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Bipolar disorder patients often develop diabetes, and the medications used to treat bipolar symptoms may be to blame.

People with bipolar disorder struggle with many side effects related to both their mental illness and their treatment therapies. In recent years, diabetes has emerged as one of the more serious health risks for people with bipolar disorder.

Diabetes is found in people with bipolar disorder nearly three times more often than in the general population. This has prompted much research into the link between diabetes and bipolar disorder. Studies have found that people with bipolar disorder tend to be overweight or obese, a key risk factor in developing diabetes. Research into potential causes of this weight gain has identified the medications used to treat bipolar disorder as the likely culprits.

Bipolar Disorder: The Obesity and Diabetes Chain Reaction

Being overweight or obese is a primary risk factor for developing type 2 diabetes. People who carry extra body weight and body fat, particularly around the abdomen, are less able to properly control their blood sugar. That’s because extra body fat interferes with the function of insulin, the naturally occurring hormone produced in the pancreas that helps cells convert sugar into energy or store it away as fat. The body is forced to produce more insulin to handle the conversion. If this situation continues without treatment, permanent damage to the pancreas can occur.

The percentage of patients with bipolar disorder who are overweight is remarkable: Studies have found that between 54 and 68 percent of bipolar patients are either overweight or obese, with obesity affecting about one-fourth of patients and more women than men.

Obesity is one of the criteria for metabolic syndrome, the health condition that includes these serious health risks:

• High levels of LDL, the “bad” cholesterol
• High blood pressure
• Elevated blood glucose levels
• Abdominal fat

Metabolic syndrome places people at risk for diabetes, cardiovascular disease, and a host of other systemic illnesses. A Spanish study of patients with bipolar disorder found that they were 58 percent more likely to have metabolic syndrome than the rest of the population.

Causes of Obesity and Diabetes in Bipolar Patients

Researchers have paid close attention to the causes of obesity in bipolar patients in recent years. The use of bipolar medications has been singled out as a likely factor in weight gain, although some doctors suspect there may be a genetic component involved as well.

Research has linked the use of lithium and antiepileptic medications in particular with weight gain. One review of 24 medication trials found that these drugs caused significant weight gain in pediatric bipolar patients 75 percent of the time.

Antipsychotic medications also are used to treat bipolar patients, and they too have been linked with weight gain, particularly second-generation drugs like clozapine and olanzapine. The same review of medication trials found that bipolar patients gained more weight when taking second-generation antipsychotics and gained an extreme amount of weight when taking antipsychotics along with mood-stabilizing medications.

A genetic link between bipolar disorder and diabetes is suspected because common genetic factors between the two can cause a rare disorder called Wolfram syndrome. People with Wolfram syndrome develop diabetes and exhibit bipolar symptoms. However, researchers have not extensively explored this potential genetic connection.

Due to the clear link between bipolar medications and weight gain, researchers are urging doctors to closely monitor the health of any patient placed on these drugs. If you are taking a drug to manage bipolar disorder, talk to your doctor if you notice changes in your weight or an increase in abdominal fat. Your doctor may also closely monitor your blood pressure, cholesterol levels, and blood sugar.

If you find it hard to concentrate, controlling mood swings can help. There are also some tips you can use to reduce stress, get more sleep, and stay organized.

Lack of concentration is a common symptom of bipolar disorder. People with bipolar disorder find they are easily distracted or feel lost and confused whether they are at home, at work, or in school.

Being unable to concentrate can be a problem because it makes it hard for people with bipolar disorder to perform tasks such as grocery shopping or preparing meals, or to enjoy activities such as playing a game or watching television. Young people with bipolar disorder may have trouble in school or when studying or reading. The symptom also can put the person with bipolar disorder at risk for injury — accidents happen when people aren’t paying attention.

Distracted by Mood Swings

People with bipolar disorder experience mood swings — they go from episodes of very high energy to extreme lows of depression. When depressed, people often do not concentrate as well. They may have trouble thinking and making decisions. Almost anything can become a distraction when they are down.

The key to improving concentration and avoiding distraction is controlling mood swings. Bipolar disorder is commonly treated with mood-stabilizing medications. It is important that people with bipolar disorder who are on medications take them as prescribed.

At the same time, it is possible that medications can contribute to attention problems. Certain medications have been shown to make it more difficult to concentrate and to learn. People with bipolar disorder should talk to their doctor if they find their medications are making their ability to concentrate worse. Their doctor may be able to adjust the medications to resolve the problem.

