1
|
Shapiro LR, Kennedy KG, Dimick MK, Goldstein BI. Elevated atherogenic lipid profile in youth with bipolar disorder during euthymia and hypomanic/mixed but not depressive states. J Psychosom Res 2022; 156:110763. [PMID: 35193092 DOI: 10.1016/j.jpsychores.2022.110763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Abnormal blood lipid levels are common in individuals with bipolar disorder (BD). Previous studies have revealed lipid-mood associations in adults with BD, but no data on this relationship is available in youth populations. This cross-sectional study examined the associations of lipid levels with mood states and symptoms in a cohort of youth with BD. METHODS Participants were youth with BD and healthy controls (HCs) between the ages of 13-20 years. We compared the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and TG/HDL-C ratio between 4 participant episode groups: BD-euthymic (n = 28), BD-depressed (n = 29) BD-hypomanic/mixed (n = 31), and HCs (n = 89). We also examined for dimensional associations of lipids with mania and depression scores in the overall BD group and within BD episode subgroups. RESULTS TG levels were significantly higher in the BD-euthymic group (p = 0.008, d = 0.59) and in the BD-mixed/hypomanic group (p = 0.03, d = 0.44) compared to the HC group. TG/HDL-C ratio was also higher in the BD-euthymic group compared to the HC group (p = 0.01, d = 0.51). No dimensional associations were found between lipids and mood symptom scores in the overall BD group. However, within the BD-mixed/hypomanic subgroup, higher mania scores were associated with higher TG (β = 0.42, p = 0.04), TG/HDL-C ratio (β = 0.59, p = 0.002), and lower HDL-C (β = 0.56 p = 0.002). CONCLUSIONS Youth with BD demonstrate atherogenic lipid profiles. Higher atherogenic lipids were associated with hypomanic but, contrasting adult BD studies, not depressive symptoms. Future prospective studies are warranted to evaluate the temporal association between lipids and mood among youth with BD.
Collapse
Affiliation(s)
- Lila R Shapiro
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada.
| |
Collapse
|
2
|
Giménez-Palomo A, Gomes-da-Costa S, Dodd S, Pachiarotti I, Verdolini N, Vieta E, Berk M. Does metabolic syndrome or its component factors alter the course of bipolar disorder? A systematic review. Neurosci Biobehav Rev 2021; 132:142-153. [PMID: 34800584 DOI: 10.1016/j.neubiorev.2021.11.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022]
Abstract
Metabolic syndrome (MetS) and its component factors, obesity, hypertension, dyslipidaemia and insulin resistance, have shown a bidirectional relationship with the prevalence and severity of bipolar disorder (BD). A systematic search of electronic databases (Pubmed, PsycINFO, clinicaltrials.gov) was conducted to explore and integrate current evidence about the role of MetS and its component factors with clinical outcomes of BD. Thirty-four articles met the inclusion criteria. Studies were grouped by the metabolic factors assessed, which included MetS, obesity and body mass index (BMI), dyslipidaemia, impaired glucose metabolism (IGM), diabetes mellitus and hypertension. They were then classified according to outcomes such as course of episodes, rapid cycling, suicidal behavior, treatment response, and global and cognitive functioning. Although current evidence remains controversial in most aspects of clinical outcomes, metabolic risk factors could alter the course of BD, with worse global functioning, poorer treatment response and a chronic course of illness, as well as enhancing rapid cycling. Further research is needed to elucidate the role of each risk factor in the mentioned outcomes.
