Download PDF
Nervenheilkunde 2014; 33(12): 865-872
DOI: 10.1055/s-0038-1627757
Bipolare Störungen
Schattauer GmbH

Psychiatrische und medizinische Komorbidität en bei Betroffenen mit bipolar affektiver Störung

Analyse auf Basis der VIPP-Datenbank[*] Psychic and medical comorbidities of patients with bipolar disordersAn analysis based on the VIPP database
F. Seemüller
1   KBO-Lech-Mangfall-Kliniken, Garmisch-Partenkirchen
6   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
,
F. Godemann
2   Klinik für Seelische Gesundheit im Alter und Verhaltensmedizin, Alexianer St. Joseph Krankenhaus, Berlin-Weißensee
,
H. F. Wiegand
3   Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph Krankenhaus, Berlin-Weißensee
,
C. Wolff-Menzler
4   Klinik für Psychiatrie und Psychotherapie der Universitätsmedi-zin Göttingen
,
R. Nitschke
5   Zentralinstitut für Seelische Gesundheit, Mannheim
,
S. Häfner
4   Klinik für Psychiatrie und Psychotherapie der Universitätsmedi-zin Göttingen
,
O. Pogarell
6   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
,
P. Falkai
6   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
,
M. Löhr
7   Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale)
8   Fachhochschule der Diakonie Bielefeld
› Author Affiliations
Further Information

Publication History

eingegangen am: 20 August 2014

angenommen am: 27 August 2014

Publication Date:
22 January 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Gegenstand und Ziel

Bipolare Störungen gehen oft mit psychischen und somatischen Komorbiditäten einher. Diese führen häufig zu einer Verlängerung der Liegedauern und einer Verschlechterung der Responseraten. Ziel der Analyse ist es, eine Übersicht über die Häufigkeit psychiatrischer und somatischer Komorbiditäten bipolar affektiver Erkrankter anhand von Sekundärdaten des Projektes “Versorgungsindikatoren in der Psychiatrie und Psychosomatik” (VIPP) zu gewinnen.

Material und Methoden

In die Analyse wurden 8 528 stationäre Fälle mit der ICD-Diagnose (F31.X) aus den Jahren 2011 und 2012 eingeschlos-sen.

Ergebnisse

61% aller bipolar Betroffenen litten an mindestens einer Komorbidität. Die häufigsten Komorbiditäten waren in absteigender Reihenfolge: Hypertonie (18%), psychische und Verhaltensstörungen durch psychotrope Substanzen (16%), Schilddrüsenerkrankungen (9%), Diabetes mellitus (8%), ischämische Herzkrankheiten (7%), Persönlichkeits-und Verhaltensstörungen (6%), neurotische, Belastungs- und somatoforme Störungen (4%), organische, einschließlich symptomatischer psychischer Störungen (3%).

Schlussfolgerungen

Da Patienten mit psychischen Störungen krankheitsbedingt der Zugang zum medizinischen Versorgungssystem erschwert ist, werden dem Psychiater zunehmend bei der interdisziplinären Versorgung der Komorbiditäten auch Aufgaben aus dem allgemeinmedizinischen Bereich übertragen.

Summary

Objective

Bipolar disorders are often associated with psychiatric and somatic comorbidities, which can result in longer hospital stays and worse response rates. Aim of the descriptive analysis was to give an overview over the prevalence rates of psychiatric and somatic comorbidities of patients with bipolar affective disorder, based on secondary data of the VIPP project “Supply indicators for psychiatric and psychosomatic settings”.

Material and methods

The analysis included 8 528 adult cases with any ICD-10 bipolar diagnosis (F31.X) (years 2011 and 2012).

Results

61% of all patients had at least one psychic or somatic comorbidity. The most prevalent psychic comorbidities were in declining order: Hypertensive diseases (18%), mental and behavioral disorders due to psychoactive substance use (16%), disorders of the thyroid gland (9%), diabetes mellitus (8%), ischemic heart diseases (7%), disorders of adult personality and behavior (6%), obesity and other hyperalimentation (4%), neurotic, stress-related and somatoform disorders (4%), organic, including symptomatic, mental disorders (3%).

