51
|
Charles EF, Lambert CG, Kerner B. Bipolar disorder and diabetes mellitus: evidence for disease-modifying effects and treatment implications. Int J Bipolar Disord 2016; 4:13. [PMID: 27389787 PMCID: PMC4936996 DOI: 10.1186/s40345-016-0054-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/18/2016] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Bipolar disorder refers to a group of chronic psychiatric disorders of mood and energy levels. While dramatic psychiatric symptoms dominate the acute phase of the diseases, the chronic course is often determined by an increasing burden of co-occurring medical conditions. High rates of diabetes mellitus in patients with bipolar disorder are particularly striking, yet unexplained. Treatment and lifestyle factors could play a significant role, and some studies also suggest shared pathophysiology and risk factors. OBJECTIVE In this systematic literature review, we explored data around the relationship between bipolar disorder and diabetes mellitus in recently published population-based cohort studies with special focus on the elderly. METHODS A systematic search in the PubMed database for the combined terms "bipolar disorder" AND "elderly" AND "diabetes" in papers published between January 2009 and December 2015 revealed 117 publications; 7 studies were large cohort studies, and therefore, were included in our review. RESULTS We found that age- and gender- adjusted risk for diabetes mellitus was increased in patients with bipolar disorder and vice versa (odds ratio range between 1.7 and 3.2). DISCUSSION Our results in large population-based cohort studies are consistent with the results of smaller studies and chart reviews. Even though it is likely that heterogeneous risk factors may play a role in diabetes mellitus and in bipolar disorder, growing evidence from cell culture experiments and animal studies suggests shared disease mechanisms. Furthermore, disease-modifying effects of bipolar disorder and diabetes mellitus on each other appear to be substantial, impacting both treatment response and outcomes. CONCLUSIONS The risk of diabetes mellitus in patients with bipolar disorder is increased. Our findings add to the growing literature on this topic. Increasing evidence for shared disease mechanisms suggests new disease models that could explain the results of our study. A better understanding of the complex relationship between bipolar disorder and diabetes mellitus could lead to novel therapeutic approaches and improved outcomes.
Collapse
Affiliation(s)
- Ellen F. Charles
- />David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Christophe G. Lambert
- />Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico, MSC10 5550, Albuquerque, NM 87131 USA
| | - Berit Kerner
- />Semel Institute for Neuroscience and Human Behavior, University of California, 695 Charles E. Young Drive South, Box 951761, Los Angeles, CA 90095 USA
- />Fakultät für Gesundheit, Private Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| |
Collapse
|
52
|
Naiberg MR, Newton DF, Collins JE, Dickstein DP, Bowie CR, Goldstein BI. Elevated triglycerides are associated with decreased executive function among adolescents with bipolar disorder. Acta Psychiatr Scand 2016; 134:241-8. [PMID: 27329743 DOI: 10.1111/acps.12603] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Cardiovascular risk factors that comprise metabolic syndrome (MetS) have been linked with cognition in adults with bipolar disorder (BD). This study examines the association between MetS components and executive function in adolescents with BD. METHODS A total of 34 adolescents with BD and 35 healthy control (HC) adolescents were enrolled. MetS components included triglycerides, high-density lipoprotein, glucose, waist circumference, and systolic and diastolic blood pressure. Executive functioning was measured using the intra-extra-dimensional (IED) set-shifting task from the Cambridge Neuropsychological Tests Automated Battery. RESULTS Adolescents with BD were more likely to have ≥1 MetS components (64.7%) as compared to HC participants (22.9%, χ(2) = 12.29, P = <0.001). Adolescents with BD also had poorer IED task performance compared to HC adolescents (composite Z-score: 0.21 ± 0.52 vs. 0.49 ± 0.51, P = 0.011). Within the BD group, IED composite Z-scores were correlated with diastolic blood pressure and triglyceride levels (ρ = -0.358, P = 0.041 and ρ = -0.396, P = 0.020 respectively). The association of triglycerides with executive function remained significant after controlling for age, IQ, and current use of second-generation antipsychotics. CONCLUSION Elevated triglycerides are associated with poorer executive function among adolescents with BD. Studies of behavioural and pharmacological interventions targeting MetS components for the purpose of improving executive function among adolescents with BD are warranted.
Collapse
Affiliation(s)
- M R Naiberg
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - D F Newton
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - J E Collins
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D P Dickstein
- Bradley Hospital, Pedi-MIND Program, East Providence, RI, USA
| | - C R Bowie
- Department of Psychology, Department of Psychiatry, Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - B I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
53
|
Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review. J Gen Intern Med 2016; 31:1083-91. [PMID: 27149967 PMCID: PMC4978675 DOI: 10.1007/s11606-016-3712-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications.In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system.Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.
Collapse
|
54
|
Benedetti F, Dallaspezia S. Improving outcome of bipolar disorder when considering glucose metabolism. EVIDENCE-BASED MENTAL HEALTH 2016; 19:e15. [PMID: 27311586 PMCID: PMC10699458 DOI: 10.1136/eb-2015-102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/13/2016] [Accepted: 05/27/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Francesco Benedetti
- Department of Clinical Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Sara Dallaspezia
- Department of Clinical Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
55
|
Burghardt KJ, Goodrich JM, Dolinoy DC, Ellingrod VL. Gene-specific DNA methylation may mediate atypical antipsychotic-induced insulin resistance. Bipolar Disord 2016; 18:423-32. [PMID: 27542345 PMCID: PMC5322870 DOI: 10.1111/bdi.12422] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Atypical antipsychotics (AAPs) carry a significant risk of cardiometabolic side effects, including insulin resistance. It is thought that the insulin resistance resulting from the use of AAPs may be associated with changes in DNA methylation. We aimed to identify and validate a candidate gene associated with AAP-induced insulin resistance by using a multi-step approach that included an epigenome-wide association study (EWAS) and validation with site-specific methylation and metabolomics data. METHODS Subjects with bipolar disorder treated with AAPs or lithium monotherapy were recruited for a cross-sectional visit to analyze peripheral blood DNA methylation and insulin resistance. Epigenome-wide DNA methylation was analyzed in a discovery sample (n = 48) using the Illumina 450K BeadChip. Validation analyses of the epigenome-wide findings occurred in a separate sample (n = 72) using site-specific methylation with pyrosequencing and untargeted metabolomics data. Regression analyses were conducted controlling for known confounders in all analyses and a mediation analysis was performed to investigate if AAP-induced insulin resistance occurs through changes in DNA methylation. RESULTS A differentially methylated probe associated with insulin resistance was discovered and validated in the fatty acyl CoA reductase 2 (FAR2) gene of chromosome 12. Functional associations of this DNA methylation site with untargeted phospholipid-related metabolites were also detected. Our results identified a mediating effect of this FAR2 methylation site on AAP-induced insulin resistance. CONCLUSIONS Going forward, prospective, longitudinal studies assessing comprehensive changes in FAR2 DNA methylation, expression, and lipid metabolism before and after AAP treatment are required to assess its potential role in the development of insulin resistance.
Collapse
Affiliation(s)
- Kyle J. Burghardt
- Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice. 259 Mack Avenue, Suite 2190. Detroit Michigan 48201. USA
| | - Jacyln M. Goodrich
- University of Michigan School of Public Health, Department of Environmental Sciences; 6638 SPH Tower, 1415 Washington Heights Ann Arbor, Michigan 48109. USA
| | - Dana C. Dolinoy
- University of Michigan School of Public Health, Department of Environmental Sciences; 6638 SPH Tower, 1415 Washington Heights Ann Arbor, Michigan 48109. USA
| | - Vicki L. Ellingrod
- University of Michigan, College of Pharmacy, Department of Clinical Social and Administrative Sciences. 428 Church Street, Ann Arbor, Michigan 48109. USA
- University of Michigan, School of Medicine, Department of Psychiatry. 1301 Catherine Ann Arbor, MI 48109. USA
| |
Collapse
|
56
|
Rosenblat JD, Gregory JM, McIntyre RS. Pharmacologic implications of inflammatory comorbidity in bipolar disorder. Curr Opin Pharmacol 2016; 29:63-9. [DOI: 10.1016/j.coph.2016.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/22/2016] [Indexed: 12/13/2022]
|
57
|
Huang JH, Berkovitch SS, Iaconelli J, Watmuff B, Park H, Chattopadhyay S, McPhie D, Öngür D, Cohen BM, Clish CB, Karmacharya R. Perturbational Profiling of Metabolites in Patient Fibroblasts Implicates α-Aminoadipate as a Potential Biomarker for Bipolar Disorder. MOLECULAR NEUROPSYCHIATRY 2016; 2:97-106. [PMID: 27606323 DOI: 10.1159/000446654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/04/2016] [Indexed: 12/27/2022]
Abstract
Many studies suggest the presence of aberrations in cellular metabolism in bipolar disorder. We studied the metabolome in bipolar disorder to gain insight into cellular pathways that may be dysregulated in bipolar disorder and to discover evidence of novel biomarkers. We measured polar and nonpolar metabolites in fibroblasts from subjects with bipolar I disorder and matched healthy control subjects, under normal conditions and with two physiologic perturbations: low-glucose media and exposure to the stress-mediating hormone dexamethasone. Metabolites that were significantly different between bipolar and control subjects showed distinct separation by principal components analysis methods. The most statistically significant findings were observed in the perturbation experiments. The metabolite with the lowest p value in both the low-glucose and dexamethasone experiments was α-aminoadipate, whose intracellular level was consistently lower in bipolar subjects. Our study implicates α-aminoadipate as a possible biomarker in bipolar disorder that manifests under cellular stress. This is an intriguing finding given the known role of α-aminoadipate in the modulation of kynurenic acid in the brain, especially as abnormal kynurenic acid levels have been implicated in bipolar disorder.
