Metabolic dysregulation in psychotic mania: longitudinal cardiometabolic changes with exploratory analyses of serum uric acid

Abstract Background: Psychotic mania is a severe manifestation of bipolar disorder characterized by elevated mood, hyperactivity, and psychotic features. It often disrupts metabolic processes, putting patients at risk for metabolic syndrome and cardiovascular diseases. Method: This study employed a prospective study design involving 30 patients with psychotic mania, 30 first-degree relatives, and 30 age- and sex-matched healthy controls. Serum uric acid levels and various metabolic parameters were analyzed concurrently to elucidate their potential interrelationship. Results: Results: Serum uric acid levels showed no significant changes between baseline (mean ± SD: 5.84 ± 1.74 mg/dL) and follow-up (mean ± SD: 5.15 ± 1.63 mg/dL). However, notable increases were observed in triglycerides (from 125.73 ± 69.67 to 169.07 ± 72.46 mg/dL, p = 0.010), systolic blood pressure (from 116.80 ± 7.59 to 119.80 ± 6.99 mm Hg, p < 0.001), and body mass index (BMI) (from 20.90 ± 3.91 to 21.12 ± 3.91 kg/m², p < 0.001). Negative correlations emerged between changes in uric acid and select metabolic indicators, including triglycerides and low-density lipoprotein (LDL). Conclusion: This study demonstrates the necessity for integrated care approaches that address both psychiatric symptoms and metabolic health in patients with psychotic mania, emphasizing the potential of uric acid as a marker of underlying metabolic dysfunction.