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Comorbidity in Bipolar Disorder: Page 5 of 5

Comorbidity in Bipolar Disorder: Page 5 of 5


Given the substantial overlap between symptoms of BPD and other psychiatric conditions, an accurate cross-sectional assessment is inherently difficult to achieve. A careful longitudinal assessment that establishes a chronology of onset of different conditions, a symptom and functional profile between mood episodes, the course of illness, and response to treatment are essential for a more robust diagnosis.44 Furthermore, the inherent challenge in obtaining an accurate history from a bipolar patient—especially one with comorbidities—requires corroboration from family members.

Although clinical guidelines for BPD acknowledge the complexity of treating the illness, most have limited recommendations specific to the patient with comorbidities. This may reflect the limited nature of the clinical evidence in this field.68,69 The cost of diagnostic and therapeutic uncertainty, however, is calculated through the high cost of chronicity, with elevated rates of suicide, legal and interpersonal difficulties, and repeated hospitalizations.

As the field of neurobiology of bipolar and affective disorders advances, we hope to begin to refine our view of the comorbid interface. Forging the pathophysiological links between specific medical illnesses and BPD, including the use of clinical biomarkers to help refine the understanding of bipolar subtypes, may help clarify the pathophysiology of BPD itself. This will ultimately suggest new measures for secondary prevention and long-term treatments.4,70

Dr Sagman is staff psychiatrist, Toronto East General Hospital, Toronto, and associate vice-president, clinical research, Eli Lilly Canada Inc, and Dr Tohen is Distinguished Lilly Scholar for Neurosciences, Lilly Research Laboratories, Indianapolis. The authors report that they have no other conflicts of interest concerning the subject matter of this article.



Drugs Mentioned in This Article

Aripiprazole (Abilify)
Carbamazepine (Carbatrol, Tegretol, others)
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Lithium (Eskalith, Lithane, Lithobid)
Olanzapine (Zyprexa)
Pregabalin (Lyrica)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Topiramate (Topamax)
Valproate/valproic acid (Depakote, others)


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Evidence-Based References
Kessler R. Comorbidity of unipolar and bipolar depression with other psychiatric disorders in a general population survey. In: Tohen M, ed. Comorbidity in Affective Disorders. New York: Marcel Dekker Inc; 1999: 1-25.
Perlis RH, Miyahara S, Marangell LB, et al. Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2004;55:875-881.

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