Medical comorbidity and health-related quality of life in bipolar disorder across the adult age span

Adjunct Clinical Associate Professor of Psychiatry Stanford University
Journal of Affective Disorders (Impact Factor: 3.38). 05/2005; 86(1):47-60. DOI: 10.1016/j.jad.2004.12.006
Source: PubMed


Little is known about medical comorbidity or health-related quality of life (HRQOL) in bipolar disorder across the adult age span, especially in public sector patients.
We obtained cross-sectional demographic, clinical, and functional ratings for 330 veterans hospitalized for bipolar disorder with Mini-Mental State score > or = 27 and without active alcohol/substance intoxication or withdrawal, who had had at least 2 prior psychiatric admissions in the last 5 years. Structured medical record review identified current/lifetime comorbid medical conditions. SF-36 Physical (PCS) and Mental (MCS) Component Scores, measured physical and mental HRQOL. Univariate and multivariate analyses addressed main hypotheses that physical and mental function decrease with age with decrements due to increasing medical comorbidity.
PCS decreased (worsened) with age; number of current comorbid medical diagnoses, but not age, explained the decline. Older individuals had higher (better) MCS, even without controlling for medical comorbidity. Multivariate analysis indicated association of MCS with age, current depressed/mixed episode, number of past-year depressive episodes, and current anxiety disorder, but not with medical comorbidity, number of past-year manic episodes, current substance disorder or lifetime comorbidities.
This cross-sectional design studied a predominantly male hospitalized sample who qualified for and consented to subsequent randomized treatment.
Medical comorbidity is associated with lower (worse) physical HRQOL, independent of age. Surprisingly, younger rather than older subjects reported lower mental HRQOL. This appears due in part to more complex psychiatric presentations, and several mechanisms are discussed. Both results suggest that age-specific assessment and treatment may enhance HRQOL outcome.

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    • "The assessment package previously implemented by study investigators was informed by the RE-AIM framework for evaluating implementation of EBPs and includes measures used in routine clinical care [75,76]. Key measures include patient-level outcomes, LG fidelity, organizational factors, and REP, EF, and IF activities [49,77–79]. "
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    ABSTRACT: Background Despite the availability of psychosocial evidence-based practices (EBPs), treatment and outcomes for persons with mental disorders remain suboptimal. Replicating Effective Programs (REP), an effective implementation strategy, still resulted in less than half of sites using an EBP. The primary aim of this cluster randomized trial is to determine, among sites not initially responding to REP, the effect of adaptive implementation strategies that begin with an External Facilitator (EF) or with an External Facilitator plus an Internal Facilitator (IF) on improved EBP use and patient outcomes in 12 months.Methods/DesignThis study employs a sequential multiple assignment randomized trial (SMART) design to build an adaptive implementation strategy. The EBP to be implemented is life goals (LG) for patients with mood disorders across 80 community-based outpatient clinics (N¿=¿1,600 patients) from different U.S. regions. Sites not initially responding to REP (defined as <50% patients receiving ¿3 EBP sessions) will be randomized to receive additional support from an EF or both EF/IF. Additionally, sites randomized to EF and still not responsive will be randomized to continue with EF alone or to receive EF/IF. The EF provides technical expertise in adapting LG in routine practice, whereas the on-site IF has direct reporting relationships to site leadership to support LG use in routine practice. The primary outcome is mental health-related quality of life; secondary outcomes include receipt of LG sessions, mood symptoms, implementation costs, and organizational change.DiscussionThis study design will determine whether an off-site EF alone versus the addition of an on-site IF improves EBP uptake and patient outcomes among sites that do not respond initially to REP. It will also examine the value of delaying the provision of EF/IF for sites that continue to not respond despite EF.Trial identifier: NCT02151331.
    Implementation Science 09/2014; 9(1):132. DOI:10.1186/s13012-014-0132-x · 4.12 Impact Factor
    • "Co-morbid medical disorders are fairly common in bipolar patients; over 80% have at least one active medical problem, while 19-23% have 2 such conditions and 35-40% have 3 or more.[78] When compared to the general population, bipolar patients have more tendency to have from cardiovascular disease, type 2 diabetes mellitus, and other endocrine disorders.[19] "
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    ABSTRACT: Background: Bipolar disorder is a relatively common, long-term, and disabling psychiatric illness that is associated with high levels of functional impairment, morbidity, mortality, and an increased risk of suicide. Psychiatric co-morbidity in bipolar disorder ranges from 57.3% to 74.3%, whereas medical co-morbidity varies from 2.7-70%. Indian scenario in this aspect is not clear. Materials and Methods: The objective was to ascertain the prevalence of physical and psychiatric co-morbidities in patients attending a tertiary care center over a period of 1 year and its relationship with socio-demographic and clinical variables. One hundred and twenty-five case record files were included in the review. OPCRIT software was used for re-establishing the diagnosis of bipolar disorder, which yielded 120 cases. A semi-structured pro-forma, specifically designed for the study, was used to collect the socio-demographic and clinical details. Results: Co-morbid psychiatric disorders were found in 52 (43.3%) of the sample, whereas co-morbid physical illness was present in 77 (64.2%) patients. The most common psychiatric disorder associated was substance use disorder (27.5%), whereas co-morbid cardiovascular disorder was the most frequent physical diagnosis in the sample (20%). Discussion: The prevalence of co-morbid psychiatric disorders in bipolar patients was lower than that reported in western literature. It could be related to retrospective nature of study or reflect true lower prevalence rates. Also, certain disorders such as eating disorders were absent in our sample, and migraine diagnosis was very infrequent.
    Indian Journal of Psychological Medicine 07/2014; 36(3):270-5. DOI:10.4103/0253-7176.135377
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    • "QOL increases if protective factors (e.g., intensive social support by families in traditional Chinese societies) predominate over distressing factors (e.g., cognitive deficits), which may explain the nonsignificant association between QOL and cognitive deficits in this study. Previous studies suggested that age (Fenn et al., 2005) and earlier age at onset (Perlis et al., 2004) contribute to poor QOL, but these findings are not replicated for Chinese patients in this study. "
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    ABSTRACT: Little is known about quality of life (QOL) in Chinese patients with bipolar disorder (BD) in remission (euthymia). This study examined the QOL of such a cohort of BD patients and its demographic, clinical, and cognitive correlates. Forty-seven euthymic BD patients and 47 matched healthy controls formed the study sample. Socio-demographic characteristics, prospective memory, retrospective memory, intelligence quotient, and executive functioning were measured in all participants together with patients' psychopathology ratings. Multivariate analyses revealed that compared to controls, euthymic BD patients had significantly lower satisfaction with physical QOL domain. Only subthreshold depressive symptoms independently contributed to reduced satisfaction with physical and environmental QOL domains, whereas no variable predicted its psychological and social domains. Contrary to findings from Western settings, demographic variables and cognitive deficits had no associations with any QOL domain in euthymic Chinese BD patients. Control of subthreshold depressive symptoms in euthymic BD patients might enhance their QOL.
    Perspectives In Psychiatric Care 05/2013; 50(1). DOI:10.1111/ppc.12024 · 0.65 Impact Factor
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