Metabolic syndrome under-recognized in bipolar disorder
MedWire News: The rate of metabolic syndrome in individuals with bipolar disorder is up to 2-fold greater than in the general population and is associated with a more complex illness presentation, poor treatment response, and adverse illness course, a review of the literature shows.
Study co-author Roger McIntyre (University of Toronto, Ontario, Canada) and colleagues highlight the need for better metabolic screening and primary prevention in this group.
The metabolic syndrome is a collection of clinical and biochemical risk factors that predispose affected individuals to cardiovascular disease, diabetes mellitus, and premature death.
The increased risk for the metabolic syndrome in individuals with psychotic disorders has been well documented in both epidemiological and clinical studies.
Prior to 2005, however, there were no published reports describing the association between the metabolic syndrome and bipolar disorder.
McIntyre and colleagues therefore performed a PubMed search of all English-language articles published since January 2005 with the following search terms: metabolic syndrome, bipolar disorder, mania, and manic-depression.
They found 19 such studies with adequate sample size, standardized experimental procedures, and validated assessment measures from 13 countries across Europe, Australia, Asia, North and South America.
The rate of the metabolic syndrome in individuals with bipolar disorder relative to that in the general population ranged from comparability to an approximate 2-fold elevation.
The co-occurrence of the metabolic syndrome in patients with bipolar disorder was associated with a more complex illness presentation, less favorable response to treatment, and adverse course and outcome. For example, individuals with the metabolic syndrome had a greater risk for depressive symptoms and episodes, as well as suicidality.
The increased risk for the metabolic syndrome in the bipolar disorder population was modified by iatrogenic and health system factors, including administration of psychotropic agents and non-iatrogenic factors such as unhealthy lifestyles including inactivity, overeating, smoking, and alcohol consumption.
Discussing the findings, McIntyre et al say that blood pressure and plasma glucose should be obtained annually in bipolar disorder patients.
They comment in the Journal of Affective Disorders: “Taken together, this review underscores the need for integrated care between psychiatry and primary care providers and for mental health care practitioners to be familiar with basic primary prevention and routine diagnostic screening.
“For many psychiatric patients, the psychiatrist represents the primary health care provider and is most often the individual to oversee an integrated care plan for the patients.”
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By Andrew Czyzewski