Bipolar Disorder

Comobidity

Substance Abuse

Approximately 60% of people with bipolar disorder have a substance abuse problem (NIMH, 2000), and a recent study by the National Institute of Mental Health (NIMH) found that 46% of patients with bipolar disorder are dependent on alcohol and about 40% exhibit drug abuse or dependency (Evans, 2000). Substance abuse can make bipolar disorder more severe and worsen the course of the disease by exacerbating symptoms or precipitating episodes (Evans, 2000). The factors which may increase the risk of comorbid substance abuse are family history of substance use, an early age of onset of bipolar disorder and the presence of mixed episodes (NIMH, 2000).

Psychiatric Conditions

The Stanley Foundation Bipolar Network reports a high percentage of concomitant psychiatric conditions with bipolar disorder. One of the most common comorbid conditions is anxiety disorder, including panic disorder and social phobia. Symptoms of anxiety and panic followed by hypomaina may complicate the course of bipolar disorder (Suppes et al, 2000).

Other psychiatric conditions that can occur with bipolar disorder include post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) and impulse control disorders (e.g. pathologic gambling, kleptomania) (NIMH, 2000; Suppes et al, 2000). The NIMH recently reported a high incidence of PTSD and OCD in patients with bipolar disorder, with 43% of patients exhibiting symptoms for PTSD. However, only 2% had the symptoms of PTSD listed on their charts, suggesting that improved diagnosis of this concomitant condition may lead to better treatment of bipolar disorder (NIMH, 2000). This may be especially relevant in the case of OCD as the course of the OCD and mood disorders often alter in line with each other.

Attention Deficit Hyperactivity Disorder (ADHD)

Bipolar disorder that develops in early childhood may be more commonly associated with disruptive behavioural conditions, such as ADHD or conduct disorder (CD), than with bipolar disorders onsetting later in life. A study by Wozniak et al, 1995, found that 11% of 301 children under the age of 12 with bipolar disorder also met criteria for ADHD. In contrast, those patients that develop bipolar disorder later in adolescence or as adults do not tend to have high rates of concomitant ADHD or CD (Evans, 2000; NIMH, 2000).

Other Comorbid Conditions

Research into the association between secondary mania and brain injury has found that secondary mania may be linked to brain injury in the right-sided sub-cortical structures and cortical areas linked to limbic structures. Secondary mania has also been associated with stroke, tumours, migraine  and head injuries and appears to be more common in patients with multiple sclerosis . Anecdotal evidence suggests that mania is also associated with systemic illnesses, such as hyperthyroidism, AIDS, Lyme borreliosis, Wolfram syndrome and neurosyphilis. After antidepressant therapy, corticosteroids are the medication most frequently associated with secondary mania, (Keck, Jr. et al, 2001).