PITTSBURGH — Patients with bipolar disorder have an unexpectedly high prevalence of medical comorbidities, based on findings from a study of 175 patients.
These 175 patients, with an average age of 35, had a high prevalence of gastrointestinal, musculoskeletal, genitourinary, and other medical comorbidities, Ellen Frank, Ph.D., said at the Sixth International Conference on Bipolar Disorder.
The rates were “very high for such a young population. It stunned us,” said Dr. Frank, professor of psychiatry and psychology at the University of Pittsburgh, which sponsored the conference.
If physicians focus only on the psychiatric symptoms of patients with bipolar disorder, they “do their patients a disservice because they also have a lot of medical illness … associated with poor psychiatric outcomes,” she told this newspaper.
The Pittsburgh Study of Maintenance Therapies in Bipolar Disorders was designed to assess the efficacy of a psychosocial therapy as an adjunct to pharmacotherapy. But as part of the study, the participants underwent a thorough medical work-up at baseline.
The initial assessment found large numbers of patients with an active medical illness. For example, 59 of the 175 patients (34%) had active gastrointestinal disease; a total of 97 (55%) had a history of gastrointestinal disease, but the condition was not active in all patients.
Active musculoskeletal or joint disease was found in 56 patients (32%), and a total of 131 (75%) had a history of this comorbidity. A substantial fraction also had active genitourinary disease (43 patients, 25%), headaches or migraines (42 patients, 24%), asthma or respiratory disease (41 patients, 23%), and cardiovascular disease (32 patients, 18%). In addition, 58 patients (33%) were obese.
One analysis of the findings assessed the efficacy of maintenance treatment in patients with four or more active comorbidities, compared with those with fewer comorbidities. The analysis showed that, during 2 years of follow-up, patients with four or more active comorbidities were about twice as likely to have a recurrence of bipolar symptoms as were patients with fewer comorbidities, reported Dr. Frank, who is also director of the depression and manic-depression prevention program at the Western Psychiatric Institute and Clinic in Pittsburgh.
In the subgroup of patients with a high number of active, medical comorbidities, intensive clinical management was the superior maintenance therapy. The second psychosocial treatment tested—interpersonal and social rhythm therapy—was more effective for patients with fewer medical comorbidities.
The high prevalence of medical comorbidities seen in this study leads to two additional messages on how to best manage patients: First, “some treatments for bipolar disorder may exacerbate medical symptoms,” Dr. Frank said. “We need to be careful when treating patients who are at risk” for obesity, cardiovascular disease, and other conditions. “Many bipolar disorder drugs have cardiac effects, so physicians have to be aware of these risk factors.”
Since bipolar patients often find it hard to adhere to a healthy diet and exercise plan, they need tools for improving their physical health-related behavior, Dr. Frank said.