Obesity appears to be associated with a history of suicide attempts in patients with bipolar disorder, study findings show.

The researchers point out that this association remained significant even after taking into account well-established risk factors for suicide attempt such as lifetime comorbid anxiety, alcohol use disorders, and depressive symptoms.

“Clinicians must be aware that obesity may be a severity feature relevant not only to pharmacological treatment decisions but also to the comprehensive management of bipolar disorder,” say Flávio Kapczinski, from Hospital de Clínicas de Porto Alegre in Brazil, and colleagues.

The team examined the association between suicide attempts and obesity in 250 outpatients with bipolar disorder, of whom 133 (52.2%) had a history of suicide attempt and 80 (31.4%) were obese (body mass index [BMI]?30). The majority (87.8%) of the patients were taking mood stabilizers alone or in combination, 20.4% were taking atypical antipsychotics, and 23.5% were receiving antidepressants.

As reported in the journal Acta Neuropsychiatrica, bipolar disorder patients who were obese were nearly twice as likely to have a history of suicide attempts as patients of normal weight.

The suggest that depression may be a possible link between obesity and suicide in bipolar disorder patients. Depressive episodes are related to changes in appetite and eating behavior that contribute to obesity, and bipolar disorder with predominant depressive polarity is strongly related to suicidal behavior.

Alternatively, recent data have suggested common features in the underlying pathophysiology of obesity and bipolar disorder.

Specifically, leptin, a key hormone in the regulation of adiposity, has been shown to be positively associated with the risk for depression. Also, disturbances in metabolic pathways such as insulin-mediated glucose homeostasis, overactivation of the hypothalamic??”pituitary??”adrenal axis, dysregulated immune and inflammatory processes, and adipocytokine profiles are present in both adiposity and depression.

Obesity may therefore be a correlate of allostatic load in bipolar disorder, the researchers suggest.

They caution about generalizing their findings, noting that most of their patients were recruited from the Bipolar Disorder Program and so were considered difficult to treat.

Kapczinski and team conclude: “It is plausible to speculate that therapeutic interventions targeted to obesity may be of potential benefit in the course of bipolar disorder.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Researchers have found that heightened emotional arousal in bipolar disorder patients, compared with mentally healthy individuals, may enhance their reaction time to cognitive tasks.

However, when emotionally aroused, deficits in response inhibition ??” the ability to suppress responses that are no longer needed or are inappropriate ??” may also become more apparent.

“It is well known that optimal performance requires an intermediate level of emotional intensity ??” too little emotional intensity has negative effects on performance, whereas too much emotional intensity may lead to disorganization of thinking and physical self-control,” Stephanie Krüger, from Charite-Universitätsmedizin Berlin in Germany, and colleagues comment.

The researchers induced a transient intense sadness and a relaxed mood state in 34 euthymic patients with bipolar I disorder, 22 of their mentally healthy siblings, and 33 unrelated mentally healthy individuals. After this, the participants performed a stop-signal paradigm to measure response and response inhibition times.

The patients with bipolar disorder and their siblings required less time to become sad as a result of mood induction and cried more frequently than mentally healthy individuals, suggesting emotional vulnerability could be an endophenotype of bipolar disorder.

Following the induction of intense sadness bipolar disorder patients had reaction times on the stop-signal paradigm that were around 100 ms faster than following induction of a relaxed mood state.

In contrast, both mentally healthy siblings and controls reacted faster when in a relaxed mood state than after intense sadness induction. The researchers note that the reaction times of bipolar disorder patients were similar to those of mentally healthy individuals following intense sadness induction, but were much slower following relaxed mood induction.

In contrast, response inhibition times were longer in bipolar disorder patients after induction of transient sadness compared with controls in both sad and relaxed states.

Healthy siblings also showed longer inhibition times under relaxation compared with controls, but this was not statistically significant.

“Our data provide evidence that patients with bipolar disorder have faster reaction times under strong emotional arousal. In contrast, under the same emotional arousal the inhibitory deficits become more apparent,” the researchers report.

“It is possible that patients with bipolar disorder will function best under moderate emotional arousal,” they conclude.

“Psychotherapeutic strategies for emotion regulation could help patients with bipolar disorder to deal better with their strong emotions and could improve inhibitory deficits.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Patients with bipolar disorder and comorbid obsessive-compulsive disorder (OCD) present with more depressive episodes and are at a greater risk for treatment-emergent mania than their peers with bipolar disorder alone, research shows.

As the comorbid patients also had a greater burden of anxiety and impulse control disorders the findings raise the possibility that this group represents a distinct disease entity.

A recent analysis of the US Epidemiological Catchment Area Study data set found that lifetime rates of OCD in patients with bipolar disorder and major depression were 21% and 12.2%, respectively.

“Although OCD-bipolar disorder comorbidity is now considered highly prevalent, very few controlled studies have examined the impact of comorbid OCD on the course and treatment of bipolar disorder,” Beny Lafer (University of São Paulo School of Medicine, Brazil) and colleagues comment in the journal Acta Neuropsychiatrica.

For the present study the researchers recruited 30 clinically stable female outpatients with bipolar disorder, divided into two groups: bipolar disorder-OCD, consisting of 15 patients; and bipolar disorder only, also 15 patients.

The groups were matched for age, ethnicity, education, and socioeconomic status.

Following structured clinical interview with the DSM-IV, Lafer and team found that the bipolar disorder-OCD patients presented with a greater number of previous depressive episodes, more chronic episodes, and more residual symptoms after an episode, than the bipolar disorder only patients.

Of the bipolar disorder-OCD patients, 86% had a history of treatment-emergent mania, compared with only 40% of the bipolar disorder only patients.

In addition patients with bipolar disorder-OCD showed a higher prevalence of several psychiatric disorders compared with the bipolar disorder only patients, including any anxiety disorder (93.3 vs 53.3%); impulse control disorders (60% vs 13.3%); eating disorders (33.3 vs 0%); and tic disorders (33.3 vs 0%).

“Although the data available are insufficient to allow us to define OCD-bipolar disorder comorbidity as a distinct entity, future research examining the familial-genetic and neurobiological aspects of this comorbidity will further the understanding of its exact nature,” Lafer and colleagues conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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