title: Acute manic episode is associated with an increased risk of lower limb edema.
abstract: OBJECTIVE
  Lower limb edema (LLE) was suggested to be associated with the use of psychotropic drugs among patients suffering from severe mental illnesses; however no direct mechanism was found. Therefore, we examined the association between the occurrence of LLE and acute untreated episode leading to hospitalization.
  
  
  METHODS
  A retrospective cross-sectional study was conducted using medical charts of 2529 patients admitted to Geha Mental Health Center between 2002 and 2012. Incident cases of LLE, demographic and clinical data were retrieved. Admission clinical status was modeled as three non-overlapping groups of patients: (i) Patients with a non-affective psychosis (NAP) episode (n = 1563), (ii) patients with a manic episode (n = 366), and (iii) patients with a depressive episode (n = 600). We performed a logistic regression analysis with LLE as the dependent variable controlling for the demographic and clinical variables that may be associated with LLE.
  
  
  RESULTS
  LLE was diagnosed in 3.8% (n = 95) of the study population. The rate of LLE was 3-fold higher (χ(2) = 51.9, df = 2, p<0.001) in patients admitted with a manic episode (n = 38; 10.4%) compared to patients admitted with a NAP episode (n = 41; 2.6%) and patients admitted with a depressive episode (n = 16; 2.7%). Manic episode was associated with an increased risk for LLE compared to depressive episode (OR 8.72, 95% CI: 3.53-21.52, p<0.001) or NAP episode (OR 3.96, 95% CI: 2.16-7.26, p<0.001) after controlling for relevant confounders.
  
  
  CONCLUSIONS
  Acute manic episode, leading to hospitalization, is associated with an increased risk of LLE, compared to NAP or depressive episode, suggesting causal relationship between mood and fluid imbalance. Yet, future prospective studies are needed to rule out the contribution of physical agitation and lithium treatment.
authors.affiliation: Geha Mental Health Center, Petach-Tikva, Israel; Sackler's Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel. Electronic address: hochmaneldar@gmail.com.
authors.forename: Eldar
authors.initials: E
authors.lastname: Hochman
authors.forename: Amir
authors.initials: A
authors.lastname: Krivoy
authors.forename: Gal
authors.initials: G
authors.lastname: Shoval
authors.forename: Avi
authors.initials: A
authors.lastname: Valevski
authors.forename: Abraham
authors.initials: A
authors.lastname: Weizman
authors.forename: Tsvi
authors.initials: T
authors.lastname: Fischel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000453:epidemiology*; D004487:Edema / Q000453:epidemiology* / Q000473:pathology*; D005121:Extremities / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: ALT; AST; Acute manic episode; Bipolar disorder; CK; HBG; K; LLE; Lower leg edema; NAP; Na; PANSS; Psychotropic drugs and non-affective psychosis; SMI; TSH; WBC; alanine aminotransferase; aspartate aminotransferase; creatine-kinase; hemoglobin; lower limb edema; non-affective psychosis; positive and negative syndrome scale; potassium; severe mental illnesses; sodium; thyroid stimulating hormone; white blood cell count