Question: Are there other health conditions that occur at a higher rate with bipolar disorder?
Dr. Haupt: Yes, and this fact is central to my interest in psychiatry. People with bipolar disorder have higher death rates due to cardiovascular disease compared to the general population. There are many factors that probably contribute to this increased cardiovascular disease rate.
As a group, people with bipolar disorder have higher rates of established cardiovascular risk factors such as obesity, smoking, diabetes, hypertension, and hyperlipidemia (elevations in total cholesterol, low density lipoprotein cholesterol, or triglycerides).
It is not fully understood what accounts for these increases in cardiovascular risk factors. One possible explanation is that people with bipolar disorder may experience reductions in their standard of living once their symptoms begin. This reduced standard of living could result in poorer diet and lifestyle leading to poorer health.
Intertwined with such lifestyle factors is the possibility that genes that predispose people to develop bipolar disorder may also be associated with genes that increase cardiovascular risk.
Another possible factor is the historical split between psychiatry and the rest of medicine. During the deinstitutionalization movement of the 1960s and 1970s, the bulk of psychiatric care shifted from centralized hospitals to scattered community mental health centers. As a result, most psychiatrists have been practicing in relative isolation from the rest of the medical community for more than 30 years.
However, the “elephant(s) in the corner” are the treatments themselves that psychiatrists use to treat bipolar illness. Almost all of the treatments psychiatrists commonly use for bipolar disorder are associated with weight gain. Treatment-related weight gain likely underlies a great deal of the increase in risk factors such as diabetes, hypertension, and dyslipidemia. Moreover, many of these drugs are used in combination with each other, with few good studies to describe the potential ways that these combinations may affect cardiovascular risk factors. Only recently have psychiatrists begun to consider the role of medications when monitoring and managing potential cardiovascular side effects associated with their treatments.
Each of these factors underscores Why Psychiatry is a Branch of Medicine, the title of Sam Guze, MD’s 1992 book that summarized the philosophy he imparted to me and the other doctors he helped train during his career at Washington University.
The good news is that treatment of bipolar disorder has improved dramatically in recent years. Now the biggest task facing doctors and their patients is how to maximize treatment response while minimizing side effects that may shorten the lives of people with bipolar disorder. This challenge forms the core of the ongoing NIMH clinical studies that my lab group is involved in. With the results of these studies, we are able to provide essential information for doctors, patients, and family members to use when considering management options for bipolar disorder and other major mental illnesses.
As a relative or person with bipolar disorder, it is important to consider the potentially increased cardiovascular risk associated with the illness and its treatment. One step is to make sure that your psychiatrist and primary care physician are aware of these issues, and aware that you want to reduce your risk factors. A valuable cardiovascular risk factor resource for patients is the National Institute of Health.
(Note: Visitors interested in the evolution of psychiatric treatment models and Sam Guze’s role in reshaping American psychiatry should read A History of Psychiatry: From the Era of the Asylum to the Age of Prozac by Edward Shorter.)
Keep your questions coming! Send them to firstname.lastname@example.org.
Published On: June 06, 2006
Living With6 Chronic Condition Guidelines to Live By
Facing the challenges5 Rules for Bipolar Relationships