Metabolic syndrome in psychiatry: advances in understanding and management

SUMMARY Metabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.

[1]  J. Mckenney,et al.  Executive Summary of The 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). , 2001, JAMA.

[2]  B. Kirkpatrick,et al.  Parental history of Type 2 diabetes in patients with nonaffective psychosis , 2008, Schizophrenia Research.

[3]  S. Kasper.  The World Journal of Biological Psychiatry , 2010 .

[4]  Eiji Yano,et al.  Association of the metabolic syndrome with depression and anxiety in Japanese men: A 1‐year cohort study , 2009, Diabetes/metabolism research and reviews.

[5]  R. Lu,et al.  The prevalence of metabolic syndrome in drug-naïve bipolar II disorder patients before and after twelve week pharmacological intervention. , 2013, Journal of affective disorders.

[6]  U. Smith,et al.  Smoking induces insulin resistance—a potential link with the insulin resistance syndrome , 1993, Journal of internal medicine.

[7]  P. Björntorp,et al.  The metabolic syndrome — a neuroendocrine disorder? , 2000, British Journal of Nutrition.

[8]  J. Lieberman,et al.  The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial: Clinical comparison of subgroups with and without the metabolic syndrome , 2005, Schizophrenia Research.

[9]  Jitender Sareen,et al.  The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid substance use disorders. , 2012, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[10]  N. Manjunatha,et al.  Metabolic syndrome in first episode schizophrenia — A randomized double-blind controlled, short-term prospective study , 2008, Schizophrenia Research.

[11]  J. Lieberman,et al.  Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III , 2005, Schizophrenia Research.

[12]  Jack C. de la Torre,et al.  The vascular hypothesis of Alzheimer's disease: bench to bedside and beyond. , 2010 .

[13]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[14]  C. Correll,et al.  Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. , 2006, The Journal of clinical psychiatry.

[15]  C. Correll,et al.  Effectiveness of Medications Used to Attenuate Antipsychotic-Related Weight Gain and Metabolic Abnormalities: A Systematic Review and Meta-Analysis , 2010, Neuropsychopharmacology.

[16]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[17]  J. Mechanick,et al.  The metabolic syndrome: definition, global impact, and pathophysiology. , 2009, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[18]  Karl J. Friston,et al.  The anatomy of melancholia – focal abnormalities of cerebral blood flow in major depression , 1992, Psychological Medicine.

[19]  M. Szmitkowski,et al.  [Effect of ethanol on metabolic syndrome]. , 2007, Polskie Archiwum Medycyny Wewnetrznej.

[20]  P. Keck,et al.  Role of Antiepileptic Drugs in the Management of Eating Disorders , 2009, CNS drugs.

[21]  C. Nemeroff,et al.  The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. , 1998, Archives of general psychiatry.

[22]  T. Lehtimäki,et al.  Metabolic syndrome and carotid intima media thickness in the Health 2000 Survey. , 2009, Atherosclerosis.

[23]  D. Jacobs,et al.  ReviewIs Serum Gamma Glutamyltransferase a Marker of Oxidative Stress? , 2004, Free radical research.

[24]  K. Min,et al.  Relationship between inflammation and metabolic syndrome following treatment with paliperidone for schizophrenia , 2012, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[25]  E. Brietzke,et al.  Similar immune profile in bipolar disorder and schizophrenia: selective increase in soluble tumor necrosis factor receptor I and von Willebrand factor. , 2010, Bipolar disorders.

[26]  D. Rujescu,et al.  At-Risk Variant in TCF7L2 for Type II Diabetes Increases Risk of Schizophrenia , 2011, Biological Psychiatry.

[27]  S. Kennedy,et al.  The rate of metabolic syndrome in euthymic Canadian individuals with bipolar I/II disorder , 2010, Advances in therapy.

[28]  G. Matfin,et al.  Therapeutic Advances in Endocrinology and Metabolism , 2010 .

[29]  B. Balkau,et al.  Comment on the provisional report from the WHO consultation , 1999, Diabetic medicine : a journal of the British Diabetic Association.

[30]  W. Fleischhacker,et al.  Effects of adjunctive treatment with aripiprazole on body weight and clinical efficacy in schizophrenia patients treated with clozapine: a randomized, double-blind, placebo-controlled trial. , 2010, The international journal of neuropsychopharmacology.

[31]  A. Convit,et al.  Impact of metabolic syndrome on cognition and brain: a selected review of the literature. , 2012, Arteriosclerosis, thrombosis, and vascular biology.