Collapse
Affiliation(s)
- Anna Giménez-Palomo
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain
| | - Susana Gomes-da-Costa
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Isabella Pachiarotti
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain
| | - Norma Verdolini
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
| |
Collapse
|
3
|
Bocchetta A, Chillotti C, Ardau R, Sollaino MC. Microcytic Anaemia as Susceptibility Factors in Bipolar Spectrum Disorders: Review of the Literature, Replication Survey, and Co-Segregation within Families. Clin Pract Epidemiol Ment Health 2021; 17:81-91. [PMID: 34733347 PMCID: PMC8493829 DOI: 10.2174/1745017902117010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
Background: Potential interactions between mood disorders and microcytic anaemias have been suggested by case reports, surveys of haematological parameters in psychiatric populations, and surveys of psychiatric morbidity in thalassaemic carriers. Objectives: a) To review published studies. b) To study the prevalence of microcytic anaemia in a sample of Sardinian outpatients with recurrent mood disorders. c) To check whether mood disorders and microcytic anaemia co-segregate within families. Methods: We extracted data on blood count and serum iron concentrations from the records of patients admitted between January 1st, 2001 and December 31st, 2016, to our clinic for mood disorders. Moreover, we studied siblings of subjects with both major mood disorders (according to Research Diagnostic Criteria) and heterozygous thalassaemia (according to Mean Corpuscular Volume, serum iron, and haemoglobin A2 concentrations). Siblings affected with a major mood disorder were examined for haematological concordance with the proband (reduced MCV and/or increased HbA2 in case of heterozygous β-thalassaemia, or presence of gene deletions in case of α-thalassaemia). Results: Microcytic anaemia was highly prevalent (81/337 = 24.0%) among outpatients with mood disorders. Starting from 30 probands with heterozygous ß-thalassaemia, concordance for reduced MCV and/or increased HbA2 was found in 78% (35/45) of affected siblings. Starting from 3 probands with heterozygous α-thalassaemia, only one of the 5 affected siblings carried four α-globin functional genes. Conclusion: Based on the review of the literature, the high prevalence of microcytic anaemia in outpatients, and the concordance between affected siblings, we can conclude that a role of heterozygous thalassaemias is highly probable. Future studies are required to establish the relevance of heterozygous thalassaemias and evaluate the magnitude of the effect, possibly using a molecular diagnosis also in the case of heterozygous β-thalassaemia.
Collapse
Affiliation(s)
- Alberto Bocchetta
- Department of Biomedical Sciences, Section of Clinical Pharmacology, University of Cagliari, Via Ospedale 46, 09124 Cagliari, Italy.,Unit of Clinical Pharmacology, Cagliari University Hospital, Cagliari, Italy
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, Cagliari University Hospital, Cagliari, Italy
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, Cagliari University Hospital, Cagliari, Italy
| | - Maria Carla Sollaino
- Ospedale Microcitemico "Antonio Cao" -Azienda di Rilievo Nazionale ed Alta Specializzazione"GiuseppeBrotzu", Cagliari, Italy
| |
Collapse
|
4
|
Fusar-Poli L, Amerio A, Cimpoesu P, Natale A, Salvi V, Zappa G, Serafini G, Amore M, Aguglia E, Aguglia A. Lipid and Glycemic Profiles in Patients with Bipolar Disorder: Cholesterol Levels Are Reduced in Mania. ACTA ACUST UNITED AC 2020; 57:medicina57010028. [PMID: 33396922 PMCID: PMC7824186 DOI: 10.3390/medicina57010028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Bipolar disorder (BD) is a severe mental condition with a lifetime prevalence estimated around 2% among the general population. Due to risk factors, etiological mechanisms, and the chronic use of psychotropic medications, people with BD are frequently affected by medical comorbidities, such as metabolic syndrome (MetS), associated with altered blood levels of glucose, cholesterol, and triglycerides. Moreover, the lipid concentration may be associated with the severity of psychiatric symptoms. Materials and Methods: Five hundred and forty-two in- and outpatients (418 affected by BD and 124 affected by schizophrenia) were recruited in two Italian university hospitals. A blood examination assessing the fasting glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides was performed. Results: No significant differences were found in the lipid and glycemic profiles between patients with BD and schizophrenia. When considering only the BD sample, we found that patients experiencing a manic episode had significantly lower total cholesterol, HDL, and LDL than euthymic patients. Moreover, the total and LDL cholesterol levels were significantly lower in (hypo)manic than depressed patients. Mood episodes did not influence the triglyceride and glucose levels in our sample. Conclusions: Clinicians should pay attention to blood cholesterol levels in patients with BD, as differences in concentrations may predispose them to severe medical conditions and can be associated with the onset of mood episodes.
