Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder

Abstract

BackgroundMetabolic syndrome (MetS) is highly prevalent among patients with bipolar disorder. MetS may cause complications in the brain, but studies investigating MetS-associated clinical psychiatric outcomes remain scant.MethodsWe enrolled clinically stable outpatients with bipolar disorder aged 18–65 years and performed anthropometric and fasting biochemical assessments to investigate MetS prevalence. We then performed clinical assessments by using the Young Mania Rating Scale for manic symptoms, the Montgomery–Åsberg Depression Rating Scale for depressive symptoms, the Positive and Negative Symptom Scale for psychotic symptoms, the Involuntary Movement Scale for tardive dyskinesia, the Barnes Akathisia Rating Scale for akathisia, the Udvalg for Kliniske Undersogelser for general side effects, the Schedule for Assessment of Insight for insight, the Global Assessment of Functioning scale for global functioning, and the Wisconsin Card Sorting Test (WCST) for cognitive executive function.ResultsIn total, 143 patients were enrolled and had a MetS prevalence of 29.4%. The patients treated with atypical antipsychotics plus mood stabilizers (36.3%) and atypical antipsychotics alone (36.0%) had a significantly higher prevalence of MetS than did those treated with mood stabilizers alone (10.5%; p = 0.012). According to multivariate regression analyses adjusted for age, sex, smoking status, bipolar disorder subtype (I or II), pharmacological treatment duration, and psychiatric medication, compared with patients without MetS, those with MetS had significantly more previous hospitalizations (p = 0.036), severer tardive dyskinesia (p = 0.030), poorer insight (p = 0.036), poorer global function (p = 0.046), and more impaired executive function (conceptual level response on the WCST; p = 0.042).ConclusionsOur results indicated that patients with comorbid bipolar disorder and MetS have more adverse clinical outcomes than those without, with more hospitalizations, severer tardive dyskinesia, poorer insight, poorer global function, and more impaired executive function. Monitoring MetS is crucial for assessing not only physical burden, but also psychiatric outcomes.

A comparison study of metabolic profiles, immunity, and brain gray matter volumes between patients with bipolar disorder and depressive disorder

“…Our previous study also found that BD patients with obesity and metabolic diseases are associated with poor clinical outcomes, including more hospitalizations, more severe tardive dyskinesia, poor insight, poor global function, and more impaired executive function [63]. Other studies also found that BD patients with obesity had a longer illness duration, poorer global function, more disabilities, and poorer response to lithium [64], and poor cognitive function [65][66][67][68] than non-obese patients did.…”

Gender differences in metabolic syndrome risk factors among patients with serious mental illness

“…The potential reason is that male patients with bipolar disorder tend to have low physical activity levels and noncompliance with physical activity guidelines, particularly those who have low education levels (Vancampfort et al 2017). Moreover, here, men with prolonged illness and history of medical illness were more likely to have MetS, potentially because patients with prolonged illness receive more psychotropic medication and experience high levels of sedation, which contributes to a sedentary lifestyle and results in poor physical health (Bai et al 2016). In general, our results in combination with the findings of previous studies on patients with bipolar disorder confirm that the longer the individuals take psychotropic medication, the higher is their MetS risk.…”

Impact of metabolic syndrome and clinical features on functioning in patients with bipolar disorder: a cross-sectional study

“…12 In another study evaluating the effects of the MS on clinical outcome in BD, MS was associated with previous hospitalizations, severe tardive dyskinesia, poor insight, and poor global functioning. 24 However, Vancamfort et al evaluated physical activity levels and functioning in BD patients with MS, and found no significant between-group differences in physical activity or global functioning. 25 In our study, we evaluated the correlation between specific functional areas, clinical features, and MS in bipolar patients in remission.…”