scholarly journals Comorbid medical illness in bipolar disorder

2014 ◽  
Vol 205 (6) ◽  
pp. 465-472 ◽  
Author(s):  
Liz Forty ◽  
Anna Ulanova ◽  
Lisa Jones ◽  
Ian Jones ◽  
Katherine Gordon-Smith ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Mental Health Disorder ◽  
Acute Onset ◽  
Medical Illness ◽  
Illness Burden ◽  
Increased Risk ◽  
History Of ◽  
Dsm Iv ◽  
The Uk

BackgroundIndividuals with a mental health disorder appear to be at increased risk of medical illness.AimsTo examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.MethodParticipants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.ResultsWe found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.ConclusionsBipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.Declarations of interestNone.

scholarly journals Dissecting clinical heterogeneity of bipolar disorder using multiple polygenic risk scores

2020 ◽  
Author(s):  
Brandon J. Coombes ◽  
Matej Markota ◽  
J. John Mann ◽  
Colin Colby ◽  
Eli Stahl ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Suicide Attempts ◽  
Risk Scores ◽  
Rapid Cycling ◽  
Clinical Heterogeneity ◽  
Polygenic Risk ◽  
Clinical Observations ◽  
History Of ◽  
Dsm Iv

AbstractBipolar disorder (BD) has high clinical heterogeneity, frequent psychiatric comorbidities, and elevated suicide risk. To determine genetic differences between common clinical sub-phenotypes of BD, we performed a systematic PRS analysis using multiple polygenic risk scores (PRSs) from a range of psychiatric, personality, and lifestyle traits to dissect differences in BD sub-phenotypes in two BD cohorts: the Mayo Clinic BD Biobank (N = 968) and Genetic Association Information Network (N = 1001). Participants were assessed for history of psychosis, early-onset BD, rapid cycling (defined as four or more episodes in a year), and suicide attempts using questionnaires and the Structured Clinical Interview for DSM-IV. In a combined sample of 1969 bipolar cases (45.5% male), those with psychosis had higher PRS for SCZ (OR = 1.3 per S.D.; p = 3e-5) but lower PRSs for anhedonia (OR = 0.87; p = 0.003) and BMI (OR = 0.87; p = 0.003). Rapid cycling cases had higher PRS for ADHD (OR = 1.23; p = 7e-5) and MDD (OR = 1.23; p = 4e-5) and lower BD PRS (OR = 0.8; p = 0.004). Cases with a suicide attempt had higher PRS for MDD (OR = 1.26; p = 1e-6) and anhedonia (OR = 1.22; p = 2e-5) as well as lower PRS for educational attainment (OR = 0.87; p = 0.003). The observed novel PRS associations with sub-phenotypes align with clinical observations such as rapid cycling BD patients having a greater lifetime prevalence of ADHD. Our findings confirm that genetic heterogeneity underlies the clinical heterogeneity of BD and consideration of genetic contribution to psychopathologic components of psychiatric disorders may improve genetic prediction of complex psychiatric disorders.

Scope and Characteristics of Suicide Attempts Among Manic Patients With Bipolar Disorder

Crisis ◽  
2018 ◽  
Vol 39 (6) ◽  
pp. 489-492
Author(s):  
Marnina Swartz-Vanetik ◽  
Mark Zeevin ◽  
Yoram Barak
Keyword(s):  
Bipolar Disorder ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Clinical Severity ◽  
Mixed States ◽  
Retrospective Design ◽  
Raising Awareness ◽  
Increased Risk ◽  
Dsm Iv ◽  
Manic Patients

Abstract. Background: Suicide is often associated with depression in patients suffering from bipolar disorder (BD) and less is known about its relation to mania. Available data suggest that patients in the manic phase of BD may be at risk of suicide. Aim: We characterized suicide attempts in a cohort of patients with BD in manic and mixed phases. Method: We focused on the scope, rate, and characteristics of suicide attempts among BD patients during manic or mixed states. Associations between suicide as well as clinical and sociodemographic variables were analyzed using computerized medical chart data from 209 adult inpatients diagnosed (DSM-IV) as experiencing manic and mixed BD episodes. Results: The rate of recent suicide attempts among BD inpatients with manic and mixed episodes was 10.5%. Married patients had a decreased rate of suicide attempts. Comorbid alcohol or substance abuse were correlated with an increased risk of suicide attempts. Presence of suicidal ideation increased suicide risk while older age was linked to a decrease in the rate of suicide attempts. Limitations: The retrospective design of the study and overrepresentation of the clinical severity of BD were limitations. Conclusion: The rate of suicide attempts in the manic and mixed phases of BD is substantial and calls for raising awareness among psychiatrists.

