Schizophrenia-Associated Idiopathic Unconjugated Hyperbilirubinemia (Gilbert's Syndrome)

Sartorius N. Physical illness and schizophrenia: a review of the literature.Objective: The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. Method: We searched MEDLINE (1966( -May 2006 combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. Results: A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. Conclusion: The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients. Summations• According to this review it has been known for decades that incidences physical diseases are frequent in schizophrenia. Nevertheless, some areas such as infectious diseases have not been sufficiently studied.• Psychiatrists are often not trained well enough in the detection and treatment of physical diseases.They must be aware of the frequent medical comorbidities and should play a more active role in their diagnosis, prevention, and treatment.• Other necessary strategies include the education of patients, general practitioners and of doctors working in other medical specialities. The access to medical care of the mentally ill also needs to be improved, among others, by reducing the stigma associated with mental disorders. Considerations• The review covered a broad area of research accordingly, focusing attention to details has not been possible.• Despite the broad search strategy, studies not covered by MEDLINE or not indexed by the MeSH term of schizophrenia could have been missed. • Due to considerable differences in the design and quality of the studies in assorted and diverse areas, quantitative approaches using meta-analysis were not possible, but should be the target of future reviews focusing.

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“…Two preliminary studies suggested increased rates of GilbertÕs syndrome (idiopathic unconjugated hyperbilirubinemia) in schizophrenia (266,267).…”

Section: Nutritional and Metabolic Diseases (Medline 1234 Hits)mentioning

confidence: 99%

Physical illness and schizophrenia: a review of the literature

Leucht

Burkard

Henderson³

et al. 2007

Acta Psychiatr Scand

563

358

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“…One of these studies controlled for symptom severity and found no diff erence between patients with and without hyperbilirubinemia [11] in the PANSS [8] and the brief psychiatric rating scale (BPRS; [16] ), while an earlier study of the same group reported a higher positive symptom score for patients with schizophrenic disorder and hyperbilirubinemia [9] . On the other hand, at stable state, both positive and negative symptoms have been shown to covary with elevated bilirubin [12] , a fi nding that might be confi ned to schizophrenia rather than ATPD patients who are supposed to fully recover after acute psychosis (although note that full recovery is diffi cult to operationalise, [7] ).…”

Section: Diagnosismentioning

confidence: 99%

“…Two more recent studies of patients admitted to psychiatric hospitals have collected evidence to confi rm this association in a German [14] and a Japanese [9] sample. These studies indicate an incidence of elevated total and unconjugated bilirubin of 20 -25 % in patients with disorders from the schizophrenic spectrum compared to 10 % of all psychiatric patients.…”

Section: Introductionmentioning

confidence: 97%

Elevated Bilirubin in Acute and Transient Psychotic Disorder

2009

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“…Hyperbilirubinemia subsequently increases the risk of schizophrenia [Miyaoka et al, 2000] or leads to acute unconjugated bilirubin encephalopathy, even kernicterus [Brito et al, 2006]. Hence, the genetic mechanism of hyperbilirubinemia has been pursued for decades.…”

Section: Introductionmentioning

confidence: 99%

Association of polymorphisms in four bilirubin metabolism genes with serum bilirubin in three Asian populations

Lin

Wang

et al. 2009

Hum. Mutat.

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Numerous studies have shown that the (TA)n repeat polymorphism in the uridine diphosphate glycosyltransferase 1 (UGT1A1) gene promoter is associated with hyperbilirubinemia. Several studies also indicated that single nucleotide polymorphism (SNP) rs4148323:G>A at Exon 1 of UGT1A1 is associated with hyperbilirubinemia. However, it remains unclear what role the polymorphisms play in influencing serum total bilirubin (TBIL) levels in general populations, and whether polymorphisms in other genes involved in the bilirubin metabolism pathway are associated with TBIL levels. The present study addressed these questions by investigating the association of four bilirubin metabolism genes with TBIL levels in three Asian populations: 11 genetic polymorphisms in heme oxygenase-1 (HMOX1); biliverdin reductase A (BLVRA); solute carrier organic anion transporter family member 1B1 (SLCO1B1); and UGT1A1. The populations consisted of 502 Kazak herdsmen, 769 Uyghur farmers, and 789 Han farmers, with distinct genetic backgrounds. UGT1A1 was found to be associated with the (TA)(7) allele of the (TA)n repeat polymorphism. We also showed that the A allele of SNP rs4148323:G>A was strongly associated with high TBIL levels in all three populations (each P<0.005). Among polymorphisms in other genes, only the (GT)n repeat polymorphism in the HMOX1 promoter region showed association with TBIL levels in the Uyghur population, but not in the Han and Kazak populations. We also assessed the contributions of (TA)n polymorphism and rs4148323:G>A to phenotypic variations in all three populations. Finally, we observed that significant differences of TBIL levels existed among the three populations; however, this could not be completely explained by the differences at the (TA)n repeat polymorphism and SNP rs4148323:G>A.

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Schizophrenia-Associated Idiopathic Unconjugated Hyperbilirubinemia (Gilbert's Syndrome)

Cited by 56 publications

References 0 publications

Physical illness and schizophrenia: a review of the literature

Physical illness and schizophrenia: a review of the literature

Elevated Bilirubin in Acute and Transient Psychotic Disorder

Association of polymorphisms in four bilirubin metabolism genes with serum bilirubin in three Asian populations

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