Assessment of the relationship between metabolic syndrome agouti related peptid and eating behavior in bipolar disorder: A cross-sectional comparison study with healthy controls dissertation

Introduction: Metabolic Syndrome (MS) is a disease which affects more and more people in the world. The insulin resistance plays a role in its pathogenesis and it has an increasing prevalence with age. Cardiovascular complications caused by MS or its components are moving towards the major cause of deaths. In recent years, attention has been given to the studies associated with the prevalence of MS in patients with bipolar disorder and schizophrenia. These studies shows that MS and related metabolic disorders have been seen at higher rates in bipolar disorder patients than the general population. Fagiolini and colleagues found the prevalence of MS as 30% in a study on patients with bipolar disorder. In a study in our country, Yumru and colleagues found the prevalence of MS according to ATP-III in patients with bipolar disorder as 36.2% in women and 29.5% in men. Objective: The purpose of this study was to evaluate the relationship between metabolic changes and serum agouti related peptide levels in bipolar disorder patients used only mood stabilizers and to compare the scores of emptional, restrictive and external eating behaviors with metabolic syndrome and DEBQ (The Dutch Eating Behavior Questionnaire) subscales objective. Method: A total of 40 patients (20 female, 20 male) who have diagnostic criteria for bipolar disorder according to DSM IV criteria and who only used mood stabilizator as a preventive treatment for at least three months were taken by Ege University department of Psychiatry affective disorders treatment unit. It is stipulated that patients should not use psychotropic antilipidemic and antidiabetic drugs for at least six months. The healthy control group included40 people, Those people was selected according to the similar age and gender characteristics with other group and no use of mood stabilizator in their life-long and no use of antilipidemic and antidiabetic drugs at the time of study. People who complied with the participation criteria were included in the psychiatric examination. Social, demographic and anthropometric characteristics, information about psikotrop medication use, blood studies for biochemical panel and hormone levels were recorded. Psychometric evaluations were conducted by the interviewer within the same day or as soon as possible. Results: Twenty patients (50%) from the patient group and 11patients (27.5%) from the control group diagnosed with metabolic syndrome. In terms of the presence of metabolic syndrome, there was no statistically significant difference between the groups, with p value of 0.066. The relationship between BMI and metabolic syndrome between patient and control group was studied. It was found that BMI was seen significantly higher in patients and controls who were diagnosed with the metabolic syndrome. The relationship between the disease duration and the metabolic syndrome of patients was assessed and there was a statistically significant correlation between the increase in disease duration and the metabolic syndrome. Antropometric measurements, hormonal and biochemical data were analyzed and Triglyceride, fasting blood glucose levels, systolic and diastolic blood pressure were significantly higher but FT3 level was lower in patients than control group. When the relationship between metabolic parameters and alcohol and smoking is examined, a statistically significant relationship was found between alcohol use and total kolesterol, LDL, smoking and HDL in the control group. When the patients and control groups were examined on the basis of DEBQ subscales, a significant difference was found between the patient group and the control group. more restrictive eating behavior was observed in the patient group, the control group had more external eating behavior. When the participants were grouped according to BMI and the DEBQ subscales are analized, statistically significant difference was not found between the groups While there were more external eating behavior in participants who have 18.0≤(BMI)≤24.9, there were more restrictive and external eating behavior in participants who have (BMI)>24.9 Conclusion: The metabolic syndrome, is a lethal endocrinopathy which can causes systemic disorders such as abdominal obesity, glucose intolerance or diabetes mellitus, dislipidemia, hipertansion, and coronary artery disease (CAD). This syndrome is also associated with bipolar disorder so we may need to pay more attention to early detection of metabolic syndrome in bipolar patients Due to the fact that obesity is one of the most important clues of metabolic syndrome, if eating habit can manupulate with psychoeducation in these patients, we can contribute a good alternative theraphy instead of medical or surgical treatments. It is suggested to continue interdisciplinary studies examining the relationship between metabolic syndrome and serum AgRP level, which is considered to be a new predictor of obesity, prevention of metabolic syndrome and early follow-up treatment in case of detection and psychoeducational monitoring studies on how patients quality of life changes. KEYWORDS: Bipolar Disorder, Metabolic syndrome, AgRP(Agouti Related Peptid), Eating Behavior