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Health Services Research & Development

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2005 HSR&D National Meeting Abstract

1008 — Co-Morbid Medical Conditions in Bipolar Affective Disorder

Author List:
Fenn HH (VAHCS Palo Alto)
Bauer MS (VAHCS Providence)
Evans DR (VAHCS Atlanta)
Altshuler L (VAHCS Los Angeles)
Williford WO (VA Cooperative Study430)
Kilbourne AM (VAHCS Pittsburgh)
Stedman M (MAVERIC, Boston)
Fiore L (MAVERIC, Boston)

Introduction: Prevalence rates for medical conditions among patients with bipolar affective disorder are not well delineated. A literature review over the past 20 years found one study showing the prevalence of diabetes mellitus among hospitalized bipolar patients at a rate 9.9% vs. 3.4% from national norms, two studies on head injuries, and one on cholesterol levels. The impact of co-morbid medical conditions on the functioning of bipolar affective disordered patients across the lifespan has not been studied.

Methods: Between 1/1/97 and 12/31/00, 330 subjects were recruited from 11 VA medical centers as part of Cooperative Study #430. Each had been admitted to an acute psychiatric unit with a diagnosis of bipolar disorder and an acute manic, depressive, or mixed episode. Intake assessment included Structured Clinical Interview for DSM-IV (SCID; First et al, 1996) and a battery of interview and self-report instruments. A structured chart review instrument was used to gather medical history from available VA records for the prior 10 years.

Results: Of 233 charts reviewed, prevalence rates above 10% were found for: current hypothyroidism 10.7% and past hypothyroidism 4.3%, current hyperlipidemias 26.0% and past hyperlipidemias 3.0%, current obesity 16.2%, current hepatitis C 12.0%, current osteoarthritis 11.5 % and past osteoarthritis 3.4%; current diabetes mellitus in 8.54%. Prevalence rates were compared with US population rates and VA patient rates; Medical burden as an independent variable was correlated with functional ratings on SF-36 at baseline. As expected, medical burden was higher in the older groups and physical function as measured by the SF-36 physical component score was lower. An unexpected finding was that the mental component score of the SF-36 remained high in the older groups of bipolar.affective veterans. Speculation is offered as to whether or not this apparent retention of mental function in older bipolars was a cohort effect or a result of adaptation over time in older individuals to the challenges of bipolar affective condition and its deficits.

It is clear that multiple, active medical comorbidities are the rule rather the exception among individuals with bipolar disorder, that this medical burden increases significantly with age, and that it impacts physical HRQOL. These data further indicate that reduced physical HRQOL is not an inevitable correlate of aging, but that attention to medical comorbidities will likely minimize decrements in HRQOL.

Therefore comprehensive screening and integrated treatment of such individuals across medical and mental health sectors is likely to improve both physical and mental HRQOL. The intriguing age-related findings of higher mental HRQOL in older individuals suggest future avenues of investigation. These will ultimately require longitudinal, within-subjects follow up over relatively long periods of time.

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