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Cerebrovascular Disease and Bipolar Disorder

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Neuropsychiatric Symptoms of Cerebrovascular Diseases

Part of the book series: Neuropsychiatric Symptoms of Neurological Disease ((NSND))

Abstract

Bipolar disorder has been strongly associated with cardiovascular disease although the relationship between the two conditions is complex with regard to directionality and mechanisms. The defining syndromes of bipolar disorder, mania and hypomania, can occur following stroke, including in individuals who are seemingly otherwise not at risk based on age, family history, and past psychiatric history. This has led many experts to conclude that bipolar disorder may occur secondary to stroke. Individuals with idiopathic forms of bipolar disorder further face a considerably increased risk for cerebrovascular mortality and stroke. This elevation in risk is large and estimated to be approximately twice that expected from general population estimates for both cerebrovascular mortality and events. There exist a variety of mechanisms that may link bipolar disorder with cerebrovascular disease, and some risk factors may predispose vulnerable individuals to both conditions. These mechanisms include–though are not limited to–inflammation, oxidative stress/mitochondrial dysfunction, abnormalities in the hypothalamic-pituitary-adrenal axis, and sleep disorders. Clinicians should be mindful of the potential for stroke to induce mania and recognize that individuals with bipolar disorder are at special risk for vascular disease, a risk that early and assertive clinical intervention may potentially mitigate.

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Authors and Affiliations

  1. Department of Neurology, University of Florida College of Medicine, 100236, Gainesville, FL, 32610-0236, USA

    Joanne A. Byars MD

  2. Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Jess G. Fiedorowicz MD, PhD

  3. Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Jess G. Fiedorowicz MD, PhD

  4. Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, 52242, USA

    Jess G. Fiedorowicz MD, PhD

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Correspondence to Joanne A. Byars MD .

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  1. , Serviço de Neurologia, Hospital de Santa Maria, Av. Prof. Egas Moniz, Lisboa, 1649-035, Portugal

    José M. Ferro

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Byars, J.A., Fiedorowicz, J.G. (2013). Cerebrovascular Disease and Bipolar Disorder. In: Ferro, J. (eds) Neuropsychiatric Symptoms of Cerebrovascular Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2428-3_14

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