Bipolar disorder and metabolic syndrome: an international perspective

Hypomania across the binge eating spectrum. A study on hypomanic symptoms in full criteria and sub-threshold binge eating subjects

BACKGROUNDS

Obese subjects affected by binge eating can be distinguished between those showing full criteria Binge Eating Disorder (BED) and those who show binge eating of insufficient frequency to satisfy DSM criteria, or sub-threshold BED (s-BED). The present paper aims to investigate whether subjects with BED full criteria show more hypomanic symptoms than those with s-BED, after controlling for personality variables as potential confounders.

METHODS

The Hypomania Checklist (HCL-32), the Beck Depression Inventory (BDI) and the Temperament and Character Inventory (TCI) were administered to 103 obese patients with binge eating.

RESULTS

Full criteria BED subjects were more likely to be female and showed higher HCL-32 scores and lower scores in character dimensions (Self-directedness and Cooperativeness) compared to s-BED subjects. A logistic regression with Eating Disorder Diagnosis as outcome measure (BED or s-BED) revealed that lower Cooperativeness, higher Hypomania scores and female sex predicted having BED full criteria.

LIMITATIONS

Further research is necessary to replicate these findings in a larger sample.

CONCLUSIONS

Patients with more severe binge eating might be more likely to have a comorbid bipolar spectrum disorder. Hypomanic symptoms should be assessed and mood stabilizing treatment should be considered in these patients.

Genetic and metabolic characterization of insomnia

Insomnia is reported to chronically affect 10∼15% of the adult population. However, very little is known about the genetics and metabolism of insomnia. Here we surveyed 10,038 Korean subjects whose genotypes have been previously profiled on a genome-wide scale. About 16.5% reported insomnia and displayed distinct metabolic changes reflecting an increase in insulin secretion, a higher risk of diabetes, and disrupted calcium signaling. Insomnia-associated genotypic differences were highly concentrated within genes involved in neural function. The most significant SNPs resided in ROR1 and PLCB1, genes known to be involved in bipolar disorder and schizophrenia, respectively. Putative enhancers, as indicated by the histone mark H3K4me1, were discovered within both genes near the significant SNPs. In neuronal cells, the enhancers were bound by PAX6, a neural transcription factor that is essential for central nervous system development. Open chromatin signatures were found on the enhancers in human pancreas, a tissue where PAX6 is known to play a role in insulin secretion. In PLCB1, CTCF was found to bind downstream of the enhancer and interact with PAX6, suggesting that it can probably inhibit gene activation by PAX6. PLCB4, a circadian gene that is closely located downstream of PLCB1, was identified as a candidate target gene. Hence, dysregulation of ROR1, PLCB1, or PLCB4 by PAX6 and CTCF may be one mechanism that links neural and pancreatic dysfunction not only in insomnia but also in the relevant psychiatric disorders that are accompanied with circadian rhythm disruption and metabolic syndrome.

The metabolic syndrome and its constituting variables in atypical antipsychotic-treated subjects: comparison with other drug treatments, drug-free psychiatric patients, first-degree relatives and the general population in Venezuela

BACKGROUND

Few studies on the association between atypical antipsychotic drug (AAP) administration and metabolic dysfunction have concurrently evaluated the general population (GP), other psychotropic drug treatments and drug-free psychiatric patients.

METHODS

We assessed the frequency of the metabolic syndrome (MS) according to the National Cholesterol Education Program criteria (NCEP) and its constituting variables in a GP sample (n=271) and in patients receiving, for at least three consecutive months, antiepileptic drugs (n=93), olanzapine (n=162), clozapine (n=105), typical antipsychotics (n=117), other AAP (n=58), other psychotropic drugs (n=185), and drug-free individuals (n=636). Subjects were clinically classified as schizophrenia, bipolar or other axis I disorders (DSM-IV-RT), and as first-degree relatives of each diagnostic group.

