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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Review Article 

Time to Fix the Perceived Physical and  

Psychiatric Disanalogy 
Anum Haider 

AQ Khan Center, Institute of Behavioral Sciences, Karachi. 

Corresponding Author: dranum.haider@gmail.com 

 

Abstract 

Health is a combination of good physical and mental well-being. Hence, it is important to cater 

both physical and psychiatric health elements equally. Current practice is mismatch of this 

ideology and both specialties are very much separately working. In this article, the association 

between these two health aspects along with underlying mechanisms, underpinning factors for 

such dissociation, appropriate recommendations and implications will be discussed. 

 

Keywords 

Physical, psychiatric, health, factors, mechanisms. 

 

Background 

According to the Health definition by WHO 

(World health Organization), the complete 

health is with both physical and mental 

(psychiatric) well-being of a person. If health 

compromises in either way it may hamper 

functioning or productivity of a person 

(Alonso, et al., 2011). However the research 

pool is not sufficient in relation to the demand 

of this subject. Nevertheless, to date studies 

have clearly mentioned the connection 

between physical and psychiatric disorders 

rather considering these as separate entities. 

 

The Linkage between Physical and 

Psychiatric Disorders 

They can present either as a comorbidity or 

as an associated condition. 

 

As a comorbidity 

A person with one kind of disorder is more 

susceptible to develop the other (Druss, 

2011). Chronic physical conditions like 

cardiovascular diseases, Diabetes mellitus 

(D.M), Pulmonary diseases (Vogele, 2008), 

renal diseases(Moreira, 2008), neurological 

or dental diseases (Tomar, et al., 2011 & 

Kisley, et al., 2011), If not managed well, it 

can lead to psychiatric problems, most 

commonly depression, anxiety and suicide 

(Jones, et al., 2004). Almost half (58%) of the 

population with medical problems develop 

psychiatric problems (Druss, 2011). 

Similarly chronic and severe psychiatric 

disorders (Depression, Bipolar disorder, 

Schizophrenia) can also produce physical 

problems such as cardiovascular disorders, 

D.M and Chronic pain (Hert, et al., 2009 & 

Smith, 2011). More than half (68%) of the 

population with mental disorder can develop 

comorbid medical problems (Druss, 2011). 

 

As an associated condition 

Psychiatric problems like depression are very 

much associated with physical problems that 

are chronic, multiple in number and poorly 

managed. (Gunn, et al., 2012). Physical 

problems may also manifest as psychiatric 

problems like SLE (systemic lupus 

erythromatosis) (Hajighaemi, 2016). 

Psychiatric problem may present as medical 

problems for instance, chronic pain 

syndromes. (Phillips, 2011). Richard et al. in 

his study re-explained that 46% of cases 

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Anum Haider 17 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

appear as medical disorders once reassessed 

in comparison with previously diagnosed 

psychiatric cases with full battery (physical, 

psychiatric, neurological exam and labs), 

(Nousin, et al., 2013) 

 

The Underpinning Mechanisms of 

Linkage 

It is a well-established fact that inflammatory 

markers get increased when a person suffers 

from physical problems. The inflammatory 

markers are involved in almost all kind of 

physical illnesses in form of predisposing, 

triggering or maintaining factor. There are 

also similar evidences for psychiatric 

disorders in terms of potentiated pro-

inflammatory mediators and inflammatory 

reactions and decreased immunity (Druss, 

2011 & Nousin, et al., 2013). Hence 

inflammation is a common underpinning 

factor that plays a bidirectional role in the 

manifestation of physical or psychiatric 

conditions (Druss, 2011). The pro-

inflammatory markers and cytokines (C-

Reactive Proteins, TNF-Tumor necrosis 

factor 𝛼, gamma interferons,interleukin-6, 

interleukin-8) are responsible to execute 

inflammatory process and production of 

physical and psychiatric problems while on 

the other hand physical or psychiatric 

disorders may also turn on the inflammatory 

cascade (Druss, 2011 & Leboyer, et al., 

2012).  

