Diagnosing and Treating Comorbid (Complicated) Bipolar Disorder

Comorbidity is the rule, not the exception, in bipolar disorder. The most common mental disordersthat co-occur with bipolar disorder in community studies include anxiety, substance use, and conductdisorders. Disorders of eating, sexual behavior, attention-deficit/hyperactivity, and impulse control, aswell as autism spectrum disorders and Tourette’s disorder, co-occur with bipolar disorder in clinicalsamples. The most common general medical comorbidities are migraine, thyroid illness, obesity, typeII diabetes, and cardiovascular disease. Bipolarity is a marker for comorbidity, and comorbid disorders,especially multiple conditions occurring when a patient is young, may be a marker for bipolarity.Relatively few controlled clinical studies have examined the treatment of bipolar disorder in the contextof comorbid conditions (i.e., complicated or comorbid bipolar disorder). However, the first stepin treating any type of complicated bipolar disorder—stabilizing a patient’s mood—may be associatedwith improving the comorbid disorder. Standard mood stabilizers, atypical antipsychotics, and nonantimanicantiepileptic agents are emerging as potentially useful treatments for several of thedisorders that frequently co-occur with bipolar disorder, and therefore may be useful treatments forcomorbid bipolar disorder.