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: 2.41). 08/2006; 57(8):1140-4. DOI: 10.1176/
Source: PubMed


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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    • "Given these findings, the relationship between these two conditions deserves further investigation. However, most studies to date have been cross-sectional (Calabrese et al., 2003, Goodwin et al., 2003, Hirschfeld et al., 2003, Beyer et al., 2005, McIntyre et al., 2006, Jerrell et al., 2010, Castilla-Puentes et al., 2011) and/or reliant on questionnaires or self-report for ascertaining one or both of the conditions (Calabrese et al., 2003, Hirschfeld et al., 2003, Castilla-Puentes et al., 2011). In the study described here, we used a nationwide, populationbased dataset in Taiwan, with physician diagnoses, to investigate the association between asthma and bipolar disorder and to test if there was any further association between prednisone use and bipolar disorder in asthma cases. "
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    ABSTRACT: Background The relationship between asthma and bipolar disorder has received little research. We sought to investigate this in a large national sample. Previous studies have found mood changes after prednisone use in asthma patients, and we therefore also investigated this exposure in relation to bipolar disorder. Methods Cases were identified from Taiwan׳s National Health Insurance Research Database with a new primary diagnosis of asthma (ICD-9:493) between 2000 and 2007. Case status required the presence of any inpatient diagnosis of asthma and/or at least one year diagnosis of asthma in outpatient service. These 46,558 cases were compared to 46,558 sex-, age-, residence- and insurance premium-matched controls and both groups were followed until the end of 2008 for first diagnosis of bipolar disorder (ICD-9 codes 296.0 to 296.16, 296.4 to 296.81 and 296.89). Competing risk adjusted Cox regression analyses were applied, adjusting for sex, age, residence, insurance premium, prednisone, hyperthyroidism, COPD (chronic obstructive pulmonary disease), Charlson comorbidity index, and hospital admission days for any disorder. Results Of the 93,116 subjects, 161 were ascertained as having bipolar disorder during a mean (SD) follow-up period of 5.7 (2.2) years. Asthma was an independent risk for bipolar disorder in the fully adjusted model. Higher daily dose of prednisone was a risk factor in asthma cases. Limitations The severity of asthma and bipolar disorder, and the route/duration of prednisone treatment were not evaluated. Conclusions Asthma was associated with increased risk of bipolar disorder. Higher daily dose of prednisone was associated with a further increased risk.
    Journal of Affective Disorders 10/2014; 168:30–36. DOI:10.1016/j.jad.2014.06.033 · 3.38 Impact Factor
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    • "Patients with bipolar disorder (BD) were reported to present higher physical morbidity and mortality than the general population (McIntyre et al., 2006). The relationship between affective Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: Conclusion: MD and AAD were highly represented in our sample, while cancer and neoplastic diseases were uncommon. The clinical correlates of different sub-groups of GMC suggest different interpretations. The presence of MD seems to be correlated with the progression of BD and the chronic medication exposure, while comorbid AAD seems to correlate with a specific clinical subtype of BD, characterized by mood reactivity and temperamental mood instability. If the link with autoimmune-allergic diathesis will be confirmed, it could provide an interesting new paradigm for the study of the "systemic" nature of mood disorders and a promising target for future treatment options.
    Journal of Affective Disorders 09/2014; 170(2015):95-103. DOI:10.1016/j.jad.2014.08.052 · 3.38 Impact Factor
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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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