雙極性疾患共罹身體疾病的性別差異

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