Relationship between Serum Homocysteine and Metabolic Syndrome among Patients with Schizophrenia and Bipolar Disorder: A Cross Sectional Study
,
Abstract
Objective: This study aimed to compare the prevalence of metabolic syndrome and hyperhomocysteinemia and to specify predictors of the metabolic syndrome among patients with schizophrenia and bipolar disorder.
Method: This cross sectional study was conducted on 100 patients with schizophrenia and 100 patients with bipolar disorder. The participants' metabolic syndrome was determined according to the criteria set by Third Report of the National Cholesterol Education Program–Adult Treatment Panel III. Hyperhomocysteinemia was considered as homocysteine levels higher than 15 µmol/L. Chi-square test, Fisher's exact test, student t test, Mann-Whitney test, and logistic regression were used for data analysis.
Results: The prevalence of metabolic syndrome was not significantly different (P = 0.07) between patients with schizophrenia (27%) and bipolar disorder (39%). No statistically significant difference (P = 0.17) was observed between patients with schizophrenia (82%) and bipolar disorder (74%) in the prevalence of hyperhomocysteinemia. The results of multivariable logistic regression model showed a significant association of smoking and BMI with metabolic syndrome in patients with schizophrenia (OR = 3.69, 95% CI: 1.13-12.05, and OR = 1.38, 95% CI: 1.20-1.60, respectively). In patients with bipolar disorder, BMI was a significant predictor of developing metabolic syndrome (OR = 1.29, 95% CI: 1.14-1.47). Metabolic syndrome was more prevalent in women than in men in both diagnostic groups (P < 0.05). No significant difference was observed in hyperhomocysteinemia prevalence between male and female patients with schizophrenia (P = 1.00). However, hyperhomocysteinemia was more prevalent in males than in females among patients with bipolar disorder (P = 0.001).
Conclusion: Findings showed a high prevalence of metabolic syndrome and hyperhomocysteinemia among patients with schizophrenia and bipolar disorder. To deal with this problem, regular monitoring and conducting early interventions are recommended to determine the metabolic risk profile and to prevent the cardiovascular diseases.
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3. Das D, Bora K, Baruah B, Konwar G. Prevalence and predictors of metabolic syndrome in schizophrenia patients from Assam. Indian J Psychiatry. 2017;59(2):228-32.
4. Shakeri J, Karimi K, Farnia V, Golshani S, Alikhani M. Prevalence of Metabolic Syndrome in Patients with Schizophrenia Referred to Farabi Hospital, Kermanshah, Iran. Oman Med J. 2016;31(4):270-5.
5. Saloojee S, Burns JK, Motala AA. Metabolic Syndrome in South African Patients with Severe Mental Illness: Prevalence and Associated Risk Factors. PLoS One. 2016;11(2):e0149209.
6. M DEH, Schreurs V, Vancampfort D, R VANW. Metabolic syndrome in people with schizophrenia: a review. World Psychiatry. 2009;8(1):15-22.
7. Łopuszańska UJ, Skorzyńska-Dziduszko K, Lupa-Zatwarnicka K, Makara-Studzińska M. Mental illness and metabolic syndrome--a literature review. Ann Agric Environ Med. 2014;21(4):815-21.
8. Heald A, Pendlebury J, Anderson S, Narayan V, Guy M, Gibson M, et al. Lifestyle factors and the metabolic syndrome in Schizophrenia: a cross-sectional study. Ann Gen Psychiatry. 2017;16:12.
9. Silarova B, Giltay EJ, Van Reedt Dortland A, Van Rossum EF, Hoencamp E, Penninx BW, et al. Metabolic syndrome in patients with bipolar disorder: comparison with major depressive disorder and non-psychiatric controls. J Psychosom Res. 2015;78(4):391-8.
10. Nayerifard R, Bureng MA, Zahiroddin A, Namjoo M, Rajezi S. Comparison of metabolic syndrome prevalence in patients with schizophrenia and bipolar I disorder. Diabetes Metab Syndr. 2017;11 Suppl 1:S411-s6.
