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Zandifar A, Badrfam R, Gholamian F, Shafiee A. Efficacy of spironolactone as adjunctive therapy to sodium valproate in bipolar-I disorder: A double-blind, randomized, placebo-controlled clinical trial. Brain Behav 2023; 13:e3313. [PMID: 37933420 PMCID: PMC10726882 DOI: 10.1002/brb3.3313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/01/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Treatment of mood and cognitive symptoms of patients with bipolar disorder is associated with many complications and is generally not associated with therapeutic satisfaction. In this clinical trial, we evaluated the effectiveness of spironolactone in controlling mood and cognitive symptoms, sleep quality, appetite, and body mass index in patients with bipolar disorder in manic episodes. METHODS Sixty inpatients with bipolar disorder in manic episodes were treated with spironolactone/placebo in an 8-week randomized, double-blind, placebo-controlled clinical trial. They were evaluated using the Young Mania Rating Scale (YMRS), mini-mental state examination (MMSE), Pittsburgh sleep quality index, Simplified Nutritional Appetite Questionnaire, and body mass index in weeks 1, 4, and 8. RESULTS For cognitive impairment (MMSE), there were significant interaction effects of group and time at week 8 (B = -1.60, SE = 0.69, t = -2.33, p = .021) such that individuals in the spironolactone group experienced more improvement in their cognitive performance. For manic symptoms (YMRS), there were no significant interaction effects of group and time at week 8 (B = -2.53, SE = 1.46, t = -1.73, p = .085). CONCLUSIONS Considering the promising findings in this clinical trial, further study of spironolactone as adjunctive therapy in bipolar disorder in manic episodes with larger sample sizes, multicenter settings, and longer follow-ups are recommended.
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Affiliation(s)
- Atefeh Zandifar
- Social Determinants of Health Research CenterAlborz University of Medical SciencesKarajIran
- Department of Psychiatry, Imam Hossein Hospital, School of MedicineAlborz University of Medical SciencesKarajIran
| | - Rahim Badrfam
- Department of Psychiatry, Imam Hossein Hospital, School of MedicineAlborz University of Medical SciencesKarajIran
| | | | - Arman Shafiee
- Clinical Research Development UnitAlborz University of Medical SciencesKarajIran
- Student Research Committee, School of MedicineAlborz University of Medical SciencesKarajIran
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Hochman E, Feldman B, Weizman A, Krivoy A, Gur S, Barzilay E, Gabay H, Levinkron-Fisch O, Lawrence G. Gestational hemodilution as a putative risk factor for postpartum depression: A large-scale nationwide longitudinal cohort study. J Affect Disord 2023; 325:444-452. [PMID: 36610600 DOI: 10.1016/j.jad.2022.12.157] [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: 06/04/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND While anemia during pregnancy has been linked to increased postpartum depression (PPD) risk, longitudinal studies on the association between gestational hemodilution, represented by decreased hematocrit (Hct) during the transition from the 1st to 2nd trimester, and PPD risk, are scarce. The current study aimed to investigate this association in a nationwide cohort over the perinatal period. METHODS This retrospective cohort study included 104,715 women who gave birth between January 2008 and December 2015. The cohort was followed up for new-onset PPD during the year post birth and gestational hemodilution was assessed by the change in Hct levels (Δ: 2nd-1st trimester). The cohort was divided into three hemodilution groupings: maximal and minimal 10 % of mothers and intermediate 80 %. Multivariable regression analyses were performed to estimate the association between gestational hemodilution and PPD, adjusting for confounders. RESULTS Among the full cohort, 2.2 % (n = 2263) met the definition of new-onset PPD. Mothers with greater hemodilution had higher rates of PPD: 2.7 % (n = 269) in the maximal hemodilution group, 2.1 % (n = 1783) in the intermediate and 1.9 % (n = 211) in the minimal hemodilution group (p < 0.001). The maximal hemodilution group had higher rates of pre-gestational psychiatric disorders (p < 0.001) and higher adjusted risk for PPD [OR = 1.18, 95 % CI (1.04, 1.35)]. LIMITATIONS Data on iron levels and supplementation were unavailable, thus it could not be adjusted for in the analysis. CONCLUSIONS Women in the top 10th percentile of gestational hemodilution may be at risk for PPD, justifying monitoring of gestational Hct as a biomarker for PPD.
