Comorbidities and Mortality in Bipolar Disorder A Swedish National Cohort Study
Casey Crump,Kristina Sundquist,Kristina Sundquist,Marilyn A. Winkleby,Jan Sundquist,Jan Sundquist +5 more
TLDR
Patients with bipolar disorder had increased mortality from cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), influenza or pneumonia, unintentional injuries, and suicide for both women and men and cancer for women only.Abstract:
Importance Bipolar disorder is associated with premature mortality, but the specific causes and underlying pathways are unclear. Objective To examine the physical health effects of bipolar disorder using outpatient and inpatient data for a national population. Design, Setting, and Participants National cohort study of 6 587 036 Swedish adults, including 6618 with bipolar disorder. Main Outcomes and Measures Physical comorbidities diagnosed in any outpatient or inpatient setting nationwide and mortality (January 1, 2003, through December 31, 2009). Results Women and men with bipolar disorder died 9.0 and 8.5 years earlier on average than the rest of the population, respectively. All-cause mortality was increased 2-fold among women (adjusted hazard ratio [aHR], 2.34; 95% CI, 2.16-2.53) and men (aHR, 2.03; 95% CI, 1.85-2.23) with bipolar disorder, compared with the rest of the population. Patients with bipolar disorder had increased mortality from cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), influenza or pneumonia, unintentional injuries, and suicide for both women and men and cancer for women only. Suicide risk was 10-fold among women (aHR, 10.37; 95% CI, 7.36-14.60) and 8-fold among men (aHR, 8.09; 95% CI, 5.98-10.95) with bipolar disorder, compared with the rest of the population. Substance use disorders contributed only modestly to these findings. The association between bipolar disorder and mortality from chronic diseases (ischemic heart disease, diabetes, COPD, or cancer) was weaker among persons with a prior diagnosis of these conditions (aHR, 1.40; 95% CI, 1.26-1.56) than among those without a prior diagnosis (aHR, 2.38; 95% CI, 1.95-2.90; P interaction = .01). Conclusions and Relevance In this large national cohort study, patients with bipolar disorder died prematurely from multiple causes, including cardiovascular disease, diabetes, COPD, influenza or pneumonia, unintentional injuries, and suicide. However, chronic disease mortality among those with more timely medical diagnosis approached that of the general population, suggesting that better provision of primary medical care may effectively reduce premature mortality among persons with bipolar disorder.read more
Citations
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Excess mortality in severe mental disorders: A systematic review and meta-regression.
TL;DR: A systematic review of studies examining excess mortality in people with psychotic disorders and bipolar disorder was conducted in this article , where meta-regression models were used to calculate pooled relative risks (RRs) of all-cause and cause-specific mortality adjusted for study-and population-level covariates.
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Drug safety evaluation of aripiprazole in bipolar disorder
Alessandro Cuomo,Bruno Beccarini Crescenzi,Arianna Goracci,Simone Bolognesi,Nicola Giordano,Rodolfo Rossi,Edvige Facchi,Stephen M Neal,Andrea Fagiolini +8 more
TL;DR: Compared to many other antipsychotics, aripiprazole has a relatively favorable tolerability profile, with a lower risk for weight gain, dyslipidemia, diabetes, and hyperprolactinemia, and a reduced propensity for extrapyramidal side effects and a better cardiovascular safety.
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Evidence-Based Psychotherapies for Bipolar Disorder
TL;DR: A systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder found a strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs.
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Differentially methylated regions in bipolar disorder and suicide.
Marie E. Gaine,Fayaz Seifuddin,Sarven Sabunciyan,Richard S. Lee,Kelly S. Benke,Eric T. Monson,Peter P. Zandi,James B. Potash,Virginia L. Willour +8 more
TL;DR: This comprehensive study provides further support that DNA methylation alterations influence the risk for BD and suicide and identifies an association with several pathways including axonal guidance signaling, calcium signaling, β‐adrenergic signaling, and opioid signaling.
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