Lack of Sleep and Stress Can Affect Concentration

People also can lose their ability to concentrate when they are extremely tired, and people with bipolar disorder can have trouble sleeping, especially if they are in a depressed state. If you want to improve your concentration, try to get enoughsleep. To get a good night’s sleep, you should go to bed and wake up the same time every night — weekdays and weekends. Make sure the bedroom is dark, quiet, and a comfortable temperature for sleeping.

Stress also can cause a lack of concentration, and people with bipolar disorder may feel as though they are under a lot of stress.

Here are some tips to help those with bipolar disorder control stress and get organized:

• Manage your time. Don’t try to do too much. Say no if you can’t do it.
• Lead a healthy lifestyle. Eat a balanced diet rich in fruits and vegetables and whole grains. Eat only low-fat meats and poultry. Get regular exercise, which can have both mental and physical health benefits. Avoid caffeine.
• Learn relaxation techniques. These include breathing exercises, yoga, and massage. Remember to balance periods of activity with periods of relaxation.
• Keep a daily planner. It will help you to remember appointments and commitments.
• Seek support from family and friends. Spend time talking and listening to each other. Don’t be afraid to ask for help if you need it. Choose a support group you can trust to tell you the truth even if it’s not what you want to hear.
• Avoid drugs and alcohol. Taking drugs and alcohol may lessen the effectiveness of your bipolar medications and lead to potentially dangerous side effects.
• Get in a routine. A daily schedule can add structure to your life, and structure can help you cope with stress.

Lack of concentration is a common symptom of bipolar disorder. To control it, seek proper treatment for your mood swings. Also, be sure to get enough sleep and learn to limit stress.

Clang associations, verbal linking of words with similar sounds, is a hallmark of psychotic phases of bipolar disorder.

Linking words together based on similar sounds rather than coherent meaning is a symptom of psychosis in people with bipolar disorder. Such bipolar symptomsoccur during psychotic episodes in the manic phase, but can also occur with depressive psychosis.

“This speech pattern is characteristic of disorganized thinking in psychotic disorders,” explains psychiatrist Michael Peterson, MD, PhD, an assistant professor in the department of psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison. Dr. Peterson offers these examples of clang associations: “that boat hope floats” or “the train brain rained on me.” The words involved often have a rhyming, near-rhyming, or punning (choosing words based on double meanings) quality to them.

There are other types of language changes that may be present with bipolar symptoms in addition to clang associations, including:

• Word salad. A jumble of words that are not apparently linked and may be hard to understand.
• Disorganization. Jumping from one idea to another without transition.
• Neologism. Making up words that have no meaning to anyone but the speaker.
• Echolalia. Repeating others’ words or phrases.

Typically, if you spend time with a person who is becoming psychotic, you will notice that his language gets less sensible and understandable as his psychosisgets worse. He may not be aware that he is not making sense as he strings together clang associations or other unusual language associations. Eventually he may become totally incoherent or appear to be “speaking in tongues.” Rationalizing with him or trying to talk to him about what he is saying is not going to get you any clear answers. Instead, start seeking treatment for his bipolar symptoms as soon as you notice that his language is starting to fall apart.

Other Signs of Bipolar Psychosis

Clang associations and other language changes may be accompanied by other symptoms of psychosis, which include:

• Hallucinations
• Paranoia
• Delusions
• Disordered thinking or speaking
• Being excessively responsive to stimulation in the environment
• Difficulty determining what is real and what is not
• Problems completing ordinary tasks (problems may be related to memory, concentration, clear thinking, etc)

Bipolar psychosis looks a lot like symptoms of schizophrenia, which can result in a misdiagnosis for some patients with manic depression or other psychiatric illnesses. About half of people with bipolar disorder will have a psychotic episode at some point in their lives. Psychosis is usually temporary, but it is important to get treatment immediately.

Management of Clang Associations

Because clang associations are a symptom of psychosis, managing them requires treatment of the psychosis.

“They are managed primarily using antipsychotic medications. The goal in treating bipolar episodes with psychosis is to resolve the acute symptoms and to stabilize mood. Antipsychotic medication for bipolar disorder may be used either during the psychotic episode only, or as longer-term mood-stabilizing medications,” says Peterson.

As worrying as clang associations and other language problems may be, effective treatments exist that can get your loved one back on track.