Collapse
Affiliation(s)
- Joanne H Huang
- Center for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, Mass., USA; Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA
| | - Shaunna S Berkovitch
- Center for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, Mass., USA; Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA
| | - Jonathan Iaconelli
- Center for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, Mass., USA; Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA
| | - Bradley Watmuff
- Center for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, Mass., USA; Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA
| | - Hyoungjun Park
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Mass., USA
| | - Shrikanta Chattopadhyay
- MGH Cancer Center, Boston, Mass., USA; Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA
| | - Donna McPhie
- Schizophrenia and Bipolar Disorder Program, Harvard Medical School and McLean Hospital, Belmont, Mass., USA
| | - Dost Öngür
- Schizophrenia and Bipolar Disorder Program, Harvard Medical School and McLean Hospital, Belmont, Mass., USA
| | - Bruce M Cohen
- Schizophrenia and Bipolar Disorder Program, Harvard Medical School and McLean Hospital, Belmont, Mass., USA
| | - Clary B Clish
- Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA
| | - Rakesh Karmacharya
- Center for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, Mass., USA; Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA; Chemical Biology Program, Broad Institute of Harvard and MIT, Mass., USA
| |
Collapse
|
58
|
Loebel A, Xu J, Hsu J, Cucchiaro J, Pikalov A. The development of lurasidone for bipolar depression. Ann N Y Acad Sci 2016; 1358:95-104. [PMID: 26771990 DOI: 10.1111/nyas.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Bipolar disorder is a chronic, recurrent illness that ranks among the top 10 causes of disability in the developed world. As the illness progresses, major depressive episodes increasingly predominate. However, few treatment options are available that have demonstrated efficacy in the treatment of bipolar depression, either as monotherapy or adjunctive therapy in combination with mood stabilizers. Lurasidone is an atypical antipsychotic drug that was initially developed for the treatment of schizophrenia. Since no previous atypical antipsychotic development program had proceeded directly from work on schizophrenia to bipolar depression, the decision to focus on this indication represented an innovation in central nervous system drug development and was designed to address a clinically significant unmet need. The current review summarizes key results of a clinical development program undertaken to characterize the efficacy and safety of lurasidone in patients diagnosed with bipolar depression. Lurasidone is currently the only treatment for bipolar depression approved in the United States as both a monotherapy and an adjunctive therapy with lithium or valproate. The approval of lurasidone expands available treatment options for patients with bipolar depression and provides a therapy with an overall favorable risk-benefit profile.
Collapse
Affiliation(s)
- Antony Loebel
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Jane Xu
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Jay Hsu
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Josephine Cucchiaro
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Andrei Pikalov
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| |
Collapse
|
59
|
Improvements in Somatic Complaints Among Individuals With Serious Mental Illness Receiving Treatment in a Psychiatric Hospital. Psychosom Med 2016; 78:271-80. [PMID: 26867074 DOI: 10.1097/psy.0000000000000298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) experience significant comorbid somatic complaints. Little is known about response to integrated inpatient care that addresses psychiatric and general medical needs among individuals with SMI. METHODS Latent growth curve analyses were used to model somatic symptom trajectories across adult inpatients with SMI (n = 989). The Patient Health Questionnaire-15 (PHQ-15) was administered at admission, every 14 days, and at discharge. RESULTS Patients evidenced substantial reduction in somatization from admission (mean [standard deviation] = 9.0 [5.2]) to discharge (mean [standard deviation] = 5.2 [4.4]), with large effects (d = 0.83, 95% confidence interval = 0.76-0.90). Results indicate nonlinear improvement in somatic symptoms for 8 weeks of treatment, with greatest symptom reduction occurring during the first weeks of treatment with continued, albeit slowed, improvement until discharge. Initial PHQ-15 scores were lower among men and those who reported regular exercise in the 30 days preceding this hospitalization. In addition, presence of an anxiety disorder or personality disorder at admission; history of trauma, a gastrointestinal disorder, or major medical illness (within the past 3 months); and significant sleep disturbance independently contribute to higher PHQ-15 scores at admission. A substance use disorder and sleep disturbance were associated with greater immediate symptom reduction. CONCLUSIONS Somatic complaints can be managed in the context of inpatient psychiatric care integrated with 24-hour nursing and internal medicine specialists. Addressing psychiatric impairments, improving sleep, and ensuring abstinence from drugs and alcohol are associated with significant improvement in somatic complaints.
Collapse
|
60
|
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.
Collapse
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.
| |
Collapse
|
61
|
BAUER ISABELLEE, GÁLVEZ JUANF, HAMILTON JANEE, BALANZÁ-MARTÍNEZ VICENT, ZUNTA-SOARES GIOVANA, SOARES JAIRC, MEYER THOMASD. Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review. J Psychiatr Res 2016; 74:1-7. [PMID: 26724541 PMCID: PMC4744495 DOI: 10.1016/j.jpsychires.2015.12.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/19/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a serious mental illness associated with a high risk of medical comorbidities, long-term disability and premature death. This systematic review examined the current literature on therapeutic interventions targeting nutrition, physical activity and wellness in BD and collecting health-related measures such as mood and course of illness. METHODS Scopus (all databases), Pubmed and Ovid Medline were systematically searched with no language or year restrictions, up to June 2015, for studies focusing on lifestyle interventions in BD. Search terms were related to bipolar disorder, nutrition, physical activity, wellbeing, psychosocial interventions and course of illness. We hand searched content pages of Bipolar Disorders and Journal of Affective Disorders and checked references of relevant reviews and dissertations to identify additional papers. RESULTS After applying inclusion and exclusion criteria to identified hits, this literature search retrieved six papers. Overall findings point towards a beneficial role of lifestyle interventions on mood, weight, blood pressure, lipid profile, physical activity and overall wellbeing. Methodological limitations include small sample size, gender ratio imbalance, inconsistencies in terms of laboratory measures, and lack of randomized controlled trials and absence of follow-up and longitudinal studies to determine the benefits of these factors on clinical and functional outcomes over time CONCLUSIONS Lifestyle interventions in BD targeting nutrition, exercise, wellbeing alongside beliefs, coping strategies and attitudes towards health show promise in reducing the risk of comorbid ailments in BD. There is still a strong need for studies a) developing interventions which are informed by the patient's input and b) examining the effectiveness of such interventions targeting general wellness using well-controlled trials.
Collapse
Affiliation(s)
- ISABELLE E. BAUER
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA,Corresponding author: Thomas D. Meyer, Ph.D., University of Texas HSC at Houston, UT Center of Excellence on Mood Disorders, Biomedical and Behavioral Sciences Building (BBSB), 1941 East Rd Suite 3118 Houston, TX 77054, USA.
| | - JUAN F. GÁLVEZ
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA,Department of Psychiatry. Pontificia Universidad Javeriana School of Medicine. Bogotá, Colombia,Corresponding author: Thomas D. Meyer, Ph.D., University of Texas HSC at Houston, UT Center of Excellence on Mood Disorders, Biomedical and Behavioral Sciences Building (BBSB), 1941 East Rd Suite 3118 Houston, TX 77054, USA.
| | - JANE E. HAMILTON
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA
| | - VICENT BALANZÁ-MARTÍNEZ
- Teaching Unit of Psychiatry, Department of Medicine, La Fe University and Polytechnic Hospital, University of Valencia, CIBERSAM, ISNPR, Valencia, Spain
| | - GIOVANA ZUNTA-SOARES
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA
| | - JAIR C. SOARES
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA
| | - THOMAS D. MEYER
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA,Corresponding author: Thomas D. Meyer, Ph.D., University of Texas HSC at Houston, UT Center of Excellence on Mood Disorders, Biomedical and Behavioral Sciences Building (BBSB), 1941 East Rd Suite 3118 Houston, TX 77054, USA.
| |
Collapse
|
62
|
Leopold K, Reif A, Haack S, Bauer M, Bury D, Löffler A, Kittel-Schneider S, Pfeiffer S, Sauer C, Schwarz P, Pfennig A. Type 2 diabetes and pre-diabetic abnormalities in patients with bipolar disorders. J Affect Disord 2016; 189:240-5. [PMID: 26451510 DOI: 10.1016/j.jad.2015.09.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 08/17/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abnormalities in the glucose metabolism cause nervous and organic damage and are a cardiovascular risk factor. They could be a main cause for the increased morbidity and mortality rates found in patients with bipolar disorders. The exact prevalence of diabetes and pre-diabetic abnormalities, however, is not clear. METHODS 85 euthymic outpatients with bipolar disorders from two university hospitals in Germany underwent an oral glucose tolerance test, laboratory screening and clinical measurements. Socio-demographic data, medication, severity of illness, global functioning and life quality were assessed. RESULTS Diabetes mellitus was found in 7% of the patients, pre-diabetic abnormalities in 27%. The group of patients with abnormalities in the glucose metabolism had significantly lower quality of life and global functioning. Higher BMI, leptin, triglycerides and CRP levels significantly increased the likelihood for pre-diabetes/diabetes. LIMITATIONS The low sample size did only allow limited assessment of impact of medication on the results. No healthy controls were assessed. CONCLUSIONS One-third of the patients with bipolar disorders showed abnormalities in the glucose metabolism and this was associated with impaired global functioning and lower quality of life. Early detection and intervention strategies fitting the needs of patient with bipolar disorder are needed to improve both physical and mental health.
