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Guest Editorial
Highlighting Bipolar II Disorder
Gordon Parker, MD, PhD, DSc, FRANZCP
(PDF)

In Review
Neurobiological Findings in Bipolar II Disorder Compared With Findings in Bipolar I Disorder
Brent M McGrath, BSc, MSc, Phillip H Wessels, MD, FRCPC, Emily C Bell, BSc, MSc, Michele Ulrich, BSc, Peter H Silverstone, MB, BS, MD, MRCPsych, FRCPC
(PDF)

Bipolar II Disorder: An Overview of Recent Developments
George Hadjipavlou, MA, MD, Hiram Mok, MA, MB, BCh, BAO, FRCPC, Lakshmi N Yatham, MBBS, MRCPsych, FRCPC3 (PDF)

Review Paper
Bipolar Disorder: It’s All in Your Mind? The Neuropsychological Profile of a Biological Disorder
Gin S Malhi, BSc, MB, ChB, MRCPsych, FRANZCP, Belinda Ivanovski, Ssc Psychol, M Clin Psychol, Viktoria Szekeres, BSc,Psychol
(PDF)

Original Research
Impact of Culture on Depressive Symptoms of Elderly Chinese Immigrants
Glenda MacQueen, MD, PhD, FRCPC
Daniel WL Lai, PhD
(PDF)

Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Nicole Smolla, PhD, Jean-Pierre Valla, MD, MSc, Lise Bergeron, PhD, Claude Berthiaume, MSc, Marie St-Georges, MPs
(PDF)

Command Hallucinations Among Asian Patients With Schizophrenia
Theresa MY Lee, MBBS, MMed, Siow Ann Chong, MBBS, MMed, Yiong Huat Chan, PhD, Gangaharan Sathyadevan, MBBS, MRCPsych
(PDF)

The Centre for Addiction and Mental Health Concurrent Disorders Screener
Juan C Negrete, MD, FRCPC, Jane Collins, MSc, Nigel E Turner, PhD, Wayne Skinner, MSW
(PDF)

Validation de la version française du questionnaire de Sociotropie-Autonomie de Beck et collègues
Mathilde M Husky, MSc, Olivier S Grondin, MSc, Philippe D Compagnone, PhD
(PDF)

Brief Communication
Depressive Symptoms and Alcohol Consumption Among Nonalcoholic Depression Patients Treated With Desipramine
Benjamin I Goldstein, MD, PhD, Ayal Schaffer, MD, FRCPC, Anthony Levitt, MD, FRCPC, Ari Zaretsky, MD, FRCPC, Russell T Joffe, MD, FRCPC, Virginia Wesson, MD, R Michael Bagby, PhD
Pierre Bleau, MD, FRCPC
(PDF)

Letters to the Editor
(PDF)

Safety of Clozapine in 2 Successive Pregnancies

Revisiting the Diagnostic Challenges of Secondary Mania and Bipolar Disorder in a Patient With Borderline Hyperthyroidism

Dyslipidaemia and Psychiatric Patients

Dream Contents in Patients With Major Depressive Disorder

Sensory Deprivation and Disorders of Perception

Re: The Internet’s Impact on the Practice of Psychiatry

Response: The Internet’s Impact on the Practice of Psychiatry

Denial and Avoidance in an Unusual Case of Death From Breast Cancer

Interferon-Induced Mania

Drug-Induced Psychosis After Long-Term Treatment With Levetiracetam

Priapism

An Ounce of Prevention: “COPEing with Toddler Behaviour”

Internet Gaming Addiction

Letters to the Editor

Dyslipidaemia and Psychiatric Patients

Dear Editor:
Associations between atypical antipsychotics (ATPs), weight gain (1), and diabetes (2) have been reported, and links between some ATPs and dyslipidaemia, particularly elevated triglycerides, have been identified (3). Dyslipidaemia is a major contributor to cardiovascular disease and 36% of deaths (over 78 900) in Canada yearly are due to diseases of the circulatory system (4). Raised C-reactive protein is also seen as a strong predictor of a cardiovascular event (5).

Nine months ago, I began routinely testing patients’ lipid, C-reactive protein, and blood glucose levels. So far, I have tested 89 patients, about one-sixth of my practice. Among those patients tested, 67% had a two-fold or more risk of a cardiovascular event, based on a raised total cholesterol/HDL-C ratio. This held true whether the patient was on a conventional antipsychotic, (11 of 13 or 85%) , an ATP (25 of 41or 61%, or no antipsychotic (25 of 35 or 66%). Elevated C-reactive protein was present in 8% of patients. The screening process did not allow for any attribution of cause or determination of how long the elevated levels had been present.

Monitoring weight, blood glucose, and lipids should become routine psychiatric practice, and where necessary, the primary physician should be alerted. These measures are not routinely done in psychiatric inpatient settings, and a recent survey found that only about 50% of inpatients were checked for blood glucose and weight (6). Encouraging healthy diets, weight loss, and exercise is necessary. However, results of exercise programs may not be encouraging, as motivation is crucial (7). Medical management, including the use of statins, may be indicated.

If my results are characteristic of a general adult psychiatric population, all patients, regardless of diagnosis and treatment, should be appropriately screened and monitored. Psychiatric populations, for various reasons, appear to be at increased risk of cardiovascular disease.

References

1. McIntyre RS, Trakas K, Lin D, Balshaw R, Hwang P, Robinson K, and others. Risk of weight gain associated with antipsychotic treatment: results from the Canadian National Outcomes Measurement Study in Schizophrenia. Can J Psychiatry 2003:48:689–94.

2. Gianfrancesco F, White R, Wang RH, Nasrallah AH. Differential effects of risperidone, olanzapine, clozapine and conventional antipsychotics on type 2 diabetes: findings from a large health plan database. J Clin Psychiatry 2003:64:847–8.

3. McIntyre RS, McCann SM, Kennedy SH. Antipsychotic metabolic effects: weight gain, diabetes and lipid abnormalities. Can J Psychiatry 2001:46:273–81.

4. Health Canada. The growing burden of heart disease and stroke in Canada. Ottawa: Health Canada, May 2003.

5. Ridker PM, Rifai N, Buring JE, Cook NR. Comparisons of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Eng J Med 2002;347:1557–65.

6. Boilson M, Hamilton RJ. A survey of monitoring of weight and blood glucose in in-patients. Psychiatr Bull 2003;27:424–6.

7. Archie S, Wilson JH, Osborne S, Hobbs H, McNiven J. Pilot study: access to fitness facility and exercise levels in olanzapine-treated patients. Can J Psychiatry 2003:48:628–32.

Robin Menzies, MB, BS, MRCPsych, FRCPC
Saskatoon, Saskatchewan