Background

Cardiovascular disease

Respiratory disease

Cancer

Discussion

Conclusion

References

Abstract

Background: Somatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–۲۰ years in patients with bipolar disorder as compared to the general population. In the general population an increase in survival has been observed over the last decades, primarily due to the advances in primary prophylaxis, medical treatment and progress in early detection and monitoring of somatic diseases. In this narrative review, we discuss the existing literature on treatment and outcomes of cardiovascular, respiratory, and cancer diseases in patients with bipolar disorder, and put this in the context of fndings in studies on patients diagnosed with other severe mental disorders.
Main body: The existing literature suggests that patients with bipolar disorder receive fewer or delayed medical interventions, when admitted with severe somatic diseases, compared to those not diagnosed with bipolar disorder. Cardiovascular disease is the most investigated disease regarding outcomes in patients with severe mental illness, and novel fndings indicate that the increased mortality following cardiac events in these patients can be reduced if they are intensively treated with secondary prophylactic cardiac intervention. Elderly patients diagnosed with mental disorders and cancer experience a delay in receiving specifc cancer treatment. No studies have investigated treatment outcomes in patients with severe mental disease and respiratory diseases.
Conclusion: It is surprising and of major concern that patients with bipolar disorder have not beneftted from the signifcant improvement that has taken place over time over time of somatic treatments in general, especially in countries with equal and free access to healthcare services. Therefore, no matter whether this situation is a result of a negative attitude from health care providers to patients with mental illness, the result of the patient’s lack of awareness of their physical illness or the results of other factors, further attention including research on developing strategies for improving the management of somatic diseases in patients with bipolar disorder is needed.

Background

Data from both primary and secondary care have shown that bipolar disorder is associated with an increased relative mortality rate over time as compared to the general population (Hoang et al. 2011; Hayes et al. 2015, 2017; John et al. 2018; Staudt Hansen et al. 2018); some data even suggest that an increased life expectancy in the general population is the primary driver, more than a decreased life expectancy in patients with bipolar disorder (Hayes et al. 2017). A recent meta-analysis indicated that for patients diagnosed with bipolar disorder, the standardized mortality ratio (SMR) due to suicide was 13–۱۶ times higher, compared to the SMR of 1.7 for natural causes of death as compared to the general population (Hayes et al. 2015). Suicide often occurs early in the course of the bipolar disorder (Plans et al. 2019), and therefore results in large percentage contribution to the reduced overall life expectancy, despite the relatively low overall number of deaths from this cause (see below) (Kessing et al. 2015; Jayatilleke et al. 2017).