BACKGROUND: Little is known about the impact of insulin resistance on bipolar disorder. AIMS: To examine the relationships between insulin resistance, type 2 diabetes and clinical course and treatment outcomes in bipolar disorder. METHOD: 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.

Cynthia 5 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 and 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

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Evid Based Ment Health. 2016 Aug;19(3):e15. doi: 10.1136/eb-2015-102070. PubMed

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