雙極性疾患共罹身體疾病的性別差異

Gender Difference in Medical Comorbidity of Bipolar Disorder

10.29478/TJP.200609.0007

張耿嘉(Kun-Chia Chang)；蔡尚穎(Shang-Ying Tasi)；黃意霖(Yi-Lin Huang)；陳喬琪(Chiao-Chicy Chen)

雙極性疾患 ； 共病性 ； 生理疾病 ； 性別差異 ； bipolar disorder ； comorbidity ； physical diseases ； gender difference

台灣精神醫學

20卷3期（2006 / 09 / 01）

221 - 229

繁體中文

Background: The prevalence of co-existing physical illness among bipolar patients is different from that of the general population. Data are limited, however, on the difference in medical comorbidity of bipolar disorder between genders. Methods: The study group consisted of randomly recruited patients with bipolar I disorder (DSM-Ⅳ) who visited Taipei City Psychiatric Center or the Psychiatric Department of Taipei Medical University Hospital between 1999 and 2003. Clinical data for each subject was obtained from direct interview with patients, self-administered questionnaire, and review of medical records. Results: We recruited 126 male patients with mean 42.4 years of age and 198 female patients with mean age of 41.0 years. The average number of years after illness onset at the time of inclusion was l5.4. Concurrent medical morbidities were classified on the basis of organ-system categories. Female patients were more vulnerable to morbidities of the endocrine metabolic/breast category (24.3%, compared with 12.7% for males, p＜0.02). Male patients were more likely to develop pulmonary disease (11.9%, compared with 5.2% in females. p＜0.05). Peptic ulcer was the disease with the greatest difference between genders (15.1% in males compared with 5.2% in females, p＜0.05). Males had a significantly higher prevalence of substance use such as smoking (51.7%, p＜0.001) and alcohol problems (39.6%, p＜0.001) than in females (9.8% and 13.6%, respectively). Conclusion: This study demonstrated that in addition to the general tendency for increased rates of co-morbid physical diseases among bipolar patients associated with idiosyncratic predisposition, medical comorbidity of gender difference also existed. Substance use was associated with a higher rate of pulmonary disease and peptic ulcer in male bipolar patients. The high rate of endocrine disease in female bipolar patients may be associated with some biological predisposing factors. (Full text in Chinese)

Background: The prevalence of co-existing physical illness among bipolar patients is different from that of the general population. Data are limited, however, on the difference in medical comorbidity of bipolar disorder between genders. Methods: The study group consisted of randomly recruited patients with bipolar I disorder (DSM-Ⅳ) who visited Taipei City Psychiatric Center or the Psychiatric Department of Taipei Medical University Hospital between 1999 and 2003. Clinical data for each subject was obtained from direct interview with patients, self-administered questionnaire, and review of medical records. Results: We recruited 126 male patients with mean 42.4 years of age and 198 female patients with mean age of 41.0 years. The average number of years after illness onset at the time of inclusion was l5.4. Concurrent medical morbidities were classified on the basis of organ-system categories. Female patients were more vulnerable to morbidities of the endocrine metabolic/breast category (24.3%, compared with 12.7% for males, p＜0.02). Male patients were more likely to develop pulmonary disease (11.9%, compared with 5.2% in females. p＜0.05). Peptic ulcer was the disease with the greatest difference between genders (15.1% in males compared with 5.2% in females, p＜0.05). Males had a significantly higher prevalence of substance use such as smoking (51.7%, p＜0.001) and alcohol problems (39.6%, p＜0.001) than in females (9.8% and 13.6%, respectively). Conclusion: This study demonstrated that in addition to the general tendency for increased rates of co-morbid physical diseases among bipolar patients associated with idiosyncratic predisposition, medical comorbidity of gender difference also existed. Substance use was associated with a higher rate of pulmonary disease and peptic ulcer in male bipolar patients. The high rate of endocrine disease in female bipolar patients may be associated with some biological predisposing factors. (Full text in Chinese)