RESULTS

The MS was detected in 26.6% of the GP (95% confidence interval: 21.5-31.8). No diagnostic or treatment group had a significantly higher age-adjusted frequency than the GP (p>0.05). Treatment duration did not significantly affect the results. However, significant differences were observed in the frequency of abnormal MS constituting variables in comparison to the GP. For example, schizophrenia patients and their relatives, bipolar subjects and olanzapine- and clozapine-treated patients had higher abnormal waist circumference values. In addition, bipolar patients and their relatives and subjects treated with olanzapine and other AAPs had higher frequencies of abnormal glucose levels. Neither schizophrenia nor bipolar patients in the diagnostic categories nor the olanzapine or the clozapine groups displayed higher proportions of abnormal triglycerides, high density cholesterol or blood pressure levels than the GP.

CONCLUSIONS

While we did not demonstrate an increased frequency of the MS in AAP-treated subjects, our results confirm that specific metabolic variables must be monitored in psychiatric patients. Besides they stress the importance, in epidemiological studies, of concurrently comparing the figures recorded in AAP-treated patients with those obtained in the local GP, other drug treatment groups and drug-free subjects when referring to the magnitude of the metabolic effects of specific antipsychotic agents.

Metabolic syndrome and bipolar disorder: what should psychiatrists know?

This paper reviews the association between bipolar disorder (BD) and metabolic syndrome (MetS), focusing on the etiopathogenetic and pathophysiological aspects of this association and on the recommendations for preventing and managing MetS in patients with BD. We conducted a nonsystematic literature review by means of a MEDLINE search. The exact causal relationship between MetS and BD is still uncertain. The side effects of psychotropic medications may be a major contributor to the increased rates of MetS in patients with BD. Other factors such as unhealthy lifestyles, common neuroendocrine and immuno-inflammatory abnormalities, and genetic vulnerability may also play a role in explaining the high rates of MetS in BD. Strategies to prevent and treat the MetS and its cardiovascular consequences in patients with BD include accurate screening and monitoring of the patient and appropriate psychoeducation on weight control, healthy nutrition, and increased physical activity. When deciding on pharmacological therapy for the treatment of the components of the MetS, drug interactions and the effects of the medications on mood must be taken into account.

The rate of metabolic syndrome in euthymic Canadian individuals with bipolar I/II disorder

OBJECTIVE

To report on the rate of metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), in asymptomatic adults with bipolar I/II disorder evaluated at the Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto. To our knowledge, this is the first study reporting on the rate of metabolic syndrome in a Canadian clinical sample and exclusively evaluating asymptomatic individuals.

METHODS

This was a post-hoc, cross-sectional analysis of adult bipolar subjects who were primarily enrolled in a clinical intervention study. All subjects in this sample were asymptomatic at the time of assessing metabolic parameters.

RESULTS

Data from 99 euthymic bipolar subjects (n=51 female, n=48 male) were included for the analysis. The sample mean age±SD was 38±11.15 years. Thirty-one subjects (32.6%) met criteria for the metabolic syndrome with no significant differences as a function of sex. The waist circumference criterion was met in 37 (41.1%) subjects. Diastolic and systolic blood pressure criteria were met in 26 (27.6%) and 28 (29.7%) subjects, respectively. Thirty-one subjects (36.4%) met the high-density lipoprotein (HDL) criterion, while 33 (38.8%) met the triglyceride criterion. Moreover, five (6.1%) met the criterion for high fasting glucose level (diabetes mellitus or glucose/insulin dysregulation at screening was an exclusion criterion). Men were more likely to have high diastolic (P=0.001) and systolic blood pressure (P=0.007) as well as hypertriglyceridemia (P=0.037). Abdominal obesity, HDL, and fasting glucose levels were not significantly different between men and women. Bipolar individuals with concurrent metabolic syndrome had a later age at first treatment and increased number of total hospitalizations.

CONCLUSION

Asymptomatic Canadian individuals with bipolar disorder exhibit a high rate of concurrent metabolic syndrome. The results herein buttress recommendations for risk factor screening and modification, ongoing surveillance, as well as primary and secondary prevention strategies for metabolic abnormalities in individuals with bipolar disorder.