LAUSR

MORTALITY IN PATIENTS with psychiatric disorders has been demonstrated to be higher than that of the general population, with their life expectancy also being 10–17.5 years shorter. As a background of premature mortality in psychiatric patients, a high comorbidity of medical illness (rather than suicide) has been established. Especially, cardiovascular disease (CVD) has been suggested to be an important medical comorbidity as an avoidable contributor to early death. Furthermore, CVD-related death was found to be increased in patients with bipolar disorder (BD) compared with controls in a recent meta-analysis of 92 studies that included 3 million patients with severe mental illness. Concerning BD, a large sample of data (over 3000 patients) from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEPBD) was analyzed, and results showed that the prevalence of any medical comorbidity was 58.8%. A sub-analysis from the aforementioned large-scale meta-analysis showed that the presence of BD was significantly associated with CVD incidence (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.28–1.93) and CVD-related death (HR, 1.65; 95%CI, 1.10–2.47) in longitudinal studies. Moreover, a registration study using the Taiwan National Health Insurance Research Database including 913 570 patients with BD showed that the highest relative risk of CVD in BD was found in participants aged younger than 20 years. These studies indicated that CVD comorbidity was more important in younger patients with BD. Risk factors of early CVD-related death were retrospectively investigated by Tsai et al. (716–724), who focused on patients’ physiological condition during the acute phase. These researchers used data of 35 BD patients who died from CVD before 65 years of age. They found that CVD mortality was associated with leukocyte count and heart rate (or systolic blood pressure) upon admission, suggesting that systemic inflammation and sympathetic overactivity during the acute phase may be risk factors for CVDrelated mortality. The checking and management of patients’ systematic physical condition during the acute phase in people with psychiatric disorders, including BD, is often insufficient, especially in psychiatric clinics and hospitals. From evidence of previous reports, including the investigation by Tsai et al., psychiatrists are strongly recommended to recognize the importance of managing physical conditions in the acute phase for people with psychiatric disorders.