Excess Mortality in Bipolar and Unipolar Disorder in Sweden

Ösby, Urban; Brandt, Lena; Correia, N.; Ekbom, Anders; Sparén, Pär

doi:10.1001/archpsyc.58.9.844

Cited by 994 publications

(745 citation statements)

References 34 publications

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“…1,2 A growing body of evidence suggests that impaired cellular plasticity and resilience may contribute toward central nervous system structural alterations associated with affective illness. [3][4][5] The hippocampal formation is a particularly plastic and vulnerable brain region.…”

Section: Introductionmentioning

confidence: 99%

Glutamate as a spectroscopic marker of hippocampal structural plasticity is elevated in long-term euthymic bipolar patients on chronic lithium therapy and correlates inversely with diurnal cortisol

et al. 2008

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While an excess of glucocorticoids is associated with hippocampal pathology in mood disorders, lithium exerts robust neuroprotective and neurotrophic effects. Here, 21 stably remitted bipolar I patients who had been on chronic lithium maintenance therapy, on average, for more than a decade, and 19 carefully matched healthy controls were studied using 3 T 1 Hmagnetic resonance spectroscopy of left and right hippocampus. Salivary cortisol samples were obtained to assess activity of the hypothalamus-pituitary-adrenal system. Absolute concentrations of N-acetylaspartate (NAA), choline-containing compounds and total creatine were similar in euthymic bipolar patients and healthy controls. Hippocampal glutamate concentrations were significantly increased as an effect of patient status (patients > controls) and laterality (left hippocampus > right hippocampus). Hippocampal glutamate content (Glu) was strongly correlated with NAA. Across groups and within the patient group, diurnal saliva cortisol levels showed a significant inverse relationship with both Glu and NAA. Taken together, these results add to the concept of bipolar disorder as an illness involving disturbed hippocampal structural plasticity under the opposing influences of lithium and glucocorticoids.

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Section: Introductionmentioning

confidence: 99%

Glutamate as a spectroscopic marker of hippocampal structural plasticity is elevated in long-term euthymic bipolar patients on chronic lithium therapy and correlates inversely with diurnal cortisol

et al. 2008

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“…21 The relation between OPG and cardiovascular disease is of particular interest for severe mental disorders, for which recent evidence indicates increased cardiovascular risk factors 22,23 and mortality rates. 24,25 It has been speculated that there may be common mechanisms involved in severe mental disorders and cardiovascular disease, and altered inflammation could be one such mechanism. 26 Based on the link between OPG and both inflammation and cardiovascular disorders, our aim was to investigate differences in OPG levels in a large and well-characterized population of patients with schizophrenia and bipolar disorder and sex-and age-matched healthy controls.…”

Section: Introductionmentioning

confidence: 99%

Osteoprotegerin levels in patients with severe mental disorders

Hope

Melle²,

Aukrust³

et al. 2010

jpn

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Background: Severe mental disorders are associated with elevated levels of inflammatory markers. In the present study, we investigated whether osteoprotegerin (OPG), a member of the tumour necrosis factor receptor family involved in calcification and inflammation, is elevated in patients with severe mental disorders. Methods: We measured the plasma levels of OPG in patients with severe mental disorders (n = 312; 125 with bipolar disorder and 187 with schizophrenia) and healthy volunteers (n = 239). Results: The mean plasma levels of OPG were significantly higher in patients than in controls (t 531 = 2.6, p = 0.01), with the same pattern in bipolar disorder and schizophrenia. The increase was significant after adjustment for possible confounding variables, including age, sex, ethnic background, alcohol consumption, liver and kidney function, diabetes, cardiovascular disease, autoimmune diseases and levels of cholesterol, glucose and C-reactive protein. Limitations: Owing to the cross-sectional design, it is difficult to determine causality. Conclusion: Our results indicate that elevated OPG levels are associated with severe mental disorders and suggest that mechanisms related to calcification and inflammation may play a role in disease development.

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“…La mortalidad se encuentra duplicada, fundamentalmente por suicidio, y es 10 veces superior a la de la población general, pero también por otros factores como el incremento del riesgo de síndrome metabóli-co y enfermedades cardiovasculares que presentan estos pacientes [4][5][6][7] .…”

Section: Introductionunclassified

Consenso Español de Salud Física del Paciente con Trastorno Bipolar

Bobes

Ruiz

Montes

et al. 2008

Revista de Psiquiatría y Salud Mental

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ResumenIntroducción y objetivos: Los pacientes con trastorno bipolar presentan una morbilidad físi-ca y una mortalidad muy superior a la de la población general. Además de una mayor mortalidad por suicidio, tienen también una mayor prevalencia de enfermedades físicas. El objetivo de este consenso, promovido por las Sociedades Españolas de Psiquiatría y Psiquiatría Biológica, en colaboración con las sociedades de médicos de asistencia primaria, es establecer recomendaciones prácticas sobre los procedimientos de detección, prevención e intervención en las enfermedades somáticas que coexisten con el trastorno bipolar para mejorar la calidad y esperanza de vida de estos pacientes. Método: Las Sociedades Españolas de Psiquiatría y Psiquiatría Biológica eligieron un ComitéCientífico que seleccionó a su vez a 32 psiquiatras expertos y 10 médicos expertos en otras especialidades médicas. Se crearon grupos de trabajo para cada especialidad con la finalidad de adaptar las guías aplicadas en la población general a pacientes con trastorno bipolar. Partiendo de una revisión sistemática sobre la comorbilidad médica y la mortalidad en el trastorno bipolar se realizaron dos reuniones para acordar el consenso. Resultados: En la revisión bibliográfica se detectó un riesgo aumentado, entre los pacientes con trastorno bipolar, de presentar hipertensión arterial, obesidad, tabaquismo, enfermedades pulmonares, migraña e infección por virus de la inmunodeficiencia humana (VIH). También se encontró evidencia de un aumento de mortalidad por enfermedades cardiovasculares, respiratorias e infecciones, además del suicidio. El grupo de expertos alcanzó el consenso en una serie de medidas básicas para la detección de comorbilidad médica aplicables a la monitorización de estos pacientes. Las recomendaciones resultantes serán asumidas y divulgadas por las sociedades promotoras. Conclusiones: El decálogo generado en el Consenso Español de Salud Física del Paciente con Trastorno Bipolar recoge los aspectos más relevantes para la mejora del funcionamiento psicosocial, la calidad y la esperanza de vida en los pacientes con esta patología.

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Excess Mortality in Bipolar and Unipolar Disorder in Sweden

Abstract: Background: Selected groups of patients with bipolar and unipolar disorder have an increased mortality rate from suicide and natural causes of death. However, there has been no population-based study of mortality of patients followed up from the onset of the illness.

Cited by 994 publications

References 34 publications

Glutamate as a spectroscopic marker of hippocampal structural plasticity is elevated in long-term euthymic bipolar patients on chronic lithium therapy and correlates inversely with diurnal cortisol

Glutamate as a spectroscopic marker of hippocampal structural plasticity is elevated in long-term euthymic bipolar patients on chronic lithium therapy and correlates inversely with diurnal cortisol

Osteoprotegerin levels in patients with severe mental disorders

Consenso Español de Salud Física del Paciente con Trastorno Bipolar

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