Correlates of Metabolic Abnormalities in Bipolar I Disorder at Initiation of Acute Phase Treatment

OBJECTIVE: Treatment of bipolar patients is often complicated by metabolic abnormalities such as obesity, diabetes, and dyslipidemia. We therefore evaluated the prevalence of these abnormalities and their correlates, in bipolar I patients, at the time of commencement of pharmacological treatment for acute mood episodes. METHODS: The study cohort consisted of 184 bipolar I patients hospitalized for treatment of acute mood episodes. Socio-demographic and clinical variables were noted and metabolic parameters, including body mass index, fasting plasma glucose, fasting total cholesterol, and current treatment(s) for diabetes and/or dyslipidemia were measured before initiating medication(s). RESULTS: Fifty-six (30.4%) subjects met our criteria for obesity; 80 (43.5%) had hyperglycemia, with 8 (4.3%) receiving anti-diabetic medication; and 38 (20.7%) had hypercholesterolemia, with 2 (1.1%) receiving cholesterol-lowering agents. We found that male sex (chi-square=5.359, p=0.021), depressed or mixed state versus manic state (chi-square=4.302, p=0.038), and duration of illness (t=2.756, p=0.006) were significantly associated with obesity. Older age (t=3.668, p<0.001), later age of disease onset (t=2.271, p=0.024), and lower level of educational attainment (beta=-0.531, p=0.001) were associated with hyperglycemia. CONCLUSION: Our finding that metabolic abnormalities are prevalent when initiating acute pharmacological treatment in bipolar I patients indicates that these factors should be integrated into treatment plans at the onset of disease management.

The Validation Study of the Korean Version of the Bipolar Spectrum Diagnostic Scale / 신경정신의학

OBJECTIVES: Because bipolar spectrum disorders frequently go unrecognized in clinical practice, sensitive screening tools for bipolar spectrum disorders are much needed. This study was conducted to confirm the validity of the Korean version of the Bipolar Spectrum Diagnostic Scale (BSDS), which was originally designed by Ronald Pies. METHODS: The BSDS, which was translated into Korean by the authors, was administered to patients with known bipolar disorders (N=60) and unipolar depressive disorders (N=27). Using various cut-off scores, we calculated the sensitivities and specificities of the Korean version of the BSDS in order to determine the optimal cut-off score. RESULTS: In this study, a cut-off score of 10 was shown to be optimal, with a sensitivity of 0.73 and a specificity of 0.85, although a cut-off score of 13 was proposed to be optimal by the original authors of the BSDS. CONCLUSION: These results indicate that the Korean version of the BSDS is a valid screening tool for bipolar spectrum disorder.

Elevation of Serum Creatine Kinase Level in a Patient Treated with Atypical Antipsychotics: A Case Report / 대한정신약물학회지

We report a case of serum creatine kinase (CK) elevation in a 42-year-old man with schizoaffective disorder treated with olanzapine, aripiprazole, quetiapine, and modified electroconvulsive therapy (ECT). To elucidate the clinical meaning of serum CK elevation, we repeatedly measured psychotic severity and chemical data, including serum CK, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and cholesterol. Pearson's correlation analysis was performed between each measurement. The peak CK level during hospitalization was correlated with Clinical Global Impression (CGI) severity. Dissociation of CK level and myoglobinuria was observed, and elevated did not result in renal failure or any renal decompensation. Medication change among atypical antipsychotics could not terminate CK level, which did not seem to be associated with dosage or duration of use. The patient's mother showed similar CK level, which suggests genetic control of serum CK. Repeated measurement of serum CK is recommended for determining the clinical significance of CK level, which is not yet clear.