Severe mental disorders as bipolar disorder and schizophrenia often co-occur with chronic medical illnesses, especially cardiovascular disease and diabetes. Our aim was to estimate the prevalence of physical health problems in hospitalized patients and to determine the sociodemographic and clinical factors associated with physical comorbidity.

The medical records of all inpatients followed up between September 2007 and September 2009 were reviewed retrospectively.

144 patients were evaluted of which 59 (%41) had schizophrenia, 31(%21.5) had bipolar disorder and 54 (%37.5) had other disorders. 43 (%29.9) patients had at least one medical illness, hypertension being the most common (%30) followed by thyroid disorders (%16) and diabetes mellitus (%11). Diabetes Mellitus was detected only in bipolar patients (p=0.005). Females were affected more than males regarding physical comorbidity (p=0.009). Patients with physical comorbidity were older (42.9 vs 35.54 yrs) and had a longer duration of illness (16.2 vs 10.0 yrs). Their hemoglobin levels were lower, blood glucose, urea, thyroid stimulating hormone levels were higher than the patients with no physical illness and the differences were all statistically significant (p=0.05). There was no difference regarding length of hospital stay, drug compliance, previous neuroleptic use, family history for medical and mental illness.

Conclusions: Although it is generally accepted that many physical conditions have been associated with serious mental disorders, the exact nature of the relationship between them is still unclear. Further research is required to identify medical comorbidity risk factors in order to improve the physical health of these patients.

There is a high co-morbidity between chronic inflammatory disorders and depression1. Proinflammatory cytokines like TNFα seems to play a central role in the pathogenesis of these disorders and its neutralization provides a potent treatment for inflammatory disorders2. Trying et al (2006) showed that a TNF-α blocker -etanercept- caused at least a 50% improvement in depression scores in psoriasis patients.3 These observations together with the theoretical background led to the hypothesis that TNF-α blockers may reverse depressive symptoms associated with chronic inflammatory disorders.

To evaluate the effectiveness of TNF-α blockers on symptoms of ankylosing spondylitis (AS) and depression.

9 treatment resistant AS patients with no contraindications for TNFα blockers, who were not using any psychotropic or nonbiological drugs were enrolled for the study. TNF-α blockers were given at weeks 0, 2 and 6 and Hamilton Depression and Anxiety Scales (HAMD, HAMA), Hospital Depression and Anxiety Questionnaire (HAD), Quality of Life Scale (SF36), AS severity index (BASDAI) was applied to the patients at week 0, 2 and 6.

There was a significant reduction in HAMD (p = 0.00), HAMA (p = 0.00), HAD-anxiety scores (p = .004) and a significant improvement in SF36- physical role (p = 0.00), physical role limitations (p = 0.01), bodily pain (p = 0.01), general health perception (p = 0.00), vitality (p = 0.02) and emotional role limitations (p = 0.01) subscales and BASDAI scores (p = 0.00) from week 0 to weeks 2 and 6.

This study showed that TNFα blockers may have a potential antidepressant effect besides its antiinflammatory effect in AS patients in a small sample.