Bipolarni poremećaj raspoloženja, metabolički sindrom i alostatsko opterećenje-multidimenzionalna analiza

Vuksan-Ćusa, Bjanka (2010) Bipolarni poremećaj raspoloženja, metabolički sindrom i alostatsko opterećenje-multidimenzionalna analiza. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The comorbidity of somatic and mental ilnesses is one of the greatest scientific and clinical challenges of modern psychiatry. Patient with mental ilnesses such as schizophrenia and bipolar disorder have an increased mortality rate and shorter life span (10-25 years) compared to general population, not only due to the increased suicididality, but due to increased prevalence of somatic ilnesses such as cardiovascular diseases and type 2 diabetes. Metabolic syndrome, defined as cluster of symptoms like dyslipidemia, hypertension, glucose intolerance and obesity, is most important predictor of earlier onset of cardiovascular disease and premature mortality and it is more prevalent in psychiatric patients than in general population. The main goal of the study was to determine the prevalence of the metabolic disorder and its subcomponents in bipolar disorder patients in comparison to patients with schizophrenia and healthy controls. Furthermore, the secondary goals were to determine the prevalence of increased homocysteine, C-reactive protein and basal cortisol and decrease DHEA serum levels in all three group of participants. We hypothesized that altered levels of aforementioned parameters could be related to the increased risk for development of metabolic syndrome and somatic ilnesses. The study sample consisted of 182 participants divided in the following three groups:59 (32.4%) healthy controls, 60 (33.0%) bipolar disorder patients and 63 (34.6%) patients with schizophrenia. All participants have signed an informed consent document which was approved by local Ethics Committee. All patients were diagnosed according to ICD –X classifications. Biochemical parameters were determined at Biochemical laboratory of University Hospital Center Zagreb. Results of the study showed similar prevalence of metabolic syndrome in bipolar and schizophrenia. Serum homocysteine levels were higher in bipolar group compared to healthy controls, while CRP values were higher in bipolar group than in schizophrenia group and helathy controls. Patients had higher basal cortisol levels than controls. There was no difference in DHEA levels in all three examined groups. Elevated homocysteine and CRP levels are associated with increased risk for the development of metabolic syndrome in patients with bipolar disorder and schizophrenia. Metabolic syndrome, the most important predictor for the development of cardiovascular disease and type II diabetes , is associated with psychiatric disorder per se and it is not exclusively connected with specific psychiatric diagnosis.Our results indicate the possibility for biological typization of bipolar disorder regarding these parameters(homocysteine, CRP, cortisol and DHEA) and evaluation of their influence to the development of metabolic disorder. This could be of , not only theoretical, but practical clinical importance since B-vitamine supplementation could normalize elevated homocysteine levels and thus probably decrease the risk for metabolic syndrome.

Abstract in Croatian

Komorbiditet tjelesnih i mentalnih poremećaja je jedan od najvećih znanstvenih i kliničkih izazova moderne psihijatrije. Pacijenti oboljeli od psihijatrijskih poremećaja imaju veću stopu smrtnosti i kraći životni vijek (10-25g) u odnosu na opću populaciju, ne samo zbog povećane stope suicida nego i tjelesnih komorbiditetnih bolesti, u prvom redu KVB i šećerne bolesti tipa 2. Metabolički sindrom (MS), koji se se definira kao skup poremećaja u vidu dislipidemije, hipertenzije, intolerancije glukoze i pretilosti, najznačajniji je prediktor ranijeg nastanka KVB i rane smrtnosti i češći je kod psihijatrijskih bolesnika u odnosu na opću populaciju. Cilj istraživanja je utvrditi prevalenciju MS i njegovih sastavnica u skupini bipolarnih pacijenata u usporedbi sa skupinom sch bolesnika i skupinom zdravih dragovoljaca iste dobi i spola. Daljnji ciljevi istraživanja su utvrditi prevalenciju povišenih vrijednosti homocisteina, kortizola, CRP-a i sniženih vrijednosti DHEA u ispitivanim skupinama te pokazati da li promijenjene vrijednosti navedenih parametara nose veći rizik za razvoj MS, odnosno tjelesnih komorbiditetnih bolesti. U istraživanju je sudjelovalo 182 ispitanika, od čega 59 (32.4%) kontrolne skupine, 60 (33.0%) s dijagnozom bipolarnog poremećaja te 63 (34.6%) s dijagnozom shizofrenije. Rezultati istraživanja ukazuju na usporedive prevalencije MS u skupini shizofrenih i bipolarnih bolesnika. U skupini bipolarnih bolesnika utvrđena je statistički značajno viša razina homocisteina u odnosu na zdrave kontrole, viši CRP-a u odnosu na shizofrene ispitanike i zdrave kontrole. Vrijednosti bazalnog kortizola bile su više u skupini shizofrenih i bipolarnih bolesnika u usporedbi sa zdravim kontroloma , dok nije bilo razlike u razini DHEA u ispitivanim skupinama. Povišene razine homocisteina i CRP-a se povezuju s većim rizikom za razvoj tjelesnih bolesti kod shizofrenih i bipolarnih bolesnika. MS kao prediktor tjelesnih bolesti, u prvom redu kardiovaskularnih bolesti i šećerne bolesti tipa II, povezan je s psihijatrijskim poremećajem per se i nije specifično vezan za pojedinu psihijatrijsku dijagnozu. Postoji mogućnost biološke tipizacije bipolarnog poremećaja glede ispitivanih parametara (homocisteina, bazalnog kortizola, CRP-a i DHEA) i mogućeg utjecaja tih parametara na rizik za razvoj metaboličkog sindroma, odnosno tjelesnog komorbiditeta, što bi moglo imati ne samo teorijske, nego i praktične terapijske implikacije.

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