Studying the relationship between plasma dopamine levels and clinical characteristics of bipolar disorder, manic episode – Nguyen Manh Phat

Journal of military pharmaco-medicine n 0 6-2018 167 STUDYING THE RELATIONSHIP BETWEEN PLASMA DOPAMINE LEVELS AND CLINICAL CHARACTERISTICS OF BIPOLAR DISORDER, MANIC EPISODE Nguyen Manh Phat*; Ngo Ngoc Tan**; Nguyen Trong Dao** SUMMARY Objectives: To investigate the relationship between plasma dopamine level and clinical features in patients with bipolar disorder, manic episode. Subjects and methods: The study included 62 inpatients with bipolar disorder, manic episode, who were received treatment at National Psychiatric Hospital No 1, from July 2015 to December 2017. Use criteria ICD-10 for diagnosis. Use method of prospective, cross-sectional, case-by-case analysis. Test plasma dopamine twice (first time in week 1, second time after first time 25 - 30 days). The data were processed by medical statistics using program STATA 12.0. Results: After a period of treatment, mean plasma dopamine levels in patients decreased significantly with p < 0.001 (from 31.40 ± 7.38 ng/L in first time to 17.66 ± 5.95 ng/L in the second time). Plasma dopamine levels were statistically significantly decreased in patients with diagnostic groups F31.1 and F31.2. Plasma dopamine levels were statistically significant decreased in patients with increased mood, emotional tension, hyperactivity, agitated activity and grandiose delusions. Conclusion: Plasma dopamine levels significantly associated with many symptoms of manic episode. * Keywords: Bipolar disorder; Plasma dopamine levels. INTRODUCTION The manic episode in bipolar disorder has many symptoms with diverse clinical manifestation. Dopamine plays an important role in the pathogenesis of bipolar mood disorder, the manic episode. In Vietnam, there is no study on the relationship between clinical characteristics and plasma dopamine levels in patients with bipolar disorders, the manic episode. Objectives of the study: To study the relationship between plasma dopamine levels and clinical characteristics of bipolar disorder, the manic episode. SUBJECTS AND METHODS 1. Subjects. 62 inpatients with bipolar disorder, the manic episode, who was received treatment at National Psychiatric Hospital No 1, from July 2015 to December 20107. 2. Methods. - Use criteria ICD-10 for diagnosis. - A prospective, cross-sectional, case- by-case analysis. Test plasma dopamine twice by ANOVA single factor methods. * National Psychiatric Hospital No 1 ** 103 Military Hopsital Corresponding author: Nguyen Manh Phat (bsphat1999@gmail.com) Date received: 17/05/2018 Date accepted: 21/06/2018 Journal of military pharmaco-medicine n 0 6-2018 168 - Time for the dopamine plasma test: + First time in week 1, after hospitalization. + Second time after first time 25 - 30 days. The data were processed by medical statistics using program STATA 12.0. RESULTS Table 1: Plasma dopamine levels in patients. Statistical index Time of test n X SD SE CI First time 62 31.40 7.38 0.94 29.52 - 33.27 Second time 62 17.66 5.95 0.75 16.15 - 19.18 The first time test: n = 62; X= 34.40 ng/L; SD = 7.38 ng/L; SE = 0.94; CI = 29.52 - 33.27. The second time test: n = 62; X= 17.66 ng/L; SD = 5.95 ng/L; SE = 0.75; CI = 16.15 - 19.18. The two surveys of test dopamine had statistically significant differences with p < 0.001. Table 2: Relationship between diagnostic groups and plasma dopamine levels. Plasma dopamine levels (ng/L) Statistical index Groups n = 62 Test 1 time (t1) Test 2 time (t2) p1,2 F31.0 5 21.24 ± 3.65 16.54 ± 4.35 p > 0.05 F31.1 13 27.28 ± 4.44 17.30 ± 6.44 p < 0.001 F31.2 44 33.76 ± 6.90 17.90 ± 6.05 p < 0.001 (1: t1 - t2 = 2.3310 and p1 - p2 = 0.0802; 2: t1 - t2 = 8.4377 and p1 - p2 = 0.0000; 3: t1 - t2 = 13.6622 and p1 - p2 = 0.0000) Plasma dopamine levels in 2 surveys of F31.1 and F31.2 were statistically significant differences with p < 0.001. Table 3: Relationship between plasma dopamine levels and mood symptoms. Plasma dopamine levels (ng/L) Test 1 time (t1) Test 2 time (t2) Statistical index Symptoms n = 62 ( X ± SD) n = 62 ( X = SD) p1 = p2 Increasing mood n = 62 31.40 ± 7.38 n = 12 21.50 ± 6.09 p < 0.001 Unstalbe mood n = 10 32.42 ± 6.76 n = 1 19.13 ± 0.00 p > 0.05 Explosive mood n = 21 35.30 ± 8.84 n = 2 24.71 ± 2.65 p > 0.05 Tensive mood n = 30 32.75 ± 7.32 n = 3 21.60 ± 5.71 p < 0.05 (1: t1 - t2 = 9.8928 and p = 0.0000; 2: t1 - t2 = 13.29 and p = 0.094; 3.: t1 - t2 = 10.5855 and p = 0.113; 4: t1 - t2 = 11.1473 and p = 0.016) Journal of military pharmaco-medicine n 0 6-2018 169 Plasma dopamine levels in 2 surveys of increasing mood were statistically significant differences with p < 0.001. Plasma dopamine levels in 2 surveys of