Collapse
Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
- Correspondence: ; Tel.: +39-095-378-2470
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, MA 02111, USA
| | - Patriciu Cimpoesu
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
| | - Virginio Salvi
- Department of Clinical Neurosciences, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Guendalina Zappa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| |
Collapse
|
5
|
Kidnapillai S, Bortolasci CC, Panizzutti B, Spolding B, Connor T, Bonifacio K, Sanigorski A, Dean OM, Crowley T, Jamain S, Gray L, Leboyer M, Berk M, Walder K. Drugs used in the treatment of bipolar disorder and their effects on cholesterol biosynthesis - A possible therapeutic mechanism. World J Biol Psychiatry 2019; 20:766-777. [PMID: 31535581 DOI: 10.1080/15622975.2019.1669823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: To understand the therapeutic mechanisms of bipolar disorder (BD) drugs at molecular and cellular levels.Methods: Next generation sequencing was used to determine the transcriptional effects of a combination of four commonly prescribed BD drugs (lithium, valproate, lamotrigine and quetiapine) or vehicle (0.2% DMSO) in NT2-N (human neuronal) cells and rats. Differential expression of genes and pathway analysis were performed using edgeR in R and Gene Set Enrichment Analysis software respectively. Free cholesterol levels and neurite outgrowth were quantified in NT2-N cells following combination and individual BD drug treatments.Results: Pathway analysis showed up-regulation of many elements of the cholesterol biosynthesis pathway in NT2-N cells and oxidative phosphorylation in rat brains. Intracellular cholesterol transport genes were upregulated (NPC1, NPC2 and APOE), while the cholesterol efflux gene (ABCA1) was downregulated. BD drug combination tended to increase intracellular cholesterol levels and neurite outgrowth, but these effects were not seen for the drugs when used individually.Conclusions: These data suggest that BD drug combination is increasing cholesterol biosynthesis and the newly synthesised cholesterol is being utilised within the cells, possibly for synthesis of new membranes to facilitate neurite outgrowth. This mechanism possibly underpins clinical efficacy in individuals with BD treated with polypharmacy.
Collapse
Affiliation(s)
- Srisaiyini Kidnapillai
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Chiara C Bortolasci
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Bruna Panizzutti
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA) and Programa de Pós-graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Briana Spolding
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Timothy Connor
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Kamila Bonifacio
- Laboratory of Graduation Research, State University of Londrina, Londrina, Brazil
| | - Andrew Sanigorski
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Olivia M Dean
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Tamsyn Crowley
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia.,Bioinformatics Core Research Facility (BCRF), Deakin University, Geelong, Australia
| | - Stéphane Jamain
- INSERM U955, Psychiatrie Translationnelle, Université Paris Est, Créteil, France
| | - Laura Gray
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Marion Leboyer
- INSERM U955, Psychiatrie Translationnelle, Université Paris Est, Créteil, France
| | - Michael Berk
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Australia Parkville.,Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| |
Collapse
|
6
|
Huang YJ, Tsai SY, Chung KH, Chen PH, Huang SH, Kuo CJ. State-dependent alterations of lipid profiles in patients with bipolar disorder. Int J Psychiatry Med 2018; 53:273-281. [PMID: 29280686 DOI: 10.1177/0091217417749786] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Serum lipid levels may be associated with the affective severity of bipolar disorder, but data on lipid profiles in Asian patients with bipolar disorder and the lipid alterations in different states of opposite polarities are scant. We investigated the lipid profiles of patients in the acute affective, partial, and full remission state in bipolar mania and depression. Methods The physically healthy patients aged between 18 and 45 years with bipolar I disorder, as well as age-matched healthy normal controls were enrolled. We compared the fasting blood levels of glucose, cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein of manic or depressed patients in the acute phase and subsequent partial and full remission with those of their normal controls. Results A total of 32 bipolar manic patients (12 women and 20 men), 32 bipolar depressed participants (18 women and 14 men), and 64 healthy control participants took part in this study. The mean cholesterol level in acute mania was significantly lower than that in acute depression (p < 0.025). The lowest rate of dyslipidemia (hypertriglyceridemia or low high-density lipoprotein cholesterol) was observed in acute bipolar mania. Conclusion Circulating lipid profiles may be easily affected by affective states. The acute manic state may be accompanied by state-dependent lower cholesterol and triglyceride levels relative to that in other mood states.
