title: Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder.
abstract: BACKGROUND
  Metabolic syndrome (MetS) is highly prevalent among patients with bipolar disorder. MetS may cause complications in the brain, but studies investigating MetS-associated clinical psychiatric outcomes remain scant.
  
  
  METHODS
  We enrolled clinically stable outpatients with bipolar disorder aged 18-65 years and performed anthropometric and fasting biochemical assessments to investigate MetS prevalence. We then performed clinical assessments by using the Young Mania Rating Scale for manic symptoms, the Montgomery-Åsberg Depression Rating Scale for depressive symptoms, the Positive and Negative Symptom Scale for psychotic symptoms, the Involuntary Movement Scale for tardive dyskinesia, the Barnes Akathisia Rating Scale for akathisia, the Udvalg for Kliniske Undersogelser for general side effects, the Schedule for Assessment of Insight for insight, the Global Assessment of Functioning scale for global functioning, and the Wisconsin Card Sorting Test (WCST) for cognitive executive function.
  
  
  RESULTS
  In total, 143 patients were enrolled and had a MetS prevalence of 29.4%. The patients treated with atypical antipsychotics plus mood stabilizers (36.3%) and atypical antipsychotics alone (36.0%) had a significantly higher prevalence of MetS than did those treated with mood stabilizers alone (10.5%; p = 0.012). According to multivariate regression analyses adjusted for age, sex, smoking status, bipolar disorder subtype (I or II), pharmacological treatment duration, and psychiatric medication, compared with patients without MetS, those with MetS had significantly more previous hospitalizations (p = 0.036), severer tardive dyskinesia (p = 0.030), poorer insight (p = 0.036), poorer global function (p = 0.046), and more impaired executive function (conceptual level response on the WCST; p = 0.042).
  
  
  CONCLUSIONS
  Our results indicated that patients with comorbid bipolar disorder and MetS have more adverse clinical outcomes than those without, with more hospitalizations, severer tardive dyskinesia, poorer insight, poorer global function, and more impaired executive function. Monitoring MetS is crucial for assessing not only physical burden, but also psychiatric outcomes.
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan. ymbi@mail2000.com.tw.|Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan. ymbi@mail2000.com.tw.
authors.forename: Ya-Mei
authors.initials: YM
authors.lastname: Bai
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Li
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Pei-Chi
authors.initials: PC
authors.lastname: Tu
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy; D003071:Cognition; D056344:Executive Function; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D009483:Neuropsychological Tests; D063868:Patient Outcome Assessment; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Bipolar disorder; Clinical outcome; Metabolic syndrome