What type of comorbid conditions do you feel need the most urgent attention? Why?

• a. physical (e.g. obesity, CVD)
• b. medical (e.g. hypothyroidism, multiple sclerosis)
• c. psychiatric (e.g. ADHD, personality disorders, substance abuse)

That’s a hard question. I would say that as psychiatrists, we are very aware of other psychiatric comorbidities because that is your job. So you look for that – if you see your bipolar patient has anxiety, you know what that is and you know how to treat it. You spot it easily. But for me, of more importance would be the physical and medical conditions. It is hard for bipolar patients to maintain an awareness of their physical problems. As a psychiatrist you have to be really aware that they can also suffer from physical problems, not only because of the treatments you give them, but because they are people – they get old and they can have physical problems. We usually forget that and that’s why there’s these guidelines to have them in mind.

Could you tell us about a case of mania with depressive symptoms you’ve had which was complicated by comorbidities?

There was a woman that we admitted two years ago. She was a bipolar patient who also had a personality disorder – a really complicated patient. She was admitted after a suicide attempt and we found she was depressed but also had mania symptoms. After additional routine checks, she was diagnosed with hepatitis (type C and type B). She was with mania symptoms and with depressive symptoms – she just didn’t control herself and didn’t take care of herself. I saw her the other day and I know she is doing much better – she is taking some treatment for her liver, as well as her psychiatric treatments.