胰岛素抵抗成为焦点：双相情感障碍进展的新模式。
Insulin resistance takes center stage: a new paradigm in the progression of bipolar disorder.
机构信息
Department of Psychiatry, Dalhousie University , Halifax , Canada.
Department of Medical Neuroscience, Dalhousie University , Halifax , Canada.
出版信息
Ann Med. 2019 Aug-Sep;51(5-6):281-293. doi: 10.1080/07853890.2019.1659511. Epub 2019 Aug 27.
Bipolar Disorder (BD) is a major psychiatric illness affecting up to 5% of the population. BD can progress over time to a chronic "neuroprogressive" course with cognitive and functional impairment. Currently, there are no validated predictors indicating which patients will develop a neuroprogressive course and there are no specific treatments. This review presents data supporting a novel hypothesis on the mechanisms underlying bipolar neuroprogression. Insulin resistance (IR) is present in 52% of BD patients and is associated with chronic course, treatment nonresponse, adverse brain changes and cognitive impairment. Further, bipolar morbidity increases 12-fold following the onset of IR indicating that IR may modify disease progression. I review evidence that IR is a testable and treatable modifying factor in neuroprogression and that reversing IR may be an efficient (and perhaps the only) means of obtaining remission in some patients. I draw a parallel with in peptic ulcer disease (a novel mechanism that brought together two previously unrelated phenomena that uncovered a new treatment approach). This model of bipolar progression combines shared dysregulated mechanisms between IR and BD, allowing for early screening, case finding, and monitoring for neuroprogression, with the potential for intervention that could prevent advanced bipolar illness. KEY MESSAGES Neuroprogression in bipolar disorder is defined by a more severe form of illness and poor outcome. Currently, there are no validated predictors of neuroprogression, which could help inform treatment and improve prognosis. Insulin resistance is present in more than half of all bipolar patients and is associated with a chronic course of illness, lack of response to mood stabilizing treatment, cognitive impairment and poor functional outcomes. Insulin resistance may modify the course of bipolar disorder and promote neuroprogression. Insulin resistance may be a testable and potentially modifiable risk factor for neuroprogression in bipolar disorder.
双相情感障碍（BD）是一种影响高达 5%人口的主要精神疾病。BD 可能随着时间的推移发展为慢性“神经进行性”病程，伴有认知和功能损害。目前，尚无有效的预测指标可以表明哪些患者会发展为神经进行性病程，也没有特定的治疗方法。这篇综述介绍了支持双相情感神经进行性假说的机制的数据。52%的 BD 患者存在胰岛素抵抗（IR），与慢性病程、治疗无反应、不良脑改变和认知障碍有关。此外，IR 发作后双相情感障碍的发病率增加了 12 倍，表明 IR 可能会改变疾病的进展。我回顾了 IR 是神经进行性改变的可检测和可治疗的修饰因子的证据，并且认为逆转 IR 可能是获得某些患者缓解的有效（也许是唯一）方法。我借鉴了消化性溃疡病中的一个新机制（将 IR 和 BD 之间两个以前不相关的现象结合在一起，揭示了一种新的治疗方法），将这一模型应用于双相情感障碍的进展。这种双相情感障碍进展的模型结合了 IR 和 BD 之间共同失调的机制，使得可以对神经进行性进行早期筛查、病例发现和监测，从而有可能进行干预，预防晚期双相情感障碍。关键信息 双相情感障碍的神经进行性定义为更严重的疾病形式和不良结局。目前，尚无神经进行性的有效预测指标，这可能有助于指导治疗和改善预后。超过一半的双相情感障碍患者存在胰岛素抵抗，与疾病的慢性病程、对情绪稳定剂治疗无反应、认知障碍和功能结局不良有关。胰岛素抵抗可能会改变双相情感障碍的病程并促进神经进行性。胰岛素抵抗可能是双相情感障碍神经进行性的一个可检测和潜在可修饰的风险因素。
Zotero 插件