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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Phillipa on March 9, 2009, at 20:34:30
Interesting as atypical antipsychtics play large role. Phillipa
February 12, 2009 Bipolar disorder appears to increase the risk for premature death due to medical illness, including cardiovascular and cerebrovascular disease, endocrine disorders, and chronic obstructive pulmonary disease.
The first systematic review to examine mortality data in bipolar disorder shows that affected individuals have between a 1.5- and 2-fold increased risk for premature death due to these common medical conditions.
"It appears bipolar disorder is as big a risk factor for premature mortality as smoking. This is a major finding and drives home the message that as psychiatrists we should be regularly monitoring the physical status of our patients with chronic mental illness," principal investigator Wayne Katon, MD, from the University of Washington School of Medicine, in Seattle, said.
With first author Babak Roshanaei-Moghaddam, MD, the study is published in the February issue of Psychiatric Services.
Striking Findings
According to Dr. Katon, several studies have shown a link between major depression and an increased risk for early mortality due to general medical illnesses. Recent evidence from literature reviews in schizophrenia reveals similar results.
In the past, excess deaths associated with bipolar illness were attributed to unnatural causes, such as suicide, homicide, and unintentional injuries. However, a growing body of literature suggests this may account for only a portion of premature mortality in these individuals.
The investigators reviewed 17 studies involving more than 331,000 patients with bipolar disorder, affective psychosis, affective disorder requiring inpatient psychiatric care or treatment with lithium, or schizoaffective disorder.
Compared with age- and sex-matched control samples without mental illness from the general population, mortality ratios for death from natural causes and from specific general medical conditions such as heart disease, stroke, diabetes, and chronic obstructive pulmonary disease were significantly higher.
The investigators point out this finding was particularly striking in larger studies of more than 2500 patients with bipolar disorder.
Vicious Cycle
Although the mechanism is not entirely clear, Dr. Katon said research by his group investigating the link between major depression and conditions such as heart disease, osteoarthritis, and diabetes suggests there may be a bidirectional adverse interaction between chronic mental illness and medical illness.
Having a major mental illness such as bipolar disorder increases the likelihood of developing physical illness through a variety of factors, including poor diet, smoking, lack of exercise, substance abuse, social deprivation, and a lack of medical care, among others.
In addition, he said, the chronic stress inherent in having a major medical illness can affect the hypothalamic-pituitary-adrenal axis, increasing cortisol levels and leading to heightened activity of the sympathetic nervous system, possibly leading to earlier development of medical illness.
Once patients with a mental illness contract a medical illness, it is often a greater challenge for them to manage their condition. With diseases like diabetes, which requires a lot of self-care, poor management can lead to more complications, which in turn can feed back and exacerbate the mental-health condition.
"It really can turn into a vicious cycle," said Dr. Katon.
Role of Atypical Antipsychotics
Another potential contributing factor to physical illness and premature mortality in patients with bipolar disorder has been the introduction of second-generation, or atypical, antipsychotics and mood stabilizers, which are now in widespread use.
Although these agents have fewer adverse effects, including extrapyramidal symptoms, than their first-generation counterparts, they are associated with obesity and metabolic abnormalities that may increase the risk for morbidity and mortality resulting from diabetes and cardiovascular disease, the researchers note.
"So what we've seen in recent years is a beginning of the understanding in the field that mood stabilizers and atypical antipsychotics, although effective in treating mental illness, are bringing new problems to bear.
"This has really gotten people's attention and raised awareness in a way I've never seen before that, as psychiatrists, we need to pay closer attention to our patients' physical health. There's not much point in effectively treating them for their mental-health problems only to watch them die prematurely from their medical diseases," said Dr. Katon.
Attempts to reduce rates of premature mortality in mentally ill patients are under way and include increased training among psychiatry residents about common medical illnesses and the importance of addressing risk factors.
New Models of Care Needed
In addition, he said, new models of care that marry primary-care health services with community mental-health care are currently being developed and tested.
"Psychiatrists are now on the staff of a growing number of medical-specialty clinics, such as centers for diabetes, heart disease, and cancer, and at primary-care centers such as family-medicine practices," Dr. Katon said.
