Article

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/appi.ps.57.8.1140
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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    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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    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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