11. Obradovic M, Zaric BL, Haidara MA, Isenovic ER. Link between homocysteine and cardiovascular diseases. Current Pharmacology Reports. 2018;4(1):1-9.
12. McCully KS. Homocysteine and the pathogenesis of atherosclerosis. Expert Rev Clin Pharmacol. 2015;8(2):211-9.
13. Dierkes J, Westphal S. Effect of drugs on homocysteine concentrations. Semin Vasc Med. 2005;5(2):124-39.
14. Permoda-Osip A, Dorszewska J, Skibinska M, Chlopocka-Wozniak M, Rybakowski JK. Hyperhomocysteinemia in bipolar depression: clinical and biochemical correlates. Neuropsychobiology. 2013;68(4):193-6.
15. Vuksan-Cusa B, Sagud M, Jakovljevic M, Peles AM, Jaksic N, Mihaljevic S, et al. Association between C-reactive protein and homocysteine with the subcomponents of metabolic syndrome in stable patients with bipolar disorder and schizophrenia. Nord J Psychiatry. 2013;67(5):320-5.
16. Zhao J, Chen H, Liu N, Chen J, Gu Y, Chen J, et al. Role of Hyperhomocysteinemia and Hyperuricemia in Pathogenesis of Atherosclerosis. J Stroke Cerebrovasc Dis. 2017;26(12):2695-9.
17. Permoda-Osip A, Dorszewska J, Skibinska M, Chlopocka-Wozniak M, Rybakowski JK. Hyperhomocysteinemia in bipolar depression: clinical and biochemical correlates. Neuropsychobiology. 2013;68(4):193-6.
18. Ezzaher A, Mouhamed DH, Mechri A, Omezzine A, Neffati F, Douki W, et al. Hyperhomocysteinemia in Tunisian bipolar I patients. Psychiatry Clin Neurosci. 2011;65(7):664-71.
19. Pal S, Ghosh C, Roy SS, Suhrita P. PREVALENCE OF METABOLIC SYNDROME AND HYPERHOMOCYSTEINEMIA IN DEPRESSION AND SCHIZOPHRENIA. International Journal of Pharmaceutical, Chemical & Biological Sciences. 2013;3(4).
20. Ezzaher A, Mouhamed DH, Mechri A, Omezzine A, Neffati F, Douki W, et al. Hyperhomocysteinemia in Tunisian bipolar I patients. Psychiatry Clin Neurosci. 2011;65(7):664-71.
21. Vuksan-Ćusa B, Jakovljević M, Sagud M, Mihaljević Peleš A, Marčinko D, Topić R, et al. Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with second generation antipsychotics. Psychiatry Res. 2011;189(1):21-5.
22. Moustafa AA, Hewedi DH, Eissa AM, Frydecka D, Misiak B. Homocysteine levels in schizophrenia and affective disorders-focus on cognition. Front Behav Neurosci. 2014;8:343.
23. Salagre E, Vizuete AF, Leite M, Brownstein DJ, McGuinness A, Jacka F, et al. Homocysteine as a peripheral biomarker in bipolar disorder: A meta-analysis. Eur Psychiatry. 2017;43:81-91.
24. Mabrouk H, Douki W, Mechri A, Younes MK, Omezzine A, Bouslama A, et al. [Hyperhomocysteinemia and schizophrenia: case control study]. Encephale. 2011;37(4):308-13.
25. Zhou SJ, Zhang LG, Chen HM, Li JY, Li R, Zhang XM, et al. Prevalence and clinical-demographic correlates of hyperhomocysteinemia in inpatients with bipolar disorder in a Han Chinese population. Psychiatry Res. 2018;259:364-9.
26. Vuksan-Ćusa B, Jakovljević M, Sagud M, Mihaljević Peleš A, Marčinko D, Topić R, et al. Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with second generation antipsychotics. Psychiatry Res. 2011;189(1):21-5.
27. Santini I, Stratta P, D'Onofrio S, De Lauretis I, Santarelli V, Pacitti F, et al. The metabolic syndrome in an Italian psychiatric sample: a retrospective chart review of inpatients treated with antipsychotics. Riv Psichiatr. 2016;51(1):37-42.
