UW News

February 26, 2009

Bipolar disorders linked to risk of early death from natural causes

UW Health Sciences/UW Medicine

Bipolar disorders appear to increase the risk of early death from a medical illness, according to a literature review study by Wayne Katon, UW professor of psychiatry, and Babak Roshanaei-Moghaddam, third-year psychiatry resident.

The researchers 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 percent to 200 percent 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.

In the past, the higher premature death rate among people with bipolar disorder was attributed to a higher rate of suicides and accidents. More recently, Katon said, 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, Katon said, shows that the majority of early deaths among people with bipolar disorder come from medical conditions.

Many factors could be contributing to poor physical health among people with bipolar disorder, according to the researchers. 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.

Biological abnormalities associated with bipolar illness might also be shortening lives, Katon noted. The 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.

The researchers said attempts to reduce premature death in people with bipolar disorder include: providing psychiatrists and other mental health professionals with guidelines and training in monitoring their patients’ basic physical health and teaching them how to advise their patients about smoking cessation, exercise and other preventive measures; teaching new physicians in all specialties how to recognize psychiatric illnesses and to understand the serious health risks associated with mental illness; adding primary care physicians and nurse practitioners to community mental health center staff; and adding mental health practitioners to medical specialty centers.

The researchers’ article, “Premature Mortality from General Medical Illnesses Among Persons with Bipolar Disorder: A Review,” was published in the January issue of the journal Psychiatric Services.