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Misiak B, Stramecki F, Kasznia J, Lis M, Stańczykiewicz B. Adiponectin levels in patients with bipolar disorder: A systematic review and meta-analysis. Psychoneuroendocrinology 2019; 104:74-79. [PMID: 30818254 DOI: 10.1016/j.psyneuen.2019.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/24/2022]
Abstract
Bipolar disorder (BD) is associated with high prevalence rates of obesity-related conditions and subclinical inflammation. Adiponectin is produced by adipose tissue and exerts anti-inflammatory activities. We aimed to perform a systematic review and meta-analysis of studies investigating adiponectin levels in BD patients and healthy controls. Electronic databases were searched from their inception until 15th Jan 2019. Random-effects models with the Hedges' g as the effect size (ES) estimate were used. We included 11 studies, representing 477 patients and 380 controls. Pooled data analysis revealed no significant differences in adiponectin levels between BD patients and controls (ES = 0.28, 95%CI: -0.34 - 0.90, p = 0.372). The levels of adiponectin were significantly higher during euthymia (ES = 1.09, 95%CI: 0.03-2.16, p = 0.044). The levels of adiponectin in depressed patients were lower, but this result did not reach statistical significance (ES = -0.90, 95%CI: -1.85 - 0.05, p = 0.063). Due to low number of studies, the subgroup analysis of manic patients was not performed; however, a severity of manic symptoms was not associated with the ES estimates. Longer illness duration and a higher percentage of BD type I (BD-I) patients were associated with higher ES estimates. A higher severity of depressive symptoms was associated with lower ES estimates. Heterogeneity was significant in all analyses. Results of the Egger's test were insignificant, showing no publication bias. Our results indicate that adiponectin might be a state marker of BD as it appears to be elevated in euthymia and decreased in depression. Illness progression and a diagnosis of BD-I might contribute to higher adiponectin levels.
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Affiliation(s)
- Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| | - Filip Stramecki
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Justyna Kasznia
- Inpatient Psychiatric Unit, Municipal General Hospital, Limanowskiego 20/22 Street, 63-400, Ostrów Wielkopolski, Poland
| | - Michał Lis
- Clinical Department of Internal Diseases, Endocrinology and Diabetology, the Central Clinical Hospital of the Ministry of the Interior in Warsaw, Wołoska 137 Street, 02-507 Warsaw, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618, Wroclaw, Poland
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Coello K, Vinberg M, Knop FK, Pedersen BK, McIntyre RS, Kessing LV, Munkholm K. Metabolic profile in patients with newly diagnosed bipolar disorder and their unaffected first-degree relatives. Int J Bipolar Disord 2019; 7:8. [PMID: 30937579 PMCID: PMC6443746 DOI: 10.1186/s40345-019-0142-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/19/2019] [Indexed: 02/07/2023] Open
Abstract
Objective The prevalence of metabolic syndrome and insulin resistance is twice as high in patients with bipolar disorder compared with the general population, and possibly associated with a disabling illness trajectory of bipolar disorder, an increased risk of cardiovascular disease and premature death. Despite these detrimental effects, the prevalence of metabolic syndrome and insulin resistance in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives is largely unknown. Methods In a cross-sectional study of 206 patients with newly diagnosed bipolar disorder, 50 of their unaffected first-degree relatives and 109 healthy age- and sex-matched individuals, we compared the prevalence of metabolic syndrome and insulin resistance (HOMA-IR). In patients with bipolar disorder, we further investigated illness and medication variables associated with the metabolic syndrome and insulin resistance. Results Higher rates of metabolic syndrome (odds ratio = 3.529, 95% CI 1.378–9.041, P = 0.009) and levels of insulin resistance (B = 1.203, 95% CI 1.059–1.367, P = 0.005) were found in patients newly diagnosed with bipolar disorder, but not in their unaffected first-degree relatives compared with matched healthy individuals (data adjusted for sex and age). Most patients with bipolar disorder (94.7%) were diagnosed within the preceding 2 years, and the average illness duration, defined as time from first mood episode, was 10 years. Conclusion Our findings of elevated prevalence of metabolic syndrome and insulin resistance in patients with newly diagnosed bipolar disorder highlight the importance of screening for these conditions at an early stage to employ adequate and early care reducing the risk of cardiovascular disease and premature death.
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Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Department O, 6243, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Department O, 6243, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, Hellerup, Denmark
| | - Bente K Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre of Inflammation and Metabolism (CIM) and the Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Lars V Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Department O, 6243, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Munkholm
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Department O, 6243, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Bora E, McIntyre RS, Ozerdem A. Neurococognitive and neuroimaging correlates of obesity and components of metabolic syndrome in bipolar disorder: a systematic review. Psychol Med 2019; 49:738-749. [PMID: 30326979 DOI: 10.1017/s0033291718003008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) have a higher prevalence of obesity and metabolic syndrome (MetS) compared with the general population. Obesity and MetS are associated with cognitive deficits and brain imaging abnormalities in the general population. Obesity and components of MetS might potentially associate with neuroimaging and neurocognitive findings in BD. METHODS A literature search of studies investigating the association between obesity (and other components of MetS) and neurocognitive and neuroimaging findings in BD was conducted. In addition to a systematic review, a random-effects meta-analysis was conducted when sufficient data were available. RESULTS Twenty-three studies were included in the current systematic review. Overweight/obese patients were significantly associated with impaired neurocognition compared normal weight individuals with BD (d = 0.37). The most robust association between obesity and cognitive deficits in BD was observed in the cognitive subdomain of executive functions (d = 0.61). There was also evidence for a significant relationship between cognitive impairment in BD and other components of MetS including hypertension, dyslipidemia, and diabetes. Overweight/obese individuals with BD had more pronounced brain imaging abnormalities than normal weight individuals with BD. CONCLUSIONS Obesity and related cardiovascular risk factors significantly are associated with more severe cognitive and brain imaging abnormalities in BD. Medical co-morbidities can potentially contribute to functional decline observed in some patients throughout the course of BD.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
| | - Roger S McIntyre
- Department of Psychiatry,University of Toronto,Toronto, ON,Canada
| | - Aysegul Ozerdem
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
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Possible association between social cognition and metabolic dysfunctions in Bipolar Disorder and Schizophrenia: Preliminary results. J Affect Disord 2019; 246:828-835. [PMID: 30795487 DOI: 10.1016/j.jad.2018.12.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/17/2018] [Accepted: 12/24/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Social cognition (SC) and Theory of Mind (ToM) are compromised in patients with Schizophrenia (SKZ) and Bipolar Disorder (BD) and an increased frequency of metabolic abnormalities is reported in both disorders. Obesity seems associated with cognitive impairments The aim of our study is thus to assess the relationship between obesity and ToM in SKZ and BD. METHODS 36 stabilized outpatients (18 SKZ and 18 BD) were recruited and completed Reading the Mind in the Eyes Test, Italian version and Faux Pas Recognition Test, adult version. BMI was calculated from self-reported height and weight. Two different Generalized Linear Models were created including performance in Eyes test and in Faux Pas test as outcomes and BMI as covariate. RESULTS After stratifying for sex, we found a significant relationship between BMI and Faux Pas performance for male patients (p = 0.017), without significant interactions between sex and diagnosis. These results suggest a BMI effect on both affective and cognitive ToM in male patients. LIMITATIONS Major confounders need to be considered: the greater number of subjects with SKZ in male subsample, a possible influence of neurocognitive performance, small sample size and self-reported BMI. CONCLUSIONS There could be a relationship between ToM and metabolic dysfunctions, at least in male patients. The exact nature of this relationship has yet to be determined; an interesting theoretical framework is based on a combination of increased brain energy request and inefficient peripheral compensatory mechanisms, resulting in inefficient energy allocation to the brain.
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Arranz B, Sanchez-Autet M, San L, Safont G, Fuente-Tomás LDL, Hernandez C, Bogas JL, García-Portilla MP. Are plasma 25-hydroxyvitamin D and retinol levels and one-carbon metabolism related to metabolic syndrome in patients with a severe mental disorder? Psychiatry Res 2019; 273:22-29. [PMID: 30639560 DOI: 10.1016/j.psychres.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/15/2018] [Accepted: 01/01/2019] [Indexed: 11/27/2022]
Abstract
There is a scarcity of studies assessing the influence of biomarkers in metabolic syndrome in psychiatric patients. Our aim was to correlate serum or plasma levels of 25-hydroxyvitamin D (25-OH-VD), retinol, vitamin B12 (VB12), folate and homocysteine (Hcy), with the metabolic status, in a sample of 289 outpatients with Schizophrenia or Bipolar Disorder. Logistic regression and multiple linear regressions were performed to assess the ability of biomarkers to predict the presence of MetS, the number of risk factors for MetS, and insulin resistance indexes (HOMA and QUICKI). Regarding the association between biomarkers and the QUICKI index, the model explained 6.8% of the variance, with folate and 25-OH-VD levels contributing significantly to the model. The model predicting the number of MetS risk factors was significant and explained 21.7% of the variance, being 25-OH-VD and retinol the statistically significant factors. As for the impact of biomarkers on MetS, the model was statistically significant, being 25-OH-VD and retinol levels the significant factors. We report for the first time an association between MetS and both low 25-OH-VD and high retinol concentrations. Inflammation-related biomarkers may help identify patients with a high risk of MetS who might benefit from healthy lifestyle counselling and early intervention.
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Affiliation(s)
- Belén Arranz
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Mónica Sanchez-Autet
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
| | - Luis San
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; University of Barcelona, Barcelona, Spain
| | - Gemma Safont
- Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; University of Barcelona, Barcelona, Spain
| | - Lorena De La Fuente-Tomás
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | | | | | - María Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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Steardo L, Fabrazzo M, Sampogna G, Monteleone AM, D'Agostino G, Monteleone P, Maj M. Impaired glucose metabolism in bipolar patients and response to mood stabilizer treatments. J Affect Disord 2019; 245:174-179. [PMID: 30391773 DOI: 10.1016/j.jad.2018.10.360] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/15/2018] [Accepted: 10/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Metabolic dysfunctions in patients with bipolar disorder (BD) are critical factors that interfere with outcome, but only one study evaluated the influence of glucose dysmetabolism on the response to treatment with lithium. We aimed to investigate the potential impact of glucose metabolic status on clinical characteristics of BD patients and their response to treatment with different mood stabilizers in monotherapy or in combination. METHODS 45 BD patients with insulin resistance (IR) or type 2 diabetes mellitus (DM2) and 46 patients with normal glucose metabolism, treated with mood stabilizers for at least one year were assessed by diagnostic and rating instruments. Their clinical characteristics were compared and an ordinal logistic regression model was adopted to identify possible predictors of response to mood stabilizer treatments. RESULTS Compared to patients with normal glucose metabolism, BD patients with impaired glucose metabolism showed a worse clinical presentation of their psychiatric illness and a worse response to mood stabilizers. Ordinal logistic regression analysis evidenced that impaired glucose metabolism was the only predictor of poor response to mood stabilizers (OR 4.3; 95% CI: 1.7-11.1; p < 0.002). LIMITATIONS Cross-sectional design and the relatively small sample size, are the main limitations of our study. CONCLUSIONS Our findings expand literature data suggesting that BD patients with impaired glucose metabolism are at a greater risk of not responding to lithium as well as to different mood stabilizer treatments.
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Affiliation(s)
- Luca Steardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessio M Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia D'Agostino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Park DI, Turck CW. Interactome Studies of Psychiatric Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1118:163-173. [PMID: 30747422 DOI: 10.1007/978-3-030-05542-4_8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
High comorbidity and complexity have precluded reliable diagnostic assessment and treatment of psychiatric disorders. Impaired molecular interactions may be relevant for underlying mechanisms of psychiatric disorders but by and large remain unknown. With the help of a number of publicly available databases and various technological tools, recent research has filled the paucity of information by generating a novel dataset of psychiatric interactomes. Different technological platforms including yeast two-hybrid screen, co-immunoprecipitation-coupled with mass spectrometry-based proteomics, and transcriptomics have been widely used in combination with cellular and molecular techniques to interrogate the psychiatric interactome. Novel molecular interactions have been identified in association with different psychiatric disorders including autism spectrum disorders, schizophrenia, bipolar disorder, and major depressive disorder. However, more extensive and sophisticated interactome research needs to be conducted to overcome the current limitations such as incomplete interactome databases and a lack of functional information among components. Ultimately, integrated psychiatric interactome databases will contribute to the implementation of biomarkers and therapeutic intervention.