Collapse
Affiliation(s)
- Yu-Jui Huang
- 1 Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- 1 Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,2 Department of Psychiatry, Taipei Medical University Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- 1 Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,2 Department of Psychiatry, Taipei Medical University Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pao-Huan Chen
- 1 Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,2 Department of Psychiatry, Taipei Medical University Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shou-Hung Huang
- 1 Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,2 Department of Psychiatry, Taipei Medical University Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chian-Jue Kuo
- 2 Department of Psychiatry, Taipei Medical University Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,3 Taipei City Psychiatric Center, Taipei City Hospital, Songde Branch, Taipei, Taiwan
| |
Collapse
|
7
|
De La Vega D, Giner L, Courtet P. Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances. Curr Psychiatry Rep 2018; 20:26. [PMID: 29594718 DOI: 10.1007/s11920-018-0885-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and body dysmorphic disorder), with special emphasis on findings published in the last years. RECENT FINDINGS Overall, anxiety disorders increase the risk of suicide. Specifically, 16% of patients with social anxiety disorder reported suicidal ideation in the previous month, and 18% of them had a history of suicide attempts. Similarly, in patients with panic disorder, suicidal ideation prevalence ranged between 17 and 32%, and 33% of them had a history of suicide attempts. Generalized anxiety disorder (GAD) was the most frequent anxiety disorder in completed suicides (present in 3% of people who committed suicide) and also subthreshold GAD was clearly linked to suicide ideation. Post-traumatic stress disorder was positively associated with suicidal ideation, and in patients with obsessive-compulsive disorder, suicide ideation rates ranged from 10 to 53% and suicide attempts from 1 to 46%. Body dysmorphic disorders presented a suicide ideation prevalence of about 80%. Suicide risk is increased in subjects with anxiety disorder. This risk is higher in the presence of comorbidities, but it is not clear whether it is independent from such comorbidities in some disorders.
Collapse
Affiliation(s)
- Diego De La Vega
- Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, Servicio Andaluz de Salud, Sevilla, Spain
| | - Lucas Giner
- Department of Psychiatry, School of Medicine, Universidad de Sevilla, Av. Sánchez-Pizjuán s/n, 41009, Seville, Spain.
| | - Philippe Courtet
- CHRU Montpellier, University of Montpellier, INSERM unit 1061, Montpellier, France.,Fondamental Foundation, Créteil, France
| |
Collapse
|
8
|
Persons JE, Coryell WH, Solomon DA, Keller MB, Endicott J, Fiedorowicz JG. Mixed state and suicide: Is the effect of mixed state on suicidal behavior more than the sum of its parts? Bipolar Disord 2018; 20:35-41. [PMID: 28833953 PMCID: PMC6237077 DOI: 10.1111/bdi.12538] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/29/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess whether suicidal behavior during mixed states exceeds that expected from the manic or depressive components alone. METHODS This study included 429 participants with bipolar disorder from the National Institute of Mental Health Collaborative Depression Study (CDS). Mood and suicidal behavior were captured using the Longitudinal Interval Follow-up Evaluation and the Schedule of Affective Disorders and Schizophrenia. Suicidal behavior during each mood state, relative to euthymia, was analyzed using Cox regression to allow for repeated events, with a frailty term to account for intra-participant correlation. Mixed states were modeled as a depression-by-mania interaction. RESULTS Individuals with a history of mixed states were at higher risk of suicidal behavior and spent more time depressed, compared to subjects with no such history. In bipolar I disorder, risk increased during episodes of mania (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.28-2.99, P = .0019) and depression (HR: 5.49, 95% CI: 4.01-7.51, P < .0001) and there was a less than additive effect of mixed states. In bipolar II disorder, risk was increased during episodes of depression (HR: 3.66, 95% CI: 2.51-5.35, P < .0001) and there was no excess risk during mixed states beyond that attributable to the depressed component. Most of the excess risk (71%) among those with a history of mixed states was attributable to a depression predominant course of illness. CONCLUSIONS Individuals with mixed states are at high risk of suicidal behavior, largely due to more time spent depressed. Clinicians should aggressively treat depression to mitigate suicide risk for patients with or without mixed states.