Collapse
Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt/Main, Germany
| | - Sarah Haack
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Daniel Bury
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Germany
| | - Antje Löffler
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt/Main, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Peter Schwarz
- Department of Internal Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany.
| |
Collapse
|
63
|
Rosenblat JD, Brietzke E, Mansur RB, Maruschak NA, Lee Y, McIntyre RS. Inflammation as a neurobiological substrate of cognitive impairment in bipolar disorder: Evidence, pathophysiology and treatment implications. J Affect Disord 2015; 188:149-59. [PMID: 26363613 DOI: 10.1016/j.jad.2015.08.058] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/05/2015] [Accepted: 08/26/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bipolar disorder (BD) has been associated with cognitive impairment during depressed, manic and euthymic periods. Inflammation has been shown to be involved in the pathophysiology of BD and cognitive impairment. METHODS For this systematic review, the MEDLINE/PubMed, Embase, Google Scholar and ClinicalTrials.gov databases were searched for relevant articles assessing the association between cognitive function and inflammatory markers in BD subjects. A discussion of potential mechanisms and therapeutic implications is also included to provide further context to the subject matter. RESULTS Eight studies, including a total of 555 BD subjects, assessing the association between cognitive function and inflammatory markers were identified. Cognitive dysfunction was associated with elevated levels of pro-inflammatory markers YKL40, IL-6, sCD40L, IL-1Ra, hsCRP and TNF-α. Mechanistically, elevation in inflammatory cytokines alters monoamine levels leading to cognitive and affective dysfunction. Neuro-inflammation, manifesting as microglial activation, leads to increased oxidative stress, pathologic synaptic pruning and impaired neuroplasticity in key brain regions sub-serving mood and cognition. Immune dysfunction also activates the hypothalamic-pituitary-adrenal (HPA) axis leading to hypercortisolemia and metabolic dysfunction, further promoting neuronal dysfunction. Anti-inflammatory agents are therefore currently being investigated in the treatment of BD and appear to exert an antidepressant effect; however, cognitive outcomes have yet to be reported. CONCLUSION Several studies suggest that immune dysfunction is associated with cognitive impairment in BD. Several neurobiological pathways have been identified whereby immune dysfunction may promote cognitive impairment in BD. Future investigations of anti-inflammatory agents targeting cognitive function as a treatment outcome are merited.
Collapse
Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Paulo, Sao Paulo, Brazil; Program of Recognition and Intervention in Individuals in AT-Risk Mental States (PRISMA), Department of Psychiatry, Universidade FeInterdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Pauloderal de São Paulo, São Paulo, Brazil
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Paulo, Sao Paulo, Brazil; Program of Recognition and Intervention in Individuals in AT-Risk Mental States (PRISMA), Department of Psychiatry, Universidade FeInterdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Pauloderal de São Paulo, São Paulo, Brazil
| | - Nadia A Maruschak
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
64
|
Green CA, Yarborough BJH, Leo MC, Stumbo SP, Perrin NA, Nichols GA, Stevens VJ. Weight maintenance following the STRIDE lifestyle intervention for individuals taking antipsychotic medications. Obesity (Silver Spring) 2015; 23:1995-2001. [PMID: 26334929 PMCID: PMC4586363 DOI: 10.1002/oby.21205] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/09/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Individuals taking antipsychotic medications have increased risk of obesity-related early morbidity/mortality. This report presents weight maintenance results from a successful weight loss and behavioral lifestyle change program developed for people taking antipsychotic medications. METHODS STRIDE was a two-arm randomized controlled trial. Intervention participants attended weekly group meetings for 6 months, then monthly group meetings for 6 months. Assessments were completed at baseline and at 6, 12, and 24 months. RESULTS At 24 months, intervention participants lost 3.7% of baseline weight and control participants 2.1%, a non-significant difference. Fasting glucose results followed a similar pattern. There was a statistically significant difference, however, for fasting insulin-the intervention group's levels decreased between the end of the intensive intervention (at 6 months) and 24 months (10.1-7.91 μU/mL); control participants' levels increased (11.66 to 12.92 μU/mL) during this period. There were also fewer medical hospitalizations among intervention participants (5.7%) than controls (21.1%; χ(2) = 8.47, P = 0.004) during the 12- to 24-month post-intervention maintenance period. CONCLUSIONS Weight change differences between arms diminished following the intervention period, though fasting insulin levels continued to improve. Reduced hospitalizations suggest that weight loss, even with regain, may have long-term positive benefits for people taking antipsychotic medications and may reduce costs.
Collapse
Affiliation(s)
- Carla A Green
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Scott P Stumbo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Nancy A Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Gregory A Nichols
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Victor J Stevens
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| |
Collapse
|
65
|
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.
Collapse
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
| |
Collapse
|
66
|
Causes of decreased life expectancy over the life span in bipolar disorder. J Affect Disord 2015; 180:142-7. [PMID: 25909752 DOI: 10.1016/j.jad.2015.03.027] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Accelerated aging has been proposed as a mechanism explaining the increased prevalence of comorbid general medical illnesses in bipolar disorder. AIMS To test the hypothesis that lost life years due to natural causes starts in early and mid-adulthood, supporting the hypothesis of accelerated aging. METHODS Using individual data from nationwide registers of patient with a diagnosis of bipolar disorder we calculated remaining life expectancies before age 90 years for values of age 15, 25, 35…75 years among all individuals alive in year 2000. Further, we estimated the reduction in life expectancy due to natural causes (physical illnesses) and unnatural causes (suicide and accidents) in relation to age. RESULTS A total of 22,635 patients with bipolar disorder were included in the study in addition to data from the entire Danish general population of 5.4 million people. At age 15 years, remaining life expectancy before age 90 years was decreased 12.7 and 8.9 life years, respectively, for men and women with bipolar disorder. For 15-year old boys with bipolar disorder, natural causes accounted for 58% of all lost life years and for 15-year old girls, natural causes accounted for 67% increasing to 74% and 80% for 45-year old men and women, respectively. LIMITATIONS Data concern patients who get contact to hospital psychiatry only. CONCLUSIONS Natural causes of death is the most prevalent reason for lost life years already from adolescence and increases substantially during early and mid-adulthood, in this way supporting the hypothesis of accelerated aging. Early intervention in bipolar disorder should not only focus on improving outcome of the bipolar disorder but also on decreasing the risk of comorbid general medical illnesses.
Collapse
|
67
|
Azevedo Da Silva M, Lemogne C, Melchior M, Zins M, Van Der Waerden J, Consoli SM, Goldberg M, Elbaz A, Singh-Manoux A, Nabi H. Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort. Acta Psychiatr Scand 2015; 131:307-17. [PMID: 25289581 PMCID: PMC4402031 DOI: 10.1111/acps.12341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders. METHOD In a cohort of 15,811 employees, aged 35-50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up. RESULTS After controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR=1.20 (95%, 1.14-1.26)], as well as hospitalization due to MI [IRR=1.44 (95%, 1.12-1.85)]. For stroke, the IRR did not reach statistical significance [IRR=1.37 (95%, 0.95-1.99)] and there was no association with cancer [IRR=1.01 (95%, 0.86-1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder). CONCLUSION In this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations.
Collapse
Affiliation(s)
- M Azevedo Da Silva
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - C Lemogne
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris DescartesParis, France,Service universitaire de Psychiatrie de l'adulte et du sujet âgé, AP-HP, Hôpitaux Universitaires Paris OuestParis, France,Centre Psychiatrie et Neurosciences, INSERM U894Paris, France
| | - M Melchior
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - M Zins
- Université de Versailles St QuentinVillejuif, France,Cohortes épidémiologiques en population, Unité Mixte de Service 011 INSERM-UNSQVillejuif, France
| | - J Van Der Waerden
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - S M Consoli
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris DescartesParis, France,Service universitaire de Psychiatrie de l'adulte et du sujet âgé, AP-HP, Hôpitaux Universitaires Paris OuestParis, France
| | - M Goldberg
- Université de Versailles St QuentinVillejuif, France,Cohortes épidémiologiques en population, Unité Mixte de Service 011 INSERM-UNSQVillejuif, France
| | - A Elbaz
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - A Singh-Manoux
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France,Centre de Gérontologie, Hôpital Ste Périne, AP-HPParis, France,Department of Epidemiology and Public Health, University College LondonLondon, UK
| | - H Nabi
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| |
Collapse
|
68
|
Sylvia LG, Shelton RC, Kemp DE, Bernstein EE, Friedman ES, Brody BD, McElroy SL, Singh V, Tohen M, Bowden CL, Ketter TA, Deckersbach T, Thase ME, Reilly-Harrington NA, Nierenberg AA, Rabideau DJ, Kinrys G, Kocsis JH, Bobo WV, Kamali M, McInnis MG, Calabrese JR. Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Bipolar Disord 2015; 17:212-23. [PMID: 25130321 DOI: 10.1111/bdi.12243] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/15/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Individuals with bipolar disorder have high rates of other medical comorbidity, which is associated with higher mortality rates and worse course of illness. The present study examined common predictors of medical comorbidity. METHODS The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month, randomized comparative effectiveness trial. Baseline assessments included current and lifetime DSM-IV-TR diagnoses, demographic information, psychiatric and medical history, severity of psychiatric symptoms, level of functioning, and a fasting blood draw. Medical comorbidities were categorized into two groups: cardiometabolic (e.g., diabetes, hyperlipidemia, and metabolic syndrome) and non-cardiovascular (e.g., seizures, asthma, and cancer). Additionally, we looked at comorbid substance use (e.g., smoking and drug dependence). RESULTS We found that 96.3% of participants had at least one other medical comorbidity. Older age predicted a greater likelihood of having a cardiometabolic condition. Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition, but a greater chance of having other types of medical comorbidity. Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed, less time spent manic/hypomanic, and longer duration of illness. Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides. CONCLUSIONS There appears to be a substantial medical burden associated with bipolar disorder, highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients.
