title: Beneficial effect of phosphatidylcholine supplementation in alleviation of hypomania and insomnia in a Chinese bipolar hypomanic boy and a possible explanation to the effect at the genetic level.
abstract: BACKGROUND
  Recent studies indicated that supplementation of phosphatidylcholine has been found to be beneficial for psychiatric diseases and Diacylglycerol Kinase, Eta (DGKH) protein was involved in regulating the metabolism of phosphatidic acid and diacylglycerol. This study reported a case of a 16-year-old Chinese boy with bipolar hypomania symptoms receiving supplementation of phosphatidylcholine, and a genetic study of a risk variant of DGKH gene was performed in an attempt to provide an explanation for the potential beneficial effect of phosphatidylcholine supplementation.
  
  
  METHODS
  We described a case of a 16-year-old boy with bipolar disorder, who suffered from monthly episodes of insomnia accompanied by hypomania for 5 months despite adherence to medication. After supplementation of phosphatidylcholine, he returned to a normal sleeping pattern and recovered from hypomania symptoms for approximately 14 months. Furthermore, genotyping results showed that this boy carries the risk genotype (G/C) in DGKH variant rs77072822 (adjusted p-value = 0.025 after 2000 permutation tests).
  
  
  RESULTS
  The 16-year-old boy appears to have benefited from the supplementation with phosphatidylcholine and recovered from hypomania symptoms. He carries a risk genotype in rs77072822 which lies in the first intron of DGKH gene that was mostly reported to be associated with bipolar disorder. Thus, this finding is consistent with the hypothesis that alleviating the phosphatidylcholine deficiencies might accompany with the risk variants of DGKH gene, which might improve the efficacies of such supplementation and design new treatment strategies for bipolar disorder.
  
  
  CONCLUSIONS
  This study illustrated that a 16-year-old boy with hypomania symptoms responded well to supplementation of phosphatidylcholine and the boy carries a risk genotype in DGKH gene for bipolar disorder, which provides a possible explanation for the boy's beneficial effect at the genetic level.
authors.affiliation: Croucher Laboratory for Human Genomics, School of Biomedical Sciences, The Chinese University of Hong Kong, Rm324A, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T. Hong Kong.
authors.forename: Shitao
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Psychiatry, Shatin Hospital, The Chinese University of Hong Kong, 33 Ah Kong Kok Street, Shatin, N.T. Hong Kong.
authors.forename: Marco H B
authors.initials: MH
authors.lastname: Lam
authors.affiliation: Department of Psychiatry, Shatin Hospital, The Chinese University of Hong Kong, 33 Ah Kong Kok Street, Shatin, N.T. Hong Kong.
authors.forename: Yun Kwok
authors.initials: YK
authors.lastname: Wing
authors.affiliation: Department of Psychiatry, Shatin Hospital, The Chinese University of Hong Kong, 33 Ah Kong Kok Street, Shatin, N.T. Hong Kong.
authors.forename: Larina C L
authors.initials: LC
authors.lastname: Yim
authors.affiliation: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T. Hong Kong.
authors.forename: Winnie C W
authors.initials: WC
authors.lastname: Chu
authors.affiliation: Croucher Laboratory for Human Genomics, School of Biomedical Sciences, The Chinese University of Hong Kong, Rm324A, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T. Hong Kong.
authors.forename: Venus S Y
authors.initials: VS
authors.lastname: Yeung
authors.affiliation: Croucher Laboratory for Human Genomics, School of Biomedical Sciences, The Chinese University of Hong Kong, Rm324A, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T. Hong Kong.
authors.forename: Mary M Y
authors.initials: MM
authors.lastname: Waye
keywords: Bipolar hypomania; Diacylglycerol kinase eta (DGKH); Metabolism of diacylglycerol; Phosphatidylcholine supplementation; Susceptibility polymorphism