Collapse
Affiliation(s)
- Jane E. Persons
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA.,Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - William H. Coryell
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - David A. Solomon
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA.,UpToDate, Waltham, MA, USA
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA
| | - Jean Endicott
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jess G. Fiedorowicz
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA.,Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.,Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,Francois M. Abboud Cardiovascular Research Center, The University of Iowa, Iowa City, IA, USA.,Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA.,The Obesity Research and Education Initiative, The University of Iowa, Iowa City, IA, USA
| |
Collapse
|
9
|
Abstract
Variation in telomere length is heritable and is currently considered a promising biomarker of susceptibility for neuropsychiatric disorders, particularly because of its association with memory function and hippocampal morphology. Here, we investigate telomere length in connection to familial risk and disease expression in bipolar disorder (BD). We used quantitative PCRs and a telomere-sequence to single-copy-gene-sequence ratio method to determine telomere length in genomic DNA extracted from buccal smears from 63 patients with BD, 74 first-degree relatives (49 relatives had no lifetime psychopathology and 25 had a non-BD mood disorder), and 80 unrelated healthy individuals. Participants also underwent magnetic resonance imaging to determine hippocampal volumes and cognitive assessment to evaluate episodic memory using the verbal paired associates test. Telomere length was shorter in psychiatrically well relatives (p=0.007) compared with unrelated healthy participants. Telomere length was also shorter in relatives (regardless of psychiatric status; p<0.01) and patients with BD not on lithium (p=0.02) compared with lithium-treated patients with BD. In the entire sample, telomere length was positively associated with left and right hippocampal volume and with delayed recall. This study provides evidence that shortened telomere length is associated with familial risk for BD. Lithium may have neuroprotective properties that require further investigation using prospective designs.
Collapse
|
10
|
De Berardis D, Serroni N, Campanella D, Marini S, Rapini G, Valchera A, Iasevoli F, Mazza M, Fornaro M, Perna G, Di Iorio G, Martinotti G, Di Giannantonio M. Alexithymia, Suicide Ideation, C-Reactive Protein, and Serum Lipid Levels Among Outpatients with Generalized Anxiety Disorder. Arch Suicide Res 2017; 21:100-112. [PMID: 25856390 DOI: 10.1080/13811118.2015.1004485] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to investigate the relationships between alexithymia, suicide ideation, C-Reactive Protein (CRP), and serum lipid levels in adult outpatients with a DSM-IV diagnosis of Generalized Anxiety Disorder (GAD). Seventy consecutive patients with GAD were recruited and evaluated. Measures were the Hamilton Anxiety Scale, the Toronto Alexithymia Scale (TAS-20), the Scale of Suicide Ideation (SSI), and the Montgomery Åsberg Depression Rating Scale (MADRS). All patients were assessed for: CRP, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG), and very-low-density lipoprotein cholesterol (VLDL-C). TC/HDL-C and LDL-C/HDL-C ratios were also evaluated. Alexithymic patients showed higher scores on almost all rating scales and altered serum CRP and lipid levels vs. non-alexithymics. In the hierarchical regression model, the presence of higher MADRS scores together with higher scores at the Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher rates of suicide ideation. Although alexithymic subjects with GAD may show a CRP and cholesterol dysregulation, this latter seems independent on increased suicide ideation, rather to Difficulty in Identifying Feelings, and subthreshold depressive symptoms. Study limitations and future research implications are discussed.
Collapse
|
11
|
Hsu JH, Chien IC, Lin CH. Increased risk of hyperlipidemia in patients with bipolar disorder: a population-based study. Gen Hosp Psychiatry 2015; 37:294-8. [PMID: 25892153 DOI: 10.1016/j.genhosppsych.2015.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We conducted this nationwide study to examine the epidemiology of hyperlipidemia among Taiwanese patients with bipolar disorder. METHODS We used a random sample of 766,427 subjects who were ≥18 years old in 2005. Subjects with at least one primary diagnosis of bipolar disorder were identified. Individuals with a primary or secondary diagnosis of hyperlipidemia or medication treatment for hyperlipidemia were also identified. We compared the prevalence of hyperlipidemia in patients with bipolar disorder with the general population in 2005. Furthermore, we investigated this cohort from 2006 to 2010 to detect the incident cases of hyperlipidemia. RESULTS The prevalence of hyperlipidemia in patients with bipolar disorder was higher than that of the general population [13.5% vs. 7.9%; odds ratio, 1.75; 95% confidence interval (CI), 1.52-2.02] in 2005. The average annual incidence of hyperlipidemia in patients with bipolar disorder was also higher than that of the general population (4.37% vs. 2.55%; risk ratio, 1.66; 95% CI, 1.47-1.87) from 2006 to 2010. CONCLUSIONS Patients with bipolar disorder had a higher prevalence and incidence of hyperlipidemia compared with the general population. Patients with bipolar disorder coexisting hypertension exhibited a higher likelihood of hyperlipidemia.
