Bipolar Disorder Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
Expert Rev Neurother. 2011 Jul;11(7):1017-28. doi: 10.1586/ern.10.185.
Bipolar disorder (BD) is associated with substantial morbidity, as well as premature mortality. Available evidence indicates that 'stress-sensitive' chronic medical disorders, such as cardiovascular disease, obesity and Type 2 diabetes mellitus, are critical mediators and/or moderators of BD. Changes in physiologic systems implicated in allostasis have been proposed to impact brain structures and neurocognition, as well as medical comorbidity in this population. For example, abnormalities in insulin physiology, for example, insulin resistance, hyperinsulinemia and central insulinopenia, are implicated as effectors of allostatic load in BD. Insulin's critical role in CNS physiological (e.g., neurotrophism and synaptic plasticity) and pathophysiological (e.g., neurocognitive deficits, pro-apoptosis and amyloid deposition) processes is amply documented. This article introduces the concept that insulin is a mediator of allostatic load in the BD and possibly a therapeutic target.
双相情感障碍（BD）与大量的发病率，以及过早死亡。现有证据表明，“应激敏感”的慢性疾病，如心血管疾病、肥胖和 2 型糖尿病，是关键的调解人和/或调节人 BD。生理系统的变化，在体内平衡中牵连已经提出影响大脑结构和神经认知，以及在这一人群中的医学合并症。例如，胰岛素生理学的异常，例如，胰岛素抵抗、高胰岛素血症和中枢性胰岛素缺乏，被认为是 BD 中全身适应负荷的效应器。胰岛素在中枢神经系统生理（如神经发生和突触可塑性）和病理生理（如神经认知缺陷、促凋亡和淀粉样蛋白沉积）过程中的关键作用有充分的记录。本文介绍了胰岛素是 BD 中全身适应负荷的中介，也可能是治疗靶点的概念。
