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Traditional cardiac risk factors, such as smoking, hypertension and obesity, are widely accepted contributors to the onset and progression of cardiovascular disease (CVD), one of the foremost causes of morbidity and mortality worldwide. Largely overlooked, however, is the impact of mental health on cardiac disease. From extensive MEDLINE and PsycINFO searches, we have reviewed the association between specific psychiatric disorders and CVD-related morbidity and mortality, the efficacy and safety of their treatments, and plausible behavioral and biological mechanism through which these associations may occur. The preponderance of evidence suggests that depression, anxiety disorders, bipolar disorder and schizophrenia are all important cardiac risk factors, and patients with these disorders are at significantly higher risk for cardiac morbidity and mortality than are their counterparts in the general population. Antidepressants, antipsychotics, mood stabilizers and benzodiazepines are effective therapeutic interventions, and many are safe to use in cardiac populations. Some, such as selective serotonin reuptake inhibitors and atypical antipsychotics, may even improve cardiac outcomes in healthy individuals and patients with CVD, although more work is needed to confirm this hypothesis. A combination of behavioral and biological mechanisms underlies the association between cardiac disease and mental illness, many of which are shared across disorders. With further research, it may be learned that psychiatric treatments definitively reverse the detrimental effects of mental illness on cardiac health. Currently, however, the challenge lies in raising awareness of mental health issues in cardiac patients, so that basic but critical treatments may be initiated in this population.
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PMID:The impact of mental illness on cardiac outcomes: a review for the cardiologist. 1900 12

We explored whether obesity in patients with bipolar disorder is associated with their chronotype. A group of 29 patients with bipolar I disorder, not currently experiencing an affective episode, were assessed for total body fat, mood symptoms, and self-reported circadian chronotype and sleep quality. Chronotype explained 19% of the variance in body fat, after age, sex, mood state, and sleep quality were accounted for. This association suggested that evening chronotype patients have a higher percentage of total body fat. Evening chronotype could be a proxy for as yet unknown specific causes of the high rate of obesity and obesity-related diseases in bipolar disorder.
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PMID:Chronotype and body composition in bipolar disorder. 1944 56

Polycystic Ovary Syndrome (PCOS) is a polygenic disorder caused by the interaction of susceptible genomic polymorphisms with environmental factors. PCOS, characterized by hyperandrogenism and menstrual abnormalities, has a higher prevalence in women with Bipolar Disorder (BD). Theories explaining this high prevalence have included the effect of PCOS itself or the effect of drugs such as Valproate, which may cause PCOS either directly or indirectly. Incidentally, metabolic abnormalities are observed in both bipolar and PCOS patients. Endophenotypes such as insulin resistance, obesity, and hyperglycemia are common among BD and PCOS patients, suggesting some degree of pathophysiological overlap. Since both BD and PCOS are complex polygenetic diseases, the endophenotype overlap may be the result of common genetic markers. This paper postulates that shared clinical endophenotypes between PCOS and BD indicate common pathophysiological platforms and will review these for the potential of genetic overlap between the two disorders.
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PMID:Genetic overlap between polycystic ovary syndrome and bipolar disorder: the endophenotype hypothesis. 1955 71

Patients with severe mental illnesses have a higher risk of premature mortality than the general US population. Illnesses such as schizophrenia and bipolar disorder are frequently complicated by physical comorbidities such as diabetes and cardiovascular disease, including both coronary heart disease and cerebrovascular disease, which are associated with increased mortality and morbidity. Coronary heart disease is the leading cause of death among individuals with severe mental illnesses. Modifiable risk factors such as dyslipidemia, hyperglycemia, hypertension, smoking, and obesity are common in this population and contribute to risk for both diabetes and coronary heart disease. While many psychotropic medications used in the treatment of schizophrenia or bipolar disorder have similar efficacy, some medications are associated with more metabolic side effects than others, and clinicians should consider these risks when choosing among these medications. Patients with severe mental illnesses tend to have reduced access to health care and treatment for medical comorbidities compared with the general population. Therefore, clinicians involved in the care of this patient population should screen and monitor carefully for cardiometabolic side effects and risk factors.
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PMID:Comparing the safety and efficacy of atypical antipsychotics in psychiatric patients with comorbid medical illnesses. 1957 Apr 99

Patients with severe mental disorders have increased mortality rates compared with the general population. The leading cause of death for individuals with psychotic illnesses or bipolar disorder is cardiovascular disease (CVD), which is often the result of patients' health problems associated with their psychiatric disorders, including, but not limited to, obesity, metabolic syndrome, and diabetes. Such problems occur more often and have worse outcomes in patients with serious mental illness than the general population because of a combination of factors such as inadequate access to quality care, poor lifestyle choices, and the association between some antipsychotic medications and weight gain. Coordinated somatic and psychiatric treatment, weight-neutral or weight-reducing pharmaceuticals, and behavioral weight management programs may help lessen the burden of CVD in the mental health population.
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PMID:Overview of managing medical comorbidities in patients with severe mental illness. 1957 73