scholarly journals History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk

2005 ◽  
Vol 7 (6) ◽  
pp. 525-535 ◽  
Author(s):  
Tina R Goldstein ◽  
Boris Birmaher ◽  
David Axelson ◽  
Neal D Ryan ◽  
Michael A Strober ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Pediatric Bipolar Disorder ◽  
Factors Associated ◽  
Increased Risk ◽  
History Of

Obesity is associated with previous suicide attempts in bipolar disorder

2010 ◽  
Vol 22 (2) ◽  
pp. 63-67 ◽  
Author(s):  
Fabiano A. Gomes ◽  
Márcia Kauer-Sant’Anna ◽  
Pedro V. Magalhães ◽  
Felice N. Jacka ◽  
Seetal Dodd ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempt ◽  
Suicide Attempts ◽  
University Hospital ◽  
Comprehensive Management ◽  
History Of ◽  
Axis I ◽  
Dsm Iv ◽  
Bipolar Patients ◽  
The University

Gomes FA, Kauer-Sant’Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha Â, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder.Objective:There is a paucity of data about risk factors for suicide attempts in bipolar disorder. The aim of this study is to examine the association between suicide attempts and obesity in people with bipolar disorder.Methods:Two hundred fifty-five DSM-IV out-patients with bipolar disorder were consecutively recruited from the Bipolar Disorder Program at Hospital das Clínicas de Porto Alegre and the University Hospital at the Universidade Federal de Santa Maria, Brazil. Diagnosis and clinical variables were assessed with Structured Clinical Interview for DSM-IV-axis I (SCID I) and Program structured protocol. History of suicide attempts was obtained from multiple information sources including patients, relatives and review of medical records. Patients with body mass index (BMI) ≥ 30 were classified as obese.Results:Over 30% of the sample was obese and over 50% had a history of suicide attempt. In the multivariate model, obese patients were nearly twice (OR = 1.97, 95% CI: 1.06–3.69, p = 0.03) as likely to have a history of suicide attempt(s).Conclusion:Our results emphasise the relevance of obesity as an associated factor of suicide attempts in bipolar disorder. Obesity may be seen as correlate of severity and as such, must be considered in the comprehensive management of bipolar patients.

Functional impairment and previous suicide attempts in bipolar disorder

2008 ◽  
Vol 20 (6) ◽  
pp. 300-306 ◽  
Author(s):  
Adriane R. Rosa ◽  
Carolina Franco ◽  
Anabel Martínez-Aran ◽  
Jose Sánchez-Moreno ◽  
Manel Salamero ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Functional Impairment ◽  
Degrees Of Freedom ◽  
Suicide Attempts ◽  
Structured Interview ◽  
Psychotic Symptoms ◽  
History Of ◽  
Dsm Iv ◽  
Bipolar Patients

Objective:The aim of the present study was to assess the association between previous suicide attempts and functional impairment among euthymic patients with bipolar disorder (BD).Methods:Seventy-one Diagnostic Statistical Manual IV (DSM-IV) patients with BD and 61 healthy volunteers were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. Patients with (n = 36, 50.7%) and without (n = 35, 49.3%) previous suicide attempts were assessed using the Structured Clinical Interview for DSM-IV-TR (SCID-P). Previous suicide attempts were carefully investigated by means of patient and caregiver interview and by a standard structured interview from the protocol of our BD Program. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment.Results:Euthymic patients with previous suicide attempts showed functional impairment, particularly in occupational (F = 30.39; p = 0.001) and cognitive functioning (F = 18.43; p = 0.001). In addition, family history of psychiatric illness (χ2: 6.49; degrees of freedom (df) = 2;132; p = 0.010), family history of affective disorders (χ2 = 5.57; p = 0.017), psychotic symptoms (χ2 = 5.88; p = 0.014) and axis II comorbidity were associated with previous suicide attempts (χ2 = 5.16; p = 0.021).Conclusion:Bipolar patients with previous suicide attempts had lower overall functioning than patients who did not attempt suicide. Previous suicide attempts were particularly associated with the occupational and cognitive domains of functioning.

scholarly journals Polypharmacy and suicide attempts in bipolar disorder

2006 ◽  
Vol 29 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Fernando Kratz Gazalle ◽  
Pedro Curi Hallal ◽  
Juliana Tramontina ◽  
Adriane Ribeiro Rosa ◽  
Ana Cristina Andreazza ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Outcome Measure ◽  
Age Of Onset ◽  
Main Outcome Measure ◽  
History Of ◽  
Dsm Iv ◽  
Multiple Drugs ◽  
Socioeconomic Data ◽  
Structured Questionnaire

