title: Insulin resistance and outcome in bipolar disorder.
abstract: BACKGROUND
  Little is known about the impact of insulin resistance on bipolar disorder.
  
  
  OBJECTIVE
  To examine the relationships between insulin resistance, type 2 diabetes and clinical course and treatment outcomes in bipolar disorder.
  
  
  METHODS
  We measured fasting glucose and insulin in 121 adults with bipolar disorder. We diagnosed type 2 diabetes and determined insulin resistance. The National Institute of Mental Health Life Chart was used to record the course of bipolar disorder and the Alda scale to establish response to prophylactic lithium treatment.
  
  
  RESULTS
  Patients with bipolar disorder and type 2 diabetes or insulin resistance had three times higher odds of a chronic course of bipolar disorder compared with euglycaemic patients (50% and 48.7% respectively v. 27.3%, odds ratio (OR) = 3.07, P = 0.007), three times higher odds of rapid cycling (38.5% and 39.5% respectively v. 18.2%, OR = 3.13, P = 0.012) and were more likely to be refractory to lithium treatment (36.8% and 36.7% respectively v. 3.2%, OR = 8.40, P<0.0001). All associations remained significant after controlling for antipsychotic exposure and body mass index in sensitivity analyses.
  
  
  CONCLUSIONS
  Comorbid insulin resistance may be an important factor in resistance to treatment in bipolar disorder.
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: Cynthia V
authors.initials: CV
authors.lastname: Calkin
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: Martina
authors.initials: M
authors.lastname: Ruzickova
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Uher
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Hajek
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Slaney
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Garnham
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: M Claire
authors.initials: MC
authors.lastname: O'Donovan
authors.affiliation: Cynthia V. Calkin, MD, CCFP, FRCPC, Martina Ruzickova, MD, PhD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Rudolf Uher, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Institute of Psychiatry, MRC Social, Genetic & Developmental Psychiatry Centre, King's College London, UK; Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic; Claire M. Slaney, RN, Julie S. Garnham, RNBN, Capital District Health Authority, Halifax, Canada; M. Claire O'Donovan, MB, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada; Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Canada and Department of Psychiatry, 3rd School of Medicine, Prague, Charles University, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Alda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018692:Antimanic Agents; D001786:Blood Glucose; D007328:Insulin; D008094:Lithium