Asthma has been initially believed to be a disorder of inflammation. In asthmatic patients, inflammatory cytokines are altered with asthma exacerbation. People with bipolar disorder are also found to have dysfunction of inflammation during various emotional states. As such, some researchers suggest that these two disorders may share similar mechanisms in their pathophysiology.

What is the evidence for the co-occurrence of asthma and bipolar disorder?

Moderate to high quality evidence finds a small increased risk of bipolar disorders in people with asthma. Lower quality evidence also found a small increased risk of asthma in those with bipolar disorders.

October 2021

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Autoimmune disease occurs when the body attacks its own tissues due to an abnormally functioning immune system. Common autoimmune diseases include systemic lupus erythematosus, rheumatoid arthritis, psoriasis, multiple sclerosis, ulcerative colitis, Crohn’s disease, ankylosing spondylitis, pemphigus, and Sjogren’s syndrome.

What is the evidence for comorbid autoimmune disease?

Moderate quality evidence finds a significant, small increased rate of bipolar disorder in people with autoimmune disease, particularly sicca syndrome, systemic lupus erythematosus, and psoriasis.

Moderate to low quality evidence finds the prevalence of bipolar disorder in people with multiple sclerosis is ~6%. This finding is based on one study conducted in England, so may not be applicable to other populations.

October 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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What is the evidence for comorbid cancer?

Moderate to high quality evidence finds a small, significant increased risk of any cancer in people with bipolar disorder compared to people without bipolar disorder. Analysis containing only patients on lithium showed no increased rates of cancer.

October 2021

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People with bipolar disorder may show increased rates of co-occurring conditions when compared to general population rates. Cerebrovascular disease includes strokes, transient ischemic attacks, aneurysms, and vascular malformations. A stroke happens when blood flow to the brain is interrupted due to a blocked artery (ischaemic stroke) or when an artery bursts (haemorrhagic stroke). A transient ischemic attack is similar to a stroke, but less severe, and an aneurysm involves an enlarged artery caused by weakness in the arterial wall. These can all cause brain damage if cells do not get enough of the oxygen and nutrients that are carried by the blood to the brain.

What is the evidence for cerebrovascular disease in people with bipolar disorder?

Moderate quality evidence finds a small increase in cerebrovascular disease and stroke in people with bipolar disorder compared to people without bipolar disorder. The effect size was reduced, but remained significant in longitudinal studies, after adjustment for other variables that may have explained this association (e.g. co-occurring obesity, alcohol and substance-related disorders, diabetes, hypertension or hyperlipidemia).

October 2021

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Dementia is characterised by significant cognitive impairment. Symptoms include memory impairment, aphasia (impaired language functioning), apraxia (aberrant movement), agnosia (inability to identify objects, people, sound or smell), and impaired executive functioning (for example, the ability to think abstractly, plan, initiate or stop actions). Other symptoms include behavioural disturbances, anxiety, apathy, delirium, and mood and sleep disturbances.

What is the evidence for dementia in people with bipolar disorder?

Moderate quality evidence funds a medium-sized increased risk of dementia in people with the disorder compared to people without the disorder. Moderate to high quality evidence finds a medium-sized decreased risk of dementia in people with the disorder who are taking lithium compared to those not taking lithium.

October 2021

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People with bipolar disorder may show increased rates of unrelated co-occurring illnesses, one example is diabetes. Diabetes is a state of impaired insulin function, either as a result of reduced insulin production (type I diabetes) or reduced insulin responsiveness (type II diabetes). Insulin regulates blood glucose levels, and reduced insulin function effectively increases blood glucose levels (hyperglycaemia). This is a dangerous state in the long term, and can ultimately damage the retina, kidneys, nerves and blood vessels. Consequently, effective management of diabetes is crucial. It is unclear if any increased risk in people with bipolar disorder is purely a consequence of biological risk, the metabolic impact of antipsychotic administration, or unhealthy lifestyle choices, but it is likely a combination of many factors.

What is the evidence for comorbid diabetes?

Moderate quality evidence suggests the overall prevalence of type 2 diabetes in people with bipolar disorder is ~9.4%, with a small to medium-sized increased risk of diabetes when compared to age and gender-matched controls.

October 2021

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People with bipolar disorder may show increased rates of co-occurring conditions. These can include digestive system disorders such as appendicitis, gastric ulcers, irritable bowel syndrome, and celiac (or coeliac) disease.

What is the evidence for digestive disorders?

High quality evidence suggests a medium-sized increased rate of bipolar disorder in people with irritable bowel syndrome compared to people without irritable bowel syndrome. Moderate quality evidence found no difference in the rate of bipolar disorder between people with or without celiac disease.

October 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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Fibromyalgia is a centralised pain syndrome characterised by the presence of chronic widespread pain in association with fatigue, sleep disturbances and cognitive dysfunction. Fibromyalgia has been associated with higher rates of mood recurrences and greater disability. The use of antidepressants in fibromyalgia management may promote manic switches and episodes with mixed features.

What is the evidence for comorbid fibromyalgia?

Moderate quality evidence suggests the overall prevalence of bipolar disorder in people with fibromyalgia is ~15%, which represents a large increased risk when compared to people without fibromyalgia.

October 2021

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