Psychiatric and physical comorbidities and their impact on the course of bipolar disorder: A prospective, naturalistic 4-year follow-up study.

Publisher: Wiley-Blackwell Munksgaard Country of Publication: Denmark NLM ID: 100883596 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-5618 (Electronic) Linking ISSN: 13985647 NLM ISO Abbreviation: Bipolar Disord Subsets: MEDLINE

Publication: Copenhagen : Wiley-Blackwell Munksgaard
Original Publication: Copenhagen, Denmark : Munksgaard, 1999-

Bipolar Disorder*/diagnosis ; Bipolar Disorder*/physiopathology ; Cardiovascular Diseases*/epidemiology ; Cardiovascular Diseases*/psychology ; Mental Disorders*/epidemiology ; Mental Disorders*/physiopathology ; Metabolic Diseases*/epidemiology ; Metabolic Diseases*/psychology ; Nervous System Diseases*/epidemiology ; Nervous System Diseases*/psychology ; Thyroid Diseases*/epidemiology ; Thyroid Diseases*/psychology; Adult ; Austria/epidemiology ; Comorbidity ; Female ; Follow-Up Studies ; Humans ; International Classification of Diseases ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Recurrence ; Time

Objectives: The aim of the present study was to increase the available evidence on how physical and psychiatric comorbidities influence the long-term outcome in bipolar I and II disorder.
Methods: We examined the prevalence of comorbid physical (metabolic, cardiovascular, thyroid, and neurological) diseases and psychiatric (neurotic, stress-related, somatoform, and personality) disorders and their impact on the risk of relapse in bipolar disorder. A total of 284 consecutively admitted patients with ICD-10 bipolar I (n=161) and II (n=123) disorder were followed up naturalistically over a period of 4 years.
Results: Globally, 22.0% patients had metabolic, 18.8% cardiovascular, 18.8% thyroid, and 7.6% neurological diseases; 15.5% had neurotic, stress-related, and somatoform disorders; 12.0% had personality disorders; and 52.9% had nicotine dependence. We did not find any effect of comorbid metabolic, cardiovascular or neurological diseases or psychiatric disorders on the relapse risk. However, the presence of thyroid diseases, and especially hypothyroidism, was associated with an increased risk of manic relapse in bipolar disorder I (thyroid disease: hazard ratio [HR]=2.7; P=.003; hypothyroidism: HR=3.7;, P<.001). Among patients with hypothyroidism, higher blood levels of baseline thyroid-stimulating hormone (bTSH) were also associated with an increased risk of manic relapse (HR=1.07 per milli-international units per liter; P=.011), whereas blood levels of free triiodothyronine (fT 3 ) or free thyroxine (fT 4 ) were not found to have an influence.
Conclusions: Our data underline the negative long-term impact of thyroid diseases, and especially hypothyroidism with high blood levels of bTSH, on bipolar disorder with more manic episodes, and the importance of its detection and treatment.
(© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Keywords: bTSH; affective disorders; bipolar disorder; comorbidity; relapse; thyroid diseases

Date Created: 20170526 Date Completed: 20180222 Latest Revision: 20181202

20231215

10.1111/bdi.12495

28544558