Multimorbidity in bipolar disorder and undertreatment of cardiovascular disease: a cross sectional study

BMC Medicine

Stewart W Mercer¹  Bruce Guthrie³  Julie Langan²  Gary McLean¹  Daniel Martin²  Daniel J Smith² 

[1] Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK;Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK;Quality, Safety and Informatics Research Group, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK

关键词: Comorbidity;    Medication;    Coronary heart disease;    Bipolar disorder;   

Others  :  855213
DOI  :  10.1186/1741-7015-11-263

 received in 2013-05-15, accepted in 2013-11-29,  发布年份 2013

【 摘 要 】

Background

Individuals with serious mental disorders experience poor physical health, especially increased rates of cardiometabolic morbidity and premature morbidity. Recent evidence suggests that individuals with schizophrenia have numerous comorbid physical conditions that may be under-recorded and undertreated, but to date very few studies have explored this issue for bipolar disorder.

Methods

We conducted a cross-sectional analysis of a dataset of 1,751,841 registered patients within 314 primary care practices in Scotland, UK. Bipolar disorder was identified using Read Codes recorded within electronic medical records. Data on 32 common chronic physical conditions were also assessed. Potential prescribing inequalities were evaluated by analysing prescribing data for coronary heart disease (CHD) and hypertension.

Results

Compared to controls, individuals with bipolar disorder were significantly less likely to have no recorded physical conditions (OR 0.59, 95% CI 0.54 to 0.63) and significantly more likely to have one physical condition (OR 1.27, 95% CI 1.16 to 1.39), two physical conditions (OR 1.45, 95% CI 1.30 to 1.62) and three or more physical conditions (OR 1.44, 95% CI 1.30 to 1.64). People with bipolar disorder also had higher rates of thyroid disorders, chronic kidney disease, chronic pain, chronic obstructive airways disease and diabetes but, surprisingly, lower recorded rates of hypertension and atrial fibrillation. People with bipolar disorder and comorbid CHD or hypertension were significantly more likely to be prescribed no antihypertensive or cholesterol-lowering medications compared to controls, and bipolar individuals with CHD or hypertension were significantly less likely to be on two or more antihypertensive agents.

Conclusions

Individuals with bipolar disorder are similar to individuals with schizophrenia in having a wide range of comorbid and multiple physical health conditions. They are also less likely than controls to have a primary-care record of cardiovascular conditions such as hypertension and atrial fibrillation. Those with a recorded diagnosis of CHD or hypertension were less likely to be treated with cardiovascular medications and were treated less intensively. This study highlights the high physical healthcare needs of people with bipolar disorder, and provides evidence for a systematic under-recognition and undertreatment of cardiovascular disease in this group.