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Affiliation(s)
- Dong Ik Park
- Danish Research Institute of Translational Neuroscience (DANDRITE), Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Christoph W Turck
- Proteomics and Biomarkers, Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
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Zhao L, Chang H, Zhou DS, Cai J, Fan W, Tang W, Tang W, Li X, Liu W, Liu F, He Y, Bai Y, Sun Y, Dai J, Li L, Xiao X, Zhang C, Li M. Replicated associations of FADS1, MAD1L1, and a rare variant at 10q26.13 with bipolar disorder in Chinese population. Transl Psychiatry 2018; 8:270. [PMID: 30531795 PMCID: PMC6286364 DOI: 10.1038/s41398-018-0337-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/07/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022] Open
Abstract
Genetic analyses of psychiatric illnesses, such as bipolar disorder (BPD), have revealed essential information regarding the underlying pathological mechanisms. While such studies in populations of European ancestry have achieved prominent success, understanding the genetic risk factors of these illnesses (especially BPD) in Chinese population remains an urgent task. Given the lack of genome-wide association study (GWAS) of BPD in Chinese population from Mainland China, replicating the previously reported GWAS hits in distinct populations will provide valuable information for future GWAS analysis in Han Chinese. In the present study, we have recruited 1146 BPD cases and 1956 controls from Mainland China for genetic analyses, as well as 65 Han Chinese brain amygdala tissues for mRNA expression analyses. Using this clinical sample, one of the largest Han Chinese BPD samples till now, we have conducted replication analyses of 21 single nucleotide polymorphisms (SNPs) extracted from previous GWAS of distinct populations. Among the 21 tested SNPs, 16 showed the same direction of allelic effects in our samples compared with previous studies; 6 SNPs achieved nominal significance (p < 0.05) at one-tailed test, and 2 additional SNPs showed marginal significance (p < 0.10). Aside from replicating previously reported BPD risk SNPs, we herein also report several intriguing findings: (1) the SNP rs174576 was associated with BPD in our Chinese sample and in the overall global meta-analysis, and was significantly correlated with FADS1 mRNA in diverse public RNA-seq datasets as well as our in house collected Chinese amygdala samples; (2) two (partially) independent SNPs in MAD1L1 were both significantly associated with BPD in our Chinese sample, which was also supported by haplotype analysis; (3) a rare SNP rs78089757 in 10q26.13 region was a genome-wide significant variant for BPD in East Asians, and this SNP was near monomorphic in Europeans. In sum, these results confirmed several significant BPD risk genes. We hope this Chinese BPD case-control sample and the current brain amygdala tissues (with continuous increasing sample size in the near future) will provide helpful resources in elucidating the genetic and molecular basis of BPD in this major world population.
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Affiliation(s)
- Lijuan Zhao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Hong Chang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China
| | - Dong-Sheng Zhou
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Jun Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weixing Fan
- Jinhua Second Hospital, Jinhua, Zhejiang, China
| | - Wei Tang
- Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenxin Tang
- Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
| | - Xingxing Li
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Weiqing Liu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Fang Liu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yuanfang He
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Bai
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Sun
- Wuhan Institute for Neuroscience and Neuroengineering, South-Central University for Nationalities, Wuhan, Hubei, China
- Chinese Brain Bank Center, Wuhan, Hubei, China
| | - Jiapei Dai
- Wuhan Institute for Neuroscience and Neuroengineering, South-Central University for Nationalities, Wuhan, Hubei, China
- Chinese Brain Bank Center, Wuhan, Hubei, China
| | - Lingyi Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China
| | - Xiao Xiao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China.
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ming Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
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Kocakaya H, Batmaz S, Demir O, Songur E, Celikbas Z. Metabolic syndrome in bipolar disorder: prevalence, demographics and clinical correlates in individuals with bipolar I, bipolar II, and healthy controls. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0101-60830000000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Sedat Batmaz
- Gaziosmanpasa University School of Medicine, Turkey
| | - Osman Demir
- Gaziosmanpasa University School of Medicine, Turkey
| | - Emrah Songur
- Ankara Kecioren Training and Research Hospital, Turkey
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Bengesser SA, Reininghaus EZ, Dalkner N, Birner A, Hohenberger H, Queissner R, Fellendorf F, Platzer M, Pilz R, Hamm C, Rieger A, Kapfhammer HP, Mangge H, Reininghaus B, Meier-Allard N, Stracke A, Fuchs R, Holasek S. Endoplasmic reticulum stress in bipolar disorder? - BiP and CHOP gene expression- and XBP1 splicing analysis in peripheral blood. Psychoneuroendocrinology 2018; 95:113-119. [PMID: 29843019 DOI: 10.1016/j.psyneuen.2018.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endoplasmic Reticulum stress activates the Unfolded Protein Response, which is partially impaired in Bipolar Disorder (BD) according to previous in-vitro studies. Thus, BiP and CHOP gene expression and XBP1 splicing were analyzed in peripheral blood of study participants with BD and controls. METHODS RNA was isolated from fasting blood of study participants with BD (n = 81) and controls (n = 54) and reverse transcribed into cDNA. BiP and CHOP gene expression was analyzed with quantitative RT-PCR. Atypical splicing of XBP1 mRNA was measured by semi-quantitative RT-PCR, gel-electrophoresis and densitometry. ANCOVAs with the covariates age, BMI, sex, lithium and anticonvulsants intake were used with SPSS. Bonferroni correction was used to correct for multiple testing (adjusted p = 0.0083). RESULTS BiP gene expression was significantly higher in BD than in controls (F(1/128) = 10.076, p = 0.002, Partial η2 = 0.073). Total XBP1 (F(1/126) = 9.550, p = 0.002, Partial η2 = 0.070) and unspliced XBP1 (F(1/128)= 8.803, p= 0.004, Patial η2 = 0.065) were significantly decreased in BD. Spliced XBP1 (F(1/126) = 5.848, p = 0.017, Partial η2 = 0.044) and the ratio spliced XBP1/ unspliced XBP1 did not differ between BD and controls (F(1/126) = 0.599, p = 0.441, Partial η2 = 0.005). Gene expression did not differ between euthymia, depression and mania. DISCUSSION BiP gene expression was significantly higher in BD compared to controls. Total and unspliced XBP1 were significantly lower in BD than in the control group. Thus, both genes may be considered as putative trait markers. Nevertheless, XBP1 splicing itself did not differ between both groups.
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Affiliation(s)
- Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria.
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Helena Hohenberger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Rene Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Alexandra Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Graz, Austria
| | | | - Nathalie Meier-Allard
- Institute of Pathophysiology and Immunology, Medical University of Graz, Heinrichstrasse 31A, 8010 Graz, Austria
| | - Anika Stracke
- Institute of Pathophysiology and Immunology, Medical University of Graz, Heinrichstrasse 31A, 8010 Graz, Austria
| | - Robert Fuchs
- Institute of Pathophysiology and Immunology, Medical University of Graz, Heinrichstrasse 31A, 8010 Graz, Austria
| | - Sandra Holasek
- Institute of Pathophysiology and Immunology, Medical University of Graz, Heinrichstrasse 31A, 8010 Graz, Austria
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Özkorumak Karagüzel E, Kural BV, Tiryaki A, Keleş Altun İ, Özer SY, Civil Arslan F. Blood levels of agouti-related peptide (AgRP), obestatin, corticosteroid-binding globulin (CBG), and cortisol in patients with bipolar disorder (BD): a case–control study. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1487649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Birgül Vanizor Kural
- Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Ahmet Tiryaki
- Department of Psychiatry, İstanbul Aydın University, Faculty of Medicine, İstanbul, Turkey
| | | | - Serap Yaman Özer
- Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Filiz Civil Arslan
- Department of Psychiatry, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
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Tully A, Murphy E, Smyth S, Conway Y, Geddes J, Devane D, Kelly JP, Jordan F. Interventions for the management of obesity in people with bipolar disorder. Hippokratia 2018. [DOI: 10.1002/14651858.cd013006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Agnes Tully
- National University of Ireland Galway; School of Nursing and Midwifery; Galway Ireland
| | - Edel Murphy
- National University of Ireland Galway; PPI Ignite Programme; Galway Ireland
| | - Siobhan Smyth
- National University of Ireland Galway; School of Nursing and Midwifery; Galway Ireland
| | - Yvonne Conway
- National University of Ireland Galway; School of Nursing and Midwifery; Galway Ireland
| | - John Geddes
- University of Oxford/Warneford Hospital; Department of Psychiatry; Oxford UK OX3 7JX
| | - Declan Devane
- National University of Ireland Galway; School of Nursing and Midwifery; Galway Ireland
| | - John P Kelly
- National University of Ireland Galway; Pharmacology and Therapeutics; University Road Galway Ireland
| | - Fionnuala Jordan
- National University of Ireland Galway; School of Nursing and Midwifery; Galway Ireland
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Ikeda M, Takahashi A, Kamatani Y, Okahisa Y, Kunugi H, Mori N, Sasaki T, Ohmori T, Okamoto Y, Kawasaki H, Shimodera S, Kato T, Yoneda H, Yoshimura R, Iyo M, Matsuda K, Akiyama M, Ashikawa K, Kashiwase K, Tokunaga K, Kondo K, Saito T, Shimasaki A, Kawase K, Kitajima T, Matsuo K, Itokawa M, Someya T, Inada T, Hashimoto R, Inoue T, Akiyama K, Tanii H, Arai H, Kanba S, Ozaki N, Kusumi I, Yoshikawa T, Kubo M, Iwata N. A genome-wide association study identifies two novel susceptibility loci and trans population polygenicity associated with bipolar disorder. Mol Psychiatry 2018; 23:639-647. [PMID: 28115744 PMCID: PMC5822448 DOI: 10.1038/mp.2016.259] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 11/09/2022]
Abstract
Genome-wide association studies (GWASs) have identified several susceptibility loci for bipolar disorder (BD) and shown that the genetic architecture of BD can be explained by polygenicity, with numerous variants contributing to BD. In the present GWAS (Phase I/II), which included 2964 BD and 61 887 control subjects from the Japanese population, we detected a novel susceptibility locus at 11q12.2 (rs28456, P=6.4 × 10-9), a region known to contain regulatory genes for plasma lipid levels (FADS1/2/3). A subsequent meta-analysis of Phase I/II and the Psychiatric GWAS Consortium for BD (PGC-BD) identified another novel BD gene, NFIX (Pbest=5.8 × 10-10), and supported three regions previously implicated in BD susceptibility: MAD1L1 (Pbest=1.9 × 10-9), TRANK1 (Pbest=2.1 × 10-9) and ODZ4 (Pbest=3.3 × 10-9). Polygenicity of BD within Japanese and trans-European-Japanese populations was assessed with risk profile score analysis. We detected higher scores in BD cases both within (Phase I/II) and across populations (Phase I/II and PGC-BD). These were defined by (1) Phase II as discovery and Phase I as target, or vice versa (for 'within Japanese comparisons', Pbest~10-29, R2~2%), and (2) European PGC-BD as discovery and Japanese BD (Phase I/II) as target (for 'trans-European-Japanese comparison,' Pbest~10-13, R2~0.27%). This 'trans population' effect was supported by estimation of the genetic correlation using the effect size based on each population (liability estimates~0.7). These results indicate that (1) two novel and three previously implicated loci are significantly associated with BD and that (2) BD 'risk' effect are shared between Japanese and European populations.
