title: Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder.
abstract: BACKGROUND
  Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated.
  
  
  METHODS
  The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900 outpatients with bipolar disorder who gave informed consent. The relationship of PPFs to the number of medical comorbidities was examined by Mann-Whitney U, Pearson r, and logistic regression.
  
  
  RESULTS
  When examined individually, each of the 6 PPFs associated with an adverse course of bipolar disorder was significantly related to the number of medical comorbidities patients had. When age, gender, and independence of their relationships to each other were controlled for via regression, 3 of the PPFs remained significant (anxiety disorder, childhood abuse, and age of onset), and having 20 or more prior episodes was a strong trend. The number of PPFs was correlated with the number of comorbidities, although the above 3 PPFs show a similar magnitude of relationship.
  
  
  CONCLUSIONS
  A history of childhood adversity, early age of onset of bipolar disorder, and an anxiety comorbidity were independently related to the number of medical comorbidities that patients experienced as adults. While the nature and mechanisms of this linkage remain to be further explored, the findings indicate the need for greater attention to and treatment of these 3 PPFs in hopes of ameliorating both the adverse course of bipolar illness and the burden of medical comorbidities with which they are associated.
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, United States. Electronic address: robert.post@speakeasy.net.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.affiliation: UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, United States.
authors.forename: Lori
authors.initials: L
authors.lastname: Altshuler
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, United States.
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Leverich
authors.affiliation: Mayo Clinic, Rochester, MI, United States.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States; Palo Alto Health Care System, Palo Alto, CA, United States.
authors.forename: Trish
authors.initials: T
authors.lastname: Suppes
authors.affiliation: Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.affiliation: Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.affiliation: Universitair Medisch Centrum Groningen (UMCG), Groningen, the Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
authors.affiliation: VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Kupka
authors.affiliation: Newcastle University, Institute of Neuroscience, Newcastle upon the Tyne, UK.
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, United States.
authors.forename: Mike
authors.initials: M
authors.lastname: Rowe
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011379:Prognosis; D012044:Regression Analysis; D012737:Sex Factors; D011795:Surveys and Questionnaires