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Affiliation(s)
- Eldar Hochman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel.
| | | | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel; Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Hagit Gabay
- Clalit Research Institute, Ramat Gan, Israel
| | | | - Gabriella Lawrence
- Clalit Research Institute, Ramat Gan, Israel; Braun School of Public Health, Hebrew University - Hadassah Medical Center, Jerusalem, Israel
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Wu X, Niu Z, Zhu Y, Shi Y, Qiu H, Gu W, Liu H, Zhao J, Yang L, Wang Y, Liu T, Xia Y, Yang Y, Chen J, Fang Y. Peripheral biomarkers to predict the diagnosis of bipolar disorder from major depressive disorder in adolescents. Eur Arch Psychiatry Clin Neurosci 2022; 272:817-826. [PMID: 34432143 DOI: 10.1007/s00406-021-01321-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022]
Abstract
The onset of bipolar disorder (BD) occurs in childhood or adolescence in half of the patients. Early stages of BD usually present depressive episodes, which makes it difficult to be distinguished from major depressive disorder (MDD). Objective biomarkers for discriminating BD from MDD in adolescent patients are limited. We collected basic demographic data and the information of the first blood examination performed after the admission to psychiatry unit of BD and MDD inpatients during 2009-2018. We recruited 261 adolescents (aged from 10 to 18), including 160 MDD and 101 BD. Forward-Stepwise Selection of binary logistic regression was used to construct predictive models for the total sample and subgroups by gender. Independent external validation was made by 255 matched patients from another hospital in China. Regression models of total adolescents, male and female subgroups showed accuracy of 73.3%, 70.6% and 75.2%, with area under curves (AUC) as 0.785, 0.816 and 0.793, respectively. Age, direct bilirubin (DBIL), lactic dehydrogenase (LDH), free triiodothyronine (FT3) and C-reactive protein (CRP) were final factors included into the models. The discrimination was well at external validation (AUC = 0.714). This study offers the evidence that accessible information of common clinical laboratory examination might be valuable in distinguishing BD form MDD in adolescents. With good diagnostic accuracies and external validation, the total regression equation might potentially be applied to individualized clinical inferences on adolescent BD patients.
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Affiliation(s)
- Xiaohui Wu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zhiang Niu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yuncheng Zhu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yifan Shi
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Hong Qiu
- Information and Statistical Department, Shanghai Mental Health Center, Shanghai, 200030, China
| | - Wenjie Gu
- Information and Statistical Department, Shanghai Mental Health Center, Shanghai, 200030, China
| | - Hongmei Liu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jie Zhao
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Lu Yang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yun Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Tiebang Liu
- Shenzhen Mental Health Center, Shenzhen, 518003, China
| | - Yong Xia
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, 310013, China
| | - Yan Yang
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, 310013, China
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Yiru Fang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, 200031, China.
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200118, China.
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Memic-Serdarevic A, Burnazovic-Ristic L, Sulejmanpasic G, Tahirovic A, Valjevac A, Lazovic E. Review of Standard Laboratory Blood Parameters in Patients with Schizophrenia and Bipolar Disorder. Med Arch 2020; 74:374-380. [PMID: 33424093 PMCID: PMC7780782 DOI: 10.5455/medarh.2020.74.374-380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Symptomatic and etiopathologic heterogeneity of schizophrenia (SCH) and bipolar disorder (BD) can be adequately addressed using a dimensional approach to psychopathology, as well as interpreting physiological properties and markers as predictors of disease onset and relapse. Risk factors, genetic and environmental, are likely to modify the neurobiological processes characteristic of certain physiological processes that manifest to a greater degree of overlapping symptoms. One of the most common laboratory tests in psychiatric patients is a standard laboratory blood test. It gives us an insight into the general somatic condition of the patient. It assesses the ability to transport oxygen to tissues and carbon dioxide back to the lungs via erythrocytes (RBC) and hemoglobin (HGB) as their most important constituents, and is also an indicator of iron status and blood oxygenation. Aim Schizophrenia (SCH) and bipolar disorder (BD) are psychiatric disorders whose complex etiology and pathogenesis are still far from known. A correlation between red blood cell abnormalities and these diseases has been recognized in some studies. One of the most common laboratory tests in psychiatric patients is a standard laboratory blood test. However, so far there is a small number of published papers that relate to the relationship between laboratory parameters of blood and the aim of this paper is to reveal more light in this subject. Methods The research was done as an observational prospective clinical study that has evaluated different physiological and pathological parameters in patients with BD and SCH over a two-year period. A total of 159 patients with schizophrenia, 61 patients diagnosed with bipolar disorder and 82 healthy subjects participated in this study. Results At baseline, BD compared to SCH patients had higher mean lymphocyte count (2,6±0,7 vs. 2,0±0,6x109; p=0,006) and haemoglobin concentration (146,8±12,2 vs. 140,2±14,7 g/L; p=0,03), and significantly lower red cell distribution width (13,6±2,2 vs. 14,7±1,8%; p=0,008). In both BD and SCH patients there was a significant number of patients with low red blood cells count and low haemoglobin concentration, and high MCH and MCHC at baseline and at 3 and 6 months of follow up. Conclusions The finding that SCH as well as BD differed from controls with respect to red blood cells, hemoglobin, lymphocytes, and average platelet count was consistent with previous findings and could be understood as a qualitative measure in the evaluation of this sample. The fact that no association with other parameters was found, as well as an association with the diagnosis, does not exclude that these associations can be found in larger samples.
