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Neurol Sci (2008) 29:S99S102 DOI 10.1007/s10072-008-0898-1
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Towards a definition of comorbidity in the light of clinical complexity
Vincenzo Bonavita Roberto De Simone
Springer-Verlag 2008
Abstract Clinical complexity encompasses multiple levels, including all the disorders and conditions experienced by a person along cross-sectional and longitudinal contexts, the diversity of severity levels and courses of clinical conditions, but also the plurality of values of people experiencing health problems and seeking help for them. The term comorbidity refers to the association of two distinct diseases in the same individual at a rate higher than expected by chance. Looking systematically to comorbidity represents the main road to approach patients clinical complexity. Once epidemiologically established through population or community surveys, the study of the comorbidity direction and of the chronological patterns of associated clinical entities may offer relevant information from both a clinical and a scientific point of view. Comorbidity profiles of migraine and tension-type headache offer a paradigmatic example to appraise and highlight headache patient clinical complexity, allowing the conversion of diagnosis from a validated cluster of symptoms to a person-centred clinical diagnosis.
Keywords Comorbidity Migraine Tension-type headache Person-centred diagnosis Clinical complexity
Introduction
A debate on comorbidity is a debate of both clinical and scientific interest. More than 40 years ago Feinstein [1], who is credited with coining the term, defined comorbidity as any distinct additional clinical entity that has existed or may occur during the clinical course of a patient who has the index disease under study. It is quite obvious that the broadness of additional clinical entities under the Feinstein concept of comorbidity included even physiological conditions requiring clinical monitoring, such as pregnancy.
The original concept has undergone a historical evolution: comorbidity should be regarded today as a non-casual association of clinical entities [2] or of a clinical entity with a physiological condition requiring clinical monitoring.
Looking systematically to comorbidity represents the main road to converting the diagnosis of a disease into a person-centred clinical diagnosis. This way of looking at the patient underlines clinical complexity as a pointed indicator of the conceptual and empirical richness of general medicine and even more so of neurology and psychiatry [3].
The work group on comorbidity of the Word Health Organization has taken into account even the...