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Affiliation(s)
- M Ikeda
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - A Takahashi
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory for Omics Informatics, Omics Research Center, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Y Okahisa
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - H Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - N Mori
- Department of Psychiatry and Neurology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - T Sasaki
- Laboratory of Health Education, Graduate School of Education, the University of Tokyo, Tokyo, Japan
| | - T Ohmori
- Department of Psychiatry, Course of Integrated Brain Sciences, Medical Informatics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Y Okamoto
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Kawasaki
- Department of Psychiatry, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - S Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - T Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Wako, Japan
| | - H Yoneda
- Department of Neuropsychiatry, Osaka Medical College, Takatsuki, Japan
| | - R Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - M Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - K Matsuda
- Laboratory of Clinical Sequence, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - M Akiyama
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - K Ashikawa
- Laboratory for Genotyping Development, Center for Integrative Medical Sciences, RIKEN, Japan
| | - K Kashiwase
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
| | - K Tokunaga
- Department of Human Genetics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - K Kondo
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - T Saito
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - A Shimasaki
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - K Kawase
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - T Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - K Matsuo
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - M Itokawa
- Center for Medical Cooperation, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - T Someya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - T Inada
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - R Hashimoto
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Suita, Japan
| | - T Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - K Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - H Tanii
- Department of Neuropsychiatry, Mie University, Graduate School of Medicine, Tsu, Japan
| | - H Arai
- Department of Psychiatry and Behavioral Sciences, Juntendo Graduate School of Medicine, Tokyo, Japan
| | - S Kanba
- Department of Neuropsychiatry, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - N Ozaki
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - I Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Yoshikawa
- Laboratory for Molecular Psychiatry, RIKEN Brain Science Institute, Wako, Japan
| | - M Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - N Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
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Lithium + Colchicine: A Potential Strategy to Reduce Pro-inflammatory Effects of Lithium Treatment. J Clin Psychopharmacol 2018; 38:80-85. [PMID: 29232311 DOI: 10.1097/jcp.0000000000000830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Rosenblat and McIntyre (Acta Psychiatr Scand. 2015;132: 180-191) propose that immune disorders are important mediators between bipolar disorders and medical comorbidities. Rosenblat et al (Bipolar Disord. 2016;18:89-101) present a meta-analysis showing that adjunctive anti-inflammatory agents could evoke moderate antidepressant responses in bipolar disorders. We propose using the anti-inflammatory drug colchicine to improve the long-term safety and efficacy of lithium treatment for bipolar disorders. METHODS This report is based on searches of the PubMed and Web of Science databases. RESULTS Bipolar disorders are associated with significant medical comorbidities such as hypertension, overweight/obesity, diabetes mellitus, metabolic syndrome, and arteriosclerosis, accompanied by enhanced release of pro-inflammatory markers during changes in mood state. During lithium therapy, granulocyte-colony stimulating factor, CD34+ hematopoietic stem/progenitor cells, and neutrophil elastase enter the circulation with activated neutrophils to promote the extravascular migration of activated neutrophils and enhance tissue inflammation. Concurrent treatment with lithium and low-dose colchicine could facilitate the responsiveness of bipolar patients to lithium by reducing leukocyte tissue emigration, the release of neutrophil elastase, and the release of leukocyte pro-inflammatory cytokines such as IL-1β that are regulated by the NLRP3 inflammasome assembly complex. CONCLUSIONS Concurrent therapy with lithium and low-dose colchicine could reduce complications involving leukocyte-mediated inflammatory states in bipolar patients and promote patient acceptance and responsiveness to lithium therapy.
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Ikeda M, Saito T, Kondo K, Iwata N. Genome-wide association studies of bipolar disorder: A systematic review of recent findings and their clinical implications. Psychiatry Clin Neurosci 2018; 72:52-63. [PMID: 29057581 DOI: 10.1111/pcn.12611] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 01/05/2023]
Abstract
Recent advances in molecular genetics have enabled assessments of the associations among genetic variants (e.g., single-nucleotide polymorphisms) and susceptibility for complex diseases, including psychiatric disorders. Specifically, genome-wide association studies (GWAS), meta-analyses of the GWAS summary statistics, and mega-analyses (which use raw data, not summary statistics) of GWAS have provided revolutionary results and have identified numerous susceptibility genes or single-nucleotide polymorphisms. By using several tens of thousands of subjects, >40 genes have been identified as being associated with susceptibility for bipolar disorder so far. The purpose of this systematic review was to summarize the recent findings of bipolar disorder GWAS and discuss their clinical implications.
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Affiliation(s)
- Masashi Ikeda
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takeo Saito
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Kondo
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
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Tunçel ÖK, Sarısoy G, Bilgici B, Pazvantoğlu O, Çetin E, Tunçel EK. Adipocytokines and ghrelin level of bipolar patients from manic episode to euthymic episode. Nord J Psychiatry 2018; 72:150-156. [PMID: 29132244 DOI: 10.1080/08039488.2017.1402953] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Obesity and metabolic syndrome (MeS) are more frequently observed in bipolar patients than the general population. This may result from the differences of adipocytokines and ghrelin levels in bipolar disorder. MATERIAL AND METHODS We evaluated the leptin, adiponectin, resistin and ghrelin levels in bipolar patients (n = 30) in manic episode and in a control group (n = 30). After treatment, the same patients were evaluated again during the euthymic episode. We also measured the insulin, glucose, insulin resistance (HOMA), trygliceride (TG), total cholesterol (TCHOL), high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) in relation to the (MeS). RESULTS When controlling for age, BMI and glucose, leptin levels were higher in the bipolar disorder manic episode group (BD-ME) and bipolar euthymic episode group (BD-EE) than the control group; resistin levels were higher in the BD-ME compared to the control group and it had a positive correlation with Young Mania Rating Scale (YMRS). After treatment, ghrelin levels were higher in the BD-EE compared to the BD-ME group. There was no difference among the groups with respect to adiponectin. CONCLUSIONS The present results point that high leptin, resistin and ghrelin levels may be involved in the early pathophysiological process which can lead to later obesity and MeS in patients with bipolar disorder.
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Affiliation(s)
- Özgür Korhan Tunçel
- a Medical Biochemistry Department, Faculty of Medicine , Ondokuz Mayıs University , Samsun , Turkey
| | - Gökhan Sarısoy
- b Psychiatry Department, Faculty of Medicine , Ondokuz Mayıs University , Samsun , Turkey
| | - Birşen Bilgici
- a Medical Biochemistry Department, Faculty of Medicine , Ondokuz Mayıs University , Samsun , Turkey
| | - Ozan Pazvantoğlu
- b Psychiatry Department, Faculty of Medicine , Ondokuz Mayıs University , Samsun , Turkey
| | - Eda Çetin
- b Psychiatry Department, Faculty of Medicine , Ondokuz Mayıs University , Samsun , Turkey
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Abstract
Variation in telomere length is heritable and is currently considered a promising biomarker of susceptibility for neuropsychiatric disorders, particularly because of its association with memory function and hippocampal morphology. Here, we investigate telomere length in connection to familial risk and disease expression in bipolar disorder (BD). We used quantitative PCRs and a telomere-sequence to single-copy-gene-sequence ratio method to determine telomere length in genomic DNA extracted from buccal smears from 63 patients with BD, 74 first-degree relatives (49 relatives had no lifetime psychopathology and 25 had a non-BD mood disorder), and 80 unrelated healthy individuals. Participants also underwent magnetic resonance imaging to determine hippocampal volumes and cognitive assessment to evaluate episodic memory using the verbal paired associates test. Telomere length was shorter in psychiatrically well relatives (p=0.007) compared with unrelated healthy participants. Telomere length was also shorter in relatives (regardless of psychiatric status; p<0.01) and patients with BD not on lithium (p=0.02) compared with lithium-treated patients with BD. In the entire sample, telomere length was positively associated with left and right hippocampal volume and with delayed recall. This study provides evidence that shortened telomere length is associated with familial risk for BD. Lithium may have neuroprotective properties that require further investigation using prospective designs.
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Lin CY, Chang FW, Yang JJ, Chang CH, Yeh CL, Lei WT, Huang CF, Liu JM, Hsu RJ. Increased risk of bipolar disorder in patients with scabies: A nationwide population-based matched-cohort study. Psychiatry Res 2017; 257:14-20. [PMID: 28709117 DOI: 10.1016/j.psychres.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/17/2017] [Accepted: 07/04/2017] [Indexed: 02/09/2023]
Abstract
Both scabies and bipolar disorder (BD) are common and troublesome disorders. There are several similarities in both diseases: pruritus, a higher prevalence in crowded environments, and cytokine-mediated inflammatory processes in the pathophysiology. We conducted this nationwide population-based study to investigate the possible relationship between scabies and BD. Based on the National Health Insurance Research Database (NHIRD) of Taiwan, a total of 7096 patients with scabies were identified as a study group and 28,375 matched patients as a control. We tracked the patients in both groups for a 7-year period to identify those newly diagnosed with BD. The demographic characteristics and comorbidities of the patients were analyzed, and Cox proportional hazard regressions were performed to calculate the hazard ratio (HR) of BD. Of the 35,471 patients in this study, 183 (0.5%) patients with newly diagnosed BD were identified, with 58 (0.8%) from the scabies group and 125 (0.4%) from the control group. The patients with scabies had a higher risk of subsequent BD, with a crude hazard ratio of 1.86 and an adjusted hazard ratio of 1.55 (95% confidence interval: 1.12-2.09, P < 0.05). This study shows there is an increased risk for BD among patients with scabies. Immunopathology may contribute to this association.
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Affiliation(s)
- Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan; Division of Infection and Pathway Medicine, College of Medicine and Veterinary Medicine, the University of Edinburgh, Scotland, UK.
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Jing-Jung Yang
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
| | - Chun-Hung Chang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.
| | - Chia-Lun Yeh
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
| | - Chun-Fa Huang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Nursing, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Marshe VS, Pira S, Mantere O, Bosche B, Looper KJ, Herrmann N, Müller DJ, Rej S. C-reactive protein and cardiovascular risk in bipolar disorder patients: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:442-451. [PMID: 28764912 DOI: 10.1016/j.pnpbp.2017.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/09/2017] [Accepted: 07/28/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES New research is revealing a strong association between inflammatory markers with bipolar disorder (BD), potentially due to the high prevalence of cardiovascular disease and cardiovascular risk factors in BD. We aimed to synthesize the literature examining the association between the clinically most relevant inflammatory marker, C-reactive protein (CRP) and cardiovascular disease and cardiovascular risk factors in patients with BD. METHODS MEDLINE, Embase and PsychInfo were systematically searched for all relevant English language articles published prior to April 2017. Articles were included if they examined the association between CRP and cardiovascular risk factors/disease in BD. RESULTS Fifteen relevant articles were retrieved. Studies were mostly cross-sectional and heterogeneous in the cardiovascular risk factors investigated. Overall, elevated CRP was associated with increased risk of metabolic syndrome, elevated body mass index, higher waist circumference, and obesity. CRP was inconsistently associated with elevated fasting glucose, insulin levels, serum triglycerides, total cholesterol levels, and low high density lipoprotein (HDL) levels. Atypical antipsychotic use may mediate some of these effects. No study examined CRP's association with actual cardiovascular disease (e.g. coronary artery disease) in BD. CONCLUSIONS In BD, CRP is associated with increases in several cardiovascular risk factors, suggesting that systemic inflammation could be a shared driving force for both outcomes of BD and cardiovascular risk. Further longitudinal research is needed in this area to verify causality, including an examination of actual cardiovascular disease. Non-pharmacological and pharmacological treatments with anti-inflammatory effects should also be investigated, particularly in patients with increased CRP, for their potential to reduce cardiovascular risk in BD.
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Affiliation(s)
- Victoria S Marshe
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Pharmacogenetics Research Clinic, Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Shamira Pira
- Geri-PARTy Research Group, Jewish General Hospital, Montréal, Quebec, Canada
| | - Outi Mantere
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Bert Bosche
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada; Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Karl J Looper
- Geri-PARTy Research Group, Jewish General Hospital, Montréal, Quebec, Canada; Department of Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel J Müller
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Pharmacogenetics Research Clinic, Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital, Montréal, Quebec, Canada; Department of Psychiatry, McGill University, Montréal, Quebec, Canada.
