目的︰瞭解精神病患經過長期的精神科治療後，其身體健康狀態及合併之生理疾病。方法︰自台北市某精神科專科教學醫院與某區域醫院精神科，選擇目前診斷為雙極性情感疾患（DSM-III-R），且於1995年12月以前就醫記錄超過15年之病患。藉由病歷回溯、訪談病患與家屬，必要時安排實驗診斷學檢查，以了解其身體健康狀況。結果︰共收集158位（男60位、女98位）研究樣本進行病歷回溯，平均年齡45.3 ±10.7歲，平均病程21.2 ±5.6年，其中再接受會談評估者101位。好發疾病以器官--系統分類，依序為︰內分泌╱代謝╱乳房（23.4%）、消化系（16.5%）與神經系（12.7%）；女性好發內分泌╱代謝╱乳房疾病（p<0.025），男性好發下消化道（p<0.05）與肝臟疾病（p<0.05）。其中50% 樣本罹患必須長期追蹤或治療的慢性疾病；單一疾病以糖尿病罹患率最高為12.0%；其他值得注意的疾病其罹患率分別如下︰肺結核病5.7%、梅毒1.9%、高血壓7.0%、過敏體質與相關疾病17.1%，而腎臟或血液疾病則少見。結論︰躁鬱症求醫患者共存內分泌╱代謝疾病最常見，且所好發的疾病有性別差異；肺結核病與梅毒的感染率顯著高於一般人口，因此感染途徑如︰性行為與免疫功能需要進一步探討；腎臟病罹患率低，支持鋰鹽不會導致腎病變的文獻報告；高血壓明顯低於同年齡層的一般人。此外，高達半數的中年以上躁鬱症求醫患者，罹患會影響精神病預後的慢性疾病，故至醫療單位就診的躁鬱症病患其共存生理疾病極為普遍，值得臨床上特別重視。

　　　　　Objective: Psychotic patients have high mortality rates due to both natural and unnatural causes. However, physicians or care givers usually ignore their physical problems. Here have been few reports regarding the physical health of psychotic patients under long-term management in Taiwan. The aims of this study were to find out the prevalence of co-existing physical illness in help-seeking patients with bipolar disorder under long-term follow-up and to establish the preliminary data for further investigation. Methods: The study group comprised all patients with bipolar disorder (DSM-Ⅲ-R) who had been treated for more than 15 years at either the Taipei City Psychiatric Center or the Department of Psychiatry of Taipei Medical College Hospital. Clinical data of each subject were obtained from a review of medical records. Besides, if available, interviewing patients and reliable family member's confirmation were performed. Results: There were a total of 98 women and 60 men (men age, 45.3 ±10.7years) in the study. Follow-up interviews were conducted in 101 subjects. Illnesses were classified according to the organ-system categories. The rates of co-existing illness were found to be highest in the endocrine/metabolic/breast category (24.3%), followed by gastrointestinal tract (16.5%) and neurology (12.7%). Women were vulnerable to have endocrine/metabolic/breast diseases (p<0.025). Men were more likely to develop lower gastrointestinal tract (p<0.05) or liver diseases (p<0.05). Fifty percent of the subjects had more than one important chronic physical illness indicating to long-term follow-up as defined by the Bureau of National Insurance. The most prevalent disease entity was diabetes mellitus (12.0%). In additon, the rate of pulmonary tuberculosis (5.7%), syphilis (1.9%), hypertension (7.0%), or atopic diseases (17.1%) was higher than that of the report of general population in Taiwan. Diseases of the kidney or blood were rare in those subjects. Conclusions: The high prevalence of disease in the endocrine/metabolic/breast category suggests that there may be a genetic vulnerability to these diseases in individuals with bipolar disorder. There was also a higher prevalence of pulmonary tuberculosis and syphilis in these bipolar subjects than in the general population. It reveals that further investigations concerning the immunity and routes of infection (for example, sexual behavior) are necessary. Our result supports the previous findings that long-term lithium therapy does not induce renal insufficiency. The reason for the low rate of hypertension in bipolar patients is unclear. Approximately 50% of the middle-aged bipolar patients had more than one kind of important chronic physical illness. Therefore, general health problems and co-existing physical illness are very common among bipolar patients. Awareness of the high prevalence of associated illness should be emphasized particularly in the long-term management of bipolar disorder.