“精神健康专业人士与提供生理疾病治疗的医师并肩作战。许多地方，卫生保健和身心健康方案的新方法正在测试以发现预防双相患者和其他精神疾病患者过早死亡的有效模型”他补充道。
Katon博士坦言自己已经收到了来自礼来公司，辉瑞公司，森林实验室和惠氏公司的谢礼。他同时也是礼来公司的咨询会的成员。Roshanei-Moghaddam博士中立报道。
译者注：
social deprivation 社会剥夺
指因自幼父母过分保护，或因自幼生活环境过份孤立，致使个体无从参与社会性活动。无法获得社会经验与能力，终而影响其个性发展的情形。社会性剥夺与生活贫穷无关。自幼生活艰苦的孩子，其社会经验可能远较自幼娇生惯养者更为丰富。
Bipolar Disorder Increases Risk for Premature Death from Medical IllnessBipolar Disorder Increases Risk for Premature Death From Medical Illness
First Systematic Review Reveals Bipolar Patients Have up to 2-Fold Increased Risk for Early Death
Caroline Cassels
February6, 2009 — Bipolar disorder appears to increase the risk for prematuredeath due to medical illness, including cardiovascular andcerebrovascular disease, endocrine disorders, and chronic obstructivepulmonary disease.
The first systematic review to examinemortality data in bipolar disorder shows that affected individuals havebetween a 1.5- and 2-fold increased risk for premature death due tothese common medical conditions.
"It appears bipolar disorder is asbig a risk factor for premature mortality as smoking. This is a majorfinding and drives home the message that as psychiatrists we should beregularly monitoring the physical status of our patients with chronicmental illness," principal investigator Wayne Katon, MD, from theUniversity of Washington School of Medicine, in Seattle, said.
With first author Babak Roshanaei-Moghaddam, MD, the study is published in the February issue of Psychiatric Services.
Striking Findings
Accordingto Dr. Katon, several studies have shown a link between majordepression and an increased risk for early mortality due to generalmedical illnesses. Recent evidence from literature reviews inschizophrenia reveals similar results.
In the past, excess deathsassociated with bipolar illness were attributed to unnatural causes,such as suicide, homicide, and unintentional injuries. However, agrowing body of literature suggests this may account for only a portionof premature mortality in these individuals.
The investigatorsreviewed 17 studies involving more than 331,000 patients with bipolardisorder, affective psychosis, affective disorder requiring inpatientpsychiatric care or treatment with lithium, or schizoaffectivedisorder.
Compared with age- and sex-matched control sampleswithout mental illness from the general population, mortality ratiosfor death from natural causes and from specific general medicalconditions such as heart disease, stroke, diabetes, and chronicobstructive pulmonary disease were significantly higher.
Theinvestigators point out this finding was particularly striking inlarger studies of more than 2500 patients with bipolar disorder.
Vicious Cycle
Althoughthe mechanism is not entirely clear, Dr. Katon said research by hisgroup investigating the link between major depression and conditionssuch as heart disease, osteoarthritis, and diabetes suggests there maybe a bidirectional adverse interaction between chronic mental illnessand medical illness.
Having a major mental illness such as bipolardisorder increases the likelihood of developing physical illnessthrough a variety of factors, including poor diet, smoking, lack ofexercise, substance abuse, social deprivation, and a lack of medicalcare, among others.
In addition, he said, the chronic stressinherent in having a major medical illness can affect the hypothalamicpituitary adrenal axis, increasing cortisol levels and leading toheightened activity of the sympathetic nervous system, possibly leadingto earlier development of medical illness.
Once patients with amental illness contract a medical illness, it is often a greaterchallenge for them to manage their condition. With diseases likediabetes, which requires a lot of self-care, poor management can leadto more complications, which in turn can feed back and exacerbate themental-health condition.
"It really can turn into a vicious cycle," said Dr. Katon.
Role of Atypical Antipsychotics
Anotherpotential contributing factor to physical illness and prematuremortality in patients with bipolar disorder has been the introductionof second-generation, or atypical, antipsychotics and mood stabilizers,which are now in widespread use.
Although these agents have feweradverse effects, including extrapyramidal symptoms, than theirfirst-generation counterparts, they are associated with obesity andmetabolic abnormalities that may increase the risk for morbidity andmortality resulting from diabetes and cardiovascular disease, theresearchers note.
"So what we've seen in recent years is abeginning of the understanding in the field that mood stabilizers andatypical antipsychotics, although effective in treating mental illness,are bringing new problems to bear.
"This has really gottenpeople's attention and raised awareness in a way I've never seen before— that, as psychiatrists, we need to pay closer attention to ourpatients' physical health. There's not much point in effectivelytreating them for their mental-health problems only to watch them dieprematurely from their medical diseases," said Dr. Katon.
Attemptsto reduce rates of premature mortality in mentally ill patients areunder way and include increased training among psychiatry residentsabout common medical illnesses and the importance of addressing riskfactors.
New Models of Care Needed
In addition, he said, newmodels of care that marry primary-care health services with communitymental-health care are currently being developed and tested.
"Psychiatristsare now on the staff of a growing number of medical-specialty clinics,such as centers for diabetes, heart disease, and cancer, and atprimary-care centers such as family-medicine practices," Dr. Katon said.
"Mental-healthprofessionals are working side by side with providers who treat medicalillnesses. New approaches to healthcare and wellness programs are beingtested at a number of places to find effective models for preventingpremature deaths associated with bipolar disorder and other mentalillnesses," he added.
Dr. Katon discloses that he has receivedhonoraria from Eli Lilly, Pfizer, Forest Laboratories, and Wyeth. He isalso on an advisory board for Eli Lilly. Dr. Roshanei-Moghaddam reportsno competing interests.