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Mansur RB, Rizzo LB, Santos CM, Asevedo E, Cunha GR, Noto MN, Pedrini M, Zeni-Graiff M, Cordeiro Q, McIntyre RS, Brietzke E. Plasma copeptin and metabolic dysfunction in individuals with bipolar disorder. Psychiatry Clin Neurosci 2017; 71:624-636. [PMID: 28457001 DOI: 10.1111/pcn.12535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/10/2017] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
Abstract
AIM This study aimed to compare plasma copeptin levels, the c-terminal of provasopressin, between individuals with bipolar disorder (BD) and healthy controls and to assess the relation between copeptin and metabolic parameters. METHODS We measured plasma levels of copeptin in individuals with BD (n = 55) and healthy controls (n = 21). Information related to psychiatric/medical history, as well as to metabolic comorbidities and laboratorial parameters was also captured. Insulin resistance and β-cell function in basal state were calculated from fasting plasma glucose and C-peptide using the HOMA2 calculator. Impaired glucose metabolism was defined as pre-diabetes or type 2 diabetes mellitus. Copeptin, adiponectin, and leptin plasma levels were determined by enzyme-linked immunosorbent assay. RESULTS Plasma copeptin levels were lower in individuals with BD, relative to healthy controls (P < 0.001). There were significant interactions between BD and plasma copeptin on β-cell function (rate ratio [RR] = 1.048; P = 0.030) and on leptin levels (RR = 1.087; P = 0.012), indicating that there was a positive correlation between these markers in the BD group, but a negative one in healthy controls. Finally, in individuals with BD only, the association between β-cell function, body mass index (RR = 1.007; P < 0.001), and insulin resistance (RR = 1.001; P = 0.037) was moderated by copeptin levels. CONCLUSION Copeptin levels were lower in individuals with BD than in healthy controls. There were differential associations between copeptin and metabolic parameters within the BD and healthy control subgroups, suggesting an association between abnormal copeptin and metabolic dysregulation only in the BD population.
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Affiliation(s)
- Rodrigo B Mansur
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Lucas B Rizzo
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Psychiatry, Clinic for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Camila M Santos
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elson Asevedo
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Graccielle R Cunha
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariane N Noto
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Vila Maria Outpatient Clinic, São Paulo, Brazil
| | - Mariana Pedrini
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maiara Zeni-Graiff
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Quirino Cordeiro
- Department of Psychiatry, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Elisa Brietzke
- Reserach Group in Behavioral and Molecular Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Dalkner N, Platzer M, Bengesser SA, Birner A, Fellendorf FT, Queissner R, Painold A, Mangge H, Fuchs D, Reininghaus B, Kapfhammer HP, Holasek SJ, Reininghaus EZ. The role of tryptophan metabolism and food craving in the relationship between obesity and bipolar disorder. Clin Nutr 2017; 37:1744-1751. [PMID: 28712531 DOI: 10.1016/j.clnu.2017.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS Individuals with bipolar disorder (BD) have a significantly increased risk of obesity-related conditions. The imbalance between food intake and energy expenditure is assumed to be a major risk factor for obesity in BD. This study analyzed food craving in relation to anthropometric, metabolic, and neurobiological parameters in a well-characterized cohort of euthymic individuals with BD. METHODS One-hundred-thirty-five patients completed the Food-Craving Inventory assessing four categories of food craving (fat, fast-food, sweets and carbohydrate craving). Additionally, clinical, metabolic and anthropometric parameters were assessed. RESULTS Higher levels of fat craving were observed in males, versus females, with BD. High levels of carbohydrate craving positively correlated with kynurenine and the kynurenine-to-tryptophan ratio. Higher serum nitrite and neopterin levels were related to fat craving. Parameters of fat metabolism (triglycerides, high-density lipoprotein) were associated with fat and fast-food craving. Anthropometric measures of obesity (e.g. body mass index, waist-to-hip-ratio) were not related to food craving. CONCLUSIONS Overweight/obese individuals with BD show an increased driving of tryptophan down the kynurenine pathways, as indicated by an increase in the serum kynurenine-to-tryptophan ratio. The driving of tryptophan down the kynurenine pathway is mediated by immune-inflammatory activity and stress. The correlation of increased kynurenine with food craving, especially carbohydrate craving, probably indicates a regulatory deficit in the maintenance of chronic inflammatory processes in obesity and BD. Food craving seems to be of clinical importance in the treatment of metabolic disturbances in BD, although not associated with anthropometric measures of obesity. Rather, food craving correlates with blood metabolic parameters and an increased activation of the kynurenine pathway, both of which are linked to higher affective symptomatology and the development of cardiovascular diseases.
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Affiliation(s)
- N Dalkner
- Department of Psychiatry, Medical University Graz, Austria
| | - M Platzer
- Department of Psychiatry, Medical University Graz, Austria.
| | - S A Bengesser
- Department of Psychiatry, Medical University Graz, Austria
| | - A Birner
- Department of Psychiatry, Medical University Graz, Austria
| | - F T Fellendorf
- Department of Psychiatry, Medical University Graz, Austria
| | - R Queissner
- Department of Psychiatry, Medical University Graz, Austria
| | - A Painold
- Department of Psychiatry, Medical University Graz, Austria
| | - H Mangge
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Austria
| | - D Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Austria
| | - B Reininghaus
- Therapiezentrum Justuspark, Versicherungsanstalt öffentlich Bediensteter, Bad Hall, Austria
| | - H P Kapfhammer
- Department of Psychiatry, Medical University Graz, Austria
| | - S J Holasek
- Department of Pathophysiology and Immunology, Medical University Graz, Austria
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) mixed features specifier provides a less restrictive definition of mixed mood states, compared to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), including mood episodes that manifest with subthreshold symptoms of the opposite mood state. A limited number of studies have assessed the efficacy of treatments specifically for DSM-5-defined mixed features in mood disorders. As such, there is currently an inadequate amount of data to appropriately inform evidence-based treatment guidelines of DSM-5 defined mixed features. However, given the high prevalence and morbidity of mixed features, treatment recommendations based on the currently available evidence along with expert opinion may be of benefit. This article serves to provide these interim treatment recommendations while humbly acknowledging the limited amount of evidence currently available. Second-generation antipsychotics (SGAs) appear to have the greatest promise in the treatment of bipolar disorder (BD) with mixed features. Conventional mood stabilizing agents (ie, lithium and divalproex) may also be of benefit; however, they have been inadequately studied. In the treatment of major depressive disorder (MDD) with mixed features, the comparable efficacy of antidepressants versus other treatments, such as SGAs, remains unknown. As such, antidepressants remain first-line treatment of MDD with or without mixed features; however, there are significant safety concerns associated with antidepressant monotherapy when mixed features are present, which merits increased monitoring. Lurasidone is the only SGA monotherapy that has been shown to be efficacious specifically in the treatment of MDD with mixed features. Further research is needed to accurately determine the efficacy, safety, and tolerability of treatments specifically for mood episodes with mixed features to adequately inform future treatment guidelines.
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Birner A, Platzer M, Bengesser SA, Dalkner N, Fellendorf FT, Queissner R, Pilz R, Rauch P, Maget A, Hamm C, Herzog-Eberhard S, Mangge H, Fuchs D, Moll N, Zelzer S, Schütze G, Schwarz M, Reininghaus B, Kapfhammer HP, Reininghaus EZ. Increased breakdown of kynurenine towards its neurotoxic branch in bipolar disorder. PLoS One 2017; 12:e0172699. [PMID: 28241062 PMCID: PMC5328271 DOI: 10.1371/journal.pone.0172699] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/08/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Bipolar disorder (BD) is a chronic psychiatric disease which can take most different and unpredictable courses. It is accompanied by unspecific brainstructural changes and cognitive decline. The neurobiological underpinnings of these processes are still unclear. Emerging evidence suggests that tryptophan catabolites (TRYCATs), which involve all metabolites of tryptophan towards the kynurenine (KYN) branch, are involved in the etiology as well as in the course of BD. They are proposed to be mediators of immune-inflammation and neurodegeneration. In this study we measured the levels of KYN and its main catabolites consisting of the neurotoxic hydroxykynurenine (3-HK), the more neuroprotective kynurenic acid (KYNA) and anthranilic acid (AA) and evaluated the ratios between end-products and substrates as proxies for the specific enzymatic activity (3-HK/KYN, KYNA/KYN, AA/KYN) as well as 3-HK/KYNA as a proxy for neurotoxic vs. neuroprotective end-product relation in individuals with BD compared to healthy controls (HC). METHODS We took peripheral TRYCAT blood levels of 143 euthymic to mild depressive BD patients and 101 HC. For statistical analyses MANCOVA's controlled for age, sex, body mass index, cardiovascular disease and smoking were performed. RESULTS The levels of KYNA (F = 5,579; p <.05) were reduced in BD compared to HC. The enzymatic activity of the kynurenine-3-monooxygenase (KMO) reflected by the 3-HK/KYN ratio was increased in BD individuals compared to HC (F = 5,394; p <.05). Additionally the ratio of 3-HK/KYNA was increased in individuals with BD compared to healthy controls (F = 11,357; p <.01). DISCUSSION In conclusion our findings subserve the concept of KYN -pathway alterations in the pathophysiology of BD. We present evidence of increased breakdown towards the neurotoxic branch in KYN metabolism even in a euthymic to mild depressive state in BD. From literature we know that depression and mania are accompanied by inflammatory states which should be capable to produce an even greater imbalance due to activation of key enzymes in the neurotoxic direction of KYN -conversion. These processes could finally be involved in the development of unspecific brain structural changes and cognitive deficits which are prevalent in BD. Further research should focus on state dependent changes in TRYCATs and its relation to cognition, brain structure and staging parameters.
