Many bipolar patients unaware of co-occurring medical conditions

By Mark Cowen

Co-occurring medical conditions are common among patients with bipolar disorder (BD), but many may not be aware that they have such conditions, say researchers.

The team found that 31% of BD patients excluded from two medication trials just before randomization were rejected because of previously unreported medical conditions. Of these patients, 70% had no prior knowledge of such conditions.

"These findings indicate that co-occurring general medical conditions may be a more serious problem in the treatment of BD than previously appreciated and that more stringent monitoring and guidelines are needed regardless of medication regimen," comment Trisha Suppes (Veterans Affairs Palo Alto Health Care System, California, USA) and colleagues.

The findings come from a study of 78 BD patients recruited from 2009 through 2011 for two medication trials who had passed the phone screen and new-intake visit, signed the informed consent form, and participated in a screening visit.

In total, 32 patients were excluded from these studies immediately prior to randomization, 10 of whom were excluded because of medical conditions.

Most of these patients (n=7) were unaware of the medical condition in question before it was diagnosed during the screening process.

The most common medical conditions in these patients were cardiovascular risk indications (n=5), including hypertension, elevated triglycerides, and abnormal electrocardiogram findings, and endocrinologic abnormalities (n=3), including untreated diabetes, and hypothyroidism.

"This case series supports past findings that patients with BD have high rates of serious or untreated medical conditions and suggests an additional, disturbing trend: many patients with BD are unaware of their general medical conditions," conclude Suppes et al in the Journal of Clinical Psychiatry.

As previous studies have shown that co-occurring medical conditions may have a negative impact on the effectiveness of psychiatric treatment, the researchers add that "regardless of a patient's claim of having no medical conditions, more general medical screening may be needed in outpatient psychiatric settings."

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