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Comorbidity: meaning and synonyms in medicine and psychology

By Cristiano Antonino On Jul 30, 2022

Comorbidity in the medical field indicates by definition the coexistence of several different pathologies in the same individual

Comorbidity (or comorbidities): the term may refer to the coexistence of two or more pathologies

that have appeared at different times
that have appeared at the same time
which are totally independent of each other (e.g. affecting different systems);
which are partly connected (e.g. affecting the same apparatus);
in which one disease (called primary) occurred first and was the direct or indirect cause of the other(s) (called secondary).

Charlson comorbidity index

Knowledge of comorbidity is useful in assessing the cost/benefit ratio in the treatment of a particular morbid condition: for this reason the ‘Charlson Index’ was developed, an index which allows the calculation of the probability of survival at 10 years in a patient in whom two or more pathologies were present simultaneously.

For each pathology (out of a total of 22) the patient was assigned a score of 1, 2, 3 or 6 and the sum of the scores determined the life expectancy.

The Charlson Index has undergone numerous revisions and variations over the years and has been transformed into a questionnaire to be submitted to the patient himself, but it has nevertheless remained a reference standard in clinical survival studies.

The scores for each morbid condition are as follows:

1 point: myocardial infarction, congestive heart failure, peripheral vasculopathy, cerebral vasculopathy, dementia, chronic bronchopneumopathy, connective tissue disease, peptic ulcer disease, chronic hepatopathy, uncomplicated diabetes mellitus;

2 points: hemiplegia, moderate or severe renal insufficiency, diabetes mellitus with organ damage, tumours, leukaemia, lymphoma;

3 points: moderate or severe liver disease;

6 points: malignant tumours, metastases, AIDS.

This score allows a decision to be made before embarking on a particularly aggressive therapy, e.g. treating a malignant neoplasm in a patient with heart failure and diabetes.

In this case, the risks and costs of aggressive therapy outweigh the benefits to the patient and the physician can make important considerations regarding therapy.

Comorbidity in psychology and psychiatry

In psychology and psychiatry, the concept of comorbidity does not necessarily indicate two separate illnesses, as is always the case in the medical field, but rather the possibility of several diagnoses in the same patient based on the symptoms presented.

Comorbidity in ASDs (Specific Learning Disorders)

Comorbidity in the field of specific learning disorders can be divided into two large groups

homotypic comorbidity: when two or more specific developmental disorders (of the ‘same type’) are present simultaneously, such as dyslexia, dysorthography, dysgraphia and dyscalculia;
heterotypic comorbidity: when the learning disorder is associated with internalising or externalising psychopathological disorders of a ‘different type’, such as significant problems in the emotional, social and behavioural spheres.

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