When mental and physical illnesses occur together, patients’ subjective accounts of physical symptoms they’re experiencing are sometimes arbitrarily discredited or dismissed by physicians, even though the relationship between mental and physical health is well established and documented.
Recent research by State University of New York (SUNY) Downstate Medical Center professor of psychiatry Jeremy D. Coplan, MD, and colleagues has discovered a high rate of association between panic disorder and four domains of physical illness — findings that could alter the way physicians and psychiatrists view perceived boundaries within and between psychiatric and medical disorders.
“Patients who appear to have certain somatic disorders – illnesses for which there is no detectable medical cause and which physicians may consider to be imagined by the patient — may instead have a genetic propensity to develop a series of real, related illnesses,” maintains Dr. Coplan, who is also an expert in neuropsychopharmacology, In a SUNY Downstate release.
The research team led by Dr. Coplan found a high correlation between panic disorder, bipolar disorder, and physical illness, and noted significantly higher prevalence of certain physical illnesses among panic disorder patients as compared to the general population.
“Panic disorder itself may be a predictor for a number of physical conditions previously considered unrelated to mental conditions, and for which there may be no or few biological markers,” Dr. Coplan explains.
The study is published in The Journal Of Neuropsychiatry and Clinical Neurosciences entitled “A Novel Anxiety and Affective Spectrum Disorder of Mind and Body – The ALPIM (Anxiety-Laxity-Pain-Immune-Mood) Syndrome: A Preliminary Report“ (Volume 27 Issue 2, Spring 2015, pp. 93-103 http://dx.doi.org/10.1176/appi.neuropsych.14060132), coauthored by Jeremy Coplan, M.D., Deepan Singh, M.D., Srinath Gopinath, M.D., Sanjay J. Mathew, M.D., and Antonio Bulbena, variously of Winthrop University Hospital, Mineola, New York; the Michael E. DeBakey VA Medical Center, Houston, Texas; Baylor College of Medicine, Houston, Texas; and the Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
In the article, the researchers propose existence of and describe a spectrum disorder comprising (A) a core anxiety disorder (mostly panic disorder); and four domains: (L) Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising); (P) chronic pain syndromes (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis); (I) Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and (M) Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants) — for which they’ve coined the term “ALPIM syndrome”.
The study examined 76 consecutive outpatients with an anxiety disorder plus at least one somatic condition from three domains. More than 80 percent of the patients had panic attacks, fibromyalgia, and major depressive episodes. Associations were found between joint laxity and bipolar III, headache with bipolar II, and bipolar II with chronic fatigue syndrome. Significant relationships were demonstrated within and between domains, validating ALPIM as a syndrome.
Dr. Coplan acknowledges that the precepts underlying the ALPIM model as a syndrome are not entirely new, insomuch as it embodies significant elements of previously described spectrum disorders. However he maintains that ALPIM’s primary contribution is to add novel elements and groupings in aid of shedding light on how they overlap, such as the study’s documentation of a high prevalence of physical disorders among patients with panic disorder compared to the general population.
For example, the researchers note that joint laxity was observed in 59.3 percent of patients in the study compared with a prevalence of approximately 10 percent to 15 percent in the general population; fibromyalgia was observed in 80.3 percent of the subjects compared with approximately 2.1 percent to 5.7 percent in the general population; and allergic rhinitis was observed in 71.1 percent of subjects, whereas its prevalence is approximately 20 percent in the general population.
“Our argument is that delineations in medicine can be arbitrary and that some disorders that are viewed as multiple disparate and independent conditions may best be viewed as a single spectrum disorder with a common genetic etiology,” says Dr. Coplan. “Patients deserve a more informed scientific understanding of spectrum disorders. The disorders that are part of the ALPIM syndrome may be better understood if viewed as a common entity.”
The journal article is available online at:
The research was supported in part by the National Institute of Mental Health (NIMH-CRC Grant 30906 and NIMH Research Scientist Development Award MH-01039 to Dr. Coplan). Dr. Coplan has received grant support from NIMH, NYSTEM, GlaxoSmithKline, Pfizer, Corcept, and Alexza Pharmaceuticals. However, the content of the published article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, NIMH, or other funders.
SUNY Downstate Medical Center
The Journal Of Neuropsychiatry and Clinical Neurosciences
SUNY Downstate Medical Center