De Berardis, Domenico

Fornaro, Michele

Martinotti, Giovanni

Frontiers in Psychiatry

English

University of Hertfordshire Research Archive

TYPE EditorialPUBLISHED 09 January 2024DOI 10.3389/fpsyt.2023.1356817OPEN ACCESSEDITED AND REVIEWED BYMarcin Siwek,Jagiellonian University MedicalCollege, Poland*CORRESPONDENCEDomenico De Berardisdomenico.deberardis@aslteramo.itRECEIVED 16 December 2023ACCEPTED 26 December 2023PUBLISHED 09 January 2024CITATIONMartinotti G, Fornaro M and De Berardis D(2024) Editorial: Comorbidity in bipolardisorder and schizophrenia, volume III.Front. Psychiatry 14:1356817.doi: 10.3389/fpsyt.2023.1356817COPYRIGHT© 2024 Martinotti, Fornaro and De Berardis.This is an open-access article distributedunder the terms of the Creative CommonsAttribution License (CC BY). The use,distribution or reproduction in other forums ispermitted, provided the original author(s) andthe copyright owner(s) are credited and thatthe original publication in this journal is cited,in accordance with accepted academicpractice. No use, distribution or reproductionis permitted which does not comply withthese terms.Editorial: Comorbidity in bipolardisorder and schizophrenia,volume IIIGiovanni Martinotti1,2, Michele Fornaro3 andDomenico De Berardis4,5,6*1Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio,Chieti, Italy, 2Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom, 3ClinicalSection of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, andOdontostomatology, University School of Medicine Federico II, Naples, Italy, 4Department ofPsychiatry, Azienda Sanitaria Locale 4, Teramo, Italy, 5School of Nursing, University of L’Aquila, L’Aquila,Italy, 6International Centre for Education and Research in Neuropsychiatry, Samara State MedicalUniversity, Samara, RussiaKEYWORDSbipolar (a ective/mood) disorders, schizophrenia, comorbidity, recovery, treatment,prognosis factors, anxiety, substance use disorderEditorial on the Research TopicComorbidity in bipolar disorder and schizophrenia, volume IIIUnderstanding comorbidities in bipolar disorder and schizophrenia is crucial forproviding comprehensive and effective care for individuals affected by these complexpsychiatric conditions (1, 2). Comorbidities refer to the presence of two or more distinctdisorders or conditions within the same individual, and the co-occurrence of bipolardisorder and schizophrenia with other mental health disorders, physical health conditions,and substance use disorders is well-documented. This Research Topic aimed to explorethe complexities of comorbidities in bipolar disorder and schizophrenia, including theirimpact on diagnosis, treatment, and clinical outcomes.Comorbidities in bipolar disorder and schizophrenia encompass a wide range ofpsychiatric and medical conditions that can significantly influence the course of illness andtreatment outcomes. Common comorbid psychiatric disorders include anxiety disorders,personality disorders, substance use disorders, and attention-deficit/hyperactivity disorder(ADHD), among others (3–5). Individuals with bipolar disorder or schizophrenia mayalso experience comorbid medical conditions such as cardiovascular disease, diabetes, andobesity, which can further complicate their overall health and wellbeing. The presenceof comorbid psychiatric disorders in individuals with bipolar disorder or schizophreniahas important implications for diagnosis and treatment. The overlapping symptoms andshared risk factors between these conditions can pose challenges for accurate differentialdiagnosis, potentially leading to delayed or misdiagnoses. For example, symptoms ofanxiety or substance use disorders can intersect with the mood and psychotic symptomsof bipolar disorder and schizophrenia, complicating the identification of primary andcomorbid conditions.Frontiers in Psychiatry 01 frontiersin.orgMartinotti et al. 10.3389/fpsyt.2023.1356817Moreover, the presence of comorbid psychiatric disorderscan impact the choice and management of treatment forindividuals with bipolar disorder or schizophrenia (4, 6, 7). Co-occurring anxiety disorders, for example, may require integratedtreatment approaches that address both anxiety and moodor psychotic symptoms. Similarly, substance use disorders cancomplicate medication adherence and contribute to increasedrisk of relapse or exacerbation of psychiatric symptoms. Inaddition to psychiatric comorbidities, individuals with bipolardisorder and schizophrenia often face a greater burden of physicalhealth comorbidities compared to the general population. Medicalconditions such as cardiovascular disease, diabetes, and obesityare disproportionately prevalent among individuals with severemental illness, contributing to reduced life expectancy and poorerphysical health outcomes. The interplay between psychiatric andphysical health comorbidities underscores the importance ofcomprehensive and integrated care that addresses the diverse needsof individuals affected by bipolar disorder and schizophrenia.Comorbidities