28. Marthoenis M, Aichberger MC, Puteh I, Syahrial S, Schouler-Ocak M. Metabolic syndrome among psychiatric inpatients with schizophrenia in Indonesia. Asian J Psychiatr. 2015;15:10-4.
29. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-421.
30. Vuksan-Cusa B, Sagud M, Jakovljevic M, Peles AM, Jaksic N, Mihaljevic S, et al. Association between C-reactive protein and homocysteine with the subcomponents of metabolic syndrome in stable patients with bipolar disorder and schizophrenia. Nord J Psychiatry. 2013;67(5):320-5.
31. P.Jewell N. Statistics for Epidemiology. 4th ed. USA: Taylor & Francis e-Library; 2009. 258-9 p.
32. Godin O, Etain B, Henry C, Bougerol T, Courtet P, Mayliss L, et al. Metabolic syndrome in a French cohort of patients with bipolar disorder: results from the FACE-BD cohort. J Clin Psychiatry. 2014;75(10):1078-85; quiz 85.
33. Kumar A, Narayanaswamy JC, Venkatasubramanian G, Raguram R, Grover S, Aswath M. Prevalence of metabolic syndrome and its clinical correlates among patients with bipolar disorder. Asian J Psychiatr. 2017;26:109-14.
34. Seow LS, Chong SA, Wang P, Shafie S, Ong HL, Subramaniam M. Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care. Compr Psychiatry. 2017;74:196-203.
35. Ganesh S, Ashok AH, Kumar CN, Thirthalli J. Prevalence and determinants of metabolic syndrome in patients with schizophrenia: A systematic review and meta-analysis of Indian studies. Asian J Psychiatr. 2016;22:86-92.
36. Vancampfort D, Vansteelandt K, Correll CU, Mitchell AJ, De Herdt A, Sienaert P, et al. Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators. Am J Psychiatry. 2013;170(3):265-74.
37. Salvi V, D'Ambrosio V, Rosso G, Bogetto F, Maina G. Age-specific prevalence of metabolic syndrome in Italian patients with bipolar disorder. Psychiatry Clin Neurosci. 2011;65(1):47-54.
38. Czepielewski L, Daruy Filho L, Brietzke E, Grassi-Oliveira R. Bipolar disorder and metabolic syndrome: a systematic review. Braz J Psychiatry. 2013;35(1):88-93.
39. Łopuszańska UJ, Skorzyńska-Dziduszko K, Lupa-Zatwarnicka K, Makara-Studzińska M. Mental illness and metabolic syndrome--a literature review. Ann Agric Environ Med. 2014;21(4):815-21.
40. He BM, Zhao SP, Peng ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013;114(11):2431-6.
41. Kim TH, Moon SW. Serum homocysteine and folate levels in korean schizophrenic patients. Psychiatry Investig. 2011;8(2):134-40.
42. Akanji AO, Ohaeri JU, Al-Shammri SA, Fatania HR. Associations of blood homocysteine concentrations in Arab schizophrenic patients. Clin Biochem. 2007;40(13-14):1026-31.
43. Moustafa AA, Hewedi DH, Eissa AM, Frydecka D, Misiak B. Homocysteine levels in schizophrenia and affective disorders-focus on cognition. Front Behav Neurosci. 2014;8:343.
44. Bouaziz N, Ayedi I, Sidhom O, Kallel A, Rafrafi R, Jomaa R, et al. Plasma homocysteine in schizophrenia: determinants and clinical correlations in Tunisian patients free from antipsychotics. Psychiatry Res. 2010;179(1):24-9.
45. Salagre E, Vizuete AF, Leite M, Brownstein DJ, McGuinness A, Jacka F, et al. Homocysteine as a peripheral biomarker in bipolar disorder: A meta-analysis. Eur Psychiatry. 2017;43:81-91.
46. Dierkes J, Westphal S. Effect of drugs on homocysteine concentrations. Semin Vasc Med. 2005;5(2):124-39.
47. Garcin JM, Cremades S, Garcia-Hejl C, Bordier L, Dupuy O, Mayaudon H, et al. Is hyperhomocysteinemia an additional risk factor of the metabolic syndrome? Metab Syndr Relat Disord. 2006;4(3):185-95.
