Psychiatric Annals

Guest Editorial Free

Facing Chronic Conditions

Theodore A. Stern, MD

As people are living longer, more people are developing and suffering from chronic conditions (both medical and psychiatric). Therefore, it seemed reasonable to devote an issue to chronic conditions, such as drug addiction, heart disease, diabetes, and overweight/obesity issues. The authors, who are clinicians in psychiatry, place chronic conditions in perspective, thereby helping to guide both patients and providers.

The issue begins with a cogent article entitled, “Facing Addiction,” by Dr. Sarah E. Wakeman in which she identifies drug addiction as of one of the largest public health crises of modern times, and notes that drug overdose is the leading cause of death for Americans younger than age 50 years, which accounts for the decline in life expectancy in the United States for the past 2 years. Moreover, Dr. Wakeman highlights that our collective approach to addiction treatment1,2 differs from how we treat other chronic conditions; drug addiction has historically been treated as a social problem rather than a medical matter, and she calls for a shift in our treatment paradigm.

In the next article, “Facing Heart Disease: A Guide for Psychiatric Clinicians,” Dr. Daniel J. Daunis, Jr. and I highlight the comorbidity of psychiatric illness and heart disease. The fundamentals and etiologies of heart disease are reviewed, and treatment strategies (encompassing behavioral techniques, lifestyle interventions, and pharmacological approaches) are discussed.3 The importance of considering the affective, behavioral, and cognitive components of heart disease are elucidated. Additional resources for clinical mental health professionals round out the discussion.4–6

In the third article, “Facing Diabetes: A Guide for Psychiatric Providers,” Dr. Maria C. Prom focuses on how diabetes impacts mental health and in turn how mental illness impacts diabetes.7–9 Armed with this knowledge, patients, family members, and health care providers will be better positioned to facilitate change (eg, enhanced screening, monitoring, and management) to improve quality of life.

In the last article, “Facing Overweight and Obesity: A Guide for Mental Health Professionals,” Dr. Jonathan R. Stevens and I elaborate on the biological, psychological, social and, cultural aspects of overweight and obesity. We enumerate the pharmacological and nonpharmacological approaches to managing weight and lifestyles to create effective change, as has been the focus of additional efforts.10

As the practice of medicine and psychiatry collaborate more closely (eg, with integrated and collaborative care,11,12 and with telepsychiatry13) our collective experience in managing chronic conditions10,13,14 will be increasingly important. It is our sincere hope that these articles on chronic conditions are engaging, informative, and useful to you and to your patients.


  1. Nisavic M, Nejad SH. Patients with substance use disorders. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF, eds. Massachusetts General Hospital Handbook of General Hospital Psychiatry. 7th ed. Philadelphia, PA: Elsevier; 2018:149–160.
  2. Ho P, Rosenheck R. Substance use disorder among current cancer patients: rates and correlates nationally in the Department of Veterans Affairs. Psychosomatics. 2018;59:267–276. doi:. doi:10.1016/j.psym.2018.01.003 [CrossRef]
  3. Nikrahan GR, Suarez L, Asgari K, et al. Positive psychology interventions for patients with heart disease: a preliminary randomized trial. Psychosomatics. 2016;57:348–358. doi:. doi:10.1016/j.psym.2016.03.003 [CrossRef]
  4. Campbell KA, Madva EN, Villegas AC, et al. Non-cardiac chest pain: a review for the consultation-liaison psychiatrist. Psychosomatics. 2017;58:252–265. doi:. doi:10.1016/j.psym.2016.12.003 [CrossRef]
  5. Huffman JC, Adams CN, Celano CM. Collaborative care and related interventions in patients with heart disease: an update and new directions. Psychosomatics. 2018;59:1–18. doi:. doi:10.1016/j.psym.2017.09.003 [CrossRef]
  6. Farquhar JM, Stonerock GL, Blumenthal JA. Treatment of anxiety in patients with coronary disease: a systematic review. Psychosomatics. 2018;59:318–332. doi:. doi:10.1016/j.psym.2018.03.008 [CrossRef]
  7. Golden SH, Shah N, Naqibuddin M, et al. The prevalence and specificity of depression diagnosis in a clinic-based population of adults with type 2 diabetes mellitus. Psychosomatics. 2017;58:28–37. doi:. doi:10.1016/j.psym.2016.08.003 [CrossRef]
  8. Huang C-J, Hsieh H-M, Chiu H-C, et al. Impact of anxiety disorders on mortality for persons with diabetes. Psychosomatics. 2017;58:266–273. doi:. doi:10.1016/j.psym.2016.11.009 [CrossRef]
  9. Tu H-P, Hsieh H-M, Liu T-L, et al. Prevalence of depressive disorder in persons with type 2 diabetes: a national population-based cohort study 2000–2010. Psychosomatics. 2017;58:151–163. doi:10.1016/j.psym.2016.11.007 [CrossRef]
  10. Stanford FC, Stevens JR, Stern TA. Facing Overweight and Obesity: A Complete Guide for Children and Adults. Boston, MA: Massachusetts General Hospital Psychiatry Academy; 2018.
  11. Joseph R, Kester R, O'Brien C, Huang H. The evolving practice of psychiatry in the era of integrated care. Psychosomatics. 2017;58:466–473. doi:. doi:10.1016/j.psym.2017.04.003 [CrossRef]
  12. Uga A, Kulkarni S, Heeramun V, Bottum K. Evaluation of a model of integrated care for patients with chronic medical and psychiatric illness. Psychosomatics. 2017;58:437–440. doi:. doi:10.1016/j.psym.2017.02.007 [CrossRef]
  13. Stern TA, Beach SR, Januzzi JL. Facing Heart Disease: A Guide for Patients and Their Families. Boston, MA: Massachusetts General Hospital Psychiatry Academy; 2018.
  14. Wexler DJ, Celano CM, Stern TA. Facing Diabetes: A Guide for Patients and Their Families. Boston, MA: Massachusetts General Hospital Psychiatry Academy; 2018.
Theodore A. Stern, MD

Theodore A. Stern, MD, is the Ned H. Cassem Professor of Psychiatry, Harvard Medical School; the Chief Emeritus, Avery D. Weisman Psychiatry Consultation Service; the Director, Thomas P. Hackett Center for Scholarship in Psychosomatic Medicine; and the Director, Office for Clinical Careers, Massachusetts General Hospital (MGH).

Address correspondence to Theodore A. Stern, MD, MGH, 55 Fruit Street, WRN 606, Boston, MA 02114; email:

Disclosure: Theodore A. Stern receives a salary from the Academy of Consultation-Liaison Psychiatry for his work as Editor-in-Chief of Psychosomatics; and he receives royalties from the MGH Psychiatry Academy for his work as an editor of textbooks on psychiatry.


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