Aggravation of hypertriglyceridemia and acute pancreatitis in a bipolar patient treated with quetiapine

Pancreatitis is a very rare adverse effect of quetiapine treatment, with only 5 cases of quetiapine-associated pancreatitis reported in the English literature to date. Herein, we report one patient who developed severe hypertriglyceridemia (>1000 mg/dL) after quetiapine administration, resulting in acute pancreatitis. An analysis of the underlying pathogenic mechanisms and a review of relevant literature are also presented. Clinicians should be aware of the potentially life-threatening metabolic disturbances and/or pancreatitis associated with quetiapine therapy.

Elevated depressive symptoms are associated with hypertriglyceridemia in Japanese male workers

OBJECTIVE

The aim of this study was to determine whether elevated depressive symptoms are associated with metabolic syndrome and its components in the Japanese population.

METHODS

Out of 1,386 male workers who underwent measurements of variables of metabolic syndrome components in their health checkup, 1,186 subjects (44.5 ± 9.6 years) completed the Zung self-rating depression scale (ZSDS) (response rate 85.6%). In this study, metabolic syndrome was defined according to the joint scientific statement proposed by 6 major organizations, including the International Diabetes Federation.

RESULTS

The overall frequency of elevated depressive symptoms (ZSDS scores ≥40) was 42.1% (n=499). The incidence of metabolic syndrome was significantly higher in subjects with elevated depressive symptoms than in those without (13.2% vs. 8.9%, p<0.05). Of all the metabolic syndrome components, mean triglyceride levels were significantly higher in subjects with elevated depressive symptoms than in those without [124.7 (95% confidence interval (CI): 117.8-131.7) mg/dL vs. 111.5 (95% CI: 107.2-115.9) mg/dL, p<0.05]. Consequently, hypertriglyceridemia (28.9% vs. 21.0%, p<0.01) was the main component correlated with the between-group difference of metabolic syndrome incidence. In the logistic regression analysis after adjustment for potential confounders, the odds ratio of the total ZSDS scores for the diagnosis of hypertriglyceridemia was 1.52 (95% CI: 1.13-2.04; p<0.01), and the major depressive symptom was psychomotor agitation (odds ratio: 1.47; 95% CI: 1.10-1.94; p<0.01).

CONCLUSION

This study showed that elevated depressive symptoms were associated with hypertriglyceridemia in Japanese male workers, which affected the clinical diagnosis of metabolic syndrome.

Enhanced serum cholesterol and triglyceride levels in bulimia nervosa: relationships to psychiatric comorbidity, psychopathology and hormonal variables

Increased levels of cholesterol have been reported in patients with bulimia nervosa (BN), but all but one of the published studies were performed on non-fasting subjects, which limits the interpretation of this finding. Moreover, the relationships between serum lipids and comorbid psychiatric disorders or bulimic psychopathology have scarcely been investigated. We measured serum levels of total cholesterol, triglycerides, glucose, 17beta-estradiol and thyroid hormones in 75 bulimic women and 64 age-matched healthy females after an overnight fast. Compared with healthy women, bulimic patients exhibited significantly enhanced serum levels of cholesterol and triglycerides, but similar values of glucose, 17beta-estradiol, FT3 and FT4. No significant differences emerged in these variables between patients with or without comorbid depression, borderline personality disorder or lifetime anorexia nervosa. Circulating cholesterol was positively correlated to the patients' drive for thinness, ineffectiveness, enteroceptive awareness and impulse regulation sub-item scores of the Eating Disorder Inventory-2. These findings confirm that BN is associated with increased levels of serum lipids. This alteration may be involved in the pathophysiology of certain psychopathological characteristics of BN and cannot be explained by the co-occurrence of other psychiatric disorders.

Hypocholesterolemia, hypertriglyceridemia, suicide, and suicide ideation in children hospitalized for psychiatric diseases

To assess relationships of total plasma cholesterol (TC) and triglyceride (TG) values to suicide, suicide ideation, and hospitalization for psychiatric disease, we studied 220 children, ages 5 to 18 y, hospitalized with affective, adjustment, disruptive, anxiety, schizophrenic, other, and organic psychiatric disorders. The 135 male and 85 female patients had higher TG values (p = 0.0001 and 0.0003, respectively) and higher Quetelet Indices (p = 0.0001 and 0.003, respectively) than the 732 male and 316 female schoolchild controls; male patients had higher TC values than male controls (p = 0.014). Substance abuse in patients was an independent inverse determinant of TC value (p = 0.05); TG value correlated positively with alcohol use (p < or = 0.1) and substance abuse (p < 0.05). After covariance adjustment for age, race, sex, and Quetelet, children having adjustment disorders with depression had much lower covariance-adjusted TC value than control schoolchildren (3.91 versus 4.29 mmol/L, p = 0.003), whereas those with disruptive behavior with oppositional defiant disorder had much higher adjusted TC value (5.09 mmol/L, p = 0.0001). After covariance adjusting for age, race, sex, Quetelet, cigarette smoking, alcohol use, and substance abuse, children having adjustment disorders with concomitant depression had the highest group suicide tendencies (attempts and ideation) and the lowest covariance-adjusted TC value (4.03 mmol/L). Conversely, children having disruptive behavior with attention deficit hyperactivity disorder or disruptive behavior with oppoistional defiant disorder had 50% lower suicide index than those with adjustment disorders with concomitant depression and higher adjusted TC levels (4.45 and 5.12 mmol/L, p = 0.0003).(ABSTRACT TRUNCATED AT 250 WORDS)

Improvement in symptoms of depression and in an index of life stressors accompany treatment of severe hypertriglyceridemia

In 14 men and nine women referred because of severe primary hypertriglyceridemia, our specific aim in a 54-week single-blind treatment (Rx) period was to determine whether triglyceride (TG) lowering with a Type V diet and Lopid would lead to improvement in symptoms of depression, improvement in an index of life stressors, change in locus of control index, and improved cognition, as serially tested by Beck (BDI), Hassles (HAS) and HAS intensity indices, Locus of Control index, and the Folstein Mini-Mental status exam. On Rx, median TG fell 47%, total cholesterol (TC) fell 15%, and HDLC rose 19% (all p < or = 0.001). BDI fell at all nine Rx visits (p < or = 0.001), a major reduction in a test of depressive symptoms. The HAS score also fell at all nine visits (p < or = 0.05 - < or = 0.001). Comparing pre-Rx baseline BDI vs BDI at 30 and 54 weeks on Rx, there was a major shift towards absence or amelioration of depressive symptoms (chi 2= 5.9, p = 0.016). On Rx, the greater the percent reduction in TG, the greater the percent fall in BDI (r = 0.47, p < or = 0.05); the greater the percent reduction in TC, the greater the percent fall in HAS (r = 0.41, p < or = 0.05). Improvement in the BDI and HAS accompanied treatment of severe hypertriglyceridemia, possibly by virtue of improved cerebral perfusion and oxygenation. There may be a reversible causal relationship between high TG and symptoms of depression.