Allostatic load, emotional hyper‐reactivity, and functioning in individuals with bipolar disorder

Abstract

Objectives Diagnosis and management of bipolar disorder (BD) are limited by the absence of available biomarkers. Allostatic load (AL) represents the strain that stress, including the effects of acute phases and inter‐episode chronic mood instability, exerts on interconnected biological systems. This study aimed to operationalize an AL index and explore whether it could be relevant to better characterize BD patients with and without emotional hyper‐reactivity particularly those at higher risk of immune‐cardiometabolic dysregulation and functional impairment. Methods Levels of biomarkers of chronic inflammation (hsCRP and albumin), cardiovascular (systolic/diastolic blood pressure) and metabolic functions (fasting glucose, glycosylated hemoglobin, total cholesterol, LDL, HDL, and triglycerides) were measured in 1072 adult BD outpatients. Patients were classified in two groups (with/without emotional hyper‐reactivity) assessed by the Multidimensional Assessment of Thymic States scale. An Allostatic Load Index for BD (BALLI), comprising six biomarkers, was constructed using data‐driven biomarker selection. Results BALLI showed 81.1% accuracy with good sensitivity (81%) and specificity (81.2%) for characterizing BD patients presenting emotional hyper‐reactivity, elevated risk of inflammation (increased hsCRP, hypoalbuminemia) and cardiometabolic disturbances (hypertension, hyperglycemia, and hypertriglyceridemia). Patients classified by the BALLI as presenting emotional hyper‐reactivity had significantly lower global and cognitive functioning than those without emotional hyper‐reactivity (P < .0001). Conclusions A multidimensional approach based on a simple AL score (eg, BALLI) and dimensions of behavior (eg, emotional hyper‐reactivity) alongside mood is clinically relevant. AL index could be a useful tool to detect multisystemic physiological dysregulations in BD patients with/without emotional hyper‐reactivity particularly those at higher risk of immune‐cardiometabolic disturbances and functional impairment.

Key findings on bipolar disorders from the longitudinal FondaMental Advanced Center of Expertise-Bipolar Disorder (FACE-BD) cohort

“…We identified associations between: 1) emotional reactivity, sleep disturbances and functioning 5 ; 2) sleep disturbances and childhood trauma 6 ; 3) emotional reactivity, cardiometabolic risk, elevated inflammation (C-reactive protein [CRP] and allostatic load) and functioning [7][8][9][10] .…”

Affective lability and social functioning in severe mental disorders

“…Negative affect has been found to predict social functioning across schizophrenia and bipolar disorder, and high levels of negative affect have been linked to greater fluctuations in affective states [10,71]. This has again been associated with delayed return to a more adaptive affective baseline which can result in adverse health effects [72][73][74]. One can speculate that a pattern with elevated affective lability, high levels of negative affect and slow return to a neutral physiological state could give rise to a vicious cycle, fostering coping behaviors that are counterproductive to social functioning, such as withdrawal, avoidance and disengagement.…”

Heterogeneity of psychosocial functioning in patients with bipolar disorder: Associations with sociodemographic, clinical, neurocognitive and biochemical variables

“…Several sociodemographic, clinical and neurocognitive factors such as age, gender, subthreshold symptoms, age of onset, number of depressive or hypo/manic episodes, psychotic symptoms, chronicity, comorbidities and cognitive reserve have been suggested to influence psychosocial functioning in patients with BD (10,15,(17)(18)(19)(20). Neurocognitive impairment has been demonstrated to be a key predictor of poor functional outcomes (21,22), which is highly related to functional deficits in patients with BD (23).…”