Association of Serum Uric Acid Levels with Manic Episodes, Effect on Symptom Severity: A Case-Control Study

Abstract

Background: Bipolar disorder is marked by alternating depressive and manic episodes. Recent studies suggest a correlation between serum uric acid levels and manic symptoms, yet limited research exists in Pakistan. Objectives: This study aims to investigate the association between serum uric acid levels and manic episodes, and to evaluate the impact of elevated uric acid on symptom severity in patients with bipolar disorder. Methods: A case-control study was conducted at Khyber Teaching Hospital, Peshawar, involving 110 participants (55 with manic episodes and 55 controls). Serum uric acid levels were measured, and manic symptom severity was assessed using the Young Mania Rating Scale (YMRS). Results: Patients with manic episodes exhibited significantly higher serum uric acid levels (6.84 ± 1.42 mg/dL) compared to controls (5.36 ± 1.18 mg/dL, p<0.001). Hyperuricemia prevalence was 63.6% in manic patients versus 25.5% in controls. A strong positive correlation was found between uric acid levels and YMRS scores (r=0.583, p<0.001), indicating increased severity of manic symptoms with higher uric acid levels. Conclusion: Elevated serum uric acid levels are associated with manic episodes and the severity of symptoms in bipolar disorder. These findings suggest that serum uric acid may serve as a potential biomarker for manic episodes, warranting further investigation into therapeutic interventions targeting the purinergic system.

Keywords: Bipolar disorder, Manic episodes, Serum uric acid, Hyperuricemia, Young Mania Rating Scale (YMRS), Case-control study, Symptom severity, Purinergic system