Identifying and treating comorbidities in people with bipolar disorder
Bipolar disorder is associated with significant morbidity and mortality. To reduce rates of early morbidity and mortality, identify and manage chronic conditions.
- Monitor patients for problem substance use. Inform patients that problem substance use can be associated with an increased risk of relapse and self-harm. Treating problem substance use and bipolar disorder concurrently with an integrated treatment program appears to provide the best outcome (see Alcohol and other drug problems).
- Assess patients for comorbid anxiety disorders and manage accordingly, but be cautious with antidepressant use because of the risk of manic switch—anxiety disorders occur in around half of patients with bipolar disorder and are associated with worse outcomes.
- Maintain physical health to reduce rates of cardiometabolic disease and improve psychological outcomes:
- support the patient to undertake regular physical activity1—as well as improving fitness, physical activity may help with depressive and anxious symptoms and promote better sleep
- support the patient to eat a healthy diet2—many drugs used to treat bipolar disorder can cause weight gain or increased appetite (eg lithium, sodium valproate, antipsychotics). For prevention, monitoring and management of cardiometabolic effects of antipsychotics, see here
- help the patient to maintain a healthy weight
- reduce alcohol intake
- encourage the patient to stop smoking—however, smoking cessation can increase the blood concentrations of some antipsychotics (eg olanzapine), necessitating a dose reduction
- avoid using an antipsychotic with significant cardiometabolic adverse effects (see Approximate relative frequency of common adverse effects of antipsychotics).
1 For advice on physical activity, see
Australia’s Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines.Return