Prevalence and clinical correlates of medical comorbidities in patients with bipolar I disorder: analysis of acute-phase data from a randomized controlled trial.
OBJECTIVE
We studied the relationship between number of medical comorbidities in patients with bipolar I disorder and their demographic and clinical characteristics.


METHODS
Data were from 174 patients in the acute phase of the Pittsburgh Maintenance Therapies in Bipolar Disorder (MTBD) study, a randomized controlled trial comparing Interpersonal and Social Rhythm Therapy to an intensive clinical management approach for individuals with a lifetime diagnosis of bipolar I disorder or schizoaffective disorder, manic type, according to Research Diagnostic Criteria, who were receiving adjunctive protocol-driven pharmacotherapy. Patients entered the MTBD study from 1991 to 2000. We examined the acute-phase Hamilton Rating Scale for Depression (HAM-D) and Bech-Rafaelsen Mania Scale scores, demographics, clinical history, and medical comorbidities.


RESULTS
Patients with a high number of medical comorbidities had longer duration of both lifetime depression (p = .02) and lifetime inpatient depression treatment (p = .04), had higher baseline HAM-D score (p = .01), and were more likely to be treated for a depressed clinical state during the acute phase of the MTBD study (p = .05). Moreover, higher severity of baseline medical comorbidities predicted slower decreases in HAM-D score among depressed (p = .004) and mixed/cycling (p = .003) patients even after controlling for baseline HAM-D score.


CONCLUSIONS
Medical illness is correlated with several indicators of poorer prognosis and outcome in bipolar I disorder. Not only do preventing and treating medical comorbidities in bipolar patients decrease the morbidity and mortality related to physical illness, but they could also enhance psychological well-being and possibly improve the course of bipolar illness. Identification of characteristics in bipolar I patients that are correlated to increased risk for medical comorbidities is a fundamental step in understanding the nature of the relationship between bipolar disorder and medical illness.
Thompson
Wesley K
WK
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15260, USA. wesleyt@pitt.edu
Kupfer
David J
DJ
Fagiolini
Andrea
A
Scott
John A
JA
Frank
Ellen
E
D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D011613:Psychotherapy / Q000379:methods; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D011619:Psychotropic Drugs