in bipolar disorder and schizophrenia alsopresent challenges for treatment adherence and engagementin care (8–10). The complex interplay between multiplecomorbid conditions can contribute to treatment resistanceand greater difficulty in achieving stabilization of mood andpsychotic symptoms. Individuals with comorbidities may alsoface greater barriers to accessing and utilizing mental healthservices, further exacerbating their clinical needs and functionalimpairments. In clinical practice, addressing comorbiditiesin bipolar disorder and schizophrenia requires a holistic andmultidisciplinary approach that considers the diverse andinterconnected needs of affected individuals. Collaborative effortsbetween mental health professionals, primary care providers, andspecialists in relevant medical fields are essential for conductingcomprehensive assessments, developing integrated treatmentplans, and facilitating coordinated care that addresses bothpsychiatric and physical health comorbidities. The high prevalenceof comorbid substance use disorders in individuals with bipolardisorder and schizophrenia presents unique challenges fortreatment and recovery (11, 12). Substance use can exacerbatethe severity of mood and psychotic symptoms, interfere withmedication adherence, and contribute to increased risk of relapseand hospitalization. Integrated treatment models that combinepsychosocial interventions with specialized substance use disordertreatment are essential for addressing the complex needs ofindividuals with comorbid bipolar disorder, schizophrenia, andsubstance use disorders.In addition to substance use disorders, comorbid anxietydisorders are common among individuals with bipolar disorderand schizophrenia and can significantly impact their clinicalpresentation and quality of life (13). The presence of anxietysymptoms can exacerbate the severity of mood and psychoticsymptoms, contribute to functional impairment, and increasethe risk of suicide in individuals affected by bipolar disorder orschizophrenia. Integrating evidence-based treatments for anxietydisorders into the overall care plan is essential for addressingthe diverse needs of individuals with comorbid anxiety andsevere mental illness. The management of comorbidities inbipolar disorder and schizophrenia also necessitates a focus onaddressing the physical health needs of affected individuals. Theelevated risk of cardiovascular disease, diabetes, and obesity amongindividuals with severe mental illness requires proactive screening,prevention, and management strategies to mitigate the impactof these comorbid conditions on overall health and wellbeing.Integrated care models that encompass both psychiatric andphysical health services are essential for promoting holistic andcomprehensive care for individuals affected by bipolar disorder andschizophrenia comorbidities.Research into the comorbidities of bipolar disorder andschizophrenia is critical for advancing our understanding of thecomplex interactions between psychiatric and medical conditionsand informing the development of targeted interventions (11,14, 15). Longitudinal studies that examine the impact ofcomorbidities on clinical outcomes, treatment response, andhealthcare utilization can provide valuable insights into thechallenges and opportunities associated with addressing the diverseneeds of individuals affected by bipolar disorder and schizophreniacomorbidities. Public health initiatives aimed at raising awarenessabout the comorbidities in bipolar disorder and schizophreniaare essential for reducing stigma, promoting early detection, andimproving access to integrated care. Greater public awareness andadvocacy can contribute to enhanced support and resources forindividuals and families affected by comorbid conditions, fosteringa more informed and compassionate societal response to thecomplex challenges posed by the intersection of bipolar disorder,schizophrenia, and comorbidities.In the last published present of this Research Topic, van Deeet al. aimed to evaluate the role of psychiatric comorbidity asa predictor of schizophrenia spectrum disorders outcomes. Thisresearch contributed to the progress of personalized prognosticprediction models by introducing a new machine learning pipelinethat might enable more precise and tailored treatment for patientswith schizophrenia spectrum disorders. Using such complexmachine learning models and a counterfactual model explanationtechnique, the Authors found that at the group level, mostpsychiatric comorbidities had a negative influence on the predictedlikelihood of symptomatic remission in schizophrenia spectrumdisorders. At the individual level, the Researchers found highvariability in the influence of the presence of comorbiditieson the chance of remission. Thus, the results emphasized theimportance of identifying and including relevant comorbidities inpredictionmodels and provided valuable insights for improving thetreatment and prognosis of individual patients with