People with bipolar disorder in Brazil are more likely to be obese than the general population, say researchers in findings that emphasize the importance of early detection and treatment of obesity and the metabolic syndrome among such patients in developing countries.

Previous studies conducted in the USA and other developed countries have shown an “alarmingly” high prevalence of obesity and the metabolic syndrome in patients with bipolar disorder, explain Karla Mathias de Almeida and colleagues from the University of São Paulo School of Medicine in Brazil.

But they add that “little is known about the prevalence of these conditions in patients with bipolar disorder in developing countries,” which have lower overall levels of obesity compared with developed countries.

The team therefore studied the prevalence of obesity and the metabolic syndrome among 84 Brazilian outpatients, aged at least 18 years, with bipolar disorder who were participating in the Bipolar Research Program at University of São Paulo.

Patients were considered overweight if their body mass index (BMI) was 25??”29.99 kg/m² and obese if their BMI was more than 30 kg/m².

The metabolic syndrome was defined by the presence of at least three of the following: a waist circumference of >102 cm in men or >88 cm in women; elevated triglycerides (? 150 mg/dl); reduced high-density lipoprotein cholesterol (<40 mg/dl in men or <50 mg/dl in women); elevated blood pressure (systolic blood pressure ? 130 mmHg or diastolic blood pressure ? 85 mmHg); and elevated fasting glucose (? 100 mg/dl).

The researchers found that 27 (32.0%) bipolar patients were overweight and 30 (35.7%) were obese. The prevalence of obesity among the patients was significantly higher than that in the Brazilian population (8.8??”13.0%), notes the team.

Nearly one-third (28.6%) of patients also met criteria for the metabolic syndrome, which the researchers say is similar to that in the Brazilian population, (20.0??”29.8%).

“Our data suggest that the higher prevalence of obesity among patients with bipolar disorder is a cause for concern not only in developed countries but may also apply for developing countries,” de Almeida and team conclude in the journal Acta Neuropsychiatrica.

They add: “In the interest of early detection and treatment of the metabolic syndrome and obesity, psychiatrists should routinely assess metabolic parameters and weight gain in patients with bipolar disorder.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Study results suggest that the lifetime presence of recurrent panic attacks may differentiate between subgroups of patients with mood disorders, especially in those with bipolar disorder.

To elucidate the relationship between the comorbidity of panic and affective disorders, UK researchers compared lifetime clinical illness characteristics and items of symptomatology in 290 patients with bipolar I disorder (BPI) and 335 patients with major depressive disorder (MDDR) according to the lifetime presence of recurrent panic attacks.

Nick Craddock (Cardiff University) and co-authors found that 47% and 58% of patients with BPI and MDDR, respectively, had a lifetime history of panic attacks.

A higher score on the Beck Depression Inventory was significantly associated with the lifetime presence of panic attacks in patients with BPI and MDDR (odds ratio [OR]=1.05), as did a younger age at the baseline interview in patients with BPI (OR=0.97).

Compared with patients with BPI and without a lifetime history of recurrent panic attacks, those with a history of panic attacks were significantly more likely to experience suicidal behavior, more severe impairment during the worst depressive episode (as rated using the Global Assessment Scale), and more frequent and severe depressive episodes (according to the Bipolar Affective Disorder Dimension Scale [BADDS]) with corresponding odds ratios (ORs) of 1.82, 0.97, and 1.02.

Patients with MDDR and a positive history of recurrent panic attacks were twice as likely to have had inpatient treatment at least once in their lifetime as their counterparts without a panic attack history, and scored higher on the BADDS (OR=1.03).

The researchers also looked at items of psychopathology in BPI and MDDR patients using the Operational Criteria symptom checklist. They found that patients with BPI and a history of panic attacks were approximately twice as likely to experience diurnal variation, slowed activity, and insomnia, and almost four times more likely to early-morning waking and agitated activity compared with BPI patients without panic attacks.

Furthermore, MDDR patients with a panic attack history were approximately twice as likely to experience suicidal ideation and slowed activity as MDDR patients without this history.

The authors note that no association was seen between the lifetime presence of panic attacks and clinical characteristics of illness relating to mania.

“The presence of recurrent panic attacks in bipolar and unipolar disorder may be indicative of a course of illness associated with a greater depressive morbidity,” conclude the authors in the journal Bipolar Disorders.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Researchers have found significant elevations of choline-containing compounds in the hippocampus and orbitofrontal cortex of euthymic patients with bipolar disorder (BD), suggesting that these regions are involved in the pathophysiology of BD.

Since metabolite concentrations in the orbitofrontal cortex and hippocampus have not been extensively studied in BD patients, Canadian researchers performed proton magnetic resonance spectroscopy in 12 euthymic BD patients and 12 age- and gender-matched controls to assess levels of N-acetyl aspartate (NAA), glutamate, and glycerophosphocholine+phosphocoline (GPC+PCh).

Patients were aged 42.1 years on average and had an average illness duration of 30.0 years, mean Young Mania Rating Scale score of 2.4, and a mean Beck Depression Inventory score of 7.5. In total, 67% were being treated with lithium, 33% with atypical antipsychotic medication, 75% with anti-convulsant medications, and 33% with antidepressants.

Geoffrey Hall (McMaster University, Ontario, Canada) and co-authors found that levels of GPC+PCh were significantly increased in the hippocampus (1.97 vs 1.61 µM) and in the orbitofrontal cortex (2.07 vs 1.79 µM) compared with controls.

As choline is a marker of membrane phospholipid metabolism, elevated choline levels may indicate increased membrane turnover and active neurodegeneration characteristic of disorders such as Alzheimer’s and Huntington’s disease, say the authors.

Glutamate levels were also significantly elevated in the occipital cortex in BD patients compared with controls (16.52 vs 13.98 µM), but not in the hippocampus or orbitofrontal cortex.

Conversely, NAA levels were comparable between the groups in all three studied brain regions ??” a result consistent with previous studies, and one that may “may reflect a lithium-induced normalization of NAA in these regions,” according to Hall et al.

Writing in the journal Psychiatry Research: Neuroimaging, the researchers caution: “An obvious limitation of the study is that patients were treated with a variety of medications and these medications may influence metabolite levels.”

They suggest that future studies should include patients with variable illness burden to determine whether the findings generalize from this chronic group of patients to those earlier in the course of illness.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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