Medical Comorbidity Posted on October 24, 2007 Andrea Fagiolini (bio) explains why comorbidity is so important to investigate in patients with bipolar disorder.

My primary research interest is in the relationship between bipolar disorder and the medical comorbidity. This started several years ago, about six, seven years ago from the observation that the rate of medical comorbidity in patients with bipolar disorder is much higher than in the general population and from the observation that the majority of patients that were experiencing medical comorbidity along with depressive episodes or with mixed episodes were less likely than patients without to do well psychiatrically. So the problem was medical first of all, but it was also psychiatric.

So we started developing programs, testing possible interventions to address the problem of the medical comorbidity and one of the possible solutions was to bring in the psychiatric clinic primary care physicians, to bring specialists, to have somebody like a nurse practitioner, well knowledgeable with medical issues in our clinic because just like in the past with the advent of SSRIs, primary care physicians started treating psychiatric symptoms. For bipolar disorder, we are their primary reference, so we want to treat their medical issues in our clinic and we have done a very successful pilot study where we had a nurse practitioner helping these patients, not only treating very serious illnesses like detecting a melanoma and getting it removed, but also minor illnesses like urinary tract infection, like a cold, like a flu that will go away by themselves without any treatment, but for these patients are twice as bothersome and twice as dangerous as for a patient without bipolar disorder because many of the new episodes of depression or mania are triggered by a physical condition that impairs their sleep, that impairs their general wellbeing and so given that their equilibrium is so unstable, even a minor medical illness can have a dramatic impact on the outcome.

So we hired this nurse practitioner, we hired a lifestyle coach whom they loved because it was like having a personal trainer and all these patients started doing more physical exercise, more physical activity, so they started addressing the problems that they were having and we were monitoring not only the medical outcome, but also the psychiatric outcome and not surprisingly, we saw that they improved, they lost weight, the cholesterol improved, but also the psychiatric outcome was better.

It’s not like they went from disability to becoming a university professor, but many of them went from disability to getting a part time job, to going back to school, so there was an improvement not only in the usual measures that we look at, but also in functioning and quality of life that are as important as those measures that evaluate depression or mania.

It’s very intuitive, I mean, it seems almost stupid, it’s like help these patients – it’s like they have to eat well, they have to sleep, they have to conduct a normal routine and take care of their medical issues. Many times we forget about these basic advices and we try to treat with medications or with very complicated psychotherapies. These patients are experiencing very severe symptoms without thinking that the first step would be going towards natural interventions that everyone should think of, sleeping well, eating appropriately, not too much and not too little, good variety of food and taking good care of their physical health because if they’re not feeling well physically, it’s extremely difficult to feel well mentally. In Latin they say “mens sana in corpore sano,” which means a healthy mind in a healthy body.

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