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Cochrane Special Collections

Reflecting on comorbidity in mental health and neuroscience

9 October 2019
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Special Collection

The World Health Organization has proposed that “premature mortality and morbidity could be reduced if there was a greater focus on comorbidity”.[1]

Comorbidity has been identified as a key cross-cutting theme by Cochrane Review Groups in the Mental Health and Neuroscience Network. A Special Collection on this theme has been produced for World Mental Health Day on 10 October 2019.

The Mental Health and Neuroscience Network has collated this Special Collection as a multidisciplinary resource for people who use neurological and mental health services and for clinicians and decision-makers involved in service provision around the world. This Special Collection is the first to bring together the latest Cochrane evidence for interventions in people who are living with a range of comorbid conditions affecting the brain, nerves, or mind. It aims to inform clinical practice by highlighting the current evidence for the management of comorbidity, and potential gaps in the evidence that could inform new clinical questions and trials in mental health and neuroscience.

This Special Collection consists largely of reviews on comorbidity from Cochrane Review Groups in the Mental Health and Neuroscience Network, including Cochrane Common Mental Disorders, Cochrane Dementia and Cognitive Improvement, Cochrane Drugs and Alcohol, Cochrane Epilepsy, and Cochrane Schizophrenia; and also reviews from Cochrane Injuries in the Acute and Emergency Care Network, and Cochrane Stroke in the Circulation and Breathing Network. 

Living with alcohol dependence and substance use disorders

Reviews from the Cochrane Common Mental Disorders, Cochrane Drugs and Alcohol and Cochrane Schizophrenia Groups

Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence

Alcohol dependence is a major public health concern, and the co‐occurrence of major depression in people entering treatment for alcohol dependence is common. This review assesses the effects of antidepressants for the treatment of people with comorbid depression and alcohol dependence.

Pharmacotherapy for anxiety and comorbid alcohol use disorders

Anxiety disorders are a potentially disabling group of disorders that frequently co‐occur with alcohol use disorders. Comorbid anxiety and alcohol use disorders are associated with poorer outcomes and are difficult to treat with standard psychosocial interventions. Improved understanding of the biological basis of the conditions has contributed to a growing interest in the use of medications for the treatment of people with both diagnoses. This review assesses the effects of pharmacotherapy for the treatment of people with comorbid anxiety and alcohol use disorders.

Interventions for drug‐using offenders with co‐occurring mental health problems

Many people under the care of the criminal justice system have co‐occurring mental health problems and drug misuse problems. It is important to identify the most effective treatments for this vulnerable population. This review assesses the effectiveness of interventions for drug‐using offenders with co‐occurring mental health problems in reducing criminal activity or drug use, or both.

Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder

Post‐traumatic stress disorder (PTSD) is a debilitating mental health disorder that may develop after exposure to traumatic events. Substance use disorder (SUD) is a behavioural disorder in which the use of one or more substances is associated with heightened levels of distress, clinically significant impairment of functioning, or both. PTSD and SUD frequently occur together, and the comorbidity is recognized as being difficult to treat and is associated with poorer treatment completion and outcomes than for either condition alone. Several psychological therapies have been developed to treat the comorbidity, without consensus on the most effective therapies. This review assesses the effects of psychological therapies for the treatment of people with comorbid PTSD and SUD.

Risperidone versus other antipsychotics for people with severe mental illness and co‐occurring substance misuse

People with serious mental illness such as schizophrenia and bipolar disorder may have co‐occurring substance use disorders (dual diagnosis). Dual diagnosis can have an adverse effect on treatment and prognosis of serious mental illness. This review evaluates the effects of risperidone compared to treatment with other antipsychotics used in people with serious mental illness and co‐occurring substance misuse.

