Open Access Open Access  Restricted Access Subscription or Fee Access

Comorbidity, psychiatric diagnosis and the Person-centered Integrative Diagnostic Model

Ihsan M. Salloum, Mohammed T. Abou-Saleh, Valery Krasnov


Clinical comorbidity has increasingly become a defining reality of presenting health needs, the frequency of which is expected to increase in an aging world population affecting developing and developed countries alike. Clinical comorbidities are the rule and not the exception in regular clinical care settings and are associated with increased morbidity, mortality and overall economic and humanitarian burden. Comorbidity within psychiatry presents additional challenges related to the limited nosological validity of psychiatric diagnoses. The challenges of clinical comorbidity require a comprehensive and integrated approach to diagnosis and care. Patient-centered, holistic, community-oriented and comprehensive approaches, as opposed to a narrow, single-disease, acute care model, are critical to addressing the challenges and complexities of clinical comorbidities. The growing challenges of comorbidity underscore the importance of integrating psychiatric, medical and contextual healthcare models within primary care in its various manifestations around the world. Person-centered Integrated Diagnosis (PID) emphasises the totality of the person’s health in an integrative and dynamic approach that is inclusive of both ill and positive health along three fundamental axes promising to provide an optimal model of care to address the challenges of clinical comorbidity.


Comorbidity of mental disorders, Person-centered Intergrative Diagnostic Model, person-centered psychiatry, psychiatric diagnosis

Full Text:



Salloum, I.M., Mezzich, J.E. & Cordoba, S.E. (2009). Conceptual and methodological considerations in comorbidity. In: Psychiatric Diagnosis: Challenges and Prospects, (Ed. I.M. Salloum). Oxford: Wiley-Blackwell.

Feinstein, A. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases 23, 455-468.

Salloum, I.M., Moss, H.B & Daley, D.C. (1991). Substance abuse and schizophrenia: impediments to optimal care. American Journal of Drug & Alcohol Abuse 17 (3) 321-336.

World HealthOrganization. (1992). The Tenth Revison of the International Classification of Diseases and Related Health Problems (ICD-10). Geneva: WHO.

American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision.Washington, DC: American Psychiatric Association.

Klerman, G.L. (1990). Approaches to the phenomena of comorbidity. In: Comorbidity of mood and anxiety disorders, (Eds. J.D. Maser & C.R. Cloninger). Washington, DC: American Psychiatric Press, Inc.

Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.U. & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51 (1) 8-19.

Mezzich, J.E. (1998). On developing a psychiatric multiaxial schema for ICD-10. British Journal of Psychiatry - Supplement (1), 38-43.

Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J., Judd, L.L. & Goodwin, F.R. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. Journal of the American Medical Association 264 (19) 2511-2518.

Mezzich, J.E., Fabrega, H. Jr., Coffman, G.A. & Haley, R. (1989). DSM-III disorders in a large sample of psychiatric patients: frequency and specificity of diagnoses. American Journal of Psychiatry 146 (2) 212-219.

Merikangas, K.R., Mehta, R.L., Molnar, B.E., Walters, E.E., Swendsen, J.D., Aquilar-Gaziola, S., Bijl, R., Borges, G., Caraveo-Anduaga, J.J., DeWit, D.J., Kolody, B., Vega, W.A., Wittchen, H.U. & Kessler, R.C. (1998). Comorbidity of substance use disorders with mood and anxiety disorders - results of the international consortium in psychiatric epidemiology. Addictive Behaviors 23 (6) 893-907.

Krasnov, V.N. (2011). Diagnosis and classification of mental disorders in Russian speaking psychiatry: focus on affective spectrum disorders. European Psychiatry 26 (Special issue 2) 11-14.

Krasnov, V.N. (2010). The relationship of generalized anxiety disorder and major depression over time, in Diagnostic Issues. In: Depression and Generalized Anxiety Disorder, pp. 171-177 (Eds. D. Goldberg et al). Arlington VA: American Psychiatric Association.

Weiss, R.D., Griffin, M.L., Kolodziej, M.E., Greenfield, S.F., Najavits, L.M., Daley, D.C., Doreau, H.R. & Hennen, J.A. (2007). A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. American Journal of Psychiatry 164 (1) 100-107.

Salloum, I.M., et al. (2006). Enhancing treatment adherence in comorbid bipolar disorder and alcoholism: A pilot psychotherapy study. Bipolar Disorders 8 (Supplement 1) 55.

Balint, M. (1955). The doctor, his patient and the illness. Lancet 1, 318.

Balint, M. (1956). The doctor, his patient and the illness. London: Pitman.

Armstrong, D. (1982). The Problem of Medical Knowledge. Examining the Social Construction of Medicine. In: The Doctor-Patient Relationship, pp. 1930-1980 (Ed. P.W.A. Treacher). Edinburgh: Edinburgh University Press.

Henbest, R.J. & Stewart, M.A. (1989). Patient-centredness in the consultation: a method for measurement. Family Practice Research Journal 6 (4) 249-253.

Mead, N. & Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science and Medicine 51 (7) 1087-1110.

Lewin, S.A. & Skea, Z.C. et al. (2004). Cochrane Database of Systematic Reviews. 2 (2).

Salloum, I.M. & Mezzich, J.E. (2011). Conceptual appraisal of the Person-centered Integrative Diagnosis Model. International Journal of Person Centered Medicine 1 (1) 39-42.

Mezzich, J.E., Salloum, I.M., Cloninger, C.R., Salvador-Carulla, L., Kirmayer, L.J., Banzato, C.E., Wallcraft, J. & Botbol, M. (2010). Person-centred integrative diagnosis: conceptual bases and structural model. Canadian Journal of Psychiatry - Revue Canadienne de Psychiatrie 55 (11) 701-708.

Cloninger, C.R., Salloum, I.M. & Mezzich, J.E. (2012). The dynamic origin of positive health and wellbeing. International Journal of Person-centered Medicine. In press.



  • There are currently no refbacks.