Medical Comorbidities in 181 Patients With Bipolar Disorder vs. Schizophrenia and Related Psychotic Disorders: Findings From a Single-Center, Retrospective Study From an Acute Inpatients Psychiatric Unit

Abstract

Introduction: Medical comorbidities (MCs) represent a significant burden in terms of more frequent hospitalizations and overall lower life expectancy among people with severe mental disorders, such as schizophrenia and related psychotic disorders (SZ) and bipolar disorder (BD). The present article aims to compare the prevalence of MCs and to examine the associated characteristics as marital status, job occupation, level of education, and living arrangements, between BD and SZ patients.Methods: One-hundred-eight-one patients with MCs (85/47% had BD and 96/53% had SZ) were recruited retrospectively from the Acute Inpatients Psychiatry Unit of Policlinico Tor Vergata, Rome, between January-2017 and December-2020. MCs were: cardiovascular diseases (CVD), bacterial infections, mycoses, viral diseases, neoplasms, musculoskeletal, respiratory tract, urological and male genital, gynecological, neurological, gastrointestinal, metabolic syndrome, nutritional, and metabolic diseases.Results: BD had more MC than SZ (36.2 vs. 28.2%, respectively, p = 0.04). CVD and metabolic MC were more common among BD (51.8 vs.34.4%; 51.8 vs.35.3%; p = 0.018; p = 0.039; respectively), while viral diseases were more frequent in SZ (13.5 vs.3.5%, p = 0.035). Hypertension was common in both psychiatric illnesses (81.8% BD vs. 65.6% SZ, p = 0.18). Obesity was the most frequent metabolic disease in both BD and SZ (75% BD vs. 73.5% SZ, p = 0.91), followed by diabetes mellitus (52.3% BD vs. 55.9% SZ, p = 0.93), metabolic syndrome (54.5% BD vs. 47.1% SZ, p = 0.67) and dysthyroidism (47.7% BD vs. 25.7% SZ, p = 0.093). After performing a binary logistic regression analysis, only two MCs showed a statistically significant association: patients with SZ had an OR of 2.01 [CI 95% (1.00–4.01)] for CVD compared to BD; on the other hand, patients with BD had an OR of 16.57 [CI 95% (3.58–76.77)] for gynecological diseases compared to SZ patients.Conclusions: MCs are common among people with severe mental illness, especially CVD and metabolic diseases, highlighting the need for a more collaborative relationship between general medical providers and psychiatrists.

Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study

“…Incidentally, individuals with severe mental illnesses, represented by schizophrenia, have a higher prevalence of comorbidities, such as obesity, hypertension, diabetes mellitus, and metabolic syndrome [ 6 ]. Appendicitis is one of the most common abdominal emergencies and one of the most frequent indications for emergency surgery [ 7 ].…”

Advances in the pathophysiology of bipolar disorder

“…Current knowledge about the BD's pathophysiology discussed above indicates that [1] genetic and environmental factors, [2] mitochondria dysfunction and inflammation, and [3] HPA axis and circadian rhythm alterations are related to the development and progression of this disease. However, regardless of which of the mechanisms described above plays a primary or secondary role in the pathophysiology of BD, we suggest that all of these interact to form a deadly downward spiral.…”

“…All three types involve clear changes in mood, energy, and activity levels [1]. Systemically, BD is not only associated with strong individual suffering and increased probability of suicide but also with physical complications such as hypertension, diabetes, autoimmune diseases, immunological impairments, cancer, and accelerated aging [2]. In the past few years, long-term BD has frequently led to enduring functional and cognitive impairment and is associated with a higher risk of dementia, which has been linked with low-grade stress, inflammation, and brain structural alterations [3].…”

Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature

“…Inclusion criteria were: English published studies with a high/medium level of evidence according to the Canadian Task Force on the Periodic Health Examination ( 21 ), i.e., randomized controlled trials (RCTs), case-control, and cross-sectional studies; the articles must include patients diagnosed with either FEP or UHR for psychosis according to the DSM-V ( 1 ) or ICD-10/ICD-11 ( 22 ).…”

“…Psychotic spectrum disorders (PSDs), e.g., schizophrenia. schizoaffective disorder, affective disorders with psychotic manifestations, are devastating conditions generally accompanied by a consistent number of medical comorbidities ( 1 ).…”