Metabolic syndrome screening in bipolar disorder warranted

Nov 12 2014

By Lucy Piper, Senior medwireNews Reporter

The frequency of the metabolic syndrome in patients with bipolar disorder warrants systematic screening, say researchers, particularly among men, older patients and those receiving atypical antipsychotic treatment.

Lead researcher Ophélia Godin (Hôpital La Salpêtriere, Paris, France) and colleagues found that 18.5% of the 654 bipolar disorder patients they studied had the metabolic syndrome, a rate that is consistent with that generally reported in Europe, but slightly lower than rates previously reported for North America.

Of concern, two-thirds of the patients with the metabolic syndrome were not receiving adequate treatment for individual components, the researchers note.

Indeed, 78.4% of individuals with hypertension, 89.4% of those with high cholesterol and 72.1% of patients with hyperglycaemia were not receiving treatment at enrolment in the study.

“Undertreatment of hypertension and diabetes in patients with bipolar disorder are the areas of greatest concern, because of the high rates of CVD [cardiovascular disease]-related mortality and morbidity in this population”, point out Godin et al in the Journal of Clinical Psychiatry.

They say that regular monitoring of the various components of the metabolic syndrome is “the cornerstone” of early detection and management of the syndrome.

Patients most at risk were men, whose risk of the metabolic syndrome was twice that for women, and patients older than 48 years of age, who had a 3.5-fold greater risk than patients younger than 35 years of age.

As expected, body mass index (BMI) significantly affected the risk of having the syndrome, with each 1-point increase in BMI raising the risk by 30%.

Bipolar illness characteristics were not associated with an increased risk, but the use of atypical antipsychotic medication, which has been associated with weight gain, increased the risk 2.3-fold.

Due to the cross-sectional nature of the study, the researchers were unable to assert the underlying causes of the association between bipolar disorder and the metabolic syndrome, but suggest that it may be related to poor lifestyle or common physiological pathways.

They say that attempts should be made to improve the lifestyle of bipolar patients and advise care when choosing which psychotropic drugs to use.

“These findings also highlight the need for integrated care, with more interaction and coordination between psychiatrists and primary care providers”, the team concludes.

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