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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Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis
TL;DR: Estimates suggest that mental disorders rank among the most substantial causes of death worldwide, and efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.
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Risks of all-cause and suicide mortality in mental disorders: a meta-review.
TL;DR: The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients.
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Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls.
Christoph U. Correll,Marco Solmi,Nicola Veronese,Beatrice Bortolato,Stella Rosson,Paolo Santonastaso,Nita Thapa-Chhetri,Michele Fornaro,Davide Gallicchio,Enrico Collantoni,Giorgio Pigato,Angela Favaro,Francesco Monaco,Cristiano A. Köhler,Davy Vancampfort,Philip B. Ward,Fiona Gaughran,André F. Carvalho,Brendon Stubbs +18 more
TL;DR: This large‐scale meta‐analysis confirms that SMI patients have significantly increased risk of CVD and CVD‐related mortality, and that elevated body mass index, antipsychotic use, andCVD screening and management require urgent clinical attention.
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Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology
Guy M. Goodwin,Peter M. Haddad,I. N. Ferrier,Jeffrey K Aronson,T R H Barnes,Andrea Cipriani,David Coghill,Seena Fazel,John R. Geddes,Heinz Grunze,Emily A. Holmes,Oliver D. Howes,S. Hudson,N. Hunt,Ian Jones,Iain Macmillan,H. McAllister-Williams,D. R. Miklowitz,Richard Morriss,Marcus R. Munafò,Carol Paton,B. J. Saharkian,Kate E. A. Saunders,Julia Sinclair,David Taylor,Eduard Vieta,Allan H. Young +26 more
TL;DR: The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder, and recommend strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment.
Journal ArticleDOI
Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder
Lakshmi N. Yatham,Sidney H. Kennedy,Sagar V. Parikh,Ayal Schaffer,David J. Bond,Benicio N. Frey,Verinder Sharma,Benjamin I. Goldstein,Soham Rej,Serge Beaulieu,Martin Alda,Glenda MacQueen,Roumen Milev,Arun V. Ravindran,Claire O'Donovan,Diane McIntosh,Raymond W. Lam,Gustavo Vazquez,Flávio Kapczinski,Roger S. McIntyre,Jan Marie Kozicky,Shigenobu Kanba,Beny Lafer,Trisha Suppes,Joseph R. Calabrese,Eduard Vieta,Gin S Malhi,Robert M. Post,Michael Berk +28 more
TL;DR: These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments.
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