Abstract
BackgroundSomatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–20 years in patients with bipolar disorder as compared to the general population. In the general population an increase in survival has been observed over the last decades, primarily due to the advances in primary prophylaxis, medical treatment and progress in early detection and monitoring of somatic diseases. In this narrative review, we discuss the existing literature on treatment and outcomes of cardiovascular, respiratory, and cancer diseases in patients with bipolar disorder, and put this in the context of findings in studies on patients diagnosed with other severe mental disorders.Main bodyThe existing literature suggests that patients with bipolar disorder receive fewer or delayed medical interventions, when admitted with severe somatic diseases, compared to those not diagnosed with bipolar disorder. Cardiovascular disease is the most investigated disease regarding outcomes in patients with severe mental illness, and novel findings indicate that the increased mortality following cardiac events in these patients can be reduced if they are intensively treated with secondary prophylactic cardiac intervention. Elderly patients diagnosed with mental disorders and cancer experience a delay in receiving specific cancer treatment. No studies have investigated treatment outcomes in patients with severe mental disease and respiratory diseases.ConclusionIt is surprising and of major concern that patients with bipolar disorder have not benefitted from the significant improvement that has taken place over time over time of somatic treatments in general, especially in countries with equal and free access to healthcare services. Therefore, no matter whether this situation is a result of a negative attitude from health care providers to patients with mental illness, the result of the patient’s lack of awareness of their physical illness or the results of other factors, further attention including research on developing strategies for improving the management of somatic diseases in patients with bipolar disorder is needed.
Highlights
Somatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–20 years in patients with bipolar disorder as compared to the general population
Jayatilleke et al showed that the main causes of death for patients diagnosed with severe mental illness (SMI), including bipolar disorder, in general were cardiovascular disease (23.9% of males and 17.6% of females), cancer (13.5% of males and 19.9% of females) and respiratory diseases (16.2% of males and 15.4% of females), with 6.7% of males and 4.4% of females with SMI having suicide recorded as cause of death (Jayatilleke et al 2017)
These findings are similar to the findings in older studies which in patients diagnosed with bipolar disorder mainly showed an increased relative mortality rate caused by cardiovascular and respiratory disease with some studies showing an increased and others showing no increased risk of cancer as specific cause of death (Roshanaei-Moghaddam and Katon 2009) with the main causes of death being cardiovascular disease, cancer and infection in the general population (Nielsen et al 2013)
Summary
Patients with bipolar disorder have an excess mortality with somatic diseases most often being defined as cause of death. Author details 1 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Lundbeck and Otsuka Pharmaceuticals for clinical trials, received speaking fees from Bristol-Myers Squibb, Astra Zeneca, Janssen & Cilag, Lundbeck, Servier, Otsuka Pharmaceuticals, and Eli Lilly and has acted as advisor to Astra Zeneca, Eli Lilly, Lundbeck, Otsuka Pharmaceuticals, Takeda, and Medivir. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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