Later-Life Bipolar Comorbidities Raise Health Care Costs

Article excerpt

BALTIMORE -- A substantial number of adults with bipolar disorder who are approaching older age have at least one psychiatric comorbidity, which is often substance abuse or dependence or posttraumatic stress disorder, Frederic C. Blow, Ph.D., said at the annual meeting of the American Association for Geriatric Psychiatry.

The courses of substance abuse or dependence and PTSD appear to be separate from bipolar disorder in many patients, he said, but they certainly can co-occur and interact. Very little has been published about these comorbidities and whether they continue into later life in bipolar disorder patients.

Psychiatric comorbidities are quite prevalent at all ages in bipolar disorder:

* About 65% of patients with bipolar disorder meet the criteria for at least one additional comorbid lifetime Axis I disorder. This is the highest level of comorbidity of another disorder for all psychiatric illnesses, said Dr. Blow, director of the Serious Mental Illness Treatment Research and Evaluation Center, Veterans Health Administration.

* About 50% of patients with bipolar disorder have a lifetime prevalence of substance abuse or dependence.

* About 43% of patients with bipolar disorder have a lifetime prevalence of PTSD.

Substance abuse or dependence and PTSD tend to promote mixed states and set up a poor response to treatment, said Dr. Blow, also of the department of psychiatry at the University of Michigan, Ann Arbor. The nature of bipolar disorder also may make affected individuals more vulnerable to traumatic events.

Previous work has indicated that older bipolar disorder patients use mental health services four times more often and are placed in psychiatric hospitals four times more often than older patients with depression (Am. …

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