Collapse
Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Ministry of Health and Welfare, 600 Chiayi City, Taiwan
| | - I-Chia Chien
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 54249 Nantou County, Taiwan; Department of Public Health and Institute of Public Health, National Yang-Ming University, 112 Taipei City, Taiwan.
| | - Ching-Heng Lin
- Taichung Veteran General Hospital, 407 Taichung City, Taiwan
| |
Collapse
|
12
|
Baptista T, Sandia I, Fernandez E, Balzán L, Connell L, Uzcátegui E, Serrano A, Pabón A, Angeles F, Araque Y, Delgado H, González A, Alviarez Y, Piãero J, Baptista EAD. Metabolic syndrome and related variables, insulin resistance, leptin levels, and PPAR-γ2 and leptin gene polymorphisms in a pedigree of subjects with bipolar disorder. REVISTA BRASILEIRA DE PSIQUIATRIA 2015. [DOI: 10.1590/1516-4446-2014-1425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | | | | | | | | | | | - Ana Serrano
- Los Andes University Medical School, Venezuela
| | - Albis Pabón
- Los Andes University Medical School, Venezuela
| | | | | | | | | | | | - Jose Piãero
- Los Andes University Medical School, Venezuela
| | | |
Collapse
|
13
|
Forty L, Ulanova A, Jones L, Jones I, Gordon-Smith K, Fraser C, Farmer A, McGuffin P, Lewis CM, Hosang GM, Rivera M, Craddock N. Comorbid medical illness in bipolar disorder. Br J Psychiatry 2014; 205:465-72. [PMID: 25359927 PMCID: PMC4248234 DOI: 10.1192/bjp.bp.114.152249] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individuals with a mental health disorder appear to be at increased risk of medical illness. AIMS To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden. METHOD Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria. RESULTS We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset. CONCLUSIONS Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.
Collapse
|
14
|
Chung KH, Huang SH, Wu JY, Chen PH, Hsu JL, Tsai SY. The link between high-sensitivity C-reactive protein and orbitofrontal cortex in euthymic bipolar disorder. Neuropsychobiology 2014; 68:168-73. [PMID: 24051690 DOI: 10.1159/000353613] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 06/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE C-reactive protein (CRP), a marker of underlying low-grade inflammation, has been associated with the pathophysiology of bipolar disorder. Additionally, bipolar disorder may be accompanied by functional or structural cerebral alterations. We attempted to discover whether serum high-sensitivity CRP (hs-CRP) levels are linked to the structural volume change of a specific brain region along with cognitive performance. METHODS We recruited 17 physically healthy patients with bipolar I disorder (DSM-IV), aged 18-45 years and euthymic, to undergo the Wisconsin Card Sorting Test (WCST) and volumetric magnetic resonance imaging at 1.5 T. The analytic method was based on the hidden Markov random field model with an expectation-maximization algorithm, and the volume of each brain region was presented as a percentage of the total intracranial volume. RESULTS Among the various regions, only the orbitofrontal cortex had a significantly negative correlation with serum hs-CRP levels after adjustment for age and gender (left and right orbitofrontal cortex: r = -0.62, p < 0.01, and r = -0.67, p < 0.005, respectively). Regarding cognitive function, poor WCST performance was also associated with certain subregions of the orbitofrontal cortex. CONCLUSION Elevation of serum hs-CRP levels, an indicator of inflammation, may be associated with reduced volume of the orbitofrontal cortex. Persistent inflammation in the euthymic phase of bipolar disorder may involve the pathogenesis or pathophysiology of alteration of the frontal pathway.