48. Budak N, Yazici C, Oztürk A, Bayram F, Mazicioğlu MM, Kurtoglu S. Is plasma homocysteine level associated with metabolic syndrome components in adolescents? Metab Syndr Relat Disord. 2009;7(4):357-62.
49. Sreckovic B, Sreckovic VD, Soldatovic I, Colak E, Sumarac-Dumanovic M, Janeski H, et al. Homocysteine is a marker for metabolic syndrome and atherosclerosis. Diabetes Metab Syndr. 2017;11(3):179-82.
2. Esteghamati A, Hafezi-Nejad N, Zandieh A, Sheikhbahaei S, Ebadi M, Nakhjavani M. Homocysteine and metabolic syndrome: from clustering to additional utility in prediction of coronary heart disease. J Cardiol. 2014;64(4):290-6.
3. Das D, Bora K, Baruah B, Konwar G. Prevalence and predictors of metabolic syndrome in schizophrenia patients from Assam. Indian J Psychiatry. 2017;59(2):228-32.
4. Shakeri J, Karimi K, Farnia V, Golshani S, Alikhani M. Prevalence of Metabolic Syndrome in Patients with Schizophrenia Referred to Farabi Hospital, Kermanshah, Iran. Oman Med J. 2016;31(4):270-5.
5. Saloojee S, Burns JK, Motala AA. Metabolic Syndrome in South African Patients with Severe Mental Illness: Prevalence and Associated Risk Factors. PLoS One. 2016;11(2):e0149209.
6. M DEH, Schreurs V, Vancampfort D, R VANW. Metabolic syndrome in people with schizophrenia: a review. World Psychiatry. 2009;8(1):15-22.
7. Łopuszańska UJ, Skorzyńska-Dziduszko K, Lupa-Zatwarnicka K, Makara-Studzińska M. Mental illness and metabolic syndrome--a literature review. Ann Agric Environ Med. 2014;21(4):815-21.
8. Heald A, Pendlebury J, Anderson S, Narayan V, Guy M, Gibson M, et al. Lifestyle factors and the metabolic syndrome in Schizophrenia: a cross-sectional study. Ann Gen Psychiatry. 2017;16:12.
9. Silarova B, Giltay EJ, Van Reedt Dortland A, Van Rossum EF, Hoencamp E, Penninx BW, et al. Metabolic syndrome in patients with bipolar disorder: comparison with major depressive disorder and non-psychiatric controls. J Psychosom Res. 2015;78(4):391-8.
10. Nayerifard R, Bureng MA, Zahiroddin A, Namjoo M, Rajezi S. Comparison of metabolic syndrome prevalence in patients with schizophrenia and bipolar I disorder. Diabetes Metab Syndr. 2017;11 Suppl 1:S411-s6.
11. Obradovic M, Zaric BL, Haidara MA, Isenovic ER. Link between homocysteine and cardiovascular diseases. Current Pharmacology Reports. 2018;4(1):1-9.
12. McCully KS. Homocysteine and the pathogenesis of atherosclerosis. Expert Rev Clin Pharmacol. 2015;8(2):211-9.
13. Dierkes J, Westphal S. Effect of drugs on homocysteine concentrations. Semin Vasc Med. 2005;5(2):124-39.
14. Permoda-Osip A, Dorszewska J, Skibinska M, Chlopocka-Wozniak M, Rybakowski JK. Hyperhomocysteinemia in bipolar depression: clinical and biochemical correlates. Neuropsychobiology. 2013;68(4):193-6.
15. Vuksan-Cusa B, Sagud M, Jakovljevic M, Peles AM, Jaksic N, Mihaljevic S, et al. Association between C-reactive protein and homocysteine with the subcomponents of metabolic syndrome in stable patients with bipolar disorder and schizophrenia. Nord J Psychiatry. 2013;67(5):320-5.
16. Zhao J, Chen H, Liu N, Chen J, Gu Y, Chen J, et al. Role of Hyperhomocysteinemia and Hyperuricemia in Pathogenesis of Atherosclerosis. J Stroke Cerebrovasc Dis. 2017;26(12):2695-9.
