Mansur Rodrigo B, Rizzo Lucas B, Santos Camila M, Asevedo Elson, Cunha Graccielle R, Noto Mariane N, Pedrini Mariana, Zeni Maiara, Cordeiro Quirino, McIntyre Roger S, Brietzke Elisa
Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Psychiatry, Clinic for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
J Affect Disord. 2016 May;195:57-62. doi: 10.1016/j.jad.2016.02.002. Epub 2016 Feb 4.
The longitudinal course of bipolar disorder (BD) is highly heterogeneous, and is moderated by the presence of general medical comorbidities. This study aimed to investigate the moderating effects of impaired glucose metabolism (IGM) on variables of illness course and severity in a BD population.
Fifty-five patients with BD were evaluated. All subjects were evaluated with respect to current and past psychiatric and medical disorders, as well as lifetime use of any medication. Body mass index (BMI) and metabolic parameters were obtained. IGM was operationalized as pre-diabetes or type 2 diabetes mellitus.
Thirty (54.5%) individuals had IGM. After adjustment for age, gender, ethnicity, alcohol use, smoking, BMI and past and current exposure to psychotropic medications, individuals with IGM, when compared to euglycemic participants, had an earlier age of onset (RR: 0.835, p=0.024), longer illness duration (RR: 1.754, p=0.007), a higher number of previous manic/hypomanic episodes (RR: 1.483, p=0.002) and a higher ratio of manic/hypomanic to depressive episodes (RR: 1.753, p=0.028). Moreover, we observed a moderating effect of IGM on the association between number of mood episodes and other variables of illness course, with the correlation between lifetime mood episodes and frequency of episodes being significantly greater in the IGM subgroup (RR: 1.027, p=0.029). All associations observed herein remained significant after adjusting for relevant confounding factors (e.g. age, alcohol and tobacco use, exposure to psychotropic agents, BMI).
Cross-sectional design, small sample size.
Comorbid IGM may be a key moderator of illness progression in BD.
双相情感障碍（BD）的病程具有高度异质性，且受一般躯体共病的影响。本研究旨在探讨葡萄糖代谢受损（IGM）对双相情感障碍患者病程和严重程度相关变量的调节作用。
对55例双相情感障碍患者进行评估。所有受试者均接受了当前和既往精神及躯体疾病评估，以及任何药物的终生使用情况评估。获取体重指数（BMI）和代谢参数。IGM定义为糖尿病前期或2型糖尿病。
30例（54.5%）个体存在IGM。在调整年龄、性别、种族、饮酒、吸烟、BMI以及既往和当前使用精神药物情况后，与血糖正常的参与者相比，存在IGM的个体起病年龄更早（风险比：0.835，p = 0.024），病程更长（风险比：1.754，p = 0.007），既往躁狂/轻躁狂发作次数更多（风险比：1.483，p = 0.002），且躁狂/轻躁狂发作与抑郁发作的比例更高（风险比：1.753，p = 0.028）。此外，我们观察到IGM对情绪发作次数与病程其他变量之间的关联具有调节作用，在IGM亚组中，终生情绪发作次数与发作频率之间的相关性显著更高（风险比：1.027，p = 0.029）。在调整相关混杂因素（如年龄、饮酒和吸烟、使用精神药物、BMI）后，本文观察到的所有关联仍然显著。
横断面设计，样本量小。
IGM共病可能是双相情感障碍疾病进展的关键调节因素。