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Affiliation(s)
- Armin Birner
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | - Nina Dalkner
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | - Robert Queissner
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Rene Pilz
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Philipp Rauch
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Alexander Maget
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Carlo Hamm
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Natalie Moll
- Institute of Laboratory Medicine, Medical Center of Munich University (LMU), Munich, Germany
| | - Sieglinde Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gregor Schütze
- Institute of Laboratory Medicine, Medical Center of Munich University (LMU), Munich, Germany
| | - Markus Schwarz
- Institute of Laboratory Medicine, Medical Center of Munich University (LMU), Munich, Germany
| | - Bernd Reininghaus
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Hans-Peter Kapfhammer
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Eva Z. Reininghaus
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
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Bartoli F, Crocamo C, Dakanalis A, Brosio E, Miotto A, Capuzzi E, Clerici M, Carrà G. Purinergic system dysfunctions in subjects with bipolar disorder: A comparative cross-sectional study. Compr Psychiatry 2017; 73:1-6. [PMID: 27837679 DOI: 10.1016/j.comppsych.2016.09.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Subjects with bipolar mania may have increased uric acid levels, based on a purinergic system dysfunction with reduced neurotransmission of adenosine. We investigated whether there were differences in uric acid levels between individuals with bipolar disorder (in manic or depressive phases) and those with major depressive disorder. METHODS We conducted a cross-sectional study recruiting 128 subjects with bipolar disorder and 118 with major depressive disorder, admitted to a psychiatric inpatient unit. Standard demographic and clinical information were retrieved from electronic charts and relevant clinical records. Fasting serum values of uric acid, as well as metabolic (total cholesterol, triglycerides, and glycaemia), oxidative stress (albumin, bilirubin), and kidney function (creatinine), parameters, were collected. RESULTS Subjects with bipolar mania (5.27±1.63mg/dL), but not those with bipolar depression (4.89±1.94mg/dL), had higher levels of serum uric acid (p<0.05), as compared with individuals with major depressive disorder (4.59±1.62mg/dL). Relevant linear regression analyses, controlling for metabolic profile, oxidative stress markers, kidney function, and comorbid alcohol use disorder, showed a significant association between bipolar mania (p<0.01) and increased uric acid. CONCLUSIONS Findings of this study add evidence to the role of uric acid as state, rather than trait, marker in bipolar disorders. Explored, relevant, confounders do not seem to influence these results. The current study supports the hypothesis of a purinergic system dysfunction associated with manic phases of bipolar disorder.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Enrico Brosio
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Alessio Miotto
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Enrico Capuzzi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy; Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK
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Mansur RB, Ahmed J, Cha DS, Woldeyohannes HO, Subramaniapillai M, Lovshin J, Lee JG, Lee JH, Brietzke E, Reininghaus EZ, Sim K, Vinberg M, Rasgon N, Hajek T, McIntyre RS. Liraglutide promotes improvements in objective measures of cognitive dysfunction in individuals with mood disorders: A pilot, open-label study. J Affect Disord 2017; 207:114-120. [PMID: 27721184 DOI: 10.1016/j.jad.2016.09.056] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/16/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a paucity of treatments that are capable of reliably and robustly improving cognitive function in adults with mood disorders. Glucagon-like peptide-1 is synthesized centrally and its receptors are abundantly expressed in neural circuits subserving cognitive function. We aimed to determine the effects of liraglutide, a GLP-1 receptor (GLP-1R) agonist, on objective measures of cognition in adults with a depressive or bipolar disorder. METHODS In this 4-week, pilot, open-label, domain-based study (e.g. cognition), we recruited 19 individuals with major depressive disorder (MDD) or bipolar disorder (BD) and an impairment in executive function, defined as a below-average performance in the Trail Making Test-B (TMTB). Liraglutide 1.8mg/day was added as an adjunct to existing pharmacotherapy. RESULTS Participants had significant increases from baseline to week 4 in the TMTB standard score (age and education corrected) (Cohen's d=0.64, p=0.009) and in a composite Z-score comprising multiple cognitive tests (i.e. Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Stroop test) (Cohen's d=0.77, p<0.001). Neither changes in mood rating scales nor metabolic parameters were associated with changes in cognitive performance (all p>0.05); however baseline insulin resistance (IR) and body mass index (BMI) moderated the changes in the composite Z-score (p=0.021 and p=0.046, respectively), indicating larger responses in individuals with higher IR and BMI at baseline. There was a significant increase in lipase (p<0.001), but individual values were above the upper limit of normality. LIMITATIONS Small sample size, open-label design, lack of a placebo group. CONCLUSIONS Liraglutide was safe and well tolerated by a sample of non-diabetic individuals with mood disorders and had beneficial effects on objective measures of cognitive function. Larger studies with controlled trial designs are necessary to confirm and expand the results described herein.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Juhie Ahmed
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Hanna O Woldeyohannes
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Julie Lovshin
- Division of Endocrinology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Jung G Lee
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | - Jae-Hon Lee
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Department of Psychiatry, Samsung Seoul Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Elisa Brietzke
- Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Kang Sim
- Research Division, Institute of Mental Health, Singapore
| | - Maj Vinberg
- Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Natalie Rasgon
- Department of Psychiatry, Stanford University, Palo Alto, CA, United States
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
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Capuron L, Lasselin J, Castanon N. Role of Adiposity-Driven Inflammation in Depressive Morbidity. Neuropsychopharmacology 2017; 42:115-128. [PMID: 27402495 PMCID: PMC5143483 DOI: 10.1038/npp.2016.123] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 02/07/2023]
Abstract
Depression and metabolic disorders, including overweight and obesity, appear tightly interrelated. The prevalence of these conditions is concurrently growing worldwide, and both depression and overweight/obesity represent substantial risk factors for multiple medical complications. Moreover, there is now multiple evidence for a bidirectional relationship between depression and increased adiposity, with overweight/obesity being associated with an increased prevalence of depression, and in turn, depression augmenting the risk of weight gain and obesity. Although the reasons for this intricate link between depression and increased adiposity remain unclear, converging clinical and preclinical evidence points to a critical role for inflammatory processes and related alterations of brain functions. In support of this notion, increased adiposity leads to a chronic low-grade activation of inflammatory processes, which have been shown elsewhere to have a potent role in the pathophysiology of depression. It is therefore highly possible that adiposity-driven inflammation contributes to the development of depressive disorders and their growing prevalence worldwide. This review will present recent evidence in support of this hypothesis and will discuss the underlying mechanisms and potential therapeutic targets. Altogether, findings presented here should help to better understand the mechanisms linking adiposity to depression and facilitate the identification of new preventive and/or therapeutic strategies.
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Affiliation(s)
- Lucile Capuron
- Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), INRA, Bordeaux, France
- University of Bordeaux, Nutrition and Integrative Neurobiology (NutriNeuro), Bordeaux, France
| | - Julie Lasselin
- Institute of Medical Psychology and Behavioral Immunobiology, Universitäts Klinikum Essen, Essen, Germany
- Department of Clinical Neuroscience, Division for Psychology, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Nathalie Castanon
- Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), INRA, Bordeaux, France
- University of Bordeaux, Nutrition and Integrative Neurobiology (NutriNeuro), Bordeaux, France
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77
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Bai YM, Li CT, Tsai SJ, Tu PC, Chen MH, Su TP. Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder. BMC Psychiatry 2016; 16:448. [PMID: 27978821 PMCID: PMC5159954 DOI: 10.1186/s12888-016-1143-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/25/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is highly prevalent among patients with bipolar disorder. MetS may cause complications in the brain, but studies investigating MetS-associated clinical psychiatric outcomes remain scant. METHODS We enrolled clinically stable outpatients with bipolar disorder aged 18-65 years and performed anthropometric and fasting biochemical assessments to investigate MetS prevalence. We then performed clinical assessments by using the Young Mania Rating Scale for manic symptoms, the Montgomery-Åsberg Depression Rating Scale for depressive symptoms, the Positive and Negative Symptom Scale for psychotic symptoms, the Involuntary Movement Scale for tardive dyskinesia, the Barnes Akathisia Rating Scale for akathisia, the Udvalg for Kliniske Undersogelser for general side effects, the Schedule for Assessment of Insight for insight, the Global Assessment of Functioning scale for global functioning, and the Wisconsin Card Sorting Test (WCST) for cognitive executive function. RESULTS In total, 143 patients were enrolled and had a MetS prevalence of 29.4%. The patients treated with atypical antipsychotics plus mood stabilizers (36.3%) and atypical antipsychotics alone (36.0%) had a significantly higher prevalence of MetS than did those treated with mood stabilizers alone (10.5%; p = 0.012). According to multivariate regression analyses adjusted for age, sex, smoking status, bipolar disorder subtype (I or II), pharmacological treatment duration, and psychiatric medication, compared with patients without MetS, those with MetS had significantly more previous hospitalizations (p = 0.036), severer tardive dyskinesia (p = 0.030), poorer insight (p = 0.036), poorer global function (p = 0.046), and more impaired executive function (conceptual level response on the WCST; p = 0.042). CONCLUSIONS Our results indicated that patients with comorbid bipolar disorder and MetS have more adverse clinical outcomes than those without, with more hospitalizations, severer tardive dyskinesia, poorer insight, poorer global function, and more impaired executive function. Monitoring MetS is crucial for assessing not only physical burden, but also psychiatric outcomes.
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Affiliation(s)
- Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
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Bartoli F, Crocamo C, Mazza MG, Clerici M, Carrà G. Uric acid levels in subjects with bipolar disorder: A comparative meta-analysis. J Psychiatr Res 2016; 81:133-9. [PMID: 27442964 DOI: 10.1016/j.jpsychires.2016.07.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/22/2016] [Accepted: 07/06/2016] [Indexed: 12/12/2022]
Abstract
Previous research has hypothesised increased uric acid levels, possibly because of an amplified purinergic metabolism and a reduced adenosine activity, in subjects with bipolar disorder. This systematic review and meta-analysis aimed at estimating if individuals with bipolar disorder had uric acid levels higher than both healthy controls and subjects with major depression (trait marker hypothesis). It also tested if uric acid levels could differ in different phases of bipolar disorder (state marker hypothesis). Meta-analyses were carried out generating pooled standardized mean differences (SMDs), using random-effects models. Heterogeneity between studies was estimated using the I(2) index. Relevant sensitivity and meta-regression analyses were conducted. We searched main Electronic Databases, identifying twelve studies that met our inclusion criteria. Meta-analyses showed increased uric acid levels in individuals with bipolar disorder as compared with both healthy controls (SMD = 0.65, p < 0.001, I(2) = 82.9%) and those with major depression (SMD = 0.46, p < 0.001; I(2) = 68.7%). However, meta-regression analyses confirmed this association only as compared with healthy controls. Finally, though uric acid levels were higher in manic/mixed phases as compared with depressive ones (SMD = 0.34; p = 0.04, I(2) = 58.8%), a sensitivity analysis did not confirm the association. In sum, our meta-analysis shows that subjects with bipolar disorder have uric acid levels higher than healthy controls. The potential role of factors that might clarify the nature of this association deserves additional research.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Mario Gennaro Mazza
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy; Division of Psychiatry, University College London, London W1T 7NF, UK
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79
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Lackner N, Bengesser SA, Birner A, Painold A, Fellendorf FT, Platzer M, Reininghaus B, Weiss EM, Mangge H, McIntyre RS, Fuchs D, Kapfhammer HP, Wallner-Liebmann SJ, Reininghaus EZ. Abdominal obesity is associated with impaired cognitive function in euthymic bipolar individuals. World J Biol Psychiatry 2016; 17:535-46. [PMID: 26068130 DOI: 10.3109/15622975.2015.1046917] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Overweight/obesity has been implicated to play a role in cognitive deficits in bipolar disorder (BD). This study aims to identify the relationship between body fat distribution and different domains of cognition in BD during euthymia. METHODS A sample of 100 euthymic individuals with BD was measured with a cognitive test battery (i.e., Trail Making Test-A-B/TM-A/B, d2 Test of Attention, Stroop test, California Verbal Learning Test/CVLT) and an anthropometric measures set (body mass index, waist circumference, hip circumference, waist-to-hip-ratio, waist-to-height-ratio, and lipometry). Patient data were compared with a healthy control group (n = 64). RESULTS Results show that overweight patients with BD exhibit lower performance in the TMT-A/B as well as in the free recall performance of the CVLT compared to normal-weight patients with BD and controls. In bipolar individuals, (abdominal) obesity was significantly associated with a poor cognitive performance. In bipolar females, associations with measures of verbal learning and memory were found; in bipolar males, associations with poor performance in the TMT-A/B and in the Stroop interference task were demonstrated. In controls, no associations were found. CONCLUSIONS There are several possible pathways moderating the association between obesity and cognition in BD. Anthropometric and lipometry data underline the substantial mediating impact of body fat distribution on cognition in BD.
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Affiliation(s)
- N Lackner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S A Bengesser
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Birner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Painold
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - F T Fellendorf
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - M Platzer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - B Reininghaus
- b Therapiezentrum Justuspark, Versicherungsanstalt öffentlich Bediensteter , Austria
| | - E M Weiss
- c Department of Biological Psychology , Karl-Franzens University Graz , Graz , Austria
| | - H Mangge
- d Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria.,e BioTechMed-Graz , Graz , Austria
| | - R S McIntyre
- f Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , Canada
| | - D Fuchs
- g Division of Biological Chemistry, Medical University of Innsbruck , Innsbruck , Austria
| | - H P Kapfhammer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S J Wallner-Liebmann
- h Department of Pathophysiology and Immunology , Medical University Graz , Graz , Austria
| | - E Z Reininghaus
- a Department of Psychiatry , Medical University Graz , Graz , Austria
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Kim EY, Kim SH, Lee HJ, Kim B, Kim YS, Ahn YM. Sex-specific association between the albumin D-element binding protein gene and metabolic syndrome in patients with bipolar disorder and schizophrenia. Psychiatry Res 2016; 240:47-52. [PMID: 27084990 DOI: 10.1016/j.psychres.2016.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 02/22/2016] [Accepted: 03/25/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Eun Young Kim
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Neuropsychiatry, Dongguk University Medical School, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Hyun Jeong Lee
- Mental Health Clinic, National Cancer Center, Goyang, Republic of Korea
| | - Bora Kim
- Department of Psychiatry, University of California, San Francisco, USA
| | - Yong Sik Kim
- Department of Neuropsychiatry, Dongguk University Medical School, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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81
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Chang TT, Chen SL, Chang YH, Chen PS, Chu CH, Chen SH, Huang SY, Tzeng NS, Wang LJ, Wang TY, Li CL, Chung YL, Hsieh TH, Lee IH, Chen KC, Yang YK, Hong JS, Lu RB, Lee SY. The DRD3 Ser9Gly Polymorphism Predicted Metabolic Change in Drug-Naive Patients With Bipolar II Disorder. Medicine (Baltimore) 2016; 95:e3488. [PMID: 27310943 PMCID: PMC4998429 DOI: 10.1097/md.0000000000003488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patients with bipolar II disorder (BDII) have a higher prevalence rate of metabolic disturbance. Whether BDII itself, in addition to its current standard treatment, is a risk factor for metabolic syndrome warrants additional study. The dopamine receptor D3 (DRD3) gene, one of the candidate genes for BDII, is also involved in the dopaminergic system. We investigated whether it is related to changes in the metabolic indices of patients with BDII given 12 weeks of standard treatment.Patients with a first diagnosis of BDII (n = 117) were recruited. Metabolic profiles (cholesterol, triglycerides, fasting serum glucose, body mass index) were measured at baseline and at 2, 8, and 12 weeks. The genotype of the DRD3 Ser9Gly polymorphism (rs6280) was determined. Multiple linear regressions with generalized estimating equation methods were used.Seventy-six (65.0%) patients completed the 12-week intervention. Significant differences in triglyceride change were associated with the DRD3 Ser9Gly genotype (P = 0.03). Patients with the Ser/Ser genotype had significantly smaller triglyceride increases and a lower risk of developing metabolic syndrome than did those with the Ser/Gly+Gly/Gly genotype. However, the associations between the DRD3 Ser9Gly polymorphism with changes in triglyceride level become nonsignificant after correcting for multiple comparisons.We conclude that the DRD3 Ser9Gly polymorphism is nominally associated with changes in triglycerides and metabolic syndrome after 12 weeks of standard BDII treatment.