【 授权许可】

   
2013 Smith et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Osby U, Brandt L, Correia N, Ekbom A, Sparén P: Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001, 58:844-850.
• [2]Astrup C, Fossum A, Holboe R: A follow-up of 270 patients with acute affective psychoses. Acta Psychiatr Scand Suppl 1959, 34:1-65.
• [3]Bratfos O, Haug JO: The course of manic-depressive psychosis: a follow up investigation of 215 patients. Acta Psychiatr Scand 1968, 44:89-112.
• [4]Petterson U: Manic-depressive illness: a clinical, social and genetic study. Acta Psychiatr Scand Suppl 1977, 26:91-93.
• [5]Tsuang MT, Woolson RF, Fleming JA: Premature deaths in schizophrenia and affective disorders: an analysis of survival curves and variables affecting the shortened survival. Arch Gen Psychiatry 1980, 37:979-983.
• [6]Weeke A, Vaeth M: Excess mortality of bipolar and unipolar manic-depressive patients. J Affect Disord 1986, 11:227-234.
• [7]Vestergaard P, Aagaard J: Five-year mortality in lithium-treated manic-depressive patients. J Affect Disord 1991, 21:33-38.
• [8]Sharma R, Markar HR: Mortality in affective disorder. J Affect Disord 1994, 31:91-96.
• [9]Høyer EH, Mortensen PB, Olesen AV: Mortality and causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993. Br J Psychiatry 2000, 17:676-682.
• [10]Angst F, Stassen HH, Clayton PJ, Angst J: Mortality of patients with mood disorders: follow-up over 34–38 years. J Affective Disorders 2002, 68:167-181.
• [11]Colton CW, Manderscheid RW: Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2002, 3:A42.
• [12]Laursen TM, Munk-Olsen T, Gasse C: Chronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder. PLoS One 2011, 6:e24597.
• [13]Myles N, Newall HD, Curtis J: Tobacco use before, at and after first-episode psychosis: a systematic meta-analysis. J Clin Psychiatry 2012, 73:468-475.
• [14]Ya-Mei B, Tung-Ping S, Mu-Hong C, Tzeng-Ji C, Wen-Han C: Risk of developing diabetes mellitus and hyperlipidemia among patients with bipolar disorder, major depressive disorder, and schizophrenia: a 10-year nationwide population-based prospective cohort study. J Affect Disord 2013, 150:57-62.
• [15]Smith DJ, Langan J, McLean G, Guthrie B, Mercer S: Schizophrenia is associated with excess multiple physical comorbidities but low levels of cardiovascular disease in primary care: cross-sectional study. BMJ Open 2013, 17:3.
• [16]Mitchell AJ, Lord O, Malone D: Differences in the prescribing of medication for physical disorders in individuals with v. without mental illness: meta-analysis. Brit J Psychiatry 2012, 201:435-443.
• [17]Laursen TM, Munk-Olsen T, Agerbo E, Gasse C, Mortensen PB: Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry 2009, 66:713-720.
• [18]Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012, 380:37-43.
• [19]Carstairs VMR: Deprivation and Health in Scotland. Aberdeen, UK: Aberdeen University Press; 1991.
• [20]Tohen M, Greenfield SF, Weiss RD: The effect of comorbid substance use disorders on the course of bipolar disorder: a review. Harvard Rev Psychiatry 1998, 6:133-141.
• [21]Weinryb RM, Osterberg E, Blomquist L, Hultcrantz R, Krakau I, Asberg M: Psychological factors in irritable bowel syndrome: a population-based study of patients, non-patients and controls. Scandinavian J Gastroenterol 2003, 38:503-510.
• [22]Han SH, Lee OY, Bae SC, Lee SH, Chang YK, Yang SY, Yoon BC, Choi HS, Hahm JS, Lee MH: Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria. J Gastroenterol Hepatol 2006, 21:1687-1692.
• [23]De Hert M, Hudyana H, Dockx L, Bernagie C, Sweers K, Tack J: Second-generation antipsychotics and constipation: a review of the literature. Eur Psychiatry 2011, 26:34-44.
• [24]Crump C, Winkleby MA, Sundquist K, Sundquist J: Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. Am J Psychiatry 2013, 170:324-333.
• [25]De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, Newcomer JW, Uwakwe R, Asai I, Möller HJ, Gautam S, Detraux J, Correll CU: Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011, 10:138-151.
• [26]Holt R: Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management. PCCJ Prac RevIn press
• [27]Mackell JA, Harrison DJ, McDonnell DD: Relationship between preventative physical health care and mental health in individuals with schizophrenia: a survey of caregivers. Ment Health Serv Res 2005, 7:225-228.
• [28]Koranyi E: Morbidity and rate of undiagnosed physical illness in a psychiatric population. Arch Gen Psychiatry 1979, 36:414-419.
• [29]Felker B, Yazell JJ, Short D: Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv 1996, 47:1356-1363.
• [30]Koran LM, Sox HC, Marton KI, Moltzen S, Sox CH, Kraemer HC, Imai K, Kelsey TG, Rose TG Jr, Levin LC, Chandra S: Medical evaluation of psychiatric patients. 1. Results in a state mental health system. Arch Gen Psychiatry 1989, 46:733-734.
• [31]Fleury MJ, Bamvita JM, Tremblay J: Variables associated with general practitioners taking on serious mental disorder patients. BMC Fam Pract 2009, 10:41. BioMed Central Full Text
• [32]Kurdyak PA, Gnam WH: Medication management of depression - the impact of comorbid chronic medical conditions. J Psychosom Res 2004, 57:565-571.
• [33]Callréus T, Agerskov Andersen U, Hallas J, Andersen M: Cardiovascular drugs and the risk of suicide: a nested case–control study. Eur J Clin Pharmacol 2006, 63:591-596.
• [34]Ferrari AJ, Baxter AJ, Whiteford HA: A systematic review of the global distribution and availability of prevalence data for bipolar disorder. J Affect Disord 2011, 134:1-13.
• [35]Johnson J, Horwath E, Weissman M: The validity of major depression with psychotic features based on a community sample. Arch Gen Psychiatry 1991, 48:1075-1081.
• [36]Joseph FG, Martin H, Joyce E: Whiteside: risk for bipolar illness in patients initially hospitalized for unipolar depression. Am J Psychiatry 2001, 158:1265-1270.
• [37]De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S: Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011, 10:52-77.
• [38]Langan J, Mercer SW, Smith DJ: Multimorbidity and mental health: can psychiatry rise to the challenge? Brit J Psychiatry 2013, 202:391-393.
• [39]The King’s Fund: Long-Term Conditions And Mental Health. The Cost Of Co-Morbidities. http://www.kingsfund.org.uk/publications/long-term-conditions-and-mental-health webcite
• [40]Department of Health: No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy For People Of All Ages. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf webcite
• [41]London School of Economics: How Mental Illness Loses Out On The NHS. http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf webcite