Living with epilepsy

Review from the Cochrane Epilepsy Group

Antidepressants for people with epilepsy and depression

Depressive disorders are the most common psychiatric comorbidity in patients with epilepsy, affecting around one‐third of patients and having a significant negative impact on quality of life. There is concern that patients may not receive appropriate treatment for depression due to uncertainty regarding which antidepressant or class works best and the perceived risk of exacerbating seizures. This review assesses the effects of antidepressants for the treatment of people with comorbid depression and epilepsy. 

Living with stroke and traumatic brain injury

Reviews from the Cochrane Stroke and Cochrane Injuries Groups

Interventions for treating anxiety after stroke

 Approximately 20% of stroke patients experience clinically significant levels of anxiety after stroke. Physicians treat these patients with antidepressants or other anxiety‐reducing drugs, or both, or they can provide psychological therapy. This review assesses the effects of interventions for the treatment of people with anxiety after having a stroke. 

Non‐pharmacological interventions for depression in adults and children with traumatic brain injury

Following traumatic brain injury there is an increased prevalence of depression compared to the general population. It is unknown whether non‐pharmacological interventions for depression are effective for people with traumatic brain injury. This review includes the effects of non‐pharmacological interventions for the treatment of people with depression following traumatic brain injury.

Children and adolescents living with long-term conditions

Reviews from the Cochrane Common Mental Disorders Group

Psychological therapies for anxiety and depression in children and adolescents with long‐term physical conditions

Children with long-term physical conditions are at greater risk of developing psychological problems, particularly anxiety and depression, sometimes directly related to their illness or medical care. There is limited evidence regarding the effectiveness of psychological therapies for treating anxiety and depression in this population. Therapies designed for children and adolescents without medical issues may or may not be appropriate for use with those who have long‐term physical conditions. This review assesses the effects of psychological therapies for the treatment of anxiety and depression in children and adolescents with long‐term physical conditions.

E‐Health interventions for anxiety and depression in children and adolescents with long‐term physical conditions

Access to face‐to‐face treatment for children with long-term physical and psychological conditions is often limited. As technology improves, e‐health interventions (delivered via digital means, such as computers and smart phones) offer a potential solution to address the psychological needs of this group. This review assesses the effects of e‐health interventions for the treatment of anxiety and depression in children and adolescents with long‐term physical conditions.

Living with dementia and cognitive impairment

Reviews from the Cochrane Dementia and Cognitive Improvement Group

Antidepressants for treating depression in dementia

The use of antidepressants in dementia accompanied by depressive symptoms is widespread, but their clinical efficacy is uncertain. This review assesses the effects of antidepressants for the treatment of people who have been diagnosed as having dementia of any type and depression as defined by recognized criteria.

Psychological treatments for depression and anxiety in dementia and mild cognitive impairment

Anxiety and depression are very common in people with dementia and mild cognitive impairment. Psychological interventions have been suggested as a potential treatment for these populations. Current research suggests that people with dementia and mild cognitive impairment have limited opportunities for psychological treatments aimed at improving their well‐being. This review assesses the effects of psychological interventions for the treatment of anxiety and depression in people with dementia or mild cognitive impairment. 

About this Special Collection

References

1. World Health Organization. Addressing comorbidity between mental disorders and major noncommunicable diseases. 2017. www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/publications/2017/addressing-comorbidity-between-mental-disorders-and-major-noncommunicable-diseases-2017

Acknowledgements

Thank you to the review authors and to Cochrane Common Mental Disorders, Cochrane Dementia and Cognitive Improvement, Cochrane Drugs and Alcohol, Cochrane Epilepsy, Cochrane Injuries, Cochrane Schizophrenia, and Cochrane Stroke for producing the reviews included in this Special Collection. Katherine Jones (of the Cochrane Mental Health and Neuroscience Network team) contributed the introductory text and collated the reviews, working with the Cochrane Editorial & Methods Department and with input from Rachel Churchill of the Cochrane Common Mental Disorders Group.

Image credit

Cochrane Mental Health and Neuroscience Network

Contact

Cochrane Editorial and Methods Department ([email protected])

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