| Keywords [eng] |
Metabolic syndrome, ATP III, IDF, dyslipidemia, triglyceridemia, insulin resistance, diabetes mellitus, hypertension, obesity, HDL, LDL, cholesterol, abdominal obesity, DSM-V, major depression, bipolar disorder, psychotic disorders, anxiety disorders, SSRI, TCA, mirtazapine, dopamine, serotonin, 5-HTC, noradrenaline, HPA-axis, CRH, ACTH, cortisol, leptin, leptin resistance, inflammatory cytokines, chronic inflammation, olanzapine, clozapine, lithium, valproate, smoking, nicotine, alcohol, M.O.B.I.L.I.S |
| Abstract [eng] |
The metabolic syndrome is a rising disease pattern in modern society, caused by a variety of interconnected factors that ultimately lead to an increased risk of cardiovascular events such as myocardial infarction or stroke. The most important causative components are unhealthy lifestyle choices such as lack of physical activity, a diet consisting of mostly ultra-processed, calorie-dense foods that are rich in saturated fats, refined sugar and salt. This drives insulin resistance, hypertension and finally obesity. Especially psychiatric inpatients have a greater risk of developing metabolic dysregulations compared to the normal population. The most common affected parameters among this patient group are dyslipidemia, abdominal obesity, hypertension and hyperglycemia. However, finding data supporting Hypertension as a risk factor in general was reported rather seldomly. The scope of this literature review was to compare different psychiatric diseases, their pathology and pharmacotherapy regarding to metabolic dysregulations. Patient suffering from Depression tend to have increased levels of cortisol and visceral body fat. Hypercortisolemia due to internal or external stressors is associated with weight gain, especially visceral body fat. Controverse results were shown in studies observing the use of antidepressant drugs. In general, the use of SSRIs and TCAs is not necessarily associated with metabolic dysregulations. Only slight systolic and diastolic blood pressure elevations were reported in subjects using TCAs. On the other hand, the use of mirtazapine, which is classified as an atypical antidepressant, is associated with increased risk of weight gain due to increase in appetite and craving for sweet foods. Additionally, the use of paroxetine, sertraline and fluoxetine, displayed significant negative effects on the metabolic profile. Nevertheless, correlations were found in bipolar patient groups. Increased rates of hypertension, obesity, and weight gain are found in the literature, mainly associated with the use of antipsychotics like olanzapine and clozapine. Also drugs like lithium, valproic acid potentially led to an increase in abdominal fat mass. Neuroleptics like olanzapine and clozapine, by far are the most well-known and well-studied drugs to cause weight gain and increase in blood lipid parameter. According to the literature several explanations were hypothesized. Deficient leptin signaling, H2-antihistminergic actions leading to an increase in appetite and consequently to an accumulation of a calorie surplus. The role of the metabolic syndrome among patients suffering from anxiety or panic disorders is less clear. Some correlations were found between the metabolic syndrome and single anxiety symptoms but not anxiety disorders themselves. In general, psychiatric patients are predisposed to worse lifestyle choices, which could be explained by social isolation, stigma, financial difficulties and a lower socioeconomic status. These variables are observed in most psychiatric illnesses, and most of these patients showed metabolic dysregulations previous starting pharmacotherapy. Psychiatric patients often feel unsatisfied and compensate, by indulging in hedonistic behavior like smoking, drinking, gambling or unhealthy food choices that cause instant gratification but is detrimental long-term. Patients should be educated on nutrition and exercise programs that could be affordable and easy to maintain long-term. Moreover, it is necessary to control the metabolic risks and side effects of psychotropic medication by monitoring the blood lipid panel in a regularly. Preventive programs such as M.O.B.I.L.I.S potentially could reduce the burden of the metabolic syndrome in the future. |
