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    Electrocardiography changes in bipolar patients during long-term lithium monotherapy
    (Elsevier Science Inc, 2014) Altinbas, Kursat; Guloksuz, Sinan; Caglar, Ilker Murat; Caglar, Fatma Nihan Turhan; Kurt, Erhan; Oral, Esat Timucin
    Objective: Cardiovascular side effects of lithium have been reported to occur mainly at higher-than-therapeutic serum levels. We aimed to investigate the impact of the long-term lithium use on electrocardiogram (ECG) parameters in association with the serum levels in patients with bipolar disorder (BD) and in healthy controls (HCs) serving as the reference group. Methods: The study sample consisted of 53 euthymic BD type I patients on lithium monotherapy at therapeutic serum levels (M=0.76, S.D.=0.14, range=0.41-1.09 mmol/l) for at least 12 months and 45 HCs. A 12-lead surface ECG was obtained from all participants at resting state for at least half an hour for 5-min recording. Heart-rate, Pmax, Pmin, QRS interval, QT dispersion, QT dispersion ratio (QTdR) and Tpeak-to-end interval (TpTe) were measured. Results: Regression analyses revealed that QTdR (B=14.17, P=.001), TpTe (B=18.38, P<.001), Pmax (B=17.84, P<.001) and Pmin (B=25.10, P<.001) were increased in BD patients who were on chronic lithium treatment than in HCs after controlling for age, sex and strict Bonferroni correction for multiple testing. There were no associations between serum lithium levels and ECG parameters. Conclusion: Our findings suggest that the use of lithium is associated with both atrial and ventricular electrical instability, even when lithium levels are in the therapeutic range. (C) 2014 Elsevier Inc. All rights reserved.
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    Seasonal variation of metabolic syndrome prevalence in bipolar disorder
    (Yerkure Tanitim & Yayincilik Hizmetleri A S, 2012) Altinbas, Kursat; Darcin, Asli Enez; Guloksuz, Sinan; Oral, Timucin Esat
    Objective: Metabolic disturbances and diagnosis of metabolic syndrome are more prevalent in bipolar disorder patients than general population. The underlying biological pathway regarding this high rate of metabolic syndrome compared to general population in bipolar disorder is still unknown. The side effects of second generation antipsychotics causing weight gain and insulin resistance are considered as one of the main factors. However, this knowledge is not sufficient to understand the association between bipolar disorder and metabolic syndrome entirely. The aim of this study was to investigate the seasonal variation in prevalence of the metabolic syndrome criteria and diagnosis in type 1 bipolar disorder. Methods: With that purpose 69 clinically remitted type 1 bipolar disorder patients, who also met inclusion criteria for the study, were recruited. Metabolic syndrome was diagnosed by using the International Diabetes Federation (IDF) criteria. Young Mania Rating Scale and Hamilton Depression Rating Scale with 17 items were used in clinical interview in each visit to assess mood. All patients were assessed in four visits during one year, with one visit per each season. To evaluate patients for metabolic syndrome criteria, blood sampling, blood pressure, and waist circumference measures were carried out. The data of 49 patients, who were evaluated in all four visits and met inclusion criteria in each visit, were analyzed. These data were used in investigation of the seasonal variation in the prevalence of metabolic syndrome criteria and metabolic syndrome diagnosis. Results: In the group of type 1 bipolar patients recruited to the study, the prevalence of metabolic syndrome diagnosis was 42.9%, 42.9%, 34.7% and 34.7% in winter, spring, summer, and autumn, respectively. Although metabolic syndrome diagnosis was more prevalent in winter and in spring, the difference was not statistically significant. Among the metabolic syndrome criteria, prevalence of low- HDL criterion, that was found lowest in spring, showed seasonal variation. Discussion: Although the results of this study do not support that the prevalence of metabolic syndrome diagnosis has a seasonal variation in type 1 bipolar patients, it shows that the prevalence of one of the metabolic syndrome criteria, low- HDL criterion, has seasonal variation among patients with bipolar disorder. Long term, large sample-sized follow-up studies are still required to investigate the seasonal variation in prevalence of metabolic syndrome criteria and metabolic syndrome diagnosis in bipolar disorder patients. Metabolic syndrome, which is more prevalent in individuals with major mental disorders such as schizophrenia and bipolar disorder than in general population, is an important health issue considering its association with cardiovascular diseases and high mortality and morbidity rates. Due to possible seasonal variation of metabolic disturbances, clinicians should monitor metabolic changes beside the mood changes in bipolar disorder patients.