1. Arnold LM(2003).Gender differences in bipolar disorder.Psychiatr Clin North Am,26,595-620.
2. Dixon L,Weiden P,Delahanty J(2000).Prevalence and correlates of diabetes in national schizophrenia sample.Schizophr Bull,26,903-912.
3. Fenn HH,Bauer MS,Alshuler L(2005).Medical comorbidity and health-related quality of life in bipolar disorder across the adult age span.J Affect Disord,86,47-60.
4. Kendrick T(1996).Cardiovascular and Respiratory risk factors and symptoms among general practice patients with long-term mental illness.Br J Psychiatry,169,33-39.
5. Kilbourne AM,Cornelius JR,Han X(2004).Burden of general medical conditions among individuals with bipolar disorder.Bipolar Disord,6,368-373.
6. Koong SL,Serdula MK,Williamson DF,Malison MD,Davis RM(1991).Smoking prevalence in the United States and Taipei City, Taiwan.Am J Prey Med,7,161-165.
7. Lilliker SL(1980).Prevalence of diabetes in a manic-depressive population.Compr Psychiatry,21,270-275.
8. Maity P,Biswas K,Roy S,Banerjee RK,Bandyopadhyay U(2003).Smoking and the pathogenesis of gastroduodenal ulcer--recent mechanistic update.Mol Cell Biochem,253,329-338.
9. Miller MD,Cynthia F,Houck PR(1992).Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale.Psychiatry Res,41,237-248.
10. Nasr S,Altman EG,Meltzer HY(1981).Concordance of atopic and affective disorder.J Affect Disord,3,291-296.
11. Newcomer JW(2004).Abnormalities of glucose metabolism associated with atypical antipsychotic drugs.J Clin Psychiatry,65(suppl 18),36-46.
12. Regier DA,Farmer ME,Rae DS(1990).Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area(ECA) Study.JAMA,264,2511-2518.
13. Ruzickova M,Slaney C,Garnham J,Alda M(2003).Clinical features of bipolar disorder with and without comorbid diabetes mellitus.Can J Psychiatry,48,458-461.
14. Strakowski SM,Keck PW,McElroy SL,Lonczak HS,West SA(1995).Chronology of comorbidity and principal syndromes in first-episode psychosis.Compr Psychiatry,36,106-112.
15. Tai TY,Yang CL,Chang CJ(1987).Epidemiology of diabetes mellitus among adults in Taiwan, R.O. C.J Med Assoc Thai,70(suppl 2),42-48.
16. Tsai SY,Chen CC,Yeh EK(1997).Alcohol problems and long-term psychosocial outcome in Chinese bipolar disorder.J Affect Disord,46,143-150.
17. Tsai SY,Chen KP,Yang YY(1999).Activation of indices of cell-mediated immunity in bipolar mania.Biol Psychiatry,45,989-994.
18. Tsai SY,Kuo CJ,Chen CC,Lee HC(2002).Risk factors for completed suicide in bipolar disorder.J Clin Psychiatry,63,469-476.
19. Tsai SY,Lee CH,Kuo CJ,Chen CC(2005).Retrospective analysis for risk and protective factors for natural death in bipolar disorder.J Clin Psychiatry,66,1586-1591.
20. Tsai SY,Lee JC,Chen CC(1999).Characteristics and psychosocial problems of patients with bipolar disorder at high risk for suicide attempt.J Affect Disord,52,145-152.
21. Tsuang MG,Perkins K,Simposon JC(1983).Physical disease in schizophrenia and affective disorder.J Clin Psychiatry,44,42-46.
22. Wang TN,Ko YC,Wang TH,Cheng LS,Lin YC(2000).Segregation analysis of asthma: recessive major gene component for asthma in relation to history of atopic diseases.Am J Med Genet,93,373-380.
23. Winokur G,Coryell W,Akiskal HS(1996).Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary -secondary distinction.Am J Psychiatry,1531,674-676.
24. 陳武正、劉興政、葉乙靜(1994)。行政院衛生署研究計劃行政院衛生署研究計劃,未出版
25. 蔡尚穎(2001)。重大精神疾病治療後衍生的議題。台灣精醫，15，259-260。
26. 蔡尚穎、李儒卿、陳喬琪(1997)。雙極性情感疾患患者之生理疾病。台灣精醫，11，249-261。
27. 蔡尚穎、陳坤波、陳喬琪(1998)。急性躁期患者細胞免疫功能之活化。台灣精醫，12，207-217。
28. 蔡尚穎、陳喬琪、胡維恆(1996)。躁鬱症患者之共存物質濫用：十五年追綜研究。中華精醫，10，357-364。