Background: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent, progressive condition often associated with psychiatric comorbidities such as depression and anxiety, which negatively affect disease progression, treatment adherence, and quality of life. Methods: A narrative review was conducted by searching PubMed and Google Scholar for English-language publications from January 2015 to July 2025. This type of review was selected to allow for a broad and integrative analysis of the current evidence on the association between COPD and psychiatric comorbidities, particularly depression and anxiety. To increase comprehensiveness, the reference lists of the included articles and systematic reviews were manually screened, and data extraction and evaluation were conducted independently by two reviewers. Results: Reported prevalence rates vary widely in COPD patients with depression ranging from 10 to 57% and anxiety from 7 to 50%, largely due to differences in patient populations, diagnostic tools, and disease severity. Identified risk factors include female gender, social isolation, smoking, low BMI, comorbidities, and systemic inflammation. These comorbidities are associated with increased exacerbations, higher hospitalization rates, and poorer clinical outcomes. While inhaled therapies may have limited impact on psychiatric symptoms, antidepressants must be used cautiously. Non-pharmacological interventions, including pulmonary rehabilitation, cognitive-behavioral therapy, physical activity, and social support, demonstrate clear benefits. Conclusions: Effective management of COPD requires integrated approaches that address both pulmonary and psychiatric components. Tailored interventions can improve clinical outcomes and quality of life. This review explores the bidirectional relationship between COPD and psychiatric disorders, aiming to highlight risk factors, diagnostic tools, and both pharmacological and non-pharmacological treatment strategies.

Background/Objectives: In chronic obstructive pulmonary disease (COPD), forced expiratory volume in one second (FEV₁) explains only part of the variability in symptoms and prognosis, while anxiety and depression are common but rarely quantified in composite indices. We aimed to develop and internally validate an Integrated Pulmonary Severity Score (IPSS) that combines respiratory function, symptom burden and affective status. Methods: In a prospective observational study, 390 adults with spirometry-confirmed COPD were consecutively enrolled at two tertiary Romanian centres (October 2022–September 2024). Within 48 h of admission, patients underwent spirometry (FEV₁% predicted), dyspnoea grading (mMRC), symptom assessment (CAT), affective evaluation (HADS-Anxiety/Depression) and cognitive screening (MoCA, MMSE). A PulmoScore was built from CAT, mMRC and ventilatory deficit (100 − FEV₁%) and extended with a HADS-based psychiatric multiplier to obtain IPSS. Spectral clustering, logistic regression, a multilayer perceptron (MLP) and LIME were used for phenotyping and validation. Results: Spectral clustering identified two phenotypes—psycho-respiratory and predominantly respiratory—with acceptable separation (silhouette coefficient 0.26). The psycho-respiratory group showed lower FEV₁%, higher CAT and mMRC scores, more severe anxiety–depression and markedly higher IPSS values. Logistic regression and the MLP achieved an accuracy of 0.89, an AUC of 0.95 and Cohen’s κ ≥ 0.75 for identifying this phenotype when using the same core clinical variables that informed phenotyping and IPSS construction. IPSS values were distributed across four strata (<30, 30–69, 70–119, ≥120 points), reflecting progressively worse respiratory and affective burden. Conclusions: In this cohort, IPSS captured a clinically meaningful psycho-respiratory phenotype and improved integrated severity assessment beyond spirometry alone, with potential utility for risk stratification. It can be computed from routine measures, is compatible with explainable AI workflows and warrants external, longitudinal validation before widespread implementation.