Conclusion

Since patients with bipolar disorders have less access to the healthcare system as compared to patients without mental disorders, psychiatrists should also focus on the diagnosis and treatment of associated medical comorbidities. This often may include tasks usually provided by general practitioners.

Schlüsselwörter

Komorbiditäten - bipolare Störungen - metabolisches Syndrom

Keywords

Comorbidity - bipolar disorders - metabolic syndrome

* VIPP: Versorgungsrelevante Indikatoren in der Psychiatrie und Psychosomatik (Steuerungsgruppe: Frank Godemann (Sprecher), Claus Woff-Menzler (stellvertretender Sprecher), Florian Seemüller, Roland Nitschke, Michael Löhr, Hans-Joachim Salize, Iris Hauth (DGPPN), Gerhard Längle (Bundes-direktorenkonferenz), Arno Deister (ackpa)


 

  • Literatur

  • 1 WHO. World Health Organization The global burden of disease: 2004. www.who.int/entity/heal thinfo/global_burden_disease/GBD_report_2004update_full.pdf
  • 2 McElroy SL. et al. Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry 2001; 158 (03) 420-6.
    CrossrefPubMedGoogle Scholar
  • 3 Berger M, Musil R, Seemüller F. [Long-term Treatment of Bipolar Disorder]. Fortschr Neurol Psychiatr 2014; 82 (06) E1.
    Article in Thieme ConnectGoogle Scholar
  • 4 Grunze H. et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. World J Biol Psychiatry Off J World Fed Soc Biol Psychiatry 2009; 10 (02) 85-116.
    Google Scholar
  • 5 Grunze H. et al. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression. World J Biol Psychiatry Off J World Fed Soc Biol Psychiatry 2010; 11 (02) 81-109.
    Google Scholar
  • 6 Bauer M. [A new evidence and consensus-based German guidelines for diagnosis and treatment of bipolar disorders]. Nervenarzt 2012; 83 (05) 564-7.
    CrossrefPubMedGoogle Scholar
  • 7 Hert MD. et al. Cardiovascular disease and diabetes in people with severe mental illness. Rev Psiquiatr Salud Ment 2009; 02 (01) 49-59.
    CrossrefPubMedGoogle Scholar
  • 8 De Hert M. et al. 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). Eur Psychiatry J Assoc Eur Psychiatr 2009; 24 (06) 412-24.
    Google Scholar
  • 9 Seemüller F. et al. [The challenge of treating bipolar outpatients]. Fortschr Neurol Psychiatr. 2013; 81 (Suppl. 01) S35-39.
    PubMedGoogle Scholar
  • 10 Krishnan KRR. Psychiatric and medical comorbidities of bipolar disorder. Psychosom Med 2005; 67 (01) 1-8.
    PubMedGoogle Scholar
  • 11 Wolff-Menzler C. et al. [Indicators of patient care in Psychiatric and Psychosomatic Facilities (VIPP project)– a database project]. Fortschr Neurol Psychiatr 2014; 82 (07) 394-400.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 McIntyre RS. et al. Medical comorbidity in bipolar disorder: implications for functional outcomes and health service utilization. Psychiatr Serv Wash DC 2006; 57 (08) 1140-4.
    Google Scholar
  • 13 Seemüller F. et al. Do efficacy and effectiveness samples differ in antidepressant treatment outcome? An analysis of eligibility criteria in randomized controlled trials. J Clin Psychiatry 2010; 71 (11) 1425-33.
    CrossrefPubMedGoogle Scholar
  • 14 Dittmann S. et al. The Stanley Foundation Bipolar Network: results of the naturalistic follow-up study after 2.5 years of follow-up in the German centres. Neuropsychobiology 2002; 46 (Suppl. 01) 2-9.
    CrossrefPubMedGoogle Scholar
  • 15 Frye MA, Salloum IM. Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord 2006; 08 (06) 677-85.
    CrossrefPubMedGoogle Scholar