17. Permoda-Osip A, Dorszewska J, Skibinska M, Chlopocka-Wozniak M, Rybakowski JK. Hyperhomocysteinemia in bipolar depression: clinical and biochemical correlates. Neuropsychobiology. 2013;68(4):193-6.
18. Ezzaher A, Mouhamed DH, Mechri A, Omezzine A, Neffati F, Douki W, et al. Hyperhomocysteinemia in Tunisian bipolar I patients. Psychiatry Clin Neurosci. 2011;65(7):664-71.
19. Pal S, Ghosh C, Roy SS, Suhrita P. PREVALENCE OF METABOLIC SYNDROME AND HYPERHOMOCYSTEINEMIA IN DEPRESSION AND SCHIZOPHRENIA. International Journal of Pharmaceutical, Chemical & Biological Sciences. 2013;3(4).
20. Ezzaher A, Mouhamed DH, Mechri A, Omezzine A, Neffati F, Douki W, et al. Hyperhomocysteinemia in Tunisian bipolar I patients. Psychiatry Clin Neurosci. 2011;65(7):664-71.
21. Vuksan-Ćusa B, Jakovljević M, Sagud M, Mihaljević Peleš A, Marčinko D, Topić R, et al. Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with second generation antipsychotics. Psychiatry Res. 2011;189(1):21-5.
22. Moustafa AA, Hewedi DH, Eissa AM, Frydecka D, Misiak B. Homocysteine levels in schizophrenia and affective disorders-focus on cognition. Front Behav Neurosci. 2014;8:343.
23. Salagre E, Vizuete AF, Leite M, Brownstein DJ, McGuinness A, Jacka F, et al. Homocysteine as a peripheral biomarker in bipolar disorder: A meta-analysis. Eur Psychiatry. 2017;43:81-91.
24. Mabrouk H, Douki W, Mechri A, Younes MK, Omezzine A, Bouslama A, et al. [Hyperhomocysteinemia and schizophrenia: case control study]. Encephale. 2011;37(4):308-13.
25. Zhou SJ, Zhang LG, Chen HM, Li JY, Li R, Zhang XM, et al. Prevalence and clinical-demographic correlates of hyperhomocysteinemia in inpatients with bipolar disorder in a Han Chinese population. Psychiatry Res. 2018;259:364-9.
26. Vuksan-Ćusa B, Jakovljević M, Sagud M, Mihaljević Peleš A, Marčinko D, Topić R, et al. Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with second generation antipsychotics. Psychiatry Res. 2011;189(1):21-5.
27. Santini I, Stratta P, D'Onofrio S, De Lauretis I, Santarelli V, Pacitti F, et al. The metabolic syndrome in an Italian psychiatric sample: a retrospective chart review of inpatients treated with antipsychotics. Riv Psichiatr. 2016;51(1):37-42.
28. Marthoenis M, Aichberger MC, Puteh I, Syahrial S, Schouler-Ocak M. Metabolic syndrome among psychiatric inpatients with schizophrenia in Indonesia. Asian J Psychiatr. 2015;15:10-4.
29. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-421.
30. Vuksan-Cusa B, Sagud M, Jakovljevic M, Peles AM, Jaksic N, Mihaljevic S, et al. Association between C-reactive protein and homocysteine with the subcomponents of metabolic syndrome in stable patients with bipolar disorder and schizophrenia. Nord J Psychiatry. 2013;67(5):320-5.
31. P.Jewell N. Statistics for Epidemiology. 4th ed. USA: Taylor & Francis e-Library; 2009. 258-9 p.
32. Godin O, Etain B, Henry C, Bougerol T, Courtet P, Mayliss L, et al. Metabolic syndrome in a French cohort of patients with bipolar disorder: results from the FACE-BD cohort. J Clin Psychiatry. 2014;75(10):1078-85; quiz 85.
33. Kumar A, Narayanaswamy JC, Venkatasubramanian G, Raguram R, Grover S, Aswath M. Prevalence of metabolic syndrome and its clinical correlates among patients with bipolar disorder. Asian J Psychiatr. 2017;26:109-14.