 

The common negative health behaviors in 

both kinds of disorders that are responsible to 

start the inflammatory cascade are poor diet, 

lack of exercise, alcohol, smoking or other 

psychoactive substance use (Druss, et al., 

2011 & Larsen, 2009). These negative health 

behaviors are commonly observed in patients 

with mental disorders and chronic medical 

problems. These patients also have shared 

genetic predisposition to develop metabolic 

disturbances and psychopathologies (Nousin, 

et al., 2013). Other than genetic basis, 

medications make the person susceptible to 

develop metabolic disturbances (obesity, 

impaired glucose tolerance, hypertension, 

and dyslipidemia) like antipsychotics as well 

anti-hypertensive or prescribed medications 

may cause psychological disturbances (Hert, 

et al., 2011). Metabolic disturbances may 

itself drift into various psychopathologies 

(schizophrenia, ADHD-Attention deficit 

hyperactivity disorder, ASD-Autism 

spectrum disorder), (Nousin, et al., 2013). 

Inflammatory process is good to handle the 

short term stress but when the stress becomes 

chronic or prolonged, it brings damaging 

health consequences by decreasing immunity 

and release of common pro-inflammatory 

mediators (cytokines, interleukins, tumor 

necrosis factors), (Sareen, 2007). 

 

This results in devastating changes in 

neuronal structure and functions by alteration 

in synaptic proteins and intracellular 

signaling, loss of neurotropic support, 

inhibited neurogenesis, inhibited neuronal 

network connectivity, cytoskeletal 

destabilization and glutamate toxicity. These 

changes manifest as different 

neuropsychiatric and medical conditions 

(Duric, 2016). Broadly it disrupts the 

hypothalamic pituitary axis (HPA) and 

neuro-modulatory apparatus (like 

neurotransmitters). These are common risk 

factors that underpin this inflammatory 

cascade to bring various physical and 

psychiatric problems on the surface (Druss, 

2011 & Taylor, et al., 2012). 

 

Biological Factors 

- Genetics 

- Leptin sensitivity 

- Obesity 

- Smoking or other psychoactive substance 

use. 

- Poor nutrition 

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Anum Haider 18 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

 

Psychological factors 

- Adverse life events 

- Abuse/Neglect 

- Chronic stressors 

- Negative cognitive process and emotions 

- Maladaptive personality traits 

 

Social factors 

- Poverty 

- Poor social support 

- Isolation 

- Sedentary life style 

- Poor neighborhood / household 

 

Beside biological factors; the psychosocial 

factors (exposure to early life trauma, chronic 

stressors, and low socioeconomic status) 

have equal role in the causation of different 

medical and psychiatric disorders by 

disruption of HPA-axis (Druss, et al., 2011 & 

Sareen, 2007). Hence there is a complex 

interplay of various neurobiological and 

psychosocial factors for the production of 

almost any kind of medical or psychiatric 

disorders (Druss, 2011 & Taylor et al., 2012). 

 

Perception and Practice in the 

Community 

Despite the strong association between these 

two kinds of disorders the comorbidity 

remains unattended or mislabeled as 

psychosomatic, functional or self-inducing at 

a significantly higher rate. It ultimately 

worsens the psychological stability, 

treatment adherence, quality of life and life 

expectancy (Phillips, et al., 2011 & Gray, 

2012). (Erwin, et al., 2011) in his study has 

found high rate of physical comorbidity in 

psychiatric disorders (43%) and found both 

physician and psychiatrists to be least 

proficient in identification and management 

of such comorbidities and associated  

Conditions both in primary care and mental 

health settings (Walker, 2011). 

 

Factors behind This Perception 

The ultimate question arises in mind,” how 

such an important presentation can be 

overlooked by health professionals?” The 

research has proposed the possible answers: 

-There are lack of expertise of psychiatrists to 

identify and treat medical conditions or they 

discount it due to lack of available resources. 

-The physicians at their end feel discomfort 

to treat medical conditions in psychiatric 

patients or take it for granted.  

-There is lack of adequate communication 

and coordination between physician and 

psychiatrist. 

 

Consequences-Facts and Figures 

 (Scoll, et al., 2009) have worked to measure 

the burden of disability due to physical 

(medical) and psychiatric problems. The 

disability due to psychiatric problems is high 

than physical problems and it carry 

remarkable synergistic effects on disability 

burden as a result of comorbidity with 

physical disorders. It increases the burden 

usually in two ways: 

 

Increasing the rate of comorbidity 

The properly unaddressed physical or 

psychiatric disorders result in high rate of 

comorbidity. In patients with severe mental 

illness there is high comorbidity with 

physical disorders like CVD, D.M, 

Pulmonary, dental. Similarly many chronic 

medical conditions may be worsened due to 

comorbid psychiatric conditions such as 

depression in diabetic patient decreases 

motivation for maintaining diet control, 

exercise and other stress relieving activities. 

