Gender warns of bipolar I disorder risks

By Lucy Piper, Senior medwireNews Reporter

Researchers have confirmed several features that differ between men and women with bipolar disorder, which may impact on the course and treatment of the condition.

The main difference in their study was that depressive features dominated in women with bipolar disorder, whereas manic features were found to predominate in men.

This difference was reflected in the first episode of illness, which was more often depressive in women but manic in men, and was deemed responsible for a longer delay before correct diagnosis in women versus men, and a higher number of suicide attempts in women.

In addition to having a higher risk for suicide attempts, women with bipolar disorder were also more likely than men with the condition to have eating disorders and specific phobia. By contrast, men were more likely to have high rates of substance abuse, suggests the study published in the Journal of Affective Disorders.

The 461 men and 629 women with bipolar I disorder studied also differed with regard to organic medical comorbidities, with women more likely to suffer from metabolic disorders and men from neurologic conditions and cancer.

The researchers, led by Jean-Michel Azorin (Sainte Marguerite Hospital, Marseille, France), suggest that “the differences in psychiatric comorbidity may to a certain extent account for the differences found in medical comorbidity.”

Indeed, “the higher neurologic comorbidity of bipolar men may be due to their higher comorbidity with substance abuse,” the neurologic complications of which are numerous, they say. In bipolar women, the increased risk for comorbid endocrine and metabolic disorders could be partly explained by their increased prevalence of eating disorders.

“In any event, the differences in medical comorbidity may suggest gender-specific preventive measures,” the team writes.

Seven variables were found to be independently associated with male gender on multivariate analysis. Being single, excessive alcohol use, excessive use of substances other than alcohol, presence of mood-congruent psychotic features, and manic polarity at onset were all significantly increased in men with bipolar disorder whereas depressive and cyclothymic temperament were significantly decreased.

“The study findings are likely to have several clinical implications, particularly with respect to the risks that may be differentially shared by bipolar women and bipolar men,” the researchers conclude.

“These risks are related to misdiagnosis, psychiatric complications and comorbidity issues.”

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