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Affiliation(s)
- Ting-Ting Chang
- From the Department of Psychiatry, E-Da Hospital, I-Shou University (T-TC); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University (KMU), Lipid Science and Aging Research Center, KMU, Kaohsiung (S-LC); Department of Psychiatry, National Cheng Kung University Hospital, Tainan (S-LC, Y-HC, P-SC, T-YW, C-LL, Y-LC, T-HH, I-HL, K-CC, Y-KY, R-BL, S-YL); Department of Psychology, Asia University, Taichung (Y-HC); Institute of Allied Health, College of Medicine (Y-HC, R-BL); Department of Psychiatry, College of Medicine (P-SC, T-YW, I-HL, K-CC, Y-KY, R-BL, S-YL); Addiction Research Center (P-SC, R-BL); Institute of Molecular Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C-HC); Neurobiology Laboratory, NIH/NIEHS, Research Triangle Park, North Carolina (S-HC, J-SH); Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (S-YH, N-ST); Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung (L-JW); Institute of Basic Medical Sciences, National Cheng Kung University, Tainan (Y-LC); Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin (Y-KY); Institute of Behavioral Medicine Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan (R-BL); Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan (R-BL); Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (S-YL)
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82
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Abstract
The pathophysiology of bipolar disorder (BD) remains poorly understood. Current psychopharmacologic treatments are often poorly tolerated and carry high rates of treatment resistance. Mounting evidence has suggested that innate immune system dysfunction may play a role in the pathophysiology of BD. Elevated proinflammatory cytokine levels have been identified. The innate immune system is a novel therapeutic target in BD. Lithium has been shown to have antiinflammatory properties. Further research is needed to establish the role of antiinflammatory agents in the treatment of BD; however, evidence from several clinical trials indicates that antiinflammatory agents may be incorporated into clinical practice soon.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario M5T 2S8, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario M5T 2S8, Canada.
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83
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Mansur RB, Rizzo LB, Santos CM, Asevedo E, Cunha GR, Noto MN, Pedrini M, Zeni M, Cordeiro Q, McIntyre RS, Brietzke E. Adipokines, metabolic dysfunction and illness course in bipolar disorder. J Psychiatr Res 2016; 74:63-9. [PMID: 26748249 DOI: 10.1016/j.jpsychires.2015.12.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/27/2015] [Accepted: 12/03/2015] [Indexed: 12/11/2022]
Abstract
Replicated evidence indicates that individuals with BD are differentially affected by metabolic comorbidities and that its occurrence is a critical mediator and/or moderator of BD outcomes. This study aimed to explore the role of adipokines on bipolar disorder (BD) course and its relationship with metabolic comorbidities (i.e. type 2 diabetes mellitus, obesity). We measured plasma levels of adiponectin and leptin, as well as anthropometric and metabolic parameters of 59 patients with BD and 28 healthy volunteers. Our results showed that, in female participants, adiponectin was lower in individuals with BD, relative to healthy controls (p = 0.017). In the BD population, adiponectin levels were correlated with fasting glucose (r = -0.291, p = 0.047), fasting insulin (r = -0.332, p = 0.023), C-peptide (r = 0.040, p = 0.040), homeostatic model assessment-insulin resistance (r = -0.411, p = 0.004), HDL (r = 0.508, p < 0.001), VLDL (r = -0.395, p = 0.005) and triglycerides (r = -0.310, p = 0.030). After adjustment for age, gender and BMI, individuals with BD and low adiponectin levels (i.e. < 7.5 μg/ml), had a higher number of mood episodes (p < 0.001), lower number of psychiatric hospitalizations (p = 0.007), higher depressive symptoms (p < 0.001) and lower levels of functioning (p = 0.020). In conclusion, adiponectin levels, either directly or as a proxy of metabolic dysfunction, is independently associated with an unfavorable course of illness in BD.
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Affiliation(s)
- Rodrigo B Mansur
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
| | - Lucas B Rizzo
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Department of Psychiatry, Clinic for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Camila M Santos
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Elson Asevedo
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Graccielle R Cunha
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariane N Noto
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Vila Maria Outpatient Clinic in São Paulo, Brazil
| | - Mariana Pedrini
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Maiara Zeni
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Quirino Cordeiro
- Department of Psychiatry, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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84
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Morales-Marín ME, Genis-Mendoza AD, Tovilla-Zarate CA, Lanzagorta N, Escamilla M, Nicolini H. Association between obesity and the brain-derived neurotrophic factor gene polymorphism Val66Met in individuals with bipolar disorder in Mexican population. Neuropsychiatr Dis Treat 2016; 12:1843-8. [PMID: 27524902 PMCID: PMC4966648 DOI: 10.2147/ndt.s104654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The brain-derived neurotrophic factor (BDNF) has been considered as an important candidate gene in bipolar disorder (BD); this association has been derived from several genetic and genome-wide studies. A polymorphic variant of the BDNF (Val66Met) confers some differences in the clinical presentation of affective disorders. In this study, we evaluated a sample population from Mexico City to determine whether the BDNF (rs6265) Val66Met polymorphism is associated with the body mass index (BMI) of patients with BD. METHODS This association study included a sample population of 357 individuals recruited in Mexico City. A total of 139 participants were diagnosed with BD and 137 were classified as psychiatrically healthy controls (all individuals were interviewed and evaluated by the Diagnostic Interview for Genetic Studies). Genomic DNA was extracted from peripheral blood leukocytes. The quantitative polymerase chain reaction (qPCR) assay was performed in 96-well plates using the TaqMan Universal Thermal Cycling Protocol. After the PCR end point was reached, fluorescence intensity was measured in a 7,500 real-time PCR system and evaluated using the SDS v2.1 software, results were analyzed with Finetti and SPSS software. Concerning BMI stratification, random groups were defined as follows: normal <25 kg/m(2), overweight (Ow) =25.1-29.9 kg/m(2), and obesity (Ob) >30 kg/m(2). RESULTS In the present work, we report the association of a particular BMI phenotype with the presence of the Val66Met allele in patients with BD (P=0.0033 and odds ratio [95% confidence interval] =0.332 [157-0.703]), and correlated the risk for valine allele carriers with Ow and Ob in patients with BD. CONCLUSION We found that the methionine allele confers a lower risk of developing Ow and Ob in patients with BD. We also confirmed that the G polymorphism represents a risk of developing Ow and Ob in patients with BD. In future studies, the haplotype analysis should provide additional evidence that BDNF may be associated with BD and BMI within the Mexican population.
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Affiliation(s)
- Mirna Edith Morales-Marín
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), CDMX, Mexico
| | - Alma Delia Genis-Mendoza
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), CDMX, Mexico; Psychiatric Care Services, Child Psychiatric Hospital Dr Juan N Navarro, CDMX, Mexico
| | | | | | - Michael Escamilla
- Department of Psychiatry, Paul L Foster School of Medicine, Texas Tech University Health Science Center, El Paso TX, USA
| | - Humberto Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), CDMX, Mexico; Carracci Medical Group, CDMX, Mexico
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85
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Lee S, Matejkowski J. Associations between comorbid health conditions and the use of mental health services among adults with bipolar disorder. SOCIAL WORK IN HEALTH CARE 2016; 55:28-40. [PMID: 26872526 DOI: 10.1080/00981389.2015.1107016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Using a nationally representative sample, this study examined to what extent the number of comorbid health conditions was associated with various mental health service utilization among people with bipolar disorder. The results of logistic regression models indicate that a greater number of comorbid medical conditions were associated with higher odds of using specialty mental health service, while they were not associated with utilization of services provided by general health care providers. The type of bipolar disorder, functional impairment, and marital status were found to be associated with the use of a specialty service, while ethnicity was the only covariate significantly related to general health care use.
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Affiliation(s)
- Sungkyu Lee
- a School of Social Welfare , Soongsil University , Seoul , South Korea
| | - Jason Matejkowski
- b School of Social Welfare and Center for Mental Health Research and Innovation , University of Kansas , Lawrence , Kansas , USA
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86
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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87
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Archie S, Zangeneh-Kazemi A, Akhtar-Danesh N. First-episode affective psychosis and lipid monitoring: survival analysis of the first abnormal lipid test. Early Interv Psychiatry 2015; 9:507-11. [PMID: 25130568 DOI: 10.1111/eip.12180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to assess the probability of developing a lipid test abnormality over time, among first-time users of antipsychotic medications with affective psychosis. METHODS Survival analysis was used to analyse data from an early intervention in psychosis programme for the first 53 consecutive and eligible cases of patients between the ages of 14 and 40 years who had a diagnosis of affective psychosis. Data on initiation of antipsychotic medications and lipid laboratory test results were abstracted from chart reviews. RESULTS Within the first 18 months of receiving antipsychotic medications, the probability of surviving without an abnormal lipid test was only 25% (confidence interval 95%: 13.1%, 40.4%). The median time to the development of an abnormal test was 8 months for males and 12 months for females (P < 0.001). CONCLUSIONS Additional studies are needed to document the incidence over time of abnormal lipid tests to inform clinicians about the optimal frequency of monitoring.
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Affiliation(s)
- Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Azadeh Zangeneh-Kazemi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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88
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Rosso G, Cattaneo A, Zanardini R, Gennarelli M, Maina G, Bocchio-Chiavetto L. Glucose metabolism alterations in patients with bipolar disorder. J Affect Disord 2015; 184:293-8. [PMID: 26120808 DOI: 10.1016/j.jad.2015.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 05/18/2015] [Accepted: 06/09/2015] [Indexed: 12/20/2022]
Abstract
Patients with bipolar disorder (BD) are more frequently affected by metabolic syndrome (MetS) than the general population, but the neurobiological correlates underlying such association are still not clarified and few studies in BD have evaluated the role of regulators of lipid and glucose metabolism. The present study was aimed to investigate putative alterations in markers linked to metabolic dysfunctions as C-peptide, Ghrelin, GIP, GLP-1, Glucagon, Insulin, Leptin, PAI-1 (total), Resistin and Visfatin in a sample of BD patients compared to controls. Furthermore, associations between changes of metabolic markers and relevant clinical features, such as severity of symptomatology, number and type of past mood episodes, drug treatments and presence/absence of metabolic alterations (MetS, diabetes and cardiovascular disease) were analyzed. A total of 57 patients with BD and 49 healthy controls were recruited. The main results showed lower serum levels of Glucagon, GLP-1, Ghrelin, and higher levels of GIP in BD patients as compared to controls (p = 0.018 for Ghrelin; p < 0.0001 for Glucagon; p < 0.0001 for GLP-1; p < 0.0001 for GIP). Further, Glucagon and GLP-1 levels were significantly associated with the number of past mood episodes. These findings support the hypothesis that alterations in Glucagon, GLP-1, GIP and Ghrelin might be involved in BD pathogenesis and might represent useful biomarkers for the development of preventive and personalized therapies in this disorder.
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Affiliation(s)
- Gianluca Rosso
- Psychiatric Clinic, 'San Luigi Gonzaga Hospital' of Orbassano - Department of Neuroscience, University of Torino, Italy
| | - Annamaria Cattaneo
- IRCCS Centro S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy; Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | | | - Massimo Gennarelli
- IRCCS Centro S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Giuseppe Maina
- Psychiatric Clinic, 'San Luigi Gonzaga Hospital' of Orbassano - Department of Neuroscience, University of Torino, Italy
| | - Luisella Bocchio-Chiavetto
- IRCCS Centro S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy; Faculty of Psychology, eCampus University, Novedrate, Como, Italy.
