Impact of comorbid migraine on the clinical course of bipolar disorder.

BACKGROUND: Recent evidence suggests an association between migraine and bipolar disorder (BD), although the impact of this association in the clinical course of BD is relatively unknown. OBJECTIVE: This study aimed to compare 2 groups of individuals with BD (with vs without comorbid migraine) and evaluate differences in severity of clinical course. METHODS: Three hundred thirty-nine adults with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined bipolar I or II disorder were enrolled and divided into 2 groups: with and without comorbid migraine. Demographic and clinical data were obtained using standardized interviews. RESULTS: Patients with comorbid migraines had more mood episodes, especially those with depressive polarity. In addition, comorbid migraine was associated with a higher prevalence of psychiatric and general medical comorbidities. Differences between the 2 groups in number of lifetime hospitalizations for depression/mania, rates of rapid cycling, and history of suicide attempts were not observed after Bonferroni correction. CONCLUSIONS: Comorbid migraine seems to be associated with poor outcomes in BD. Additional studies should be conducted to investigate shared vulnerabilities and pathophysiologic mechanisms as well as treatment optimization of both illnesses.

Comorbidades médicas em pacientes ambulatoriais com transtorno do humor bipolar tipo I / General medical comorbidities in Brazilian outpatients with bipolar disorder type I

CONTEXTO: O transtorno do humor bipolar (THB) está associado a altas taxas de comorbidades médicas gerais (CMGs) e fatores de risco para problemas médicos, porém há escassos relatos sobre a prevalência dessas condições em brasileiros com THB. OBJETIVO: Descrever a prevalência de CMGs em uma amostra de pacientes com THB tipo I. MÉTODOS: Dados clínicos de 195 pacientes com THB tipo I foram revisados para identificação de CMGs. Pacientes com e sem CMGs foram comparados usando o teste não paramétrico Mann-Whitney e o teste qui-quadrado. RESULTADOS: Sessenta e três por cento dos pacientes relataram pelo menos uma comorbidade médica. As condições mais prevalentes foram: enxaqueca (31,8%), hipotireoidismo (24,1%), hipertensão (11,3%), traumatismo craniano (10,3%), asma (9,7%), epilepsia (8,2%), diabetes (5,1%), acidente vascular cerebral (2,1%) e hipertireoidismo (1%). Idade e duração da doença foram positivamente associadas à presença de CMGs (p < 0,001). CONCLUSÃO: Em concordância com relatos prévios, a maioria dos pacientes apresentou pelo menos uma doença médica. A principal limitação deste estudo reside no fato de o diagnóstico de CMGs ter sido baseado no autorrelato. Há escassos estudos visando à identificação de comorbidades médicas na população brasileira com THB e este estudo pode contribuir para melhor vigilância diagnóstica, avaliação, tratamento e diminuição da sobrecarga associada ao THB.

BACKGROUND: Bipolar disorder (BD) has been associated with high rates of general medical comorbidities (GMC) and medical risk factors. There have been scarce reports about this prevalence in Brazilian subjects with BD. OBJECTIVE: Describe the prevalence of GMC in a sample of BD type I patients. METHODS: Clinical records of 195 patients with BD type I were reviewed for identification of GMC. Patients with and without GMC were compared using the Mann-Whitney nonparametric test and the chi-Square test. RESULTS: Sixty-three percent of patients had at least one medical comorbidity. The most prevalent conditions were: migraine (31.8%), hypothyroidism (24.1%), hypertension (11.3%), traumatic brain injuries (10.3%), asthma (9.7%), epilepsy (8.2%), diabetes (5.1%), stroke (2.1%) and hyperthyroidism (1%). Age and duration of illness were positively associated with the presence of GMC (p < 0.001). DISCUSSION: In our study, in accordance with previous reports, the majority of patients presented at least one general medical disorder. The principal limitation of this study is the fact that diagnose of GMC was made based on self-report. There are scarce studies addressing GMC in the Brazilian population with BD and this report can contribute to improve diagnostic vigilance, assessment, treatment planning and decrease the burden associated with BD.