Premature Mortality From General Medical Illnesses Among Persons With Bipolar Disorder: A Review

Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 03/2009; 60(2):147-56. DOI: 10.1176/
Source: PubMed


Despite recent evidence that patients with bipolar disorder are at increased risk of premature mortality resulting from general medical disorders, there has been no systematic review of published studies. The authors reviewed the literature to determine whether there is evidence of increased risk of mortality from general medical causes among patients with bipolar spectrum disorders.
MEDLINE was searched from 1959 to 2007 with a focus on bipolar disorder and medical mortality. Published studies in English with more than 100 patients were included.
Seventeen studies were identified involving 331,000 patients with bipolar disorder, affective psychosis, affective disorder severe enough to require inpatient psychiatric care or treatment with lithium, or schizoaffective disorder (that is, bipolar spectrum disorders) meeting the inclusion criteria. Compared with age- and sex-matched control samples without mental illness in the general population, mortality ratios for death from natural causes and from specific general medical conditions, such as cardiovascular, respiratory, cerebrovascular, and endocrine disorders, were significantly higher among patients with bipolar spectrum disorders in most studies. This finding was more consistent in larger studies with more than 2,500 patients with bipolar spectrum disorders. Cumulatively, cardiovascular disorder appeared to be the most consistent cause of excess mortality in larger studies.
The available evidence suggests that bipolar spectrum disorders are associated with increased premature mortality secondary to general medical illnesses. Unhealthy lifestyle, biological factors, adverse pharmacologic effects, and disparities in health care are possible underlying causes for this excess mortality.

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Available from: Babak Roshanaei-Moghaddam, Aug 28, 2015
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    • "The only mental disorder for which cause-specific deaths and YLLs were estimated in GBD was schizophrenia; however, several mental disorders, such as major depression and bipolar disorder, exhibit significant and documented excess-mortality (Roshanaei-Moghaddam & Katon, 2009; Baxter et al. 2011b) (Table 1). There were four disorders for which sufficient evidence of excess all-cause mortality could not be found in the literature (anxiety, childhood behavioural disorders, cannabis dependence and migraine) and therefore excess mortality was not included in the natural history of disease for these disorders. "
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    ABSTRACT: Aims: Mortality-associated burden of disease estimates from the Global Burden of Disease 2010 (GBD 2010) may erroneously lead to the interpretation that premature death in people with mental, neurological and substance use disorders (MNSDs) is inconsequential when evidence shows that people with MNSDs experience a significant reduction in life expectancy. We explore differences between cause-specific and excess mortality of MNSDs estimated by GBD 2010. Methods: GBD 2010 cause-specific death estimates were produced using the International Classification of Diseases death-coding system. Excess mortality (all-cause) was estimated using natural history models. Additional mortality attributed to MNSDs as underlying causes but not captured through GBD 2010 methodology is quantified in the comparative risk assessments. Results: In GBD 2010, MNSDs were estimated to be directly responsible for 840 000 deaths compared with more than 13 million excess deaths using natural history models. Conclusions: Numbers of excess deaths and attributable deaths clearly demonstrate the high degree of mortality associated with these disorders. There is substantial evidence pointing to potential causal pathways for this premature mortality with evidence-based interventions available to address this mortality. The life expectancy gap between persons with MNSDs and the general population is high and should be a focus for health systems reform.
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    • "their life expectancy is reduced by about 10 years due to cardiovascular and metabolic diseases [30]. High body mass index (BMI) impacts negatively on clinical and functional outcomes in BD. "

    No preview · Article · Mar 2014 · Médecine du Sommeil
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    • "Bipolar disorders (BD) are one of the worldwide leading causes of disability, measured in Disability Adjusted Life Years (DALYs), in the 15–44 age group [1]. Indeed, BD are associated with an increased risk of morbidity [2] [3] [4] [5], mortality by suicide [6] [7], as well as somatic diseases [8] and social impairment [9]. However, patients with BD are often unrecognized or misdiagnosed, mainly due to the difficulty differentiating between BD and major depressive disorder (MDD) in depressed patients [10]. "
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    ABSTRACT: This study assessed the psychometric performance of the Mood Disorder Questionnaire (MDQ) and its modified MDQ7 version, to screen for bipolar disorders (BD) in depressive inpatients according to depression severity, number of current axis I psychiatric comorbidities and suicidal behavior disorders. Depressed adult inpatients (n=195) were consecutively enrolled. Psychiatric diagnoses were made using the standardized DSM-IV-TR structured interview MINI 5.0.0 and medical case notes. Depression severity was assessed with the Beck Depression Inventory and the Hamilton Depression Scale. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each MDQ version were evaluated in the whole sample and according to depression severity, current axis I psychiatric comorbidities and suicidal behavior. The occurrence and the number of axis I disorders affected performance of both versions. Among depressed patients with two or more comorbidities, PPV and NPV of the MDQ were 65% and 80%, respectively, and they were respectively 56.2% and 87.9% with MDQ7. Current suicidal behavior disorders also dramatically reduced the PPV of MDQ (from 81.2% to 63.3%) and MDQ7 (from 72.2% to 52.6%) but the NPV remained above 80%. The performance of both versions of the MDQ tended to improve with the severity of depression. The MDQ is not a suitable screening instrument to diagnose BD in subjects with a complex major depressive episode and/or a current history of suicidal behavior. Nevertheless MDQ particularly in its modified version may be useful for ruling out the presence of BD among these complex patients.
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