Metabolic disorders such as overweight and obesity are widespread among individuals with bipolar disorder. The phenomenon affects a significant percentage of the population. Metabolic disorders cause a substantial financial liability and reduce the quality of life in both the general public and people with bipolar disorder. Excess weight has been proven to be crucial and an increasing health challenge across the world. The body mass index, which is calculated by dividing body weight by height, is primarily used in measuring overweight and obesity. The World Health Organization (WHO) considers a body mass index of up to 24kg/m^2 as overweight and a body mass index of greater than or equal to 31kg/m^2 as obese. Numerous studies have found out that more than 1.5 billion individuals are overweight, and another 300 million people are obese (Chen et al., 2018). Extra weight gain has serious mental issues, and it is ranked among the leading cause of the overall disease burden globally. The metabolic syndrome has raised numerous concerns in the health sectors because it is a complicated and multifactorial disorder that has been linked with augmented risk factors of stroke, heart conditions, diabetes mellitus, myocardial infarction, stroke, among others. Additionally, it is subject to debate because it has been connected to increased cardiovascular disease and mortality.
The prevalence of obesity in the U.S has been rising steadily over the past years. It has been followed by reported cases of metabolic syndrome, rising from 25% in 1988-95 to 30% in 1997 to 2005 (Moreira et al., 2017). Metabolic syndrome has been related to mood disorders, especially bipolar disorder. The study found that people with bipolar disorder are at high risk than the general public with obesity and overweight (Moreira et al., 2017). There is also sufficient evidence of an association between metabolic syndromes and their types. For instance, in the general public, overweight incidence has amplified from 24% to 40% in 2017 (Moreira et al., 2017). Patients with bipolar disorder have a high incidence rate, which stood at 45% in 2017 (Moreira et al., 2017). Bipolar disorder has been linked to an increased risk factor of dyslipidemia, hypertension, and diabetes.
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The lifestyle and behavioral dimensions of people with bipolar disorder play a crucial role in the high incidences of metabolic syndrome. Tobacco, a significant risk variable for cardiovascular illness, has been established to harm insulin performance and has been connected as a vital risk variable for metabolic syndrome, making it greatly predominant among patients with bipolar disorder. There is an existence of comorbidities for using nicotine for a more extended period. Substance abuse leads to anxiety and mood swings among patients with bipolar disorder. Co-morbid drug abuse disorder is also a common connection with metabolic syndrome and bipolar disorder. Excessive drinking and other toxins cause pancreatitis that increases the likelihood of diabetes.
Additionally, lack of physical exercise is also linked with a relationship between bipolar disorder and metabolic syndrome because it causes obesity and overweight. Studies found that the highest ratio of calories from sugars, whole liquid consumption of sugared intakes leads to rapid weight gain in bipolar individuals than in the general population (Bora et al., 2018). This is because people with bipolar disorder have the lowest basal metabolic proportions than people without the condition. There is also a significant gap between unusual intake habits and mood dysregulation. The reward system in the brain that controls the desire for food reinforces bad eating behaviors. Dopamine is found to facilitate the rewarding elements of diet in the brain. The region has been associated with increased feeding behaviors and obesity.
Healthcare and Financial Costs of Metabolic Syndrome among Bipolar Disorder Patients
Bipolar disorder is linked with premature mortality. The risk of bipolar disorder is high due to psychological signs and dysfunction related to the condition, which causes even high mortality, morbidity, and disability rates. It has been found that patients with bipolar disorder die earlier than people without due to metabolic issues, vascular and gastrointestinal infections (Bora et al., 2018). The occurrence of metabolic syndrome adds extra challenges to patients. The condition has serious health issues such as high risks of diabetes mellitus and increased mortality due to cardiovascular disease. It has other related conditions such as sleeping difficulties, fatty liver, lipodystrophies, among others.
The association between metabolic syndrome and bipolar disorders has serious economic burdens. It is estimated that the expenses of bipolar disorder in the United States stand at $70 billion in only direct financial costs such as outpatient and inpatient expenses (Bora et al., 2018). The indirect costs, which include lost productivity, amount to $40 billion (Bora et al.,2018). Fees from overall healthcare conditions contribute significantly to the financial burden of the two diseases. Bora et al. (2018) found that bipolar disorder patients use more than three times the medical resources and incur four times medical costs than non-bipolar disorder individuals. The increasing prices among the population are due to inpatient care.
Existing Literature
There is extensive literature regarding the association between metabolic syndrome and bipolar disorder. Silarova et al. (2015) investigated the incidence of metabolic syndrome and its characteristics amongst individuals with bipolar disorder. The study examined 2431 respondents, of which 241 has bipolar disorder and 1648 had major depressive disorder, while the rest of the population was a controlled sample. The study found high risks of MetS amongst individuals with bipolar disorder, unlike those with major depressive disorder. These people have a high chance of a high level of depression and abdominal obesity. Bai et al. (2016) also supported the study by evaluating the occurrence of MetS among BD patients. They found that bipolar disorder and metabolic syndrome have standard risk variables such as sympathetic nervous system dysregulation, lack of exercise, endocrine issues, and behavioral issues. Both conditions are at significant risk as they increase mortality among patients, low life expectancy, and heart-related illnesses.
