Abstract
BackgroundBlood homocysteine concentration (BHC) is higher in patients with alcohol use disorder (AUD). Previous studies have found a relationship between depressive symptoms severity and BHC in AUD patients and recently some authors have found high BHC among patients with bipolar disorder, both during manic and depressive episodes and in euthymic state. However, BHC in patients with mixed mood episode has not yet been investigated. The aim of this study was to evaluate the BHC of patients with AUD and mixed mood episode.MethodsA sample of AUD outpatients was assessed by Mini-International Neuropsychiatric Interview (MINI Plus): those with a DSM-IV-TR mood disorder with mixed features were included in the MIXED group (n = 45), whereas those without mood episode were gathered in the NO MOOD group (n = 23). Two subgroups, MIXMANIA and MIXDEPRESSION, were formed according to the prevalence of manic or depressive symptoms, assessed by Young Mania Rating Scale (YMRS), and Hamilton Rating Scale for Depression (HDRS). The Alcohol Use Disorder Identification Test (AUDIT) was used to appraise the AUD. BHC was determined by High-Performance Liquid Chromatography.ResultsThe MIXED group showed greater severity of both depressive (26.35 ± 9.96 vs. 4.77 ± 0.92; p < 0.001) and manic (22.35 ± 3.30 vs. 6.14 ± 1.12; p < 0.001) symptoms, and higher BHC (28.80 ± 11.47 vs. 10.83 ± 2.81; p < 0.001), than the NO MOOD group. BHC was strongly correlated to the HDRS, YMRS and AUDIT scores, just as HDRS was to YMRS, and AUDIT was to both HDRS and YMRS, in the MIXED group only (p < 0.001).The MIXDEPRESSION subgroup showed higher BHC than the MIXMANIA subgroup (Mdn = 42.96, IQR = 10.44 vs. Mdn = 19.77, IQR = 5.93; p < 0.001).A linear regression model conducted on the MIXED group found a significant predictive value for BHC of both HDRS (β = 0.560, t = 2.43, p = 0.026) and AUDIT (β = 0.348, t = 2.17, p = 0.044).ConclusionsDepressive symptoms seem to be mainly implicated in the BHC elevation among patients with both mixed features mood disorder and AUD.
Highlights
Blood homocysteine concentration (BHC) is higher in patients with alcohol use disorder (AUD)
Several authors since the early 1990s have studied the association between HHcy and AUD, reporting both that the increase of Hcy among AUD patients is proportional to AUD severity and that alcohol abstinence leads to a reduction of blood homocysteine concentration (BHC) [6,7,8,9,10,11]
Assuming the aforementioned relationship between mixed state, AUD and HHcy, we aimed to evaluate whether the BHC of AUD patients with mixed mood episode was higher than that of AUD patients without current episode of any mood disorder, and we focused on the differences between mixed episodes with prevalent depressive symptoms and mixed episodes with prevalent manic symptoms
Summary
Blood homocysteine concentration (BHC) is higher in patients with alcohol use disorder (AUD). The aim of this study was to evaluate the BHC of patients with AUD and mixed mood episode. Alcohol use disorder (AUD) is a problematic pattern of drinking, leading to clinically significant impairment or distress, characterized by behavioral and physical symptoms, such as withdrawal, tolerance, and craving [5]. Several authors since the early 1990s have studied the association between HHcy and AUD, reporting both that the increase of Hcy among AUD patients is proportional to AUD severity and that alcohol abstinence leads to a reduction of blood homocysteine concentration (BHC) [6,7,8,9,10,11]. It was postulated that the HHcy found in patients suffering from AUD was due to a low intake of folate [15, 16], but succeeding studies discovered a complex interaction between alcohol, smoke, vitamin B6, vitamin B12, folate, betaine and Hcy metabolism that may involve poor absorption, hepatic uptake and retention of these nutrients, as well as both greater damage to the liver and an inhibition of enzyme activity [2, 19,20,21,22,23,24,25]
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