schizophreniaspectrum disorders.Dragasek et al. analyzed data for a nationwide multicenterobservational study (COSMOS, COmorbiditieS in MOst severeneurology and psychiatric disorders in Slovakia) in orderto observe, measure and characterize the cross-sectionalconnections of psychiatric and physical comorbidities withselected demographic and clinical characteristics in patientswith bipolar disorder. The results suggested that the comorbiddisorders in bipolar disorder are associated with several indicesof harmful dysfunction, decrements in functional outcomes,increased utilization of medical services, and can negatively affectthe course of bipolar disorder, severity of bipolar disorder andits treatment. Finally, bipolar disorder comorbidities can lead toFrontiers in Psychiatry 02 frontiersin.orgMartinotti et al. 10.3389/fpsyt.2023.1356817even greater disability and mortality and the findings revealed thatthe associations between psychiatric and somatic comorbidities ofbipolar disorder seem to be bidirectional.On the other hand, Grunze et al. performed a narrative reviewaimed to overview the current knowledge- and lack of- aboutepidemiology, physical and mental health impact and treatmentof tobacco use disorder and nicotine dependence in peoplewith bipolar disorders. They pointed out that lifetime and pointprevalence of smoking in people with bipolar disorders was in therange of 45%−70% and thus about 2–3 times more frequent in suchpatients than in general population. Smoking, tobacco use disorderand nicotine dependence might have a harmful impact both onmental and physical health as well as mortality in people withbipolar disorders. Besides, pharmacological treatments normallyfollow the individual guidance for each disorder, but community-based psychosocial interventions for tobacco use disorder andnicotine dependence seemed to be suitable in people with bipolardisorders, too, as well as Cognitive Behavioral or Acceptance andCommitment based psychotherapies.In the first published article of the Research Topic, Ferracutiet al. theorized that patients affected by schizophrenia mightshow peculiar gyrification of certain cortical brain areas correlatedwith the symptom severity, evaluating a sample of 36 patients(with a mean age of 26.5 ± 7.4 years) affected by schizophreniaundergoing structural magnetic resonance imaging to calculate thelocal gyrification index (LGI). They found that acute inpatientswith schizophrenia showed increased LGI correlated to symptomseverity in bilateral frontal, cingulate, parietal, temporal cortices,and right occipital cortex. The comparison between low hostilitysymptoms and high hostility symptoms showed in the first groupa significantly lower LGI related to the severity of symptoms inthe bilateral frontal and temporal cortices. These changes in LGIinvolved abnormalities in areas that have been already associatedwith a lack of insight and awareness of the illness, severity ofpsychotic symptoms, and aggressive and antisocial behavior, whichare often related to involuntary hospitalization.In conclusion, comorbidities in bipolar disorder andschizophrenia encompass a wide range of psychiatric andphysical health conditions that significantly influence the clinicalpresentation, treatment, and outcomes of affected individuals.Addressing comorbidities requires a comprehensive and integratedapproach that considers the intersecting needs of individualswith complex psychiatric and medical conditions. By fosteringcollaborative research, clinical practice, and public awarenessinitiatives, it is possible to improve our understanding of thediverse needs of individuals affected by bipolar disorder andschizophrenia comorbidities and enhance the quality of careprovided to these populations.Author contributionsGM: Conceptualization, Data curation, Formal analysis,Funding acquisition, Investigation, Methodology, Projectadministration, Resources, Software, Supervision, Validation,Visualization, Writing – original draft, Writing – review & editing.MF: Conceptualization, Data curation, Formal analysis, Fundingacquisition, Investigation, Methodology, Project administration,Resources, Software, Supervision, Validation, Visualization,Writing – original draft, Writing – review & editing. DD:Conceptualization, Data curation, Formal analysis, Fundingacquisition, Investigation, Methodology, Project administration,Resources, Software, Supervision, Validation, Visualization,Writing – original draft, Writing – review & editing.FundingThe author(s) declare that no financial support was received forthe research, authorship, and/or publication of this article.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that could beconstrued as a potential conflict of interest.The author(s) declared that they were an editorial boardmember of Frontiers, at the time of submission. This had no impacton the peer review process and the final decision.Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. 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