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89
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Díaz-Anzaldúa A, Ocampo-Mendoza Y, Hernández-Lagunas JO, Díaz-Madrid FA, Romo-Nava F, Juárez-García F, Ortega-Ortiz H, Díaz-Anzaldúa A, Gutiérrez-Mora D, Becerra-Palars C, Berlanga-Cisneros C. Differences in body mass index according to fat mass- and obesity-associated (FTO) genotype in Mexican patients with bipolar disorder. Bipolar Disord 2015; 17:662-9. [PMID: 26529281 DOI: 10.1111/bdi.12328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 07/07/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The prevalence of obesity has dramatically increased in many countries and it is particularly high in patients with bipolar disorder (BD). A region in the first intron of the fat mass- and obesity-associated (FTO) gene, encompassing markers rs9939973, rs8050136, and rs9939609, has been consistently associated with obesity and body mass index (BMI) in different populations. We sought to determine whether FTO is associated with BMI and/or obesity in patients with BD. METHODS The sample included 129 Mexican Mestizo patients with bipolar I or bipolar II disorder. After obtaining informed consent, participants were evaluated with the Structured Clinical Interview for DSM-IV Axis I Disorders and weight, height, and body measurements were recorded. DNA was extracted from a 5-mL blood sample and real-time polymerase chain reaction was performed. The results were analyzed with Haploview v4.2 and SPSS v21. RESULTS Differences in mean BMI were explained by rs8050136 and rs9939609 genotypes, especially by comparing non-carriers and carriers of two copies of the risk allele (Tukey's p ≤ 0.019), with a mean difference in BMI as high as 7.81 kg/m(2) . Differences in BMI were also explained by the interaction of the genotype (rs8050136 and/or rs9939609), the use of second-generation antipsychotics, and the use of mood stabilizers (p ≤ 0.41). Obesity was also associated with these two markers when patients with and without obesity were compared. CONCLUSIONS In patients with BD, differences in BMI may be affected by the presence of FTO risk alleles, especially in homozygous individuals for these variants. Besides evaluating the possible metabolic effects of certain antipsychotics or mood stabilizers, it is important to evaluate the role of other factors such as FTO risk alleles.
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Affiliation(s)
- Adriana Díaz-Anzaldúa
- Departamento de Genética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Pisquiatría Ramón de la Fuente Muñiz (INPRF), Mexico D.F, Mexico
| | - Yolanda Ocampo-Mendoza
- Departamento de Genética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Pisquiatría Ramón de la Fuente Muñiz (INPRF), Mexico D.F, Mexico
| | - José Octavio Hernández-Lagunas
- Departamento de Genética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Pisquiatría Ramón de la Fuente Muñiz (INPRF), Mexico D.F, Mexico
| | - Federico Alejandro Díaz-Madrid
- Departamento de Genética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Pisquiatría Ramón de la Fuente Muñiz (INPRF), Mexico D.F, Mexico
| | - Francisco Romo-Nava
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico D.F, Mexico
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90
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Rosenblat JD, McIntyre RS. Are medical comorbid conditions of bipolar disorder due to immune dysfunction? Acta Psychiatr Scand 2015; 132:180-91. [PMID: 25772638 DOI: 10.1111/acps.12414] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Epidemiological data have shown a clear association between bipolar disorder (BD) and medical comorbidities. The aim of this article was to assess the evidence of immune dysfunction as a key mediator of this observed association. METHOD For this narrative clinical overview, the MEDLINE/PubMed, EMBASE, Google Scholar, and ClinicalTrials.gov databases were searched for relevant articles. RESULTS Bipolar disorder has been shown to have an increased prevalence in patients with autoimmune disorders, cardiovascular disease, and metabolic dysfunction. Further, an elevation in proinflammatory cytokines in BD has been repeatedly demonstrated. Several mechanisms have been proposed to explain the effect of immune dysfunction on mood and cognition. Anti-inflammatory agents including TNF-α inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), minocycline and omega-3 polyunsaturated fatty acids (O3PUFA) are being investigated for their use as novel treatment of BD in patients with immune dysfunction. CONCLUSION Immune dysfunction appears to be an important mediator of the association observed between BD and medical comorbidities. It therefore serves as a potential novel target for treatment of BD. Further, the observed bidirectional interaction merits screening for psychiatric disorders in patients with immune dysfunction and vice versa to allow for early detection and treatment of this at risk population.
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Affiliation(s)
- J D Rosenblat
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada.,Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - R S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
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Tunçel ÖK, Sarısoy G, Bilgici B, Pazvantoglu O, Çetin E, Ünverdi E, Avcı B, Böke Ö. Oxidative stress in bipolar and schizophrenia patients. Psychiatry Res 2015; 228:688-94. [PMID: 26117246 DOI: 10.1016/j.psychres.2015.04.046] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 03/13/2015] [Accepted: 04/18/2015] [Indexed: 02/08/2023]
Abstract
Oxidative stress has an important place in studies investigating the pathophysiology of psychiatric diseases. In spite of this fact, longitudinal studies are required to clarify the subject. Therefore, in this study, we examined lipid peroxidation, protein oxidation, total oxidized guanine species, superoxide dismutase (SOD) and total glutathione (GSH) levels in blood collected from adult bipolar patients (n=18) during manic and euthymic episodes, schizophrenic patients (n=18) during acute psychotic attack and remission phases and the control group (n=18). There was a significant increase in the level of lipid peroxidation in the bipolar disorder manic episode group (BD-ME) compared to control group. The level of protein oxidation was significantly higher in the schizophrenia acute psychotic attack group (SZ-APA) compared to the control group. The level of total oxidized guanine species was statistically higher in all psychiatric groups compared to the control group. There was no significant difference among the groups with regard to SOD and GSH. Consequently, we believe that lipid peroxidation may be effective in the pathogenesis of bipolar patients; that protein oxidation may be of importance in the pathogenesis of schizophrenia and that total oxidized guanine species may be crucial in the pathogeneses of both psychiatric disorders.
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Affiliation(s)
- Özgür Korhan Tunçel
- Medical Biochemistry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey.
| | - Gökhan Sarısoy
- Psychiatry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Birşen Bilgici
- Medical Biochemistry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Ozan Pazvantoglu
- Psychiatry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Eda Çetin
- Psychiatry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Esra Ünverdi
- Psychiatry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Bahattin Avcı
- Medical Biochemistry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Ömer Böke
- Psychiatry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
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92
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Goldstein BI, Carnethon MR, Matthews KA, McIntyre RS, Miller GE, Raghuveer G, Stoney CM, Wasiak H, McCrindle BW. Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2015; 132:965-86. [PMID: 26260736 DOI: 10.1161/cir.0000000000000229] [Citation(s) in RCA: 328] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2) position MDD and BD as tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations. In this scientific statement, there is an integration of the various factors that putatively underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications.
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93
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Birner A, Seiler S, Lackner N, Bengesser SA, Queissner R, Fellendorf FT, Platzer M, Ropele S, Enzinger C, Schwingenschuh P, Mangge H, Pirpamer L, Deutschmann H, McIntyre RS, Kapfhammer HP, Reininghaus B, Reininghaus EZ. Cerebral White Matter Lesions and Affective Episodes Correlate in Male Individuals with Bipolar Disorder. PLoS One 2015; 10:e0135313. [PMID: 26252714 PMCID: PMC4529150 DOI: 10.1371/journal.pone.0135313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/20/2015] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral white matter lesions (WML) have been found in normal aging, vascular disease and several neuropsychiatric conditions. Correlations of WML with clinical parameters in BD have been described, but not with the number of affective episodes, illness duration, age of onset and Body Mass Index in a well characterized group of euthymic bipolar adults. Herein, we aimed to evaluate the associations between bipolar course of illness parameters and WML measured with volumetric analysis. Methods In a cross-sectional study 100 euthymic individuals with BD as well as 54 healthy controls (HC) were enrolled to undergo brain magnetic resonance imaging using 3T including a FLAIR sequence for volumetric assessment of WML-load using FSL-software. Additionally, clinical characteristics and psychometric measures including Structured Clinical Interview according to DSM-IV, Hamilton-Depression, Young Mania Rating Scale and Beck’s Depression Inventory were evaluated. Results Individuals with BD had significantly more (F = 3.968, p < .05) WML (Mdn = 3710mm3; IQR = 2961mm3) than HC (Mdn = 2185mm3; IQR = 1665mm3). BD men (Mdn = 4095mm3; IQR = 3295mm3) and BD women (Mdn = 3032mm3; IQR = 2816mm3) did not significantly differ as to the WML-load or the number and type of risk factors for WML. However, in men only, the number of manic/hypomanic episodes (r = 0.72; p < .001) as well as depressive episodes (r = 0.51; p < .001) correlated positively with WML-load. Conclusions WML-load strongly correlated with the number of manic episodes in male BD patients, suggesting that men might be more vulnerable to mania in the context of cerebral white matter changes.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Department of Neurology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Nina Lackner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Robert Queissner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Martina Platzer
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Petra Schwingenschuh
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit at the University Health Network, University of Toronto, Toronto, Canada
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94
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Bonaccorso S, Sodhi M, Li J, Bobo WV, Chen Y, Tumuklu M, Theleritis C, Jayathilake K, Meltzer HY. The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with increased body mass index and insulin resistance measures in bipolar disorder and schizophrenia. Bipolar Disord 2015; 17:528-35. [PMID: 25874530 DOI: 10.1111/bdi.12294] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 12/17/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We tested the hypothesis that a common functional variant in brain-derived neurotrophic factor (BDNF), Val66Met, which has been shown to be associated with increased body mass index (BMI) in schizophrenia (SCZ) and schizoaffective disorder (SAD), is also associated with antipsychotic-induced weight gain in bipolar disorder (BPD). Association of Val66Met with other metabolic measures, including high- and low-density cholesterol, triglycerides, total cholesterol, fasting blood glucose, and hemoglobin A1c, was also tested. METHODS This was a 12-month, prospective, randomized trial of two atypical antipsychotic drugs (APDs) with moderate (risperidone) or high (olanzapine) risk to cause weight gain. Subjects were diagnosed as having BPD (n = 90) and SCZ or SAD (n = 76). RESULTS BMI was significantly greater in all diagnoses for Met66 allele carriers at six months (p = 0.01). Met66 carriers with BPD showed a greater increase in the triglycerides/high-density (HDL) cholesterol ratio (p = 0.01), a key marker for metabolic syndrome related to insulin resistance, and log-triglycerides (p = 0.04), after three or six months of treatment. Met66 carriers had the greatest increase in log-triglycerides (p = 0.03) and triglycerides/HDL cholesterol ratio after three months of treatment with risperidone (p = 0.003), and the highest BMI at six months (p = 0.01). CONCLUSIONS The positive association of BNDF Val66Met with high BMI values replicates previous findings in patients with SCZ and indicates the BDNF Val66Met genotype as a potential risk factor for obesity and insulin resistance measures in patients with BPD receiving antipsychotics as well.