Collapse
Affiliation(s)
- Kuo-Hsuan Chung
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
15
|
De Berardis D, Serroni N, Marini S, Rapini G, Carano A, Valchera A, Iasevoli F, Mazza M, Signorelli M, Aguglia E, Perna G, Martinotti G, Varasano PA, Pressanti GL, Di Giannantonio M. Alexithymia, suicidal ideation, and serum lipid levels among drug-naïve outpatients with obsessive-compulsive disorder. ACTA ACUST UNITED AC 2014; 36:125-30. [PMID: 24554275 DOI: 10.1590/1516-4446-2013-1189] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/17/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE As obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder with a significant suicide risk, the individuation of potential biomarkers of suicidality, such as cholesterol levels, may enable recognition of at-risk subjects. Therefore, the aims of this study were to: 1) evaluate potential differences in clinical and laboratory parameters between patients with and without alexithymia and compare them with healthy controls; and 2) investigate which clinical and laboratory variables were associated with suicidal ideation. METHODS 79 drug-naïve adult outpatients with a DSM-IV diagnosis of OCD were recruited. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), suicidal ideation was assessed with the Scale for Suicide Ideation, and depressive symptoms were evaluated with the Montgomery-Åsberg Depression Rating Scale (MADRS). Serum lipid levels of 40 healthy controls were also evaluated. RESULTS Alexithymic patients had altered serum lipid levels in comparison with non-alexithymics and healthy controls. Using a linear regression model, the presence of symmetry/ordering obsessions and compulsions, lower HDL-C levels, and difficulty in identifying feelings dimension of the TAS-20 were associated with higher suicidal ideation. CONCLUSIONS Alexithymic individuals with OCD may exhibit dysregulation of the cholesterol balance, which in turn may be linked to suicidal ideation. Further prospective studies are required to elucidate this potential association.
Collapse
Affiliation(s)
- Domenico De Berardis
- Psychiatric Service of Diagnosis and Treatment, Department of Mental Health, G. Mazzini Hospital, Teramo, Italy
| | - Nicola Serroni
- Psychiatric Service of Diagnosis and Treatment, Department of Mental Health, G. Mazzini Hospital, Teramo, Italy
| | - Stefano Marini
- Psychiatric Service of Diagnosis and Treatment, Department of Mental Health, G. Mazzini Hospital, Teramo, Italy
| | - Gabriella Rapini
- Psychiatric Service of Diagnosis and Treatment, Department of Mental Health, G. Mazzini Hospital, Teramo, Italy
| | - Alessandro Carano
- Department of Neurosciences and Imaging, Chair of Psychiatry, Universitè degli Studi G. d'Annunzio Chieti e Pescara, Chieti Scalo, Italy
| | | | - Felice Iasevoli
- Section of Psychiatry, Department of Neuroscience, School of Medicine, Universitè degli Studi di Napoli Federico II, Naples, Italy
| | - Monica Mazza
- Department of Science of Health, Universitè degli Studi dell'Aquila, L'Aquila, Italy
| | - Maria Signorelli
- Department of Clinical and Molecular Biomedicine, Universitè degli Studi di Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Universitè degli Studi di Catania, Catania, Italy
| | - Giampaolo Perna
- Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands
| | | | - Paola A Varasano
- Department of Immunohematology and Transfusional Medicine, G. Mazzini Hospital, Teramo, Italy
| | | | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, Universitè degli Studi G. d'Annunzio Chieti e Pescara, Chieti Scalo, Italy
| |
Collapse
|
16
|
De Berardis D, Campanella D, Serroni N, Moschetta FS, Di Emidio F, Conti C, Carano A, Acciavatti T, Di Iorio G, Martinotti G, Siracusano A, Di Giannantonio M. Alexithymia, suicide risk and serum lipid levels among adult outpatients with panic disorder. Compr Psychiatry 2013; 54:517-22. [PMID: 23332553 DOI: 10.1016/j.comppsych.2012.12.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 11/18/2022] Open
Abstract
To elucidate the relationships between alexithymia, suicide ideation and serum lipid levels in drug-naïve adult outpatients with a DSM-IV diagnosis of Panic Disorder (PD), 72 patients were evaluated. Measures were the Panic Attack and Anticipatory Anxiety Scale, the Toronto Alexithymia Scale (TAS-20), the Scale of Suicide Ideation (SSI) and the Montgomery Åsberg Depression Rating Scale (MADRS). Alexithymic patients showed higher scores on all rating scales and altered serum lipid levels than non-alexithymics. In the hierarchical regression model, the presence of lower HDL-C and higher VLDL-C levels and Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher suicide ideation. In conclusion, alexithymic individuals with PD may show a cholesterol dysregulation that may be linked to suicide ideation. The authors discuss study limitations and future research needs.
