Implications of Bipolar Disorder as a vascular disease

With the intent of helping to reduce stigma around mental illness, Dr. Benjamin Goldstein presented at the latest Grand Rounds session.  Closely examining the implications of bipolar disorder as a cardiovascular risk, Dr. Goldstein indicated that psychiatric illnesses affect the mood and thinking as well as the body.

“This then presents us with an opportunity for stigma reduction because psychiatric disorders should be considered systemic illnesses,” says Dr. Goldstein.
Bipolar Disorder is usually characterized by periods of depressive illness and mania or hypo mania.  This disorder affects one to five percent of the Canadian population and it affects both males and females equally.  The widespread nature of the illness means that there are high direct and indirect healthcare costs associated with bipolar disorder.

Some of the symptoms that present in an individual living with bipolar disorder include changes in speech pattern, impulsivity, decreased need for sleep and risky behaviour. There are also usually comorbid diseases such as anxiety and substance abuse seen in persons with bipolar disorder.

“About 32 to 65 percent of adults who have bipolar have had the onset before age 18 and this is why we have looked at adolescents to determine if there any cardiovascular risks associated the disorder,” explained Dr. Goldstein.  “The results are that people with bipolar disorder usually show signs of cardiovascular risk and usually very early on in their life,” adds Dr. Goldstein.

The causes for the early cardiovascular disease may be pathophysiology, where there is a response in the body; behaviour and environment; or from medication.

“It is hard to determine the root causes, as those with bipolar disorder usually engage in risky behavior and may not always exercise or they may smoke more or have poor nutritional habits, so these may lead to a cardiovascular risk in any case,” says Dr. Goldstein.
One marker that is used in the physiological test is the measure of inflammation present and this marker was seen to increase during both periods of mania and depression.  Additionally, a cross sectional research showed that adolescents who were identified as risk takers also presented with high blood pressure and obesity.

Another study is also examining how aerobic exercise many benefit individuals living with a mental illness and may be used as a treatment for those with bipolar disorder.

The session ended with the reminder that multiple factors converge to result in cardiovascular risk for those individuals living with bipolar disorder.