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Bipolar disorder linked to risk of premature death from heart disease, respiratory disease, diabetes and stroke


Bipolar disorder appears to increase the risk of early death from medical illnesses, according to a literature review study published in the journal Psychiatric Services.

The researchers comprehensively reviewed 17 studies involving more than 331,000 patients. Evidence suggested that people with bipolar disorder have a higher mortality from natural causes compared to people in the general population of similar age and gender but without mental illness. The various studies indicated that the risk was from 35% to 200% higher. The risk is the same for men and women. The most common conditions leading to premature death were heart disease, respiratory diseases, stroke, and endocrine problems such as diabetes.

People with bipolar disorder tend to have manic phases and depressed phases in their lives. During mania, they might be too wound up to sleep, their thoughts might race, and they might have boundless energy. During depression, they might feel painfully sad, hopeless, and immobilized.

In the past, the higher premature death rate among people with bipolar disorder was attributed to a higher rate of suicide and accidents. More recently, researchers are finding that, while rates of suicides and accidents are indeed greater among those with bipolar disorder compared to the general population, they only partly account for the higher premature death rate. Emerging evidence shows that the majority of early deaths among people with bipolar disorder come from medical conditions.

The possible reasons for this higher risk of premature death are manifold. Many factors could be contributing to poor physical health among people with bipolar disorder. These include unhealthy diet, binge eating, lack of exercise, smoking, substance abuse, social deprivation, living alone, homelessness, lack of access to health services, biased attitudes of health professionals towards people with psychiatric illnesses, failure among psychiatrists to address their patient's medical problems, or delaying medical care because of the overriding need for psychiatric treatment.

Bipolar illness can stress the immune system and the hypothalamic-pituitary axis, a system that controls many body processes. Bipolar disorders also heighten the activity of the sympathetic nervous system, which sets off the fight-or-flight response to stress.

Some new antipsychotic drugs used to successfully treat bipolar disorders are safer and more comfortable for the patient in some ways than previous medications, but can cause weight gain leading to obesity and other metabolic changes that predispose people to type 2 diabetes. Some mood stabilizers also are associated with weight gain and metabolic disorders.

Source: University of Washington, 2009

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