Collapse
Affiliation(s)
- Domenico De Berardis
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio" of Chieti, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Relationship among low cholesterol levels, depressive symptoms, aggression, hostility, and cynicism. J Clin Lipidol 2013; 7:208-16. [DOI: 10.1016/j.jacl.2013.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/23/2012] [Accepted: 01/27/2013] [Indexed: 11/23/2022]
|
18
|
Solomon DA, Fiedorowicz JG, Leon AC, Coryell W, Endicott J, Li C, Boland RJ, Keller MB. Recovery from multiple episodes of bipolar I depression. J Clin Psychiatry 2013; 74:e205-11. [PMID: 23561241 PMCID: PMC3837577 DOI: 10.4088/jcp.12m08049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the duration of bipolar I major and minor depressive episodes and factors associated with time to recovery. METHOD As part of the National Institute of Mental Health Collaborative Depression Study, 219 participants with bipolar I disorder based on Research Diagnostic Criteria analogs to DSM-IV-TR criteria were recruited at 5 academic medical centers from 1978 to 1981 and followed for up to 25 years with the Longitudinal Interval Follow-Up Evaluation. The probability of recovery over time from depressive episodes, the primary outcome measure, was examined with mixed-effects grouped-time survival models. RESULTS The median duration of major depressive episodes was 14 weeks, and over 70% of participants recovered within 12 months of episode onset. The median duration of minor depressive episodes was 8 weeks, and approximately 90% of participants recovered within 6 months of onset of the episode. Aggregated data demonstrated similar durations of the first 3 major depressive episodes. However, for each participant with multiple episodes of major depression or minor depression, the duration of each episode was not consistent (intraclass correlation coefficient = 0.07 and 0.25 for major and minor depression, respectively). The total number of years in episode over follow-up with major plus minor depression prior to onset of a major depressive episode was significantly associated with a decreased probability of recovery from that episode; with each additional year, the likelihood of recovery was reduced by 7% (hazard ratio = 0.93; 95% CI, 0.89-0.98; P = .002). CONCLUSIONS Bipolar I major depression generally lasts longer than minor depression, and the duration of multiple episodes within an individual varies. However, the probability of recovery over time from an episode of major depression appears to decline with each successive episode.
Collapse
Affiliation(s)
- David A Solomon
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA, UpToDate, Waltham, MA, USA
| | - Jess G. Fiedorowicz
- Department of Psychiatry, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Andrew C. Leon
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - William Coryell
- Department of Psychiatry, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jean Endicott
- New York State Psychiatric Institute, New York, NY, USA
| | - Chunshan Li
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Robert J. Boland
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA, UpToDate, Waltham, MA, USA
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA, UpToDate, Waltham, MA, USA
| |
Collapse
|
19
|
Abstract
Individuals with bipolar disorder experience twice the cardiovascular mortality expected from general population estimates. The metabolic syndrome is more common in those with bipolar disorder, with a prevalence ratio of 1.6, and includes many traditional cardiovascular risk factors, which may explain much of the elevated risk. Manic symptom burden also predicts cardiovascular mortality, begging questions regarding other explanations for elevated cardiovascular risk. Ultimately, the mechanisms that lead to elevated cardiovascular risk in bipolar disorder are complex and potentially involve behavior, treatment, access to quality health care, and underlying pathophysiology. Much remains unknown about the etiology of any mechanisms inherent to illness or, for that matter, treatment effects. Addressing access and health behaviors can mitigate risk for individuals with bipolar disorder. Recent evidence indicates that psychiatrists are becoming aware of the vascular risk associated with bipolar disorder, although further education will improve monitoring and subsequent outcomes.
Collapse
|