presence of a psychiatric disorder also adversely influences the quality of medical care. Whilst the diagnosis of co-morbid psychiatric conditions remains challenging, treatment approaches are similar to evidence-based treatment for uncomplicated psychiatric disorder. Preliminary research suggests that successful psychiatric treatment benefits the morbidity and possibly the mortality of individuals with chronic physical disease. Clinicians working in all settings should be aware of likely co-morbidity; they should consider medical patients vulnerable to psychiatric conditions and psychiatric patients vulnerable to medical conditions.