The relationship between adenosine deaminase and serum uric acid levels with psychological resilience in patients with bipolar disorder

OBJECTIVE: The physiological and psychological responses to stress vary and these differences are associated with psychological resilience. Resilience is thought to play a significant protective role in patients diagnosed with bipolar disorder. Adenosine interacts with many other receptor systems as a neuromodulator, and previous studies have shown that adenosine system function is impaired in bipolar disorder. To the best of our knowledge, there is no study has examined the relationship between psychological resilience and the adenosine system in patients with bipolar disorder. The objective of this study is to investigate the presence of purinergic system dysfunction and explore the relationship of this dysfunction with psychological resilience in patients with bipolar affective disorder. Relationship of ADA (adenosine deaminase) and serum uric acid levels with psychological resilience, treatment response, functionality, remaining in remission during the 6-month follow-up, suicidal ideation and impulsivity are aimed to be investigated. MATERIALS AND METHODS: This study included 55 participants diagnosed with Bipolar Disorder according to DSM-5 criteria and 55 healthy controls matched for age, gender, and educational level. Participants were recruited from the outpatient clinic of the Department of Psychiatry, Faculty of Medicine, Karadeniz Technical University, between August 2023 and November 2023. The control group included individuals with no diagnosis of mood or psychotic disorders. All participants were assessed using seven scales: the Resilience Scale for Adults (YİDÖ), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMDÖ), Bipolar Disorder Functionality Scale (BBİÖ), Barratt Impulsiveness Scale-11 short form (BDÖ-11), Beck Suicide Ideation Scale (BİDÖ) and blood samples were also collected from all participants. The study is designed as a 6-month follow-up study, Bipolar Disorder patient group underwent reassessments of scales and biochemical tests every three months. For the control group, these tests were conducted only during the initial assessment. FINDINGS: At the initial assessment, the Bipolar Disorder patient group had lower YİDÖ scores compared to the healthy control group, while their HAM-D, MADRS, YMDÖ, BDÖ-11, and BİDÖ scores were higher. Increase in YİDÖ scores was associated with decreases in HAM-D, MADRS, YMDÖ, BDÖ-11, and BİDÖ, and increase in BBİÖ scores. At the 3-month and 6-month follow-ups, patients with increased YİDÖ scores showed a corresponding decrease in HAM-D, MADRS, YMDÖ, and BDÖ-11 scores. At the start of the study, patients with higher YİDÖ scores experienced a greater decrease in HAM-D and MADRS depression scale scores, a decrease in impulsivity as measured by the BDÖ-11, and an increase in functionality as measured by the BBİÖ at the 3-month follow-up. In the Bipolar Disorder patient group, when all patients were included, ADA and uric acid levels were higher compared to the healthy control group. As uric acid levels increased, depression scale scores decreased, and functionality scale scores increased. Higher ADA levels were associated with reductions in depression scale scores and fewer suicidal thoughts. At the initial assessment, patients classified as "depressed" had lower uric acid levels, while those who recovered showed an increase in uric acid levels. ADA levels were higher in patients who showed improvement from the initial assessment to the 6-month follow-up. In the Bipolar Disorder group, patients who were initially classified as depressed and had higher ADA levels were more likely to enter remission. By the end of the study, ADA levels had decreased in patients who entered remission. CONCLUSIONS: Our findings indicate that resilience levels are low in the bipolar disorder group and also indicate that there is evidence for adenosine system dysfunction. However, no relationship was found between resilience and the adenosine system elements uric acid and ADA. Resilience has been found to be protective against depressive and manic symptoms. Patients with higher resilience had lower impulsivity and suicidal ideation, and higher functionality. Over a 6-month follow-up, patients with greater increases in resilience showed a greater reduction in depressive and manic symptoms, a significant decrease in impulsivity, and improvement in functionality. In addition to psychopharmacological treatments, interventions aimed at increase resilience in patients with bipolar disorder might be beneficial for reducing depressive and manic symptoms, impulsivity, and improving functionality. Low uric acid levels seem to trigger depressive episodes, while high levels appear to be associated with an increased inflammatory response. ADA levels have been shown to be a prognostic indicator for bipolar depression patients, with patients with higher ADA levels having a better treatment response over 6 months. This suggests that ADA levels could be used as a biomarker for treatment response in bipolar disorder patients.