Lifestyle, illness and treatment factors in people with bipolar disorder (BD) may confer additional risk of morbidity and mortality to the increasing rates of obesity, metabolic syndrome, diabetes mellitus and cardiovascular mortality in the general population.The aim of this review is to examine whether the risk of obesity and related morbidity and mortality are raised in BD, and possible contributory effects of lifestyle, illness and treatment factors to this risk.Systematic search of Medline and Cochrane Collaboration for relevant studies followed by a critical review of literature was carried out.Mortality from cardiovascular causes and pulmonary embolism (standardized mortality ratio approximately 2.0), and morbidity from obesity and type 2 diabetes mellitus may be increased in BD compared to the general population. Reduced exercise and poor diet, frequent depressive episodes, comorbidity with substance misuse and poor quality general medical care contribute to the additional risk of these medical problems in people with BD. There is no evidence that patients with BD are more sensitive than other patients to weight gain and medical problems associated with long-term use of psychotropic medication; in fact long-term treatment with lithium, antipsychotics and tricyclic antidepressants may reduce overall mortality. Psychiatrists, general practitioners and other health professionals should work together to systematically assess and manage weight gain and related medical problems to reduce the morbidity and mortality associated with obesity in BD. There is insufficient evidence to associate any of these factors with specific drug treatments. More research is required to understand how BD changes the risk for physical health comorbidity.
"Guidelines have been produced for the treatment of depression using PA as an adjunctive therapy, for example the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom have recommended PA as an intervention for individuals with mild unipolar depression, and individuals with BD who are currently experiencing depressive symptoms (NICE, 2006, 2007). Both the American Psychiatric Association (2004) and NICE (2006) recommend PA to mitigate against weight gain in individuals with severe mental illness or BD, in keeping with calls made by a number of researchers in the field (Basu et al., 2004; Keck & McElroy, 2003; McElroy et al., 2002; Morriss & Mohammed, 2005; Wildes, Marcus, & Fagiolini, 2006). However, it has been recognised that the evidence base underpinning the recommendation of PA to individuals with BD or serious mental illness for mental health benefits is lacking (Barbour, Edenfield, & Blumenthal, 2007; Richardson, Faulkner, et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: ProblemDespite calls for physical activity (PA) to be prescribed to individuals with Bipolar Disorder (BD) as a means of improving physical and mental health there has been no systematic review of the potential health risks and benefits of increased PA for individuals with BD. This paper presents the first such review.Method
Systematic searches of six databases were conducted from database inception until January 2009, using a range of search terms to reflect both PA and BD. Studies were subsequently considered eligible if they reported on quantitative studies investigating the effect of PA upon some aspect of physical or mental health in individuals with BD.ResultsOf the 484 articles retrieved, six studies met the inclusion criteria.DiscussionFew studies have considered how PA may impact on the physical and mental health of people with BD. Nevertheless existing studies do suggest that physical activity interventions may be feasible and have a role in promoting mental health in this population. We discuss methodological, practical and ethical challenges to research in this area, and outline three research questions that future work should seek to address.Conclusions
Research into the efficacy and safety of PA as an intervention in BD is required to support the development of detailed, population-specific guidelines.
Mental Health and Physical Activity 12/2009; 2(2):86–94. DOI:10.1016/j.mhpa.2009.09.001
"There has recently been interest in the prevalence of the 'metabolic syndrome', a cluster of risk factors for the development of type II diabetes mellitus and/or cardiovascular disease (CVD) (Basu et al. 2004; Morriss and Mohammed 2005; Ryan and Thakore 2002; Tirupati and Chua 2007). This interest has largely been driven by concern over the potential that medicines prescribed to treat SMI (in particular second-generation antipsychotics), have to cause or worsen these risks. "
[Show abstract][Hide abstract] ABSTRACT: People with serious mental illness have higher rates of morbidity and mortality from cardiovascular disease. This study describes health practitioners' views on their role and confidence assessing and managing cardiovascular risk. The key findings were of a widespread acknowledgement of the need to undertake systematic risk assessment and offer structured approaches to risk factor management. Barriers of client engagement, lack of good systems and poor information sharing between primary and secondary care providers were identified. Solutions discussed included a collaborative care model or the integration of physical health services, perhaps a general practitioner-led clinic, within the secondary care setting. Whilst there is a need to identify an optimal care model there is an even greater need to take some rather than no action.
Community Mental Health Journal 09/2009; 46(6):531-9. DOI:10.1007/s10597-009-9237-0 · 1.03 Impact Factor
"Aging is accompanied by a loss of muscle mass and by an increase in body fat, which may lead to increased insulin resistance and subsequent metabolic syndrome.30 Moreover, diabetic bipolar patients have been reported to be significantly older than non-diabetic bipolar patients.13,17,31 The prevalence of hyperglycemia was significantly associated with a lower level of education in bipolar patients. "
[Show abstract][Hide abstract] ABSTRACT: Treatment of bipolar patients is often complicated by metabolic abnormalities such as obesity, diabetes, and dyslipidemia. We therefore evaluated the prevalence of these abnormalities and their correlates, in bipolar I patients, at the time of commencement of pharmacological treatment for acute mood episodes.
The study cohort consisted of 184 bipolar I patients hospitalized for treatment of acute mood episodes. Socio-demographic and clinical variables were noted and metabolic parameters, including body mass index, fasting plasma glucose, fasting total cholesterol, and current treatment(s) for diabetes and/or dyslipidemia were measured before initiating medication(s).
Fifty-six (30.4%) subjects met our criteria for obesity; 80 (43.5%) had hyperglycemia, with 8 (4.3%) receiving anti-diabetic medication; and 38 (20.7%) had hypercholesterolemia, with 2 (1.1%) receiving cholesterol-lowering agents. We found that male sex (chi(2)=5.359, p=0.021), depressed or mixed state versus manic state (chi(2)=4.302, p=0.038), and duration of illness (t=2.756, p=0.006) were significantly associated with obesity. Older age (t=3.668, p<0.001), later age of disease onset (t=2.271, p=0.024), and lower level of educational attainment (beta=-0.531, p=0.001) were associated with hyperglycemia.
Our finding that metabolic abnormalities are prevalent when initiating acute pharmacological treatment in bipolar I patients indicates that these factors should be integrated into treatment plans at the onset of disease management.
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