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Comorbid medical illness in bipolar disorder

  • Liz Forty (a1), Anna Ulanova (a1), Lisa Jones (a2), Ian Jones (a1), Katherine Gordon-Smith (a3), Christine Fraser (a1), Anne Farmer (a4), Peter McGuffin (a4), Cathryn M. Lewis (a4), Georgina M. Hosang (a5), Margarita Rivera (a6) and Nick Craddock (a1)...

Abstract

Background

Individuals with a mental health disorder appear to be at increased risk of medical illness.

Aims

To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.

Method

Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.

Results

We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.

Conclusions

Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.

Declarations of interest

None.

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Copyright

Corresponding author

Nick Craddock, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK. Email: craddockn@cf.ac.uk

Footnotes

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Participants at the Birmingham and Cardiff sites were recruited to the Bipolar Disorder Research Network (BDRN). Funding for BDRN was provided by the Stanley Medical Research Institute and the Wellcome Trust. Participants at the London site were recruited to the Bipolar Association Case Control Study (BACCS) (funded by GlaxoSmithKline Research and Development). The Depression Case Control (DeCC) sample was funded by the Medical Research Council. The funding sources had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Footnotes

References

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Comorbid medical illness in bipolar disorder

  • Liz Forty (a1), Anna Ulanova (a1), Lisa Jones (a2), Ian Jones (a1), Katherine Gordon-Smith (a3), Christine Fraser (a1), Anne Farmer (a4), Peter McGuffin (a4), Cathryn M. Lewis (a4), Georgina M. Hosang (a5), Margarita Rivera (a6) and Nick Craddock (a1)...
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eLetters

Re: "Comorbid medical illness in bipolar disorder" Forty, et al. 2014, BJP 205: 465-472.

Dieter Schoepf
12 January 2015

Forty and colleagues investigate whether the presence of physical morbidity in individuals with bipolar disorder is associated with a more severe bipolar illness course that may contribute to the worsening of themortality gap between individuals with bipolar disorder and the general community. Forty et al. claimed this to be the first study on this issue in a United Kingdom clinical sample, i.e. the first study that assesses rates of physical comorbidities in individuals with bipolar disorder and that makes direct comparisons with unipolar and control samples. The studyis done statistically carefully. Whilst the results concerning the self-remembered physical comorbidities over the lifespan in the unipolar sampleand the bipolar sample are clear, we have reservations concerning the composition of the control sample. Specifically, Forty et al. use mixed samples of treatment seeking individuals with unipolar and bipolar disorders that were originally recruited in genetic studies from psychiatric clinics, hospitals, general medical practices and self help groups, as well as from volunteers responding to media advertisements [1].The observed odds of Forty et al. may be falsely calculated as the younger control sample is chosen, at least to a substantial proportion, froma specialized community sample that is neither representative of the general population nor of treatment seeking individuals of the general community. However, the interested reader might want to know that we recently published a paper on this issue [2]. During 1 January 2000 and 30June 2012, 621 individuals with bipolar disorder were admitted to three General Manchester Hospitals. All mental and physical comorbidities with aprevalence > 1% were compared with those of 6210 randomly selected and group-matched hospital controls of the same age and gender, regardless of priority of diagnoses. Comorbidities that increased the risk for hospital-based mortality (but not mortality outside of the hospitals) were identified using multivariate logistic regression analyses. The study was intended to determine which specific mental and physical comorbidities contribute to later in-hospital deaths in individuals with bipolar disorder, and whether the risk factors for hospital-based mortality differfor individuals with bipolar disorder in comparison with hospital controls. In our view our study has the advantage that a more representative and more relevant control sample was used and that the mostrelevant outcome from comorbidity, i.e. mortality was addressed. In partial agreement with Forty et al. we found that the excess comorbidity in individuals with bipolar disorder compared to controls was in particular caused by asthma and type-2 diabetes mellitus (T2DM). In addition, T2DM in individuals with bipolar disorder represented a major risk factor for general hospital-based mortality with excess mortality of acute T2DM, as well as of other diabetic related complications. Our study gives support for an aggressive multidisciplinary approach to identify andtreat T2DM to prevent diabetic, respiratory and vascular complications in all individuals with bipolar disorder.

References

(1) Korszun A, Moskvina V, Brewster S, Craddock N, Ferrero F, Gill M,et al. Familiality of symptom dimensions in depression. Arch Gen Psychiatry 2004; 61:468-474.

(2) Schoepf D, Heun R. Bipolar disorder and comorbidity: Increased prevalence and increased relevance of comorbidity for hospital-based mortality during a 12.5-year observation period in general hospital admissions. Journal of Affective Disorders 2014; 169: 170-178.

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Conflict of interest: None declared

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