"Mental-health professionals are working side by side with providers who treat medical illnesses. New approaches to healthcare and wellness programs are being tested at a number of places to find effective models for preventing premature deaths associated with bipolar disorder and other mental illnesses," he added.
Dr. Katon discloses that he has received honoraria from Eli Lilly, Pfizer, Forest Laboratories, and Wyeth. He is also on an advisory board for Eli Lilly. Dr. Roshanaei-Moghaddam has disclosed no relevant financial relationships.
Psychiatr Serv. 2009;60:147-156.
Clinical Context
Bipolar spectrum disorders may promote early mortality through a number of mechanisms, as reviewed in the current study. The disease state itself is associated with higher serum cortisol levels and sympathetic activation, both of which may lead to the metabolic syndrome and atherosclerosis. Furthermore, most mood stabilizers are associated with weight gain, and second-generation antipsychotics can also promote diabetes. Finally, patients with severe mental health disorders often receive less attention for their chronic medical conditions, for a variety of reasons.The current study uses a comprehensive literature review to quantify the effect of bipolar spectrum disorders on the risk for death.
Study Highlights
Studies examining bipolar spectrum disorders and mortality data were collected from the MEDLINE database. Bipolar spectrum disorders included bipolar disorder, schizoaffective disorder, affective disorder requiring hospitalization or treatment with lithium, affective psychosis, or any combination of these disorders.
Only English-language studies with data on more than 100 patients were included in the review.
Of 44 studies identified in the initial query, 17 were included in the review. The studies included a total of 331,000 patients.
In one of the larger studies, bipolar and schizoaffective disorders were found to be independent predictors of earlier mortality. This effect was most pronounced in younger patients.
Another study demonstrated that affective psychosis was associated with a 35% increase in the risk for mortality.
There was evidence in 1 trial that the cardiovascular mortality rate was higher in patients with affective psychosis vs control subjects, but rates of revascularization procedures were lower for psychiatric patients.
1 study demonstrated that the risk for death attributable to bipolar disorder was highest in the first year after psychiatric hospitalization, and it declined thereafter.
Overall, bipolar spectrum disorders were associated with an increased risk for death, which varied between 35% and 100%.
Larger studies demonstrated that bipolar spectrum disorders increased the risks for mortality from multiple causes, including mortality related to cardiovascular, respiratory, cerebrovascular, and endocrine causes.
However, bipolar spectrum disorders did not generally increase the risk for cancer death, despite a higher number of cancer risk factors in these patients.
Cardiovascular causes accounted for the most excess deaths associated with bipolar spectrum disorders.
Pearls for Practice
Bipolar spectrum disorders may contribute to a higher risk for mortality because of higher levels of circulating cortisol, increased sympathetic activation, and negative metabolic effects of medications. In addition, patients with severe mental health disorders frequently receive worse care of medical conditions.
In the current study, bipolar spectrum disorders were associated with a higher risk for mortality, particularly death secondary to cardiovascular disease.
Posted by Garnet71 on March 9, 2009, at 23:46:40
In reply to Premature Death From Bipolar Disease, posted by Phillipa on March 9, 2009, at 20:34:30
Thanks for posting that Phillipa. The more medical studies that link mental and physical health, the better for us.
Although there was some depressing stuff in there, I found something positive:
New Models of Care Needed
"In addition, he said, new models of care that marry primary-care health services with community mental-health care are currently being developed and tested.
"Psychiatrists are now on the staff of a growing number of medical-specialty clinics, such as centers for diabetes, heart disease, and cancer, and at primary-care centers such as family-medicine practices," Dr. Katon said.
"Mental-health professionals are working side by side with providers who treat medical illnesses. New approaches to healthcare and wellness programs are being tested at a number of places to find effective models for preventing premature deaths associated with bipolar disorder and other mental illnesses," he added."
Also noted was that people with mental health disorders get crappy medical care. This I can identify with.
But I did notice he disclosed his interest with Eli Lilly..not sure what to think about that.
