On 22.11.2023, the next communication event in the form of a psychoeducation class on the topic: "Comorbidity: definition, possible directions of diagnosis and treatment"

At present, the problem of simultaneous combination of various diseases of the human body, including comorbidity (from Latin co - together + morbus - disease) - the presence of several chronic diseases interconnected by a single pathogenetic mechanism - remains outside the scope of evidence-based medicine. In this regard, the problem of personalization of the patient in terms of comorbidity is also gaining special attention. The prominent American epidemiologist Alvan R. Feinstein (1925-2001) introduced the concept of "comorbidity" (Latin co - together, morbus - disease). He used this term to describe the presence of an additional clinical picture that already exists or can manifest independently, regardless of the underlying disease, and always differs from the latter. Comorbidity is the combination of two and/or more chronic diseases in one patient that are pathogenetically related to each other or comparable in time in one patient, regardless of the activity of each of them.  Diseases may have a mutual influence and potentiate each other's development, and they may also have common pathophysiological mechanisms of pathogenesis.

Among the main diseases of the human body in Ukraine, the largest share of comorbid conditions is made up of pathologies of the circulatory system, respiratory and digestive organs, diseases of the musculoskeletal and endocrine systems. Among patients with cardiovascular disease, 10% have mental disorders. An important aspect of comorbidity is psychosocial disorders, which have a significant adverse effect on the risk of developing, course and prognosis of cardiovascular disease, especially in people with socially significant cardiovascular disease and high cardiovascular risk groups.

The most significant post-traumatic stress disorders include: mental disorders, including PTSD, low socioeconomic status, social isolation, chronic stress at work and in the family, depression, anxiety (typical components of anxiety are fear, shame, guilt, transfer of negative emotions from the past to the present, creation of a negative model of the future), etc. Post-traumatic stress disorders are associated with behavioral risk factors for cardiovascular disease: unhealthy lifestyle - smoking, alcohol, unhealthy diet, physical inactivity, etc. That's why the results of pathopsychological diagnostics are often key to understanding the causes of our patients' somatic chronic diseases.

Compliance of a psychologist and a patient with psychosocial comorbidity (Wright V., Hopkins R., 1977; Koch-Weser S. et al, 2009): devote enough time to the patient, listen carefully and repeat essential keywords; take into account psychosocial and cultural aspects depending on age, gender, level of education and social status; support the expression of emotions, do not simplify the patient's psychosocial difficulties and problems; explain important medical information at a level accessible to the patient, express hope and help to get rid of guilt, support in actions; find out preferences in treatment and make joint decisions on further diagnostic and therapeutic actions; summarize important points of the consultation to confirm that the patient understands them; offer the patient regular follow-up; recommend psychiatric consultation if necessary.

Having considered the peculiarities of comorbidities, we have come to the following conclusions:

In patients with somatic diseases and comorbid conditions, the severity of the underlying disease increases and the prognosis of mental disorder worsens;
comorbidity should be taken into account when diagnosing somatic diseases and mental disorders;
treatment of comorbid pathology requires taking into account the interaction of drugs;
comorbidities require a significant increase in medical and psychological resources;
comorbidities reduce patient compliance.
Thus, comorbidity is not just a combination of several diseases; it implies new mechanisms of disease development, additional clinical picture, complications and course not typical of the underlying disease, as well as a significant impact on the quality and duration of life.