Cardiovascular Risk in Tunisian Patients with Bipolar I Disorder

Bipolar disorder (previously also labeled manic-depressive illness) is typically referred to as an episodic, yet lifelong and clinically severe affective (or mood) disorder, affecting approximately 3.5% of the population (Marmol, 2008; Simon, 2003; Wittchen et al., 2003; Woods, 2000). The term bipolar disorder, however, encompasses several phenotypes of mood disorders, i.e. mania, hypomania or cyclothymia that may present with a puzzling variety of other symptoms and disorders. According to the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 2004), the diagnostic classificatory system used in most epidemiological studies, bipolar disorder is defined by a set of specific symptom criteria. Bipolar type I requires the presence or the history of at least one manic or mixed episode. Although, typically, patients with a manic episode also experience major depressive episodes, bipolar disorder can be diagnosed even if only one manic episode and no past major depressive episodes are present. Bipolar disorder type II differs from type I only by presence of hypomanic but no manic episodes. Hypomanic episodes differ from mania by a shorter duration (at least 4 days instead of 1 week), and less severe impairment (not severe enough to cause marked impairment in social or occupational functioning, psychiatric hospitalization, or psychotic features). The DSM-IV also includes “cyclothymia” as a bipolar spectrum disorder with hypomanic as well as depressive episodes that do not meet criteria for major depression (American Psychiatric Association, 2004). Bipolar disorder is a chronic disease that is associated with a potentially devastating impact on patients’ wellbeing and social, occupational, and general functioning (Revicki et al., 2005). The disorder ranks as the sixth leading cause of disability in the world, with an economic burden that in the US alone that was estimated more than a decade ago at $7 billion in direct medical costs and $38 billion (1991 values) in indirect costs (Wyatt et al., 1991). A number of reviews and studies have shown that people with severe mental illness, including bipolar disorder, have an excess mortality, being two or three times as high as that