Posted by Phillipa on March 10, 2009, at 0:10:50
In reply to Re: Premature Death From Bipolar Disease » Phillipa, posted by Garnet71 on March 9, 2009, at 23:46:40
Garnet I think it's both positive and negative. The important message to me anyway is that left untreated I want to add as maybe they should have also is that depression unipolar also untreated leads to medical diseases. Now that's in my opinion only of course!!!! Love Phillipa
Posted by yxibow on March 10, 2009, at 4:31:10
In reply to Premature Death From Bipolar Disease, posted by Phillipa on March 9, 2009, at 20:34:30
I won't put the obvious but the most prominent premature death from any untreated major psychiatric disorder is... well.... one can finish the sentence.
Sorry to be morbid.
-- Jay
Posted by manic666 on March 10, 2009, at 5:48:02
In reply to Re: Premature Death From Bipolar Disease, posted by yxibow on March 10, 2009, at 4:31:10
this tread is a barrel of laughs, NOT
Posted by yxibow on March 10, 2009, at 15:37:46
In reply to Re: Premature Death From Bipolar Disease, posted by manic666 on March 10, 2009, at 5:48:02
> this tread is a barrel of laughs, NOT
No, its serious -- I took what I posted seriously.
I'm sorry if you are not feeling well at this time, perhaps this thread is getting a bit dour.
-- feel better
Jay
Posted by Phillipa on March 10, 2009, at 19:15:55
In reply to Re: Premature Death From Bipolar Disease, posted by manic666 on March 10, 2009, at 5:48:02
Manic why do you feel this way??? Love Phillipa
Posted by yxibow on March 10, 2009, at 21:22:58
In reply to Re: Premature Death From Bipolar Disease » manic666, posted by Phillipa on March 10, 2009, at 19:15:55
> Manic why do you feel this way??? Love Phillipa
Well it would seem sort of obvious, pardon me Jan, that someone with a diagnosis that includes bipolar wouldn't particularly want to read a research article on premature death from their own illness.
I'm not trying to attack you, you understand.
It would be the same for anyone with any other illness -- I mean its enough to go through it without hearing that it will shorten your lifetime. We're given one for whatever random reason in the universe and we should take advantage of it.
-- tidings
Jay
Posted by manic666 on March 11, 2009, at 7:02:01
In reply to Re: Premature Death From Bipolar Disease » Phillipa, posted by yxibow on March 10, 2009, at 21:22:58
its ok i ment it in a matter of fact way. im off to the hospital friday an im in a dilemer the zoloft may have broke though but only in a small way after 8 weeks. or i could just be a little up.now if they ask do i want to change i dont no if to carry on a little longer or swap.my mind could just be playing tricks , you no i dont change an bang down hill, i do change an worse off . we have this dillema every time it screws your head
Posted by Phillipa on March 11, 2009, at 22:31:44
In reply to Re: Premature Death From Bipolar Disease, posted by manic666 on March 11, 2009, at 7:02:01
Manic just home from my pdocs gone all day and as I understand it you are depressed right. As the article notes it also affects really all mental illness. Nothing new there if untreated. manic is a sweetie. Let me know how it went today Manic. Love Phillipa
Posted by linkadge on March 13, 2009, at 21:10:48
In reply to Re: Premature Death From Bipolar Disease » manic666, posted by Phillipa on March 11, 2009, at 22:31:44
The premature death that occurs in psychiatric disorders like bipolar disorder and schizophrenia is due to the negative health effects of antipsychotics and mood stabilizers.
Bipolar patients often gain major weight on theraputic doses of lithium / zyprexa, depakote etc. This is not to mention the effects the medications have on blood sugar, cholesterol, etc.
Linkadge
Posted by Neal on March 16, 2009, at 0:08:42
In reply to Premature Death From Bipolar Disease, posted by Phillipa on March 9, 2009, at 20:34:30
__
The more science finds out about "mental disorders" the more interesting it's getting. I read awhile back that, "Some people are (mentally impaired) all of the day; All of the people are (mentally impaired) some of the day." :) The so-called "normal" doesn't exist, in my opinion.
The newer biographies of famous people routinely say something like, "he suffered from depression", or she, "self-medicated with alcohol", or she, "took to her bed for the next 3 weeks".
There are some folks who don't seem to have a nerve in their body, but when you read their biographies you find something else that's just as "different", whatever "it" is.