[32]  V. Pankratz,et al.  Metabolic Syndrome, Inflammation, and Nonamnestic Mild Cognitive Impairment in Older Persons: A Population-based Study , 2010, Alzheimer disease and associated disorders.

[33]  M. Deuschle,et al.  The effect of a 4-week treatment with reboxetine on metabolic parameters of depressed inpatients , 2011, European Archives of Psychiatry and Clinical Neuroscience.

[34]  A. Newman,et al.  The metabolic syndrome, inflammation, and risk of cognitive decline. , 2004, JAMA.

[35]  Z. Bloomgarden.  Definitions of the insulin resistance syndrome: the 1st World Congress on the Insulin Resistance Syndrome. , 2004, Diabetes care.

[36]  M. Nauck.  Incretin-based therapies for type 2 diabetes mellitus: properties, functions, and clinical implications. , 2011, The American journal of medicine.

[37]  M. Connolly,et al.  Lifestyle and physical health in schizophrenia , 2005 .

[38]  S. Grundy,et al.  Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International As , 2009, Circulation.

[39]  R. Freeman,et al.  Leptin: Linking obesity, the metabolic syndrome, and cardiovascular disease , 2008, Current hypertension reports.

[40]  F. Schaffner,et al.  Metabolic correlates of eating behavior in severe obesity , 2001, International Journal of Obesity.

[41]  H. Kim,et al.  Insulin resistance and C‐reactive protein as independent risk factors for non‐alcoholic fatty liver disease in non‐obese Asian men , 2004, Journal of gastroenterology and hepatology.

[42]  Tae Hyeon Kim,et al.  Association of serum alanine aminotransferase and γ-glutamyltransferase levels within the reference range with metabolic syndrome and nonalcoholic fatty liver disease , 2011, The Korean journal of hepatology.

[43]  Claude Lenfant,et al.  Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[44]  J. Ballenger,et al.  At-Risk Variant in TCF7L2 for Type II Diabetes Increases Risk of Schizophrenia , 2012 .

[45]  J. Newcomer.  Metabolic syndrome and mental illness. , 2007, The American journal of managed care.

[46]  Y. Ahn,et al.  The effect of clozapine on the AMPK-ACC-CPT1 pathway in the rat frontal cortex. , 2012, The international journal of neuropsychopharmacology.

[47]  D. Baker,et al.  Metabolic syndrome: relative risk associated with post-traumatic stress disorder (PTSD) severity and antipsychotic medication use. , 2012, Psychosomatics.

[48]  A. Taylor,et al.  Impact of binge eating on metabolic and leptin dynamics in normal young women. , 1999, The Journal of clinical endocrinology and metabolism.

[49]  J. Suls,et al.  Associations of Depression With C-Reactive Protein, IL-1, and IL-6: A Meta-Analysis , 2009, Psychosomatic medicine.

[50]  S. Kahn,et al.  Enhanced cortisol production rates, free cortisol, and 11beta-HSD-1 expression correlate with visceral fat and insulin resistance in men: effect of weight loss. , 2009, American journal of physiology. Endocrinology and metabolism.

[51]  E. Papanastasiou.  Interventions for the metabolic syndrome in schizophrenia: a review , 2012, Therapeutic advances in endocrinology and metabolism.

[52]  V. Vaccarino,et al.  Depressive Symptoms and Metabolic Syndrome: Is Inflammation the Underlying Link? , 2008, Biological Psychiatry.

[53]  Philippe Moulin,et al.  Associations Between Anxiety, Depression, and the Metabolic Syndrome , 2007, Biological Psychiatry.

[54]  M. Järvelin,et al.  The prevalence and predictive value of individual criteria for metabolic syndrome in schizophrenia: A Northern Finland 1966 Birth Cohort Study , 2010, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[55]  D. Drucker,et al.  Incretin-based therapies for type 2 diabetes mellitus , 2009, Nature Reviews Endocrinology.

[56]  D. Kupfer,et al.  Metabolic syndrome in bipolar disorder: findings from the Bipolar Disorder Center for Pennsylvanians. , 2005, Bipolar disorders.

[57]  J. Bishop,et al.  Pharmacogenetics of leptin in antipsychotic-associated weight gain and obesity-related complications. , 2011, Pharmacogenomics.

[58]  Cardiovascular disease and diabetes in people with severe mental illness. , 2009, Revista de psiquiatria y salud mental.