Collapse
Affiliation(s)
- Louisa G Sylvia
- Bipolar Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
69
|
Abitbol R, Rej S, Segal M, Looper KJ. Diabetes mellitus onset in geriatric patients: does long-term atypical antipsychotic exposure increase risk? Psychogeriatrics 2015; 15:43-50. [PMID: 25369990 DOI: 10.1111/psyg.12081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/10/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) in common in adults using psychotropic medications. However, it remains largely unknown whether there is an additional risk of diabetes mellitus (DM) in elderly psychiatric outpatients, particularly those with long-term exposure to atypical antipsychotics (AP). METHODS In this retrospective longitudinal study, 61 atypical AP-exposed and 64 atypical AP-unexposed geriatric psychiatric patients were compared to a group of 200 psychotropic-naïve controls. Our main composite outcome was diabetes incidence over a 4-year period, defined by fasting blood glucose ≥ 7.0 mmol/L or a new-onset oral hypoglycaemic or insulin prescription during the 4-year period. RESULTS The 4-year incidence of DM did not differ significantly between groups: 12.3%, 6.7%, and 11.9% in the atypical AP-exposed, atypical AP-unexposed, and control groups, respectively (χ(2) = 1.40, P = 0.50). Depression and antidepressant, cholinesterase inhibitor, and valproate use were independently associated with increases in fasting glucose. However, hyperglycaemia and hypoglycaemic prescriptions were not more common in geriatric psychiatric patients. CONCLUSIONS DM does not appear to be more common in geriatric psychiatric patients than similarly aged controls and is not more common in atypical AP users. However, depression and antidepressant, cholinesterase inhibitor, and valproate use may increase fasting glucose levels, and the clinical significance of this warrants further investigation. Nonetheless, given the rates of untreated and undertreated fasting hyperglycaemia in both our geriatric psychiatric and control samples (>10% of all patients), we recommend regular screening for DM in these populations.
Collapse
Affiliation(s)
- Roza Abitbol
- Faculty of Medicine, Laval University, Laval, Quebec, Canada
| | | | | | | |
Collapse
|
70
|
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.
Collapse
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
| |
Collapse
|
71
|
Calkin CV, Ruzickova M, Uher R, Hajek T, Slaney CM, Garnham JS, O'Donovan MC, Alda M. Insulin resistance and outcome in bipolar disorder. Br J Psychiatry 2015; 206:52-7. [PMID: 25323142 DOI: 10.1192/bjp.bp.114.152850] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Little is known about the impact of insulin resistance on bipolar disorder. AIMS To examine the relationships between insulin resistance, type 2 diabetes and clinical course and treatment outcomes in bipolar disorder. METHOD We measured fasting glucose and insulin in 121 adults with bipolar disorder. We diagnosed type 2 diabetes and determined insulin resistance. The National Institute of Mental Health Life Chart was used to record the course of bipolar disorder and the Alda scale to establish response to prophylactic lithium treatment. RESULTS Patients with bipolar disorder and type 2 diabetes or insulin resistance had three times higher odds of a chronic course of bipolar disorder compared with euglycaemic patients (50% and 48.7% respectively v. 27.3%, odds ratio (OR) = 3.07, P = 0.007), three times higher odds of rapid cycling (38.5% and 39.5% respectively v. 18.2%, OR = 3.13, P = 0.012) and were more likely to be refractory to lithium treatment (36.8% and 36.7% respectively v. 3.2%, OR = 8.40, P<0.0001). All associations remained significant after controlling for antipsychotic exposure and body mass index in sensitivity analyses. CONCLUSIONS Comorbid insulin resistance may be an important factor in resistance to treatment in bipolar disorder.
Collapse
Affiliation(s)
- Cynthia V Calkin
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| | - Martina Ruzickova
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| | - Rudolf Uher
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| | - Tomas Hajek
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| | - Claire M Slaney
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| | - Julie S Garnham
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| | - M Claire O'Donovan
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| | - Martin Alda
- Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic
| |
Collapse
|
72
|
Nguyen M, Stewart AM, Kalueff AV. Aquatic blues: modeling depression and antidepressant action in zebrafish. Prog Neuropsychopharmacol Biol Psychiatry 2014; 55:26-39. [PMID: 24657522 DOI: 10.1016/j.pnpbp.2014.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/03/2014] [Accepted: 03/09/2014] [Indexed: 12/20/2022]
Abstract
Depression is a serious psychiatric condition affecting millions of patients worldwide. Unipolar depression is characterized by low mood, anhedonia, social withdrawal and other severely debilitating psychiatric symptoms. Bipolar disorder manifests in alternating depressed mood and 'hyperactive' manic/hypomanic states. Animal experimental models are an invaluable tool for research into the pathogenesis of bipolar/unipolar depression, and for the development of potential treatments. Due to their high throughput value, genetic tractability, low cost and quick reproductive cycle, zebrafish (Danio rerio) have emerged as a promising new model species for studying brain disorders. Here, we discuss the developing utility of zebrafish for studying depression disorders, and outline future areas of research in this field. We argue that zebrafish represent a useful model organism for studying depression and its behavioral, genetic and physiological mechanisms, as well as for anti-depressant drug discovery.
Collapse
Affiliation(s)
- Michael Nguyen
- Department of Biomedical Engineering, University of Virginia, 415 Lane Road, Charlottesville, VA 22908, USA; ZENEREI Institute, 309 Palmer Court, Slidell, LA 70458, USA
| | - Adam Michael Stewart
- ZENEREI Institute, 309 Palmer Court, Slidell, LA 70458, USA; International Zebrafish Neuroscience Research Consortium (ZNRC), 309 Palmer Court, Slidell, LA 70458, USA; Department of Neuroscience, University of Pittsburgh, A210 Langley Hall, Pittsburgh, PA 15260, USA.
| | - Allan V Kalueff
- ZENEREI Institute, 309 Palmer Court, Slidell, LA 70458, USA; International Zebrafish Neuroscience Research Consortium (ZNRC), 309 Palmer Court, Slidell, LA 70458, USA
| |
Collapse
|
73
|
The prevalence and burden of bipolar depression. J Affect Disord 2014; 169 Suppl 1:S3-11. [PMID: 25533912 DOI: 10.1016/s0165-0327(14)70003-5] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bipolar disorder is characterized by debilitating episodes of depression and mood elevation (mania or hypomania). For most patients, depressive symptoms are more pervasive than mood elevation or mixed symptoms, and thus have been reported in individual studies to impose a greater burden on affected individuals, caregivers, and society. This article reviews and compiles the literature on the prevalence and burden of syndromal as well as subsyndromal presentations of depression in bipolar disorder patients. METHODS The PubMed database was searched for English-language articles using the search terms "bipolar disorder," "bipolar depression," "burden," "caregiver burden," "cost," "costs," "economic," "epidemiology," "prevalence," "quality of life," and "suicide." Search results were manually reviewed, and relevant studies were selected for inclusion as appropriate. Additional references were obtained manually from reviewing the reference lists of selected articles found by computerized search. RESULTS In aggregate, the findings support the predominance of depressive symptoms compared with mood elevation/mixed symptoms in the course of bipolar illness, and thus an overall greater burden in terms of economic costs, functioning, caregiver burden, and suicide. LIMITATIONS This review, although comprehensive, provides a study-wise aggregate (rather than a patient-wise meta-analytic) summary of the relevant literature on this topic. CONCLUSION In light of its pervasiveness and prevalence, more effective and aggressive treatments for bipolar depression are warranted to mitigate its profound impact upon individuals and society. Such studies could benefit by including metrics not only for mood outcomes, but also for illness burden.
Collapse
|
74
|
Prieto M, Cuéllar-Barboza A, Bobo W, Roger V, Bellivier F, Leboyer M, West C, Frye M. Risk of myocardial infarction and stroke in bipolar disorder: a systematic review and exploratory meta-analysis. Acta Psychiatr Scand 2014; 130:342-53. [PMID: 24850482 PMCID: PMC5023016 DOI: 10.1111/acps.12293] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the evidence on and estimate the risk of myocardial infarction and stroke in bipolar disorder. METHOD A systematic search using MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and bibliographies (1946 - May, 2013) was conducted. Case-control and cohort studies of bipolar disorder patients age 15 or older with myocardial infarction or stroke as outcomes were included. Two independent reviewers extracted data and assessed quality. Estimates of effect were summarized using random-effects meta-analysis. RESULTS Five cohort studies including 13 115 911 participants (27 092 bipolar) were included. Due to the use of registers, different statistical methods, and inconsistent adjustment for confounders, there was significant methodological heterogeneity among studies. The exploratory meta-analysis yielded no evidence for a significant increase in the risk of myocardial infarction: [relative risk (RR): 1.09, 95% CI 0.96-1.24, P = 0.20; I(2) = 6%]. While there was evidence of significant study heterogeneity, the risk of stroke in bipolar disorder was significantly increased (RR 1.74, 95% CI 1.29-2.35; P = 0.0003; I(2) = 83%). CONCLUSION There may be a differential risk of myocardial infarction and stroke in patients with bipolar disorder. Confidence in these pooled estimates was limited by the small number of studies, significant heterogeneity and dissimilar methodological features.