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Affiliation(s)
- Amra Memic-Serdarevic
- Clinic of Psychiatry, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lejla Burnazovic-Ristic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Gorana Sulejmanpasic
- Clinic of Psychiatry, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amir Tahirovic
- Clinic of Psychiatry, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amina Valjevac
- Department of Physiology and Biochemistry, Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edina Lazovic
- Department of Pathology, Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Chu CW, Liang CS. Mood state as a blood glucose modulator in a patient with bipolar disorder and diabetes mellitus: A case report. Aust N Z J Psychiatry 2018; 52:1004-1005. [PMID: 30014719 DOI: 10.1177/0004867418787643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ching-Wen Chu
- 1 Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sung Liang
- 2 Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,3 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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Kalelioglu T, Kocabiyik M, Kok B, Unalan P, Sozen S, Yuksel O, Karamustafalioglu N. Does Blood Flow Change according to Mood? Blood Rheology in Bipolar Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:310-315. [PMID: 30121981 PMCID: PMC6124873 DOI: 10.9758/cpn.2018.16.3.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/02/2017] [Accepted: 09/26/2017] [Indexed: 12/17/2022]
Abstract
Objective Bipolar disorder (BD) is associated with increased rates of cardiovascular diseases. There is growing evidence that blood viscosity may have a common role, correlated with well-known major risk factors that promote cardiovascular disease. In this study we aimed to investigate the whole blood viscosity (WBV) in different stages of BD. Methods A total of 121 bipolar patients and 41 age-gender matched healthy controls were included. Forty-four of bipolar patients were in manic, 35 were depressed and 42 were in euthymic state. WBV was calculated from hematocrit and total plasma protein according to Simone's formula at low and high shear rates (LSR and HSR). Results WBV at HSR of manic group was 16.91±1.01, depressive group was 17.23±0.80, euthymic group was 17.63±0.95, and control group was 17.52±0.71 (p =0.001). WBV at LSR of manic depressive, euthymic and control group were 53.10±20.58, 60.30±17.02, 8.91±20.33, and 62.01±19.28, respectively (p =0.001). Both WBV at HSR and LSR of manic group was significantly lower than that of the euthymic and control groups (p =0.001 and 0.010 respectively for HSR, p =0.001 and 0.011 respectively for LSR). WBV was significantly positively correlated with lipid profile except high density lipoprotein (HDL). Conclusion Our results demonstrate a decrement in blood viscosity in manic episode compared with euthymics and controls. Positive correlation of blood viscosity with lipid parameters (except HDL), and negative correlation with number of previous manic episodes suggest that manic episode has favorable effect on cardiovascular risk regarding to blood viscosity.
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Affiliation(s)
- Tevfik Kalelioglu
- Department of Psychiatry, Bakırköy Mental Health Research and Teaching Hospital, Istanbul, Turkey
| | - Murat Kocabiyik
- Department of Biochemistry, Bingöl State Hospital, Bingöl, Turkey
| | - Burcu Kok
- Department of Psychiatry, Bakırköy Mental Health Research and Teaching Hospital, Istanbul, Turkey
| | - Pelin Unalan
- Department of Psychiatry, Bakırköy Mental Health Research and Teaching Hospital, Istanbul, Turkey
| | - Sule Sozen
- Department of Psychiatry, Bakırköy Mental Health Research and Teaching Hospital, Istanbul, Turkey
| | - Ozge Yuksel
- Department of Psychiatry, Bakırköy Mental Health Research and Teaching Hospital, Istanbul, Turkey
| | - Nesrin Karamustafalioglu
- Department of Psychiatry, Bakırköy Mental Health Research and Teaching Hospital, Istanbul, Turkey
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Kalelioglu T, Karamustafalioglu N, Genc A, Kocabiyik M. Serum osmolarity in male patients with bipolar disorder manic episode. Exp Physiol 2017; 102:1264-1268. [DOI: 10.1113/ep086562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/31/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Tevfik Kalelioglu
- Department of Psychiatry; Bakırköy Mental Health Research and Training State Hospital; Istanbul Turkey
| | - Nesrin Karamustafalioglu
- Department of Psychiatry; Bakırköy Mental Health Research and Training State Hospital; Istanbul Turkey
| | - Abdullah Genc
- Department of Psychiatry; Şişli Hamidiye Etfal Research and Training State Hospital; Istanbul Turkey
| | - Murat Kocabiyik
- Department of Biochemistry; Bingöl State Hospital; Bingöl Turkey
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