**5. Conclusion**

340 Dyslipidemia - From Prevention to Treatment

In addition, obesity was more frequent in depressive patients than in those with manic episode (38.1% *Vs* 27.8%). Previous studies reported that patients who had depressive symptomatology were more likely to have excessive caloric and cholesterol intake, to smoke and to be inactive than non-depressed subjects. Another explanation might involve biological mechanisms: it is ascertained that hypothalamic–pituitary- adrenal (HPA) axis dysregulation and high cortisol blood levels lead to increased visceral fat. HPA axis dysregulation has been a common finding in both unipolar and bipolar disorders; recently, some studies reported that increased cortisol blood levels correlated to the amount of intra-

About therapeutic characteristics, we found that obesity and overweight were more frequent (72% and 52%; respectively) in patients taking valproic acid or lithium. These findings are in line with those reported by De Hert et al. (2011). Moreover, Casey et al. (2005) reported that lithium have been shown to stimulate appetite through different mechanisms. The "carbohydrate craving" that is thought to be one of the mechanisms of increased calorie intake in people taking lithium is well known. In addition, it is believed that valproate also stimulates weight gain through a variety of mechanisms, especially the development of insulin resistance and diabetes mellitus type 2. In this line, our study found that this type of diabetes is frequent in patients (16.2%). Additionally, the risk of diabetes is multiplied by 1.5 in patients (16.2% *Vs* 9.7%, OR = 1.60, IC 95% = 0.62-4.12; p = 0.325). Previous studies suggested that patients with both bipolar disorder and comorbid diabetes have more lifetime psychiatric hospitalizations than patients with bipolar patients without diabetes. The association between these two disorders underscores the importance of screening for diabetes in patients with bipolar illness, particularly because early detection and initiation of treatment to control glycemia may prevent diabetes-related complications. Moreover, other studies have demonstrated cerebrovascular lesions involving small intraparenchymal cerebral vessels and focal infarctions in patients with diabetes. These lesions predominantly occur in areas providing blood supply to the base of the pons, thalamus, and basal ganglia. Diabetes has been implicated as a risk factor for subcortical white-matter lesions observed on magnetic resonance imaging (MRI) scans; similar MRI findings have been noted in patients with bipolar disorder. Cerebral microvascular disease may lead to greater frequency of manic episodes, another reason to minimize diabetesrelated complications in patients with comorbid bipolar disorder (Cassidy et al., 1999;

Alcoholic beverage was not significantly associated with this illness but we showed that it was more frequent in patients than controls (13.1% *Vs* 6.9%, OR = 2.04, IC 95% = 0.94-4.44; p = 0.067). It has been well documented that bipolar disorder and alcoholism commonly cooccur. In fact, the lifetime prevalence of alcohol abuse and drug abuse in people with bipolar disorder are known to be three to nine times more frequent that of the general population

Additionally, some studies showed that the feelings of depression and anxiety associated with bipolar can be a factor that leads to alcoholism. People with bipolar disorder may use alcohol or other drugs to self medicate these feelings, especially in instances where the person has not been diagnosed. However, alcohol makes the symptoms of bipolar disorder worse. Anyone who shows symptoms of bipolar disorder should seek the advice of medical

(Merikangas et al., 2007; Regier et al., 1990; ten Have et al., 2002).

abdominal fat in major depression (Maina et al., 2008).

Holman et al., 2008).

professionals (Le Strat, 2010).

Our results demonstrate that Tunisian bipolar I patients are exposed to higher cardiovascular risk. In fact, they had perturbations in lipid profile: significantly higher values of triglycerides and Lp(a), and significantly lower values of ApoA1, significantly hyperhomocysteinemia and hyperuricemia (in men), significantly hypofolatemia and high prevalence of metabolic syndrome. Obesity, hyperLp(a), hypertriglyceridemia, hypofolatemia, hyperhomocysteinemia and cigarette smoking were the main cardiovascular risk factors associated with bipolar I disorder. Indeed, the risk of obesity was increased approximately for nine once, hyperLp(a), hypertriglyceridemia and hypofolatemia approximately for four once and the other factors approximately for tow once. The TG/HDL ratio and Lp(a) were found as the best predictive factors of cardiovascular risk in terms of sensibility and specificity at threshold of 1.12 and 168 mg/L, respectively.

Our findings noted a significant association between vitamin B12 values and illness episode. Manic patients had lower values of this parameter than depressive patients. Moreover, we showed that vitamin B12 was significantly associated with the therapeutic characteristics. Indeed, patients taking carbamazepine had significantly lower values of this parameter than those taking valproic acid and lithium. Additionally, there was no significant change in homocysteine, folate, uric acid values and metabolic syndrome in relation to illness episode and the treatment, whereas the patients with metabolic syndrome had significant higher levels of HOMA-IR and uric acid than metabolic syndrome free.

Therefore, bipolar I patients require specific care, particularly for lipid profile, vitamin status and weight; the effectiveness of this care will be evaluated during follow-up period Clinicians should track the effects of treatment on physical and the biological parameters, and should facilitate access to appropriate medical care.

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**17** 

D. Saravane

*France*

**Dyslipidemia and Mental Illness** 

Almost most mental illness, such as schizophrenia, bipolar disorder, and depression are associated with undue medical morbidity and mortality. It represents a major health problem, with 20 to 30 years shorter lifetime mortality are primarily due to premature cardiovascular disease (myocardial infarction, stroke…). The cardiovascular events are strongly linked to non modifiable risk factors such as age, gender, personal and/or family history, but also to crucial modifiable risk factors, such as overweight and obesity,

Although these classical risk factors exist in the general population epidemiological studies suggest that patients with severe mental illness have an increased prevalence of these risk

Another point is the causes of increased metabolic and cardiovascular risk in this population are related to poverty, poor diet, sedentary and compared to the general population. The increased morbidity and mortality limited behaviour access to medical care, but also to the use of psychotropic medication. Over recent years it has become apparent that antipsychotic

Results of most research on the physical health of people with mental health illness suggest the morbidity and the mortality from certain physical disease is high in these populations. Patients with schizophrenia are a medically vulnerable population due to underdiagnosed medical problems, and minimal or not utilization of primary care services. Not only there is

Medical comorbidity in patients with bipolar disorder, is associated with an intensification of bipolar depressive symptoms and other indices of bipolar severity, as well as premature

An increasing number of studies have found higher rates of mortality in schizophrenia patients due to natural causes (Mortensen & Juel, 1993; Ruschena et al, 1998). Such increased rates of mortality due to natural causes highlight the failure to detect and manage physical health conditions in this group. In meta-analysis deaths due to natural causes accounted for

increased medical morbidity among these patients, there is also increased mortality.

mortality. Somatic health issues remain underrecognized and suboptimally treated.

drugs can have a negative impact on some of the modifiable risk factors.

**1. Introduction** 

factors.

**2.1 Mortality** 

dyslipidemia, diabetes, hypertension and smoking.

**2. Epidemiological studies** 

*Head of Department Medicine and Specialists* 

*Ville-Evrard Hospital Neuilly/Marne* 

