Prevalence and Clinical Correlates of Medical Comorbidities in Patients With Bipolar I Disorder: Analysis of Acute-Phase Data From a Randomized Controlled Trial

Wesley K. Thompson, Ph.D.; David J. Kupfer, M.D.; Andrea Fagiolini, M.D.; John A. Scott, A.M.; and Ellen Frank, Ph.D.

Objective: We studied the relationship between number of medical comorbidities in patients with bipolar I disorder and their demographic and clinical characteristics.

Method: Data were from 174 patients in the acute phase of the Pittsburgh Maintenance Therapies in Bipolar Disorder (MTBD) study, a randomized controlled trial comparing Interpersonal and Social Rhythm Therapy to an intensive clinical management approach for individuals with a lifetime diagnosis of bipolar I disorder or schizoaffective disorder, manic type, according to Research Diagnostic Criteria, who were receiving adjunctive protocol-driven pharmacotherapy. Patients entered the MTBD study from 1991 to 2000. We examined the acute-phase Hamilton Rating Scale for Depression (HAM-D) and Bech-Rafaelsen Mania Scale scores, demographics, clinical history, and medical comorbidities.

Results: Patients with a high number of medical comorbidities had longer duration of both lifetime depression (p = .02) and lifetime inpatient depression treatment (p=.04), had higher baseline HAM-D score (p = .01), and were more likely to be treated for a depressed clinical state during the acute phase of the MTBD study (p = .05). Moreover, higher severity of baseline medical comorbidities predicted slower decreases in HAM-D score among depressed (p = .004) and mixed/cycling (p = .003) patients even after controlling for baseline HAM-D score.

Conclusions: Medical illness is correlated with several indicators of poorer prognosis and outcome in bipolar I disorder. Not only do preventing and treating medical comorbidities in bipolar patients decrease the morbidity and mortality related to physical illness, but they could also enhance psychological well-being and possibly improve the course of bipolar illness. Identification of characteristics in bipolar I patients that are correlated to increased risk for medical comorbidities is a fundamental step in understanding the nature of the relationship between bipolar disorder and medical illness.

(J Clin Psychiatry 2006;67:783-788)

Received Aug. 8, 2005; accepted Nov. 28, 2005. From the Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pa.

Supported in part by National Institute of Mental Health grants MH-29618 (Dr. Frank) and MH30915 (Dr. Kupfer), the Bosin Memorial Fund of The Pittsburgh Foundation (Drs. Fagiolini, Frank, and Kupfer), and the Commonwealth of Pennsylvania Department of Health grant ME-02385.

Dr. Kupfer is a consultant for Servier Amerique and has served on the advisory boards of Pfizer, Forest, Hoffmann-La Roche, and Solvay Wyeth. Dr. Fagiolini is a consultant for Pfizer and Bristol-Myers Squibb and has served on the speakers or advisory boards of Pfizer, Bristol-Myers Squibb, Shire, and Eli Lilly Italy. Drs. Thompson, Scott, and Frank report no additional financial or other relationships relevant to the subject matter of this article.

Corresponding author and reprints: Wesley K. Thompson, Ph.D., Department of Psychiatry, University of Pittsburgh School of Medicine, 2706 Cathedral of Learning, Pittsburgh, PA 15260 (e-mail: wesleyt@pitt.edu).