Bipolar disorder has among the highest mortality rates of any psychiatric disorder (suicide, medical comorbidities).
It turns out that increased mortality persists into late life, according to the results of this Dutch cohort study.
www.ajgponline.org/article/S106... (sorry, paywall) #medsky
![The upward spiral of community reintegration. [A] Cross-section of the virtuous spiral of community reintegration with structural support using 4 strategies. [B] Longitudinal view of the virtuous spiral of community reintegration with structural support using 4 strategies. The figure represents how the health or social care system (support column) can deliver strategies (spokes) that link to community reintegration outcomes/health states (spiral). Maroon: Develop patient and family skills à manage symptoms of underlying impairments at home; Orange: Re-establish competence to perform healthy habits and routines; Blue: Identify & support key roles and relationships à stay connected even amid change. Green: Problem-solve the physical and social environments à Enable ongoing participation in meaningful activities. [C] Problem-identification using the virtuous spiral of community reintegration. Problems are any subjective or objective barriers to continuing to make progress toward, or to maintain, community (re) integration. They can occur anywhere on the spiral. Hypothetical Example Problem: A patient is having difficulty re-establishing a rhythm for doing laundry and meal preparation. [D] Troubleshooting problems. Troubleshooting involves a root cause analysis of why things broke down and the main impacts of the breakdown. Because the spiral is interconnected, both the root cause and the impacts can occur in any or multiple quadrants. Thus, all quadrants should be assessed to identify cross-cutting issues. Example Troubleshooting: On further questioning, the problem with laundry and meal preparation (orange quadrant) is that she’s exhausted because her sleep is disrupted. Sleep is itself a routine (orange quadrant). The question is, what is disrupting her sleep? While multifactorial, the main driver seems to be insomnia related to unrecognized trauma symptoms (maroon quadrant). The trauma symptoms have also led to some irritability that is impacting her relationships (…](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:b7i26cylyzqnqtstgevcxvwc/bafkreibwye3uvib2t4px5ezkvr2xmdezpkhkkqtkuha3ordbcyn5y5algi)
![Explanation of the Medication Regimen Complexity Index (MRCI). It estimates the complexity of a patient's medication regimen based on three components: pharmaceutical dosage forms and routes, dosage frequencies, and additional instructions for use (such as breaking tablets). The total MRCI score is the sum of the subscores on these three components for each medication. The table only shows a selection of the weightings; the full tool can be found in the article by George et al. [12]. In the component form and route, each dosage form present in the regimen is only weighted once. The minimum MRCI score is 1.5, representing one tablet or capsule taken once daily as required; there is no maximum, as the score rises with the number of medications. Higher MRCI scores correspond to a higher complexity of medication use.](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:b7i26cylyzqnqtstgevcxvwc/bafkreictjamxpjvnxqekspe5qtpofmcesp37ag4njo2ey5gq2pfoyozoea)
