Lipid Correlates of Attentional Impulsivity in First Episode Mania: Results from an Indian Population

By Kavoor, Anjana; Ram, Daya et al. | Indian Journal of Psychological Medicine, October-December 2014 | Go to article overview

Lipid Correlates of Attentional Impulsivity in First Episode Mania: Results from an Indian Population


Kavoor, Anjana, Ram, Daya, Mitra, Sayantanava, Indian Journal of Psychological Medicine


Byline: Anjana. Kavoor, Daya. Ram, Sayantanava. Mitra

Background: Attentional/cognitive impulsivity has been demonstrated as being associated with an increased risk for suicide and other self-harming behaviors, along with a more severe course in patients with bipolar disorder. That an alteration of the various serum lipid fractions might be associated with increased impulsivity has been proposed in the past, but evidences are ambiguous and mainly based on western population data. Objective: The present study was aimed to analyze the attentional impulsivity and various serum lipid fractions in bipolar patients, from an Indian perspective. Materials and Methods: At presentation, 60 drug free/naive first episode Mania patients were rated on the Barratt impulsiveness scale-version 11 and Young Mania Rating Scale; body mass index (BMI) was calculated and blood samples were analyzed for total cholesterol (TC), high density lipoproteins, low density lipoproteins and very low density lipoproteins (VLDL), triglycerides (TG) and apolipoproteins A1 and B. Results: The analysis revealed statistically significant negative correlation and inverse linear relationship between TC, TG, VLDL and BMI with attentional impulsivity. Conclusion: The present study adds to the growing literature on a complex relationship between lipid fractions and attentional impulsivity. The findings present interesting insights into the possible substrates of human behavior at biochemical levels. The implications are many, including a need to introspect regarding the promotion of weight loss and cholesterol reduction programs in constitutionally vulnerable population.

Introduction

The construct of impulsivity is multifaceted, [sup][1],[2],[3] manifest as "actions which are poorly conceived, prematurely expressed, unduly risky or inappropriate to the situation and that often result in undesirable consequences". [sup][4] Impulsivity, in relation to affective disorders, have been studied extensively and a significantly higher level of impulsivity has been demonstrated in these subjects as compared to a healthy population. [sup][5],[6],[7],[8],[9],[10] Researchers have also found an increased impulsivity in euthymic bipolar patients; [sup][11],[12] though the acute neurochemical changes in brain probably leads to a particularly overt manifestation of this feature [sup][13],[14],[15] during manic episodes.

The neurobiological basis of this impulsivity has received considerable attention in recent years, in terms of both the anatomical [sup][16],[17] as well as the neurochemical [sup][18] foundations. Deficient central serotonergic transmission has been proposed [sup][19],[20],[21] as a biological substrate for impulsivity; and a number of studies in past have suggested serum cholesterol to be a surrogate marker [sup][22],[23],[24] for the same and demonstrated a correlation between serum cholesterol and various measures of impulsivity [sup][19],[20],[25],[26],[27],[28] across psychiatric diagnoses. Studies have discussed the effects of cholesterol on serotonergic function, [sup][29],[30] through its influence on the function of membrane-bound serotonergic structures by altering membrane fluidity [sup][31] and reduction in serotonin transporter activity due to their destabilization after cholesterol depletion. [sup][29] Cholesterol depletion also has been found to result in an impaired functioning of 5-HT1A and 5-HT7 receptors. [sup][32],[33] Cholesterol is also a major component of lipid rafts, which are of significance in synaptic function; [sup][34] and thus depletion of cholesterol has been shown to have diffuse effects on not only serotonergic functioning, but also on other neurotransmitter systems, including the excitatory amino acid transport, [sup][35] gamma-amino butyric acid transmission [sup][36] and opioid signaling. [sup][37] A tentative conclusion that can be drawn from studies on this aspect is that the interactions between cholesterol and serotonergic functions are almost certain. …

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