__
Posted by Phillipa on March 16, 2009, at 20:03:48
In reply to Premature death is due to medications, posted by linkadge on March 13, 2009, at 21:10:48
link new study can via e-mail to me today now seems that ad's in women up the risks of fatal MI's. Love Phillipa
Posted by yxibow on March 19, 2009, at 19:58:48
In reply to Re: Premature death is due to medications » linkadge, posted by Phillipa on March 16, 2009, at 20:03:48
Mrm.... I guess I will have to agree to disagree... yes, I am concerned as I know I have had rather bad side and -effects- from medication, and what that means for the future.
But nobody can predict the future.
I still stand that its better to be treated than not and have consequences that I won't describe.
-- Jay
Posted by JadeKelly on March 19, 2009, at 22:51:17
In reply to Re: Premature Death From Bipolar Disease » Phillipa, posted by yxibow on March 10, 2009, at 21:22:58
> > Manic why do you feel this way??? Love Phillipa
>
> Well it would seem sort of obvious, pardon me Jan, that someone with a diagnosis that includes bipolar wouldn't particularly want to read a research article on premature death from their own illness.
>
> I'm not trying to attack you, you understand.
>
> It would be the same for anyone with any other illness -- I mean its enough to go through it without hearing that it will shorten your lifetime. We're given one for whatever random reason in the universe and we should take advantage of it.
>
> -- tidings
>
> Jay
DITTO THAT.~Jade
Posted by Phillipa on March 20, 2009, at 20:19:51
In reply to Re: DITTO THAT » yxibow, posted by JadeKelly on March 19, 2009, at 22:51:17
Should let Manic answer for himself but that is not his diagnosis. Love Phillipa
Posted by JadeKelly on March 20, 2009, at 22:38:19
In reply to Re: DITTO THAT, posted by Phillipa on March 20, 2009, at 20:19:51
> Should let Manic answer for himself but that is not his diagnosis. Love Phillipa
Phillipa,
I have much to say about the posting of this "article". I don't need anyone else with Bi-polar to stand up. You know very well my son is bi-polar and has chronic pulmonary disease. One has nothing to do with the other. You changed the title from "Bipolar disorder appears to increase the risk for premature death {{due to medical illness}}" to "Premature Death from Bi-Polar" (changes meaning and is immflamatory) I have the article, do you consider yourself to be chronically ill?
Thyroid disease and Lymes and anxiety and depression? Many, if not most, here are at just as much risk for a premature death as someone who is bipolar, according to the article. How would you feel if I titled a thread "Premature Death from Thyroid Disease!"
In addition, you've lost the meaning here and added the bit about anti-psychotics, again inflammatory and provocative. Its not the meds themselves, but the weight gain that can cause diabetes and heart trouble, as with anyone very overweight.
As for the natural causes related to bi-polar and the spectrum that includes schitzophrenia, and depression:
"Having a major mental illness such as bipolar disorder increases the likelihood of developing physical illness through a variety of factors,
including poor diet, smoking, lack of exercise, substance abuse, social deprivation, and a lack of medical care, among others."Do you see the difference here? Bi-Polar itself does not cause premature death as you titled your thread. Many people that are bi-Polar are not able to care for themselves when they get sick, they may not eat right or be able to hold a job. Many are homeless, so they suffer from the elements. They die from Pneumonia that isn't treated, they die from alcohol poisoning, they die from drug use on the streets.
My son is not going to die "from bi-polar". He's going to die of old age because he gets the best medical care and he's not overweight. He gets exercise, has a roof over his head, and doesnt self medicate in a crack house somewhere.
Please don't change the meaning/wording when quoting a medical article. Some thing are difficult enough to read without added drama.
~Jade
Posted by garnet71 on March 21, 2009, at 13:49:09
In reply to Premature death is due to medications, posted by linkadge on March 13, 2009, at 21:10:48
For anxiety/panic disorder, I think not getting treatment is very detrimental to ones health. I went for years in that fight or flight state--it really damages your body, and I am concerned about future heart problems from living like that for so long. W/o reading study after study, I guess that for anxiety disorders, the benefit of the meds outweigh the risks.
