Bipolar Disorder: Keys to Reducing the Burden— and Improving Quality of Life

Type in “famous people with bipolar disorder” on Google, and you’ll instantly get 130,000 or so “hits” with Web sites that focus on the rich and famous—some living, others long dead—who have suffered from this psychiatric illness. Some of those Web sites offer the names of celebrities (arranged by birthday) who have publicly divulged that they have bipolar disorder. Other Web sites divide the lists of famous sufferers by category. . . writers (eg, William Faulkner, F. Scott Fitzgerald), composers and musicians (Tchaikovsky, Cole Porter), poets (Samuel Taylor Coleridge, T. S. Eliot), artists (Paul Gaugin, Vincent van Gogh). Moreover, if you log on to such sites as http://www.pendulum.org/information/information_famous.html, you’ll find more than just the names of people with bipolar disorder: next to many of those names is a letter indicating whether that person was admitted to an asylum or psychiatric hospital, or whether he or she attempted or committed suicide as a result of his or her illness. More common than we thought. What is startiling about the enormous amount of information available online about bipolar illness is that until only very recently, this debilitating lifelong illness was thought to be relatively rare. We have learned, however, that bipolar illness is far more prevalent than many clinicians realize. As recently as a few years ago, it was thought that no more than 1% of the general population was affected. New data provide convincing evidence that between 2.6% and 7.8% of American adults suffer from bipolar spectrum disorders.1 A devastating disease. Depression tends to be more severe in persons with bipolar disorder than in those with unipolar depression. Not surprisingly, bipolar depression is associated with more frequent hospital visits and marked psychosocial dysfunction. In addition, there is a high prevalence of psychiatric comorbidities in persons with bipolar disorder. One study found that most patients with bipolar I disorder had a coexisting anxiety disorder (Figure 1).2  In addition, nearly three quarters of the patients in that study were substance abusers, and more than half were dependent on alcohol. Figure 1 – The percentage of patients with bipolar disorder who have other psychiatric disorders is quite high. Anxiety disorders are an especially common psychiatric comorbidity; more than 90% of patients with bipolar I disorder also suffer from an anxiety disorder And psychiatric comorbidities are only part of the burden. Bipolar disorder is also frequently associated with physical disease. Beyer and colleagues3  used a clinical database from Duke University Medical Center to assess the presence of medical illnesses in 1379 patients with bipolar disorder. As Figure 2 shows, slightly less than half of patients had at least 1 comorbid illness. Fully 18% of the remainder had at least 2 medical comorbidities. There is also considerable and compelling evidence of the debilitating—and often devastating—consequences that bipolar disorder can exact. For example, in one study of over 15,000 patients with a hospital diagnosis of bipolar disorder who were observed for a mean of 10 years, standardized mortality ratios for suicide were 15 for the men and 22 for the women (see Figure 1).4  Another study showed a significant association between bipolar disorder and marked psychosocial impairment—relationship problems, interpersonal conflicts, marital discord, school or occupational dysfunction, financial problems, and alcohol and substance abuse.5 Goals for primary care practitioners. Given the magnitude of the impact of bipolar disorder, early diagnosis and proper treatment remain important goals. Nevertheless, the disorder frequently goes unrecognized—and therefore untreated or inappropriately treated—for long periods. In fact, in many patients, the correct diagnosis is delayed by 10 years or more.5  The vague nature of the symptoms, coupled with the presence of psychiatric comorbidities, frequently clouds the diagnosis. Typically, patients present with depression, yet they respond poorly to antidepressant monotherapy and may even become manic or hypomanic as a result. Thus, accurate diagnosis is crucial, since appropriate treatment can greatly improve the quality of life for affected patients, as the information in the following pages attests. A substantial number of epidemiologic studies offer evidence that patients with bipolar disorder commonly seek help from their primary care physicians. With the goal of providing practitioners with information about the impact and possible consequences of bipolar disorder and the need to diagnose and treat it appropriately, CME LLC has launched the Lifelong Learning Initiative on Bipolar Disorder. This comprehensive program of educational events involves a distinguished faculty. It includes a series of print publications—of which this is the second—on various aspects of bipolar disorder, including cost-effective management, keys to diagnosis, and treatment strategies. In the current supplement, Mark A. Frye, MD, assistant professor of psychiatry at the University of California at Los Angeles, discusses the importance of focusing on quality-of-life outcomes in patients with bipolar disorder. J. Sloan Manning, MD, a family practitioner in Greensboro, North Carolina, offers practical and useful strategies that can optimize treatment and help you reduce the burden of patient suffering. REFERENCES: 1. Tohen M, Angst J. In: Tsuang MT, Tohen M, eds. Textbook of Psychiatric Epidemiology. New York: Wiley-Liss; 2002:427-444. 2. Kessler RC, Rubinow DR, Holmes C, et al. The epidemiology of DSM-III-R bipolar I disorder in a general population survey. Psychol Med. 1997;27:1079-1089. 3. Beyer J, Kuchibhatla M, Gersing K, Krishnan KR. Medical comorbidity in a bipolar outpatient clinical population. Neuropsychopharmacology. 2005;30:401-404. 4. Osby U, Brandt L, Correia N, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58:844-850. 5. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manicdepressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64:161-174.