title: Medical comorbidity in bipolar disorder: re-prioritizing unmet needs.
abstract: OBJECTIVE
  The aim of this review is to synthesize results from extant investigations which report on the co-occurrence of bipolar disorder and medical comorbidity.
  
  
  RESULTS
  We conducted a MEDLINE search of all English-language articles published between January 2004 and November 2006. Most studies report on medical comorbidity in bipolar samples; relatively fewer studies report the reciprocal association. Individuals with bipolar disorder are differentially affected by several 'stress-sensitive' medical disorders notably circulatory disorders, obesity and diabetes mellitus. Neurological disorders (e.g. migraine), respiratory disorders and infectious diseases are also prevalent. Although relatively few studies have scrutinized the co-occurrence of bipolar disorder in medical settings, individuals with epilepsy, multiple sclerosis, migraine and circulatory disorders may have a higher prevalence of bipolar disorder. A clustering of traditional and emerging (e.g. immuno-inflammatory activation) risk factors presage somatic health issues in the bipolar disorder population. Iatrogenic factors and insufficient access to primary, preventive and integrated healthcare systems are also contributory.
  
  
  CONCLUSIONS
  Somatic health issues in individuals with bipolar disorder are ubiquitous, under-recognized and suboptimally treated. Facile screening for risk factors and laboratory abnormalities along with behavioral modification for reducing medical comorbidity are warranted.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. roger.mcintyre@uhn.on.ca
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Soczynska
authors.forename: John L
authors.initials: JL
authors.lastname: Beyer
authors.forename: Hanna O
authors.initials: HO
authors.lastname: Woldeyohannes
authors.forename: Candy W Y
authors.initials: CW
authors.lastname: Law
authors.forename: Andrew
authors.initials: A
authors.lastname: Miranda
authors.forename: Jakub Z
authors.initials: JZ
authors.lastname: Konarski
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
mesh_terms: D001714:Bipolar Disorder / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D009765:Obesity / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D013959:Thyroid Diseases / Q000453:epidemiology