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Affiliation(s)
- Stefania Bonaccorso
- Department of Psychosis Studies, Institute of Psychiatry at the Maudsley, King's College London, London, UK
| | - Monsheel Sodhi
- Department of Pharmacy Practice, University of Illinois, Chicago, IL, USA
| | - Jiang Li
- Department of Psychiatry and Behavioural Sciences, Northwestern University, Chicago, IL, USA
| | | | - Yuejin Chen
- Southern Arizona VA Health Care System, Tucson, AZ, USA
| | - Mevhibe Tumuklu
- Faculty of Medicine, Department of Psychiatry, Gaziosmanpasa University, Tokat, Turkey
| | - Christos Theleritis
- Department of Psychosis Studies, Institute of Psychiatry at the Maudsley, King's College London, London, UK
| | - Karuna Jayathilake
- Department of Psychiatry and Behavioural Sciences, Northwestern University, Chicago, IL, USA
| | - Herbert Y Meltzer
- Department of Psychiatry and Behavioural Sciences, Northwestern University, Chicago, IL, USA
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95
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Hsu JH, Chien IC, Lin CH. Increased risk of hyperlipidemia in patients with bipolar disorder: a population-based study. Gen Hosp Psychiatry 2015; 37:294-8. [PMID: 25892153 DOI: 10.1016/j.genhosppsych.2015.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We conducted this nationwide study to examine the epidemiology of hyperlipidemia among Taiwanese patients with bipolar disorder. METHODS We used a random sample of 766,427 subjects who were ≥18 years old in 2005. Subjects with at least one primary diagnosis of bipolar disorder were identified. Individuals with a primary or secondary diagnosis of hyperlipidemia or medication treatment for hyperlipidemia were also identified. We compared the prevalence of hyperlipidemia in patients with bipolar disorder with the general population in 2005. Furthermore, we investigated this cohort from 2006 to 2010 to detect the incident cases of hyperlipidemia. RESULTS The prevalence of hyperlipidemia in patients with bipolar disorder was higher than that of the general population [13.5% vs. 7.9%; odds ratio, 1.75; 95% confidence interval (CI), 1.52-2.02] in 2005. The average annual incidence of hyperlipidemia in patients with bipolar disorder was also higher than that of the general population (4.37% vs. 2.55%; risk ratio, 1.66; 95% CI, 1.47-1.87) from 2006 to 2010. CONCLUSIONS Patients with bipolar disorder had a higher prevalence and incidence of hyperlipidemia compared with the general population. Patients with bipolar disorder coexisting hypertension exhibited a higher likelihood of hyperlipidemia.
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Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Ministry of Health and Welfare, 600 Chiayi City, Taiwan
| | - I-Chia Chien
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 54249 Nantou County, Taiwan; Department of Public Health and Institute of Public Health, National Yang-Ming University, 112 Taipei City, Taiwan.
| | - Ching-Heng Lin
- Taichung Veteran General Hospital, 407 Taichung City, Taiwan
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96
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Munkholm K, Poulsen HE, Kessing LV, Vinberg M. Elevated levels of urinary markers of oxidatively generated DNA and RNA damage in bipolar disorder. Bipolar Disord 2015; 17:257-68. [PMID: 25118140 DOI: 10.1111/bdi.12245] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/15/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The pathophysiological mechanisms underlying bipolar disorder and its multi-system nature are unclear. Oxidatively generated damage to nucleosides has been demonstrated in metabolic disorders; however, the extent to which this occurs in bipolar disorder in vivo is unknown. We investigated oxidatively generated damage to DNA and RNA in patients with bipolar disorder and its relationship with the affective phase compared with healthy control subjects. METHODS Urinary excretion of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) and 8-oxo-7,8-dihydroguanosine (8-oxoGuo), markers of oxidatively generated DNA and RNA damage, respectively, was measured in 37 rapid cycling patients with bipolar disorder and in 40 age- and gender-matched healthy control subjects. Employing a longitudinal design, repeated measurements of both markers were evaluated in various affective phases in patients with bipolar disorder during a six- to 12-month period and compared with repeated measurements in healthy control subjects. RESULTS In linear mixed models, adjusting for demographical, metabolic, and lifestyle factors, the excretion of 8-oxodG and 8-oxoGuo was significantly elevated in euthymic patients with bipolar disorder compared with healthy control subjects, with increases of 40% (p < 0.0005) and 43% (p < 0.0005), respectively. The increased oxidatively generated nucleoside damage was present through all affective phases of the illness, with no significant difference between affective states. CONCLUSIONS Our results indicate that bipolar disorder is associated with increased oxidatively generated damage to nucleosides. The findings could suggest a role for oxidatively generated damage to DNA and RNA as a molecular mechanism contributing to the increased risk of medical disorders, shortened life expectancy, and the progressive course of illness observed in bipolar disorder.
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Affiliation(s)
- Klaus Munkholm
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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97
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Premorbid obesity and metabolic disturbances as promising clinical targets for the prevention and early screening of bipolar disorder. Med Hypotheses 2015; 84:285-93. [DOI: 10.1016/j.mehy.2015.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/11/2015] [Indexed: 12/12/2022]
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98
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Happell B, Stanton R, Hoey W, Scott D. Reduced ambivalence to the role of the cardiometabolic health nurse following a 6-month trial. Perspect Psychiatr Care 2015; 51:80-5. [PMID: 24602142 DOI: 10.1111/ppc.12066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/24/2014] [Accepted: 02/06/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To determine the changes in attitudes toward the inclusion of a cardiometabolic health nurse for the physical healthcare management of people with serious mental illness following a 6-month trial. DESIGN AND METHODS Repeated survey of nurses working in a regional mental health facility. FINDINGS Nurses working in mental health were initially supportive of the role. A 6-month trial of a cardiometabolic health nurse in the workplace reduced ambivalence and increased positivity toward the role. PRACTICE IMPLICATIONS Reduced ambivalence and improved positivity toward the role may facilitate less organization resistance to the implementation of a cardiometabolic health nurse in the mental healthcare setting. Specialized training and role recognition may be needed to further support this role.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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99
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Hajek T, Calkin C, Blagdon R, Slaney C, Alda M. Type 2 diabetes mellitus: a potentially modifiable risk factor for neurochemical brain changes in bipolar disorders. Biol Psychiatry 2015; 77:295-303. [PMID: 24331546 DOI: 10.1016/j.biopsych.2013.11.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neuroimaging changes in bipolar disorder (BD) may be secondary to the presence of certain clinical factors. Type 2 diabetes mellitus (T2DM) damages the brain and frequently co-occurs with BD. Studying patients with both T2DM and BD could help identify preventable risk factors for neuroimaging changes in BD. METHODS We used 1.5T magnetic resonance spectroscopy to measure prefrontal N-acetylaspartate (NAA), which is mainly localized in neurons, and total creatine (tCr), an energy metabolite, in 19 BD patients with insulin resistance/glucose intolerance (BD + IR/GI), 14 BD subjects with T2DM (BD + T2DM), 15 euglycemic BD participants, and 11 euglycemic, nonpsychiatric control. RESULTS The levels of NAA and tCr were lowest among BD + T2DM, intermediate in the BD + IR/GI, and highest among the euglycemic BD and control subjects (F₃,₅₅ = 4.57, p = .006; F₃,₅₅ = 2.92, p = .04, respectively). Even the BD + IR/GI subjects had lower NAA than the euglycemic participants (t₄₃ = 2.13, p = .04). Total Cr was associated with NAA (β = .52, t₅₆ = 5.57, p = .000001). Both NAA and tCr correlated with Global Assessment of Functioning scores (r₄₆ = .28, p = .05; r₄₆ = .48, p = .0004, respectively). CONCLUSIONS T2DM, but also prediabetes, may be risk factors for prefrontal neurochemical alterations in BD. These changes were associated with poor psychosocial functioning and could indicate impaired energy metabolism. The findings emphasize the importance of improving diabetes care in BD and suggest potential options for treatment of neuroimaging alterations.
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Affiliation(s)
- Tomas Hajek
- Department of Psychiatry (TH, CC, RB, CS, MA), Dalhousie University, Halifax, Nova Scotia, Canada; Prague Psychiatric Center (TH, MA), Department of Psychiatry and Medical Psychology, 3rd School of Medicine, Charles University, Prague, Czech Republic.
| | - Cynthia Calkin
- Department of Psychiatry (TH, CC, RB, CS, MA), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Blagdon
- Department of Psychiatry (TH, CC, RB, CS, MA), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claire Slaney
- Department of Psychiatry (TH, CC, RB, CS, MA), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Alda
- Department of Psychiatry (TH, CC, RB, CS, MA), Dalhousie University, Halifax, Nova Scotia, Canada; Prague Psychiatric Center (TH, MA), Department of Psychiatry and Medical Psychology, 3rd School of Medicine, Charles University, Prague, Czech Republic
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100
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Bengesser SA, Lackner N, Birner A, Fellendorf FT, Platzer M, Mitteregger A, Unterweger R, Reininghaus B, Mangge H, Wallner-Liebmann SJ, Zelzer S, Fuchs D, McIntyre RS, Kapfhammer HP, Reininghaus EZ. Peripheral markers of oxidative stress and antioxidative defense in euthymia of bipolar disorder--Gender and obesity effects. J Affect Disord 2015; 172:367-74. [PMID: 25451439 DOI: 10.1016/j.jad.2014.10.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 08/20/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Oxidative and nitrosative stress are implicated in the pathogenesis of uni- and bipolar disorder. Herein we primarily sought to characterize markers of oxidative/nitrosative stress during euthymia in adults with bipolar disorder (BD). Oxidative markers were further evaluated in this BD sample in synopsis with excess overweight or obesity and/or comorbid metabolic syndrome (MetS). METHODS Peripheral markers of oxidative stress [i.e. thiobarbituric acid reactive substance, (TBARS), malondialdehyde (MDA), and carbonyl proteins] and antioxidant markers [e.g. total antioxidative capacity (TAC), superoxide dismutase (SOD), glutathione S-transferase (GST)] were obtained in a cohort of euthymic adults with BD (N=113) and compared to healthy controls (CG) (N=78). Additionally, anthropometric measures included the body mass index (BMI) [kg/m(2)], waist and hip circumference [cm], waist-to-hip-ratio (WHR), waist to height ratio (WtHR) as well as the IDF-defined MetS. RESULTS The major finding was a significantly decreased TAC in BD compared to the CG (p<0.01; BD: M 1.18, SD 0.47; CG: M 1.39, SD 0.49). MDA was significantly and TBARS by trend higher in the CG compared to the euthymic bipolar test persons (MDA: p<0.01, BD: M 0.70, SD 0.18; CG: M 0.81, SD 0.25; TBARS: p<0.1, BD: M 0.78, SD 0.28; CG: M 0.76, SD 0.30). The antioxidative enzyme GST was significantly elevated in both patients and controls (BD: M 298.24, SD 133.02; CG: M 307.27 SD 118.18). Subgroup analysis revealed that the CG with concurrent MetS and obesity had significantly elevated TAC when compared to CG without concurrent MetS (p<0.05, no MetS: M 1.33, SD 0.50; MetS: M 1.67, SD 0.32), as well as persons with BD with or without current MetS (no MetS: M 1.18, SD 0.44; MetS: M 1.15, SD 0.49). Significant correlations between GST and anthropometric variables were found in male study participants. Multivariate analysis indicated a significant gender effect concerning TBARS values in all patients and CG (p<0.01, females: M 0.73, SD 0.29; males: M 0.83, SD 0.28). CONCLUSION Euthymic bipolar adults exhibit peripheral evidence of a disturbed biosignature of oxidative stress and antioxidative defense. Male test persons showed significantly higher peripheral markers of oxidative stress than women- female sex may exert protective effects. Furthermore, the biosignature of oxidative stress obtained herein was more pronounced in males with concurrent metabolic disorders. Our results further extend knowledge by introducing the moderating influence of gender and obesity on oxidative stress and BD.
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Affiliation(s)
- S A Bengesser
- Medical University of Graz, Department of Psychiatry, Graz, Austria
| | - N Lackner
- Medical University of Graz, Department of Psychiatry, Graz, Austria.
| | - A Birner
- Medical University of Graz, Department of Psychiatry, Graz, Austria
| | - F T Fellendorf
- Medical University of Graz, Department of Psychiatry, Graz, Austria
| | - M Platzer
- Medical University of Graz, Department of Psychiatry, Graz, Austria
| | - A Mitteregger
- Medical University of Graz, Department of Psychiatry, Graz, Austria
| | - R Unterweger
- Medical University of Graz, Department of Psychiatry, Graz, Austria
| | - B Reininghaus
- Medical University of Graz, Department of Psychiatry, Graz, Austria; Therapiezentrum Justuspark, Linzer Straße 7, 4540 Bad Hall, Austria
| | - H Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | | | - S Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | - D Fuchs
- Medical University of Innsbruck, Biocenter, Division of Biological Chemistry, Innsbruck, Austria
| | - R S McIntyre
- University of Toronto, Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - H P Kapfhammer
- Medical University of Graz, Department of Psychiatry, Graz, Austria
| | - E Z Reininghaus
- Medical University of Graz, Department of Psychiatry, Graz, Austria
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