Jade, In reference to your last post, although I can't speak for anyone else, in my opinion, I don't believe it was meant in a harmful way. I think you may be misdirecting anger at the messenger...shooting the messenger.
This study was a study of studies which focused on bipolar disorder; it mentioned the other studies on other mental illness in context and also in a periphial manner. You are providing your son with great support and as you said, he has excellent care and coping mechanisms. Many people don't have adequate treatment and the study is just one small step toward providing those with better treatment.
There is a lot of good news in that article since it implies that medical centers are integrating mental and physical health. It's about time because treating the body seperate from the mind seems silly, at least to me, when illness of both are clearly interrelated. Holistic on the rise is good news, as well as knowing science is paying more attention.
"The current study uses a comprehensive literature review to quantify the effect of bipolar spectrum disorders on the risk for death.
Study Highlights
Studies examining bipolar spectrum disorders and mortality data were collected from the MEDLINE database. Bipolar spectrum disorders included bipolar disorder, schizoaffective disorder, affective disorder requiring hospitalization or treatment with lithium, affective psychosis, or any combination of these disorders."
Posted by desolationrower on March 21, 2009, at 15:03:42
In reply to Re: To Phillipa » Phillipa, posted by JadeKelly on March 20, 2009, at 22:38:19
I think its good to know waht the risk factors are that one has...social anxiety predisposes one to parkinsons, so even if i get to point where i don't need psychiatric meds, i will likely take a small dose of selegiline, to maximise survival of DA neurons and hopefully prevent decline. Of course thinking about something like health harms from social isolation is discouraging so its not always worth reading for me.
-d/r
Posted by metric on March 21, 2009, at 15:57:32
In reply to knowing risks, posted by desolationrower on March 21, 2009, at 15:03:42
> I think its good to know waht the risk factors are that one has...social anxiety predisposes one to parkinsons, so even if i get to point where i don't need psychiatric meds, i will likely take a small dose of selegiline, to maximise survival of DA neurons and hopefully prevent decline. Of course thinking about something like health harms from social isolation is discouraging so its not always worth reading for me.
>
> -d/rShyness is not a known risk factor for developing Parkinson's disease.
Posted by Phillipa on March 21, 2009, at 20:01:02
In reply to Re: Premature death is due to medications, posted by garnet71 on March 21, 2009, at 13:49:09
Garnet isn't it great that finally regular docs and pdocs are working together to give better care. No changes to aritcle . Simply cut and paste from my nursing journal articles sent to me. Had to copy whole thing as last time posted a nursing link no one could open it as you must have either an MD license, RN, or Pharmacist. Holistic like accupunture and massage theraphy is listed in lots of the articles as being very helpful for all mental illnesses. That's was the point of posting study. Education. Earned a few Ceus not many but they add up in case get into nursing hoping. Love Phillipa
Posted by Deputy Racer on March 21, 2009, at 20:46:12
In reply to Re: To Phillipa » Phillipa, posted by JadeKelly on March 20, 2009, at 22:38:19
> In addition, you've lost the meaning here and added the bit about anti-psychotics, again inflammatory and provocative.
>
> Please don't change the meaning/wording when quoting a medical article. Some thing are difficult enough to read without added drama.Please don't post anything which could lead others to feel accused or put down, and please use the Notification button if you feel a post is inappropriate in any way. I notice you've been warned about both behaviors in the past, and that you have been blocked fairly recently for posting inappropriately to this same poster, therefore I am now blocking you for 2 weeks.
If you have any questions regarding the posting policies on this site, please read the FAQ, located at http://www.dr-bob.org/babble/faq.html#civil Follow ups to this action should be directed to the Administration board and should themselves be civil.
Dr Bob has ultimate authority over all administrative issues on this site, and may choose at any time to revise or reverse any action taken by a deputy.
Deputy Racer
Posted by desolationrower on March 21, 2009, at 22:03:25
In reply to Re: knowing risks » desolationrower, posted by metric on March 21, 2009, at 15:57:32
> > I think its good to know waht the risk factors are that one has...social anxiety predisposes one to parkinsons, so even if i get to point where i don't need psychiatric meds, i will likely take a small dose of selegiline, to maximise survival of DA neurons and hopefully prevent decline. Of course thinking about something like health harms from social isolation is discouraging so its not always worth reading for me.
