Original Article

General medical burden in bipolar disorder: findings from the LiTMUS comparative effectiveness trial

  1. D. E. Kemp1,*,
  2. L. G. Sylvia2,
  3. J. R. Calabrese1,
  4. A. A. Nierenberg2,
  5. M. E. Thase3,
  6. N. A. Reilly-Harrington2,
  7. M. J. Ostacher4,
  8. A. C. Leon5,†,
  9. T. A. Ketter4,
  10. E. S. Friedman6,
  11. C. L. Bowden7,
  12. D. J. Rabideau8,
  13. M. Pencina9,
  14. D. V. Iosifescu10,
  15. The LiTMUS Study Group

Article first published online: 7 MAR 2013

DOI: 10.1111/acps.12101

Additional Information

How to Cite

Kemp DE, Sylvia LG, Calabrese JR, Nierenberg AA, Thase ME, Reilly-Harrington NA, Ostacher MJ, Leon AC, Ketter TA, Friedman ES, Bowden CL, Rabideau DJ, Pencina M, Iosifescu DV and the LiTMUS Study Group. General medical burden in bipolar disorder: findings from the LiTMUS comparative effectiveness trial.

Author Information

  1. 1

    University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA

  2. 2

    Massachusetts General Hospital, Boston, MA, USA

  3. 3

    University of Pennsylvania, Philadelphia, PA, USA

  4. 4

    Stanford University School of Medicine, Stanford, CA, USA

  5. 5

    Weill Cornell Medical College, New York, NY, USA

  6. 6

    University of Pittsburgh Medical Center, Pittsburgh, PA, USA

  7. 7

    University of Texas Health Science Center, San Antonio, TX, USA

  8. 8

    Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA

  9. 9

    Harvard Clinical Research Institute, Boston, MA, USA

  10. 10

    Mount Sinai School of Medicine, New York, NY, USA

  1. †

    Posthumous.

* David E. Kemp, University Hospitals Case Medical Center, Case Western Reserve University, 10524 Euclid Ave., 12th Floor, Cleveland, OH 44106, USA.
E-mail: kemp.david@gmail.com

  1. †

    Posthumous.

Publication History

  1. Article first published online: 7 MAR 2013
  2. Manuscript Accepted: 21 JAN 2013

Funded by

  • National Institute of Mental Health. Grant Number: NO1MH80001

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Keywords:

  • bipolar disorder;
  • medical comorbidity;
  • obesity;
  • lithium;
  • effectiveness

Objective

This study examined general medical illnesses and their association with clinical features of bipolar disorder.

Method

Data were cross-sectional and derived from the Lithium Treatment – Moderate Dose Use Study (LiTMUS), which randomized symptomatic adults (n = 264 with available medical comorbidity scores) with bipolar disorder to moderate doses of lithium plus optimized treatment (OPT) or to OPT alone. Clinically significant high and low medical comorbidity burden were defined as a Cumulative Illness Rating Scale (CIRS) score ≥4 and <4 respectively.

Results

The baseline prevalence of significant medical comorbidity was 53% (n = 139). Patients with high medical burden were more likely to present in a major depressive episode (P = .04), meet criteria for obsessive–compulsive disorder (P = .02), and experience a greater number of lifetime mood episodes (P = 0.02). They were also more likely to be prescribed a greater number of psychotropic medications (P = .002). Sixty-nine per cent of the sample was overweight or obese as defined by body mass index (BMI), with African Americans representing the racial group with the highest proportion of stage II obesity (BMI ≥35; 31%, n = 14).

Conclusion

The burden of comorbid medical illnesses was high in this generalizable sample of treatment-seeking patients and appears associated with worsened course of illness and psychotropic medication patterns.

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