Vats Purvi, Das Basudeb, Khanra Sourav
Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India.
Indian J Psychol Med. 2020 Apr 25;42(3):281-289. doi: 10.4103/IJPSYM.IJPSYM_299_19. eCollection 2020 May-Jun.
The derangement of serum lipids is well documented in psychiatric disorders like schizophrenia, mania, and depression but not in obsessive compulsive disorder (OCD), where it has been inadequately examined. Also, serum lipid abnormalities are increasingly found in "impulsivity," an important sub-construct of OCD. Our study aimed to examine serum lipid profile among patients with OCD and its association with clinical profile and impulsivity among them.
Forty drug naïve or drug-free (four weeks for oral and eight weeks for any depot psychotropics) patients with OCD according to International Classification of Disease -10 version (ICD-10): Diagnostic Criteria for Research (DCR) by the World Health Organization (WHO), from outpatient and inpatient departments of a tertiary care psychiatric hospital were recruited. Measures like Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamliton Rating Scale for Depression (HAM-D), Barratt's Impulsivity Scale (BIS-11), and Hamilton Rating Scale for Anxiety (HAM-A) were administered. Forty age and sex-matched healthy controls (HC) were recruited after screening with General Health Questionnaire 12 (GHQ-12). Serum lipids were assessed in both the groups.
Serum high density lipoproteins (HDL) ( < 0.001; partial η = 0.176) and apolipoprotein B ( < 0.001; partial η = 0.531) were significantly higher in OCD group than age- and sex-matched HC. A trend toward lower serum HDL ( = 0.06; partial η = 0.060) was observed among patients of OCD with high impulsivity. Serum HDL was negatively correlated with BIS attention (r =-0.32; = 0.03), BIS motor (r = 0.40; = 0.01), BIS non-planning (r = - 0.36; = 0.02), and BIS total (r = - 0.36; = 0.01) scores. Serum triglycerides (TG) (r = 0.34; = 0.03) and apolipoprotein B (r = -0.32; = 0.04) were negatively correlated with Y-BOCS compulsion score. Serum TG (r = -0.45, < 0.01) and serum very low density lipoprotein (VLDL) was negatively (r = -0.39; = 0.01) correlated with Y-BOCS total scores. Serum VLDL was positively (r = 0.34; = 0.03) correlated with BIS motor scores.
Serum lipid fractions are deranged among patients with OCD. Different lipid fractions have different associations with clinical profiles of OCD. Impulsivity among patients with OCD may have a specific association with serum lipids. A small sample size, use of self-report measure without adaptation for impulsivity, a lack of metabolic profile assessment among participants, and a lack of assessment of impulsivity among HC were the limitations of our tudy.
血清脂质紊乱在精神分裂症、躁狂症和抑郁症等精神疾病中已有充分记录，但在强迫症（OCD）中尚未得到充分研究。此外，血清脂质异常在强迫症的一个重要子结构“冲动性”中越来越多地被发现。我们的研究旨在检查强迫症患者的血清脂质谱及其与临床特征和冲动性的关系。
根据世界卫生组织（WHO）的国际疾病分类第10版（ICD - 10）：研究诊断标准（DCR），从一家三级护理精神病医院的门诊和住院部招募了40名未服用过药物或已停药（口服药物停药四周，长效精神药物停药八周）的强迫症患者。采用耶鲁 - 布朗强迫症量表（Y - BOCS）、汉密尔顿抑郁量表（HAM - D）、巴拉特冲动量表（BIS - 11）和汉密尔顿焦虑量表（HAM - A）进行测量。在通过一般健康问卷12（GHQ - 12）筛查后，招募了40名年龄和性别匹配的健康对照（HC）。对两组进行血清脂质评估。
强迫症组的血清高密度脂蛋白（HDL）（<0.001；偏η = 0.176）和载脂蛋白B（<0.001；偏η = 0.531）显著高于年龄和性别匹配的健康对照组。在高冲动性的强迫症患者中观察到血清HDL有降低的趋势（= 0.06；偏η = 0.060）。血清HDL与BIS注意力得分（r = - 0.32；= 0.03）、BIS运动得分（r = 0.40；= 0.01）、BIS非计划性得分（r = - 0.36；= 0.02）和BIS总分（r = - 0.36；= 0.01）呈负相关。血清甘油三酯（TG）（r = 0.34；= 0.03）和载脂蛋白B（r = - 0.32；= 0.04）与Y - BOCS强迫症状得分呈负相关。血清TG（r = - 0.45，<0.01）和血清极低密度脂蛋白（VLDL）与Y - BOCS总分呈负相关（r = - 0.39；= 0.01）。血清VLDL与BIS运动得分呈正相关（r = 0.34；= 0.03）。
强迫症患者的血清脂质成分紊乱。不同的脂质成分与强迫症的临床特征有不同的关联。强迫症患者的冲动性可能与血清脂质有特定关联。本研究的局限性在于样本量小、使用未经冲动性适应性调整的自我报告测量方法、参与者缺乏代谢谱评估以及健康对照组缺乏冲动性评估。
