Medical Implications of Bipolar Disorder: Lessening the Physiological Impact
Bipolar disorder, also known as manic depressive illness, is a physically and emotionally debilitating brain disorder which affects an estimated 2 million Americans.1 Bipolar Disorder is characterized by dramatic mood swings that occur within a short period of time with no explicable environmental change. The two stages of Bipolar disorder are mania, marked by increased activity and a euphoric sense, and depression, a sustained feeling of sadness and hopelessness. Bipolar disorder usually presents in the late teens, or early adult hood and 50% of cases have onset prior to the age of 25.2 While one cause of bipolar disorder has not been singled out, scientists believe that there are both contributing genetic and environmental factors. To date there is no cure for Bipolar disorder, and it is an illness that affects someone throughout the course of their life.
Accompanying the psychological ups and downs of the disease are a number of physiological symptoms and illnesses which can have a dramatic negative impact on an individual’s personal, social, and financial life. Bipolar disorder has been associated with an increased prevalence for unhealthy behaviors such as smoking and the use of controlled substances, but has also been linked with a number of medical illnesses. These illnesses include cardiovascular and cerebrovascular disease, endocrine disorders, migraine headaches, and chronic obstructive pulmonary disease.1 In addition to this many sufferers of bipolar disorder experience chronic pain for which there seems to be no medical or physical explanation.
How severe are the medical co-morbidities associated with Bipolar Disorder? They are extremely severe. Recently a judge in the District of Columbia ruled that because of the physical severity of the disorder, and its genetic link it may be categorized as both a physical disability, as well as a mental illness. In addition to this, Wayne Katon, MD from the University of Washington School of Medicine states “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 psychiatrists and primary care physicians should be regularly monitoring the physical status of our patients with chronic mental illness.”1
Proper treatment and early detection can greatly improve the outcome of the disease, and in some instances lessen or prevent the associated physiological co-morbidities. Indicators can assist physicians in determining which patients may need to be screened for this disorder. Family history can be an early flag for the detection of the disease. Bipolar disorder frequently occurs in families, and genetic factors account for 60% of Bipolar disorder cases.3 Physicians should also be aware that people with bipolar disease are more likely to seek professional help when experiencing depression than mania.4 A full family and medical history of the patient should be taken to ensure that there is no misdiagnosis, and an appropriate treatment program should be outlined. The most effective treatment of bipolar disorder often is a combination of mood stabilizing drugs, and psychosocial treatment. A close relationship with the patient is encouraged to get sustained long term treatment and physicians are encouraged to educate suffers to ensure better adherence and outcomes. Effective treatment of bipolar disorder will not eliminate the disease, but can help to control symptoms. In addition to this ongoing medical treatment of bipolar disorder can improve patients overall physical health lessening the impact of associated disease. Taking a holistic approach in treating both the physical and mental components of the disease in a timely and continuous manner leads to the best outcomes and is stressed by Dr. Fleishchhacker who states that “the reintegration of psychiatry and medicine, with an ultimate goal of providing optimal services to this vulnerable patient population, represents the most important challenge for psychiatry today, requiring urgent and comprehensive action from the profession toward achieving an optimal solution.”5
Part four of a multipart series on the link between physical and behavioral health
1. Cassels, C. (2009). Bipolar Disorder Increaes Risk for Premature Death from Medical Illness. Medical News , 3-7.
2. Kessler RC, B. P. (2005). Lifetime prevalence and age of onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry , 593-602.
3. Nurnberger JI, Jr., Foround T. Genetics of bipolar affective disorder. Curr Psychiatry Rep. 2000 Apr; 2(2):147-157
4. RM, H. (2010, Jan 11). Psychiatric Management. Retrieved from Guideline Watch; Practice Guideline for the Treatment of Patients With Bipolar Disorder, 2nd Edition: http://www.psychiatryonline.com/content.aspx?aID=148440
5. Fleischhacker WW, C.-B. M. (2009). Comorbid somatic illnesses in patients with severe mental disorders: clinical, policy, and research challenges. Journal of Clinical Psychiatry , 1191-1192