  • 16 Van Zaane J, van den Brink W, Draisma S, Smit JH, Nolen WA. The effect of moderate and excessive alcohol use on the course and outcome of patients with bipolar disorders: a prospective cohort study. J Clin Psychiatry Juli; 71 (07) 885-93.
    Google Scholar
  • 17 Brieger P, Ehrt U, Marneros A. Frequency of comorbid personality disorders in bipolar and unipolar affective disorders. Compr Psychiatry 2003; 44 (01) 28-34.
    CrossrefPubMedGoogle Scholar
  • 18 George E. et al. The comorbidity of bipolar disorder and axis II personality disorders: prevalence and clinical correlates. Bipolar Disord 2003; 05 (02) 115-22.
    CrossrefPubMedGoogle Scholar
  • 19 Kay JH, Altshuler LL, Ventura J, Mintz J. Prevalence of axis II comorbidity in bipolar patients with and without alcohol use disorders. Ann Clin Psychiatry Off J Am Acad Clin Psychiatr 1999; 11 (04) 187-95.
    Google Scholar
  • 20 Perugi G, Fornaro M, Akiskal HS. Are atypical depression, borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis?. World Psychiatry Off J World Psychiatr Assoc WPA 2011; 10 (01) 45-51.
    Google Scholar
  • 21 Zimmerman M, Morgan TA. The relationship between borderline personality disorder and bipolar disorder. Dialogues Clin Neurosci 2013; 15 (02) 155-69.
    PubMedGoogle Scholar
  • 22 Preston GA, Marchant BK, Reimherr FW, Strong RE, Hedges DW. Borderline personality disorder in patients with bipolar disorder and response to lamotrigine. J Affect Disord 2004; 79 (1–3): 297-303.
    CrossrefPubMedGoogle Scholar
  • 23 Frankenburg FR, Zanarini MC. Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a doubleblind placebo-controlled pilot study. J Clin Psychiatry 2002; 63 (05) 442-6.
    CrossrefPubMedGoogle Scholar
  • 24 Otto MW, Perlman CA, Wernicke R, Reese HE, Bauer MS, Pollack MH. Posttraumatic stress disorder in patients with bipolar disorder: a review of prevalence, correlates, and treatment strategies. Bipolar Disord 2004; 06 (06) 470-9.
    CrossrefPubMedGoogle Scholar
  • 25 Kraepelin E. Online Ausgabe 2003: “Das manisch depressibe Irrsein” [Internet]. 1913 [zitiert 25. Mai 2014]. http://archive.today/NsJgn
    Google Scholar
  • 26 Westman J, Hällgren J, Wahlbeck K, Erlinge D, Alfredsson L, Osby U. Cardiovascular mortality in bipolar disorder: a population-based cohort study in Sweden. MJ Open. 2013 03. (4)
    Google Scholar
  • 27 Lawrence D, Kisely S. Inequalities in healthcare provision for people with severe mental illness. J Psychopharmacol Oxf Engl 2010; 24 (Suppl. 04) 61-8.
    Google Scholar
  • 28 Larsen JI. et al. Cultural diversity in physical diseases among patients with mental illnesses. Aust N Z J Psychiatry 2013; 47 (03) 250-8.
    CrossrefPubMedGoogle Scholar
  • 29 Köster I, Schubert I, Huppertz E. [Follow up of the CoDiM-Study: Cost of diabetes mellitus 2000–2009]. Dtsch Med Wochenschr 1946; 2012; 137 (19) 1013-6.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C. [Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013; 56 (5–6): 786-94.
    PubMedGoogle Scholar
  • 31 Smith DJ, Martin D, McLean G, Langan J, Guthrie B, Mercer SW. Multimorbidity in bipolar disorder and undertreatment of cardiovascular disease: a cross sectional study. BMC Med 2013; 11: 263.
    CrossrefPubMedGoogle Scholar
  • 32 Bauer M, Glenn T, Pilhatsch M, Pfennig A, Whybrow PC. Gender differences in thyroid system function: relevance to bipolar disorder and its treatment. Bipolar Disord 2014; 16 (01) 58-71.
    CrossrefPubMedGoogle Scholar
  • 33 Bschor T, Bauer M. [Side effects and risk profile of lithium: critical assessment of a systematic review and meta-analysis]. Nervenarzt 2013; 84 (07) 860-3.
    CrossrefPubMedGoogle Scholar