title: Comorbid medical illness in bipolar disorder.
abstract: BACKGROUND
  Individuals with a mental health disorder appear to be at increased risk of medical illness.
  
  
  OBJECTIVE
  To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.
  
  
  METHODS
  Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.
  
  
  RESULTS
  We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.
  
  
  CONCLUSIONS
  Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Forty
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Ulanova
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jones
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Jones
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Gordon-Smith
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Fraser
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Farmer
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: McGuffin
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Cathryn M
authors.initials: CM
authors.lastname: Lewis
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Hosang
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Margarita
authors.initials: M
authors.lastname: Rivera
authors.affiliation: Liz Forty, PhD, Anna Ulanova, MD, MSc Psych, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Lisa Jones, PhD, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Ian Jones, MRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Katherine Gordon-Smith, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; Christine Fraser, BSc, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Anne Farmer, FRCPsych, PhD, Peter McGuffin, FRCPsych, PhD, Cathryn M. Lewis, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Georgina M. Hosang, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London and Department of Psychology, Goldsmiths University of London, UK; Margarita Rivera, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK and Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Spain; Nick Craddock, FRCPsych, PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Craddock
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D017668:Age of Onset; D001007:Anxiety / Q000503:physiopathology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology; D012307:Risk Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology