title: Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE).
abstract: OBJECTIVE
  Individuals with bipolar disorder have high rates of other medical comorbidity, which is associated with higher mortality rates and worse course of illness. The present study examined common predictors of medical comorbidity.
  
  
  METHODS
  The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month, randomized comparative effectiveness trial. Baseline assessments included current and lifetime DSM-IV-TR diagnoses, demographic information, psychiatric and medical history, severity of psychiatric symptoms, level of functioning, and a fasting blood draw. Medical comorbidities were categorized into two groups: cardiometabolic (e.g., diabetes, hyperlipidemia, and metabolic syndrome) and non-cardiovascular (e.g., seizures, asthma, and cancer). Additionally, we looked at comorbid substance use (e.g., smoking and drug dependence).
  
  
  RESULTS
  We found that 96.3% of participants had at least one other medical comorbidity. Older age predicted a greater likelihood of having a cardiometabolic condition. Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition, but a greater chance of having other types of medical comorbidity. Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed, less time spent manic/hypomanic, and longer duration of illness. Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides.
  
  
  CONCLUSIONS
  There appears to be a substantial medical burden associated with bipolar disorder, highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients.
authors.affiliation: Bipolar Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.forename: Richard C
authors.initials: RC
authors.lastname: Shelton
authors.forename: David E
authors.initials: DE
authors.lastname: Kemp
authors.forename: Emily E
authors.initials: EE
authors.lastname: Bernstein
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Brody
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.forename: Vivek
authors.initials: V
authors.lastname: Singh
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Noreen A
authors.initials: NA
authors.lastname: Reilly-Harrington
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.forename: Gustavo
authors.initials: G
authors.lastname: Kinrys
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
authors.forename: William V
authors.initials: WV
authors.lastname: Bobo
authors.forename: Masoud
authors.initials: M
authors.lastname: Kamali
authors.forename: Melvin G
authors.initials: MG
authors.lastname: McInnis
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D057186:Comparative Effectiveness Research; D003920:Diabetes Mellitus / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D000069348:Quetiapine Fumarate / Q000627:therapeutic use; D012640:Seizures / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D000069348:Quetiapine Fumarate
keywords: bipolar disorder; medical comorbidity; metabolic syndrome; mood symptoms