Journal of International Psychiatry

Objectives The purpose of this study was to compare the differences in gut microbiota characteristics between bipolar manic phase patients and healthy controls and the changes of gut microbiota after remission of mania symptoms. In addition, to explore the possibility of gut microbiota as a biomarker for the diagnosis and prognosis of bipolar disorder. Method Thirty-six patients with bipolar disorder manic phase hospitalized in the Second Affiliated Hospital of Xinxiang Medical University from October 2019 to January 2021 were included as the patient group, and 30 patients from their non-direct accompanying family members were recruited as the healthy control group during the same period.All subjects had clinical information collected by a psychiatrist to assess manic severity using the Young Mania Rating Scale (YMRS) and depression severity using the 17-item Hamilton Rating Scale for Depression (HRSD-17).Fecal samples of all subjects were collected within 48 hours of enrollment and stored in a refrigerator at -80℃ within 30 minutes.All patients received YMRS and HRSD-17 scores once a week, and fecal samples were collected again when YMRS < 6 and HRSD-17 < 7.After the sample collection was completed, the gut microbiota was sequenced and analyzed using the 16SrDNA sequencing method and the Miseq sequencer.Then, QIIME2 software was used to analyze the sequencing results to compare the differences of gut microbiota between the patient group and the healthy control group during the acute attack period and after remission.Results 1.The abundance (P=0.047, P=0.040) and diversity (P=0.047, P=0.014) of gut microbiota in patients at the onset and remission stage were significantly higher than those in healthy control group.2.LEFSE analysis found that there were 71 signature species with significant differences in the patient group before and after treatment, including 35 enrichment species in the acute attack group and 36 enrichment species in the remission group (LDAScore > 2, P < 0.05). There was no significant difference in gut microbiota between the acute attack stage, remission stage and the healthy control group. Conclusion 1.There were significant changes in the abundance and diversity of gut microbiota in bipolar manic disorder patients, which may be related to the occurrence of bipolar manic disorder.2.After treatment, there were statistically significant differences in gut microbiota between acute phase and remission phase, which may provide a new basis for the treatment of manic phase with bipolar disorder by adjusting gut microbiota.

[Key words] Bipolar disorder; Gut microbiota; Microbiota-gut-brain axis; 16S rRNA sequencing