Collapse
Affiliation(s)
- M.L. Prieto
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA,Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile
| | - A.B. Cuéllar-Barboza
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA,Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, México
| | - W.V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - V.L. Roger
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - F. Bellivier
- Psychiatric Department, APHP Hôpital F. Widal, Paris, France,INSERM, UMR-S1144,FondaMenta Foundation
| | - M. Leboyer
- FondaMenta Foundation,Faculté de Médecine, Université Paris Est,INSERM, U955, Psychiatrie Génétique,Département de Psychiatrie, Hôpital H. Mondor-A. Chenevier, Créteil, France
| | - C.P. West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M.A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
75
|
A 12-week weight reduction intervention for overweight individuals taking antipsychotic medications. Community Ment Health J 2014; 50:974-80. [PMID: 24566560 DOI: 10.1007/s10597-014-9716-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
People taking antipsychotic medications are at increased risk for obesity, diabetes, and early mortality. Few weight loss interventions have targeted this population. Thirty-six individuals were randomized to an evidence-based 12-week weight loss intervention (PREMIER with DASH diet, n = 18) or to usual care (n = 18) in this feasibility trial. Average attendance was 8.6 of 12 sessions. Intent-to-treat analyses of covariance, adjusted for baseline weight, showed significant changes in weight: Mean weight in intervention participants declined from 213.3 to 206.6 pounds, while control participants' weight was unchanged. It is possible to recruit, assess, intervene with, and retain participants taking antipsychotic medications in a dietary and exercise lifestyle change trial. Participants reported high levels of satisfaction with the intervention.
Collapse
|
76
|
Galvez JF, Bauer IE, Sanches M, Wu HE, Hamilton JE, Mwangi B, Kapczinski FP, Zunta-Soares G, Soares JC. Shared clinical associations between obesity and impulsivity in rapid cycling bipolar disorder: a systematic review. J Affect Disord 2014; 168:306-13. [PMID: 25086289 DOI: 10.1016/j.jad.2014.05.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/23/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity seems to show a two-way relationship with bipolar disorder (BD), representing not only a possible vulnerability factor but also a consequence of chronic mood dysregulation associated with an overall poor prognosis. Increased impulsivity has been described across all stages and phases of BD as being also associated with a worse prognosis. Although obesity and impulsivity are common features among rapid cycling bipolar disorder (RC-BD) patients, there is a lack of understanding about the clinical implications of these conditions combined in BD. METHODS To explore and integrate available evidence on shared clinical associations between obesity and impulsivity in RC-BD a systematic search of the literature in the electronic database of the National Library of Medicine (PubMed) has been conducted. RESULTS One hundred and fourteen articles were included in our systematic review. Among RC-BD patients, substance abuse disorders (SUDs), anxiety disorders (ADs), predominantly depressive polarity, chronic exposure to antidepressants, psychotic symptoms, suicidality, and comorbid medical conditions are strongly associated with both obesity and impulsivity. LIMITATIONS Heterogeneity of published data, inconsistent measurements of both obesity and impulsivity in RC-BD and an absence of control for RC-BD in epidemiological surveys. Consequently, their combined impact on the severity of RC-BD is yet to be recognized and remains to be poorly understood. CONCLUSION In RC-BD patients the co-occurrence of obesity and impulsivity is associated with an unfavorable course of illness, specific shared clinical correlates, negative psychosocial impact, and overall worse prognosis. There is a need to examine obesity and impulsivity as modulating factors and markers of severity in RC-BD.
Collapse
Affiliation(s)
- Juan F Galvez
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Department of Psychiatry, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia.
| | - Isabelle E Bauer
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Hanjing E Wu
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Jane E Hamilton
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Flavio P Kapczinski
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Molecular Psychiatry Laboratory, UT Center of Excellence on Mood Disorders, Houston, TX, USA; Harris County Psychiatric Center (HCPC), University of Texas Health Science Center, Houston, TX, USA.
| | - Giovana Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Harris County Psychiatric Center (HCPC), University of Texas Health Science Center, Houston, TX, USA.
| |
Collapse
|
77
|
Abstract
BACKGROUND Bipolar disorder is a relatively common, long-term, and disabling psychiatric illness that is associated with high levels of functional impairment, morbidity, mortality, and an increased risk of suicide. Psychiatric co-morbidity in bipolar disorder ranges from 57.3% to 74.3%, whereas medical co-morbidity varies from 2.7-70%. Indian scenario in this aspect is not clear. MATERIALS AND METHODS The objective was to ascertain the prevalence of physical and psychiatric co-morbidities in patients attending a tertiary care center over a period of 1 year and its relationship with socio-demographic and clinical variables. One hundred and twenty-five case record files were included in the review. OPCRIT software was used for re-establishing the diagnosis of bipolar disorder, which yielded 120 cases. A semi-structured pro-forma, specifically designed for the study, was used to collect the socio-demographic and clinical details. RESULTS Co-morbid psychiatric disorders were found in 52 (43.3%) of the sample, whereas co-morbid physical illness was present in 77 (64.2%) patients. The most common psychiatric disorder associated was substance use disorder (27.5%), whereas co-morbid cardiovascular disorder was the most frequent physical diagnosis in the sample (20%). DISCUSSION The prevalence of co-morbid psychiatric disorders in bipolar patients was lower than that reported in western literature. It could be related to retrospective nature of study or reflect true lower prevalence rates. Also, certain disorders such as eating disorders were absent in our sample, and migraine diagnosis was very infrequent.
Collapse
|
78
|
The theory of bipolar disorder as an illness of accelerated aging: Implications for clinical care and research. Neurosci Biobehav Rev 2014; 42:157-69. [DOI: 10.1016/j.neubiorev.2014.02.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/17/2013] [Accepted: 02/05/2014] [Indexed: 12/20/2022]
|
79
|
The interface of physical and mental health. Soc Psychiatry Psychiatr Epidemiol 2014; 49:673-82. [PMID: 24562320 DOI: 10.1007/s00127-014-0847-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 02/05/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE The interaction between physical and mental health is complex. In this paper we aim to provide an overview of the main components of this relationship and to identify how care could be improved for people with co-morbidities. METHODS We performed a literature search of MedLine, Ovid and Psycinfo and identified studies that examined the association between mental illness and physical illness. We also examined the key policy documents and guidelines in this area. RESULTS People with mental health conditions are at higher risk of developing physical illness, have those conditions diagnosed later and have much higher mortality rates. Conversely, people with a diagnosis of physical illness, especially cardiovascular disease, diabetes and cancer have a greater chance of developing a mental health problem. When both mental and physical illnesses conditions are present together, there are higher overall rates of morbidity, healthcare utilisation, and poorer quality of life. CONCLUSIONS Physicians and psychiatrists need to be aware of the co-occurrence of mental and physical health problems and the challenges posed for both general and mental health services. There is a need to screen appropriately in both settings to ensure timely diagnosis and treatment. Liaison psychiatry provides psychological assessment and treatment for people with physical illness, but there is a gap in the provision of physical healthcare for people with severe mental illness. There is a need for public policy to drive this forward to overcome the institutional barriers to equitable access to healthcare and for educators to reverse the tendency to teach mind and body as separate systems.
Collapse
|
80
|
Baskaran A, Cha DS, Powell AM, Jalil D, McIntyre RS. Sex differences in rates of obesity in bipolar disorder: postulated mechanisms. Bipolar Disord 2014; 16:83-92. [PMID: 24467470 DOI: 10.1111/bdi.12141] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The increased standardized mortality ratio (SMR) from cardiovascular disease (CVD) in women with bipolar disorder (BD), relative to men with BD and individuals of both sexes in the general population, provides the impetus to identify factors that contribute to the differential association of obesity with BD in women. METHODS We conducted a selective PubMed search of English-language articles published from September 1990 to June 2012. The key search terms were bipolar disorder and metabolic syndrome cross-referenced with gender, sex, obesity, diabetes mellitus, hypertension, and dyslipidemia. The search was supplemented with a manual review of relevant article reference lists. Articles selected for review were based on author consensus, the use of a standardized experimental procedure, validated assessment measures, and overall manuscript quality. RESULTS It is amply documented that adults with BD are affected by the metabolic syndrome at a rate higher than the general population. Women with BD, when compared to men with BD and individuals of both sexes in the general population, have higher rates of abdominal obesity. The course and clinical presentation of BD manifest differently in men and women, wherein women exhibit a higher frequency of depression predominant illness, a later onset of BD, more seasonal variations in mood disturbance, and increased susceptibility to relapse. Phenomenological factors can be expanded to include differences in patterns of comorbidity between the sexes among patients with BD. Other factors that contribute to the increased risk for abdominal obesity in female individuals with BD include reproductive life events, anamnestic (e.g., sexual and/or physical abuse), lifestyle, and iatrogenic. CONCLUSIONS A confluence of factors broadly categorized as broad- and sex-based subserve the increased rate of obesity in women with BD. It remains a testable hypothesis that the increased abdominal obesity in women with BD mediates the increased SMR from CVD. A clinical recommendation that emerges from this review is amplified attention to the appearance, or history, of factors that conspire to increase obesity in female patients with BD.
Collapse
Affiliation(s)
- Anusha Baskaran
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
81
|
McIntyre RS, Woldeyohannes HO, Yasgur BS, Soczynska JK, Miranda A, Konarski JZ. Maintenance treatment in bipolar disorder: a focus on aripiprazole. Expert Rev Neurother 2014; 7:919-25. [PMID: 17678485 DOI: 10.1586/14737175.7.8.919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bipolar disorders (BD) are chronic medical syndromes heterogeneous in phenomenology, pathophysiology and treatment. The longitudinal course of bipolar disorders is often characterized by nonrecovery, subsyndromal symptoms, enduring cognitive deficits and impairment in psychosocial function. The risk for premature mortality from unnatural (e.g., suicide) as well as natural causes (e.g., cardiovascular disease) is significantly higher than the general population. The therapeutic objectives of maintenance therapy are to prevent relapse/recurrence, reduce the risk for premature mortality, promote functional restoration and enhance quality of life. A chronic disease management model, which includes pharmacologic and manual-based psychosocial interventions as paradigmatic components, provides a framework for best practice and optimal patient outcome. This article provides a succinct review of treatments approved by the US FDA for maintenance in bipolar disorders, with a focus on the most recently approved atypical antipsychotic, aripiprazole.