> >
> > -d/r
>
> Shyness is not a known risk factor for developing Parkinson's disease.
>
>its not hard to see how two disorders linked to DA might be related.
Prospective study of phobic anxiety and risk of Parkinson's disease
Anxiety disorders are common in Parkinson's disease (PD). However, the risk of PD among people with anxiety has not been examined in a prospective cohort study. We examined this relation prospectively within the Health Professionals Follow-Up Study, a cohort of US male health professionals. In 1988, anxiety was assessed using the Crown-Crisp phobic anxiety index in 35,815 men without PD, stroke, or cancer at baseline. There were 189 incident cases of PD during 12 years of follow-up. After adjusting for age, smoking, and caffeine intake, the relative risk of PD among men with the highest level of anxiety (Crown-Crisp index scores of 4 and above) was 1.5 (95% CI = 1.0-2.1; P-trend = 0.01) compared to men with the lowest level of anxiety. This positive association persisted after excluding cases of PD with onset in the first 2 years of follow-up. Use of anxiolytic medication was also associated with an elevated risk of PD (RR= 1.6; 95% CI = 0.9-3.1), but adjusting for this potential confounder did not materially affect the association between anxiety and risk of PD. Our results suggest that anxiety is a risk factor for PD. Whether this association is causal or the result of shared underlying biology remains a question. © 2003 Movement Disorder Society
Frequency of social phobia and psychometric properties of the Liebowitz social anxiety scale in Parkinson's diseaseThere are few studies about social anxiety disorder in Parkinson's disease (PD). The objective of this study was to assess its frequency and to explore the psychometric properties of the Liebowitz social anxiety scale (LSAS) in PD. Ninety patients with PD underwent neurologic and psychiatric examination. Psychiatric examination was composed by a structured clinical interview (MINI-Plus) followed by the application of the LSAS, the Hamilton depression rating scale (Ham-D), and the Hamilton anxiety rating scale (Ham-A). Neurologic examination included the MMSE, the UPDRS, the Hoehn-Yahr Scale, and the Schwab-England scale of activities of daily living. Social phobia was diagnosed in 50% of PD patients. The disorder was not associated with any sociodemographic or neurological feature, but was associated to major depression (P = 0.023), generalized anxiety disorder (P = 0.023), and obsessive-compulsive disorder (P = 0.013). The score of LSAS correlated positively with the scores of Ham-D and Ham-A (P < 0.001 for both). A ROC curve analysis of the LSAS suggested that a cutoff score in 41/42 provided the best balance between sensitivity and specificity. This disorder seems to be more common and not just restricted to performance as previously thought. © 2008 Movement Disorder Society
What is the evidence for a premorbid parkinsonian personality: A systematic reviewRigid and introverted personality type has been suggested as possibly associated with risk of Parkinson's disease (PD). However, to be a risk, the measurement of personality must precede the onset of PD, more than simply reported as personality in PD cases. Several reviews have been published examining the literature base for this suggestion; however, the issue of premorbid personality measurement was not emphasized. MEDLINE, EMBASE, and PSYCHINFO databases were searched for existing systematic reviews or meta-analyses, and none were found that fulfilled this criterion. The databases were searched systematically for primary research articles. Articles without robust methodology were excluded based on published quality scoring criteria. No articles met all selection criteria. Four articles met most selection criteria and three of them reported significant differences in personality features said to be present before PD onset and between PD cases and controls. PD cases were more introverted, cautious, socially alert, and tense than controls. Although the instruments used to characterize personality varied widely across studies, the general descriptions of PD patients included nervous, cautious, rigid, and conventional. There do appear to be parkinsonian characteristics, but these studies were all retrospective. To confirm that personality traits precede PD onset and are a risk for this condition, prospective research is required. Even then, the term premorbid is difficult to define due to the unknown latent period before onset of PD. Additional research would involve correlating personality characteristics to activities or changes in the brain. © 2006 Movement Disorder Society
-d/r
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