Effects of metabolic syndrome and obesity on suicidality in individuals with bipolar disorder

Prevalence of Metabolic Syndrome and Its Association With Clinical Correlates and Caregiver Burden in Patients With Bipolar Disorder at a Tertiary Hospital

INTRODUCTION

Metabolic syndrome is a cluster of metabolic abnormalities, including obesity, insulin resistance, dyslipidemia, and hypertension. The prevalence of metabolic syndrome is recognized to be high among patients with bipolar disorder. This study is relevant given the limited number of Indian studies exploring the prevalence of metabolic syndrome and its association with clinical correlates in bipolar patients. This research aims to inform clinicians about the need for timely interventions in diagnosing and managing metabolic syndrome in this population, which may contribute to significant morbidity and poor clinical outcomes.

METHODS

A cross-sectional study was conducted in the inpatient and outpatient units of the psychiatry department involving 83 subjects diagnosed with bipolar disorder. Informed consent was obtained, and sociodemographic and clinical data were collected. The National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATP III) criteria were used to diagnose metabolic syndrome. The Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HAM-D) were applied to assess the severity of manic and depressive episodes, respectively. The Suicide Behaviors Questionnaire-Revised (SBQ-R) was used to assess suicidal risk, and the Burden Assessment Schedule (BAS) was utilized to evaluate caregiver burden. Statistical significance was tested using the independent-sample t-test and Mann-Whitney U test for continuous variables, along with the chi-square test for categorical variables. A p-value of <0.05 was considered significant.

RESULTS

Metabolic syndrome was noted in 49 (59%) patients with bipolar disorder. Subjects with metabolic syndrome exhibited more severe manic episodes, had a higher number of lifetime episodes, were more likely to have a history of suicide attempts, and showed increased suicidal risk. Patients on polypharmacy were at higher risk of developing metabolic syndrome. Caregivers of patients with metabolic syndrome reported greater caregiver burden compared to those without the condition.

CONCLUSION

There is a high prevalence of metabolic syndrome in patients with bipolar disorder. Metabolic syndrome is associated with adverse prognostic factors, including a higher number of lifetime episodes, greater severity of manic episodes, and increased suicidality. This underscores the necessity for routine monitoring of blood and anthropometric parameters.

A one-year view on the association of metabolic syndrome and cognitive function in bipolar disorder - Preliminary data

BACKGROUND

Individuals with bipolar disorder have a high prevalence of metabolic syndrome and an increased risk for cognitive deficits. The aim of this longitudinal study was to investigate the trajectory of cognitive decline in dependence of metabolic syndrome over a one-year interval.

METHODS

52 well-diagnosed individuals with bipolar disorder, euthymic at baseline and follow-up (n = 17 with metabolic syndrome vs. n = 35 without metabolic syndrome) were investigated with a comprehensive neurocognitive test battery (Trail Making Test A/B, Digit Symbol Test, California Verbal Leaning Test, or the Verbal Learning and Memory Test respectively) twice within the interval of one year.

RESULTS

Patients with bipolar disorder and additional metabolic syndrome performed significantly worse in the domain of psychomotor and processing speed/attention than patients without metabolic syndrome at test point one. No deteriorating effects of metabolic syndrome on the cognitive domain scores and overall cognitive performance were found at the one-year follow up. However, no cognitive decline could be reported in both groups.

LIMITATIONS

Time interval, small sample size and selection of metabolic syndrome affected patients were the major limitations of this study.

CONCLUSION

There was no association of metabolic syndrome on the one-year trajectory of cognitive function in bipolar disorder. Future studies should expand the observation period and investigate larger samples.

Which Clinical and Biochemical Parameters Are Associated with Lifetime Suicide Attempts in Bipolar Disorder?

Introduction: Bipolar Disorder (BD) is a disabling condition with suicidal behavior as one of the most common adverse outcomes. The purpose of the present research is to investigate the relationship between lifetime suicide attempts and the clinical factors/biochemical parameters in a large sample of bipolar patients. Methods: A total of 561 patients, consecutively hospitalized for BD in Milan and Monza (Italy), were recruited. Data about the demographic and clinical variables, as well as the values of blood analyses, were collected. The groups identified according to the presence/absence of lifetime suicide attempts were compared using univariate analyses. Then, three preliminary binary logistic regressions and a final logistic regression model were performed to identify the clinical and biochemical parameters associated with lifetime suicide attempts in BD. Results: Lifetime suicide attempts in BD were predicted by a longer duration of untreated illness (DUI) (p = 0.005), absence of lifetime psychotic symptoms (p = 0.025), presence of poly-substance use disorders (p = 0.033), comorbidity with obesity (p = 0.022), a last mood episode of manic polarity (p = 0.044), and lower bilirubin serum levels (p = 0.002); higher total cholesterol serum levels showed a trend toward statistical significance (p = 0.058). Conclusions: BD patients with lifetime suicide attempts present unfavorable clinical features. Some specific biochemical characteristics of bipolar patients may represent potential markers of suicidal behavior and need to be better investigated to identify new targets of treatment in the framework of personalized medicine. These preliminary findings have to be confirmed by further studies in different clinical settings.

Clinical Value of Inflammatory and Neurotrophic Biomarkers in Bipolar Disorder: A Systematic Review and Meta-Analysis

Bipolar disorder (BD) is a multifactorial chronic psychiatric disease highly defined by genetic, clinical, environmental and social risk factors. The present systematic review and meta-analysis aimed to examine the relationship between inflammatory and neurotrophic factors and clinical, social and environmental factors involved in the development and the characterization of BD. Web of Science, PubMed, PsycINFO, Scopus and Science Direct were searched by two independent reviewers. The systematic review was registered in PROSPERO (CRD42020180626). A total of 51 studies with 4547 patients with a diagnosis of BD were selected for systematic review. Among them, 18 articles were included for meta-analysis. The study found some evidence of associations between BDNF and/or inflammatory factors and different stressors and functional and cognitive impairment, but limitations prevented firm conclusions. The main finding of the meta-analysis was a negative correlation between circulating levels of BDNF and depression severity score (standardized mean difference = −0.22, Confidence Interval 95% = −0.38, −0.05, p = 0.01). Evidence indicates that BDNF has a role in the depressive component of BD. However, the poor consistency found for other inflammatory mediators clearly indicates that highly controlled studies are needed to identity precise biomarkers of this disorder.