Collapse
Affiliation(s)
- Roger S McIntyre
- University of Toronto, Department of Psychiatry, Department of Pharmacology, Toronto, ON, Canada.
| | | | | | | | | | | |
Collapse
|
82
|
Ahmed AT, Warton EM, Schaefer CA, Shen L, McIntyre RS. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder. Bipolar Disord 2013; 15:753-63. [PMID: 23909994 PMCID: PMC3844030 DOI: 10.1111/bdi.12109] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Bariatric surgery is the most effective therapy for severe obesity. People with bipolar disorder have increased risk of obesity, yet are sometimes considered ineligible for bariatric surgery due to their bipolar disorder diagnosis. This study aimed to determine if bariatric surgery alters psychiatric course among stable patients with bipolar disorder. METHODS A matched cohort study (2006-2009) with mean follow-up of 2.17 years was conducted within Kaiser Permanente Northern California, a group practice integrated health services delivery organization that provides medical and psychiatric care to 3.3 million people. Participants were 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical center, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to Years 1 and 2, were compared between groups. RESULTS A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalization during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalization associated with bariatric surgery was 1.03 [95% confidence interval (CI): 0.83-1.23]. In fully saturated multivariate general linear models, change in outpatient psychiatric utilization was not significantly different for surgery patients versus controls, from baseline to Year 1 (-0.4 visits/year, 95% CI: -0.5 to 0.4) or baseline to Year 2 (0.4 visits/year, 95% CI: -0.1 to 1.0). CONCLUSIONS Bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder. The results of this study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery.
Collapse
Affiliation(s)
- Ameena T Ahmed
- Department of Internal Medicine, The Permanente Medical Group, San Francisco
| | | | | | - Ling Shen
- Kaiser Permanente Division of Research, Oakland CA, USA
| | - Roger S McIntyre
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
83
|
Sylvia LG, Friedman ES, Kocsis JH, Bernstein EE, Brody BD, Kinrys G, Kemp DE, Shelton RC, McElroy SL, Bobo WV, Kamali M, McInnis MG, Tohen M, Bowden CL, Ketter TA, Deckersbach T, Calabrese JR, Thase ME, Reilly-Harrington NA, Singh V, Rabideau DJ, Nierenberg AA. Association of exercise with quality of life and mood symptoms in a comparative effectiveness study of bipolar disorder. J Affect Disord 2013; 151:722-727. [PMID: 23993440 DOI: 10.1016/j.jad.2013.07.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Individuals with bipolar disorder lead a sedentary lifestyle associated with worse course of illness and recurrence of symptoms. Identifying potentially modifiable predictors of exercise frequency could lead to interventions with powerful consequences on the course of illness and overall health. METHODS The present study examines baseline reports of exercise frequency of bipolar patients in a multi-site comparative effectiveness study of a second generation antipsychotic (quetiapine) versus a classic mood stabilizer (lithium). Demographics, quality of life, functioning, and mood symptoms were assessed. RESULTS Approximately 40% of participants reported not exercising regularly (at least once per week). Less frequent weekly exercise was associated with higher BMI, more time depressed, more depressive symptoms, and lower quality of life and functioning. In contrast, more frequent exercise was associated with experiencing more mania in the past year and more current manic symptoms. LIMITATIONS Exercise frequency was measured by self-report and details of the exercise were not collected. Analyses rely on baseline data, allowing only for association analyses. Directionality and predictive validity cannot be determined. Data were collected in the context of a clinical trial and thus, it is possible that the generalizability of the findings could be limited. CONCLUSION There appears to be a mood-specific relationship between exercise frequency and polarity such that depression is associated with less exercise and mania with more exercise in individuals with bipolar disorder. This suggests that increasing or decreasing exercise could be a targeted intervention for patients with depressive or mood elevation symptoms, respectively.
Collapse
Affiliation(s)
| | | | - James H Kocsis
- Weill Cornell Medical College of Cornell University, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michael E Thase
- Perelman School of Medicine at the University of Pennsylvania, USA
| | | | - Vivek Singh
- University of Texas Health Science Center at San Antonio, USA
| | | | | |
Collapse
|
84
|
Allostatic load as a tool for monitoring physiological dysregulations and comorbidities in patients with severe mental illnesses. Harv Rev Psychiatry 2013; 21:296-313. [PMID: 24201821 DOI: 10.1097/hrp.0000000000000012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Severe mental illnesses like schizophrenia and bipolar disorder are disabling, chronic conditions that are often accompanied by medical comorbidities. In this theoretical article, we review the allostatic load model representing the "wear and tear" that chronic stress exacts on the brain and body. We propose an innovative way of monitoring physical and psychiatric comorbidities by integrating the allostatic load model into clinical practice. By interpreting peripheral biomarkers differently, medical professionals can calculate a simple, count-based, allostatic load index known to predict diverse stress-related pathologies. In addition to screening for comorbidities, allostatic load indices can be used to monitor the effects of pharmacological and psychosocial interventions. This framework can also be used to generate a dialogue between patient and practitioner to promote preventive and proactive approaches to health care.
Collapse
|
85
|
Bélanger MÈ, Provencher MD, Shriqui C. Efficacité des programmes de modifications des habitudes de vie pour la gestion de poids des personnes avec des troubles psychiatriques. ACTA ACUST UNITED AC 2013; 38:103-18. [DOI: 10.7202/1019188ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Un gain de poids significatif est associé à l’utilisation des antipsychotiques atypiques, des stabilisateurs de l’humeur et des antidépresseurs employés seuls ou en combinaison. Les personnes avec des troubles psychiatriques sont plus à risque de souffrir d’obésité et du syndrome métabolique que la population générale. Une approche prometteuse pour limiter les conséquences physiques et psychologiques du gain de poids est la modification des habitudes de vie. Nous avons révisé la littérature afin de détailler l’impact de ces programmes sur différentes mesures d’effet. Douze des dix-sept études recensées rapportent un impact significatif de leur programme sur le poids en comparaison des soins usuels généralement offerts aux personnes avec des troubles psychiatriques. L’importance de la mise en place de ces programmes pour les patients psychiatriques en externe est soulignée.
Collapse
Affiliation(s)
| | - Martin D. Provencher
- Psychologue, professeur agrégé, École de psychologie de l’Université Laval, Institut universitaire en santé mentale de Québec
| | - Christian Shriqui
- Psychiatre, professeur agrégé de psychiatrie, Centre hospitalier universitaire de Québec
| |
Collapse
|
86
|
Sylvia LG, Salcedo S, Bernstein EE, Baek JH, Nierenberg AA, Deckersbach T. Nutrition, Exercise, and Wellness Treatment in bipolar disorder: proof of concept for a consolidated intervention. Int J Bipolar Disord 2013; 1:24. [PMID: 24660139 PMCID: PMC3961757 DOI: 10.1186/2194-7511-1-24] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/08/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This pilot study examines the proof of concept of a consolidated Nutrition, Exercise, and Wellness Treatment (NEW Tx) for overweight individuals with bipolar disorder. FINDINGS Five participants completed NEW Tx, a 20-week individual cognitive behavioral therapy-based treatment comprising three modules: Nutrition teaches appropriate serving sizes and balanced diet; Exercise emphasizes increasing weekly physical activity; Wellness focuses on skills for healthy decision-making. Participants attended most sessions and reported high satisfaction with the treatment. Participants' weight, cholesterol and trigyclerides decreased over the study duration as well as number of daily calories and sugar intake. We found that weekly exercise duration more than tripled over the study duration and depressive symptoms and functioning have improved. CONCLUSIONS These results offer proof of concept that consolidated NEW Tx is feasible and acceptable and has the potential to improve nutrition, exercise, wellness, and mood symptoms in bipolar disorder. Future iterations of NEW Tx will reflect the strengths and lessons learned from this study.
Collapse
Affiliation(s)
- Louisa G Sylvia
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
- />Harvard Medical School, Boston, MA 02115 USA
| | - Stephanie Salcedo
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
| | - Emily E Bernstein
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
| | - Ji Hyun Baek
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
| | - Andrew A Nierenberg
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
- />Harvard Medical School, Boston, MA 02115 USA
| | - Thilo Deckersbach
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
- />Harvard Medical School, Boston, MA 02115 USA
| |
Collapse
|
87
|
Abstract
Bipolar disorder is now known to be associated not only with highly prevalent co-occurring psychiatric and substance use disorders but also with medical comorbidities, such as cardiovascular diseases, diabetes mellitus, obesity and thyroid dysfunction. Inflammatory disturbances repeatedly observed in bipolar disorder, can explain some of the comorbidity between bipolar disorder and medical disorder. This revised perspective of bipolar disorders should promote the development of therapeutic tools. Immuno-inflammatory dysfunction may well represent a significant component of the underlying pathophysiology of the disorder. We therefore propose to review the immuno-inflammatory hypothesis in bipolar disorder considering the co-occurence with autoimmune diseases, immunological and inflammatory markers, as well as immuno-genetic markers which could lead to personalized treatments.
