Bipolar Disorder and Diabetes Mellitus

Abstract

Comorbid endocrine and cardiovascular situations with bipolar disorder usually result from the bipolar disorder itself or as a consequence of its treatment. With habits and lifestyle, genetic tendency and side effects, this situation is becoming more striking. Subpopulations of bipolar disorders patients should be considered at high risk for diabetes mellitus. The prevalence of diabetes mellitus in bipolar disorder may be three times greater than in the general population. Comorbidity of diabetes causes a pathophysiological overlapping in the neurobiological webs of bipolar cases. Signal mechanisms of glycocorticoid/insulin and immunoinflammatory effector systems are junction points that point out the pathophysiology between bipolar disorder and general medical cases susceptible to stress. Glycogen synthetase kinase (GSK-3) is a serine/treonine kinase and inhibits the transport of glucose stimulated by insulin. It is affected in diabetes, cancer, inflammation, Alzheimer disease and bipolar disorder. Hypoglycemic effect of lithium occurs via inhibiting glycogen synthetase kinase. When comorbid with diabetes, the other disease -for example bipolar disorder, especially during its acute manic episodes-, causes a serious situation that presents its influences for a lifetime. Choosing pharmacological treatment and treatment adherence are another important interrelated areas. The aim of this article is to discuss and review the etiological, clinical and therapeutic properties of diabetes mellitus and bipolar disorder comorbidity.

Keywords

• Bipolar Disorder, Diabetes Mellitus , Late Onset, Comorbidity

Bipolar Bozukluk ve Diyabetes Mellitus

Öz

Bipolar bozukluk tanısı alan hastalarda görülen endokrin ve kardiyovasküler durumlar bipolar bozukluğun kendinden ya da sağaltımından kaynaklanmaktadır. Alışkanlıklar, yaşam tarzı, genetik yatkınlık ve tedavi yan etkileri ile bu tablolar kimi zaman giderek ağırlaşır. Bipolar bozukluğu olan olguların bir alt grubu diyabet geliştirmeye yatkındır. Öte yandan, bipolar olgular arasında diyabet sıklığı genel popülasyondakinden üç kat daha fazladır. Diyabetes mellitus eştanısı bipolar bozukluğu olan olguların nörobiyolojik ağlarında patofizyolojik olarak bir üst üste binişiklik yaratmaktadır. Glukokortikoid/insülin sinyal mekanizmaları ve immünoinflamatuar efektör sistemler bipolar bozukluk ile stres duyarlı genel tıbbi durumlar arasındaki patofizyolojiye işaret eden kesişim noktalarıdır. Glikojen sentetaz kinaz (GSK-3) bir serin/treonin kinaz olup insülinin uyardığı glukoz taşınımını baskılamaktadır. Bu enzim, diyabetes mellitus, kanser, inflamasyon, Alzheimer hastalığı ve bipolar bozuklukta etkilenir. Örneğin; bipolar bozukluk tedavisinde kullanılan lityum hipoglisemik etkisini GSK-3'ü inhibe ederek gösterir. Öte yandan, diyabetes mellitus birlikte bulunduğu diğer hastalığın -örneğin bipolar bozukluk, özellikle akut manik dönemleri- sürecini yaşam boyu etkileyen önemli bir durumdur. Tedavi seçimi ve tedavi uyumu ise bu iki hastalık arasında bir diğer önemli etkileşim alanıdır. Bu yazının amacı diyabetes mellitus ve bipolar bozukluk birlikteliğini etiyolojik, klinik ve tedavi özellikleri yönünden tartışmak ve gözden geçirmektir.

Anahtar Kelimeler

• Bipolar Bozukluk, Diyabetes Mellitus, Geç Başlangıç, Komorbidite

Kaynakça

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