OBJECTIVE: The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. METHOD: One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. RESULTS: Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. CONCLUSIONS: Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.

scholarly journals Gambling problems in bipolar disorder in the UK: Prevalence and distribution

2015 ◽  
Vol 207 (4) ◽  
pp. 328-333 ◽  
Author(s):  
Lisa Jones ◽  
Alice Metcalf ◽  
Katherine Gordon-Smith ◽  
Liz Forty ◽  
Amy Perry ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Problem Gambling ◽  
Severity Index ◽  
Gambling Problems ◽  
Rapid Cycling ◽  
Probable Significance ◽  
History Of ◽  
Gambling Severity ◽  
The Uk

BackgroundNorth American studies show bipolar disorder is associated with elevated rates of problem gambling; however, little is known about rates in the different presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling in people with bipolar disorder in the UK.MethodThe Problem Gambling Severity Index was used to measure gambling problems in 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in people with bipolar disorder than in the general population, and were associated with type 2 disorder (OR = 1.74, P = 0.036), history of suicidal ideation or attempt (OR = 3.44, P = 0.02) and rapid cycling (OR = 2.63, P = 0.008).ConclusionsApproximately 1 in 10 patients with bipolar disorder may be at moderate to severe risk of problem gambling, possibly associated with suicidal behaviour and a rapid cycling course. Elevated rates of gambling problems in type 2 disorder highlight the probable significance of modest but unstable mood disturbance in the development and maintenance of such problems.

scholarly journals Antiepileptic drugs and suicide-related outcomes in bipolar disorder: A descriptive review of published data

2018 ◽  
Vol 8 (3) ◽  
pp. 138-147 ◽  
Author(s):  
Charles F. Caley ◽  
Emily Perriello ◽  
Julia Golden
Keyword(s):  
Bipolar Disorder ◽  
Antiepileptic Drugs ◽  
Suicide Attempts ◽  
Reference Group ◽  
Lithium Treatment ◽  
Reporting Rate ◽  
Published Data ◽  
Suicide Death ◽  
Suicidal Thinking ◽  
Increased Risk

Abstract Introduction: In January 2008 the US Food and Drug Administration issued a warning to healthcare professionals about the potential for an increased risk of suicidal thinking and behavior associated with antiepileptic drugs (AEDs). Given that AEDs are important for treating bipolar disorder (BD), a better understanding of suicide-related events is necessary. Methods: A PubMed search was performed using the following search terms: anticonvulsant OR valpro* OR carbamazepine OR lamotrigine OR oxcarbazepine OR topiramate AND bipolar AND suicid*. The objective was to identify published investigations reporting rate and/or risk data of suicide-related outcomes in BD patients treated with AED monotherapy. Results: The search identified 323 reviewable citations, with 13 of these studies (4.0%) being reviewed. Valproate was studied most often, and lithium treatment was frequently used as a reference group. Carbamazepine and lamotrigine had small treatment exposure durations. Suicide attempts and suicide deaths were studied the most; a few trials investigated suicidal thinking and/or hospitalizations for suicidal behavior. Suicide attempt rates occurred in the following order: no treatment > carbamazepine > valproate > lithium, while suicide death rates were: no treatment > valproate > lithium > carbamazepine. For valproate, the risk of suicide attempts and suicide death appeared higher than lithium, but lower than no treatment. Discussion: Investigating suicide-related events for AEDs in BD is difficult; more data are necessary for valproate, carbamazepine, and lamotrigine. An improved understanding of AED treatment and suicide-related events in BD may help pharmacists become more effective at supporting their patients with BD.

Comorbid Bipolar Disorder and Borderline Personality Disorder and History of Suicide Attempts

2014 ◽  
Vol 28 (3) ◽  
pp. 358-364 ◽  
Author(s):  
Mark Zimmerman ◽  
Jennifer Martinez ◽  
Diane Young ◽  
Iwona Chelminski ◽  
Theresa A. Morgan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
History Of

General medical disorders with psychiatric implications

2015 ◽  
Author(s):  
Erik J. Garcia ◽  
Warren J. Ferguson
Keyword(s):  
Mental Illness ◽  
Psychiatric Symptoms ◽  
The United States ◽  
Prior History ◽  
Medical Illness ◽  
Medical Conditions ◽  
Presenting Symptoms ◽  
Medical Disorders ◽  
Increased Risk ◽  
History Of

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.

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