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作者：Caroline Helwick  
出處：WebMD醫學新聞

　　June 2, 2010 (紐澳良) — 躁症的躁鬱病患可能有高血壓和其他心臟代謝異常風險，根據一篇單一中心研究，有這些診斷的病患將近半數有躁症。
　　
　　密西根州立大學的Dale D'Mello醫師在美國精神科協會2010年會中報告指出，另外發現，這些病患有35%為肥胖。
　　
　　D'Mello醫師表示，我們發現，急性躁症世代的高血壓盛行率高於一般族群，發生躁鬱症的年紀越早，可預期後來會發生高血壓，同時出現高血壓和躁症情況越嚴重有關。
　　
　　躁鬱症病患之心臟代謝異常有不成比率的增加，這些共病症的發病和臨床後遺症對於躁鬱症的表現和病程的影響還不清楚。
　　
　　他表示，這篇研究的目的是確認躁鬱症盛行率以及住院病患心臟代謝異常的臨床關聯。
　　
　　研究對象包括2002至2006年間的99名精神科病房住院患者，住院接受躁鬱躁症和混合狀態之治療。穩定之後，這些病患完成人口統計學、疾病和治療變項的簡短調查。由一名精神科醫師依據精神疾病診斷與統計手冊(第四版)診斷且完成楊氏躁症量表(Young Mania Rating Scale)。
　　
　　D'Mello醫師報告指出，研究顯示，躁症或混合狀態住院的病患45%有高血壓，根據國家健康與營養檢視調查，一般族群的高血壓比率只有30.5%。他使用的高血壓代謝症狀定義為140/90 mm Hg。
　　
　　他指出，急性躁症世代的血脂異常和糖尿病盛行率也較高。
　　
　　該研究中，高血壓和正常血壓病患的比較方面，有高血壓者年紀較大，平均44歲，血壓正常者為37歲。有高血壓者也比較肥胖、身體質量指數為33，血壓正常者為28。
　　
　　有趣的是，高血壓病患發生躁鬱症時的年紀較輕，為24歲，血壓正常者則是29歲(P = .05)，平均躁症量表顯著高於其他人：40 vs 35 (P = .04)。
　　
　　D'Mello醫師認為，高血壓病患的嚴重度分數較高，這是個令人驚訝的新發現。我們在想，或許、高血壓是否是躁鬱症的一個偶然現象，而這是在急性期時的發現，我們不知道病患在6個月之後穩定時是否依舊有此關聯。
　　
　　北卡羅來納杜克大學精神科顧問教授Prakash Masand醫師為Medscape Psychiatry回顧此篇壁報且提出建議表示，可能是這兩種狀況 —高血壓與急性躁症 — 有一些共同潛在因素，例如，發炎因素。
　　
　　他表示，這是可以想像且合理的，藉由預防高血壓，或許可以修飾躁鬱症患者的表現與結果，不過，還需要更多研究來證實。
　　
　　D'Mello醫師擔任AstraZeneca、Schering和 Pfizer的發言人。Prasand醫師擔任Eli Lilly、Forest、GlaxoSmithKline、Janssen Cilag、Pfizer、Schering和UCB Pharma的發言人；是Dainippon Sumitomo、Eli Lilly、Pam Lab LLC、Pfizer、Sanofi Aventis、Schering和UCB Pharma的顧問；擁有Orexigen和Titan Pharmaceuticals公司的股權。
　　
　　美國精神科協會2010年會：摘要NR4-17。發表於2010年5月25日。  


Acute Mania Associated With Increased Hypertension Risk

By Caroline Helwick
Medscape Medical News

June 2, 2010 (New Orleans, Louisiana) — Bipolar patients with mania may be at risk for hypertension and other cardiometabolic disorders, according to a single-center study that diagnosed the condition in nearly half of patients admitted for mania.

Obesity was observed in 35% of the population as well, reported Dale D'Mello, MD, Michigan State University in Lansing, at the American Psychiatric Association 2010 Annual Meeting.

"We found the prevalence of hypertension to be higher in this cohort admitted for acute mania than for the general population. An earlier age of onset of bipolar disorder was predictive of the future development of hypertension, and the presence of concurrent hypertension was associated with more severe mania ratings," Dr. D'Mello said.

Patients with bipolar disorder experience a disproportionate burden of cardiometabolic disorders. The pathogenesis and clinical consequences of these comorbid medical conditions on the expression and course of bipolar disorder are not understood.

The purpose of the present study was to determine the prevalence and examine the clinical correlates of cardiometabolic disorders in patients hospitalized with bipolar disorder, he said.

The population included 99 patients hospitalized on an inpatient psychiatry unit for the treatment of bipolar manic and mixed states from 2002 to 2006. After stabilization, the patients completed a brief inventory that included demographic, disease, and treatment variables. A psychiatrist made the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis and completed the Young Mania Rating Scale.

The study showed that 45% of the patients admitted for mania or mixed states were hypertensive, compared with the 30.5% rate of hypertension in the general population, based on the National Health and Nutrition Examination Survey, Dr. D'Mello reported. He used the metabolic syndrome definition of hypertension (140/90 mm Hg).

The acute mania cohort also had a higher prevalence of dyslipidemia and diabetes, he added.

For the comparison between the hypertensive and normotensive patients, the patients with hypertension were older, with a mean age of 44 years vs 37 years for normotensive patients in the study. They were also more obese, with a mean body mass index of 33 vs 28 for the nonhypertensive group.

Interestingly, patients with hypertension had a significantly earlier mean age of onset of bipolar disorder — 24 vs 29 for normotensive patients (P = .05) — and achieved significantly higher mean mania ratings than the others — 40 vs 35 (P = .04).

"The finding of a higher severity score for persons with hypertension is new and surprising," Dr. D'Mello commented. "We wonder if the hypertension is an epiphenomenon of bipolar disorder, perhaps. And this is in the acute state. We don't know whether 6 months down the road when patients are stable, whether this association will still be seen."

Prakash Masand, MD, consulting professor of psychiatry at Duke University, Durham, North Carolina, viewed the poster and commented for Medscape Psychiatry that it is possible the 2 conditions — hypertension and acute mania — share some underlying factors, for instance, inflammatory factors.

It is conceivable and would be desirable, he said, that by preventing hypertension one might be able to modify the expression and outcome of persons with bipolar disorder, although much research would be necessary to show this.

Dr. D'Mello serves on the speakers' bureaus of AstraZeneca, Schering, and Pfizer. Dr. Prasand serves on the speakers' bureaus of Eli Lilly, Forest, GlaxoSmithKline, Janssen Cilag, Pfizer, Schering, and UCB Pharma; is a consultant for Dainippon Sumitomo, Eli Lilly, Pam Lab LLC, Pfizer, Sanofi Aventis, Schering, and UCB Pharma; and owns stock in Orexigen and Titan Pharmaceuticals Inc.

American Psychiatric Association 2010 Annual Meeting: Abstract NR4-17. Presented May 25, 2010.