Collapse
|
88
|
Lemogne C, Nabi H, Melchior M, Goldberg M, Limosin F, Consoli SM, Zins M. Mortality associated with depression as compared with other severe mental disorders: a 20-year follow-up study of the GAZEL cohort. J Psychiatr Res 2013; 47:851-7. [PMID: 23590806 DOI: 10.1016/j.jpsychires.2013.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
Individuals with severe mental disorders (SMD) have an increased risk of mortality from somatic diseases. This study examined whether this risk is different in persons with depressive disorders compared to those with other SMD (i.e. schizophrenia and bipolar disorder). In 1989, 20,625 employees of the French national gas and electricity company (15,011 men and 5614 women, aged 35-50) agreed to participate in the GAZEL cohort study. Three diagnosis groups were created based on sick leave spells from 1978 onwards: 1) no SMD, 2) depressive disorders and 3) other SMD. Dates and causes of death were available from January 1, 1990 to December 31, 2010. The association of diagnosis groups with mortality was estimated with hazard ratios (HR) and 95% confidence intervals (CI) computed using Cox regression. During a mean follow-up of 19.8 years, 1544 participants died, including 1343 from a natural cause, of which 258 died from cardiovascular diseases. After adjustment for age, gender, occupational status, alcohol consumption, smoking and body-mass index, participants with a history of sickness absence for SMD had a greater risk of natural mortality (HR: 1.24, CI: 1.08-1.43), cardiovascular mortality (HR: 1.49, CI: 1.08-2.05) and non-cardiovascular natural mortality (HR: 1.19, CI: 1.02-1.39). Compared to depressive disorders, other SMD were associated with an increased risk of natural mortality (HR: 1.94, CI: 1.17-3.22) and cardiovascular mortality (HR: 3.58, CI: 1.53-8.39). Job security and systematic medical follow-up may fall short of preventing premature death among workers with sickness absence due to SMD.
Collapse
Affiliation(s)
- Cédric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
89
|
Karamitri A, Renault N, Clement N, Guillaume JL, Jockers R. Minireview: Toward the establishment of a link between melatonin and glucose homeostasis: association of melatonin MT2 receptor variants with type 2 diabetes. Mol Endocrinol 2013; 27:1217-33. [PMID: 23798576 DOI: 10.1210/me.2013-1101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The existence of interindividual variations in G protein-coupled receptor sequences has been recognized early on. Recent advances in large-scale exon sequencing techniques are expected to dramatically increase the number of variants identified in G protein-coupled receptors, giving rise to new challenges regarding their functional characterization. The current minireview will illustrate these challenges based on the MTNR1B gene, which encodes the melatonin MT2 receptor, for which exon sequencing revealed 40 rare nonsynonymous variants in the general population and in type 2 diabetes (T2D) cohorts. Functional characterization of these MT2 mutants revealed 14 mutants with loss of Gi protein activation that associate with increased risk of T2D development. This repertoire of disease-associated mutants is a rich source for structure-activity studies and will help to define the still poorly understood role of melatonin in glucose homeostasis and T2D development in humans. Defining the functional defects in carriers of rare MT2 mutations will help to provide personalized therapies to these patients in the future.
Collapse
Affiliation(s)
- Angeliki Karamitri
- Institut National de la Santé et de la Recherche Médicale, U1016, Institut Cochin, Paris, France
| | | | | | | | | |
Collapse
|
90
|
Gomes FA, Almeida KM, Magalhães PV, Caetano SC, Kauer-Sant'Anna M, Lafer B, Kapczinski F. Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:126-30. [DOI: 10.1590/1516-4446-2011-0768] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/16/2012] [Indexed: 11/22/2022]
|
91
|
Sylvia LG, Kopeski L, Brown C, Bolton P, Laudate C, DiGangi G, Martin P, Reid JA, Martowski JC, Meade A, Sarmiento IA, Wang J, Utschig AC, Siegel A, Neuhaus EC. An adjunct exercise program for serious mental illness: who chooses to participate and is it feasible? Community Ment Health J 2013; 49:213-9. [PMID: 23064968 DOI: 10.1007/s10597-012-9555-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 09/18/2012] [Indexed: 01/01/2023]
Abstract
Despite evidence that exercise is beneficial for serious mental illness, it continues to be an under utilized adjunct treatment strategy. Thus, the aims of this study were to examine if self-selected or volunteer exercise programs are feasible in a structured outpatient program and who might choose to participate in such a program. Individuals with serious mental illness admitted to a partial hospital program were offered an adjunct exercise group or a control, psychoeducation group. The exercise group (N = 38) met three times a week for 50 min. Individuals who chose not to exercise (N = 28), attended a psychoeducational control group. Those who self-selected the exercise group tended to have a higher level of education, employment rate and to be Caucasian. The control group had more medical problems, a higher body mass index and alcohol intake. The groups did not differ on age, sex, or use of cigarettes and caffeine. The exercise group was regularly attended. Both groups improved equally on all outcomes symptom and psychological well-being outcomes. These data highlight that certain individuals with serious mental illness may be more likely to exercise based on demographic opposed to clinical features, or illness characteristics. Thus, adjunct exercise programs for individuals with serious mental illness seem to be feasible, but certain groups of individuals (i.e., ethnic minorities, unemployed) should be targeted for recruitment as they are less likely to volunteer for such adjunct exercise programs.
Collapse
Affiliation(s)
- Louisa G Sylvia
- Bipolar Clinic and Research Program, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
92
|
Isom AM, Gudelsky GA, Benoit SC, Richtand NM. Antipsychotic medications, glutamate, and cell death: A hidden, but common medication side effect? Med Hypotheses 2013; 80:252-8. [DOI: 10.1016/j.mehy.2012.11.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/27/2012] [Indexed: 12/25/2022]
|
93
|
Calkin CV, Gardner DM, Ransom T, Alda M. The relationship between bipolar disorder and type 2 diabetes: more than just co-morbid disorders. Ann Med 2013; 45:171-81. [PMID: 22621171 DOI: 10.3109/07853890.2012.687835] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) rates are three times higher in patients with bipolar disorder (BD), compared to the general population. This is a major contributing factor to the elevated risk of cardiovascular mortality, the leading cause of death in bipolar patients. There may be shared pathophysiology linking the two disorders, including hypothalamic-pituitary-adrenal and mitochondrial dysfunction, common genetic links, and epigenetic interactions. Life-style, phenomenology of bipolar symptoms, and adverse effects of pharmacotherapy may be contributing factors. Patients with BD and T2DM have a more severe course of illness and are more refractory to treatment. Control of their diabetes is poorer when compared to diabetics without BD, and an existing disparity in medical care may be partly responsible. Glucose abnormalities in bipolar patients need to be screened for and treated. Metformin appears to have the best benefit/risk ratio, and the dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists and analogues also appear promising, although these agents have not been specifically studied in populations with mood disorders. Physicians need to be aware of the increased risk for T2DM and cardiovascular disease in bipolar patients, and appropriate prevention, screening, case finding, and treatment is recommended.
Collapse
Affiliation(s)
- Cynthia V Calkin
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | | | | |
Collapse
|
94
|
Pfennig A, Bschor T, Falkai P, Bauer M. The diagnosis and treatment of bipolar disorder: recommendations from the current s3 guideline. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:92-100. [PMID: 23451001 DOI: 10.3238/arztebl.2013.0092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/07/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bipolar disorder is a serious mental illness, characterized by frequent recurrences and major comorbidities. Its consequences can include suicide. METHODS An S3 guideline for the treatment of bipolar disorder was developed on the basis of a systematic literature search, evaluation of the retrieved publications, and a formal consensus-finding procedure. Several thousand publications were screened, and 611 were included in the analysis, including 145 randomized controlled trials (RCT). RESULTS Bipolar disorder should be diagnosed as early as possible. The most extensive evidence is available for pharmacological monotherapy; there is little evidence for combination therapy, which is nonetheless commonly given. The appropriate treatment may include long-term maintenance treatment, if indicated. The treatment of mania should begin with one of the recommended mood stabilizers or antipsychotic drugs; the number needed to treat (NNT) is 3 to 13 for three weeks of treatment with lithium or atypical antipsychotic drugs. The treatment of bipolar depression should begin with quetiapine (NNT = 5 to 7 for eight weeks of treatment), unless the patient is already under mood-stabilizing treatment that can be optimized. Further options in the treatment of bipolar depression are the recommended mood stabilizers, atypical antipsychotic drugs, and antidepressants. For maintenance treatment, lithium should be used preferentially (NNT = 14 for 12 months of treatment and 3 for 24 months of treatment), although other mood stabilizers or atypical antipsychotic drugs can be given as well. Psychotherapy (in addition to any pharmacological treatment) is recommended with the main goals of long-term stabilization, prevention of new episodes, and management of suicidality. In view of the current mental health care situation in Germany and the findings of studies from other countries, it is clear that there is a need for prompt access to need-based, complex and multimodal care structures. Patients and their families need to be adequately informed and should participate in psychiatric decision-making. CONCLUSION Better patient care is needed to improve the course of the disease, resulting in better psychosocial function. There is a need for further high-quality clinical trials on topics relevant to routine clinical practice.