34. Seow LS, Chong SA, Wang P, Shafie S, Ong HL, Subramaniam M. Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care. Compr Psychiatry. 2017;74:196-203.
35. Ganesh S, Ashok AH, Kumar CN, Thirthalli J. Prevalence and determinants of metabolic syndrome in patients with schizophrenia: A systematic review and meta-analysis of Indian studies. Asian J Psychiatr. 2016;22:86-92.
36. Vancampfort D, Vansteelandt K, Correll CU, Mitchell AJ, De Herdt A, Sienaert P, et al. Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators. Am J Psychiatry. 2013;170(3):265-74.
37. Salvi V, D'Ambrosio V, Rosso G, Bogetto F, Maina G. Age-specific prevalence of metabolic syndrome in Italian patients with bipolar disorder. Psychiatry Clin Neurosci. 2011;65(1):47-54.
38. Czepielewski L, Daruy Filho L, Brietzke E, Grassi-Oliveira R. Bipolar disorder and metabolic syndrome: a systematic review. Braz J Psychiatry. 2013;35(1):88-93.
39. Łopuszańska UJ, Skorzyńska-Dziduszko K, Lupa-Zatwarnicka K, Makara-Studzińska M. Mental illness and metabolic syndrome--a literature review. Ann Agric Environ Med. 2014;21(4):815-21.
40. He BM, Zhao SP, Peng ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013;114(11):2431-6.
41. Kim TH, Moon SW. Serum homocysteine and folate levels in korean schizophrenic patients. Psychiatry Investig. 2011;8(2):134-40.
42. Akanji AO, Ohaeri JU, Al-Shammri SA, Fatania HR. Associations of blood homocysteine concentrations in Arab schizophrenic patients. Clin Biochem. 2007;40(13-14):1026-31.
43. Moustafa AA, Hewedi DH, Eissa AM, Frydecka D, Misiak B. Homocysteine levels in schizophrenia and affective disorders-focus on cognition. Front Behav Neurosci. 2014;8:343.
44. Bouaziz N, Ayedi I, Sidhom O, Kallel A, Rafrafi R, Jomaa R, et al. Plasma homocysteine in schizophrenia: determinants and clinical correlations in Tunisian patients free from antipsychotics. Psychiatry Res. 2010;179(1):24-9.
45. Salagre E, Vizuete AF, Leite M, Brownstein DJ, McGuinness A, Jacka F, et al. Homocysteine as a peripheral biomarker in bipolar disorder: A meta-analysis. Eur Psychiatry. 2017;43:81-91.
46. Dierkes J, Westphal S. Effect of drugs on homocysteine concentrations. Semin Vasc Med. 2005;5(2):124-39.
47. Garcin JM, Cremades S, Garcia-Hejl C, Bordier L, Dupuy O, Mayaudon H, et al. Is hyperhomocysteinemia an additional risk factor of the metabolic syndrome? Metab Syndr Relat Disord. 2006;4(3):185-95.
48. Budak N, Yazici C, Oztürk A, Bayram F, Mazicioğlu MM, Kurtoglu S. Is plasma homocysteine level associated with metabolic syndrome components in adolescents? Metab Syndr Relat Disord. 2009;7(4):357-62.
49. Sreckovic B, Sreckovic VD, Soldatovic I, Colak E, Sumarac-Dumanovic M, Janeski H, et al. Homocysteine is a marker for metabolic syndrome and atherosclerosis. Diabetes Metab Syndr. 2017;11(3):179-82.
| Files | ||
| Issue | Vol 15 No 4 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v15i4.4292 | |
| PMCID | PMC7610070 | |
| PMID | 33240376 | |
| Keywords | ||
| Bipolar Disorder Homocysteine Metabolic Syndrome Schizophrenia | ||
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How to Cite
1.
Naderyan Fe’li S, Yassini Ardekani SM, Dehghani A. Relationship between Serum Homocysteine and Metabolic Syndrome among Patients with Schizophrenia and Bipolar Disorder: A Cross Sectional Study. Iran J Psychiatry. 2020;15(4):266-273.
