The Incidence and Relative Risk of Stroke among Patients with Bipolar Disorder: A Seven-Year Follow-Up Study

Wu, Hung‐Chi; Chou, Frank Huang-Chih; Tsai, Kuan-Yi; Su, Chien-Ling; Shen, Shih-Pei; Chung, Tieh-Chi

doi:10.1371/journal.pone.0073037

Cited by 24 publications

(23 citation statements)

References 40 publications

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“…Our findings that age, male gender, diabetes mellitus, and hypertension are associated with an increased risk of stroke in patients with bipolar disorder were compatible with two previous studies similarly focusing on patients with bipolar disorder (2,3). Of note, our finding that female gender was associated with a reduced risk of stroke was consistent with these two studies but the underlying mechanism is not well understood.…”

Section: Discussionsupporting

confidence: 92%

“…Stroke is one of the most severe medical conditions and it has been reported to account for 5.5 million deaths and 44 million disability‐adjusted life‐years lost worldwide annually . Previous studies have demonstrated an increased risk of stroke of up to twofold among patients with bipolar disorder . However, the possible effects of medication on the risk of stroke were not further analyzed in these studies.…”

mentioning

confidence: 98%

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A reduced risk of stroke with lithium exposure in bipolar disorder: a population‐based retrospective cohort study

et al. 2015

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 98%

A reduced risk of stroke with lithium exposure in bipolar disorder: a population‐based retrospective cohort study

et al. 2015

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“… 10 , 21 However, studies specifically targeting the link between bipolar disorder and young stroke were lacking. Wu et al 22 reported that bipolar patients with stroke were younger than those without stroke, although the stroke event still occurred at a mean age over 45 years. 22 Another large-scale study showing the link between bipolar disorder and stroke (prevalence ratio 3.14, CI = 2.42∼4.06) had 46% of its bipolar group younger than age 40 (1873/4067 patients), but no stratified data were available.…”

Section: Discussionmentioning

confidence: 99%

“…Wu et al 22 reported that bipolar patients with stroke were younger than those without stroke, although the stroke event still occurred at a mean age over 45 years. 22 Another large-scale study showing the link between bipolar disorder and stroke (prevalence ratio 3.14, CI = 2.42∼4.06) had 46% of its bipolar group younger than age 40 (1873/4067 patients), but no stratified data were available. 23 In our study, model 1 adjusting for demographic data and medical comorbidities, but not model 2 with an additional adjustment with other psychiatric comorbidities, showed a significant relationship between bipolar disorder and young ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke in Young Adults and Preexisting Psychiatric Disorders

Chiu

Bai

et al. 2015

Medicine

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Previous studies showed that psychiatric disorders such as major depression, bipolar disorders, and alcohol misuse are associated with an increased risk of ischemic stroke. However, the link between psychiatric disorders and stroke in the young population is rarely investigated.Using the Taiwan National Health Insurance Research Database, 2063 young adults aged between 18 and 45 years with ischemic stroke and 8252 age- and sex-matched controls were enrolled in our study between 1998 and 2011. Participants who had preexisting psychiatric disorders were identified.After adjusting for preexisting physical disorders and demographic data, patients with ischemic stroke had an increased risk of having preexisting psychiatric disorders, including bipolar disorder (odds ratio [OR]: 2.23, 95% confidence interval [CI]: 1.06∼4.67), unipolar depression (OR: 2.15, 95% CI: 1.62∼2.86), anxiety disorders (OR: 2.63, 95% CI: 1.87∼3.69), and alcohol use disorders (OR: 2.86, 95% CI: 1.79∼4.57). Young ischemic stroke (age ≥30 years) was related to the risk of preexisting unipolar depression (OR: 1.49, 95% CI: 1.05∼2.11), anxiety disorders (OR: 1.99, 95% CI: 1.33∼2.97), and alcohol use disorders (OR: 2.54, 95% CI: 1.55∼4.14); very young stroke (age <30 years) was only associated with the risk of preexisting unipolar depression (OR: 4.15, 95% CI: 1.47∼11.72).Patients who had experienced ischemic stroke at age younger than 45 years had a higher risk of having pre-existing bipolar disorder, unipolar depression, anxiety disorders, and alcohol use disorders than those who did not after adjusting for demographic data and stroke-related medical comorbidities.

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“…While there is consistent evidence showing the high prevalence of comorbid medical conditions in BD768, 769, 770, 771, 772, 773, 774 and the negative impact these diagnoses have on longevity,775, 776 these conditions frequently go undiagnosed or undertreated. In a large UK cross‐sectional analysis of electronic data sets involving 1.7 million patients in primary care, those diagnosed with BD, when compared with healthy controls, had lower rates of diagnoses (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.54‐0.63) and treatment of medical conditions, despite higher rates of one (OR 1.2, 95% CI 1.16‐1.39) or multiple illnesses (OR 1.44, 95% CI 1.3‐1.64) 769…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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The Incidence and Relative Risk of Stroke among Patients with Bipolar Disorder: A Seven-Year Follow-Up Study

Cited by 24 publications

References 40 publications

A reduced risk of stroke with lithium exposure in bipolar disorder: a population‐based retrospective cohort study

A reduced risk of stroke with lithium exposure in bipolar disorder: a population‐based retrospective cohort study

Ischemic Stroke in Young Adults and Preexisting Psychiatric Disorders

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

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