Morriss Richard, Mohammed Faizal Amir
Division of Psychiatry, University of Liverpool, Liverpool, UK.
J Psychopharmacol. 2005 Nov;19(6 Suppl):94-101. doi: 10.1177/0269881105058678.
Lifestyle, illness and treatment factors in people with bipolar disorder (BD) may confer additional risk of morbidity and mortality to the increasing rates of obesity, metabolic syndrome, diabetes mellitus and cardiovascular mortality in the general population.The aim of this review is to examine whether the risk of obesity and related morbidity and mortality are raised in BD, and possible contributory effects of lifestyle, illness and treatment factors to this risk.Systematic search of Medline and Cochrane Collaboration for relevant studies followed by a critical review of literature was carried out.Mortality from cardiovascular causes and pulmonary embolism (standardized mortality ratio approximately 2.0), and morbidity from obesity and type 2 diabetes mellitus may be increased in BD compared to the general population. Reduced exercise and poor diet, frequent depressive episodes, comorbidity with substance misuse and poor quality general medical care contribute to the additional risk of these medical problems in people with BD. There is no evidence that patients with BD are more sensitive than other patients to weight gain and medical problems associated with long-term use of psychotropic medication; in fact long-term treatment with lithium, antipsychotics and tricyclic antidepressants may reduce overall mortality. Psychiatrists, general practitioners and other health professionals should work together to systematically assess and manage weight gain and related medical problems to reduce the morbidity and mortality associated with obesity in BD. There is insufficient evidence to associate any of these factors with specific drug treatments. More research is required to understand how BD changes the risk for physical health comorbidity.
双相情感障碍（BD）患者的生活方式、疾病及治疗因素，可能会使肥胖、代谢综合征、糖尿病以及心血管疾病死亡率在普通人群中日益增加的基础上，进一步增加发病和死亡风险。本综述旨在探讨BD患者肥胖及相关发病和死亡风险是否升高，以及生活方式、疾病和治疗因素对该风险可能产生的促成作用。我们对Medline和Cochrane协作网进行了系统检索以查找相关研究，随后对文献进行了批判性综述。与普通人群相比，BD患者心血管疾病和肺栓塞导致的死亡率（标准化死亡率约为2.0）以及肥胖和2型糖尿病的发病率可能会增加。运动减少、饮食不良、频繁的抑郁发作、合并物质滥用以及普通医疗护理质量差，都会增加BD患者出现这些医疗问题的额外风险。没有证据表明BD患者比其他患者对体重增加以及与长期使用精神药物相关的医疗问题更敏感；事实上，长期使用锂盐、抗精神病药物和三环类抗抑郁药进行治疗可能会降低总体死亡率。精神科医生、全科医生和其他卫生专业人员应共同努力，系统地评估和管理体重增加及相关医疗问题，以降低BD患者肥胖相关的发病率和死亡率。没有足够的证据将这些因素中的任何一个与特定药物治疗联系起来。需要更多的研究来了解BD如何改变身体健康合并症的风险。
