Clinical and dynamic features of bipolar affective disorder in patients with chronic coronary artery disease

Introduction. Currently, the study of comorbidity, which is characteristic of the clinical picture of modern patients, is relevant. This also applies to psychiatric disorders in cardiovascular diseases, which are common, affect social functioning and determine the clinical and biological characteristics of patients and prognosis. Bipolar disorder and coronary heart disease are one example of such a comorbidity. Recent evidence suggests that up to 40% of patients with bipolar disorder die from cardiovascular disease.

Aim: To study the frequency of bipolar disorders and their clinical and dynamic features in patients with chronic coronary artery disease with the assessment of seven-year survival rates.

Material and Methods. Patients with confirmed chronic coronary artery disease, aged 35–70 years, living in Tomsk and the Tomsk Region: the main group (with identified mood disorders, diagnosed by a psychiatrist, n = 262) and the comparison group (without mood or other mental disorders, n = 291). The Hamilton Depression Scale for Seasonal Affective Disorders was used to assess depressive symptoms. The survival tables and Kaplan – Meier methods were used to assess survival, survival curves were compared using the Mantel – Cox logrank test.

Results. The frequency of bipolar disorder among hospitalized patients with chronic coronary artery disease was three times higher than that in the population. Depressive symptoms in bipolar disorder did not differ clinically from those in other mood disorders. The prognostic signs indicating the risk of bipolar disorder include: family history with mental disorders, atypical specification of depression, earlier age of onset of depression, high multimorbidity with mental (anxiety disorders, dependence syndrome due to alcohol, nicotine) and physical diseases. According to a retrospective assessment, coronary artery disease in half of the cases developed against the background of bipolar disorder. During the 7-year follow-up period, the number of cases of bipolar disorder doubled compared to the beginning of the study. Patients with bipolar disorder had more frequent acute myocardial infarction and had clinically more significant functional classes of angina pectoris and heart failure.

Conclusion. During the 7-year follow-up period, the number of patients with bipolar disorder doubled. Patients with this comorbidity had an unfavorable prognosis in terms of survival (62.5%) compared with individuals without mood disorders.

1. Oganov R.G., Simanenkov V.I., Bakulin I.G., Bakulina N.V., Barbarash O.L., Boytsov S.A. et al. Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Cardiovascular Therapy and Prevention. 2019;18(1):5–66. (In Russ). DOI: 10.15829/1728-8800-2019-1-5-66.

2. Puzyrev V.P., Freidin M.B. Genetic View on the phenomenon of combined diseases in man. Acta Naturae. 2009;1(3):52–57. (In Russ). DOI: 10.32607/20758251-2009-1-3-52-57.

3. Neznanov N.G., Rukavishnikov G.V., Kaysanov E.D., Philippov D.S., Kibitov A.O., Mazo G.E. Biopsychosocial model in psychiatry as an optimal paradigm for relevant biomedical research. Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Bekhtereva. 2020;2:3–15. (In Russ). DOI: 10.31363/2313-7053-2020-2-3-15.

4. Walker E.R., Druss B.G. Mental and addictive disorders and medical comorbidities. Curr. Psychiatr. Rep. 2018;20(10):86. DOI: 10.1007/s11920-018-0956-1.

5. Vinokurov E., Sobennikov V.S. Depression and cardiac diseases (review of literature). Acta Biomedica Scientifica. 2017;2(4):63–67. (In Russ). DOI: 10.12737/article_59fad516bdb3e0.52521063.

6. Lebedeva E.V., Schastnyy E.D., Simutkin G.G., Sergienko T.N., Nonka T.G., Repin A.N. et al. Influence of affective disorders with different risk of suicidal behavior on survival of patients receiving conservative therapy of chronic coronary artery disease. Suicidology. 2017;8(3):84–94. (In Russ).

7. Schastnyi E.D., Simutkin G.G., Lebedeva E.V., Yakovleva A.L., Losenkov I.S., Repin A.N. et al. Clinical-dynamic and biological aspects of polymorphism and efficacy of therapy of mood disorders. Siberian Journal of Clinical and Experimental Medicine. 2018;33(3):86–92. (In Russ). DOI: 10.29001/2073-8552-2018-33-3-86-92.

8. Nonka T.G., Lebedeva E.V., Repin A.N. The effect of depressive disorder on the clinical presentation of coronary artery disease and five-year survival of patients after myocardial infarction. Bulletin of Siberian Medicine. 2022;21(3):81–86. (In Russ). DOI: 10.20538/1682-0363-2022-3-81-86.

9. Vasilieva S.N., Simutkin G.G., Schastnyy E.D., Lebedeva E.V., Bokhan N.А. Late diagnostics of bipolar disorder: impact on main characteristics of disease, suicidal behaviour and social adaptation level of patients. Psychiatry (Moscow). 2022;20(2):24–31. (In Russ). DOI: 10.30629/2618-6667-2022-20-2-24-31.

10. Miller C., Bauer M.S. Excess mortality in bipolar disorders. Curr. Psychiatr. Rep. 2014;16(11):499. DOI: 10.1007/s11920-014-0499-z.

11. Hayes J.F., Marston L., Walters K., King M.B., Osborn D.P.J. Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. Br. J. Psychiatry. 2017;211(3):175–181. DOI: 10.1192/bjp.bp.117.202606.

12. Hert M., Detraux J., Vancampfort D. The intriguing relationship between coronary heart disease and mental disorders. Dialogues Clin. Neurosci. 2018;20(1):31–40. DOI:10.1192/bjp.bp.117.202606.

13. Correll C.U., Solmi M., Veronese N., Bortolato B., Rosson S., Santonastaso P. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16(2):163–180. DOI: 10.1002/wps.20420.

14. Lebedeva E.V. Mood disorders in patients with chronic coronary arthery disease: patterns of formation, therapy and rehabilitation: Abstract of MD thesis. Tomsk, 2021;43.

15. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR™). American Psychiatric Association; 2022:1120.

16. Łojko D., Buzuk G., Owecki M., Ruchała M, Rybakowski J.K. Atypical features in depression: association with obesity and bipolar disorder. J. Affect. Disord. 2015;85:76–80. DOI: 10.1016/j.jad.2015.06.020.

17. Łojko D., Rybakowski J.K. Atypical depression: current perspectives. Neuropsychiatr. Dis. Treat. 2017;13:2447–2456. DOI: 10.2147/NDT.S147317.

18. Williams J.B.W., Link M.J., Rosenthal N.E., Amira L., Terman M. Structured interview guide for the Hamilton Depression Rating Scale – Seasonal Affective Disorder version. New York; New York State Psychiatric Institute; 2002. URL: esearchgate.net/publication/279233846_Structured_Interview_Guide_for_the_Hamilton_Depression_Rating_Scale_Seasonal_Affective_Disorder_Version_SIGH-SAD (10.11.2023).

19. Clemente A.S., Diniz B.S., Nicolato R. Bipolar disorder prevalence: a systematic review and meta-analysis of the literature. Rev. Bras. Psychiatr. 2015;37(2):155–161. DOI: 10.1590/1516-4446-2012-1693.

20. Esan O., Esan A. Epidemiology and burden of bipolar disorder in Africa: a systematic review of data from Africa. Soc. Psychiatry Psychiatr. Epidemiol. 2016;51(1):93–100. DOI: 10.1007/s00127-015-1091-5.