There are also additional studies that argue about the association between BD and MetS. Fagiolini et al. (2008) argue that obesity and overweight have become common in MetS and BD compared to the general public. The authors commented that the two conditions have financial implications and reduce the quality of life. Rose et al. (2015) found that patients with bipolar disorder are more likely to be affected by BD because the neurobiology revolves around glucose metabolism and lipids. Van den Ameele et al. (2018) commented on the study by arguing that mild inflammatory condition is also linked with bipolar disorder. This is because that there are changes in metabolic procedures and stimulates cytotoxic ways.
Some studies have provided the recommended medication for the two conditions. Yumru et al. (2007) proposed mood stabilizers and antipsychotics to decrease the rate of metabolic syndrome. The participants selected randomly in the study were offered medication for three months. Those who were given antipsychotics demonstrated significantly high metabolic syndrome risks compared to the rest of the population. Vancampfort et al. (2013) clarified the pervasiveness and the coordination of MetS in individuals with BD. The authors found that maximum heart conditions and significant influence of morbidity and mortality are seen to be the cause of metabolic syndrome availability. The study concluded that high metabolic rates are prevalent among BD people compared to the controlled populations.
There is still an existing gap in the topic area. The solution to reducing metabolic syndrome among bipolar syndrome patients has not been addressed fully. Although there are considerable investigative studies regarding the prevalence and etiologies of metabolic indications in BD individuals, research openly addressing connected medical prices in people with these comorbidities is still limited (Kumar et al.,2017). There is also no quantitative research that assesses medical-associated and financial consequences in BD people with comorbid metabolic syndrome. There is also no transparency regarding the financial burden and non-mental medical care.
Target Population and Stakeholders
The main target population is the affected population of the two conditions. The research study will provide a clear framework for understanding why the two conditions are related and how to increase the quality of life among them. Bipolar disorder patients with metabolic syndrome will also be part of the target population. Participants will take place in clinical trials with their full consent. The key stakeholder is the data monitoring board. These individuals are responsible for monitoring data quality and evaluating the risk/benefit ratio during the participants` recruitment process and follow-ups. The board also assists in data sharing and remains active during clinical research until completing the trial. Another vital stakeholder will the disease advocacy organization. These are a group of people with similar conditions or diseases. They will assist in sharing resources and knowledge to support the study. They will also be in charge of patient education and medical care. The organization will also collaborate on numerous areas, such as developing the study design and reviewing medical trial procedures. They also incorporate clinical trial information collected by participants and the available data from the other databases.
Other key stakeholders are funders and sponsors. They provide resources for leveraging the study and setting guidelines on how the research will be carried out. They also encourage data sharing for the study. Upon completion of the study, they promote wider dissemination of the trial's outcomes. Sponsors will apply for articles to be posted in reputable journals such as Pub Med and many more. Regulatory agencies will be part of the project because they need to seek approvals and important data distribution considerations. These agencies will review the submitted application and check on protocols to ensure that the study fits the general public.
Barriers and Facilitators of the Proposed Project Implementation
The pace of scientific development is quick, with investigators publishing essential studies each day. The main barrier in this proposed project is financial difficulties. There will be challenges in securing and sustaining resources needed in the research. Another barrier is inadequate replication research. The survey outcomes pose inherent problems that prevent replication due to insufficient data or complex study design. There are also problems with peer review because it gives room for bias and professional jealousy.
The primary facilitator is the availability of a support system that increases morale. The available research center offers career counseling services that will enable the positive development of the research. There is also the presence of deadline extension, assistance program, and well-being services, thus offering a positive environment to carry out the study.
Conclusion
During project implementation, I would like to achieve the research objectives. The study's primary purpose is to provide awareness among bipolar disorder patients with metabolic syndrome and how medical practitioners can increase the quality of life among the affected population. Additionally, I would like to offer a comprehensive paper that is easy to understand among the general population. The key takeaway points that I hope to learn from my project are honesty during the whole research process, a study that will help other clinical research, and offer concrete recommendations on tackling the clinical issue.
References
Bai, Y.-M., Li, C.-T., Tsai, S.-J., Tu, P.-C., Chen, M.-H., & Su, T.-P. (2016). Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder. BMC Psychiatry , 16(1). https://doi.org/10.1186/s12888-016-1143-8
Bora, E., McIntyre, R. S., & Ozerdem, A. (2018). Neurococognitive and neuroimaging correlates of obesity and components of metabolic syndrome in bipolar disorder: A systematic review. Psychological Medicine , 49 (5), 738-749. https://doi.org/10.1017/s0033291718003008
Chen, J., Chen, H., Feng, J., Zhang, L., Li, J., Li, R., Wang, S., Wilson, I., Jones, A., Tan, Y., Yang, F., & Huang, X. (2018). Association between hyperuricemia and metabolic syndrome in patients suffering from bipolar disorder. BMC Psychiatry , 18 (1). https://doi.org/10.1186/s12888-018-1952-z
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van den Ameele, S., Fuchs, D., Coppens, V., de Boer, P., Timmers, M., Sabbe, B., & Morrens, M. (2018). Markers of Inflammation and Monoamine Metabolism Indicate Accelerated Aging in Bipolar Disorder. Frontiers in Psychiatry , 9. https://doi.org/10.3389/fpsyt.2018.00250
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