tensive mood had statistically significant differences with p < 0.05. Table 4: Relationship between plasma dopamine levels and activity. Plasma dopamine levels (ng/L) Test 1 time (t1) Test 2 time (t2) Statistical index Disorder of activity n = 62 ( X ± SD) n = 62 ( X = SD) p1 = p2 Hyperactivity n = 57 31.08 ± 7.00 n = 9 22.43 ± 6.42 p < 0.01 Interfering in everything n = 34 31.90 ± 7.88 n = 4 22.92 ± 6.32 p < 0.05 Do not cooperate on medical examination n =13 34.45 ± 7.24 n = 1 31.87 ± 0.00 p > 0.05 Agitated activity n = 31 33.88 ± 7.93 n = 1 22.84 ± 0.00 p < 0.05 Waste of money n = 12 32.26 ± 6.23 n = 1 26.59 ± 0.00 p > 0.05 (1: t1 - t2 = 8.6597 and p = 0.001; 2: t1 - t2 = 8.9810 and p = 0.035; 3: t1 - t2 = 2.5769 and p = 0.738; 4: t1 - t2 = 11.0361 and p = 0.0181; 5: t1 - t2 = 5.6708 and p = 0.408) Plasma dopamine levels in 2 surveys of hyperactivity were statistically significant differenct with p < 0.01. Plasma dopamine levels in 2 surveys of interfering in everything and hysterical activity were statistically significant differences (p < 0.05). Table 5: Relationship between plasma dopamine levels and delusions. Plasma dopamine levels (ng/L) Test 1 time (t1) Test 2 time (t2) Statistical index Kind of delusion n = 62 ( X ± SD) n = 62 ( X= SD) p1 = p2 Delusion of persecution n = 19 37.41 ± 7.12 n = 0 0 0 Grandiose delusions n = 42 33.95 ± 7.01 n = 4 14.60 ± 1.10 p < 0.001 Delusion of jealousy n = 4 35.39 ± 8.20 n = 0 0 0 (1: t1 - t2 = 0 and p = 0; 2: t1 - t2 = 19.3457 and p = 0.0000; 3: t1 - t2 = 0 and p = 0) Plasma dopamine levels in 2 surveys of grandiose delusions were statistically significant differences with p < 0.001). DISCUSSION The first time test: n = 62; X= 34.40 ng/L; SD = 7.38 ng/L; SE = 0.94; CI = 29.52 - 33.27. The second time test: n = 62; X = 17.66 ng/L; SD = 5.95 ng/L; SE = 0.75; CI = 16.15 - 19.18. The two surveys of test dopamine were statistically significant difference with p < 0.001. Ambade V et al (2011) found that mean ± standard deviation of plasma dopamine in healthy was 21.8 ± 9.5 ng/L. Journal of military pharmaco-medicine n 0 6-2018 170 Cousins D.A et al (2009) found that dopamine plays a very important role in the pathogenesis of bipolar mood disorders, mania. The authors suggested that dopamine levels increase and dopaminergic activity increase in the brain. - Plasma dopamine levels in 2 surveys of F31.1 and F31.2 were statistically significant different with p < 0.001. Sadock B.J (2015) supposes that symptoms of manic episodes without psychosis and psychosis are similar. - Plasma dopamine levels statistically significantly decreased in patients with increasing mood, emotional tension, hyperactivity, agitated activity and grandiose delusions. According to Kristina R (2012), dopamine is a catecholamine that plays a significant role in bipolar disorders. Excess dopamine activity facilitates mania and delusional symptoms. John Cookson (2013) found that drugs with more specific dopamine-receptor blocking actions have antimanic properties although these drugs are less sedative, without blocking actions at histamine or noradrenaline receptors. He supposes drug treatment (with olanzapine, quetiapine and presumably the other antipsychotics) improved the whole range of symptoms (including elation, flight of ideas, grandiosity, sexual interest, irritability, aggression, general appearance and insight, as well as the items most sensitive to sedation: insomnia, overactivity and pressure of speech). CONCLUSION After a period of treatment: - Mean plasma dopamine levels in patients decreased significantly p < 0.001 (from 31.40 ± 7.38ng/L in the first time to 17.66 ± 5.95ng/L in the second time). - Plasma dopamine levels were statistically significantly decreased in patients with diagnostic groups F31.1 and F31.2. - Plasma dopamine levels were statistically significantly decreased in patients with increasing mood, emotional tension, hyperactivity, agitated activity and grandiose delusions. REFERENCES 1. Ambade V, Brig M.M A, Col P S et al. Adrenaline, noradrenaline and dopamine level estimation in depression: Does it help?. MJAFI. 2009, 65, pp.216-220. 2. Cousins D.A, Butts K, Young A.H. The role of dopamine in bipolar disorder. Bipolar Disord: 11, pp.787-806. The Authors. Journal Compilation. John Wiley & Sons A ⁄S. 3. John C. Dopamine hypothesis of Mania. Journal of Mood Disorders. 3 (Suppl. 1), S1-S3. 2013. 4. Kristina R.S, Bertalan D. Bipolar disorder: Diagnosis, neuroanatomical and biochemical background. Clinical research and treatment approaches to affective disorders. Edited by Dr. Mario Juruena. Published in print edition. 2012, February. 5. Sadock B.J, Sadock V.A. Mood disorders. Synopsis of Psychyatry. Eleventh edition. 2015, pp.457-486.