The majority of people with bipolar disorder will develop cerebrovascular disease, the key contributor to stroke.
People with bipolar disorder are twice as likely to die of stroke as the general population. Oddly enough, though, they are less likely to die in the hospital.
5.63% of people who have strokes die in the hospital while being treated. However, only 3.28% of people with BP do. Also, patients with BP have far fewer adverse outcomes such as respiratory distress or the need for a ventilator. Half as many people with BP had these effects.
The length of stay and cost of care for people with and without BP was essentially identical.
If they seem to do better in the hospital, why do so many more people with BP die of stroke?
Researchers studying older-aged bipolar disorder (OABP) conclude that it is because people with OABP receive suboptimal care for cerebrovascular disease. They may not even receive treatment in hospital, as they face much higher levels of dementia and substance abuse and may not be able to seek help, or even understand that they need help.
They are also more likely to be discharged without a clear understanding of steps they need to take to avoid another stroke.
As a rule, people with BP do not receive the same level of care for non-psychiatric disease as people without BP. The lower number of adverse outcomes in stroke patients with BP is likely a result of poor care and poor diagnosis of people with BP. The researchers surmise that these patients have adverse outcomes at the same rate as the general population, they just aren’t being diagnosed with or treated for these conditions.
People with BP may be neglected and not brought into medical establishments upon early symptoms of stroke. They don’t die in the hospital because they never get there.
This could explain the higher level of mortality in people with BP who have strokes while fewer of them die in the hospital.
Reasons for the higher rate of cerebrovascular disease in people with BP are unclear. Studies suggest that antipsychotics and antidepressants increase the risk of stroke. Unhealthy lifestyles also contribute to the risk of stroke, and people with BP are notorious for having unhealthy lifestyles. However, lifestyle data was not collected in the survey of research cited in this post.
All of this contributes to the fact that people with bipolar disorder have 2 to 4 times higher mortality rates and at least a 10-year reduction in life expectancy compared to the general population. Regrettably, this mortality gap has increased over the last several years.
Cardiovascular disease such as stroke is the leading cause of death in people with BP. Healthy lifestyle choices and clear information on the prevention of cerebrovascular disease can help. Education is key.
Providing better non-psychiatric medical care to the population with BP will be necessary to improve the number of stroke victims with BP. A more holistic view of overall health is called for.
Co-morbidities, such as bipolar disorder and stroke, will be best treated with an improved, more cooperative pattern of care among the doctors of various specialties who care for people with BP.