Association between history of psychosis and cardiovascular disease in bipolar disorder

Miguel L. Prieto, Susan L. Mcelroy, Sharonne N. Hayes, Bruce Sutor, Simon Kung, William V Bobo, Manuel E. Fuentes, Alfredo B. Cuellar-Barboza, Scott Crow, Urban Ösby, Mohit Chauhan, Jeanette Westman, Jennifer R. Geske, Colin L. Colby, Euijung Ryu, Joanna M Biernacka, Mark A Frye

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder. Methods: This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature. Results: In a multivariate model, age [odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95% CI: 0.96-2.13, p = 0.08). Conclusions: The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association.

Original languageEnglish (US)
Pages (from-to)518-527
Number of pages10
JournalBipolar Disorders
Volume17
Issue number5
DOIs
StatePublished - Aug 1 2015

Fingerprint

Bipolar Disorder
Psychotic Disorders
Cardiovascular Diseases
Odds Ratio
Confidence Intervals
Comorbidity
Hypertension
Diagnostic and Statistical Manual of Mental Disorders
Antipsychotic Agents
Medical Records
Life Style
Heart Diseases
Cross-Sectional Studies
Logistic Models
Interviews
Depression
Phenotype

Keywords

  • Bipolar disorder
  • Cardiovascular diseases
  • Hypertension
  • Phenotype
  • Risk

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Association between history of psychosis and cardiovascular disease in bipolar disorder. / Prieto, Miguel L.; Mcelroy, Susan L.; Hayes, Sharonne N.; Sutor, Bruce; Kung, Simon; Bobo, William V; Fuentes, Manuel E.; Cuellar-Barboza, Alfredo B.; Crow, Scott; Ösby, Urban; Chauhan, Mohit; Westman, Jeanette; Geske, Jennifer R.; Colby, Colin L.; Ryu, Euijung; Biernacka, Joanna M; Frye, Mark A.

In: Bipolar Disorders, Vol. 17, No. 5, 01.08.2015, p. 518-527.

Research output: Contribution to journalArticle

Prieto, ML, Mcelroy, SL, Hayes, SN, Sutor, B, Kung, S, Bobo, WV, Fuentes, ME, Cuellar-Barboza, AB, Crow, S, Ösby, U, Chauhan, M, Westman, J, Geske, JR, Colby, CL, Ryu, E, Biernacka, JM & Frye, MA 2015, 'Association between history of psychosis and cardiovascular disease in bipolar disorder', Bipolar Disorders, vol. 17, no. 5, pp. 518-527. https://doi.org/10.1111/bdi.12302
Prieto, Miguel L. ; Mcelroy, Susan L. ; Hayes, Sharonne N. ; Sutor, Bruce ; Kung, Simon ; Bobo, William V ; Fuentes, Manuel E. ; Cuellar-Barboza, Alfredo B. ; Crow, Scott ; Ösby, Urban ; Chauhan, Mohit ; Westman, Jeanette ; Geske, Jennifer R. ; Colby, Colin L. ; Ryu, Euijung ; Biernacka, Joanna M ; Frye, Mark A. / Association between history of psychosis and cardiovascular disease in bipolar disorder. In: Bipolar Disorders. 2015 ; Vol. 17, No. 5. pp. 518-527.
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abstract = "Objectives: To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder. Methods: This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature. Results: In a multivariate model, age [odds ratio (OR) = 3.03, 95{\%} confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95{\%} CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95{\%} CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95{\%} CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95{\%} CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95{\%} CI: 0.96-2.13, p = 0.08). Conclusions: The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association.",
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AU - Prieto, Miguel L.

AU - Mcelroy, Susan L.

AU - Hayes, Sharonne N.

AU - Sutor, Bruce

AU - Kung, Simon

AU - Bobo, William V

AU - Fuentes, Manuel E.

AU - Cuellar-Barboza, Alfredo B.

AU - Crow, Scott

AU - Ösby, Urban

AU - Chauhan, Mohit

AU - Westman, Jeanette

AU - Geske, Jennifer R.

AU - Colby, Colin L.

AU - Ryu, Euijung

AU - Biernacka, Joanna M

AU - Frye, Mark A

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N2 - Objectives: To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder. Methods: This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature. Results: In a multivariate model, age [odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95% CI: 0.96-2.13, p = 0.08). Conclusions: The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association.

AB - Objectives: To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder. Methods: This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature. Results: In a multivariate model, age [odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95% CI: 0.96-2.13, p = 0.08). Conclusions: The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association.

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KW - Cardiovascular diseases

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KW - Risk

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