Bipolar patients at higher risk for illnesses

By: BRADLEY J. FIKES - Staff Writer | Saturday, June 9, 2007 6:58 PM PDT ∞

Bipolar disorder patients have a higher risk of cardiovascular disease and diabetes than the general public, and so do their relatives. Yet the word isn't getting out to the more than 5.7 million bipolar Americans, according to a study conducted by Dr. Gary Sachs, director of the Bipolar Clinical and Research Program at Massachusetts General Hospital.

The study, funded by Pfizer, was released at the American Psychiatric Association's May meeting in San Diego.

Sachs said the study found that doctors think they are doing an adequate job of informing their bipolar patients of their risks for other diseases, which are heightened by certain medications. But the doctors are wrong: The message isn't getting through to patients.

Doctors appear to be talking to patients at the wrong time, when they're acutely ill with a bipolar episode, Sachs said in a recent interview. Messages aren't likely to stick at that time. It's when the patients are well that the message can really sink in.

"Death rates due to heart disease, cancer, stroke are two to three times greater than they are in the general population," Sachs said. "Our patients are dying early, more than a decade earlier than the general population."

What that means is that doctors need to be more active in treating their bipolar patients instead of just attending to their mood disorders, Sachs said.

"Both psychiatrists and primary care doctors are aware of the need for education," Sachs said. "They're aware of the need to do screening for general medical problems. But we also found that it simply wasn't happening. The majority of the patients hadn't gotten the message. Fewer than a third of them really had any understanding of the relationship between these general medical conditions and the choices they have in the various treatments in psychiatry."

Some medications can raise blood sugar and cholesterol levels, increasing the risk of diabetes and cardiovascular disease, Sachs said.

"Fewer than half the patients understood the need to screen for those sorts of problems," Sachs said. "But on the doctor side, they actually felt they did inform the patients about them."

Doctors need to alter their style of patient education to account for the mental disturbances of bipolar patients, he said.

"We teach these rather abstract lessons to people who are at a great disadvantage," Sachs said. "This is not the time and place to teach them. And we're asking them to teach it to their family members and friends. That is a losing proposition."

Sachs said a test program conducted at 26 treatment centers across the country has shown that bipolar patients understand more when they are given material to take home with them to look at with family and friends when they are emotionally well.

"We gave every patient a workbook and a DVD to share with their family. It taught them about the illness, basic information, treatment options. We found this did enhance the outcomes for patients," he said. "They were much more likely to get the kinds of treatments that were effective. I think it's because we moved the educational process out from the office, from the acute setting, to patients' living rooms and studies. Somebody's relative in St. Louis could access the information just as easily as me sitting here in Boston."

Sachs' clinic provides information on bipolar disorder on the Web at http://www.manicdepressive.org.

The study was conducted by Harris Interactive on behalf of bipolar disorder experts. Those who responded to the study included 300 bipolar disorder patients, 100 psychiatrists and 100 primary care doctors.

Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.

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