Collapse
Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | | | | |
Collapse
|
95
|
Hsieh MH, Tang CH, Hsieh MH, Lee IH, Lai TJ, Lin YJ, Yang YK. Medical costs and vasculometabolic comorbidities among patients with bipolar disorder in Taiwan - a population-based and matched-control study. J Affect Disord 2012; 141:449-56. [PMID: 22460055 DOI: 10.1016/j.jad.2012.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 02/29/2012] [Accepted: 02/29/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a costly disease with a high rate of vasculometabolic comorbidities. The aims of this study were to explore the 1-year treatment cost, including total medical and non-psychiatric services, and the prevalence of vasculometabolic comorbidities in individuals with BD. METHODS A nationwide population-based dataset, covering the years 2006 and 2007, was obtained from the Taiwan National Health Insurance claims database. The study sample comprised patients discharged from hospitals between 1 January 2006 and 31 December 2007. Annual non-psychiatric and total medical costs and vasculometabolic comorbidities were examined. Generalized linear models were used to examine the medical costs, and conditional logistic regression analyses were carried out to test the prevalence of vasculometabolic comorbidities in people with BD and to compare this with that found in matched controls. RESULTS The total medical cost was 11-fold higher (New Taiwan [NT] $227,040 vs. NT$20,461), and the non-psychiatric medical cost was 1.7-fold higher (NT$33,173 vs. NT$19,406) with regard to the individuals with BD vs. the matched controls. The prevalence of vasculometabolic comorbidities was significantly higher in the individuals with BD than in the controls (ratio ranging from 1.86 to 4.06). CONCLUSIONS Both the non-psychiatric healthcare utilization and the prevalence of vasculometabolic comorbidities are higher with regard to individuals with BD vs. their matched controls. Therefore, treatment of BD should integrate medical and psychiatric care to decrease the impact of medical comorbidities, which may also decrease the overall medical cost.
Collapse
Affiliation(s)
- Ming Hong Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | | | | | | | | | | | | |
Collapse
|
96
|
Svendal G, Fasmer OB, Engeland A, Berk M, Lund A. Co-prescription of medication for bipolar disorder and diabetes mellitus: a nationwide population-based study with focus on gender differences. BMC Med 2012; 10. [PMID: 23186328 PMCID: PMC3534576 DOI: 10.1186/1741-7015-10-148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Studies have shown a correlation between bipolar disorder and diabetes mellitus. It is unclear if this correlation is a part of common pathophysiological pathways, or if medication for bipolar disorder has negative effects on blood sugar regulation. METHODS The Norwegian prescription database was analyzed. Prescriptions for lithium, lamotrigine, carbamazepine and valproate were used as proxies for bipolar disorder. Prescriptions for insulin and oral anti-diabetic agents were used as proxies for diabetes mellitus. We explored the association between medication for bipolar disorder and diabetes medication by logistic regression RESULTS We found a strong association between concomitant use of medication to treat diabetes mellitus and mood stabilizers for the treatment of bipolar disorder. Females had a 30% higher risk compared to men of being treated for both disorders. Persons using oral anti-diabetic agents had higher odds of receiving valproate than either lithium or lamotrigine. Use of insulin as monotherapy seemed to have lower odds than oral anti-diabetic agents of co-prescription of mood stabilizers, compared to the general population. CONCLUSIONS This study showed a strong association between the use of mood stabilizers and anti-diabetic agents. The association was stronger among women than men.
Collapse
Affiliation(s)
- Gjertrud Svendal
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Sandviken Hospital, Sandviksleitet 1, N-5035 Bergen, Norway.
| | | | | | | | | |
Collapse
|
97
|
Pfennig A, Bschor T, Baghai T, Bräunig P, Brieger P, Falkai P, Geissler D, Gielen R, Giesler H, Gruber O, Kopp I, Meyer TD, Möhrmann KH, Muche-Borowski C, Padberg F, Scherk H, Strech D, Bauer M. [S3 guidelines on diagnostics and therapy of bipolar disorders: development process and essential recommendations]. DER NERVENARZT 2012; 83:568-86. [PMID: 22576049 DOI: 10.1007/s00115-011-3415-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bipolar disorders are severe psychiatric disorders with extensive individual and health economic consequences. Starting in 2007 the first German evidence and consensus based guideline for diagnostics and treatment of bipolar disorders was developed which holds the potential of increasing confidence of therapists, patients and relatives in the decision-making process and improving healthcare service experiences of patients and relatives. Apart from recommendations for diagnostics and treatment the guidelines provide those for trialogue action, knowledge transfer and self-help and for strategies for healthcare provision of this complex disorder. In the present article the methodology and essential recommendations are outlined and complemented in specific topics by corresponding articles in this special issue. Due to restrictions of the length of this presentation there is the need to refer to the comprehensive version of the guidelines at several points also regarding a detailed discussion of the limitations.
Collapse
Affiliation(s)
- A Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Deutschland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
98
|
Manning JS, McElroy SL. Treating bipolar disorder in the primary care setting: the role of aripiprazole. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 11:245-57. [PMID: 19956463 DOI: 10.4088/pcc.08r00635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 09/29/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this article is to present practical strategies for detecting and diagnosing bipolar disorder in the primary care setting and to review the evidence for the efficacy and safety of aripiprazole treatment for bipolar disorder. DATA SOURCES A review of the literature from 1980 to 2007 was conducted from November 2006 through February 2007 using a MEDLINE search and the key words bipolar disorder, primary care, detection, diagnosis, and aripiprazole. STUDY SELECTION A total of 100 articles that focused on the accurate detection and diagnosis of bipolar disorder and the evidence of the efficacy and safety of aripiprazole in the treatment of bipolar disorder were selected. DATA SYNTHESIS Patients with bipolar disorder often present to primary care physicians with depressive or mixed symptoms as opposed to purely hypomanic or manic symptoms. Accurate diagnosis of bipolar disorder is essential in order to provide timely and appropriate treatment. One treatment option available is aripiprazole, a partial agonist of dopamine (D)₂ and D₃ and serotonin (5-HT)(₁A) receptors and an antagonist of the 5-HT(₂A) receptor. Clinical trial data have shown aripiprazole to be effective in treating manic and mixed episodes associated with bipolar I disorder, both in the acute phase and over an extended period of treatment lasting from 6 months to 2 years. CONCLUSIONS Accurate diagnosis and treatment of bipolar disorder are challenges increasingly faced by primary care physicians. Strategies geared toward detection, diagnosis, and management of bipolar I disorder and other bipolar spectrum disorders may improve the treatment outcome for patients. Aripiprazole may be considered as another first-line choice for the treatment of bipolar I disorder; however, its utility in patients with bipolar spectrum disorders is yet to be determined.
Collapse
Affiliation(s)
- J Sloan Manning
- University of North Carolina, Chapel Hill and Mood Disorders Clinic, Moses Cone Family Practice Residency, Greensboro, North Carolina, USA.
| | | |
Collapse
|
99
|
Vinberg M, Madsen M, Breum L, Kessing LV, Fink-Jensen A. Metabolic syndrome in a cohort of affectively ill patients, a naturalistic study. Nord J Psychiatry 2012; 66:142-5. [PMID: 21770840 DOI: 10.3109/08039488.2011.595821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with affective disorder have higher mortality not only because of their affective illness but also because of a higher risk of death from physical illness especially cardiovascular diseases. AIM To investigate the prevalence in a naturalistic cohort of patient treated at a Mood Disorder Clinic. METHODS Patients were evaluated for the presence of metabolic syndrome (MeS) according to modified NCEP ATP III criteria. RESULTS Of the 143 patients eligible for participation, 100 patients participated in the study (32% male, mean age 43.6 ± 14.2); the prevalence of MeS was 26%. Higher age and high body mass index (BMI) were significantly associated with MeS. No association between present medication and MeS was seen. CONCLUSION More than a quarter of affectively ill patients had MeS, which emphasizes the importance of integrated somatic and psychiatric care in order to reduce this group of patients' risk profile concerning cardiovascular diseases and diabetes. Clinically, it seems reasonable to prioritize overweight and obese patients for further examination.
Collapse
Affiliation(s)
- Maj Vinberg
- Department of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
100
|
Mai Q, Holman CDJ, Sanfilippo FM, Emery JD, Preen DB. Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 2011; 9:118. [PMID: 22044777 PMCID: PMC3215928 DOI: 10.1186/1741-7015-9-118] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/01/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs) and non-MHCs. METHODS This was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA) from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharmaceutical benefits claims. Diabetes was identified from hospital diagnoses, prescriptions and diabetes-specific primary care claims (17,045 MHCs, 26,626 non-MHCs). Both univariate and multivariate analyses adjusted for socio-demographic factors and case mix were performed to compare the outcome measures among MHCs, category of mental disorders and non-MHCs. RESULTS The prevalence of diabetes was significantly higher in MHCs than in non-MHCs (crude age-sex-standardised point-prevalence of diabetes on 30 June 2006 in those aged ≥20 years, 9.3% vs 6.1%, respectively, P < 0.001; adjusted odds ratio (OR) 1.40, 95% CI 1.36 to 1.43). Receipt of recommended pathology tests (HbA1c, microalbuminuria, blood lipids) was suboptimal in both groups, but was lower in MHCs (for all tests combined; adjusted OR 0.81, 95% CI 0.78 to 0.85, at one year; and adjusted rate ratio (RR) 0.86, 95% CI 0.84 to 0.88, during the study period). MHCs also had increased risks of hospitalisation for diabetes complications (adjusted RR 1.20, 95% CI 1.17 to 1.24), diabetes-related mortality (1.43, 1.35 to 1.52) and all-cause mortality (1.47, 1.42 to 1.53). The disparities were most marked for alcohol/drug disorders, schizophrenia, affective disorders, other psychoses and personality disorders. CONCLUSIONS MHCs warrant special attention for primary and secondary prevention of diabetes, especially at the primary care level.
Collapse
Affiliation(s)
- Qun Mai
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - C D'Arcy J Holman
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Jonathan D Emery
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - David B Preen
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| |
Collapse
|