Medical Comorbidity in Bipolar Disorder: Implications for Functional Outcomes and Health Service Utilization

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Psychiatric Services (Impact Factor: 1.99). 08/2006; 57(8):1140-4. DOI: 10.1176/
Source: PubMed

ABSTRACT This is the first cross-national population-based investigation exploring the prevalence and functional implications of comorbid general medical disorders in bipolar disorder.
Data were extracted from the Canadian Community Health Survey (N = 36,984). Analyses were conducted to ascertain the prevalence and prognostic implications of predetermined comorbid general medical disorders among persons who screened positive for a lifetime manic episode (indicative of a diagnosis of bipolar disorder). Within the subpopulation of people who screened positive for a manic episode, the effect of medical comorbidity on employment, functional role, psychiatric care, and medication use was examined.
When the data were weighted to be representative of the household population of the ten provinces in 2002, an estimated 2.4 percent of respondents screened positive for a lifetime manic episode. Rates of chronic fatigue syndrome, migraine, asthma, chronic bronchitis, multiple chemical sensitivities, hypertension, and gastric ulcer were significantly higher in the bipolar disorder group (all p < .05). Chronic medical disorders were associated with a more severe course of bipolar disorder, increased household and work maladjustment, receipt of disability payments, reduced employment, and more frequent medical service utilization.
Comorbid medical disorders in bipolar disorder are associated with several indices of harmful dysfunction, decrements in functional outcomes, and increased utilization of medical services.

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    • "Furthermore, many people have complex medical questions, and answers are not directly available on health web sites (McCray et al. 1999). Since patients with bipolar disorder frequently take polypharmacy (Baldessarini et al. 2008; Bauer et al. 2013a) and have medical comorbidity (McIntyre et al. 2006), many unique queries would be expected suggesting a need for advanced searching skills. Finally, there are only limited Spanish language web pages in US health web sites (Berland et al. 2001). "
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    ABSTRACT: Adults routinely use the Internet as a source of health information. Patients with bipolar disorder and caregivers should be encouraged to increase their knowledge of this complex illness, including through the Internet. However, patients, caregivers, and physicians should be aware of potential perils when searching the Internet for health information, including loss of privacy, quality of web site content, and Internet scams. This review summarizes these cautionary issues. The digital divide remains and includes a lack of technical skills and competency in searching and appraising web sites, in addition to limited access to the Internet. Physicians should provide patients with a list of trustworthy web sites and a brief printed handout on concerns related to searching the Internet. More studies of the use of the Internet by patients with bipolar disorder are needed.
    10/2013; 1(1). DOI:10.1186/2194-7511-1-22
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    • "Although controlled studies of polypharmacy are increasing , only limited evidence of effectiveness and safety is available to assist the clinician (Lin et al. 2006; Malhi et al. 2012; Beynon et al. 2009; Ghaemi and Ko, 2002). Further complicating drug selection, patients often have comorbid psychiatric and medical illnesses (Kupfer 2005; McIntyre et al. 2006), including those related to psychotropic drug use (McIntyre et al. 2006; Fagiolini et al. 2005). Some drug regimens in this study may appear inconsistent with current guidelines, but we assume that these are the best regimens for the "
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    ABSTRACT: Background The objective of this study is to investigate drug treatment patterns in bipolar disorder using daily data from patients who received treatment as usual. Methods Patients self-reported the drugs taken daily for about 6 months. Daily drug use and drug combinations were determined for each patient, both by the specific drugs and by medication class. The drug load was calculated for all drugs taken within a medication class. Results and discussion Four hundred fifty patients returned a total of 99,895 days of data (mean 222.0 days). The most frequently taken drugs were mood stabilizers. Of the 450 patients, 353 (78.4%) took a stable drug combination for ≥50% of days. The majority of patients were taking polypharmacy, including 75% of those with a stable combination. Only a small number of drugs were commonly taken within each medication class, but there were a large number of unique drug combinations: 52 by medication class and 231 by specific drugs. Eighty percent of patients with a stable combination were taking three or less drugs daily. Patients without a stable combination took drugs but made frequent changes. Taking more than one drug within a medication class greatly increased the drug load. To summarize, (1) patients were more likely to take a mood stabilizer than any other drug; (2) although most patients were taking polypharmacy, there were no predominant drug regimens even among those taking a stable combination; and (3) most patients with a stable combination take a relatively small number of drugs daily. The wide variation in drug regimens and numerous possible drug combinations suggest that more evidence is needed to optimize treatment of bipolar disorder.
    05/2013; 1(1). DOI:10.1186/2194-7511-1-5
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    • "The increased hazard for cardiovascular disease in this group is the result of a clustering of risk factors including, but not limited to, obesity, diabetes, or metabolic syndrome (Stahl et al., 2009). Iatrogenic risk factors are well characterized in this population, notably metabolic disturbances (especially related to some SSRIs, SNRIs, and many SGAs) that subsequently predispose and portend cardiovascular disease (McIntyre et al., 2006c,d). Our hypothesized " innate tendency, " " developmental sequence , " or additive risk was preliminarily tested by investigating the number of cases demonstrating this progression from obesity to other metabolic conditions and hypertension and ultimately to cardiovascular conditions . "
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    ABSTRACT: This study aims to investigate the association between early treatment with psychotropic medications and the development of medical comorbidities in pediatric patients who develop bipolar disorder (BD). Data from the South Carolina Medicaid program covering all medical services and medication prescriptions between January 1996 and December 2005 were used to determine the association between childhood exposure to psychotropic medications (i.e., psychostimulants, antidepressants, and antipsychotics) and the diagnosis of select comorbid medical conditions in 1841 children and adolescents diagnosed with Diagnostic and Statistical Manual IV defined BD. In separate regressions controlling for all psychotropic medications prescribed and all comorbid medical conditions diagnosed prior to the BD, hypertension and cardiovascular disorders were more likely in those prescribed second generation antipsychotics or psychostimulants, whereas obesity/overweight was more likely in those taking serotonin norepinephrine reuptake inhibitor/heterocyclic antidepressants, and asthma was more likely in those taking selective serotonin reuptake inhibitors. Childhood cardiometabolic events appear to be systematically associated with specific classes of psychotropic medications, but no innate, developmental sequencing of cardiometabolic abnormalities was apparent before early adolescence in patients subsequently diagnosed and treated for BD.
    Human Psychopharmacology Clinical and Experimental 10/2011; 26(7):451-9. DOI:10.1002/hup.1227 · 1.85 Impact Factor
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