Binge Eating (BE) is a common eating pattern in patients with Bipolar Disorder (BD). BE may confer an increased risk for obesity, morbidity, mortality and poorer quality of life. We assessed the presence of BE and its impact on body weight, body image and self-esteem in 50 patients with BD and 50 age- and gender-matched controls. The presence and severity of BE was assessed with the Binge Eating Scale (BES). The Body Image and Self-Esteem Evaluation Scale (B-WISE) was used to assess the psychosocial impact of weight gain. Body Mass Index (BMI) was calculated. Nine (18%) patients had a score >27, indicating a likely diagnosis of BE. None of the control subjects had a BES score >17. No association between BES score and the medications was found. Patients had a significantly higher BES score, significantly higher BMI, waist circumference and fasting blood glucose. Although the B-Wise score was higher in the controls, the difference was not statistically significant. This study suggests that BE is prevalent in patients with BD. The presence of BE eating is a predictor of higher BMI, indicating that the disruption of eating behavior may be a pathway to weight gain.
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PMID:Binge eating, weight gain and psychosocial adjustment in patients with bipolar disorder. 1962 88

Extant evidence indicates that individuals with bipolar disorder (BD) are differentially affected by overweight/obesity and abdominal obesity. Excess weight is associated with a more complex illness presentation, non-recovery, and recurrence. Herein, we sought to review literature describing the effects of structured individualized physical exercise on disparate neurobiological substrates implicated in the pathophysiology of BD. We conducted a PubMed search of all English-language articles published between 1966 and July 2008 with BD cross-referenced with the following search terms: exercise, neurobiology, pathophysiology, pathoetiology, brain, cognition, neuroplasticity, and neurodegeneration. Articles selected for review were based on adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality. Contemporary models of disease pathophysiology in BD implicate disturbances in cellular resilience, plasticity, and survival in the central nervous system. Individualized exercise interventions are capable of alleviating the severity of affective and cognitive difficulties in heterogeneous samples. It is posited that exercise is a pleiotropic intervention that engages aberrant neurobiological systems implicated in metabolism, immuno-inflammatory function, and cellular respiration. Structured exercise regimens exert a salutary effect on interacting networks mediating metabolism, immuno-inflammatory function, and cellular respiration. In keeping this view, buttressed by controlled evidence describing robust anti-depressant effects with exercise (e.g., public health dose), a testable hypothesis is that structured exercise is capable of improving psychiatric and somatic health in BD.
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PMID:Exercise and bipolar disorder: a review of neurobiological mediators. 1964 51

Patients with severe mental illnesses such as bipolar disorder and schizophrenia have significantly increased rates of early mortality compared with the general population. Increased mortality in the mentally ill is often due to medical comorbidities associated with overweight or obesity. Weight gain can be associated with the mental disorder itself or with the pharmacotherapy used to treat the mental disorder. Effective weight-neutral and weight-reducing medical agents are available, and the use of an appropriate pharmacotherapy regimen with behavior modification and patient education may help manage body weight in patients with serious mental illnesses.
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PMID:Managing weight gain in patients with severe mental illness. 1965 69

In recent years, there has been an increase in obesity in the general population in both adults and children. Certain mental disorders have been found to co-occur with overweight and obesity. These include binge-eating disorder and bulimia nervosa (nonpurging type), bipolar disorder, certain forms of major depressive disorder, and some severe, chronic mental illness (ie, schizophrenia and schizoaffective disorder). At the same time, some studies have also found that obesity co-occurs with certain mental disorders--specifically binge-eating disorder and mood disorders in females. The co-occurrence of psychiatric disorders (ie, mood and psychotic disorders), binge eating, and overweight or obesity has important public health implications for the treatment of patients with mental disorders, especially since many psychotropic agents can have adverse effects on appetite, binge eating, and weight. Physicians need to keep 2 key points in mind: 1) The treatment of mental disorders in patients with obesity may be different from the treatment of such patients who are not obese, and 2) The treatment of obesity that co-occurs with psychopathology may be different from obesity that is not comorbid with psychopathology.
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PMID:The relationship between severe mental illness and obesity. 1966 51

People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors; obesity, smoking, diabetes, hypertension and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) published this statement with the aim of improving the care of patients suffering from severe mental illness. The intention is to initiate cooperation and shared care between the different healthcare professionals and to increase the awareness of psychiatrists and primary care physicians caring for patients with severe mental illness to screen and treat cardiovascular risk factors and diabetes.
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PMID:Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). 1968 63


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