High medical illness rates in bipolar disorder

By Mark Cowen

Results from a US study show that more than half of patients with bipolar disorder have a significant burden of comorbid medical illnesses.

Furthermore, an increased burden of medical illnesses was associated with a greater number of mood episodes in patients with bipolar disorder.

The findings come from a study of patients with bipolar I or II disorder who participated in the Lithium Treatment Moderate Dose Use Study.

General medical comorbidity was assessed using the Cumulative Illness Rating Scale, with a score of 4 or higher indicating a clinically significant medical comorbidity burden.

David Kemp (Case Western Reserve University, Cleveland, Ohio) and team found that among the 264 patients with sufficient data for analysis, the prevalence of significant medical comorbidity was 53% (n=139).

Medical comorbidity most commonly affected the musculoskeletal/integumentary (33%), the respiratory (27%), and the endocrinologic/metabolic (25%) systems, and the most common individual conditions were migraine (25%), history of head trauma with loss of consciousness (19%), and hypertension (16%).

The researchers also found that 31% (n=87) of patients were overweight, with a body mass index (BMI) of 25.0-29.9 kg/m², and 38% (n=105) were obese, with a BMI of more than 30.0 kg/m².

Patients with a higher burden of comorbid medical illnesses were more likely to be in a depressive episode at the time of assessment and meet criteria for obsessive-compulsive disorder than those with a lower medical illness burden.

In addition, patients with a higher burden of medical illnesses had typically experienced a greater number of depressive and manic/hypomanic episodes during their lives than those with a lower burden, and were receiving a greater number of psychotropic medications at the time of assessment.

"In this generalizable sample of patients with bipolar I and II disorder, the burden of comorbid medical illnesses is high and appears to influence course of illness and psychotropic medication patterns," conclude Kemp et al.

They add: "These findings highlight the multisystem involvement in bipolar disorder and need for improved understanding of the relationships between psychiatric pathology and medical illnesses."

The findings were presented at the annual meeting of the New Clinical Drug Evaluation Unit in Phoenix, Arizona, USA.

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