Table 1 Examples of studies suggesting suboptimal treatment of medical illness in bipolar disorder
Country | Description | Primary finding | Data source | Number of subjects analyzed (N) | Reference |
|---|---|---|---|---|---|
Denmark | Investigate cardiovascular (CV) drug use and the excess mortality in BP and schizophrenia (SCZ) | Under-prescription of most CV drugs to patients with BP or SCZ compared to general population | Population registries during 1995–1996 of those who used CV drugs | 254 with BP, 609 with SCZ, 23,065 with no mental illness | Laursen et al. 2014 |
Denmark | Investigate hospital contact for CV disease by patients with BP or SCZ compared with general population | Despite excess mortality, rates of contact for those with BP or SCZ similar to general population and lower rates of invasive procedures | Register data from 1994 to 2007 | 4997 with heart disease and BP or SCZ, 566,071 with heart disease and no mental illness | Laursen et al. 2009 |
Scotland | Investigation of medical comorbidities in BP | Frequent wide ranging medical comorbidities. CV disease under-recognized and undertreated | Primary care registry for about 1/3 of Scottish population in 2007 | 2582 with BP and 1,421,796 without | Smith et al. 2013 |
Sweden | Estimate CV mortality in BP compared to general population | Mortality rate ratios for CV disease twice as high for BP than general population. People with BP died of CV disease about 10 years earlier than general population | National population register 1987–2006 | 17,101 patients diagnosed with BP in general population of 10.6 million | Westman et al. 2013 |
Sweden | Impact of physical health on mortality rate in BP | Frequent premature mortality is from chronic medical diseases. However, mortality from chronic diseases among those with prompt treatment approached that of general population | National population registries between 2001 and 2002, with follow-up 2003–2009 | 6618 diagnosed with BP | Crump et al. 2013b |
Taiwan | Use of invasive diagnostic and revascularization procedures after acute myocardial infarction (AMI) in patients with SCZ or BP | Patients with BP and SCZ half as likely to receive catheterization or revascularization procedures after AMI | National register from 1996 to 2007 | 3661 patients with AMI of which 591 with SCZ and 243 with BP | Wu et al. 2013 |
UK | Compare screening for CV risk in primary care of patients with SCZ or BP to patients with diabetes | Much less screening of patients with mental illness for CV risk (1/5 versus 96Â %) | Five primary care centers in Northampton, England | 368 with mental illness; 1875 with diabetes | Hardy et al. 2013 |
UK | Compare screening for metabolic risk in primary care of patients with SCZ or BP to patients with diabetes | Less screening of patients with mental illness for metabolic risk (74.7 versus 97.3Â %) | NHS database between 2010 and 2011 | 2,488,948 patients with diabetes and 422,966 patients with mental illness | Mitchell and Hardy 2013 |
US | Impact of guidelines released by American Diabetic Association (ADA) in 2004 on glucose monitoring in patients treated with second generation antipsychotics (SGA) | Low levels of monitoring despite small improvement after guidelines (just over 10Â % lipid monitoring; just over 20Â % glucose monitoring) | Managed care database of patients under age 65 between 2000 and 2006 | 5787 patients before guidelines; 17,832 after | Haupt et al. 2009 |
US | Investigate diabetes screening in patients with SCZ and BP who take antipsychotics over a 1 year period | Almost 70 % not screened for diabetes using validated screening measures. Those with at least one primary care visit more than twice as likely to be screened | CA Medicaid population during 1/2009–12/2009, and 10/2010–10/2011 | 50,915 patients with SCZ, BP and other severe mental illness | Mangurian et al. 2015 |
US | Investigate hospitals selected for patients with mental illness and acute myocardial infarction (AMI) | Comorbid mental illness was associated with an increased risk for admission to lower-quality hospitals. Both lower-quality hospital and mental illness predicted worse outcome | Medicare population in 2008, aged ≥65 years | 287,881 patients with AMI, of which 41,044 also with mental illness | Cai and Li 2013 |