title: Shared clinical associations between obesity and impulsivity in rapid cycling bipolar disorder: a systematic review.
abstract: BACKGROUND
  Obesity seems to show a two-way relationship with bipolar disorder (BD), representing not only a possible vulnerability factor but also a consequence of chronic mood dysregulation associated with an overall poor prognosis. Increased impulsivity has been described across all stages and phases of BD as being also associated with a worse prognosis. Although obesity and impulsivity are common features among rapid cycling bipolar disorder (RC-BD) patients, there is a lack of understanding about the clinical implications of these conditions combined in BD.
  
  
  METHODS
  To explore and integrate available evidence on shared clinical associations between obesity and impulsivity in RC-BD a systematic search of the literature in the electronic database of the National Library of Medicine (PubMed) has been conducted.
  
  
  RESULTS
  One hundred and fourteen articles were included in our systematic review. Among RC-BD patients, substance abuse disorders (SUDs), anxiety disorders (ADs), predominantly depressive polarity, chronic exposure to antidepressants, psychotic symptoms, suicidality, and comorbid medical conditions are strongly associated with both obesity and impulsivity.
  
  
  CONCLUSIONS
  Heterogeneity of published data, inconsistent measurements of both obesity and impulsivity in RC-BD and an absence of control for RC-BD in epidemiological surveys. Consequently, their combined impact on the severity of RC-BD is yet to be recognized and remains to be poorly understood.
  
  
  CONCLUSIONS
  In RC-BD patients the co-occurrence of obesity and impulsivity is associated with an unfavorable course of illness, specific shared clinical correlates, negative psychosocial impact, and overall worse prognosis. There is a need to examine obesity and impulsivity as modulating factors and markers of severity in RC-BD.
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Department of Psychiatry, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia. Electronic address: juan.f.galvezflorez@uth.tmc.edu.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Galvez
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: isabelle.e.bauer@uth.tmc.edu.
authors.forename: Isabelle E
authors.initials: IE
authors.lastname: Bauer
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: marsal.sanches@uth.tmc.edu.
authors.forename: Marsal
authors.initials: M
authors.lastname: Sanches
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: emilysky2008@livemail.tw.
authors.forename: Hanjing E
authors.initials: HE
authors.lastname: Wu
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: jane.e.hamilton@uth.tmc.edu.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Hamilton
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: benson.irunguru@uth.tmc.edu.
authors.forename: Benson
authors.initials: B
authors.lastname: Mwangi
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Molecular Psychiatry Laboratory, UT Center of Excellence on Mood Disorders, Houston, TX, USA; Harris County Psychiatric Center (HCPC), University of Texas Health Science Center, Houston, TX, USA. Electronic address: flavio.p.kapczinski@uth.tmc.edu.
authors.forename: Flavio P
authors.initials: FP
authors.lastname: Kapczinski
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: giovana.b.zuntasoares@uth.tmc.edu.
authors.forename: Giovana
authors.initials: G
authors.lastname: Zunta-Soares
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Harris County Psychiatric Center (HCPC), University of Texas Health Science Center, Houston, TX, USA. Electronic address: jair.c.soares@uth.tmc.edu.
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage; D001008:Anxiety Disorders / Q000523:psychology; D001714:Bipolar Disorder / Q000523:psychology*; D015897:Comorbidity; D006801:Humans; D007175:Impulsive Behavior; D009765:Obesity / Q000523:psychology*; D011618:Psychotic Disorders / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology; D059020:Suicidal Ideation; D014481:United States
chemical_list: D000928:Antidepressive Agents
keywords: Bipolar disorder; Comorbidity; Impulsivity; Obesity; Rapid cycling; Severity