 

Premature mortality 

Mortality gap is very higher (2-4 fold), 

around 15-20yrs earlier people with severe 

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Anum Haider 19 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

mental illness (i.e., schizophrenia) get die 

even in high income countries due to suicide 

and other unattended physical health 

conditions. Grossly on a broader view, theses 

unrecognized and unmanaged physical and 

psychiatric comorbidities affects person both 

at individual and community level. At 

individual level it impairs functioning, 

productivity and quality of life while on 

community level poses high economic 

burden (Druss & Thornicroft, 2011; Gray, 

2012 & Lawrence, 2013). 

 

Conclusion 

The understanding of psychophysiological 

mechanisms made the clear relationship 

between physical and psychiatric disorders. 

The present health care system is not such 

integrated and coordinated to cater this 

realistic relationship. Clinical and policy 

implications are urgently needed to look into 

this matter. 

 

Implications and Recommendations 

 

Clinical 

- Education and awareness of health 

professionals 

Psychiatrists can play crucial role by 

expanding the clinical paradigm by 

inclusion of physical monitoring and 

evidence based prescription in daily 

practice along with education of patients 

regarding promotion of healthy life style 

and behaviors (Hert, et al., 2011). Nurses 

and primary care physicians are equally 

needed to be aware and educated about 

various common mental health problems in 

patients with medical illness (Hardy, et al., 

2011 & Bradshaw, 2012). 

- Improving communication 

Good level of communication is 

instrumental in any health setting 

especially in our setup where mostly mental 

health setting is separated from medical 

setting. There is crucial need to develop 

good communication bonding between the 

medical and mental health settings for 

appropriate referral and management 

(Druss, 2011). 

- Monitoring of physical and mental 

health status and effect of treatment 

The standardized monitoring tools and 

storage system must be formulated to 

record this monitoring and to appreciate 

and identify health disruptions at the 

earliest level (Carlier, 2012 & Eldridge, 

2011). 

- Promotion of healthy health behavior 

Healthy health behaviors like cessation of 

smoking and other psychoactive 

substances, exercise, healthy diet, proper 

sleep must be equally promulgated in all 

health settings (Happel, 2012). 

- Involvement of significant others in 

patient’s care 

The significant others in patient’s life can 

ensure good care act as a role model to 

emulate and maintain healthy behavers and 

habits in patients (Thoits, 2011). 

 

Policy 

The stake holders and government must do 

take it alarming and derive some policies 

accordingly, few are suggested below. 

- Expansion of health budget 

From the total health budget only 0.4% is 

allocated to mental health (Mental health 

atlas, 2014). Expansion of health budget is 

intensely needed for the provision of 

services adequately. 

- Integration of mental health in general 

health setup 

According to World health organization 

recommendation mental health facility 

must be as accessible as that of physical 

health. Depression declared to be the 

leading cause morbidity and mortality and 

found in almost 42% of the patients with 

physical diseases (WHO report 2017 

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Anum Haider 20 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

march). Hence it is essential to integrate 

both medical and psychiatric care. 

- Development of financial collaboration 

with international agencies 

In third world under developed countries 

like Pakistan international funding 

collaboration with the agencies targeting 

common area (i.e. substance use, suicide) 

can improve the care, evidence based 

working and research. 

- Building trained workforce 

There is scarcity of psychiatrists (mental 

health professionals) in relation to the given 

population size. Primary care physicians, 

nursing staff, lady health workers, social 

workers or voluntary community workers 

must have necessary training to work 

effectively in their circles to improve health 

globally. Behavioral sciences and 

psychiatry must be included in the 

curriculum of all medical students to 

develop adequate insight for career 

selection. 

- Prioritize preventive strategies 

Preventive strategies must be implemented 

both at primary and secondary level. 

 

            Primary Level 

Global awareness and promotion of healthy 

life strategies like balanced diet, exercise, 

cessation of smoking and other 

psychoactive substances and acquiring 

good social circle. 

 

Secondary level 

Specific high risk groups are focused and 

targeted for specific health measures like 

chronic medically ill for screening and 

treatment of depression/ anxiety or other 

psychological issues.  

 

This article may initiate further research 

under observational (such as, association of 

physical and psychiatric disorders in our 

population in both urban and rural setting) 

and interventional grounds (such as effect 

of education and monitoring on clinical 

outcome, liaison work). 

 

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

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