[59]  B. Kirkpatrick,et al.  Glucose abnormalities in the siblings of people with schizophrenia , 2008, Schizophrenia Research.

[60]  D. Mikhailidis,et al.  Clinical review: The pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. , 2009, The Journal of clinical endocrinology and metabolism.

[61]  M. Alda,et al.  Clinical Features of Bipolar Disorder with and without Comorbid Diabetes Mellitus , 2003, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[62]  M. Tancer,et al.  Metabolic syndrome: relevance to antidepressant treatment. , 2006, Journal of psychiatry & neuroscience : JPN.

[63]  B. Cho,et al.  Patients taking medications for bipolar disorder are more prone to metabolic syndrome than Korea's general population , 2010, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[64]  C. Correll,et al.  Does antipsychotic polypharmacy increase the risk for metabolic syndrome? , 2007, Schizophrenia Research.

[65]  B. Kirkpatrick,et al.  Metabolic Effects of Olanzapine in Patients With Newly Diagnosed Psychosis , 2011, Journal of clinical psychopharmacology.

[66]  R. McIntyre,et al.  The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid metabolic disorders. , 2012, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[67]  R. Jardri,et al.  [Metabolic side effects of risperidone in early onset schizophrenia]. , 2010, L'Encephale.

[68]  J. Hebebrand,et al.  Body weight gain induced by atypical antipsychotics: an extension of the monocygotic twin and sib pair study , 2010, Journal of clinical pharmacy and therapeutics.

[69]  P. Gean,et al.  High prevalence of metabolic disturbances in patients with bipolar disorder in Taiwan. , 2009, Journal of affective disorders.

[70]  Gregory Kaltsas,et al.  Metabolic syndrome: definitions and controversies , 2011, BMC medicine.

[71]  S. Moebus,et al.  Prevalence of the metabolic syndrome in patients with borderline personality disorder: results from a cross-sectional study , 2013, European Archives of Psychiatry and Clinical Neuroscience.

[72]  R. Holt,et al.  The prevalence of undiagnosed metabolic abnormalities in people with serious mental illness , 2010, Journal of psychopharmacology.

[73]  H. Arai,et al.  Adiponectin in plasma and cerebrospinal fluid in MCI and Alzheimer’s disease , 2011, European journal of neurology.

[74]  R. Bordet,et al.  Effets secondaires métaboliques de la rispéridone dans les schizophrénies à début précoce , 2010 .

[75]  R. Eckel,et al.  The metabolic syndrome and inflammation. , 2004, Metabolic syndrome and related disorders.

[76]  G. Reynolds,et al.  The role of 5-HT2C receptor polymorphisms in the pharmacogenetics of antipsychotic drug treatment , 2005, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[77]  S. Praharaj,et al.  Metformin for olanzapine-induced weight gain: a systematic review and meta-analysis. , 2011, British journal of clinical pharmacology.

[78]  M. Jakovljevič,et al.  Association between C-reactive protein and homocysteine with the subcomponents of metabolic syndrome in stable patients with bipolar disorder and schizophrenia , 2013, Nordic journal of psychiatry.

[79]  Sun-Hwa Park,et al.  Imbalance between pro-inflammatory and anti-inflammatory cytokines in bipolar disorder. , 2007, Journal of affective disorders.

[80]  E. Loh,et al.  Association of the ADRA1A gene and the severity of metabolic abnormalities in patients with schizophrenia , 2012, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[81]  M. Fuller,et al.  Interactions among the branched-chain amino acids and their effects on methionine utilization in growing pigs: effects on plasma amino– and keto–acid concentrations and branched-chain keto-acid dehydrogenase activity , 2000, British Journal of Nutrition.

[82]  C. Lamendola,et al.  Differentiation Between Obesity and Insulin Resistance in the Association With C-Reactive Protein , 2002, Circulation.

[83]  Daniel B. Jones,et al.  Expert Panel on Weight Loss Surgery: Executive Report Update , 2009, Obesity.

[84]  Sudha Seshadri,et al.  Biomarkers for insulin resistance and inflammation and the risk for all-cause dementia and alzheimer disease: results from the Framingham Heart Study. , 2012, Archives of neurology.

[85]  S. Bens,et al.  Cortisol, the Cortisol-Dehydroepiandrosterone Ratio, and Pro-Inflammatory Cytokines in Patients with Current Major Depressive Disorder Comorbid with Borderline Personality Disorder , 2006, Biological Psychiatry.